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Rosato L, Lavorini E, Deandrea M. Could Transplantation into the Thyroid Gland Benefit Pancreatic Islet Grafting in Unstable Type 1 Diabetes (T1DM), Complicated Type 2 Diabetes (T2DM), and Patients with Total Pancreatectomy? Stem Cell Rev Rep 2024; 20:839-844. [PMID: 38153636 DOI: 10.1007/s12015-023-10671-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Insular allograft for unstable type 1 diabetes and autograft in pancreatectomy patients are nowadays considered established procedures with precise indications and predictable outcomes. The clinical outcome of islet transplantation is similar to that of pancreas transplantation, avoiding the complications associated with organ transplantation. OBJECTIVE We hypothesised that transplantation of islets of Langerhans within an endocrine organ could better promote their engraftment and function. This could help to resolve or ameliorate known pathological conditions such as unstable type 1 diabetes and complicated type 2 diabetes. RATIONALE Pancreatic islet transplantation is currently performed almost exclusively in the liver. The liver provides a sufficiently favourable environment, although not entirely. The hepatic parenchyma has a lower oxygen tension than the pancreatic parenchyma and the vascular structure of the liver is not typical of an exclusively endocrine organ. Moreover, islet transplantation into the liver is not without complications, including hematoma or portal vein thrombosis. PROPOSED PROJECT The thyroid gland is the endocrine gland proposed as a 'container'. In fact, it has all the characteristics of 'physio-compatibility' which can address the objectives assumed. It is indeed an ideal site because it is an easily accessible anatomical site that allows islets to be implanted using ultrasound-guided transcutaneous inoculation technique. Moreover, it has physiological and anatomical endocrine affinities with pancreatic islets and, if necessary, it can be removed, using hormone supplementation or replacement therapy. CONCLUSIONS The thyroid gland may be proposed as an ideal site for islet implantation due to its anatomical and physiocompatibility characteristics.
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Affiliation(s)
- Lodovico Rosato
- Surgery and Oncology Department, School of Medicine, ASL TO4 Ivrea Hospital, University of Turin, Ivrea, 10015, Italy
| | - Eugenia Lavorini
- Department of General and Emergency Surgery, San Donato Hospital Arezzo, Arezzo, 52100, Italy.
| | - Maurilio Deandrea
- Endocrinology, Diabetes and Metabolism Department, Center for Thyroid Diseases, Ordine Mauriziano Hospital, Turin, 10128, Italy
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Landstra CP, Nijhoff MF, Roelen DL, de Vries APJ, de Koning EJP. Diagnosis and treatment of allograft rejection in islet transplantation. Am J Transplant 2023; 23:1425-1433. [PMID: 37307954 DOI: 10.1016/j.ajt.2023.05.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/07/2023] [Indexed: 06/14/2023]
Abstract
Islet transplantation stabilizes glycemic control in patients with complicated diabetes mellitus. Rapid functional decline could be due to islet allograft rejection. However, there is no reliable method to assess rejection, and treatment protocols are absent. We aimed to characterize diagnostic features of islet allograft rejection and assess effectiveness of high-dose methylprednisolone treatment. Over a median follow-up of 61.8 months, 22% (9 of 41) of islet transplant recipients experienced 10 suspected rejection episodes (SREs). All first SREs occurred within 18 months after transplantation. Important features were unexplained hyperglycemia (all cases), unexplained C-peptide decrease (ΔC-peptide, 77.1% [-59.1% to -91.6%]; ΔC-peptide:glucose, -76.3% [-49.2% to -90.4%]), predisposing event (5 of 10 cases), and increased immunologic risk (5 of 10 cases). At 6 months post-SRE, patients who received protocolized methylprednisolone (n = 4) had significantly better islet function than untreated patients (n = 4), according to C-peptide (1.39 ± 0.59 vs 0.14 ± 0.19 nmol/L; P = .007), Igls score (good [4 of 4 cases] vs failure [3 of 4 cases] or marginal [1 of 4 cases]; P = .018) and β score (6.0 [6.0-6.0] vs 1.0 [0.0-3.5]; P = .013). SREs are prevalent among islet transplant recipients and are associated with loss of islet graft function. Timely treatment with high-dose methylprednisolone mitigates this loss. Unexplained hyperglycemia, unexpected C-peptide decrease, a predisposing event, and elevated immunologic risk are diagnostic indicators for SRE.
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Affiliation(s)
- Cyril P Landstra
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Michiel F Nijhoff
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands; Leiden Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Dave L Roelen
- Leiden Transplant Center, Leiden University Medical Center, Leiden, The Netherlands; Department of Immunohematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Aiko P J de Vries
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands; Leiden Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Eelco J P de Koning
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands; Leiden Transplant Center, Leiden University Medical Center, Leiden, The Netherlands.
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3
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Huang HH, Stillman TJ, Branham LA, Williams SC. The Effects of Photobiomodulation Therapy on Porcine Islet Insulin Secretion. Photobiomodul Photomed Laser Surg 2022; 40:395-401. [DOI: 10.1089/photob.2022.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Han-Hung Huang
- Department of Physical Therapy, Angelo State University, Member, Texas Tech University System, San Angelo, Texas, USA
| | - Tori J. Stillman
- Department of Agriculture, and Angelo State University, Member, Texas Tech University System, San Angelo, Texas, USA
| | - Loree A. Branham
- Department of Agriculture, and Angelo State University, Member, Texas Tech University System, San Angelo, Texas, USA
| | - Scott C. Williams
- Department of Physics and Geosciences, Angelo State University, Member, Texas Tech University System, San Angelo, Texas, USA
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Konagaya S, Iwata H. Chemically defined conditions for long-term maintenance of pancreatic progenitors derived from human induced pluripotent stem cells. Sci Rep 2019; 9:640. [PMID: 30679498 PMCID: PMC6345937 DOI: 10.1038/s41598-018-36606-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 11/23/2018] [Indexed: 12/21/2022] Open
Abstract
Large numbers of hormone-releasing cells, approximately 109 endocrine cells, are required to treat type I diabetes patients by cell transplantation. The SOX9-positive pancreatic epithelium proliferates extensively during the early stages of pancreatic development. SOX9-positive pancreatic epithelium is thought to be an expandable cell source of β cells for transplantation therapy. In this study, we attempted to expand pancreatic progenitors (PPs: PDX1+/SOX9+) derived from four human iPSC lines in three-dimensional (3D) culture using a chemically defined medium and examined the potential of the derived PPs to differentiate into β-like cells. PPs from four human iPSC lines were maintained and effectively proliferated in a chemically defined medium containing epidermal growth factor and R-spondin-1, CHIR99021, fibroblast growth factor-7, and SB431542. PPs derived from one iPSC line can be expanded by more than 104-fold in chemically defined medium containing two of the fives, epidermal growth factor and R-spondin-1. The expanded PPs were also stable following cryopreservation. After freezing and thawing, the PPs proliferated without a decrease in the rate. PPs obtained after 50 days of culture successfully differentiated into insulin-positive β-like cells, glucagon-positive α-like cells, and somatostatin-positive δ-like cells. The differentiation efficiency of expanded PPs was similar to that of PPs without expansion culture.
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Affiliation(s)
- Shuhei Konagaya
- Institute for Frontier Medical and Life Sciences, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hiroo Iwata
- Institute for Frontier Medical and Life Sciences, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan. .,Research Promotion Institution for COI Site, Kyoto University, Yoshida-honmachi, Sakyo-ku, Kyoto, 606-8501, Japan. .,The "Compass to Healthy Life" Research Complex Program, RIKEN, 6-7-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan.
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Farina M, Ballerini A, Fraga DW, Nicolov E, Hogan M, Demarchi D, Scaglione F, Sabek OM, Horner P, Thekkedath U, Gaber OA, Grattoni A. 3D Printed Vascularized Device for Subcutaneous Transplantation of Human Islets. Biotechnol J 2017; 12. [PMID: 28734022 DOI: 10.1002/biot.201700169] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/12/2017] [Indexed: 12/17/2022]
Abstract
Transplantation of pancreatic islets or stem cell derived insulin secreting cells is an attractive treatment strategy for diabetes. However, islet transplantation is associated with several challenges including function-loss associated with dispersion and limited vascularization as well as the need for continuous immunosuppression. To overcome these limitations, here we present a novel 3D printed and functionalized encapsulation system for subcutaneous engraftment of islets or islet like cells. The devices were 3D printed with polylactic acid and the surfaces treated and patterned to increase the hydrophilicity, cell attachment, and proliferation. Surface treated encapsulation systems were implanted with growth factor enriched platelet gel, which helped to create a vascularized environment before loading human islets. The device protected the encapsulated islets from acute hypoxia and kept them functional. The adaptability of the encapsulation system was demonstrated by refilling some of the experimental groups transcutaneously with additional islets.
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Affiliation(s)
- Marco Farina
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA.,Department of Electronics and Telecommunications, Politecnico di Torino, Torino, Italy
| | - Andrea Ballerini
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA.,Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy
| | - Daniel W Fraga
- Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Eugenia Nicolov
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA
| | - Matthew Hogan
- Center for Neuroregeneration, Houston Methodist Research Institute, Houston, TX, USA
| | - Danilo Demarchi
- Department of Electronics and Telecommunications, Politecnico di Torino, Torino, Italy
| | - Francesco Scaglione
- Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy
| | - Omaima M Sabek
- Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Philip Horner
- Center for Neuroregeneration, Houston Methodist Research Institute, Houston, TX, USA
| | - Usha Thekkedath
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA
| | - Osama A Gaber
- Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Alessandro Grattoni
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA
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Konagaya S, Iwata H. Reproducible preparation of spheroids of pancreatic hormone positive cells from human iPS cells: An in vitro study. Biochim Biophys Acta Gen Subj 2016; 1860:2008-16. [DOI: 10.1016/j.bbagen.2016.05.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 04/18/2016] [Accepted: 05/09/2016] [Indexed: 01/13/2023]
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Nijhoff MF, Engelse MA, Dubbeld J, Braat AE, Ringers J, Roelen DL, van Erkel AR, Spijker HS, Bouwsma H, van der Boog PJM, de Fijter JW, Rabelink TJ, de Koning EJP. Glycemic Stability Through Islet-After-Kidney Transplantation Using an Alemtuzumab-Based Induction Regimen and Long-Term Triple-Maintenance Immunosuppression. Am J Transplant 2016; 16:246-53. [PMID: 26288226 DOI: 10.1111/ajt.13425] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 06/01/2015] [Accepted: 06/21/2015] [Indexed: 01/25/2023]
Abstract
Pancreatic islet transplantation is performed in a select group of patients with type 1 diabetes mellitus. Immunosuppressive regimens play an important role in long-term islet function. We aimed to investigate the efficacy of islet transplantation in patients with type 1 diabetes and a previous kidney transplantation using an alemtuzumab-based induction regimen and triple maintenance immunosuppression. Patients with type 1 diabetes, who had received a kidney transplant previously, were treated with alemtuzumab as induction therapy for their first islet transplantation and basiliximab induction therapy for subsequent islet transplantations. Maintenance immunosuppression consisted of triple immunosuppression (tacrolimus, mycophenolate mofetil, and prednisolone). Thirteen patients (age 50.9 ± 9.2 years, duration of diabetes 35 ± 9 years) received a total of 22 islet transplantations. One- and 2-year insulin independence was 62% and 42%, respectively; graft function was 100% and 92%, respectively. HbA1c dropped from 57.2 ± 13.1 (7.4 ± 1.2%) to 44.5 ± 11.8 mmol/molHb (6.2 ± 0.9%) (p = 0.003) after 2 years. Six of 13 patients suffered from severe hypoglycemia before islet transplantation. After transplantation, severe hypoglycemia was restricted to the only patient who lost graft function. Creatinine clearance was unchanged. Islet-after-kidney transplantation in patients with type 1 diabetes using an alemtuzumab-based induction regimen leads to considerable islet allograft function and improvement in glycemic control.
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Affiliation(s)
- M F Nijhoff
- Department of Medicine, Division of Endocrinology and Metabolism, Leiden University Medical Centre, Leiden, the Netherlands.,Division of Nephrology and Transplantation, Leiden University Medical Centre, Leiden, the Netherlands
| | - M A Engelse
- Division of Nephrology and Transplantation, Leiden University Medical Centre, Leiden, the Netherlands
| | - J Dubbeld
- Departments of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - A E Braat
- Departments of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - J Ringers
- Departments of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - D L Roelen
- Immunohematology, Leiden University Medical Centre, Leiden, the Netherlands
| | - A R van Erkel
- Radiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - H S Spijker
- Division of Nephrology and Transplantation, Leiden University Medical Centre, Leiden, the Netherlands
| | - H Bouwsma
- Division of Nephrology and Transplantation, Leiden University Medical Centre, Leiden, the Netherlands
| | - P J M van der Boog
- Division of Nephrology and Transplantation, Leiden University Medical Centre, Leiden, the Netherlands
| | - J W de Fijter
- Division of Nephrology and Transplantation, Leiden University Medical Centre, Leiden, the Netherlands
| | - T J Rabelink
- Division of Nephrology and Transplantation, Leiden University Medical Centre, Leiden, the Netherlands
| | - E J P de Koning
- Department of Medicine, Division of Endocrinology and Metabolism, Leiden University Medical Centre, Leiden, the Netherlands.,Division of Nephrology and Transplantation, Leiden University Medical Centre, Leiden, the Netherlands
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Tan TE, Peh GSL, George BL, Cajucom-Uy HY, Dong D, Finkelstein EA, Mehta JS. A cost-minimization analysis of tissue-engineered constructs for corneal endothelial transplantation. PLoS One 2014; 9:e100563. [PMID: 24949869 PMCID: PMC4065108 DOI: 10.1371/journal.pone.0100563] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 05/29/2014] [Indexed: 12/13/2022] Open
Abstract
Corneal endothelial transplantation or endothelial keratoplasty has become the preferred choice of transplantation for patients with corneal blindness due to endothelial dysfunction. Currently, there is a worldwide shortage of transplantable tissue, and demand is expected to increase further with aging populations. Tissue-engineered alternatives are being developed, and are likely to be available soon. However, the cost of these constructs may impair their widespread use. A cost-minimization analysis comparing tissue-engineered constructs to donor tissue procured from eye banks for endothelial keratoplasty was performed. Both initial investment costs and recurring costs were considered in the analysis to arrive at a final tissue cost per transplant. The clinical outcomes of endothelial keratoplasty with tissue-engineered constructs and with donor tissue procured from eye banks were assumed to be equivalent. One-way and probabilistic sensitivity analyses were performed to simulate various possible scenarios, and to determine the robustness of the results. A tissue engineering strategy was cheaper in both investment cost and recurring cost. Tissue-engineered constructs for endothelial keratoplasty could be produced at a cost of US$880 per transplant. In contrast, utilizing donor tissue procured from eye banks for endothelial keratoplasty required US$3,710 per transplant. Sensitivity analyses performed further support the results of this cost-minimization analysis across a wide range of possible scenarios. The use of tissue-engineered constructs for endothelial keratoplasty could potentially increase the supply of transplantable tissue and bring the costs of corneal endothelial transplantation down, making this intervention accessible to a larger group of patients. Tissue-engineering strategies for corneal epithelial constructs or other tissue types, such as pancreatic islet cells, should also be subject to similar pharmacoeconomic analyses.
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Affiliation(s)
- Tien-En Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Singapore National Eye Centre, Singapore
- * E-mail:
| | - Gary S. L. Peh
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore
| | - Benjamin L. George
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore
| | | | - Di Dong
- Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore
| | - Eric A. Finkelstein
- Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore
- Lien Centre for Palliative Care, Singapore
| | - Jodhbir S. Mehta
- Singapore National Eye Centre, Singapore
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore
- Department of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore
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