1
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Lee FT, Williams J, Nordgren R, Schwarz JL, Setia N, Roggin K, Polite B, Rangrass G, Liao CY, Millis JM, Keutgen XM. Single center outcomes from parenchymal-sparing resections and microwave ablations for neuroendocrine tumor liver metastases. Am J Surg 2024; 229:17-23. [PMID: 37802701 DOI: 10.1016/j.amjsurg.2023.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/10/2023] [Revised: 08/02/2023] [Accepted: 09/13/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Reported outcomes after surgical debulking in patients with advanced neuroendocrine tumor liver metastases (NETLM) are sparse. METHODS NETLM patients that underwent surgical debulking from 2019 to 2021 were reviewed. Trends in perioperative liver function, complications, symptom response, and progression-free survival were examined. RESULTS 1069 liver lesions were debulked from 53 patients using a combination of parenchymal-sparing resections (PSR) and ultrasound-guided microwave ablations (MWA). Post-operative transaminitis and thrombocytopenia were common, and severity correlated with increasing number of lesions. Laboratory markers for synthetic liver function did not differ according to the number of lesions debulked. 13% of patients sustained a Clavien-Dindo grade 3 or 4 complication which was not associated with the number of lesions targeted. All patients with preoperative symptoms had improvement after surgery. Median time to progression was 10.9 months. CONCLUSIONS PSR with MWA for large numbers of NETLM is safe and effective for symptom control and does not affect synthetic liver function.
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Affiliation(s)
- Frances T Lee
- Southern Illinois University, Department of Surgery. 701 N. 1st St, Springfield IL 62794, USA
| | - Jelani Williams
- University of Chicago, Department of Surgery. 5841 S Maryland Ave, Chicago IL 60637, USA
| | - Rachel Nordgren
- University of Chicago, Department of Public Health Sciences. 5481 S Maryland Ave, Chicago, IL 60637, USA
| | - Jason L Schwarz
- University of Chicago, Department of Surgery. 5841 S Maryland Ave, Chicago IL 60637, USA
| | - Namrata Setia
- University of Chicago, Department of Pathology. 5841 S Maryland Ave, Chicago IL 60637, USA
| | - Kevin Roggin
- University of Chicago, Department of Surgery. 5841 S Maryland Ave, Chicago IL 60637, USA
| | - Blase Polite
- University of Chicago, Department of Medicine, Section of Hematology/Oncology. 5841 S Maryland Ave, Chicago IL 60637, USA
| | - Govind Rangrass
- University of Chicago, Department of Anesthesia and Critical Care. 5841 S Maryland Ave, Chicago IL 60637, USA
| | - Chih-Yi Liao
- University of Chicago, Department of Medicine, Section of Hematology/Oncology. 5841 S Maryland Ave, Chicago IL 60637, USA
| | - J Michael Millis
- University of Chicago, Department of Surgery. 5841 S Maryland Ave, Chicago IL 60637, USA
| | - Xavier M Keutgen
- University of Chicago, Department of Surgery. 5841 S Maryland Ave, Chicago IL 60637, USA.
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2
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Millis JM, Vigneswaran J, Ogunnowo S, Dorsey C. Understanding the impact of health inequities in surgical complications: Rethinking morbidity and mortality conferences. Surgery 2023; 173:553-554. [PMID: 36372571 DOI: 10.1016/j.surg.2022.10.017] [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] [Received: 08/17/2022] [Revised: 10/05/2022] [Accepted: 10/12/2022] [Indexed: 11/13/2022]
Affiliation(s)
| | - Janani Vigneswaran
- Department of Surgery, University of Chicago Medicine, IL. https://twitter.com/JenVigneswaran
| | - Simi Ogunnowo
- University of Chicago Pritzker School of Medicine, IL
| | - Chelsea Dorsey
- Department of Surgery, University of Chicago Medicine, IL.
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3
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Witkowski P, Philipson LH, Kaufman DB, Ratner LE, Abouljoud MS, Bellin MD, Buse JB, Kandeel F, Stock PG, Mulligan DC, Markmann JF, Kozlowski T, Andreoni KA, Alejandro R, Baidal DA, Hardy MA, Wickrema A, Mirmira RG, Fung J, Becker YT, Josephson MA, Bachul PJ, Pyda JS, Charlton M, Millis JM, Gaglia JL, Stratta RJ, Fridell JA, Niederhaus SV, Forbes RC, Jayant K, Robertson RP, Odorico JS, Levy MF, Harland RC, Abrams PL, Olaitan OK, Kandaswamy R, Wellen JR, Japour AJ, Desai CS, Naziruddin B, Balamurugan AN, Barth RN, Ricordi C. The demise of islet allotransplantation in the United States: A call for an urgent regulatory update. Am J Transplant 2021; 21:1365-1375. [PMID: 33251712 PMCID: PMC8016716 DOI: 10.1111/ajt.16397] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/14/2020] [Accepted: 11/02/2020] [Indexed: 02/06/2023]
Abstract
Islet allotransplantation in the United States (US) is facing an imminent demise. Despite nearly three decades of progress in the field, an archaic regulatory framework has stymied US clinical practice. Current regulations do not reflect the state-of-the-art in clinical or technical practices. In the US, islets are considered biologic drugs and "more than minimally manipulated" human cell and tissue products (HCT/Ps). In contrast, across the world, human islets are appropriately defined as "minimally manipulated tissue" and not regulated as a drug, which has led to islet allotransplantation (allo-ITx) becoming a standard-of-care procedure for selected patients with type 1 diabetes mellitus. This regulatory distinction impedes patient access to islets for transplantation in the US. As a result only 11 patients underwent allo-ITx in the US between 2016 and 2019, and all as investigational procedures in the settings of a clinical trials. Herein, we describe the current regulations pertaining to islet transplantation in the United States. We explore the progress which has been made in the field and demonstrate why the regulatory framework must be updated to both better reflect our current clinical practice and to deal with upcoming challenges. We propose specific updates to current regulations which are required for the renaissance of ethical, safe, effective, and affordable allo-ITx in the United States.
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Affiliation(s)
- Piotr Witkowski
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois, USA
| | | | - Dixon B. Kaufman
- Division of Transplantation, Department of Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Lloyd E. Ratner
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Marwan S. Abouljoud
- Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Melena D. Bellin
- Schulze Diabetes Institute, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - John B. Buse
- Division of Endocrinology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Fouad Kandeel
- Department of Translational Research and Cellular Therapeutics, Diabetes and Metabolism Research Institute, Beckman Research Institute of City of Hope, Duarte, California, USA
| | - Peter G. Stock
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, California, USA
| | - David C. Mulligan
- Department of Surgery, Transplantation and Immunology, Yale University, New Haven, Connecticut, USA
| | - James F. Markmann
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tomasz Kozlowski
- Division of Transplantation, Department of Surgery, The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA
| | - Kenneth A. Andreoni
- Department of Surgery, University of Florida, College of Medicine, Gainesville, Florida, USA
| | - Rodolfo Alejandro
- Diabetes Research Institute and Cell Transplant Center, University of Miami, Miami, Florida, USA
| | - David A. Baidal
- Diabetes Research Institute and Cell Transplant Center, University of Miami, Miami, Florida, USA
| | - Mark A. Hardy
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Amittha Wickrema
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, Illinois, USA
| | - Raghavendra G. Mirmira
- Department of Medicine, Translational Research Center, University of Chicago, Chicago, Illinois, USA
| | - John Fung
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois, USA
| | - Yolanda T. Becker
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois, USA
| | - Michelle A. Josephson
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois, USA
| | - Piotr J. Bachul
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois, USA
| | - Jordan S. Pyda
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Charlton
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois, USA
| | - J. Michael Millis
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois, USA
| | - Jason L. Gaglia
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert J. Stratta
- Department of Surgery, Section of Transplantation, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jonathan A. Fridell
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Silke V. Niederhaus
- Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Rachael C. Forbes
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kumar Jayant
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois, USA
| | - R. Paul Robertson
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Washington, Seattle, Washington, USA
| | - Jon S. Odorico
- Division of Transplantation, Department of Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Marlon F. Levy
- Division of Transplantation, Hume-Lee Transplant Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | | | - Peter L. Abrams
- MedStar Georgetown Transplant Institute, Washington, District of Columbia, USA
| | | | - Raja Kandaswamy
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jason R. Wellen
- Department of Surgery, Washington University, St Louis, Missouri, USA
| | - Anthony J. Japour
- Anthony Japour and Associates, Medical and Scientific Consulting Inc, Miami, FL, USA
| | - Chirag S. Desai
- Department of Surgery, Section of Transplantation, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Bashoo Naziruddin
- Transplantation Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Appakalai N. Balamurugan
- Division of Pediatric General and Thoracic Surgery, Department of Surgery, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Rolf N. Barth
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois, USA
| | - Camillo Ricordi
- Diabetes Research Institute and Cell Transplant Center, University of Miami, Miami, Florida, USA
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4
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Nguyen LC, Yang D, Nicolaescu V, Best TJ, Ohtsuki T, Chen SN, Friesen JB, Drayman N, Mohamed A, Dann C, Silva D, Gula H, Jones KA, Millis JM, Dickinson BC, Tay S, Oakes SA, Pauli GF, Meltzer DO, Randall G, Rosner MR. Cannabidiol Inhibits SARS-CoV-2 Replication and Promotes the Host Innate Immune Response. bioRxiv 2021:2021.03.10.432967. [PMID: 33758843 PMCID: PMC7987002 DOI: 10.1101/2021.03.10.432967] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The rapid spread of COVID-19 underscores the need for new treatments. Here we report that cannabidiol (CBD), a compound produced by the cannabis plant, inhibits SARS-CoV-2 infection. CBD and its metabolite, 7-OH-CBD, but not congeneric cannabinoids, potently block SARS-CoV-2 replication in lung epithelial cells. CBD acts after cellular infection, inhibiting viral gene expression and reversing many effects of SARS-CoV-2 on host gene transcription. CBD induces interferon expression and up-regulates its antiviral signaling pathway. A cohort of human patients previously taking CBD had significantly lower SARS-CoV-2 infection incidence of up to an order of magnitude relative to matched pairs or the general population. This study highlights CBD, and its active metabolite, 7-OH-CBD, as potential preventative agents and therapeutic treatments for SARS-CoV-2 at early stages of infection.
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Affiliation(s)
- Long Chi Nguyen
- Ben May Department for Cancer Research, University of Chicago, Chicago, IL 60637
| | - Dongbo Yang
- Ben May Department for Cancer Research, University of Chicago, Chicago, IL 60637
| | - Vlad Nicolaescu
- Department of Microbiology, University of Chicago, Chicago, IL 60637
- Howard Taylor Ricketts Laboratory, Argonne National Laboratory, Lemont IL 60439
| | - Thomas J. Best
- Center for Health and the Social Sciences, University of Chicago, Chicago IL 60637
| | - Takashi Ohtsuki
- College of Pharmacy, Pharmacognosy Institute, University of Illinois at Chicago, Chicago IL 60612
| | - Shao-Nong Chen
- College of Pharmacy, Pharmacognosy Institute, University of Illinois at Chicago, Chicago IL 60612
| | - J. Brent Friesen
- College of Pharmacy, Pharmacognosy Institute, University of Illinois at Chicago, Chicago IL 60612
| | - Nir Drayman
- Pritzker School of Molecular Engineering, University of Chicago, Chicago IL 60637
| | - Adil Mohamed
- Pritzker School of Molecular Engineering, University of Chicago, Chicago IL 60637
| | - Christopher Dann
- Ben May Department for Cancer Research, University of Chicago, Chicago, IL 60637
| | - Diane Silva
- Department of Pathology, University of Chicago, Chicago IL 60637
| | - Haley Gula
- Department of Microbiology, University of Chicago, Chicago, IL 60637
- Howard Taylor Ricketts Laboratory, Argonne National Laboratory, Lemont IL 60439
| | - Krysten A. Jones
- Department of Chemistry, University of Chicago, Chicago IL 60637
| | | | | | - Savaş Tay
- Pritzker School of Molecular Engineering, University of Chicago, Chicago IL 60637
| | - Scott A. Oakes
- Department of Pathology, University of Chicago, Chicago IL 60637
| | - Guido F. Pauli
- College of Pharmacy, Pharmacognosy Institute, University of Illinois at Chicago, Chicago IL 60612
| | - David O. Meltzer
- Center for Health and the Social Sciences, University of Chicago, Chicago IL 60637
| | - Glenn Randall
- Department of Microbiology, University of Chicago, Chicago, IL 60637
- Howard Taylor Ricketts Laboratory, Argonne National Laboratory, Lemont IL 60439
| | - Marsha Rich Rosner
- Ben May Department for Cancer Research, University of Chicago, Chicago, IL 60637
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5
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Yang H, Xian X, Hu J, Millis JM, Zhao H, Lu X, Sang X, Zhong S, Zhang H, Yin P, Mao Y. Public Psychosocial and Behavioral Responses in the First Wave of COVID-19 Pandemic: A Large Survey in China. Front Psychiatry 2021; 12:676914. [PMID: 34393844 PMCID: PMC8355736 DOI: 10.3389/fpsyt.2021.676914] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 06/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The COVID-19 has grown into a global pandemic. This study investigated the public psychosocial and behavioral responses through different time periods of the pandemic, and assessed whether these changes are different in age, gender, and region. Methods: A three-phase survey was conducted through the DaDui Social Q&A Software for COVID-19. A total of 13,214 effective responses of COVID-19 were collected. Statistical analysis was performed based on their basic information and psychosocial responses. Results: The degree of attention, understanding, and cooperation with preventive and control measures of the disease increased and then decreased. The panic level gradually increased with the epidemic process. The degree of satisfaction with management measures and of confidence in defeating COVID-19 increased throughout the survey. Compared with residents in other areas, respondents from the COVID-19 epicenter (Wuhan) reported a higher degree of self-protection during the outbreak and a significantly lower degree of satisfaction with respect to government prevention and control measures during all phases. Shortages of medical supplies and low testing capacity were reported as the biggest shortcoming in the prevention and control strategies during COVID-19, and an abundance of disorderly and inaccurate information from different sources was the primary cause of panic. Conclusions and Relevance: Major public health events elicit psychosocial and behavioral changes that reflect the different phases of the biologic curve. Sufficient medical supplies and improved organization and accurate information during epidemics may reduce panic and improve compliance with requested changes in behavior. We need to recognize this natural phenomenon and our public policy preparedness should attempt to move the social/psychological curve to the left in order to minimize and flatten the biologic curve.
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Affiliation(s)
- Huayu Yang
- Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC & Chinese Academy of Medical Sciences (CAMS), Beijing, China
| | - Xiaomeng Xian
- Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC & Chinese Academy of Medical Sciences (CAMS), Beijing, China
| | - Jing Hu
- Department of Epidemiology and Health Statistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - J Michael Millis
- Department of Surgery, Global Surgery, University of Chicago, Chicago, IL, United States
| | - Haitao Zhao
- Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC & Chinese Academy of Medical Sciences (CAMS), Beijing, China
| | - Xin Lu
- Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC & Chinese Academy of Medical Sciences (CAMS), Beijing, China
| | - Xinting Sang
- Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC & Chinese Academy of Medical Sciences (CAMS), Beijing, China
| | - Shouxian Zhong
- Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC & Chinese Academy of Medical Sciences (CAMS), Beijing, China
| | - Hui Zhang
- International Relations and Social Development Division, Horizon iDataWay, Beijing, China
| | - Ping Yin
- Department of Epidemiology and Health Statistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yilei Mao
- Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC & Chinese Academy of Medical Sciences (CAMS), Beijing, China
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6
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Bachul PJ, Golab K, Basto L, Zangan S, Pyda JS, Perez-Gutierrez A, Borek P, Wang LJ, Tibudan M, Tran DK, Anteby R, Generette GS, Chrzanowski J, Fendler W, Perea L, Jayant K, Lucander A, Thomas C, Philipson L, Millis JM, Fung J, Witkowski P. Post-Hoc Analysis of a Randomized, Double Blind, Prospective Study at the University of Chicago: Additional Standardizations of Trial Protocol are Needed to Evaluate the Effect of a CXCR1/2 Inhibitor in Islet Allotransplantation. Cell Transplant 2021; 30:9636897211001774. [PMID: 33908301 PMCID: PMC8085379 DOI: 10.1177/09636897211001774] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 01/14/2021] [Accepted: 02/22/2021] [Indexed: 12/11/2022] Open
Abstract
A recent randomized, multicenter trial did not show benefit of a CXCR1/2 receptor inhibitor (Reparixin) when analysis included marginal islet mass (>3,000 IEQ/kg) for allotransplantation and when immunosuppression regimens were not standardized among participating centers. We present a post-hoc analysis of trial patients from our center at the University of Chicago who received an islet mass of over 5,000 IEQ/kg and a standardized immunosuppression regimen of anti-thymocyte globulin (ATG) for induction. Twelve islet allotransplantation (ITx) recipients were randomized (2:1) to receive Reparixin (N = 8) or placebo (N = 4) in accordance with the multicenter trial protocol. Pancreas and donor characteristics did not differ between Reparixin and placebo groups. Five (62.5%) patients who received Reparixin, compared to none in the placebo group, achieved insulin independence after only one islet infusion and remained insulin-free for over 2 years (P = 0.08). Following the first ITx with ATG induction, distinct cytokine, chemokine, and miR-375 release profiles were observed for both the Reparixin and placebo groups. After excluding procedures with complications, islet engraftment on post-operative day 75 after a single transplant was higher in the Reparixin group (n = 7) than in the placebo (n = 3) group (P = 0.03) when islet graft function was measured by the ratio of the area under the curve (AUC) for c-peptide to glucose in mixed meal tolerance test (MMTT). Additionally, the rate of engraftment was higher when determined via BETA-2 score instead of MMTT (P = 0.01). Our analysis suggests that Reparixin may have improved outcomes compared to placebo when sufficient islet mass is transplanted and when standardized immunosuppression with ATG is used for induction. However, further studies are warranted. Investigation of Reparixin and other novel agents under more standardized and optimized conditions would help exclude confounding factors and allow for a more definitive evaluation of their role in improving outcomes in islet transplantation. Clinical trial reg. no. NCT01817959, clinicaltrials.gov.
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Affiliation(s)
- Piotr J. Bachul
- Department of Surgery, The Transplantation Institute, University of Chicago, Chicago, IL, USA
| | - Karolina Golab
- Department of Surgery, The Transplantation Institute, University of Chicago, Chicago, IL, USA
| | - Lindsay Basto
- Department of Surgery, The Transplantation Institute, University of Chicago, Chicago, IL, USA
| | - Steven Zangan
- Department of Radiology, University of Chicago, Chicago, IL, USA
| | - Jordan S. Pyda
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Peter Borek
- Department of Surgery, The Transplantation Institute, University of Chicago, Chicago, IL, USA
| | - Ling-Jia Wang
- Department of Surgery, The Transplantation Institute, University of Chicago, Chicago, IL, USA
| | - Martin Tibudan
- Department of Surgery, The Transplantation Institute, University of Chicago, Chicago, IL, USA
| | - Dong-Kha Tran
- Department of Surgery, The Transplantation Institute, University of Chicago, Chicago, IL, USA
| | - Roi Anteby
- Department of Surgery, The Transplantation Institute, University of Chicago, Chicago, IL, USA
| | - Gabriela S. Generette
- Department of Surgery, The Transplantation Institute, University of Chicago, Chicago, IL, USA
| | - Jędrzej Chrzanowski
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
| | - Wojciech Fendler
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
| | - Laurencia Perea
- Department of Surgery, The Transplantation Institute, University of Chicago, Chicago, IL, USA
| | - Kumar Jayant
- Department of Surgery, The Transplantation Institute, University of Chicago, Chicago, IL, USA
| | - Aaron Lucander
- Department of Surgery, The Transplantation Institute, University of Chicago, Chicago, IL, USA
| | - Celeste Thomas
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Louis Philipson
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - J. Michael Millis
- Department of Surgery, The Transplantation Institute, University of Chicago, Chicago, IL, USA
| | - John Fung
- Department of Surgery, The Transplantation Institute, University of Chicago, Chicago, IL, USA
| | - Piotr Witkowski
- Department of Surgery, The Transplantation Institute, University of Chicago, Chicago, IL, USA
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7
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Generette GS, Bachul PJ, Golab K, Basto L, Pyda JS, Borek P, Tibudan M, Anteby R, Perea L, Charlton M, Perez-Gutierrez A, Jayant K, Lucander A, Matthews JB, Millis JM, Fung J, Witkowski P. En bloc liver and pancreas transplantation after total pancreatectomy with autologous islet transplantation. ACTA ACUST UNITED AC 2020; 3:11-17. [PMID: 33409500 PMCID: PMC7785098 DOI: 10.31373/ejtcm/130187] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present a patient with intractable and debilitating pain secondary to chronic pancreatitis who was effectively treated with total pancreatectomy with islet autotransplantation (TPIAT). Islets engrafted into his liver significantly contributed to improved blood glucose control and quality of life. Subsequently, the patient developed alcohol related acute liver failure and en bloc liver and pancreas transplantation was performed to replace the failing liver with engrafted islets. Pancreas transplantation was required to resolve his life-threatening severe hypoglycemic episodes. Herein, we detail an innovative and multidisciplinary management of this complex medical problem.
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Affiliation(s)
| | - Piotr J Bachul
- The Transplantation Institute, University of Chicago, USA
| | - Karolina Golab
- The Transplantation Institute, University of Chicago, USA
| | - Lindsay Basto
- The Transplantation Institute, University of Chicago, USA
| | - Jordan S Pyda
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, USA
| | - Peter Borek
- The Transplantation Institute, University of Chicago, USA
| | - Martin Tibudan
- The Transplantation Institute, University of Chicago, USA
| | - Roi Anteby
- The Transplantation Institute, University of Chicago, USA
| | | | | | | | - Kumar Jayant
- The Transplantation Institute, University of Chicago, USA
| | - Aaron Lucander
- The Transplantation Institute, University of Chicago, USA
| | | | | | - John Fung
- The Transplantation Institute, University of Chicago, USA
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8
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Golab K, Krzystyniak A, Langa P, Pikuła M, Kunovac S, Borek P, Trzonkowski P, Millis JM, Fung J, Witkowski P. Effect of serum on SmartFlare™ RNA Probes uptake and detection in cultured human cells. Biomed J Sci Tech Res 2020; 28:21788-21793. [PMID: 32851205 PMCID: PMC7447198] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
SmartFlare™ RNA Detection Probes from Millipore is a novel technology to detect RNA in live cells based on the use of 12 nm gold nanoparticles coated with nucleotides. We proved that SmartFlares™ are internalized by human primary lymphocytes. However, fluorescence signals from target RNA detection can only be observed in the presence of Fetal Bovine Serum (FBS) in the medium, whereas it is not detectable without FBS or when medium is supplemented with human albumin. Image analysis of fluorescence generated from SmartFlare™ Uptake Control (gives constant signal regardless of contact with RNA) and RNA Specific Probes revealed further differences. In the presence of FBS, the fluorescence signal for both reagents was diffused within the cells, whereas in the absence of FBS, it was detected as single spots within the cells only when the Uptake Control was used. It is possible that FBS components are necessary for SmartFlare™ Probes to be released from cellular compartments into the cytoplasm where they can get into contact with target RNA. The exact mechanism of this phenomena should be further determined. However, for the first time, we present here that FBS in the cell culture medium is essential for RNA detection by SmartFlare™ technology in human lymphocytes.
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Affiliation(s)
- Karolina Golab
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Adam Krzystyniak
- Department of Surgery, University of Chicago, Chicago, IL, USA
- Department of Clinical Immunology and Transplantology, Medical University of Gdansk, Gdansk, Poland
- Laboratory of Cell Biophysics, Department of Molecular and Cellular Neurobiology, Nencki Institute of Experimental Biology, Warsaw, Poland
| | - Paulina Langa
- Department of Clinical Immunology and Transplantology, Medical University of Gdansk, Gdansk, Poland
- Microsurgery Research, Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, USA
| | - Michał Pikuła
- Department of Clinical Immunology and Transplantology, Medical University of Gdansk, Gdansk, Poland
- Laboratory of Tissue Engineering and Regenerative Medicine, Department of Embryology, Medical University of Gdansk, Gdansk, Poland
| | - Stefan Kunovac
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Peter Borek
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Piotr Trzonkowski
- Department of Clinical Immunology and Transplantology, Medical University of Gdansk, Gdansk, Poland
| | | | - John Fung
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Piotr Witkowski
- Department of Surgery, University of Chicago, Chicago, IL, USA
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9
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Van Ha TG, Tullius TG, Navuluri R, Millis JM, Leef JA. Percutaneous treatment of IVC obstruction due to post-resection hepatic torsion associated with IVC thrombosis. CVIR Endovasc 2019; 2:14. [PMID: 32026991 PMCID: PMC7224243 DOI: 10.1186/s42155-019-0056-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/11/2019] [Indexed: 11/24/2022] Open
Abstract
Background Migration of the left hepatic lobe into the potential space following right lobe resection can result in torsion and hepatic venous outflow obstruction with compromised venous return from the IVC. If untreated, significant morbidity and mortality can develop. Case presentation We report a case of a 29-year-old female with Lynch syndrome who underwent right lobe resection for a metastatic hepatic tumor. There was subsequent migration of the liver remnant, torsion of the IVC, and impaired hepatic outflow, successfully treated with thrombectomy and stenting. Conclusion Following right hepatectomy, hepatic venous outflow obstruction should be consdered in the setting of hepatorenal failure and hemodynamic instability. Endovascular stenting is a viable treatment option.
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Affiliation(s)
- Thuong G Van Ha
- Department of Radiology, University of Chicago Medical Center, 5841 South Maryland Avenue, MC 2026, Chicago, IL, 60637, USA
| | - Thomas G Tullius
- Department of Radiology, University of Chicago Medical Center, 5841 South Maryland Avenue, MC 2026, Chicago, IL, 60637, USA.
| | - Rakesh Navuluri
- Department of Radiology, University of Chicago Medical Center, 5841 South Maryland Avenue, MC 2026, Chicago, IL, 60637, USA
| | - J Michael Millis
- Department of Surgery, University of Chicago Medical Center, 5758 South Maryland Avenue, Chicago, IL, 60637, USA
| | - Jeffrey A Leef
- Department of Radiology, University of Chicago Medical Center, 5841 South Maryland Avenue, MC 2026, Chicago, IL, 60637, USA
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10
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Abstract
Body mass index (BMI) is widely used to define obesity. In studies of pancreatic beta-cell/islet mass, BMI is also a common standard for matching control subjects in comparative studies along with age and sex, based on the existing dogma of their significant positive correlation reported in the literature. We aimed to test the feasibility of BMI and BSA to assess obesity and predict beta-cell/islet mass. We used National Health and Nutrition Examination Survey (NHANES) data that provided dual-energy Xray absorptiometry (DXA)-measured fat mass (percent body fat; %BF), BMI, and BSA for adult subjects (20-75y; 4,879 males and 4,953 females). We then analyzed 152 cases of islet isolation performed at our center for correlation between islet yields and various donor anthropometric indices. From NHANES, over 50% of male subjects and 60% of female subjects with BMI:20.1-28.1 were obese as defined by %BF, indicating a poor correlation between BMI and %BF. BSA was also a poor indicator of %BF, as broad overlap was observed in different BSA ranges. Additionally, BMI and BSA ranges markedly varied between sex and race/ethnicity groups. From islet isolation, BMI and BSA accounted for only a small proportion of variance in islet equivalent (IEQ; r2 = 0.09 and 0.11, respectively). BMI and obesity were strongly correlated in cases of high BMI subjects. However, the critical populations were non-obese subjects with BMI ranging from 20.1-28.1, in which a substantial proportion of individuals may carry excess body fat. Correlations between BMI, BSA, pancreas weight and beta-cell/islet mass were low.
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Affiliation(s)
| | - Scott K. Olehnik
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Jonas L. Fowler
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Karolina Golab
- Department of Surgery, The University of Chicago, Chicago, IL, USA
| | | | - Justyna Golebiewska
- Department of Surgery, The University of Chicago, Chicago, IL, USA
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Poland
| | - Piotr Bachul
- Department of Surgery, The University of Chicago, Chicago, IL, USA
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Piotr Witkowski
- Department of Surgery, The University of Chicago, Chicago, IL, USA
| | - Manami Hara
- Department of Medicine, The University of Chicago, Chicago, IL, USA
- CONTACT Manami Hara Department of Medicine, The University of Chicago, 5841 South Maryland Avenue, MC1027, Chicago, IL 60637
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11
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Gołębiewska JE, Bachul PJ, Wang LJ, Matosz S, Basto L, Kijek MR, Fillman N, Gołąb K, Tibudan M, Dębska-Ślizień A, Millis JM, Fung J, Witkowski P. Validation of a New North American Islet Donor Score for Donor Pancreas Selection and Successful Islet Isolation in a Medium-Volume Islet Transplant Center. Cell Transplant 2018; 28:185-194. [PMID: 30520321 PMCID: PMC6362524 DOI: 10.1177/0963689718816989] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The selection of optimal pancreas donors is one of the key factors in determining the ultimate outcome of clinical islet isolation. North American Islet Donor Score (NAIDS) allows for estimating the chance of the success of islet isolation. It was developed based on the data from over 1000 donors from 11 islet isolation centers and validated in the University of Alberta, Edmonton, on the cohort from the most active islet transplant center. Now we aimed to also validate it in our much less active program. Areas under the receiver operating characteristic curves (AUROCs) and logistic regression analyses were obtained to test if NAIDS would better predict successful islet isolation (defined as post-purification islet yield >400,000 islet equivalents (IEQ)) than previously described Edmonton islet donor score (IDS) and our modified version of IDS. We analyzed the donor scores with reference to 82 of our islet isolation outcomes. The success rate increased proportionally as NAIDS increased, from 0% success in NAIDS < 50 points to 40% success in NAIDS ≥ 80 points. AUROCs were 0.67 (95% confidence interval (CI) 0.55–0.79) for NAIDS, 0.58 (95% CI 0.44–0.71) for modified IDS, and 0.51 (95% CI 0.37–0.65) for IDS and did not differ significantly. However, based on logistic regression analyses, NAIDS was the only statistically significant predictor of successful isolation (p = 0.01). The main advantage of NAIDS is an enhanced ability to discriminate poor-quality donors than previously used scoring systems at University of Chicago, with 0% chance for success when NAIDS was <50 as compared with 40% success rate for IDS <50. NAIDS was found to be the most useful available tool for donor pancreas selection in clinical and research practice in our center, allowing for identification and rejection of poor-quality donors, saving time and resources.
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Affiliation(s)
- Justyna E Gołębiewska
- 1 Department of Surgery, University of Chicago, Chicago, IL, USA.,2 Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Piotr J Bachul
- 1 Department of Surgery, University of Chicago, Chicago, IL, USA.,3 Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Ling-Jia Wang
- 1 Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Sabrina Matosz
- 1 Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Lindsay Basto
- 1 Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Mark R Kijek
- 1 Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Natalie Fillman
- 1 Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Karolina Gołąb
- 1 Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Martin Tibudan
- 1 Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Alicja Dębska-Ślizień
- 2 Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - J Michael Millis
- 1 Department of Surgery, University of Chicago, Chicago, IL, USA
| | - John Fung
- 1 Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Piotr Witkowski
- 1 Department of Surgery, University of Chicago, Chicago, IL, USA
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12
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Gołębiewska JE, Bachul PJ, Fillman N, Basto L, Kijek MR, Gołąb K, Wang LJ, Tibudan M, Thomas C, Dębska-Ślizień A, Gelrud A, Matthews JB, Millis JM, Fung J, Witkowski P. Assessment of simple indices based on a single fasting blood sample as a tool to estimate beta-cell function after total pancreatectomy with islet autotransplantation - a prospective study. Transpl Int 2018; 32:280-290. [PMID: 30353611 DOI: 10.1111/tri.13364] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 08/19/2018] [Revised: 10/05/2018] [Accepted: 10/15/2018] [Indexed: 12/13/2022]
Abstract
We investigated six indices based on a single fasting blood sample for evaluation of the beta-cell function after total pancreatectomy with islet autotransplantation (TP-IAT). The Secretory Unit of Islet Transplant Objects (SUITO), transplant estimated function (TEF), homeostasis model assessment (HOMA-2B%), C-peptide/glucose ratio (CP/G), C-peptide/glucose creatinine ratio (CP/GCr) and BETA-2 score were compared against a 90-min serum glucose level, weighted mean C-peptide in mixed meal tolerance test (MMTT), beta score and the Igls score adjusted for islet function in the setting of IAT. We analyzed values from 32 MMTTs in 15 patients after TP-IAT with a follow-up of up to 3 years. Four (27%) individuals had discontinued insulin completely prior to day 75, while 6 out of 12 patients (50%) did not require insulin support at 1-year follow-up with HbA1c 6.0% (5.5-6.8). BETA-2 was the most consistent among indices strongly correlating with all reference measures of beta-cell function (r = 0.62-0.68). In addition, it identified insulin independence (cut-off = 16.2) and optimal/good versus marginal islet function in the Igls score well, with AUROC of 0.85 and 0.96, respectively. Based on a single fasting blood sample, BETA-2 score has the most reliable discriminant value for the assessment of graft function in patients undergoing TP-IAT.
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Affiliation(s)
- Justyna E Gołębiewska
- Department of Surgery, University of Chicago, Chicago, IL, USA.,Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Piotr J Bachul
- Department of Surgery, University of Chicago, Chicago, IL, USA.,Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Natalie Fillman
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Lindsay Basto
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Mark R Kijek
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Karolina Gołąb
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Ling-Jia Wang
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Martin Tibudan
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Celeste Thomas
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Andres Gelrud
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | | | | | - John Fung
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Piotr Witkowski
- Department of Surgery, University of Chicago, Chicago, IL, USA
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13
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Wen T, Jin C, Facciorusso A, Donadon M, Han HS, Mao Y, Dai C, Cheng S, Zhang B, Peng B, Du S, Jia C, Xu F, Shi J, Sun J, Zhu P, Nara S, Millis JM. Multidisciplinary management of recurrent and metastatic hepatocellular carcinoma after resection: an international expert consensus. Hepatobiliary Surg Nutr 2018; 7:353-371. [PMID: 30498711 DOI: 10.21037/hbsn.2018.08.01] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Hepatocellular carcinoma (HCC) is the sixth-most common cancer and the third leading cause of cancer-related death in the world. However, 40-70% patients eventually suffer from postoperative recurrence within 5 years. HCC recurrence after surgery severely affects prognosis of the patients. Nevertheless, there is an opportunity to improve patients' prognosis if doctors and researchers can recognize the importance of a standardized perioperative management and study it in clinical and pre-clinical settings. Hence, based on our own experience and published studies from other researchers, we develop this consensus regarding multidisciplinary management of locally recurrent and metastatic hepatocellular carcinoma after resection. This consensus consists of the entire course of recurrent hepatocellular carcinoma (RHCC) management, including prediction of recurrence, prevention, diagnosis, treatment and surveillance of RHCC. Consensus recommendations are presented with grades of evidences (Ia, Ib, IIa, IIb, III and IV), and strength of recommendations (A, B, C, D and E). We also develop a decision-making path for RHCC treatment, which can intuitively demonstrate the management for RHCC. It is hoped that we may make some effort to standardize the management of RHCC and ultimately understand how to improve outcomes.
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Affiliation(s)
- Tianfu Wen
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Chen Jin
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Antonio Facciorusso
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Matteo Donadon
- Department of Hepatobiliary & General Surgery, Humanitas University, Humanitas Clinical and Research Center, Milan, Italy
| | - Ho-Seong Han
- Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yilei Mao
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Chaoliu Dai
- Department of Hepatobiliary and Splenic Surgery, Shengjing Hospital, China Medical University, Shenyang 110000, China
| | - Shuqun Cheng
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Bixiang Zhang
- Hepatic Surgery Center, Tongji Hospital, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Baogang Peng
- Department of Liver Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Shunda Du
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Changjun Jia
- Department of Hepatobiliary and Splenic Surgery, Shengjing Hospital, China Medical University, Shenyang 110000, China
| | - Feng Xu
- Department of Hepatobiliary and Splenic Surgery, Shengjing Hospital, China Medical University, Shenyang 110000, China
| | - Jie Shi
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Juxian Sun
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Peng Zhu
- Hepatic Surgery Center, Tongji Hospital, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Satoshi Nara
- Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo, Japan
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14
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Gołębiewska JE, Solomina J, Thomas C, Kijek MR, Bachul PJ, Basto L, Gołąb K, Wang LJ, Fillman N, Tibudan M, Ciepły K, Philipson L, Dębska-Ślizień A, Millis JM, Fung J, Witkowski P. Comparative evaluation of simple indices using a single fasting blood sample to estimate beta cell function after islet transplantation. Am J Transplant 2018; 18:990-997. [PMID: 29218834 DOI: 10.1111/ajt.14620] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 09/28/2017] [Revised: 11/17/2017] [Accepted: 11/29/2017] [Indexed: 01/25/2023]
Abstract
Six single fasting blood sample-based indices-Secretory Unit of Islet Transplant Objects (SUITO), Transplant Estimated Function (TEF), Homeostasis Model Assessment (HOMA)2-B%, C-peptide/glucose ratio (CP/G), C-peptide/glucose creatinine ratio (CP/GCr), and BETA-2 score-were compared against commonly used 90-minute mixed meal tolerance test (MMTT) serum glucose and beta score to assess which of them best recognizes the state of acceptable blood glucose control without insulin supplementation after islet allotransplantation (ITx). We also tested whether the indices could identify the success of ITx based on the Igls classification of beta cell graft function. We analyzed values from 47 MMTT tests in 4 patients with up to 140 months follow-up and from 54 MMTT tests in 13 patients with up to 42 months follow-up. SUITO, CP/G, HOMA2-B%, and BETA-2 correlated well with the 90-minute glucose of the MMTT and beta-score (r 0.54-0.76), whereas CP/GCr showed a modest performance (r 0.41-0.52) while TEF showed little correlation. BETA-2 and SUITO were the best identifiers and predictors of the need for insulin support, glucose intolerance, and ITx success (P < .001), while HOMA2-B% and TEF were unreliable. Single fasting blood sample SUITO and BETA-2 scores are very practical alternative tools that allow for frequent assessments of graft function.
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Affiliation(s)
- Justyna E Gołębiewska
- Department of Surgery, University of Chicago, Chicago, IL.,Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Julia Solomina
- Department of Surgery, University of Chicago, Chicago, IL
| | - Celeste Thomas
- Department of Medicine, University of Chicago, Chicago, IL
| | - Mark R Kijek
- Department of Surgery, University of Chicago, Chicago, IL
| | - Piotr J Bachul
- Department of Surgery, University of Chicago, Chicago, IL.,Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Lindsay Basto
- Department of Surgery, University of Chicago, Chicago, IL
| | - Karolina Gołąb
- Department of Surgery, University of Chicago, Chicago, IL
| | - Ling-Jia Wang
- Department of Surgery, University of Chicago, Chicago, IL
| | | | - Martin Tibudan
- Department of Surgery, University of Chicago, Chicago, IL
| | - Kamil Ciepły
- Department of Surgery, University of Chicago, Chicago, IL
| | | | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | | | - John Fung
- Department of Surgery, University of Chicago, Chicago, IL
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15
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Gołąb K, Grose R, Trzonkowski P, Wickrema A, Tibudan M, Marek-Trzonkowska N, Matosz S, Solomina J, Ostrega D, Michael Millis J, Witkowski P. Utilization of leukapheresis and CD4 positive selection in Treg isolation and the ex-vivo expansion for a clinical application in transplantation and autoimmune disorders. Oncotarget 2018; 7:79474-79484. [PMID: 27821811 PMCID: PMC5346728 DOI: 10.18632/oncotarget.13101] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 10/26/2016] [Indexed: 12/20/2022] Open
Abstract
Adoptive transfer of T regulatory cells (Tregs) is of great interest as a novel immunosuppressive therapy in autoimmune disorders and transplantation. Obtaining a sufficient number of stable and functional Tregs generated according to current Good Manufacturing Practice (cGMP) requirements has been a major challenge in introducing Tregs as a clinical therapy. Here, we present a protocol involving leukapheresis and CD4+ cell pre-enrichment prior to Treg sorting, which allows a sufficient number of Tregs for a clinical application to be obtained. With this method there is a decreased requirement for ex-vivo expansion. The protocol was validated in cGMP conditions. Our final Treg product passed all release criteria set for clinical applications. Moreover, during expansion Tregs presented their stable phenotype: percentage of CD4+CD25hiCD127− and CD4+FoxP3+ Tregs was > 95% and > 80%, respectively, and Tregs maintained proper immune suppressive function in vitro. Our results suggest that utilization of leukapheresis and CD4 positive selection during Treg isolation improves the likelihood of obtaining a sufficient number of high quality Treg cells during subsequent ex-vivo expansion and they can be applied clinically.
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Affiliation(s)
- Karolina Gołąb
- Department of Surgery, Section of Transplantation, University of Chicago, Chicago, USA
| | - Randall Grose
- South Australian Health and Medical Research Institute, University of Adelaide, Australia
| | - Piotr Trzonkowski
- Department of Clinical Immunology and Transplantology, Medical University of Gdansk, Gdansk, Poland
| | - Amittha Wickrema
- Department of Medicine, Section of Hematology-Oncology, Cancer Research Center, University of Chicago, Chicago, USA
| | - Martin Tibudan
- Department of Surgery, Section of Transplantation, University of Chicago, Chicago, USA
| | | | - Sabrina Matosz
- Department of Surgery, Section of Transplantation, University of Chicago, Chicago, USA
| | - Julia Solomina
- Department of Surgery, Section of Transplantation, University of Chicago, Chicago, USA
| | - Diane Ostrega
- Department of Surgery, Section of Transplantation, University of Chicago, Chicago, USA
| | - J Michael Millis
- Department of Surgery, Section of Transplantation, University of Chicago, Chicago, USA
| | - Piotr Witkowski
- Department of Surgery, Section of Transplantation, University of Chicago, Chicago, USA
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16
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Gołąb K, Grose R, Placencia V, Wickrema A, Solomina J, Tibudan M, Konsur E, Ciepły K, Marek-Trzonkowska N, Trzonkowski P, Millis JM, Fung J, Witkowski P. Cell banking for regulatory T cell-based therapy: strategies to overcome the impact of cryopreservation on the Treg viability and phenotype. Oncotarget 2018; 9:9728-9740. [PMID: 29515766 PMCID: PMC5839397 DOI: 10.18632/oncotarget.23887] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 11/10/2017] [Indexed: 12/16/2022] Open
Abstract
The first clinical trials with adoptive Treg therapy have shown safety and potential efficacy. Feasibility of such therapy could be improved if cells are cryopreserved and stored until optimal timing for infusion. Herein, we report the evaluation of two cell-banking strategies for Treg therapy: 1) cryopreservation of CD4+ cells for subsequent Treg isolation/expansion and 2) cryopreservation of ex-vivo expanded Tregs (CD4+CD25hiCD127lo/- cells). First, we checked how cryopreservation affects cell viability and Treg markers expression. Then, we performed Treg isolation/expansion with the final products release testing. We observed substantial decrease in cell number recovery after thawing and overnight culture. This observation might be explained by the high percentage of necrotic and apoptotic cells found just after thawing. Furthermore, we noticed fluctuations in percentage of CD4+CD25hiCD127- and CD4+FoxP3+ cells obtained from cryopreserved CD4+ as well as Treg cells. However, after re-stimulation Tregs expanded well, presented a stable phenotype and fulfilled the release criteria at the end of expansions. Cryopreservation of CD4+ cells for subsequent Treg isolation/expansion and cryopreservation of expanded Tregs with re-stimulation and expansion after thawing, are promising solutions to overcome detrimental effects of cryopreservation. Both of these cell-banking strategies for Treg therapy can be applied when designing new clinical trials.
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Affiliation(s)
- Karolina Gołąb
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Randall Grose
- South Australian Health and Medical Research Institute, University of Adelaide, SA, Australia
| | - Veronica Placencia
- Department of Medicine, Hematology-Oncology, Cancer Research Center, University of Chicago, Chicago, IL, USA
| | - Amittha Wickrema
- Department of Medicine, Hematology-Oncology, Cancer Research Center, University of Chicago, Chicago, IL, USA
| | - Julia Solomina
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Martin Tibudan
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Evelyn Konsur
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Kamil Ciepły
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | | | - Piotr Trzonkowski
- Department of Clinical Immunology and Transplantology, Medical University of Gdańsk, Gdańsk, Poland
| | | | - John Fung
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Piotr Witkowski
- Department of Surgery, University of Chicago, Chicago, IL, USA
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17
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Abstract
Congenital membranous occlusion of the inferior vena cava (IVC) in pediatric liver recipients may present with outflow occlusion and if unrecognized, result in graft loss. Prompt evaluation of outflow obstruction in the setting of unexplained inflow compromise is paramount. We report a case of successful IVC reconstruction in a patient with recurrent hepatic artery thrombosis (HAT). A 2-year-old child with history of two liver transplantations developed fevers, ascites, and abdominal tenderness one month after her second liver transplant. Hepatic duplex revealed decreased flow in the hepatic artery and IVC venogram revealed patent hepatic veins with occlusion of the suprahepatic IVC. We performed reconstruction of her suprahepatic IVC to intrapericardial IVC using an end-to-side technique after complete mobilization of the liver. Recovery was uneventful and the patient has been doing well for the last 5 years.
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Affiliation(s)
- Ashley Suah
- Department of Surgery, Section of Abdominal Organ Transplantation, University of Chicago, Chicago, IL, USA
| | - J Michael Millis
- Department of Surgery, Section of Abdominal Organ Transplantation, University of Chicago, Chicago, IL, USA
| | - Adam S Bodzin
- Department of Surgery, Section of Abdominal Organ Transplantation, University of Chicago, Chicago, IL, USA
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18
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Miller P, Millis JM, Angelos P. Organ Donation and Ethical Practices. J Am Coll Surg 2017; 225:830-831. [PMID: 29173338 DOI: 10.1016/j.jamcollsurg.2017.09.006] [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] [Received: 07/26/2017] [Accepted: 09/18/2017] [Indexed: 10/18/2022]
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19
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Millis JM. Historical perspective on the importance of the Milan criteria. Hepatobiliary Surg Nutr 2017; 5:485-487. [PMID: 28124003 DOI: 10.21037/hbsn.2016.12.11] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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20
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Wang LJ, Kin T, O’Gorman D, Shapiro AJ, Naziruddin B, Takita M, Levy MF, Posselt AM, Szot GL, Savari O, Barbaro B, McGarrigle J, Yeh CC, Oberholzer J, Lei J, Chen T, Lian M, Markmann JF, Alvarez A, Linetsky E, Ricordi C, Balamurugan AN, Loganathan G, Wilhelm JJ, Hering BJ, Bottino R, Trucco M, Liu C, Min Z, Li Y, Naji A, Fernandez LA, Ziemelis M, Danobeitia JS, Millis JM, Witkowski P. A Multicenter Study: North American Islet Donor Score in Donor Pancreas Selection for Human Islet Isolation for Transplantation. Cell Transplant 2016; 25:1515-1523. [PMID: 26922947 PMCID: PMC5167495 DOI: 10.3727/096368916x691141] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Selection of an optimal donor pancreas is the first key task for successful islet isolation. We conducted a retrospective multicenter study in 11 centers in North America to develop an islet donor scoring system using donor variables. The data set consisting of 1,056 deceased donors was used for development of a scoring system to predict islet isolation success (defined as postpurification islet yield >400,000 islet equivalents). With the aid of univariate logistic regression analyses, we developed the North American Islet Donor Score (NAIDS) ranging from 0 to 100 points. The c index in the development cohort was 0.73 (95% confidence interval 0.70-0.76). The success rate increased proportionally as the NAIDS increased, from 6.8% success in the NAIDS < 50 points to 53.7% success in the NAIDS ≥ 80 points. We further validated the NAIDS using a separate set of data consisting of 179 islet isolations. A comparable outcome of the NAIDS was observed in the validation cohort. The NAIDS may be a useful tool for donor pancreas selection in clinical practice. Apart from its utility in clinical decision making, the NAIDS may also be used in a research setting as a standardized measurement of pancreas quality.
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Affiliation(s)
- Ling-jia Wang
- Department of Surgery, Section of Transplantation, University of Chicago, Chicago, IL
| | - Tatsuya Kin
- Clinical Islet Transplant Program, University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada
| | - Doug O’Gorman
- Clinical Islet Transplant Program, University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada
| | - A.M. James Shapiro
- Clinical Islet Transplant Program, University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada
| | | | | | | | - Andrew M. Posselt
- UCSF Transplantation Surgery, University of California-San Francisco, CA
| | - Gregory L. Szot
- UCSF Transplantation Surgery, University of California-San Francisco, CA
| | - Omid Savari
- Department of Surgery, Section of Transplantation, University of Chicago, Chicago, IL
| | - Barbara Barbaro
- UIC Cell Isolation Program, University of Illinois at Chicago, Chicago, IL
| | - James McGarrigle
- UIC Cell Isolation Program, University of Illinois at Chicago, Chicago, IL
| | - Chun Chieh Yeh
- UIC Cell Isolation Program, University of Illinois at Chicago, Chicago, IL
| | - Jose Oberholzer
- UIC Cell Isolation Program, University of Illinois at Chicago, Chicago, IL
| | - Ji Lei
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA
| | - Tao Chen
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA
| | - Moh Lian
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA
| | - James F. Markmann
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA
| | - Alejandro Alvarez
- Diabetes Research Institute, cGMP Cell Processing Facility, University of Miami Miller School of Medicine, Miami, FL
| | - Elina Linetsky
- Diabetes Research Institute, cGMP Cell Processing Facility, University of Miami Miller School of Medicine, Miami, FL
| | - Camillo Ricordi
- Diabetes Research Institute, cGMP Cell Processing Facility, University of Miami Miller School of Medicine, Miami, FL
| | - A. N. Balamurugan
- Schulze Diabetes Institute, University of Minnesota, Minneapolis, MN
| | | | - Joshua J. Wilhelm
- Schulze Diabetes Institute, University of Minnesota, Minneapolis, MN
| | | | - Rita Bottino
- Institute of Cellular Therapeutics, Allegheny Health Network, Pittsburgh, PA
| | - Massimo Trucco
- Institute of Cellular Therapeutics, Allegheny Health Network, Pittsburgh, PA
| | - Chengyang Liu
- Division of Transplantation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Zaw Min
- Division of Transplantation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Yanjing Li
- Division of Transplantation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ali Naji
- Division of Transplantation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Luis A. Fernandez
- Division of Organ Transplantation, University of Wisconsin, Madison, WI
| | - Martynas Ziemelis
- Division of Organ Transplantation, University of Wisconsin, Madison, WI
| | | | - J. Michael Millis
- Department of Surgery, Section of Transplantation, University of Chicago, Chicago, IL
| | - Piotr Witkowski
- Department of Surgery, Section of Transplantation, University of Chicago, Chicago, IL
- Corresponding author: Piotr Witkowski, The University of Chicago Medical Center, Department of Surgery, Division of Abdominal Organ Transplantation, 5841 S. Maryland Ave. MC5027, Room J-517, Chicago, IL 60637
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21
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Wang LJ, Cochet O, Wang XJ, Krzystyniak A, Misawa R, Golab K, Tibudan M, Grose R, Savari O, Millis JM, Witkowski P. Donor height in combination with islet donor score improves pancreas donor selection for pancreatic islet isolation and transplantation. Transplant Proc 2015; 46:1972-4. [PMID: 25131085 DOI: 10.1016/j.transproceed.2014.05.076] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
To maximize the islet isolation yield for successful islet transplantation, the key task has been to identify an ideal pancreas donor. Since implementation of the islet donor score in donor selection, we have consistently obtained higher islet yields and transplantation rates. In this study, we tested whether assessing donor height as an independent variable in combination with the donor score could improve the pancreas donor selection. Donor and islet isolation information (n = 22) were collected and studied between 2011 and 2012. Pearson correlation analysis was used in statistical analysis. Donor height as an independent variable was significantly correlated to the weight of the pancreas, pre-Islet Equivalents (pre-IEQ), post-IEQ, and IDS (P < .05). When donor with height of 179 cm ± 3 was selected in combination with IDS > 80, the clinical islet transplantation rate reached 80%.
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Affiliation(s)
- L J Wang
- Department of Surgery, Division of Abdominal Organ Transplantation, The University of Chicago, Chicago, IL
| | - O Cochet
- Department of Surgery, Division of Abdominal Organ Transplantation, The University of Chicago, Chicago, IL
| | - X J Wang
- Department of Surgery, Division of Abdominal Organ Transplantation, The University of Chicago, Chicago, IL; Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - A Krzystyniak
- Department of Surgery, Division of Abdominal Organ Transplantation, The University of Chicago, Chicago, IL
| | - R Misawa
- Department of Surgery, Division of Abdominal Organ Transplantation, The University of Chicago, Chicago, IL
| | - K Golab
- Department of Surgery, Division of Abdominal Organ Transplantation, The University of Chicago, Chicago, IL
| | - M Tibudan
- Department of Surgery, Division of Abdominal Organ Transplantation, The University of Chicago, Chicago, IL
| | - R Grose
- Department of Surgery, Division of Abdominal Organ Transplantation, The University of Chicago, Chicago, IL
| | - O Savari
- Department of Surgery, Division of Abdominal Organ Transplantation, The University of Chicago, Chicago, IL
| | - J M Millis
- Department of Surgery, Division of Abdominal Organ Transplantation, The University of Chicago, Chicago, IL
| | - P Witkowski
- Department of Surgery, Division of Abdominal Organ Transplantation, The University of Chicago, Chicago, IL.
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22
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Gołąb K, Kizilel S, Bal T, Hara M, Zielinski M, Grose R, Savari O, Wang XJ, Wang LJ, Tibudan M, Krzystyniak A, Marek-Trzonkowska N, Millis JM, Trzonkowski P, Witkowski P. Improved coating of pancreatic islets with regulatory T cells to create local immunosuppression by using the biotin-polyethylene glycol-succinimidyl valeric acid ester molecule. Transplant Proc 2015; 46:1967-71. [PMID: 25131084 DOI: 10.1016/j.transproceed.2014.05.075] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND We showed that T regulatory (Treg) cells can be attached to the surface of pancreatic islets providing local immunoprotection. Further optimization of the method can improve coating efficiency, which may prolong graft survival. In this study, we compared the effectiveness of two different molecules used for binding of the Tregs to the surface of pancreatic islets. Our aim was to increase the number of Treg cells attached to islets without compromising islets viability and function. METHODS The cell surface of human Treg cells and pancreatic islets was modified using biotin-polyethylene glycol-N-hydroxylsuccinimide (biotin-PEG-NHS) or biotin-PEG-succinimidyl valeric acid ester (biotin-PEG-SVA). Then, islets were incubated with streptavidin as islet/Treg cells binding molecule. Treg cells were stained with CellTracker CM-DiL dye and visualized using a Laser Scanning Confocal Microscope. The number of Treg cells attached per islets surface area was analyzed by Imaris software. The effect of coating on islet functionality was determined using the glucose-stimulated insulin response (GSIR) assay. RESULTS The coating procedure with biotin-PEG-SVA allowed for attaching 40% more Treg cells per 1 μm(2) of islet surface. Although viability was comparable, function of the islets after coating using the biotin-PEG-SVA molecule was better preserved than with NHS molecule. GSIR was 62% higher for islets coated with biotin-PEG-SVA compared to biotin-PEG-NHS. CONCLUSION Coating of islets with Treg cells using biotin-PEG-SVA improves effectiveness with better preservation of the islet function. Improvement of the method of coating pancreatic islets with Treg cells could further facilitate the effectiveness of this novel immunoprotective approach and translation into clinical settings.
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Affiliation(s)
- K Gołąb
- Department of Surgery, The University of Chicago, Chicago, IL, USA
| | - S Kizilel
- Department of Chemical and Biological Engineering, College of Engineering, Koç University, Istanbul, Turkey
| | - T Bal
- Department of Chemical and Biological Engineering, College of Engineering, Koç University, Istanbul, Turkey
| | - M Hara
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - M Zielinski
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - R Grose
- Department of Surgery, The University of Chicago, Chicago, IL, USA
| | - O Savari
- Department of Surgery, The University of Chicago, Chicago, IL, USA
| | - X-J Wang
- Department of Surgery, The University of Chicago, Chicago, IL, USA
| | - L-J Wang
- Department of Surgery, The University of Chicago, Chicago, IL, USA
| | - M Tibudan
- Department of Surgery, The University of Chicago, Chicago, IL, USA
| | - A Krzystyniak
- Department of Clinical Immunology and Transplantology, Medical University of Gdansk, Gdansk, Poland
| | - N Marek-Trzonkowska
- Department of Clinical Immunology and Transplantology, Medical University of Gdansk, Gdansk, Poland
| | - J M Millis
- Department of Surgery, The University of Chicago, Chicago, IL, USA
| | - P Trzonkowski
- Department of Clinical Immunology and Transplantology, Medical University of Gdansk, Gdansk, Poland
| | - P Witkowski
- Department of Surgery, The University of Chicago, Chicago, IL, USA.
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Poudel A, Savari O, Striegel DA, Periwal V, Taxy J, Millis JM, Witkowski P, Atkinson MA, Hara M. Beta-cell destruction and preservation in childhood and adult onset type 1 diabetes. Endocrine 2015; 49:693-702. [PMID: 25605478 PMCID: PMC4511725 DOI: 10.1007/s12020-015-0534-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 01/12/2015] [Indexed: 01/09/2023]
Abstract
Previous studies describing the symptomatic onset of type 1 diabetes (T1D) and rate of beta-cell loss (C-peptide) support the notion that childhood onset T1D exhibits more severe beta-cell depletion compared to adult onset T1D. To test this notion, we performed whole pancreas analyses in two T1D cases, one of childhood onset (7-year old, onset at 1.5-year) along with an adult onset case (43-year old with onset at 27-year). Both cases were matched for age and gender with control subjects. Striking regional differences in beta-cell loss were observed in both T1D cases, with severity of loss in the order of tail > body > head regions. In contrast, pancreatic alpha- and delta-cell mass was similar in controls and T1D patients. In the childhood onset T1D case, no intra-islet beta-cells were detected while in the adult onset case, beta-cell containing islets were found, exclusively in the head region. In the latter case, considerable numbers of small cellular clusters negative for three major endocrine hormones were observed, in islets with or without beta-cells. Ultrastructural analysis suggests these cells correspond to degenerating beta-cells, with empty granular membranes and abnormal morphology of nuclei with intranuclear pseudo-inclusions, adjacent to healthy alpha- and delta-cells. These results support a hypothesis that during T1D development in childhood, beta-cells are more susceptible to autoimmune destruction or immune attack is more severe, while beta-cell death in the adult onset T1D may be more protracted and incomplete. In addition, T1D may be associated with the formation of "empty" beta-cells, an interesting population of cells that may represent a key facet to the disorder's pathogenesis.
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Affiliation(s)
- Ananta Poudel
- Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Omid Savari
- Department of Surgery, The University of Chicago, Chicago, Illinois
| | - Deborah A. Striegel
- Laboratory of Biological Modeling, National Institute of Diabetes, Digestive, and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Vipul Periwal
- Laboratory of Biological Modeling, National Institute of Diabetes, Digestive, and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Jerome Taxy
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, Illinois
| | | | - Piotr Witkowski
- Department of Surgery, The University of Chicago, Chicago, Illinois
| | - Mark A. Atkinson
- Department of Pathology, The University of Florida, Gainesville, Florida
| | - Manami Hara
- Department of Medicine, The University of Chicago, Chicago, Illinois
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24
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Affiliation(s)
- J Michael Millis
- Section of Transplantation, Department of Surgery, University of Chicago, Chicago, IL
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25
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Huang J, Millis JM, Mao Y, Millis MA, Sang X, Zhong S. Voluntary organ donation system adapted to Chinese cultural values and social reality. Liver Transpl 2015; 21:419-22. [PMID: 25545626 DOI: 10.1002/lt.24069] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 12/14/2014] [Indexed: 12/31/2022]
Abstract
Organ donation and transplant systems have unique characteristics based on the local culture and socioeconomic context. China's transplant and organ donation systems developed without regulatory oversight until 2006 when regulation and policy were developed and then implemented over the next several years. Most recently, the pilot project of establishing a voluntary citizen-based deceased donor program was established. The pilot program addressed the legal, financial, and cultural barriers to organ donation in China. The pilot program has evolved into a national program. Significantly, it established a uniquely Chinese donor classification system. The Chinese donor classification system recognizes donation after brain death (category I), donation after circulatory death (category II), and donation after brain death followed by circulatory death (category III). Through August 2014, the system has identified 2326 donors and provided 6416 organs that have been allocated though a transparent organ allocation system. The estimated number of donors in 2014 is 1147. As China's attitudes toward organ donation have matured and evolved and as China, as a nation, is taking its place on the world stage, it is recognizing that its past practice of using organs from executed prisoners is not sustainable. It is time to recognize that the efforts to regulate transplantation and provide voluntary citizen-based deceased organ donation have been successful and that China should use this system to provide organs for all transplants in every province and hospital in China. At the national organ transplant congress on October 30, 2014, the Chairman of the China's national organ donation and transplantation committee, Jeifu Huang required all hospitals to stop using organs from executed prisoners immediately and the civilian organ donation will be sole source for organ transplant in China starting January 2015.
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Affiliation(s)
- Jiefu Huang
- Peking Union Medical College Hospital, Beijing, China
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26
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Savari O, Golab K, Wang LJ, Schenck L, Grose R, Tibudan M, Ramachandran S, Chon WJ, Posner MC, Millis JM, Matthews JB, Gelrud A, Witkowski P. Preservation of beta cell function after pancreatic islet autotransplantation: University of Chicago experience. Am Surg 2015; 81:421-427. [PMID: 25831191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The aim of the study was to assess the rate of insulin independence in patients after total pancreatectomy (TP) and islet autotransplantation in our center. TP followed by islet autotransplantation was performed in 10 patients. Severe unrelenting pain associated with chronic pancreatitis was the major indication for surgery. Islets were isolated using the modified Ricordi method and infused through the portal vein. Exogenous insulin therapy was implemented for at least two months posttransplant to support islet engraftment and was subsequently weaned off, if possible. Median follow-up was 26 months (range, 2 to 60 months). Median islet yield was 158,860 islet equivalents (IEQ) (range, 40,203 to 330,472 IEQ) with an average islet yield of 2,478 IEQ/g (range, 685 to 6,002 IEQ/g) of processed pancreas. One patient developed transient partial portal vein thrombosis, which resolved without sequela. Five (50%) patients are currently off insulin with excellent glucose control and HbA1c below 6. Patients who achieved and maintained insulin independence were transplanted with significantly more islets (median, 202,291 IEQ; range, 145,000 to 330,474 IEQ) than patients who required insulin support (64,348 IEQ; range, 40,203 to 260,476 IEQ; P < 0.05). Patient body mass index and time of chronic pancreatitis prior transplant procedure did not correlate with the outcome. The remaining five patients, who require insulin support, had present C-peptide in blood and experience good glucose control without incidence of severe hypoglycemic episodes. Islet autotransplantation efficiently preserved beta cell function in selected patients with chronic pancreatitis and the outcome correlated with transplanted islet mass.
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Affiliation(s)
- Omid Savari
- Department of Surgery, The University of Chicago, Chicago, Illinois
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27
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Hoang DT, Matsunari H, Nagaya M, Nagashima H, Millis JM, Witkowski P, Periwal V, Hara M, Jo J. A conserved rule for pancreatic islet organization. PLoS One 2014; 9:e110384. [PMID: 25350558 PMCID: PMC4211668 DOI: 10.1371/journal.pone.0110384] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 09/12/2014] [Indexed: 11/18/2022] Open
Abstract
Morphogenesis, spontaneous formation of organism structure, is essential for life. In the pancreas, endocrine , , and cells are clustered to form islets of Langerhans, the critical micro-organ for glucose homeostasis. The spatial organization of endocrine cells in islets looks different between species. Based on the three-dimensional positions of individual cells in islets, we computationally inferred the relative attractions between cell types, and found that the attractions between homotypic cells were slightly, but significantly, stronger than the attractions between heterotypic cells commonly in mouse, pig, and human islets. The difference between cell attraction and cell attraction was minimal in human islets, maximizing the plasticity of islet structures. Our result suggests that although the cellular composition and attractions of pancreatic endocrine cells are quantitatively different between species, the physical mechanism of islet morphogenesis may be evolutionarily conserved.
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Affiliation(s)
- Danh-Tai Hoang
- Asia Pacific Center for Theoretical Physics, Pohang, Korea
| | - Hitomi Matsunari
- Meiji University International Institute for Bio-Resource Research, Kanagawa, Japan
| | - Masaki Nagaya
- Meiji University International Institute for Bio-Resource Research, Kanagawa, Japan
| | - Hiroshi Nagashima
- Meiji University International Institute for Bio-Resource Research, Kanagawa, Japan
| | - J. Michael Millis
- Department of Surgery, The University of Chicago, Chicago, IL, United States of America
| | - Piotr Witkowski
- Department of Surgery, The University of Chicago, Chicago, IL, United States of America
| | - Vipul Periwal
- Laboratory of Biological Modeling, NIDDK, NIH, Bethesda, MD, United States of America
| | - Manami Hara
- Department of Medicine, The University of Chicago, Chicago, IL, United States of America
- * E-mail: (MH); (JJ)
| | - Junghyo Jo
- Asia Pacific Center for Theoretical Physics, Pohang, Korea
- Department of Physics, POSTECH, Pohang, Korea
- * E-mail: (MH); (JJ)
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28
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Affiliation(s)
- J Michael Millis
- Section of Transplantation, University of Chicago, Chicago, Illinois
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29
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Abstract
Hepatocellular carcinoma (HCC) is the most common primary tumor of the liver and is considered an aggressive tumor with mean survival estimated between 6 and 20 months. Hepatitis B and C are the most common etiologies. Pathological, laboratory and radiologic imaging all aid in diagnosis but much controversy exists in the utilization of any given modality. Many treatment options exist for management of HCC, each has its own limitation. Liver transplantation offers the most reasonable expectation for curative treatment while simultaneously removing the burden of the diseased liver. Still, advancements in the field have thus far not yet matched its potential, although new immunosuppressive and chemotherapy regimen may allow transplantation to push the envelope once again.
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Affiliation(s)
- Jerome Byam
- Department of Transplantation, University of Chicago, Chicago, IL 60637, USA
| | - John Renz
- Department of Transplantation, University of Chicago, Chicago, IL 60637, USA
| | - J Michael Millis
- Department of Transplantation, University of Chicago, Chicago, IL 60637, USA
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30
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Wang LJ, Young S, Misawa R, Azzam R, Wang X, Gołąb K, Cochet O, Savari O, Tibudan M, Millis JM, Matthews JB, Witkowski P. Chronic pancreatitis and primary sclerosing cholangitis--first report of intrahepatic autologous islet transplantation. J Gastrointest Surg 2014; 18:845-50. [PMID: 24297649 PMCID: PMC4435941 DOI: 10.1007/s11605-013-2414-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 11/04/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND We are reporting first successful intrahepatic autologous islet transplantation after total pancreatectomy in a patient with chronic pancreatitis and primary sclerosing cholangitis. METHODS Total pancreatectomy and subsequent islet autotransplantation were performed in a 16-year-old boy with intractable pain due to chronic pancreatitis in the setting of ulcerative colitis and primary sclerosing cholangitis (PSC). Liver biopsy revealed PSC with focal bridging fibrosis. The pancreas was surgically removed and digested, and islets were isolated, highly purified, and infused intraportally. RESULTS Over 18-month follow-up, the patient did not show progression of chronic liver disease or signs of portal hypertension. Magnetic resonance cholangiopancreatography revealed no new changes, and liver biopsy did not show progression of the periportal fibrosis. Pain medication was weaned over 12 months at which time glycemic control was excellent without exogenous insulin supplementation. HbgA1c was 5.9. Fifteen months after the procedure, stimulation with a mixed meal led to a fourfold increase of serum C-peptide and an eightfold increase of insulin level. CONCLUSION Pancreatic autologous islets can be successfully transplanted into a liver affected by PSC without compromising hepatic or graft function. Durability of the procedure may be limited in the future by the natural course of the liver injury caused by PSC.
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Affiliation(s)
- Ling-jia Wang
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Sona Young
- Department of Pediatrics, University of Chicago, Chicago, IL, USA
| | - Ryosuke Misawa
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Ruba Azzam
- Department of Pediatrics, University of Chicago, Chicago, IL, USA
| | - Xiaojun Wang
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Karolina Gołąb
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Olivia Cochet
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Omid Savari
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Martin Tibudan
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | | | | | - Piotr Witkowski
- Department of Surgery, University of Chicago, Chicago, IL, USA,Department of Surgery, University of Chicago Transplant Center, 5841 S. Maryland Ave, MC 5026, J-517, Chicago, IL 60637, USA
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31
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Mao Y, Sang X, Liang N, Yang H, Lu X, Yang Z, Du S, Xu Y, Zhao H, Zhong S, Huang J, Millis JM. Peripheral primitive neuroectodermal tumors arising in the pancreas: the first case report in Asia and a review of the 14 total reported cases in the world. Hepatobiliary Surg Nutr 2014; 2:51-60. [PMID: 24570916 DOI: 10.3978/j.issn.2304-3881.2012.08.01] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 08/01/2012] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To discuss the diagnosis and treatment of peripheral primitive neuroectodermal tumors of the pancreas based on our case and all the cases in the world. METHODS The first case of peripheral primitive neuroectodermal tumors of the pancreas in Asia was preliminarily reported by our group in 2006. The patient underwent three operations for the primary tumor and recurrences over 41 months prior to the patient's death in November 2007. All 14 reported cases of pancreatic PNETs in the world were analyzed. The corresponding literatures on its diagnosis and treatment of were reviewed. RESULTS A 13 year-old female patient was diagnosed with pancreatic PNETs by the clinical, microscopic, immunohistochemical features, and cytogenetic analysis after the resection of the tumor located in the uncinate process of the pancreas at PUMC Hospital. During the follow-up course, radiotherapy and chemotherapy were given after the first operation. Two additional operations were performed 10 months and 25 months after the first one, respectively, because of tumor recurrence. The patient died 41 months after the initial diagnosis with the recurrence and metastasis that were not suitable for a further surgery. Primitive neuroectodermal tumors of the pancreas are extremely rare. A review of the world's literature on this tumor identified fourteen cases with a mean survival time of 12 months (ranging from 6 to 50 months). These patients often have no specific clinical symptoms, but most do present with abdominal pain and/or jaundice. The diagnosis is established by small round tumor cells seen on light microscopy, immunohistochemical features of positive P30/32(MIC2) with at least two positive neuronal markers., and cytogenetic analysis showing characteristic translocation of t[11;22][q24;q12]. Since pancreatic PNETs are highly aggressive, early diagnosis, immediate surgical resection and re-resection if possible, early radiotherapy and chemotherapy and close follow-up are required. CONCLUSIONS Peripheral primitive neuroectodermal tumors can arise in pancreas. The diagnosis and treatment should be made as early as possible, aggressive surgeries for the primary and recurrences may help to improve the prognosis.
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Affiliation(s)
- Yilei Mao
- Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and PUMC, Beijing 100730, China
| | - Xinting Sang
- Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and PUMC, Beijing 100730, China
| | - Naixin Liang
- Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and PUMC, Beijing 100730, China
| | - Huayu Yang
- Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and PUMC, Beijing 100730, China
| | - Xin Lu
- Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and PUMC, Beijing 100730, China
| | - Zhiying Yang
- Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and PUMC, Beijing 100730, China
| | - Shunda Du
- Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and PUMC, Beijing 100730, China
| | - Yiyao Xu
- Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and PUMC, Beijing 100730, China
| | - Haitao Zhao
- Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and PUMC, Beijing 100730, China
| | - Shouxian Zhong
- Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and PUMC, Beijing 100730, China
| | - Jiefu Huang
- Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and PUMC, Beijing 100730, China
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Asrani SK, Wiesner RH, Trotter JF, Klintmalm G, Katz E, Maller E, Roberts J, Kneteman N, Teperman L, Fung JJ, Millis JM. De novo sirolimus and reduced-dose tacrolimus versus standard-dose tacrolimus after liver transplantation: the 2000-2003 phase II prospective randomized trial. Am J Transplant 2014; 14:356-66. [PMID: 24456026 DOI: 10.1111/ajt.12543] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [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: 05/22/2013] [Revised: 09/20/2013] [Accepted: 09/20/2013] [Indexed: 01/25/2023]
Abstract
We studied whether the use of sirolimus with reduced-dose tacrolimus, as compared to standard-dose tacrolimus, after liver transplantation is safe, tolerated and efficacious. In an international multicenter, open-label, active-controlled randomized trial (2000-2003), adult primary liver transplant recipients (n=222) were randomly assigned immediately after transplantation to conventional-dose tacrolimus (trough: 7-15 ng/mL) or sirolimus (loading dose: 15 mg, initial dose: 5 mg titrated to a trough of 4-11 ng/mL) and reduced-dose tacrolimus (trough: 3-7 ng/mL). The study was terminated after 21 months due to imbalance in adverse events. The 24-month cumulative incidence of graft loss (26.4% vs. 12.5%, p=0.009) and patient death (20% vs. 8%, p=0.010) was higher in subjects receiving sirolimus. A numerically higher rate of hepatic artery thrombosis/portal vein thrombosis was observed in the sirolimus arm (8% vs. 3%, p=0.065). The incidence of sepsis was higher in the sirolimus arm (20.4% vs. 7.2%, p=0.006). Rates of acute cellular rejection were similar between the two groups. Early use of sirolimus using a loading dose followed by maintenance doses and reduced-dose tacrolimus in de novo liver transplant recipients is associated with higher rates of graft loss, death and sepsis when compared to the use of conventional-dose tacrolimus alone.
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Affiliation(s)
- S K Asrani
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN; William J. von Liebig Transplant Center, Mayo Clinic, Rochester, MN; Annette C and Harold-Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX
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Affiliation(s)
- J Michael Millis
- Transplant Center, Section of Transplantation, University of Chicago Medicine, Chicago, USA
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Abstract
The large size of the human pancreas challenges unbiased quantitative analyses that require a practical stereological approach. While many histological studies of the pancreas in the past lacked regional information, we have shown marked heterogeneity within an individual, where islet distribution/density is relatively low in the head and gradually increases through the body toward the tail region by>2-fold. Studies focusing on the tail region may be prone to overestimation of β-cell/islet mass when normalizing measured values per person by using pancreas weight or volume. In this article, beyond technical issues, we discuss the pathophysiological importance of studying the head region of the human pancreas regarding its unique characteristics in early development, and the anatomical disposition that may lead to a preferential loss of β-cells in patients with type 2 diabetes and the development of pancreatic cancer.
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Affiliation(s)
- Omid Savari
- Department of Surgery; The University of Chicago; Chicago, IL USA
| | - Mark C Zielinski
- Department of Medicine; The University of Chicago; Chicago, IL USA
| | - Xiaojun Wang
- Department of Surgery; The University of Chicago; Chicago, IL USA
| | - Ryosuke Misawa
- Department of Surgery; The University of Chicago; Chicago, IL USA
| | - J Michael Millis
- Department of Surgery; The University of Chicago; Chicago, IL USA
| | - Piotr Witkowski
- Department of Surgery; The University of Chicago; Chicago, IL USA
| | - Manami Hara
- Department of Medicine; The University of Chicago; Chicago, IL USA
- Correspondence to: Manami Hara,
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Gołąb K, Krzystyniak A, Marek-Trzonkowska N, Misawa R, Wang LJ, Wang X, Cochet O, Tibudan M, Langa P, Millis JM, Trzonkowski P, Witkowski P. Impact of culture medium on CD4+ CD25highCD127lo/neg Treg expansion for the purpose of clinical application. Int Immunopharmacol 2013; 16:358-63. [DOI: 10.1016/j.intimp.2013.02.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 02/18/2013] [Indexed: 01/26/2023]
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Wang X, Misawa R, Zielinski MC, Cowen P, Jo J, Periwal V, Ricordi C, Khan A, Szust J, Shen J, Millis JM, Witkowski P, Hara M. Regional differences in islet distribution in the human pancreas--preferential beta-cell loss in the head region in patients with type 2 diabetes. PLoS One 2013; 8:e67454. [PMID: 23826303 PMCID: PMC3691162 DOI: 10.1371/journal.pone.0067454] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 05/17/2013] [Indexed: 12/25/2022] Open
Abstract
While regional heterogeneity in islet distribution has been well studied in rodents, less is known about human pancreatic histology. To fill gaps in our understanding, regional differences in the adult human pancreas were quantitatively analyzed including the pathogenesis of type 2 diabetes (T2D). Cadaveric pancreas specimens were collected from the head, body and tail regions of each donor, including subjects with no history of diabetes or pancreatic diseases (n = 23) as well as patients with T2D (n = 12). The study further included individuals from whom islets were isolated (n = 7) to study islet yield and function in a clinical setting of islet transplantation. The whole pancreatic sections were examined using an innovative large-scale image capture and unbiased detailed quantitative analyses of the characteristics of islets from each individual (architecture, size, shape and distribution). Islet distribution/density is similar between the head and body regions, but is >2-fold higher in the tail region. In contrast to rodents, islet cellular composition and architecture were similar throughout the pancreas and there was no difference in glucose-stimulated insulin secretion in islets isolated from different regions of the pancreas. Further studies revealed preferential loss of large islets in the head region in patients with T2D. The present study has demonstrated distinct characteristics of the human pancreas, which should provide a baseline for the future studies integrating existing research in the field and helping to advance bi-directional research between humans and preclinical models.
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Affiliation(s)
- Xiaojun Wang
- Department of Surgery, The University of Chicago, Chicago, Illinois, United States of America
- Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Ryosuke Misawa
- Department of Surgery, The University of Chicago, Chicago, Illinois, United States of America
| | - Mark C. Zielinski
- Department of Medicine, The University of Chicago, Chicago, Illinois, United States of America
| | - Peter Cowen
- Department of Medicine, The University of Chicago, Chicago, Illinois, United States of America
| | - Junghyo Jo
- Laboratory of Biological Modeling, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Vipul Periwal
- Laboratory of Biological Modeling, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Camillo Ricordi
- Cell Transplant Center, University of Miami, Miami, Florida, United States of America
| | - Aisha Khan
- Cell Transplant Center, University of Miami, Miami, Florida, United States of America
| | - Joel Szust
- Cell Transplant Center, University of Miami, Miami, Florida, United States of America
| | - Junhui Shen
- Department of Medicine, The University of Chicago, Chicago, Illinois, United States of America
| | - J. Michael Millis
- Department of Surgery, The University of Chicago, Chicago, Illinois, United States of America
| | - Piotr Witkowski
- Department of Surgery, The University of Chicago, Chicago, Illinois, United States of America
| | - Manami Hara
- Department of Medicine, The University of Chicago, Chicago, Illinois, United States of America
- * E-mail:
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Wang XJ, Leveson-Gower D, Golab K, Wang LJ, Marek-Trzonkowska N, Krzystyniak A, Wardowska A, Millis JM, Trzonkowski P, Witkowski P. Influence of pharmacological immunomodulatory agents on CD4(+)CD25(high)FoxP3(+) T regulatory cells in humans. Int Immunopharmacol 2013; 16:364-70. [PMID: 23499512 DOI: 10.1016/j.intimp.2013.02.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Accepted: 02/18/2013] [Indexed: 12/24/2022]
Abstract
T regulatory cells (Tregs) play a critical role in the immunologic tolerance to the graft in transplantation. Thus, due to their immunosuppressive capability, ex vivo expanded Tregs may be used as a cellular therapy and an attractive novel strategy to control chronic rejection and eliminate need for lifelong pharmacological immunosuppression. Since Treg therapy is still in its infancy, initially Tregs still need to be applied in combination with pharmacological agents to prevent rejection. Fortunately, some of the medications have been shown to enhance the function and number of Tregs. In the clinic, different immunosuppressive regimens are used for individual patients for different types of organ transplantation. In this review, we present the most commonly used pharmacological agents for immunosuppression and discuss how they affect the Treg population. It is extremely difficult to dissect the effect of single agent on Tregs population in clinical settings since usually the combination of several medications is applied at the same time for graft protection. Nevertheless, experimental and clinical data indicate that thymoglobulin as immunosuppressive induction and mTOR inhibitors as immunosuppressive maintenance agents have the most beneficial effect on Treg population in the blood. Among supplemental agents promoting Tregs, anti-TNFα preparations have been in clinical use (in autoimmune diseases) for many years, so they are optimal candidates for testing in transplant settings in combination with Treg based cellular therapy.
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Affiliation(s)
- Xiao-Jun Wang
- Department of Surgery, Section of Transplantation, University of Chicago, IL 60637, USA
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Terrault NA, Roland ME, Schiano T, Dove L, Wong MT, Poordad F, Ragni MV, Barin B, Simon D, Olthoff KM, Johnson L, Stosor V, Jayaweera D, Fung J, Sherman KE, Subramanian A, Millis JM, Slakey D, Berg CL, Carlson L, Ferrell L, Stablein DM, Odim J, Fox L, Stock PG. Outcomes of liver transplant recipients with hepatitis C and human immunodeficiency virus coinfection. Liver Transpl 2012; 18:716-26. [PMID: 22328294 PMCID: PMC3358510 DOI: 10.1002/lt.23411] [Citation(s) in RCA: 161] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Hepatitis C virus (HCV) is a controversial indication for liver transplantation (LT) in human immunodeficiency virus (HIV)-infected patients because of reportedly poor outcomes. This prospective, multicenter US cohort study compared patient and graft survival for 89 HCV/HIV-coinfected patients and 2 control groups: 235 HCV-monoinfected LT controls and all US transplant recipients who were 65 years old or older. The 3-year patient and graft survival rates were 60% [95% confidence interval (CI) = 47%-71%] and 53% (95% CI = 40%-64%) for the HCV/HIV patients and 79% (95% CI = 72%-84%) and 74% (95% CI = 66%-79%) for the HCV-infected recipients (P < 0.001 for both), and HIV infection was the only factor significantly associated with reduced patient and graft survival. Among the HCV/HIV patients, older donor age [hazard ratio (HR) = 1.3 per decade], combined kidney-liver transplantation (HR = 3.8), an anti-HCV-positive donor (HR = 2.5), and a body mass index < 21 kg/m(2) (HR = 3.2) were independent predictors of graft loss. For the patients without the last 3 factors, the patient and graft survival rates were similar to those for US LT recipients. The 3-year incidence of treated acute rejection was 1.6-fold higher for the HCV/HIV patients versus the HCV patients (39% versus 24%, log rank P = 0.02), but the cumulative rates of severe HCV disease at 3 years were not significantly different (29% versus 23%, P = 0.21). In conclusion, patient and graft survival rates are lower for HCV/HIV-coinfected LT patients versus HCV-monoinfected LT patients. Importantly, the rates of treated acute rejection (but not the rates of HCV disease severity) are significantly higher for HCV/HIV-coinfected recipients versus HCV-infected recipients. Our results indicate that HCV per se is not a contraindication to LT in HIV patients, but recipient and donor selection and the management of acute rejection strongly influence outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Laurie Carlson
- University of California San Francisco, San Francisco, CA
| | - Linda Ferrell
- University of California San Francisco, San Francisco, CA
| | | | - Jonah Odim
- National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | - Lawrence Fox
- National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | - Peter G. Stock
- University of California San Francisco, San Francisco, CA
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Millis JM. Are surgeons rising to the challenge of managing morbidly obese patients undergoing hepatic resection? Arch Surg 2012; 147:337. [PMID: 22184131 DOI: 10.1001/archsurg.2011.1547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- J Michael Millis
- Section of Transplantation, Department of Surgery, University of Chicago Transplant Center, 5841 S Maryland Ave, Chicago, IL 60637, USA.
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Abstract
China's aims are to develop an ethical and sustainable organ transplantation system for the Chinese people and to be accepted as a responsible member of the international transplantation community. In 2007, China implemented the Regulation on Human Organ Transplantation, which was the first step towards the establishment of a voluntary organ donation system. Although progress has been made, several ethical and legal issues associated with transplantation in China remain, including the use of organs from executed prisoners, organ scarcity, the illegal organ trade, and transplantation tourism. In this Health Policy article we outline the standards used to define cardiac death in China and a legal and procedural framework for an organ donation system based on voluntary donation after cardiac death that adheres to both China's social and cultural principles and international transplantation standards.
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Affiliation(s)
- Jiefu Huang
- Department of Liver Surgery, Peking Union Medical College Hospital, Beijing, China.
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Ison MG, Llata E, Conover CS, Friedewald JJ, Gerber SI, Grigoryan A, Heneine W, Millis JM, Simon DM, Teo CG, Kuehnert MJ. Transmission of human immunodeficiency virus and hepatitis C virus from an organ donor to four transplant recipients. Am J Transplant 2011; 11:1218-25. [PMID: 21645254 DOI: 10.1111/j.1600-6143.2011.03597.x] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In 2007, a previously uninfected kidney transplant recipient tested positive for human immunodeficiency virus type 1 (HIV) and hepatitis C virus (HCV) infection. Clinical information of the organ donor and the recipients was collected by medical record review. Sera from recipients and donor were tested for serologic and nucleic acid-based markers of HIV and HCV infection, and isolates were compared for genetic relatedness. Routine donor serologic screening for HIV and HCV infection was negative; the donor's only known risk factor for HIV was having sex with another man. Four organs (two kidneys, liver and heart) were transplanted to four recipients. Nucleic acid testing (NAT) of donor sera and posttransplant sera from all recipients were positive for HIV and HCV. HIV nucleotide sequences were indistinguishable between the donor and four recipients, and HCV subgenomic sequences clustered closely together. Two patients subsequently died and the transplanted organs failed in the other two patients. This is the first recognized cotransmission of HIV and HCV from an organ donor to transplant recipients. Routine posttransplant HIV and HCV serological testing and NAT of recipients of organs from donors with suspected risk factors should be considered as routine practice.
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Affiliation(s)
- M G Ison
- Division of Infectious Diseases Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Agarwal S, Dorafshar AH, Harland RC, Millis JM, Gottlieb LJ. Liver and vascularized posterior rectus sheath fascia composite tissue allotransplantation. Am J Transplant 2010; 10:2712-6. [PMID: 21114648 DOI: 10.1111/j.1600-6143.2010.03331.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Abdominal wall closure in pediatric solid organ recipients may be confounded by donor size discrepancy and structural insults from previous surgery. Here we describe the novel use of vascularized donor abdominal wall posterior rectus sheath fascia, as a composite tissue allotransplant (CTA), to achieve abdominal wall closure in a liver and double kidney pediatric recipient who could not be closed primarily due to donor/recipient size mismatch. The posterior rectus sheath fascia was procured in continuity with the liver and falciform ligament. Blood supply was achieved using the single hepatic artery anastomosis as part of the standard liver transplantation procedure. Specimens of posterior rectus sheath fascia taken on postoperative days 3 and 30 showed no signs of acute rejection. The patient succumbed to an overwhelming fungal infection on day 51, with no signs of intraabdominal involvement. The patient received no additional immunosuppression in conjunction with the posterior rectus sheath fascia allotransplant.
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Affiliation(s)
- S Agarwal
- Section of Plastic and Reconstructive Surgery, University of Chicago, Chicago, IL, USA
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Mao Y, Yang H, Xu H, Lu X, Sang X, Du S, Zhao H, Chen W, Xu Y, Chi T, Yang Z, Cai J, Li H, Chen J, Zhong S, Mohanti SR, Lopez-Soler R, Millis JM, Huang J, Zhang H. Golgi protein 73 (GOLPH2) is a valuable serum marker for hepatocellular carcinoma. Gut 2010; 59:1687-93. [PMID: 20876776 DOI: 10.1136/gut.2010.214916] [Citation(s) in RCA: 174] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Golgi protein 73 (GP73) as a potential serum marker for hepatocellular carcinoma (HCC) has not been validated in large cohort studies. Furthermore, its significance in the assessment of tumour recurrence after HCC resection remains unknown. The aim of this study was to determine the value of serum GP73 in the diagnosis of HCC. METHODS Serum GP73 and alpha-fetoprotein (AFP) were compared in a total of 4217 human subjects in this multicentre study, including 1690 healthy adults, 337 hepatitis B virus (HBV) carriers, 512 patients with cirrhosis, 789 patients with HCC, 61 patients with other malignant liver lesions, 206 patients with benign liver lesions and 622 patients with 14 different kinds of non-liver cancers. The main outcome measures were the specificity and sensitivity of GP73 in patients at risk for the development of HCC. RESULTS Using 8.5 relative units as a cut-off value, the sensitivity and specificity of serum GP73 for HCC were 74.6% (95% CI 71.5% to 77.6%) and 97.4% (95% CI 96.8 to 98.3%), compared with 58.2% (95% CI 55.2% to 62.1%) and 85.3% (95% CI 83.4% to 88.1%) for AFP (p<0.001) using 35 ng/ml as a cut-off value. The GP73 level was significantly increased in patients with HCC compared with healthy controls (14.7 vs 1.2, p<0.001). Although GP73 levels in HBV carriers (2.9) and patients with cirrhosis (4.7) were somewhat elevated, they were much lower than that in patients with HCC (p<0.001). GP73 decreased following surgical resection of HCC lesions and increased with tumour recurrence. Fourteen types of non-liver cancers were analysed; all the benign and other malignant liver lesions had moderate elevations of GP73, albeit at a much lower level than in HCC. CONCLUSIONS GP73 is an accurate serum marker for the detection of HCC and its recurrence after surgery, with higher sensitivity and specificity than AFP. Clinical implementation of serum GP73 measurement as a standard test for HCC is recommended.
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Affiliation(s)
- Yilei Mao
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730 China.
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Stock PG, Barin B, Murphy B, Hanto D, Diego JM, Light J, Davis C, Blumberg E, Simon D, Subramanian A, Millis JM, Lyon GM, Brayman K, Slakey D, Shapiro R, Melancon J, Jacobson JM, Stosor V, Olson JL, Stablein DM, Roland ME. Outcomes of kidney transplantation in HIV-infected recipients. N Engl J Med 2010; 363:2004-14. [PMID: 21083386 PMCID: PMC3028983 DOI: 10.1056/nejmoa1001197] [Citation(s) in RCA: 366] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The outcomes of kidney transplantation and immunosuppression in people infected with human immunodeficiency virus (HIV) are incompletely understood. METHODS We undertook a prospective, nonrandomized trial of kidney transplantation in HIV-infected candidates who had CD4+ T-cell counts of at least 200 per cubic millimeter and undetectable plasma HIV type 1 (HIV-1) RNA levels while being treated with a stable antiretroviral regimen. Post-transplantation management was provided in accordance with study protocols that defined prophylaxis against opportunistic infection, indications for biopsy, and acceptable approaches to immunosuppression, management of rejection, and antiretroviral therapy. RESULTS Between November 2003 and June 2009, a total of 150 patients underwent kidney transplantation; survivors were followed for a median period of 1.7 years. Patient survival rates (±SD) at 1 year and 3 years were 94.6±2.0% and 88.2±3.8%, respectively, and the corresponding mean graft-survival rates were 90.4% and 73.7%. In general, these rates fall somewhere between those reported in the national database for older kidney-transplant recipients (≥65 years) and those reported for all kidney-transplant recipients. A multivariate proportional-hazards analysis showed that the risk of graft loss was increased among patients treated for rejection (hazard ratio, 2.8; 95% confidence interval [CI], 1.2 to 6.6; P=0.02) and those receiving antithymocyte globulin induction therapy (hazard ratio, 2.5; 95% CI, 1.1 to 5.6; P=0.03); living-donor transplants were protective (hazard ratio, 0.2; 95% CI, 0.04 to 0.8; P=0.02). A higher-than-expected rejection rate was observed, with 1-year and 3-year estimates of 31% (95% CI, 24 to 40) and 41% (95% CI, 32 to 52), respectively. HIV infection remained well controlled, with stable CD4+ T-cell counts and few HIV-associated complications. CONCLUSIONS In this cohort of carefully selected HIV-infected patients, both patient- and graft-survival rates were high at 1 and 3 years, with no increases in complications associated with HIV infection. The unexpectedly high rejection rates are of serious concern and indicate the need for better immunotherapy. (Funded by the National Institute of Allergy and Infectious Diseases; ClinicalTrials.gov number, NCT00074386.).
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Affiliation(s)
- Peter G Stock
- University of California, San Francisco, San Francisco, CA 94143-0116, USA.
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Grossman EJ, Millis JM. Liver transplantation for non-hepatocellular carcinoma malignancy: Indications, limitations, and analysis of the current literature. Liver Transpl 2010; 16:930-42. [PMID: 20677284 DOI: 10.1002/lt.22106] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Orthotopic liver transplantation (OLT) is currently incorporated into the treatment regimens for specific nonhepatocellular malignancies. For patients suffering from early-stage, unresectable hilar cholangiocarcinoma (CCA), OLT preceded by neoadjuvant radiotherapy has the potential to readily achieve a tumor-free margin, accomplish a radical resection, and treat underlying primary sclerosing cholangitis when present. In highly selected stage I and II patients with CCA, the 5-year survival rate is 80%. As additional data are accrued, OLT with neoadjuvant chemoradiation may become a viable alternative to resection for patients with localized, node-negative hilar CCA. Hepatic involvement from neuroendocrine tumors can be treated with OLT when metastases are unresectable or for palliation of medically uncontrollable symptoms. Five-year survival rates as high as 90% have been reported, and the Ki67 labeling index can be used to predict outcomes after OLT. Hepatic epithelioid hemangioendothelioma is a rare tumor of vascular origin. The data from single-institution series are limited, but compiled reviews have reported 1- and 10-year survival rates of 96% and 72%, respectively. Hepatoblastoma is the most common primary hepatic malignancy in children. There exist subtle differences in the timing of chemotherapy between US and European centers; however, the long-term survival rate after transplantation ranges from 66% to 77%. Fibrolamellar hepatocellular carcinoma is a distinct liver malignancy best treated by surgical resection. However, there is an increasing amount of data supporting OLT when resection is contraindicated. In the treatment of either primary or metastatic hepatic sarcomas, unacceptable survival and recurrence rates currently prohibit the use of OLT.
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Affiliation(s)
- Eric J Grossman
- Section of Transplantation, Department of Surgery, University of Chicago Medical Center, Chicago, IL 60637, USA
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Reichman TW, Marino SR, Milner J, Harland RC, Cochrane A, Millis JM, Testa G. Acute humoral rejection in an ABO compatible combined liver-kidney transplant--the kidney is not always protected. Am J Transplant 2009; 9:1957-60. [PMID: 19522875 DOI: 10.1111/j.1600-6143.2009.02714.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Combined liver-kidney transplantation has become a common practice for the treatment of patients with concurrent end-stage renal disease and end-stage liver disease. Liver transplantation in the setting of multiorgan transplantation is thought to have a protective effect against humoral rejection even when a positive crossmatch is obtained prior to surgery. In most centers, a pre liver-kidney transplant crossmatch is rarely performed because of the known immunoprotective effect of the liver allograft. In this report, a case of acute humoral rejection in the kidney allograft after a combined liver-kidney transplant is described. Although humoral rejection was treated using plasmapheresis, intravenous immunoglobulin and rituximab, the kidney required 3 months to recover function and finally progressed to chronic allograft nephropathy. A heightened index of suspicion for acute humoral rejection of the renal allograft is necessary when performing combined liver-kidney transplants to highly sensitized patients due to previous organ transplants.
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Affiliation(s)
- T W Reichman
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA.
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Reichman TW, Anthony T, Millis JM, Testa G. Uncharacteristically early fatal intraperitoneal rupture of hepatocellular carcinoma following transarterial chemoembolization. Dig Liver Dis 2009; 41:175-6. [PMID: 18849205 DOI: 10.1016/j.dld.2008.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2008] [Accepted: 08/27/2008] [Indexed: 12/11/2022]
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49
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50
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Losanoff JE, Millis JM. Liver hemangioma complicated by obstructive jaundice. Am J Surg 2008; 196:e3-4. [PMID: 18519125 DOI: 10.1016/j.amjsurg.2007.08.069] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Revised: 08/13/2007] [Accepted: 08/13/2007] [Indexed: 12/01/2022]
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