Five-year follow-up of patients with type 1 diabetes transplanted with allogeneic islets: the UIC experience

Acta Diabetologica - Tập 51 - Trang 833-843 - 2014
Meirigeng Qi1, Katie Kinzer1, Kirstie K. Danielson1, Joan Martellotto1, Barbara Barbaro1, Yong Wang1, James T. Bui2, Ron C. Gaba2, Grace Knuttinen2, Raquel Garcia-Roca1, Ivo Tzvetanov1, Andrew Heitman3, Maureen Davis1, James J. McGarrigle1, Enrico Benedetti1, Jose Oberholzer1
1Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, USA
2Department of Radiology, University of Illinois at Chicago, Chicago, USA
3The Emmes Corporation Rockville, Rockville, USA

Tóm tắt

This report summarizes a 5-year phase 1/2 allogeneic islet transplantation clinical trial conducted at the University of Illinois at Chicago (UIC). Ten patients were enrolled in this single center, open label, and prospective trial in which patients received 1–3 transplants. The first four subjects underwent islet transplantation with the Edmonton immunosuppressive regimen and the remaining six subjects received the UIC immunosuppressive protocol (Edmonton plus etanercept and exenatide). All 10 patients achieved insulin independence after 1–3 transplants. At 5 years of follow-up, 6 of the initial 10 patients were free of exogenous insulin. During the follow-up period, 7 of the 10 patients maintained positive C-peptide levels and a composite hypoglycemic score of 0. Most patients maintained HbA1c levels <6.0 % (42.1 mmol/mol) and a significantly improved β-score. In conclusion, this study demonstrated long-term islet graft function without using T cell depleting induction, with an encouraging outcome that includes 60 % of patients remaining insulin independent after 5 years of initial transplantation.

Tài liệu tham khảo

Ricordi C (2003) Islet transplantation: a brave new world. Diabetes 52(7):1595–1603 Bertuzzi F, Ricordi C (2007) Beta-cell replacement in immunosuppressed recipients: old and new clinical indications. Acta Diabetol 44(4):171–176 Barton FB, Rickels MR, Alejandro R, Hering BJ, Wease S, Naziruddin B, Oberholzer J, Odorico JS, Garfinkel MR, Levy M, Pattou F, Berney T, Secchi A, Messinger S, Senior PA, Maffi P, Posselt A, Stock PG, Kaufman DB, Luo X, Kandeel F, Cagliero E, Turgeon NA, Witkowski P, Naji A, O’Connell PJ, Greenbaum C, Kudva YC, Brayman KL, Aull MJ, Larsen C, Kay TW, Fernandez LA, Vantyghem MC, Bellin M, Shapiro AM (2012) Improvement in outcomes of clinical islet transplantation: 1999–2010. Diabetes Care 35(7):1436–1445 Shapiro AM, Lakey JR, Ryan EA, Korbutt GS, Toth E, Warnock GL, Kneteman NM, Rajotte RV (2000) Islet transplantation in seven patients with type 1 diabetes mellitus using a glucocorticoid-free immunosuppressive regimen. N Engl J Med 343(4):230–238 Ryan EA, Paty BW, Senior PA, Bigam D, Alfadhli E, Kneteman NM, Lakey JRT, Shapiro AMJ (2005) Five-year follow-up after clinical islet transplantation. Diabetes 54(7):2060–2069 Bellin MD, Barton FB, Heitman A, Harmon JV, Kandaswamy R, Balamurugan AN, Sutherland DE, Alejandro R, Hering BJ (2012) Potent induction immunotherapy promotes long-term insulin independence after islet transplantation in type 1 diabetes. Am J Transplant 12(6):1576–1583 Shapiro AM, Hao EG, Lakey JR, Yakimets WJ, Churchill TA, Mitlianga PG, Papadopoulos GK, Elliott JF, Rajotte RV, Kneteman NM (2001) Novel approaches toward early diagnosis of islet allograft rejection. Transplantation 71(12):1709–1718 Vergani A, Fotino C, D’Addio F, Tezza S, Podetta M, Gatti F, Chin M, Bassi R, Molano RD, Corradi D, Gatti R, Ferrero ME, Secchi A, Grassi F, Ricordi C, Sayegh MH, Maffi P, Pileggi A, Fiorina P (2013) Effect of the purinergic inhibitor oxidized ATP in a model of islet allograft rejection. Diabetes 62(5):1665–1675 Jalili RB, Forouzandeh F, Rezakhanlou AM, Hartwell R, Medina A, Warnock GL, Larijani B, Ghahary A (2010) Local expression of indoleamine 2,3 dioxygenase in syngeneic fibroblasts significantly prolongs survival of an engineered three-dimensional islet allograft. Diabetes 59(9):2219–2227 Monti P, Scirpoli M, Maffi P, Ghidoli N, De Taddeo F, Bertuzzi F, Piemonti L, Falcone M, Secchi A, Bonifacio E (2008) Islet transplantation in patients with autoimmune diabetes induces homeostatic cytokines that expand autoreactive memory T cells. J Clin Invest 118(5):1806–1814 Huang G, Wang X, Li Z, Li H, Li X, Zhou Z (2012) Insulin autoantibody could help to screen latent autoimmune diabetes in adults in phenotypic type 2 diabetes mellitus in Chinese. Acta Diabetol 49(5):327–331 Nir T, Melton DA, Dor Y (2007) Recovery from diabetes in mice by beta cell regeneration. J Clin Invest 117(9):2553–2561 Gillard P, Ling Z, Mathieu C, Crenier L, Lannoo M, Maes B, Roep B, Gorus F, Pipeleers D, Keymeulen B (2008) Comparison of sirolimus alone with sirolimus plus tacrolimus in type 1 diabetic recipients of cultured islet cell grafts. Transplantation 85(2):256–263 Laugharne M, Cross S, Richards S, Dawson C, Ilchyshyn L, Saleem M, Mathieson P, Smith R (2007) Sirolimus toxicity and vascular endothelial growth factor release from islet and renal cell lines. Transplantation 83(12):1635–1638 Bellin MD, Barton FB, Heitman A, Harmon JV, Kandaswamy R, Balamurugan AN, Sutherland DE, Alejandro R, Hering BJ (2012) Potent induction immunotherapy promotes long-term insulin independence after islet transplantation in type 1 diabetes. Am J Transplant 12(6):1576–1583 Ngo A, Sutherland DE, Beilman GJ, Bellin MD (2014) Deterioration of glycemic control after corticosteroid administration in islet autotransplant recipients: a cautionary tale. Acta Diabetol 51(1):141–145 Gangemi A, Salehi P, Hatipoglu B, Martellotto J, Barbaro B, Kuechle JB, Qi M, Wang Y, Pallan P, Owens C, Bui J, West D, Kaplan B, Benedetti E, Oberholzer J (2008) Islet transplantation for brittle type 1 diabetes: the UIC protocol. Am J Transplant 8(6):1250–1261 Qi M, Barbaro B, Wang S, Wang Y, Hansen M, Oberholzer J (2009) Human pancreatic islet isolation: Part I: digestion and collection of pancreatic tissue. J Vis Exp (27). doi:10.3791/1125 Qi M, Barbaro B, Wang S, Wang Y, Hansen M, Oberholzer J (2009) Human pancreatic islet isolation: Part II: purification and culture of human islets. J Vis Exp (27). doi:10.3791/1343 Soltani SM, O’Brien TD, Loganathan G, Bellin MD, Anazawa T, Tiwari M, Papas KK, Vickers SM, Kumaravel V, Hering BJ, Sutherland DE, Balamurugan AN (2013) Severely fibrotic pancreases from young patients with chronic pancreatitis: evidence for a ductal origin of islet neogenesis. Acta Diabetol 50(5):807–814 Koh A, Imes S, Kin T, Dinyari P, Malcolm A, Toso C, Shapiro AM, Senior P (2010) Supplemental islet infusions restore insulin independence after graft dysfunction in islet transplant recipients. Transplantation 89(3):361–365 Lehmann R, Spinas GA, Moritz W, Weber M (2008) Has time come for new goals in human islet transplantation? Am J Transplant 8(6):1096–1100 Teuscher AU, Kendall DM, Smets YF, Leone JP, Sutherland DE, Robertson RP (1998) Successful islet autotransplantation in humans: functional insulin secretory reserve as an estimate of surviving islet cell mass. Diabetes 47(3):324–330 Ryan EA, Shandro T, Green K, Paty BW, Senior PA, Bigam D, Shapiro AM, Vantyghem MC (2004) Assessment of the severity of hypoglycemia and glycemic lability in type 1 diabetic subjects undergoing islet transplantation. Diabetes 53(4):955–962 Ryan EA, Paty BW, Senior PA, Lakey JR, Bigam D, Shapiro AM (2005) Beta-score: an assessment of beta-cell function after islet transplantation. Diabetes Care 28(2):343–347 Justesen TI, Petersen JL, Ekbom P, Damm P, Mathiesen ER (2006) Albumin-to-creatinine ratio in random urine samples might replace 24-h urine collections in screening for micro- and macroalbuminuria in pregnant woman with type 1 diabetes. Diabetes Care 29(4):924–925 Salehi P, Stull MA, Martellotto J, Gangemi A, Hatipoglu B, Benedetti E, Oberholzer J (2009) Case report: diabetic myonecrosis of the neck complicated by infection in an islet transplanted patient. J Diabetes Complications 23(2):140–142 Froud T, Faradji RN, Pileggi A, Messinger S, Baidal DA, Ponte GM, Cure PE, Monroy K, Mendez A, Selvaggi G, Ricordi C, Alejandro R (2008) The use of exenatide in islet transplant recipients with chronic allograft dysfunction: safety, efficacy, and metabolic effects. Transplantation 86(1):36–45 Faradji RN, Tharavanij T, Messinger S, Froud T, Pileggi A, Monroy K, Mineo D, Baidal DA, Cure P, Ponte G, Mendez AJ, Selvaggi G, Ricordi C, Alejandro R (2008) Long-term insulin independence and improvement in insulin secretion after supplemental islet infusion under exenatide and etanercept. Transplantation 86(12):1658–1665 Johnson JA, Kotovych M, Ryan EA, Shapiro AM (2004) Reduced fear of hypoglycemia in successful islet transplantation. Diabetes Care 27(2):624–625 Huurman VA, van der Torren CR, Gillard P, Hilbrands R, van der Meer-Prins EP, Duinkerken G, Gorus FK, Claas FH, Keymeulen B, Roelen DL, Pipeleers DG, Roep BO (2012) Immune responses against islet allografts during tapering of immunosuppression—a pilot study in 5 subjects. Clin Exp Immunol. doi:10.1111/j.1365-2249.2011.04605 Smith RN, Kent SC, Nagle J, Selig M, Iafrate AJ, Najafian N, Hafler DA, Auchincloss H, Orban T, Cagliero E (2008) Pathology of an islet transplant 2 years after transplantation: evidence for a nonimmunological loss. Transplantation 86(1):54–62 Westermark GT, Westermark P, Berne C, Korsgren O (2008) Widespread amyloid deposition in transplanted human pancreatic islets. N Engl J Med 359(9):977–979 Ponte GM, Baidal DA, Romanelli P, Faradji RN, Poggioli R, Cure P, Froud T, Selvaggi G, Pileggi A, Ricordi C, Alejandro R (2007) Resolution of severe atopic dermatitis after tacrolimus withdrawal. Cell Transplant 16(1):23–30 Bumbea V, Kamar N, Ribes D, Esposito L, Modesto A, Guitard J, Nasou G, Durand D, Rostaing L (2005) Long-term results in renal transplant patients with allograft dysfunction after switching from calcineurin inhibitors to sirolimus. Nephrol Dial Transplant 20(11):2517–2523 Liew A, Chiang GS, Vathsala A (2009) Factors associated with proteinuria in renal transplant recipients treated with sirolimus. Transpl Int 22(3):313–322 Senior PA, Zeman M, Paty BW, Ryan EA, Shapiro AM (2007) Changes in renal function after clinical islet transplantation: four-year observational study. Am J Transplant 7(1):91–98 Kaplan B, Schold J, Srinivas T, Womer K, Foley DP, Patton P, Howard R, Meier-Kriesche HU (2004) Effect of sirolimus withdrawal in patients with deteriorating renal function. Am J Transplant 4(10):1709–1712 Senior PA, Paty BW, Cockfield SM, Ryan EA, Shapiro AM (2005) Proteinuria developing after clinical islet transplantation resolves with sirolimus withdrawal and increased tacrolimus dosing. Am J Transplant 5(9):2318–2323 Olack BJ, Swanson CJ, Flavin KS, Phelan D, Brennan DC, White NH, Lacy PE, Scharp DW, Poindexter N, Mohanakumar T (1997) Sensitization to HLA antigens in islet recipients with failing transplants. Transplant Proc 29(4):2268–2269 Campbell PM, Senior PA, Salam A, Labranche K, Bigam DL, Kneteman NM, Imes S, Halpin A, Ryan EA, Shapiro AM (2007) High risk of sensitization after failed islet transplantation. Am J Transplant 7(10):2311–2317