Development of Methods for Transplanting Human Islet within Macroencapsulation Device that Reverse Diabetes in Mice

Improved recovery of human islets from young donor pancreases utilizing increased protease dose to collagenase for digesting peri-islet extracellular matrix.

Short term effects of fructose on blood glucose dynamics and meal initiation

Functional coupling between transient declines in blood glucose and feeding behavior: Temporal relationships

A new framework for understanding the control of feeding behavior, with special emphasis on the evolution of hunger, the initiation of feeding, and its dependence on patterns of blood glucose, is the subject of this chapter. A perspective on the current status and future directions of this search for a more complete understanding of the regulation of feeding behavior in laboratory rats and humans is presented, including theoretical and experimental components. Experimental evidence supports the hypothesis that spontaneous, self-resolving transient declines in blood glucose precede and signal meal initiation in nondeprived, free-feeding rats and time-isolated humans. This signal precedes food-seeking behavior and the initiation of a meal but does not predict the size of the meal or the timing of meal termination. The precise antecedent conditions required, in terms of the shape of the transient declines in blood glucose, for meal initiation or meal requests have been defined. This is followed by a statement and overview of a signal detection and pattern recognition theory of the control of meal initiation. The current working hypothesis that transient declines in blood glucose are endogenous metabolic patterns that are represented in the central nervous system is then presented. These patterns are detected and recognized by the central nervous system and are mapped into meal initiation in rats and are correlated with meal requests in humans. The distinguishing feature of the theory is that it is the temporal pattern, shape, or waveform of blood glucose dynamics – rather than the glucose molecule, or the absolute decrease in blood glucose, or blood glucose concentration, or glucose utilization – that is detected and contains critical information that is extracted by the central nervous system to control meal initiation. Then, the experimental studies on meal initiation and its dependence on patterns of blood glucose in humans are reviewed. An association between transient declines in blood glucose concentration and meal requests and changes in hunger ratings in human subjects isolated from food and time cues has been demonstrated. This association was observed following both spontaneous and insulin-induced transient declines in blood glucose. These results support and strengthen the conclusion that the transient decline in blood glucose represents a temporal pattern that reflects an antecedent physiological event or provides a signal related to the expression of hunger in humans. Finally, the implications for the understanding of the control of feeding behavior and the regulation of energy balance are discussed.

Because metabolic markers are not suitable for early diagnosis of islet graft dysfunction, magnetic resonance imaging (MRI) has been used to study islets that were labeled pretransplantation with superparamagnetic iron oxide nanoparticles. However, the relation between graft functionality assessed by glycemia, and MRI signal remains unclear. We transplanted hyperglycemic rats intraportally with 2500 ferucarbotran-labeled syngeneic (n=10) or allogeneic (n=12) islet equivalents or normoglycemic rats with 5000 xenogeneic human islet equivalents. Images were acquired on a clinical 3-Tesla MRI scanner. When rejection occurred on days 4 and 8 in xenogeneic and allogeneic recipients, 60% (57-68) and 55% (46-73) of the initial signal remained compared to 93% (71-104) and 82% (59-90) in syngeneic controls (P=0.006 and 0.03). With a cutoff value of 84% on day 4 for the diagnosis of allogeneic rejection, sensitivity of 91% and specificity of 70% were obtained. Based on MRI signal on day 4, treatment with antilymphocytic serum from day 4 allowed graft rescue in 75% of recipients. In this model, MRI of pretransplantation superparamagnetic iron oxide nanoparticle-labeled islet grafts allows timely diagnosis of immune rejection.

To isolate and purify human islet according to the method established by Ricordi and to evaluate the function and safety of these isolated human islets. Six pancreases were obtained from human corpses. The islets were isolated by liberase digestion and purificated by Ficoll density gradient centrifugation. The numbers, purity and vitality of the islets were analyzed. The various endocrine cell composition and distribution of the islets were checked by immunofluorescence staining. The glucose-induced insulin secretion was detected by chemiluminescence method. The isolated islets were transplanted under the left renal capsules of 10 streptozocin-induced diabetic nude mice. Twenty days later the left kidneys with transplanted islets of 2 mice with normal blood sugar were resected, and then blood sugar level was observed. An isolated human islet was suspended in RPMI-1066 culture medium for 72 h, then culture of pathogenic micro-organisms, endotoxin and procoagulant activity were detected so as to evaluate the security of the islet products. The mean number of the isolated islets was (229 000 +/- 31 000) islet equivalents (IEQs)/pancreas or (4970 +/- 1620) IEQs/g pancreatic tissue, the mean purity was (59.0 +/- 8.9)%, and the mean vitality was (89 +/- 3)% for the purified islets. Immunofluorescence staining showed that there were 4 types of endocrine cells normally distributed in the islets. The mean insulin stimulation index was 8.1 +/- 4.0 (3.8 - 10.2). The glycemia found in the diabetic nude mice decreased to normal levels from the third day after islet transplantation and maintained normal for over 30 days. The parameters of security in these islet products were under the standard scope. Human islets obtained according to Ricordi's method reach the standard for clinical islet transplantation in number, purity, vitality, function, and security.

There is a need to develop three-dimensional structures that mimic the natural islet tissue microenvironment. Endocrine micro-pancreata (EMPs) made up of acellular organ-derived micro-scaffolds seeded with human islets have been shown to express high levels of key beta-cell specific genes and secrete quantities of insulin per cell similar to freshly isolated human islets in a glucose-regulated manner for more than three months in vitro. The aim of this study was to investigate the capacity of EMPs to restore euglycemia in vivo after transplantation of mouse or human islets in chemically diabetic mice. We proposed that the organ-derived EMPs would restore the extracellular components of the islet microenvironment, generating favorable conditions for islet function and survival. EMPs seeded with 500 mouse islets were implanted intraperitoneally into streptozotocin-induced diabetic mice and reverted diabetes in 67% of mice compared to 13% of controls (p = 0.018, n = 9 per group). Histological analysis of the explanted grafts 60 days post-transplantation stained positive for insulin and exhibited increased vascular density in a collagen-rich background. EMPs were also seeded with human islets and transplanted into the peritoneal cavity of immune-deficient diabetic mice at 250 islet equivalents (IEQ), 500 IEQ and 1000 IEQ. Escalating islet dose increased rates of normoglycemia (50% of the 500 IEQ group and 75% of the 1000 IEQ group, n = 3 per group). Human c-peptide levels were detected 90 days post-transplantation in a dose-response relationship. Herein, we report reversal of diabetes in mice by intraperitoneal transplantation of human islet seeded on EMPs with a human islet dose as low as 500 IEQ.

Previous studies have shown that a brief rise in plasma insulin followed by a transient fall and rise in blood glucose precede the initiation of feeding in nondeprived rats. In this study, a cholinergic agonist, bethanechol chloride, which is known to induce a brief spike in plasma insulin, was infused intravenously in an attempt to induce transient declines in blood glucose and meal initiation in free-feeding rats. When the blood glucose response to bethanechol chloride administration met the criteria for a transient decline in blood glucose, meal initiation occurred within 20 min in nine out of ten trials. However, if the blood glucose response to bethanechol chloride administration failed to meet the criteria for a transient decline in blood glucose, meal initiation did not occur. The frequency of successful induction of feeding was higher in the late light cycle (80%) compared with the early light cycle (14%) of the photoperiod. These results suggest that cholinergic stimulation can induce feeding only after a brief fall and rise in blood glucose. The blood glucose and behavioral responses to the cholinergic stimulus appear to be strongly dependent on the metabolic state of the animal. These results further strengthen the evidence for a causal relationship between transient declines in blood glucose and meal initiation in free-feeding rats.

On-line continuous measurement of blood glucose and meal pattern in free-feeding rats: The role of glucose in meal initiation

Blood glucose prior to meal request in humans isolated from all temporal cues

The pancreatic islet damage that occurs through an inflammatory response and hypoxia after infusion is a major hurdle in islet transplantation. Because essential phospholipids (EPL) have been shown to exhibit anti-inflammatory properties in liver disease, we analysed their protective effect on islets in inflammatory or hypoxic conditions. We evaluated the viability of mouse and human islets cultured with cytokines or in hypoxic conditions for 48 h and measured cytokine expression in islets by quantitative polymerase chain reaction. We then employed an in vivo mouse assay, transplanting a marginal dose of human islets treated with or without EPL into the subcapsule of the kidney in diabetic nude mice and determining the cure rate. The viability of mouse and human islets damaged by cytokines was significantly improved by supplementation of EPL in the culture (p = 0.003 and <0.001 for mouse and human islets respectively). EPL significantly inhibited intracellular expression of IL-1β and IL-6 in cytokine-damaged human islets (p < 0.001). The viability of human islets in hypoxic conditions was significantly better when treated with EPL (p < 0.001). In the in vivo mouse assay, the EPL-treated islet group had a higher cure rate than the untreated control, with marginal statistical significance (75 and 17% respectively, p = 0.07). EPL could be a potent agent to protect islets from inflammatory and hypoxic conditions after isolation procedures. Further studies to clarify the effect of EPL in islet transplantation are warranted.

Hepatic regeneration in insulin-like growth factor binding protein-1 transgenic mice

Streptozocin-induced diabetic nude mice (blood glucose 493 +/- 14 mg/dl) received aliquots of 2000 human islet equivalents (IE) under the kidney capsule and were then followed for up to 30 days with measurement of blood glucose concentration and body weight. Characterization of islet aliquots before the implantation included the assessment of the endocrine beta cell and nonbeta cell mass, estimated by point counting morphometry of immunostained sections. Islet transplantation was followed by a rapid decrease in blood glucose levels and by a progressive increase in body weight; 15 days after transplantation mean glycemic levels were 102 +/- 11 mg/dl and further decreased to 70 +/- 3 mg/dl at 30 days. Despite the progressive improvement in the glucose levels, the beta cell mass of the islet grafts significantly decreased over time from 2.63 +/- 0.2 mg, at the time of transplantation, to 1.16 +/- 0.1 and 0.86 +/- 0.1 mg 15 and 30 days, respectively, after transplantation. In contrast, the endocrine nonbeta cell mass remained stable from before the implantation to 30 days after. Therefore, the endocrine nonbeta cell/beta cell ratio increased from 14% at the time of transplantation, to 35% and 37%, 15 and 30 days, respectively, after transplantation. The rate of replication of the transplanted beta cells was similar in the grafts harvested at 15 and 30 days, with the percentage of beta cells positive for bromo-2' deoxyuridine (BrdU) incorporation being in the range of approximately 0.1% 6 hr after the BrdU injection. These data demonstrate that an important decrease in beta cell mass takes place immediately after islet transplantation--the most dramatic decrease occurring in the first 15 days and persisting even after revascularization has occurred. However, endocrine nonbeta cell mass remained stable indicating that engrafted nonbeta cells are less likely to die than beta cells. The finding that the nonbeta/beta cell ratio of a human islet graft can increase over time, raises questions about whether such a change in islet structure could have an influence upon function.

Islet transplantation is an effective therapy in type 1 diabetes and recalcitrant hypoglycemia. However, there is an ongoing need to circumvent islet loss posttransplant. We explore herein the potential of the pan-caspase inhibitor F573 to mitigate early apoptosis-mediated islet death within portal and extrahepatic portal sites in mice. Mouse or human islets were cultured in standard media ±100 μM F573 and subsequently assessed for viability and apoptosis via terminal deoxynucleotidyl transferase dUTP nick end labeling staining and caspase-3 activation. Diabetic mice were transplanted with syngeneic islets placed under the kidney capsule (KC) or into the subcutaneous deviceless (DL) site at a marginal islet dose (150 islets), or into the portal vein (PV) at a full dose (500 islets). Human islets were transplanted under the KC of diabetic immunodeficient mice at a marginal dose (500 islet equivalents). Islets were cultured in the presence of F573, and F573 was administered subcutaneously on days 0 to 5 posttransplant. Control mice were transplanted with nontreated islets and were injected with saline. Graft function was measured by nonfasting blood glucose and glucose tolerance testing. F573 markedly reduced human and mouse islet apoptosis after in vitro culture (P < 0.05 and P < 0.05, respectively). Furthermore, F573 improved human islet function when transplanted under the KC (P < 0.05); whereas F573 did not enhance murine islet marginal KC transplants. Conversely, F573 significantly improved mouse islet engraftment in the PV and DL site (P < 0.05 and P < 0.05, respectively). The pan-caspase inhibitor F573 markedly reduces human and mouse islet apoptosis and improves engraftment most effectively in the portal and DL subcutaneous sites.

If pancreatic islet transplantation becomes clinically applicable, cryogenic storage of human islet preparations could solve many problems related to transportation and banking of islets, HLA matching, recipient pretreatment, or the possible use of multiple donors. The diabetic nude mouse could offer a simple model to test in vivo the function of cryopreserved human islet preparations before transplantation into diabetic patients.In this study, 6 nude mice made diabetic by an intravenous injection of streptozocin were transplanted with 400–600 cryopreserved human islets beneath the renal capsule. All the mice became normoglycemic within 3 weeks from transplantation. Nephrectomy of the kidneys bearing the grafts 45 days after transplantation resulted in an immediate return to the diabetic state, demonstrating that the only functional tissue was located in the excised kidneys. Histologic study of the renal subcapsular grafts demonstrated morphologic integrity of the islets with a normal degree of beta granulation.The results demonstrated that cryopreserved human islets will function in diabetic nude mice. This model to test human islet preparationsin vivomay be of assistance in the application of cryopreserved islet transplantation in diabetic patients.