Successful survival of large volume engineered tissues depends on the development of a vasculature to support the metabolic demands of donor tissue in vivo. Pancreatic islet transplantation is a cell therapy procedure to treat Type 1 diabetes that can potentially benefit from such a vascularization strategy. The treatment is limited as the majority of transplanted islets (60%) fail to engraft due to insufficient revascularization in the host(1, 2). Modular tissue engineering is a means of designing large volume functional tissues using micron sized tissues with an intrinsic vascularization. In this thesis, we explored the potential of endothelialized modules to drive vascularization in vivo and promote islet engraftment. Human endothelial cells (EC) covered modules were transplanted in the omental pouch of athymic rats and human EC formed vessels near implanted modules until 7 days when host macrophages were depleted. Rat endothelial cells covered modules were similarly transplanted in the omental pouch of allogeneic rats with and without immunosuppressants. When the drugs were administered, endothelialized modules significantly increased the vessel density. Moreover, donor GFP labelled EC formed vessels that integrated with the host vasculature and were perfusable until 60 days; this key result demonstrate for the first time that unmodified primary endothelial cells form stable vessels in an allograft model. Transplantation of islets in such endothelialized modules significantly improved the vessel density around transplanted islets. Donor endothelial cells formed vessels near transplanted islets in allogeneic immunesuppressed recipients. Meanwhile, there was an increase in islet viability with transplantation of endothelialized modules in syngeneic recipients but this difference was not significant. In summary, endothelialized modules were effective in promoting stable vascularization and improving transplanted islet vascularisation. Future work should promote faster maturity of donor vessels and modulate the host immune and inflammatory responses to significantly improve transplanted islet engraftment.

No description available.

Islet transplantation is a more physiological way to treat type 1 diabetes. However, shortage of donor tissue and chronic administration of immune suppressive drugs has limited the widespread application of this therapy for all patients with type 1 diabetes, particularly children suffering from this disease. Xenogeneic islet transplantation particularly neonatal porcine islets (NPI) holds promise for clinical transplantation because of the potentially unlimited supply of islets. New evidence suggests that monoclonal antibodies (mAbs) specific for immune cell surface molecules could be employed in the prevention of islet graft rejection as well as induction of immunological tolerance to the transplanted grafts without the need for continuous administration of harmful immune suppressive drugs. It was shown by our group that short-term administrations of a combination of anti-LFA-1 and anti-CD154 mAbs which targets both adhesion and costimulatory pathways of T cell activation, is highly effective in preventing NPI xenograft rejection. In this thesis, we determined whether short-term administration of a combination of anti-LFA-1 and anti-CD154 mAbs could induce tolerance to NPI xenografts. Our data show that this combination of mAbs can induce dominant, species and tissue specific tolerance to NPI xenografts which is mediated by regulatory T cells in non-autoimmune prone B6 mice. We also found that T cell subsets such as CD4+ and CD8+ T cells as well as antigen presenting cells (APC) play an important role in the induction and maintenance of tolerance to NPI xenografts. In addition we found that PD-1/PDL interaction is important for induction and maintenance of tolerance to NPI xenografts. Finally, we found that this combined mAb therapy was effective in preventing NPI xenografts rejection in autoimmune prone NOD mice when it was combined with anti-CD4 mAb. It is may hope that the research presented in this thesis will provide insight into the nature of the immune responses to xenogeneic islet transplantation in humans and aid in the development of effective, tolerance inducing therapies, so that patients with T1DM will once again know a life free from their disease. / Experimental Surgery

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23079号 / 医博第4706号 / 新制||医||1049(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 松田 道行, 教授 稲垣 暢也, 教授 妹尾 浩 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

As complicações relacionadas ao diabetes mellitus estão intimamente ligadas à hiperglicemia. Os pacientes que evoluem com grande instabilidade metabólica e progressão das complicações microvasculares apesar do tratamento intensivo com insulina são candidatos ao transplante de pâncreas. Neste contexto, o transplante de ilhotas pancreáticas surge como alternativa por ser menos invasivo e menos imunogênico. No entanto, o processo de digestão do pâncreas e isolamento das ilhotas pancreáticas expõe as células endócrinas a diversos estímulos nocivos, que resultam em diminuição da viabilidade das células isoladas e menor chance de sucesso após o transplante. A geração de espécies reativas de oxigênio (ERO) e o consumo das defesas anti-oxidantes durante o processo de digestão do pâncreas pode contribuir para a perda da viabilidade das ilhotas isoladas. O objetivo deste estudo foi avaliar o impacto da suplementação com glutationa etil mono-éster (GEE), um éster de melhor biodisponibilidade da glutationa (um importante anti-oxidante endógeno) nos resultados do isolamento e do transplante de ilhotas pancreáticas em um modelo animal. GEE foi adicionada na concentração de 10 mM na solução de colagenase durante o isolamento das ilhotas de rato. Após o isolamento, foram realizados estudos in vitro para avaliar a presença de ERO com o ensaio carboxi-H2DCFDA e a viabilidade das ilhotas isoladas com os ensaios JC-1 (integridade mitocondrial) e Sytogreen/brometo de etídio (integridade da membrana celular); viabilidade das células beta-pancreáticas por citometria de fluxo para avaliação de necrose e apoptose, TUNEL para a avaliação do índice de apoptose e secreção de insulina estimulada por glicose. Realizamos também estudos in vivo, com o transplante das ilhotas na cápsula renal de camundongos diabéticos, seguimento dos animais por 30 dias após o transplante e recuperação do enxerto para análise histológica. Quatro grupos de animais foram avaliados: 1) Animais transplantados com número suficiente de ilhotas para reverter o diabetes (500) não isoladas com GEE; 2) Animais transplantados com número suficiente de ilhotas (500) isoladas em presença de GEE; 3) Animais transplantados com número insuficiente de ilhotas (150) não isoladas com GEE e 4) Animais transplantados com número insuficiente de ilhotas (150) isoladas em presença de GEE. A suplementação com GEE na concentração de 10 mM durante o isolamento das ilhotas diminuiu a formação de ERO (Controle 57,0 ± 4,3% versus GEE 47,0 ± 3,9%, p = 0,0034) e aumentou a viabilidade das ilhotas, conforme demonstrado pelo ensaio Sytogreen/brometo de etídio (Controle 70,6 ± 3,4% versus GEE 83,6 ± 4,8%, p= 0,0010) e pela diminuição na porcentagem de células TUNEL-positivas (Controle de 39,2 ± 5,0% versus GEE 29,1 ± 1,9%, p= 0,042) no grupo tratado. O estudo de viabilidade por citometria de fluxo também mostrou um número maior de células beta pancreáticas viáveis no grupo tratado (Controle 21,4 ± 3,4% versus GEE 33,7 ± 3,9%, p= 0,0156). A manutenção da integridade funcional das ilhotas teve impacto nos resultados dos transplantes, com menor índice de célula TUNEL-positivas (Controle 23,3 ± 2,6% versus GEE 8,3 ± 0,8%, p < 0,0001) nos enxertos recuperados após as primeiras 24 horas do transplante e maior porcentagem de animais normoglicêmicos (Controle 30% versus GEE 65,2%, p = 0,004) após transplante de um número marginal de 150 ilhotas na cápsula renal após seguimento de 30 dias. Em conclusão, estes dados corroboram que a formação de ERO é uma causa relevante de dano celular durante o isolamento de ilhotas pancreáticas e sugerem que o uso do compostos anti-oxidante GEE pode ser uma estratégia para melhorar os resultados dos transplantes de ilhotas / The vascular complications related to Diabetes Mellitus are closely linked to hyperglycemia. Patients who develop metabolic instability and progression of microvascular complications despite intensive insulin therapy are candidates to pancreas transplantation. Pancreatic islet transplant is an alternative approach since it is less immunogenic and minimally invasive. However, the success of pancreatic islet transplantation still faces many challenges, mainly related to cell damage during the islet isolation process and early post-transplant period. The increase in reactive oxygen species (ROS) generation and the consumption of antioxidant defenses might be factors related to these injuries. The aim of the present study was to evaluate whether supplementation with glutathione-ethyl-ester (GEE), a compound with higher bioavailability than glutathione (an important endogenous antioxidant), could improve islet viability and efficacy in a marginal islet transplantation model in rodents. GEE was added to a final concentration of 10 mM in collagenase solution during islet isolation. After isolation, in vitro studies were conducted to evaluate the presence of ROS using carboxy-H2DCFDA assay and the viability of isolated islets with JC-1 assay (mitochondrial integrity), Sytogreen/ethidium bromide assay (cellular membrane integrity), fractional beta cell viability assay by flow cytometry, TUNEL assay for apoptosis evaluation and glucose-stimulated insulin secretion. We also performed in vivo studies with islet transplantation under the kidney capsule of diabetic mice, 30 days follow-up after transplantation and recovery of the graft for histological analysis. Four experimental groups were evaluated: 1) animals transplanted with 500 islets, a number considered sufficient to promote diabetes reversion, not isolated in presence of GEE; 2) animals transplanted with 500 islets isolated in presence of GEE; 3) animals transplanted with 150 islets, a number considered insufficient to promote diabetes reversion, not isolated in presence of GEE and 4) animals transplanted with 150 islets isolated in presence of GEE. The addition of GEE at 10 mM concentration during islet isolation was able to decrease ROS content in isolated islets (Control 57.0 ± 4.3% versus GEE 47.0 ± 3.9%, p = 0.0034) and increase islet viability, as demonstrated by the Sytogreen/ethidium bromide assay (Control 70.6 ± 3.4% versus GEE 83.6 ± 4.8%, p = 0.0010) as well as by the reduction in TUNEL-positive cells (Control 39.2 ± 5.0% versus GEE 29.1 ± 1.9%, p = 0.042) in the treated group. The fractional beta-cell viability also showed an improvement in the treated group (Control 21.4 ± 3.4% versus GEE 33.7 ± 3.9%, p = 0.0156). The improved cell viability observed in vitro was translated into better outcomes in vivo, since supplementation of GEE during the isolation process resulted in a significantly lower rate of TUNEL-positive cells (Control 23,3 ± 2,6% versus GEE 8,3 ± 0,8%, p < 0,0001) in the islet grafts recovered after 24h of transplantation and in a higher percentage of normoglycemia (Control 30% versus GEE 65,2%, p = 0,004) after 30 days of follow-up in animals transplanted with the marginal islet mass (150 islets). In conclusion, the current data corroborate that ROS production is a relevant cause of cellular damage during islet isolation and suggest that the use of GEE might be a strategy to improve islet transplantation outcomes

Estima-se que, em 2013, cerca de 382 milhões de pessoas eram portadoras de diabetes mundialmente. Já o diabetes mellitus do tipo 1 (DMT1) representa de 5-10% desse total de casos, cujo tratamento atual se pauta na administração de insulina exógena. Contudo, desde a publicação do protocolo de Edmonton, o transplante de ilhotas pancreáticas se apresenta como nova técnica no tratamento para o DMT1, inclusive obtendo a independência de insulina em alguns casos. Apesar disso, a escolha do sítio receptor ainda é essencial para diminuir efeitos adversos e permitir o acompanhamento do enxerto. Nesse sentido, destaca-se o transplante de ilhotas para a câmara anterior do olho, pois permite, além do restabelecimento do controle glicêmico, o estudo da fisiologia dos enxertos in vivo. Dessa forma, o objetivo foi estabelecer metodologia de isolamento e transplante de ilhotas de alta reprodutibilidade e baixo custo, utilizando a câmara anterior do olho como sítio receptor. O isolamento foi realizado via injeção de solução de colagenase (1 mg/mL via ducto colédoco) em camundongos machos C57BL/6 hígidos de 8 semanas de idade e posterior transplante dessas ilhotas para camundongos machos da mesma espécie com diabetes induzido por injeção de aloxana (60 mg/kg, i.v.). Esses camundongos foram submetidos a infusão de aproximadamente 250 equivalentes de ilhotas (IEQs) para a câmara anterior do olho e tiveram sua glicemia e alteração de massa corpórea acompanhadas por 14 dias após o transplante. Também foi realizado teste de tolerância a glicose via injeção de solução de glicose (2g/kg i.p.) e realização da curva glicêmica. Obteve-se, na etapa de padronização, que a adição de 0,5% (%p/v) de albumina de soro bovino à solução de colagenase foi capaz de aumentar o número de IEQs isolados por animal. Quanto ao transplante, obteve-se que 50% dos animais submetidos à técnica tiveram diminuição significativa na sua glicemia (172,5 ± 6,4 mg/dL), quando comparados com o grupo controle diabético (582,8 ± 27,5 mg/dL) (p < 0,05). Entretanto, todos os animais tiveram aumento significativo da massa corpórea no período de acompanhamento e glicemia de jejum significativamente menor que os animais diabéticos (p < 0,05). Ademais, a curva glicêmica dos animais que tiveram transplante considerado bem sucedido, no teste de tolerância a glicose, se aproxima da curva do grupo controle sadio. Conclui-se que o modelo de transplante de ilhotas pancreáticas para a câmara anterior do olho foi bem estabelecido neste projeto, confirmado pelos resultados que evidenciam o transplante de ilhotas funcionais capazes de reduzir sensivelmente a glicemia e promover o ganho de peso em camundongos diabéticos. / It is estimated that, in 2013, around 382 million people had diabetes worldwide. Of that number, 5-10% represented cases of T1DM, which treatment is based in the administration of exogenous insulin. However, since the Edmonton protocol was published, islet transplantation presented itself as novel technique for T1DM treatment, achieving insulin independence in some cases. Although, recipient site choice is still essential to diminish side effects and enable graft follow up. In that sense, transplantation to the anterior chamber of the eye stands out, since it allows, beyond the reestablishment of glycemic control, study of islet physiology in vivo. That way, the objective was to establish a low cost and high reproducible model of islet isolation and transplantation, using the anterior chamber of the eye as receptor site. Islet isolation was made by injection of collagenase solution (1 mg/mL via common bile duct) in 8 week old healthy male C57BL/6 mice and followed by transplantation of these islets to male mice of the same age and species with diabetes induced by alloxan injection (60 mg/kg i.v.). These mice were subject of 250 islet equivalents (IEQs) infusion to the anterior chamber of the eye and had their blood glucose and change in body mass monitored for 14 days after transplantation. A glucose tolerance test (GTT) was also made, by injection of glucose solution (2g/kg i.p.) and a glycemic curve was plotted. In the standardization period, was observed that the addition of 0,5% (%w/v) bovine serum albumin is capable of increasing the number of IEQs isolated from each animal. About the transplants, was obtained that 50% of animals subject to transplantation had their blood glucose decreased significantly (172,5 ± 6,4 mg/dL), when compared to the diabetic control group (582,8 ± 27,5 mg/dL) (p < 0,05). However, all animals subject to the procedure had significant body mass increase, when compared to the same control group and fasting blood glucose significantly lower than diabetic animals (p < 0,05). Moreover, the glycemic curve of animals, who had their transplantation considered successful, was similar to that found in healthy control animals, in the GTT. We conclude that the model of transplant to the anterior chamber of the eye is well established in this project, which is confirmed by results that shows transplantation of functional islets, capable of promoting a significant decrease in blood glucose and an increase in total body mass in diabetic animals.

La transplantation d’îlots pancréatiques est une des thérapies proposées aux diabétiques de type 1. Cependant, la perte d’un nombre considérable d’îlots durant le processus est un frein à l’expansion de la thérapie (en culture : anoïkis et hypoxie ; lors de la greffe : réactions inflammatoires intenses déclenchées lors de l’infusion intra-portale). L’objectif de ce travail était de valider un biomatériau permettant d’optimiser la transplantation d’îlots. Nous avons pu démontrer l’efficacité du plasma réticulé sur la survie des îlots en culture via une diminution drastique de l’anoïkis. Nous avons également mis au point une technique de greffe intra-tissulaire à l’aide d’HPMC combinée à du plasma, permettant de reverser le diabète de manière semblable à la greffe hépatique. Ces travaux ont donc permis de valider l’importance d’un support de culture adapté, mais aussi du site receveur de la greffe et placé l’omentum comme site de choix pour ce type de greffe. / Pancreatic islet transplantation is one of the therapies proposed to type 1 diabetic patients. However, the considerable loss of islets during the process is an obstacle to the expansion of this therapy (culture: anoïkis and hypoxia; at graft time: intense inflammatory reactions triggered by intra-portal islet infusion). The objective of this work was to validate a biomaterial that can optimize islet transplantation. We were able to demonstrate the effectiveness of cross-linked plasma on the islet survival in culture through a drastic reduction of anoikis. We also design a new intra-tissular grafting technique using HPMC combined with plasma, which reversed diabetes in a manner similar to the liver. This work allowed validating the importance of an adapted culture support, but also the one of the recipient site. Also, this work placed the omentum as an excellent recipient site for this kind of transplant.

<p>Transplantation of islets of Langerhans is a potential treatment of type 1 diabetes that aims to restore normal glucose homeostasis. Microencapsulation of islets could enable transplantation in the absence of immunosuppression, which would be beneficial as the side effects associated with immunosuppression outweigh the potential benefits of islet transplantation. Alginate is a polysaccharide that can be harvested from brown algae and is often used for microencapsulation of cells.</p><p>The aim of this study was to evaluate alginate/poly-L-lysine/alginate capsules with regard to their biocompatibility and permeability to cytokines. Moreover, the function of microencapsulated islets was studied <i>in vitro</i> as well as their ability to reverse hyperglycaemia in diabetic mice.</p><p>Microencapsulated rodent islets functioned well <i>in vitro</i>, with similar insulin release rates and glucose oxidation rates as naked islets. However, when cultured with interleukin-1β and tumour necrosis factor-α, microencapsulated islets were functionally suppressed, showing that the capsules are permeable to these cytokines. The biocompatibility of capsules varied depending on their composition. The presence of poly-L-lysine in the capsule decreased the biocompatibility. However, the biocompatibility of the capsules was improved when the coating alginate had been epimerised, i.e. enyzmatically tailored. Transplantation of microencapsulated allogeneic islets to immune competent mice lowered blood glucose concentrations up to 1 month after implantation. The success of the microencapsulated islet graft depended on the composition of the alginate/poly-L-lysine/alginate capsule used, as capsules that had poor biocompatibility failed to reverse hyperglycaemia more than transiently in athymic nude mice.</p><p>In conclusion, alginate/poly-L-lysine/alginate capsules can protect islets of Langerhans from allogeneic rejection in mice. However, the composition of the capsule is of critical importance in the success of transplantation. Epimerised alginates may provide a novel capsule with ideal properties for microencapsulation of islets of Langerhans.</p>

<p>During the past decade clinical islet transplantation has become a viable strategy for curing type 1 diabetes. The limited supply of organs, together with the requirement for islets from multiple donors to achieve insulin independence, has greatly limited the application of this approach. </p><p>The islets are infused into the liver via the portal vein, and once exposed to the blood, the grafted tissue has been shown to be damaged by the instant blood-mediated inflammatory reaction (IBMIR), which is characterized by coagulation and complement activation as well as leukocyte infiltration into the islets. Islet revascularization is a subsequent critical step for the long-term function of the transplanted graft, which may partially be impeded by the IBMIR. </p><p>In this thesis, we have explored novel strategies for circumventing the effects of the IBMIR and facilitating islet revascularization.</p><p>Systemic inhibitors of the IBMIR are typically associated with an increased risk of bleeding. We therefore evaluated alternative strategies for modulating the islets prior to transplantation. We demonstrated, using an adenoviral vector, that a high level of expression and secretion of the anticoagulant hirudin could be induced in human islets. An alternative approach to limiting the IBMIR was developed in which anticoagulant macromolecular heparin complexes were conjugated to the islet surface. This technique proved effective in limiting the IBMIR in both an in vitro blood loop model and an allogeneic porcine model of islet transplantation. An increased adhesion of endothelial cells to the heparin-coated islet surface was demonstrated, as was the capacity of the heparin conjugate to bind the angiogenic factors VEGF and FGF; these results have important implications for the revascularization process.</p><p>The outcome of the work in this thesis suggests that modulation of the islet surface is an attractive alternative to systemic therapy as a strategy for preventing the IBMIR. Moreover, the same techniques can be employed to induce revascularization and improve the engraftment of the transplanted islets. Ultimately, improved islet viability and engraftment will make islet transplantation a more effective procedure and increase the number of patients whose diabetes can be cured.</p>

Transplantation of islets of Langerhans is a potential treatment of type 1 diabetes that aims to restore normal glucose homeostasis. Microencapsulation of islets could enable transplantation in the absence of immunosuppression, which would be beneficial as the side effects associated with immunosuppression outweigh the potential benefits of islet transplantation. Alginate is a polysaccharide that can be harvested from brown algae and is often used for microencapsulation of cells. The aim of this study was to evaluate alginate/poly-L-lysine/alginate capsules with regard to their biocompatibility and permeability to cytokines. Moreover, the function of microencapsulated islets was studied in vitro as well as their ability to reverse hyperglycaemia in diabetic mice. Microencapsulated rodent islets functioned well in vitro, with similar insulin release rates and glucose oxidation rates as naked islets. However, when cultured with interleukin-1β and tumour necrosis factor-α, microencapsulated islets were functionally suppressed, showing that the capsules are permeable to these cytokines. The biocompatibility of capsules varied depending on their composition. The presence of poly-L-lysine in the capsule decreased the biocompatibility. However, the biocompatibility of the capsules was improved when the coating alginate had been epimerised, i.e. enyzmatically tailored. Transplantation of microencapsulated allogeneic islets to immune competent mice lowered blood glucose concentrations up to 1 month after implantation. The success of the microencapsulated islet graft depended on the composition of the alginate/poly-L-lysine/alginate capsule used, as capsules that had poor biocompatibility failed to reverse hyperglycaemia more than transiently in athymic nude mice. In conclusion, alginate/poly-L-lysine/alginate capsules can protect islets of Langerhans from allogeneic rejection in mice. However, the composition of the capsule is of critical importance in the success of transplantation. Epimerised alginates may provide a novel capsule with ideal properties for microencapsulation of islets of Langerhans.