Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 5 uppsatser.

The misfolding and aggregation of the beta cell hormone islet amyloid polypeptide (IAPP) into amyloid fibrils is the main pathological finding in islets of Langerhans in type 2 diabetes. Pathological assemblies of IAPP are cytotoxic and believed to contribute to the loss of insulin-producing beta cells. Changes in the microenvironment that could trigger the aggregation of IAPP are largely unknown. So is the possibility that islet amyloid can spread within or between tissues. The present thesis have explored the roles of glycosaminoglycan heparan sulfate (HS) and the novel anti-amyloid chaperone Bri2 BRICHOS domain in the assembly of IAPP amyloid and cytotoxic IAPP aggregates. Furthermore, cross-seeding as a molecular interaction between the observed connection of type 2 diabetes and Alzheimer disease has been examined. The N-terminal region of IAPP was required for binding to HS structures and induction of binding promoted amyloid formation. Interference in the HS-IAPP interaction by heparanase degradation of HS or by introducing short, soluble HS-structure fragments reduced amyloid deposition in cultured islets. Cytotoxicity induced by extracellular, aggregating IAPP was mediated via interactions with cell-surface HS. This suggests that HS plays an important role in islet amyloid deposition and associated toxicity. BRICHOS domain containing protein Bri2 was highly expressed in human beta cells and colocalized with IAPP intracellularly and in islet amyloid deposits. The BRICHOS domain effectively attenuated both IAPP amyloid formation and IAPP-induced cytotoxicity. These results propose Bri2 BRICHOS as a novel chaperone preventing IAPP aggregation in beta cells. The intravenous injection of IAPP, proIAPP or amyloid-β (Aβ) fibrils enhanced islet amyloidosis in transgenic human IAPP mice, demonstrating that both homologous- and heterologous seeding of islet amyloid can occur in vivo. IAPP colocalized with Aβ in brain amyloid from AD patients, and AD patients diagnosed with T2D displayed increased proportions of neuritic plaques, the more pathogenic plaque subtype. In conclusion, both IAPP amyloid formation and the cytotoxic effects of IAPP is dependent on interactions with HS whereas interactions with Bri2 BRICHOS is protective. Cross-seeding between Aβ and IAPP can occur in vivo and the two peptides colocalize in brain amyloid in AD patients.

Type II diabetes mellitus (T2D) and Alzheimer's disease (AD) share aetiology and have a high incidence of co-morbidity. Evidence suggests that both diseases are caused by the pathogenic aggregation of an intrinsically disordered native amyloid peptide. Furthermore, T2D and AD share risk factors such as age, obesity and vascular health. Recent studies demonstrate that amylin, an amyloidogenic pancreatic hormone deposited in the pancreas in T2D, is also deposited in the brain in AD. We hypothesised that amylin directly contributes to AD through deposition in the brain and activation of pathogenic signalling cascades. We provide evidence to validate that amylin is deposited in the brain parenchyma and vasculature. Furthermore, we present data demonstrating amylin (IAPP) expression in the brain is significantly elevated in AD; and that amylin treatment increases amyloid-beta (AB) secretion in neuronal culture. Soluble oligomeric species of AB cause AD by initiation of downstream signalling cascades that dysregulate kinase activity, promote tau phosphorylation and result in neuronal death. One such pathway involves AB oligomer activation of the Src-family kinase Fyn, through binding to the cellular prion protein (PrPC) receptor complex. We provide evidence that amylin activates Fyn in neuroblastoma and stem cell derived neurons, this activation is possibly mediated through PrPC. Together the data presented in this thesis demonstrate multiple modes of action whereby amylin may directly propagate or indirectly exacerbate AD-associated processes. Amylin aggregation, deposition, up-regulation and signalling should be considered one of several links between T2D and AD. The pathogenic actions of AB and amylin are mediated by oligomer species. Therefore therapeutics which prevent oligomerisation or oligomer action may be valuable in AD and T2D. One such class of therapeutic are flavonoids. Our collaborators have recently demonstrated the flavonoids rutin and quercetin reduce amylin aggregation and extend lifespan in diabetic animal models. As a result of this we investigated the anti-amyloidogenic and anti-oligomeric properties of the flavonoid quercetin against AB. Quercetin treatment prevented AB oligomerisation, cell binding of pre-formed AB oligomers and also reduced APP processing in cell models. These data suggest quercetin is a multimodal therapeutic with potential utility in AD and T2D and should be explored for further drug development.

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.

The expanding field of tissue engineering provides a new approach to regenerative medicine for common ailments such as cardiovascular disease and type-I diabetes. Biomaterials can be administered as a delivery vehicle to introduce therapeutic cells to sites of damaged or diseased tissue. A specific class of biomaterials, termed hydrogels, is suitable for this application as they can provide a biocompatible, biodegradable scaffold that mimics the physical properties of the native soft tissue. Injectable hydrogels are increasingly being developed for biomedical applications due to their ability to be delivered in a minimally invasive manner. One potential use for such materials is in the delivery of therapeutics such as cells or growth factor-releasing particles. In this study, the first aim was to determine the interactive effects between collagen-based hydrogels and additives (cells and microspheres) for cardiac regeneration. The results demonstrated that the addition of either cells or microspheres to a collagen-based hydrogel decreased its gelation time and increased its viscosity. Increased cross-linker concentrations resulted in lower cell viability. However, this cell loss could be minimized by delivering cells with the cross-linker neutralizing agent, glycine. As a potential application of these materials, the second aim of this study was to develop a hydrogel for use as an ectopic islet transplant site. Specifically, collagen-chitosan hydrogels were synthesized and characterized, with and without laminin, and tested for their ability to support angiogenic and islet cell survival and function. Matrices synthesized with lower chitosan content (20:1 collagen:chitosan) displayed greater cell compatibility for both angiogenic cells and for islets and weaker mechanical properties, while matrices with higher chitosan content (10:1 collagen:chitosan) had the opposite effect. Laminin did not affect the physical properties of the matrices, but did improve angiogenic cell and islet survival and function. Overall the proposed collagen-based hydrogels can be tailored to meet the physical property requirements for cardiac and islet tissue engineering applications and demonstrated promising cell support capabilities.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23368号 / 医博第4737号 / 新制||医||1051(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 川口 義弥, 教授 妹尾 浩, 教授 稲垣 暢也 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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