<p>Transplanting pancreatic islets into the liver through the portal vein is currently the most common procedure in clinical islet transplantations for treating patients with brittle type 1 diabetes. However, most islet grafts fail within a 5-year period necessitating retransplantation. The vascular connections are disrupted at islet isolation and implanted islets depend on diffusion of oxygen and nutrients in the immediate posttransplantation period. Rapid and efficient revascularization is of utmost importance for the survival and long-term function of transplanted islets. </p><p>In this thesis, the influence of the implantation microenvironment for islet engraftment and function was studied. Islets were transplanted into the liver, the renal subcapsular site or the pancreas. Islets implanted into the liver contained fewer glucagon-positive cells than islets implanted to the kidney and endogenous islets. Intraportally transplanted islets responded with insulin and glucagon release to secretagogues, but only when stimulated through the hepatic artery. Thus, the intrahepatic grafts were selectively revascularized from the hepatic artery. The vascular density in human islets transplanted into the liver of athymic mice was markedly lower when compared to human islets grafted to the kidney. Islets implanted into their physiological environment, the pancreas, were markedly better revascularized. Insulin content, glucose-stimulated insulin release, (pro)insulin biosynthesis and glucose oxidation rate were markedly decreased in transplanted islets retrieved from the liver, both when compared to endogenous and transplanted islets retrieved from the pancreas. Only minor changes in metabolic functions were observed in islets implanted into the pancreas when compared to endogenous islets. </p><p>The present findings demonstrate that the microenvironment has a major impact on the engraftment of transplanted islets. Elucidating the beneficial factors that promote engraftment would improve the survival and long-term function of transplanted islets. Ultimately, islet transplantation may be provided to an increased number of patients with type 1 diabetes.</p>

The mechanisms of β-cell destruction leading to type 1 diabetes are complex and not yet fully understood, but infiltration of the islets of Langerhans by autoreactive immune cells is believed to be important. Activated macrophages and T-cells may then secrete cytokines and free radicals, which could selectively damage the β-cells. Among the cytokines, IL-1β, IFN-γ and TNF-α can induce expression of inducible nitric synthase (iNOS) and cyclooxygenase-2. Subsequent nitric oxide (NO) and prostaglandin E2 (PGE2) formation may impair islet function. In the present study, the ability of melatonin (an antioxidative and immunoregulatory hormone) to protect against β-cell damage induced by streptozotocin (STZ; a diabetogenic and free radical generating substance) or IL-1β exposure was examined. In vitro, melatonin counteracted STZ- but not IL-1β-induced islet suppression, indicating that the protective effect of melatonin is related to interference with free radical generation and DNA damage, rather than NO synthesis. In vivo, non-immune mediated diabetes induced by a single dose of STZ was prevented by melatonin. Furthermore, the effects of proinflammatory cytokines were examined in islets obtained from mice with a targeted deletion of the iNOS gene (iNOS -/- mice) and wild-type controls. The in vitro data obtained show that exposure to IL-1β or (IL-1β + IFN-γ) induce disturbances in the insulin secretory pathway, which were independent of NO or PGE2 production and cell death. Initially after addition, in particular IL-1β seems to be stimulatory for the insulin secretory machinery of iNOS –/- islets, whereas IL-1β acts inhibitory after a prolonged period. Separate experiments suggest that the stimulatory effect of IL-1β involves an increased gene expression of phospholipase D1a/b. In addition, the formation of new insulin molecules appears to be affected, since IL-1β and (IL-1β + IFN-γ) suppressed mRNA expression of both insulin convertase enzymes and insulin itself.

Type 1 diabetes is resulting from the selective destruction of insulin-producing beta-cells within the pancreatic islets. Somatostatin acts as an inhibitor of hormone secretion through specific receptors (sst1-5). All ssts were expressed in normal rat and mouse pancreatic islets, although the expression intensity and the co-expression pattern varied between ssts as well as between species. This may reflect a difference in response to somatostatin in islet cells of the two species. The Non-Obese Diabetic (NOD) mouse model is an experimental model of type 1 diabetes, with insulitis accompanied by spontaneous hyperglycaemia. Pancreatic specimens from NOD mice at different age and stage of disease were stained for ssts. The islet cells of diabetic NOD mice showed increased islet expression of sst2-5 compared to normoglycemic NOD mice. The increase in sst2-5 expression in the islets cells may suggest either a contributing factor in the process leading to diabetes, or a defense response against ongoing beta-cell destruction. Somatostatin analogues were tested on a human endocrine pancreatic tumour cell line and cultured pancreatic islets. Somatostatin analogues had an effect on cAMP accumulation, chromogranin A secretion and MAP kinase activity in the cell line. Treatment of rat pancreatic islets with somatostatin analogues with selective receptor affinity was not sufficient to induce an inhibition of insulin and glucagon secretion. However, a combination of selective analogues or non-selective analogues via co-stimulation of receptors can cause inhibition of hormone production. For insulin and glucagon, combinations of sst2 + sst5 and sst1 + sst2, respectively, showed a biological effect. In summary, knowledge of islet cell ssts expression and the effect of somatostatin analogues with high affinity to ssts may be valuable in the future attempts to influence beta-cell function in type 1 diabetes mellitus, since down-regulation of beta-cell function may promote survival of these cells during the autoimmune attack.

Transplanting pancreatic islets into the liver through the portal vein is currently the most common procedure in clinical islet transplantations for treating patients with brittle type 1 diabetes. However, most islet grafts fail within a 5-year period necessitating retransplantation. The vascular connections are disrupted at islet isolation and implanted islets depend on diffusion of oxygen and nutrients in the immediate posttransplantation period. Rapid and efficient revascularization is of utmost importance for the survival and long-term function of transplanted islets. In this thesis, the influence of the implantation microenvironment for islet engraftment and function was studied. Islets were transplanted into the liver, the renal subcapsular site or the pancreas. Islets implanted into the liver contained fewer glucagon-positive cells than islets implanted to the kidney and endogenous islets. Intraportally transplanted islets responded with insulin and glucagon release to secretagogues, but only when stimulated through the hepatic artery. Thus, the intrahepatic grafts were selectively revascularized from the hepatic artery. The vascular density in human islets transplanted into the liver of athymic mice was markedly lower when compared to human islets grafted to the kidney. Islets implanted into their physiological environment, the pancreas, were markedly better revascularized. Insulin content, glucose-stimulated insulin release, (pro)insulin biosynthesis and glucose oxidation rate were markedly decreased in transplanted islets retrieved from the liver, both when compared to endogenous and transplanted islets retrieved from the pancreas. Only minor changes in metabolic functions were observed in islets implanted into the pancreas when compared to endogenous islets. The present findings demonstrate that the microenvironment has a major impact on the engraftment of transplanted islets. Elucidating the beneficial factors that promote engraftment would improve the survival and long-term function of transplanted islets. Ultimately, islet transplantation may be provided to an increased number of patients with type 1 diabetes.

Type 1 diabetes (T1D) is a chronic autoimmune disease targeted against the pancreatic β-cells. Proinflammatory cytokines are considered to play a major role in the destruction of the insulin-producing β-cells. This thesis studied strategies to counteract proinflammatory cytokines in experimental T1D. Both animal models for T1D as well as β-cell preparations exposed in vitro to putative noxious conditions were examined. In the first study we observed that cytokine treatment of mouse pancreatic islets lacking inducible nitric oxide synthase (iNOS) induced a prolongation of the early stimulatory phase of glucose stimulated insulin secretion. Various experiments led to the conclusion that this prolonged stimulatory effect may involve the DAG/PLD/PKC pathway. Next, we transplanted mouse islets deficient in iNOS to spontaneously diabetic NOD mice. We observed a normalization of hyperglycemia but not a delayed allograft rejection compared to transplanted wild type islets. Thus, absence of iNOS in the graft was not sufficient to prolong allograft survival. In paper III we found that sustained glucose stimulation of rat pancreatic islets was coupled to a decreased conversion of proinsulin to insulin. Islet treatment with IL-1β was also coupled to a decreased proinsulin conversion. Islet proconvertase activity may be a target in islet damage. In paper IV prolactin (PRL) was administered to mice in the multiple low dose streptozotocin model and we observed that PRL enhanced a Th2 response. This may contribute to the protective action by PRL in this model of autoimmune T1D. Finally, by examining β-cells overexpressing Suppressor of cytokine signalling 3 (SOCS-3) it was found that this could inhibit IL-1β induced signalling through the NF-κB and MAPK pathways. SOCS-3 overexpression also inhibited apoptosis induced by cytokines in primary β-cells. Lastly, we demonstrated that SOCS-3 transgenic islets were protected in an allogeneic transplantation model.

A suplementação dietética com AGCM induz resistência à insulina, redução de peso ponderal e aumento da adiposidade em ratos Wistar. Adipócitos isolados apresentam reduzidas captação de glicose estimulada por insulina e atividade/fosforilação da proteína AMPK. A expressão protéica do IR no tecido hepático está aumentada em animais tratados com AGCM com redução do grau de fosforilação, enquanto que o grau de fosforilação da proteína AKT permaneceu semelhante entre os grupos. Ilhotas pancreáticas isoladas apresentam redução na secreção de insulina quando incubadas com altas concentrações de glicose, diminuição do conteúdo total de insulina, hipersensibilidade a leucina e/ou arginina e aumento do percentual de morte celular com diminuída expressão da proteína AKT_1 . Desta forma, utilização em longo prazo dessa estratégia nutricional pode interferir no crescimento normal do indivíduo, na sensibilidade à insulina e possívelmente, desenvolvimento e instalação do diabetes. / The introduction of MCFA into diet induces insulin resistance, reduced body weight gain, and increased adiposity in Wistar rats. Isolated adipocytes have reduced insulin induced glucose uptake and phosphorylation/activation of AMPK protein. The insulin receptor protein expression is increased in liver of MCFA fed rats accompanied by reduced tyrosine phosphorylation, with similar AKT serine phosphorylation. Isolated pancreatic islets had reduced glucose stimulated insulin secretion due to high glucose exposure and reduced insulin content; higher insulin secretion induced by leucine and arginine, and increased apoptosis with reduced AKT protein level. In these regard, the chronic ingestion of MCFA may interfere with normal body growth, with the insulin sensitivity and may participate with the development of diabetes.

Neste projeto, demonstramos a modulação da enzima NAD(P)H oxidase pela glicose, palmitato e interleucina - 1? através da análise da expressão protéica do componente p47PHOX e pela atividade dessa enzima via produção de superóxido e peróxido de hidrogênio. Demonstramos também a participação da enzima NAD(P)H oxidase no processo de secreção de insulina induzido pela glicose pois a inibição da enzima pelo DPI e oligonucleotídeo anti p47PHOX promoveu uma diminuição da secreção do hormônio. A partir desse dado passamos a avaliar o mecanismo de ação da enzima no processo secretório e demonstramos que a inibição dessa enzima promove uma inibição de genes essenciais no processo de secreção de insulina como GLUT-2 e glicocinase.Assim podemos concluir que a enzima NAD(P)H oxidase é modulada pela glicose, palmitato e interleucina 1? e que essa enzima participa do processo de secreção insulina modulando genes essenciais para o processo secretório como GLUT-2 e glicocinase. / The expression and activity of the componenents of NAD(P)H oxidase in pancreatic islets were described for the first time in our laboratory (OLIVEIRA, HR et ai, 2003). It was shown the gene and protein expression of the components of this enzyme in Seta cells and that enzyme activation is mediated by glucose. Glucose induced insulin secretion was followed by increase in EROS generation and this increase was in part mediated by NAD(P)H oxidase activation (the same mechanism observed in phagocytes). In this study, the modulation of NAD(P)H oxidase activity by glucose, palmitate and interleukin 1ß as investigated through protein expression of p47phox vity of this enzyme through superoxide and hydrogen peroxide production. To determinate the role of NAD(P)H oxidase in the process of glucoseinduced insulin secretion the enzyme was inhibited by DPI and oligonucleotide anti p47phox, in the both cases the enzyme inhibition produced a decrease on insulin secretion. In order to investigated NAD(P)H oxidase mechanism of action in insulin secretion, we shown that the inhibition enzyme by DPI reduced the GLUT-2 and glucokinase gene expression. We can concluded hat NAD(P)H oxidase was modulated by glucose, palmitate and interleukin 1ß and that enzyme participed in process of glucoseinduced insulin secretion through modulation of GLUT-2 and glucokinase gene expression.

Actuellement les transplanteurs sont confrontés à une pénurie de greffons, conduisant à l'élargissement des critères de choix des donneurs. Cette démographie fait place à des greffons plus sensibles aux lésions d'ischémie-reperfusion (I/R). Ces lésions conduisent à des dysfonctions de reprises de fonction des greffons, et participent à l'augmentation de l'immunogénicité du greffon et à l'emergence de rejets aigus et chroniques. Dans un premier temps, il est donc nécessaire de limiter les lésions d'I/R et conserver l'intégrité du greffon. Dans un deuxième temps, il est important de réduire l'immunogénicité du greffon et de contrôler le rejet de greffe tout en maintenant le receveur immunocompétent. Afin de limiter les lésions d'I/R nous avons évalué la solution de préservation SCOT de type extracellulaire contenant 30g/L de PEG 20kDa, dans un modèle murin d'isolement et de transplantation d'îlots pancréatiques. L'amélioration des conditions de conservation a permit de préserver l'intégrité des îlots et de réduire l'immunogénicité du greffon, et ce due aux propriétés immunoprotectrices des PEG 20kDa (effets obtenus pour 10 à 30g/L). Dans ce même modèle notre second objectif était d'établir un état de tolérance périphérique par déplétion transitoire des lymphocytes T alloréactifs. La déplétion des lymphocytes T en division a été induite au moment de l'allotransplantation des îlots, par administration transitoire d'un analogue nucleosidique inductible. La déplétion transitoire a permit d'aboutir à une immunotolérance dominante via l'émergence de lymphocytes T régulateurs CD4+CD25+FoxP3+, cellules ouvrant de nouvelles perspectives dans l'inhibition des rejets d'allogreffes. / Organ and tissue transplantation is affected by a shortage of grafts, leading to enlargement of donor criteria. Consequently, these new marginal organs are more susceptible to ischemia-reperfusion injury (IRI). IRI increases primary graft dysfunctions and contributes to increase graft immunogenicity and consequently the occurence of acute and chronic rejection. Our objectives were : firstly, the necessity to limit I/R damages and preserve graft integrity, secondly, the importance to reduce graft immunogenicity and control the graft rejection while maintaining an immunocompetent recipient. To limit IRI we evaluated the new SCOT preservation extracellular type solution containing PEG 20kDa 30g/L in a murine model of pancreatic islets isolation and transplantation. The improvement of conservation with SCOT permitted to maintain the islets integrity and to reduce graft immunogenicity, due to the immunoprotective properties of PEG 20kDa (effects obtained with PEG 20kDa at 10 to 30g /L). In this same model our second objective was to establish a peripheral immunological tolerance of the graft by transient depletion of alloreactive T cells. This depletion of T cells in division was induced at the time of islet allotransplantation by an administration of an inducible nucleosidic analogue during 14 days. Transient alloreactive T cells depletion induced a dominant immunotolerance marked by the emergence of a persistent regulatory T cells CD4+CD25+FoxP3+ population. Thus, regulation of homeostatic balance between effector and regulatory T cells could open an interesting way to control the immune reaction against allograft.

Précédemment, nous avons montré que la surexpression de l'échangeur Na/Ca NCX1), une protéine responsable de la sortie de calcium (Ca2+) des cellules, augmentait la mort cellulaire programmée ou « apoptose » et réduisait la prolifération des cellules β. Afin d’étudier plus en profondeur le rôle de l’échangeur dans les cellules β in vivo, nous avons développé et caractérisé des souris présentant une inactivation de NCX1.<p>Des méthodes biologiques et morphologiques (imagerie du Ca2+, capture de Ca2+, métabolisme du glucose, sécrétion d'insuline et morphométrie par comptage de points) ont été utilisées pour évaluer la fonction de la cellule β in vitro. Les taux de glucose et d'insuline dans le sang ont été mesurés afin de déterminer le métabolisme du glucose et la sensibilité à l’insuline in vivo. Des îlots ont été transplantés sous la capsule rénale pour évaluer leur capacité à corriger le diabète chez les souris rendues diabétiques par l’alloxane.<p>L'inactivation hétérozygote de Ncx1 chez les souris provoque une augmentation de la sécrétion d’insuline induite par le glucose avec un renforcement important à la fois de la première et de la deuxième phase. Ces résultats s’accompagnent d’une augmentation de la masse et de la prolifération des cellules β. La mutation augmente également le contenu en insuline, l’immunomarquage de la proinsuline, la capture de Ca2+ induite par le glucose et la résistance à l'hypoxie des cellules β. En outre, les îlots de souris Ncx1+/- montrent une capacité à compenser le diabète 2 à 4 fois plus élevé que les îlots de souris Ncx1+/+ lorsque transplantés chez des souris diabétiques.<p>En conclusion, l’inactivation de l'échangeur Na/Ca conduit à une augmentation de la fonction de la cellule β, de sa prolifération, de sa masse et de sa résistance au stress physiologique, à savoir à divers changements de fonction des cellules β opposés aux principales anomalies rencontrées dans le diabète de type 2 (Type 2 Diabetes Mellitus,T2DM). Ceci nous procure un modèle unique pour la prévention et le traitement du dysfonctionnement des cellules β dans le T2DM et pour la transplantation d'îlots.<p> / Doctorat en Sciences biomédicales et pharmaceutiques / info:eu-repo/semantics/nonPublished

La régulation de l’homéostasie du glucose dans l’organisme est la fonction principale des cellules beta sécrétrices d’insuline dans le pancréas endocrine. Le facteur de transcription à domaine « winged helix », RFX6, a récemment, été identifié comme un nouveau régulateur de la différenciation endocrine pancréatique en aval de Ngn3 chez le poisson zèbre, la souris et l’homme. De plus, diverses mutations de Rfx6 chez l’homme ont été identifiées et reliées au syndrome de Mitchell Riley notamment caractérisé par un diabète néonatal, une atrésie de l’intestin grêle et une malabsorption intestinale. Lors de mes travaux de thèse, une approche combinée de transcriptomique chez la souris et la recherche des sites de fixation de RFX6 dans une lignée cellulaire beta et dans les ilots pancréatiques a permis de démontrer son importance dans le maintien de l’identité et de la fonction de la cellule beta. Pour la première fois, l’identification des cibles directes de RFX6 in vivo a été réalisée et a permis l’identification de l’ensemble du répertoire des gènes régulés directement par RFX6 dans les cellules beta qui n’ont pas été révélés dans le système cellulaire. Cette étude aura également permis d’identifier Mlxipl comme principale cible directement régulée par Rfx6 à la fois chez la souris et l’homme. Les expériences réalisées ont ainsi permis de déterminer les gènes cibles directs de RFX6 et contribué à élucider le rôle de ce facteur de transcription dans la différenciation et la fonction des cellules beta sécrétrices d’insuline. / Glucose homeostasis regulation in the body is the main function of insulin secreting beta cells in the endocrine pancreas. The winged-helix transcription factor RFX6 has recently been identified as a new pancreatic endocrine differentiation regulator, downstream of Ngn3,in zebra fish, mouse and human. Moreover, several Rfx6 mutations in humans were discovered and linked to the Mitchell Riley syndrome, which is characterized by neonatal diabetes, intestinal atresia and malabsorption. My thesis consisted of using an approach combining transcriptomic analysis in mouse and the identification of RFX6 target genes in a beta cell line as well as in pancreatic islets. This work has demonstrated the crucial role of RFX6 in maintaining beta cell identity and function. For the first time, RFX6 target genes were identified in vivo as well as the whole repertoire of directly regulated RFX6 target genesin beta cells, which were previously unidentified in the beta cell line. These studies have also shown that Mlxipl is a main RFX6 regulated target gene in mice and human. Overall, this work has allowed the clear identification of RFX6 target genes, thus contributing inunderstanding the role of this crucial transcription factor in the differentiation and function of insulin secreting beta cells.