Islet transplantation for brittle type 1 diabetes: The UIC protocol

A. Gangemi, P. Salehi, B. Hatipoglu, J. Martellotto, B. Barbaro, J. B. Kuechle, M. Qi, Y. Wang, P. Pallan, C. Owens, J. Bui, D. West, B. Kaplan, E. Benedetti, J. Oberholzer

Research output: Contribution to journalArticlepeer-review

140 Scopus citations

Abstract

This prospective phase 1/2 trial investigated the safety and reproducibility of allogeneic islet transplantation (Tx) in type I diabetic (T1DM) patients and tested a strategy to achieve insulin-independence with lower islet mass. Ten C-peptide negative T1DM subjects with hypoglycemic unawareness received 1-3 intraportal allogeneic islet Tx and were followed for 15 months. Four subjects (Group 1) received the Edmonton immunosuppression regimen (daclizumab, sirolimus, tacrolimus). Six subjects (Group 2) received the University of Illinois protocol (etanercept, exenatide and the Edmonton regimen). All subjects became insulin- independent. Group 1 received a mean total number of islets (EIN) of 1460 080 ± 418 330 in 2 (n = 2) or 3 (n = 2) Tx, whereas Group 2 became insulin- independent after 1 Tx (537 495 ± 190 968 EIN, p = 0.028). All Group 1 subjects remained insulin free through the follow-up. Two Group 2 subjects resumed insulin: one after immunosuppression reduction during an infectious complication, the other with exenatide intolerance. HbA1c reached normal range in both groups (6.5 ± 0.6 at baseline to 5.6 ± 0.5 after 2-3 Tx in Group 1 vs. 7.8 ± 1.1 to 5.8 ± 0.3 after 1 Tx in Group 2). HYPO scores markedly decreased in both groups. Combined treatment of etanercept and exenatide improves islet graft function and facilitates achievement of insulin-independence with less islets.

Original languageEnglish (US)
Pages (from-to)1250-1261
Number of pages12
JournalAmerican Journal of Transplantation
Volume8
Issue number6
DOIs
StatePublished - Jun 2008
Externally publishedYes

Keywords

  • Islet transplantation
  • Transplantation cell therapy
  • Transplantation research
  • Type I diabetes

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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