Long-term metabolic and hormonal effects of exenatide on islet transplant recipients with allograft dysfunction

Raquel N. Faradji, Tatiana Froud, Shari Messinger, Kathy Monroy, Antonello Pileggi, Davide Mineo, Thipaporn Tharavanij, Armando J. Mendez, Camillo Ricordi, Rodolfo Alejandro

Research output: Contribution to journalArticle

36 Scopus citations

Abstract

The initial success of islet transplantation (ITx) is followed by graft dysfunction (GDF) and insulin reintroduction. Exenatide, a GLP-1 agonist, increases insulin and decreases glucagon secretion and has potential for O-cell regeneration. To improve functional islet mass, exenatide treatment was given to ITx recipients with GDF. The objective of this study was to assess metabolic and hormonal effects of exenatide in GDF. In this prospective, single-arm, nonrandomized study, 11 type 1 diabetes recipients of ITx with GDF had HbA1c, weight, insulin requirements, and 5-h mixed meal tolerance test (MMTT; with/without exenatide given before test) at baseline, 3, 6, and 12 months after initiating exenatide treatment. Baseline MMTT showed postprandial hyperglycemia and hyperglucagonemia. Daily exenatide treatment resulted in improved glucose, increased amylin/insulin ratio, and decreased proinsulin/insulin ratio as assessed by MMTT. Glucagon responses remained unchanged. Exenatide administration 1 h before MMTT showed decreased glucagon and glucose at 0 min and attenuation in their postprandial rise. Time-to-peak glucose was delayed, followed by insulin, proinsulin, amylin, and C-peptide, indicating glucose-driven insulin secretion. Five subjects completed 12-month follow-up. Glucose and glucagon suppression responses after MMTT with exenatide were no longer observed. Retrospective 3-month analysis of these subjects revealed higher and sustained glucagon levels that did not suppress as profoundly with exenatide administration, associated with higher glucose levels and increased C-peptide responses. In conclusion, Exenatide suppresses the abnormal postprandial hyperglucagonemia and hyperglycemia observed in GDF. Changes in amylin and proinsulin secretion may reflect more efficient insulin processing. Different degrees of responsiveness to exenatide were identified. These may help guide the clinical management of ITx recipients.

Original languageEnglish (US)
Pages (from-to)1247-1259
Number of pages13
JournalCell transplantation
Volume18
Issue number10-11
DOIs
StatePublished - 2009

Keywords

  • Diabetes
  • Exenatide
  • Glucagon
  • Graft dysfunction
  • Insulin
  • Insulin independence
  • Islet
  • Islet transplantation
  • Metabolism

ASJC Scopus subject areas

  • Cell Biology
  • Transplantation
  • Biomedical Engineering

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