Operational immune tolerance towards transplanted allogeneic pancreatic islets in mice and a non-human primate

Midhat H Abdulreda, Dora Berman-Weinberg, Alexander Shishido, Christopher Martin, Maged Hossameldin, Ashley Tschiggfrie, Luis F. Hernandez, Ana Hernandez, Camillo Ricordi, Jean-Marie A Parel, Ewa Jankowska-Gan, William J. Burlingham, Esdras A. Arrieta-Quintero, Victor L. Perez, Norma S Kenyon, Per Olof Berggren

Research output: Contribution to journalArticle

Abstract

Aims/hypothesis: Patients with autoimmune type 1 diabetes transplanted with pancreatic islets to their liver experience significant improvement in quality of life through better control of blood sugar and enhanced awareness of hypoglycaemia. However, long-term survival and efficacy of the intrahepatic islet transplant are limited owing to liver-specific complications, such as immediate blood-mediated immune reaction, hypoxia, a highly enzymatic and inflammatory environment and locally elevated levels of drugs including immunosuppressive agents, all of which are injurious to islets. This has spurred a search for new islet transplant sites and for innovative ways to achieve long-term graft survival and efficacy without life-long systemic immunosuppression and its complications. Methods: We used our previously established approach of islet transplant in the anterior chamber of the eye in allogeneic recipient mouse models and a baboon model of diabetes, which were treated transiently with anti-CD154/CD40L blocking antibody in the peri-transplant period. Survival of the intraocular islet allografts was assessed by direct visualisation in the eye and metabolic variables (blood glucose and C-peptide measurements). We evaluated longitudinally the cytokine profile in the local microenvironment of the intraocular islet allografts, represented in aqueous humour, under conditions of immune rejection vs tolerance. We also evaluated the recall response in the periphery of the baboon recipient using delayed-type hypersensitivity (DTH) assay, and in mice after repeat transplant in the kidney following initial transplant with allogeneic islets in the eye or kidney. Results: Results in mice showed >300 days immunosuppression-free survival of allogeneic islets transplanted in the eye or kidney. Notably, >70% of tolerant mice, initially transplanted in the eye, exhibited >400 days of graft survival after re-transplant in the kidney without immunosuppression compared with ~30% in mice that were initially transplanted in the kidney. Cytokine and DTH data provided evidence of T helper 2-driven local and peripheral immune regulatory mechanisms in support of operational immune tolerance towards the islet allografts in both models. Conclusions/interpretation: We are currently evaluating the safety and efficacy of intraocular islet transplantation in a phase 1 clinical trial. In this study, we demonstrate immunosuppression-free long-term survival of intraocular islet allografts in mice and in a baboon using transient peri-transplant immune intervention. These results highlight the potential for inducing islet transplant immune tolerance through the intraocular route. Therefore, the current findings are conceptually significant and may impact markedly on clinical islet transplantation in the treatment of diabetes.

Original languageEnglish (US)
Pages (from-to)811-821
Number of pages11
JournalDiabetologia
Volume62
Issue number5
DOIs
StatePublished - May 1 2019

Fingerprint

Immune Tolerance
Islets of Langerhans
Primates
Transplants
Immunosuppression
Allografts
Papio
Kidney
Islets of Langerhans Transplantation
Delayed Hypersensitivity
Graft Survival
Type 1 Diabetes Mellitus
Blood Glucose
Cytokines
CD40 Ligand
Clinical Trials, Phase I
Blocking Antibodies
Survival
Aqueous Humor
C-Peptide

Keywords

  • Allogeneic rejection
  • Anterior chamber of the eye
  • Immune tolerance induction and maintenance
  • Immunosuppression-free
  • Intraocular transplantation
  • Long-term graft survival
  • Non-invasive longitudinal intravital imaging
  • Pancreatic islet transplant
  • Th2 cytokines

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

Operational immune tolerance towards transplanted allogeneic pancreatic islets in mice and a non-human primate. / Abdulreda, Midhat H; Berman-Weinberg, Dora; Shishido, Alexander; Martin, Christopher; Hossameldin, Maged; Tschiggfrie, Ashley; Hernandez, Luis F.; Hernandez, Ana; Ricordi, Camillo; Parel, Jean-Marie A; Jankowska-Gan, Ewa; Burlingham, William J.; Arrieta-Quintero, Esdras A.; Perez, Victor L.; Kenyon, Norma S; Berggren, Per Olof.

In: Diabetologia, Vol. 62, No. 5, 01.05.2019, p. 811-821.

Research output: Contribution to journalArticle

Abdulreda, MH, Berman-Weinberg, D, Shishido, A, Martin, C, Hossameldin, M, Tschiggfrie, A, Hernandez, LF, Hernandez, A, Ricordi, C, Parel, J-MA, Jankowska-Gan, E, Burlingham, WJ, Arrieta-Quintero, EA, Perez, VL, Kenyon, NS & Berggren, PO 2019, 'Operational immune tolerance towards transplanted allogeneic pancreatic islets in mice and a non-human primate', Diabetologia, vol. 62, no. 5, pp. 811-821. https://doi.org/10.1007/s00125-019-4814-4
Abdulreda, Midhat H ; Berman-Weinberg, Dora ; Shishido, Alexander ; Martin, Christopher ; Hossameldin, Maged ; Tschiggfrie, Ashley ; Hernandez, Luis F. ; Hernandez, Ana ; Ricordi, Camillo ; Parel, Jean-Marie A ; Jankowska-Gan, Ewa ; Burlingham, William J. ; Arrieta-Quintero, Esdras A. ; Perez, Victor L. ; Kenyon, Norma S ; Berggren, Per Olof. / Operational immune tolerance towards transplanted allogeneic pancreatic islets in mice and a non-human primate. In: Diabetologia. 2019 ; Vol. 62, No. 5. pp. 811-821.
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T1 - Operational immune tolerance towards transplanted allogeneic pancreatic islets in mice and a non-human primate

AU - Abdulreda, Midhat H

AU - Berman-Weinberg, Dora

AU - Shishido, Alexander

AU - Martin, Christopher

AU - Hossameldin, Maged

AU - Tschiggfrie, Ashley

AU - Hernandez, Luis F.

AU - Hernandez, Ana

AU - Ricordi, Camillo

AU - Parel, Jean-Marie A

AU - Jankowska-Gan, Ewa

AU - Burlingham, William J.

AU - Arrieta-Quintero, Esdras A.

AU - Perez, Victor L.

AU - Kenyon, Norma S

AU - Berggren, Per Olof

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Aims/hypothesis: Patients with autoimmune type 1 diabetes transplanted with pancreatic islets to their liver experience significant improvement in quality of life through better control of blood sugar and enhanced awareness of hypoglycaemia. However, long-term survival and efficacy of the intrahepatic islet transplant are limited owing to liver-specific complications, such as immediate blood-mediated immune reaction, hypoxia, a highly enzymatic and inflammatory environment and locally elevated levels of drugs including immunosuppressive agents, all of which are injurious to islets. This has spurred a search for new islet transplant sites and for innovative ways to achieve long-term graft survival and efficacy without life-long systemic immunosuppression and its complications. Methods: We used our previously established approach of islet transplant in the anterior chamber of the eye in allogeneic recipient mouse models and a baboon model of diabetes, which were treated transiently with anti-CD154/CD40L blocking antibody in the peri-transplant period. Survival of the intraocular islet allografts was assessed by direct visualisation in the eye and metabolic variables (blood glucose and C-peptide measurements). We evaluated longitudinally the cytokine profile in the local microenvironment of the intraocular islet allografts, represented in aqueous humour, under conditions of immune rejection vs tolerance. We also evaluated the recall response in the periphery of the baboon recipient using delayed-type hypersensitivity (DTH) assay, and in mice after repeat transplant in the kidney following initial transplant with allogeneic islets in the eye or kidney. Results: Results in mice showed >300 days immunosuppression-free survival of allogeneic islets transplanted in the eye or kidney. Notably, >70% of tolerant mice, initially transplanted in the eye, exhibited >400 days of graft survival after re-transplant in the kidney without immunosuppression compared with ~30% in mice that were initially transplanted in the kidney. Cytokine and DTH data provided evidence of T helper 2-driven local and peripheral immune regulatory mechanisms in support of operational immune tolerance towards the islet allografts in both models. Conclusions/interpretation: We are currently evaluating the safety and efficacy of intraocular islet transplantation in a phase 1 clinical trial. In this study, we demonstrate immunosuppression-free long-term survival of intraocular islet allografts in mice and in a baboon using transient peri-transplant immune intervention. These results highlight the potential for inducing islet transplant immune tolerance through the intraocular route. Therefore, the current findings are conceptually significant and may impact markedly on clinical islet transplantation in the treatment of diabetes.

AB - Aims/hypothesis: Patients with autoimmune type 1 diabetes transplanted with pancreatic islets to their liver experience significant improvement in quality of life through better control of blood sugar and enhanced awareness of hypoglycaemia. However, long-term survival and efficacy of the intrahepatic islet transplant are limited owing to liver-specific complications, such as immediate blood-mediated immune reaction, hypoxia, a highly enzymatic and inflammatory environment and locally elevated levels of drugs including immunosuppressive agents, all of which are injurious to islets. This has spurred a search for new islet transplant sites and for innovative ways to achieve long-term graft survival and efficacy without life-long systemic immunosuppression and its complications. Methods: We used our previously established approach of islet transplant in the anterior chamber of the eye in allogeneic recipient mouse models and a baboon model of diabetes, which were treated transiently with anti-CD154/CD40L blocking antibody in the peri-transplant period. Survival of the intraocular islet allografts was assessed by direct visualisation in the eye and metabolic variables (blood glucose and C-peptide measurements). We evaluated longitudinally the cytokine profile in the local microenvironment of the intraocular islet allografts, represented in aqueous humour, under conditions of immune rejection vs tolerance. We also evaluated the recall response in the periphery of the baboon recipient using delayed-type hypersensitivity (DTH) assay, and in mice after repeat transplant in the kidney following initial transplant with allogeneic islets in the eye or kidney. Results: Results in mice showed >300 days immunosuppression-free survival of allogeneic islets transplanted in the eye or kidney. Notably, >70% of tolerant mice, initially transplanted in the eye, exhibited >400 days of graft survival after re-transplant in the kidney without immunosuppression compared with ~30% in mice that were initially transplanted in the kidney. Cytokine and DTH data provided evidence of T helper 2-driven local and peripheral immune regulatory mechanisms in support of operational immune tolerance towards the islet allografts in both models. Conclusions/interpretation: We are currently evaluating the safety and efficacy of intraocular islet transplantation in a phase 1 clinical trial. In this study, we demonstrate immunosuppression-free long-term survival of intraocular islet allografts in mice and in a baboon using transient peri-transplant immune intervention. These results highlight the potential for inducing islet transplant immune tolerance through the intraocular route. Therefore, the current findings are conceptually significant and may impact markedly on clinical islet transplantation in the treatment of diabetes.

KW - Allogeneic rejection

KW - Anterior chamber of the eye

KW - Immune tolerance induction and maintenance

KW - Immunosuppression-free

KW - Intraocular transplantation

KW - Long-term graft survival

KW - Non-invasive longitudinal intravital imaging

KW - Pancreatic islet transplant

KW - Th2 cytokines

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