Intraportal and intrasplenic autotransplantation of pancreatic islets in the dog.

Autotransplantation of pancreatic microfragments into the liver or the spleen of totally pancreatectomized dogs is described. Both modes of transplantation resulted in restoration of normal fasting blood glucose levels. A delayed response to high glucose loads was however observed in both groups. Serum amylase levels indicated a rapid decline of exocrine activity. On the basis of postoperative levels of GOT and GPT in the serum of the dogs with intraportal transplants, permanent proteolytic or ischemic damage to the liver appeared unlikely.     

Proliferation of transplanted allogeneic pancreatic islets

Recent studies showed enhanced regeneration of pancreatic islets in some circumstances. The purpose of our study was to investigate the proliferate potential of rat pancreatic islet cells in allogeneic grafts. Adult Lewis female rats and WAG male rats served as recipients and donors, respectively. Diabetes was induced by single intravenous (IV) injection of streptozotocin producing diabetes as confirmed by nonfasting plasma glucose >300 mg% on 3 consecutive days. Islet rejection was considered complete when glycemia exceeded 250 mg% and was confirmed by histopathological examination. To obtain long survival of allogeneic islets a tolerance-inducing method used allogeneic UV-B irradiated bone marrow transplantation into nonlethally selectively cytoreducted recipients with a donor-type splenocyte infusion followed by cyclophosphamide 200 mg/kg bw. Endocrine cell proliferation was assessed morphometrically using double immunostaining for pKi-67 and insulin or glucagon. Double immunolabelling, propidium iodide staining, and TUNEL assay were used to identify both proliferating and apoptotic cells. The rise of glycemia >350 mg/dL after graftectomy in euglycemic recipients was correlated with immunohistological examination, showing that the euglycemia was due to properly functioning pancreatic islet allotransplants. The immunohistochemical examination confirmed the presence of endocrine beta and alpha cells. In comparison with normal pancreas which showed 0.4 +/- 0.12%, pKi-67-positive cells, long-surviving grafts had a significantly higher proliferation capacity (5.61 +/- 0.94%; P <.001). In contrast, rejected grafts/control groups did not show significantly enhanced proliferation (0.73 +/- 0.19%), and had endocrine cells undergoing apoptosis. The incidence of apoptosis in endocrine cells within long-surviving graft appeared to be extremely low. In conclusion, the growth and death of endocrine cells in allogeneic grafts differ between accepted and rejected cases. The level of proliferation in the graft at day 150 was significantly higher compared with normal pancreatic beta cells.     

Size-dependent revascularization of transplanted pancreatic islets

For their survival and optimal function, pancreatic islets depend posttransplantation on a rapid and adequate revascularization. Native islets display a marked size-dependent heterogeneity in both angioarchitecture and degree of blood perfusion. This study evaluated whether there also are differences in the degree of revascularization of islets of different size when transplanted. Mouse pancreatic islets were isolated by collagenase digestion, and cultured in vitro for 4-7 days before transplantation. Groups of 200 islets with a diameter either exceeding or being below 100 microm were implanted beneath the left renal capsule of syngeneic C57 BL/6 mice. One month posttransplantation, graft-bearing kidneys were removed. Histological specimens were prepared and stained for endothelium with the lectin Bandeiraea simplicifolia. Pancreata from nontransplanted control animals were prepared similarly. The vascular density in transplanted islets was markedly lower than in native islets. However, islet transplants composed of small islets (<100 microm in diameter) had a vascular density in the endocrine tissue twice that in transplants of larger islets (>100 microm). The connective tissue stroma surrounding smaller islets was also more revascularized than in corresponding grafts with large islets. The vascular density in the connective tissue stroma surrounding the individual islets in the grafts was markedly higher than in the endocrine parts per se. These combined observations indicate that smaller islets have a higher capacity to stimulate regrowth of blood vessels following transplantation. Further studies on islet differences with regard to revascularization capacity may teach us strategies for treatment of transplanted islets to improve their revascularization.     

Insulin secretion in streptozotocin-diabetic rats transplanted with immunoisolated islets

Islet transplantation may be optimized by islet immunoisolation to prevent direct contact between the islet graft and the host tissue. In this study, we examined the glycemia and insulin secretion in streptozotocin-diabetic rats transplanted with islets subjected to immunoisolation with Algire diffusion chamber or with microencapsulation. Two days after diabetes induction by streptozotocin (70 mg/kg i.v.), rats were transplanted i.p. with either 1500 or 3000 islets encapsulated in Algire diffusion chambers, or with either 1500 or 3000 microencapsulated islets. Controls were diabetic rats transplanted i.p. with 1500 overnight-cultured islets not subjected to immunoisolation. In these controls, normoglycemia was evident for 3 weeks and a normal plasma insulin response to glucose infusion (10 mg/min) was seen at day 10 after transplantation. It was found that rats transplanted with 1500 microencapsulated islets similarly were normoglycemic for 3 weeks and that the plasma insulin response to glucose infusion at day 10 was normal. Furthermore, rats transplanted with 3000 microencapsulated islets remained normoglycemic for 6 months, and a glucose infusion performed at 6 months in these rats showed a normal acute plasma insulin response, whereas the second phase of insulin secretion was reduced. In contrast, rats transplanted with 1500 islets immunoisolated in Algire chamber remained hyperglycemic, and rats transplanted with 3000 islets within Algire chamber were normoglycemic for only 2 weeks. We conclude that microencapsulation is superior to the use of diffusion chamber as the immunoisolation technique for islets used for transplantation.     

Insulin and glucagon secretion from rat islets maintained in a tissue culture-perifusion system.

A tissue culture-perifusion system is described that allows for long-term culture of pancreatic islets and study of the dynamics of islet hormone secretion. Islets cultured in this system demonstrate brisk, reproducible biphasic insulin and glucagon release. Glucose-stimulated insulin release is similar after 1 or 14 days in culture. Freshly isolated islets are relatively insensitive to somatostatin, requiring 100 ng/ml to suppress partially the glucose-induced insulin secretion. After 24 h of culture, the same islets demonstrate a marked increase in sensitivity to this hormone. Glucagon secretion from islets maintained in this system occurred in a predictable fashion to arginine stimulation and glucose inhibition.     

Reinnervation of syngeneic mouse pancreatic islets transplanted into renal subcapsular space.

A syngeneic transplantation of 150 islets into the subcapsular renal space was performed on normoglycemic or alloxan-induced diabetic male C57BL/6 mice. Six, 8, 14, or 20-21 wk after transplantation, the graft-bearing kidney was removed and processed for microscopical examinations with indirect immunofluorescence for neuropeptides and tyrosine hydroxylase, and with acetylcholinesterase staining to visualize nerve fibers within the graft. Six weeks after implantation, only a few scattered nerve fibers were observed within the grafts. A progressive increase in the number of nerves was observed until 14 wk after transplantation, after which, a stable level was reached. Alloxan-induced diabetic mice showed quantitatively and qualitatively similar reinnervation to normoglycemic mice 20 wk after transplantation. The findings demonstrate the presence of sympathetic nerve fibers (containing tyrosine hydroxylase and neuropeptide Y), mainly accompanying ingrowing blood vessels; parasympathetic nerve fibers (containing acetylcholinesterase and vasoactive intestinal peptide), possibly reaching the graft from the adjacent renal capsule; and afferent nerve fibers (containing substance P and calcitonin gene-related peptide), which were less numerous. The data suggest that transplanted islets become reinnervated by ingrowth of nerve fibers from the implantation organ and that several types of nerves are present.     

Impaired revascularization of transplanted mouse pancreatic islets is chronic and glucose-independent

BACKGROUND: Pancreatic islets are avascular immediately after transplantation and depend on revascularization. Recently, the authors found decreased vascular density in mouse islets 1 month after implantation into nondiabetic recipients. This study investigated possible differences in revascularization between islets implanted into nondiabetic and diabetic recipients, and also evaluated changes in vascular density up to 6 months posttransplantation. METHODS: Islets were syngenically transplanted beneath the renal capsule of normoglycemic or alloxan-diabetic C57BL/6 mice. One to 6 months later, the animals were killed and the grafts removed. Histologic slides were prepared and stained with Bandeiraea simplicifolia. RESULTS: The vascular density in all transplanted islets was decreased compared with native islets. There were no differences in the islet graft vascular density between nondiabetic and diabetic animals. No improvement over time occurred. CONCLUSIONS: The vascular density is decreased in islets implanted to cure diabetic recipients. No improvement occurs in transplanted islets after 1 month posttransplantation.     

Intraislet endothelial cells contribute to revascularization of transplanted pancreatic islets

Pancreatic islet transplantation is an emerging therapy for type 1 diabetes. To survive and function, transplanted islets must revascularize because islet isolation severs arterial and venous connections; the current paradigm is that islet revascularization originates from the transplant recipient. Because isolated islets retain intraislet endothelial cells, we determined whether these endothelial cells contribute to the revascularization using a murine model with tagged endothelial cells (lacZ knock-in to Flk-1/VEGFR2 gene) and using transplanted human islets. At 3-5 weeks after transplantation beneath the renal capsule, we found that islets were revascularized and that the transplant recipient vasculature indeed contributed to the revascularization process. Using the lacZ-tagged endothelial cell model, we found that intraislet endothelial cells not only survived after transplantation but became a functional part of revascularized islet graft. A similar contribution of intraislet endothelial cells was also seen with human islets transplanted into an immunodeficient mouse model. In the murine model, individual blood vessels within the islet graft consisted of donor or recipient endothelial cells or were a chimera of donor and recipient endothelial cells, indicating that both sources of endothelial cells contribute to the new vasculature. These observations suggest that interventions to activate, amplify, or sustain intraislet endothelial cells before and after transplantation may facilitate islet revascularization, enhance islet survival, and improve islet transplantation.     

Hyperoxia improves the survival of intraportally transplanted syngeneic pancreatic islets

BACKGROUND: Hypoxia in the portal vein may compromise the survival of intraportally transplanted pancreatic islets. We therefore examined the effect of inspired oxygen on the outcome of islet transplantation. METHODS: Blood glucose concentrations, glucose tolerance, and the size and number of surviving islets were measured in diabetic rats housed for 48 hr under hyperoxic (100% O(2)), hypoxic (11% O(2)), or normoxic (21%O(2)) conditions after intraportal transplantation of 350, 500, 700, or 1,000 syngeneic islets. RESULTS: In normoxic diabetic rats, the smallest graft size to consistently restore normoglycemia was 1,000 islets. A graft size of 700 islets was effective in only three of nine animals, whereas 500 islets were ineffective in all eight animals undergoing transplantation. In contrast, in hyperoxically housed rats, graft sizes of 700 or 500 islets restored normoglycemia in eight of nine or five of eight animals, respectively. In those animals that became normoglycemic, the glucose tolerance of the hyperoxically treated rats receiving 700 islets was almost identical to that of normoxically housed animals receiving 1,000 islets. The average size of the islets 6 weeks after transplantation was the same in livers of hyperoxic and control rats. However, the total islet area and number of islets engrafted in hyperoxic rats was significantly increased when compared with livers from normoxic animals receiving the same graft size, so the area in hyperoxic rats receiving 700 islets was not significantly different from normoxic recipients of 1,000 islets. CONCLUSIONS: Hyperoxia posttransplantation increases the number of islets that survive the engraftment process and allows normalization of plasma glucose levels with a smaller number of transplanted islets.     

Heat shock preconditioning impairs revascularization of freely transplanted pancreatic islets

BACKGROUND: Revascularization of freely transplanted pancreatic islets is essential for appropriate graft function and survival. During the first days after transplantation, however, islet transplants are avascular, and successful engraftment is believed to be markedly hampered by hypoxia-induced tissue injury. Because heat shock has been shown to induce cell resistance against hypoxia, it seems reasonable to stress pancreatic islets by heat before transplantation. In contrast, hypoxia is a major stimulus for angiogenesis, and thus heat shock preconditioning-induced resistance against hypoxia may decrease stimulation of angiogenesis. The authors therefore studied in vivo whether heat shock preconditioning of isolated islets affects angiogenesis and revascularization after free transplantation. METHODS: After collagenase isolation, heat shock-preconditioned islets (42 degrees C for 30 min) were transplanted syngeneically into nontreated skinfold chambers of Syrian hamsters. In a second group of animals, nontreated islets were transplanted into heat shock-preconditioned chambers. Nontreated islets transplanted into nontreated chambers served as controls. Islet angiogenesis and revascularization were quantitatively analyzed during 14 days after transplantation using intravital fluorescence microscopy. Expression of heat shock proteins (HSP) was confirmed by immunohistochemistry and Western blotting. RESULTS: Immunohistochemistry revealed expression of HSP32 (heme oxygenase [HO]-1), HSP72, and also intracellular insulin in isolated and transplanted pancreatic islets. Western blot analysis showed enhanced HSP32 but slightly decreased HSP72 expression in heat shock-preconditioned islets when compared with controls. Intravital microscopy revealed appropriate vascularization of control islets within 14 days after transplantation. Heat shock preconditioning of the host tissue (i.e., the skinfold chambers) did not affect islet vascularization when compared with controls. In contrast, heat shock preconditioning of the isolated islets resulted in a significantly (P < 0.05) impaired take rate, a reduced (P < 0.05) size of the newly formed microvascular network, and thus a smaller area (P < 0.05) of microvascularly perfused endocrine tissue. CONCLUSION: These data suggest that heat shock preconditioning of isolated pancreatic islets before transplantation impairs the process of graft angiogenesis and revascularization. Therefore, transient exposure of isolated islets to heat may not be considered a promising tool to improve the outcome of islet transplantation.     

In vivo imaging of immune rejection in transplanted pancreatic islets

As islet transplantation becomes an acceptable clinical modality for restoring normoglycemia in type 1 diabetic patients, there is a crucial need for noninvasive assessment of the fate of the grafts. In spite of the success of the Edmonton Protocol, a significant graft loss occurs due to immunological and nonimmunological events immediately after transplantation. Allogeneic rejection in graft recipients is one of the major reasons for islet death and graft failure. Therefore, monitoring the islet rejection using reliable noninvasive methods would significantly aid in clinical assessment of graft success. We have previously developed a method to detect transplanted islets noninvasively using magnetic resonance imaging (MRI). For this procedure, human pancreatic islets are labeled with an MRI contrast agent that enables their visualization on magnetic resonance images. In our present study, we not only detected labeled human islets in a preclinical intrahepatic model of human islet transplantation in mice but also showed that islet rejection can be monitored noninvasively and repeatedly in real time by MRI. In addition, in this study, we have adapted, for islet cell labeling, a Food and Drug Administration-approved commercially available contrast agent, Feridex, that is used clinically for liver imaging. We believe that this agent, in combination with our preclinical model of islet transplantation, will facilitate the transition of imaging immune rejection to clinical trials.     

Microcirculation of human pancreatic islets transplanted under the renal capsule of nude mice.

BACKGROUND: The aim was to measure the capillary blood pressure in transplanted human islets. METHODS: Human islets were isolated at the Central Unit of the beta-cell Transplant in Brussels, Belgium. After transport to our laboratory, the islets were implanted under the renal capsule of normoglycemic nude mice. Two weeks later the capillary and venous blood pressures in the islet graft and adjacent renal parenchyma were measured with a micropuncture technique. RESULTS: Capillary blood pressure was approximately 5-8 mmHg in both graft and renal capillaries: twice as high as in native islets. Venous blood pressures were similar (4-5 mmHg) in the veins draining the graft and in the renal interlobular veins. All veins leading from the graft emptied into the renal parenchyma, that is, into interlobular veins. CONCLUSIONS: The capillary hypertension seen in transplanted human islets is probably necessary to secure adequate drainage through the renal veins. Whether this contributes to the poor results of long-term islet graft survival is unknown.