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Correlation between β cell mass and glycemic control in type 1 diabetic recipients of islet cell graft

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journal contribution
posted on 14.11.2006, 00:00 authored by B Keymeulen, P Gillard, C Mathieu, B Movahedi, G Maleux, G Delvaux, D Ysebaert, B Roep, E Vandemeulebroucke, M Marichal, P In 't Veld, M Bogdani, Christel HendrieckxChristel Hendrieckx, F Gorus, Z Ling, J van Rood, D Pipeleers
Islet grafts can induce insulin independence in type 1 diabetic patients, but their function is variable with only 10% insulin independence after 5 years. We investigated whether cultured grafts with defined beta cell number help standardize metabolic outcome. Nonuremic C-peptide-negative patients received an intraportal graft with 0.5-5.0 x 10(6) beta cells per kilogram of body weight (kg BW) under antithymocyte globulin and mycophenolate mofetil plus tacrolimus. Metabolic outcome at posttransplant (PT) month 2 was used to decide on a second graft under maintenance mycophenolate mofetil/tacrolimus. Graft function was defined by C-peptide >0.5 ng/ml and reduced insulin needs, metabolic control by reductions in HbA(1c), glycemia coefficient of variation, and hypoglycemia. At PT month 2, graft function was present in 16 of 17 recipients of >2 x 10(6) beta cells per kg BW versus 0 of 5 with lower number. The nine patients with C-peptide >1 ng/ml and glycemia coefficient of variation of <25% did not receive a second graft; five of them were insulin-independent until PT month 12. The 12 others received a second implant; it achieved insulin-independence at PT month 12 when the first and second graft contained >2 x 10(6) beta cells per kg BW. Of the 20 recipients of at least one graft with >2 x 10(6) beta cells per kg BW, 17 maintained graft function and metabolic control up to PT month 12. At PT month 12, beta cell function in insulin-independent patients ranged around 25% of age-matched control values. Thus, 1-year metabolic control can be reproducibly achieved and standardized by cultured islet cell grafts with defined beta cell number.

History

Journal

Proceedings of the National Academy of Sciences

Volume

103

Issue

46

Pagination

17444 - 17449

Publisher

National Academy of Sciences

Location

Washington, D.C.

ISSN

0027-8424

eISSN

1091-6490

Language

eng

Publication classification

C1.1 Refereed article in a scholarly journal

Copyright notice

2006, National Academy of Sciences of the USA