糖尿病治疗新进展——胰岛细胞移植

随着医学科学的发展和生物学技术的进步,胰岛细胞移植已经被认为是治疗1型糖尿病的一种有效方法。技术上首先要解决好移植物的来源、提取和储存。同时,将移植物导入体内的技术也在不断发展,介入放射学技术发挥了非常重要的作用。研究发现．移植后受体的高血糖明显降低,并能在较长时期保持在正常水平。但胰岛细胞移植后,同样面临移植排斥反应,而在应用免疫抑制剂后又可能引起肝小静脉病等不良反应。利用磁共振和光学成像对标记后的胰岛细胞进行显像,对移植后的胰岛细胞在活体内进行追踪．了解其分布和存活,对于长期监测其功能、改进移植技术和免疫调节方法也很重要。目前面临的问题终将逐一得到解决．胰岛细胞移植很有希望成为治愈糖尿病的方法。     

胰岛α细胞对β细胞功能的影响

众多研究表明,胰岛移植的短期效果较显著,但长期效果仍不尽人意。在胰岛移植的早期,绝大多数病人可以获得明显的治疗效果,而后大多数的病人发生进行性的胰岛功能丧失,产生这种现象的原因至今仍不甚明了。如何解决移植胰岛的长期存活问题对于胰岛移植的临床应用至关重要。近年来人们对胰岛移植失败的原因进行了不断探索,发现胰岛移植后期的失败不仅与免疫反应有关,而且与移植物的细胞组成有密切关系,即胰岛细胞间的相互作用对移植物的功能维持可能有重要影响。因此,本文就胰岛α细胞及其分泌的胰高血糖素对β细胞功能的影响作一综述。     

成人胰岛细胞移植25例次临床研究

目的 建立新型成人胰岛细胞分离纯化方法,观察成人胰岛细胞移植的安全性与有效性.方法 对14例1型糖尿病(T1DM)患者进行PFC与UW液双层冷藏胰腺,Liberase酶消化,COBE 2991型专用胰岛细胞分离机分离及连续密度梯度纯化,获取高纯度与高活性的胰岛细胞.采用外科方法,将短期培养的胰岛细胞经门静脉移植到肝脏内...     

异种移植中Galα(1,3)Gal抗原的研究近况

同种异体组织和器官移植物供体来源有限,使得异种移植再度成为移植领域的研究热点。异种移植的主要障碍是人体内存在的天然抗体与移植物表面含有α1,3半乳糖残基[Galα(1,3)Gal,αGal]的抗原结合,激活补体系统和炎症反应,导致超急性移植排斥反应(HAR)的发生,使移植物失活。除人类和旧世纪猴外,其它所有哺乳动物的体内都含有αGal抗原,该抗原是由一组具有Galα(1,3)Gal双糖末端的糖蛋白或糖脂组成的,它的形成依赖于α1,3半乳糖基转移酶(αGT)的催化。目前,针对αGal抗原克服超急性移植排斥反应的方法主要有如下几种：(1)酶处理去除内皮细胞表面的αGal抗原;(2)物理化学方法去除人体血浆中存在的特异性天然抗体;(3)基因工程方法改造表达催化αGal抗原形成的相关酶基因,从而影响该抗原的表达。     

保护胰岛β细胞的体外研究进展

糖尿病是一种由胰岛素分泌缺陷和（或）胰岛素作用缺陷引起的高血糖症性代谢疾病。自Edmonton临床试验取得成功后,胰岛移植成为一种新型治愈糖尿病的方法。但胰岛β细胞在体外分离过程中极易发生凋亡或死亡,且长期的体外培养或冷冻储存也容易令其胰岛素分泌功能逐渐丧失。因此,有效维持或改善β细胞的成活率及功能对胰岛移植的成功至关重要。对胰岛β细胞的体外保护方法进行阐述,并对其研究前景进行展望。     

供体来源ImDex联合抗原特异性Treg保护大鼠肝脏移植物的研究

目的:探讨供体来源低剂量未成熟树突状细胞外来体(immature dendritic cells exosome,im Dex)联合供体抗原特异型调节性T细胞(regulatory t cells,Tregs)对于肝脏移植物的保护作用。方法:以BN-Lewis大鼠为供受体,建立大鼠原位肝移植模型。利用超高速梯度离心法获得im Dex,采用流式细胞术鉴定该im Dex的表型。不同剂量im Dex用于本移植模型,生存分析探究其对肝脏移植物的保护作用及该作用与剂量的相关关系。利用磁珠分选技术获得Treg,混合淋巴细胞培养获得供体抗原特异性Treg,将不同性质的Treg用于移植受体,验证抗原特异性Treg保护肝脏移植物。进一步探究两者联合使用的效果,应用免疫荧光、流式细胞术研究Treg在移植受体中的分布。结果:超高速梯度离心法分选出的im Dex具有im DC表型,其保护肝脏移植物的最佳作用剂量为20μg,Treg发挥保护移植物作用具有抗原特异性。两者联合应用组生存时间长于对照组(P0.05)。病理显示,输注的Treg分布于受体移植物。结论:Im Dex联合抗原特异性Treg可以有效保护大鼠肝脏移植物。     

免疫耐受在胰岛移植中的研究进展

胰岛移植已经被公认为治疗胰岛素依赖型糖尿病(IMDD)的有效手段,而现如今胰岛移植的最大障碍是移植排斥反应。目前控制胰岛移植的免疫抑制治疗因其对胰岛细胞的毒性作用及长期应用带来的全身并发症而无法在临床推广,诱导移植术后受体的免疫耐受是防止排斥反应的最理想方法。本文综述了诱导免疫耐受的途径及胰岛移植的最新实验进展。随着研究的深入和免疫学的发展,相信在未来的胰岛移植治疗糖尿病领域,移植排斥现象将能得到高效可靠的解决。     

免疫耐受在胰岛移植中的研究进展

胰岛移植已经被公认为治疗胰岛素依赖型糖尿病（IMDD）的有效手段,而现如今胰岛移植的最大障碍是移植排斥反应。目前控制胰岛移植的免疫抑制治疗因其对胰岛细胞的毒性作用及长期应用带来的全身并发症而无法在临床推广,诱导移植术后受体的免疫耐受是防止排斥反应的最理想方法。本文综述了诱导免疫耐受的途径及胰岛移植的最新实验进展。随着研究的深入和免疫学的发展,相信在未来的胰岛移植治疗糖尿病领域,移植排斥现象将能得到高效可靠的解决。     

封闭CD28-B7和OX40-OX40L共刺激通路诱导异种胰岛移植物耐受的研究

抑制T细胞的活化可以有效延长移植物的存活时间. 研究表明, 在体外混和淋巴细胞反应体系中分别加入CTLA4Ig和OX40Ig蛋白, 可以强烈地抑制T细胞的增殖. 用链脲佐菌素(200 mg/kg)腹腔注射诱导糖尿病小鼠, 在进行胰岛移植的-1天, 经尾静脉输注5×10⁸ pfu AdCTLA4Ig-IRES-OX40Ig, 胰岛移植物的存活时间明显延长(100.3±14.94)天, n = 6, 并对外源性葡萄糖的刺激反应正常, Th1型细胞分泌细胞因子的能力明显受到抑制, 表明重组腺病毒AdCTLA4Ig-IRES-OX40Ig在小鼠体内可以高效地表达CTLA4Ig和OX40Ig分子, 并且诱导对大鼠胰岛移植物的耐受, 提示其在器官移植耐受的诱导中具有潜在的应用价值.     

干细胞在 1 型糖尿病治疗中的应用研究进展

1型糖尿病（T1D）是一种慢性、多因素自身免疫性疾病,在发病过程中,会不断破坏胰岛β细胞,最终导致胰岛素分泌不足, 严重威胁人类健康。目前,根治T1D的主要方法是胰岛移植,即将移植的胰岛替代体内已被疾病破坏的胰岛细胞,以恢复正常血糖。但 是,胰岛移植供体的缺乏和移植免疫排斥反应,给胰岛移植的临床应用带来巨大挑战。近年来,干细胞治疗为T1D提供了一种新疗法, 成为T1D治疗领域新的研究热点,为该病的治疗提供了新思路。综述不同来源干细胞——胚胎干细胞、诱导多能干细胞和成体干细胞用 于治疗T1D的研究进展。     

In vitro transdifferentiation of adult pancreatic acinar cells into insulin-expressing cells

Despite a recent breakthrough in human islet transplantation for treating diabetes mellitus, the limited availability of insulin-producing tissue is still a major obstacle. Here, we studied whether adult pancreatic acinar cells have the potential to transdifferentiate into islet or beta cells. Pancreatic acini were isolated from 7- to 8-weeks-old male Sprague-Dawley rats and cultured in suspension. Within 1 week, most of the acinar cells lost amylase expression and converted to cells with a duct cell phenotype. Insulin-positive cells were also observed, mainly at the periphery of the acini-derived spheroids. Insulin gene and protein expression was increased. Presence of a few insulin-positive cells coexpressing cytokeratins suggests that a spontaneous acinar to ductal cell transdifferentiation process was further going on towards beta cells. This study provides the first evidence that adult pancreatic acinar cells could be differentiated into insulin-expressing cells in vitro.     

From Langerhans Islets to Pancreas Transplantation over the past 30 years: A Review with Personal Contributions

Organ, tissue and cell banking is currently an important method used to prevent death of cells in replacement transplantation therapy. From 1975 to 1985 the author performed experimental transplantations of islets isolated by collagenase digestion through injection into the liver through the portal vein, or by transplantation of minced neonatal pancreases under the renal capsule of alloxan or spreptozotocin into severely chronic diabetic rats and mice. Seventy of the 256 transplanted rats and mice were cured for 1 year, i.e. one-third of their life span, at the 3rd to 15th inbreeding and only 2 weeks of immunosuppression by azathioprine or cyclosporin A. The author compares his results with those achieved later with diabetic patients by whole pancreas transplantation, including prevention of diabetic renal and ocular complications, infertility, health of progeny of cured rats, and slow rejection and possibility of cure by repeated transplantation. He welcomes the return to islet transplantation, and possibly also of immunologically tolerant pancreatic stem cell transplantation, or transplantation of subcutaneous fibroblasts, transfected with a complex insulin gene, which will produce adequate insulin to prevent hyperglycemia, as does hepatic pyruvate kinase from an insulin analog, a therapy that will not need permanent immunosuppression.     

骨髓间充质细胞联合PDMS支架构建移植胰岛微环境的实验研究

目的为了提高移植胰岛的活性和功能,构建适合移植胰岛生存的微环境。 方法采用聚二甲基硅氧烷（PDMS）和氯化钠晶体构建三维支架,联合骨髓间充质细胞（MSCs）、纤维蛋白和胰岛共同构建迷你"人工胰腺"。采用链脲佐菌素（STZ）诱导的糖尿病大鼠移植模型评价效果,将"人工胰腺"移植到糖尿病大鼠大网膜内,对照组行假手术,术后隔天监测移植大鼠血糖水平;数据采用t检验和曼-惠特尼U检验。 结果用PDMS构建的三维巨孔支架,支架内可见大量不规则孔洞空间。胰岛和MSCs可成功装载入支架内,HE染色结果显示,支架孔内存在胰岛,胰岛周围包绕有MSCs。糖尿病大鼠大网膜内移植结果显示,移植后各时间点（1,3,5,7 d）,"人工胰腺"移植组糖尿病大鼠血糖水平分别为（278.70±86.06）mg/ dl、（323.50±44.29）mg/ dl、（283.30±74.00）mg/dl、（304.80±13.33）mg/dl,较假手术对照组（606.00±52.40）mg/dl、（589.70±55.78）mg/dl、（615.00±54.84）mg/dl、（630.30±48.17）mg/ dl均降低,差异具有统计学意义（t = 7.96、9.15、8.82,U = 0.00,P均< 0.01）。 结论MSCs联合PDMS三维支架构建的微环境,可为移植胰岛提供生存的环境,为临床开展胰岛移植提供新的策略。     

Islet alpha cell number is maintained in microencapsulated islet transplantation

Islet transplantation can reverse hyperglycaemia in Type 1 diabetes patients. One problem in islet transplantation is a loss of beta cell mass as well as blunted glucagon responses from the grafted islets. It has been suggested that alpha cell loss is associated with close contact of the alpha cells with the implantation organ. In the present study we made use of microencapsulation, where transplanted islets are not in direct contact with the host implantation site. After transplantation, the number of glucagon cells stained per microencapsulated islet section was increased whereas the number of insulin cells stained was decreased. DNA content of the islets was reduced, as was insulin content, whereas glucagon content was unchanged. This indicates that cell number in transplanted microencapsulated islets diminishes, which can be accounted for by loss of beta cells. However, in contrast to previous studies using non-encapsulated islets, alpha cell number seems to be maintained.     

Activation of AMP-activated protein kinase mediates acute and severe hypoxic injury to pancreatic beta cells

In islet transplantation, a substantial part of the graft becomes nonfunctional for several reasons including hypoxia. AMP-activated protein kinase (AMPK) in mammalian cells is a regulator of energy homeostasis, and is activated by metabolic stresses such as hypoxia. However, the role of AMPK in hypoxic injury to pancreatic beta cells is not clear. When a rat beta cell line, INS-1 cell, was incubated in an anoxic chamber, phosphorylation of both AMPK and its downstream protein, acetyl-CoA carboxylase 2 increased with time. Adenovirus-mediated expression of constitutively active form of AMPK under normoxic conditions increased caspase-3 activation, suggesting induction of apoptosis. Reactive oxygen species production also increased with time during hypoxia. Pretreatment with compound C, an AMPK inhibitor, or N-acetyl-l-cysteine, an antioxidant, significantly lowered hypoxia-mediated cell death. These results suggest that AMPK, in association with oxidative stress, plays an important role in acute and severe hypoxic injury to pancreatic beta cells.     

GLP-1 receptor signaling protects pancreatic beta cells in intraportal islet transplant by inhibiting apoptosis

To clarify the cytoprotective effect of glucagon-like peptide-1 receptor (GLP-1R) signaling in conditions of glucose toxicity in vivo, we performed murine isogenic islet transplantation with and without exendin-4 treatment. When a suboptimal number of islets (150) were transplanted into streptozotocin-induced diabetic mice, exendin-4 treatment contributed to the restoration of normoglycemia. When 50 islets expressing enhanced green fluorescent protein (EGFP) were transplanted, exendin-4 treatment reversed loss of both the number and mass of islet grafts one and 3 days after transplantation. TUNEL staining revealed that exendin-4 treatment reduced the number of apoptotic beta cells during the early posttransplant phase, indicating that GLP-1R signaling exerts its cytoprotective effect on pancreatic beta cells by inhibiting their apoptosis. This beneficial effect might be used both to ameliorate type 2 diabetes and to improve engraftment rates in clinical islet transplantation.     

Effects of synthetic antifreeze glycoprotein analogue on islet cell survival and function during cryopreservation

The antifreeze glycoprotein (AFGP), found in the blood of polar fish, is known to prevent ice crystal growth and to depress the freezing temperature, which may in turn protect tissues from freezing injury. The chemical synthesis of AFGP is an attractive alternative to its difficult isolation from natural sources, and this would permit quality control and mass production. In spite of recent success in islet transplantation for the treatment of type 1 diabetes mellitus, existing methods for the long-term preservation of islets are considered to be suboptimal and inadequate, which indicates the need for the development of improved methods. Rat islets were isolated from male Wistar rats, using intraductal collagenase distention, mechanical dissociation, and Ficoll-Conray gradient purification. Islets were cultured overnight and then cryopreserved in RPMI1640 in the presence of dimethyl sulfoxide (Me2SO) and 10% FCS with various concentrations of syAFGP, followed by slow cooling (0.3 degrees C/min) and rapid thawing (200 degrees C/min) as described by Rajotte. The freezing process was observed by cryomicroscopy. Islet recovery post-cryopreservation was 85.0 +/- 6.2% with syAFGP and 63.3 +/- 14.2% without syAFGP, both compared with the pre-cryopreservation counts (P < 0.05). The in vitro islet function measured by insulin release was equivalent to a static stimulation index of 3.86+/-0.43 for the islets that were frozen-and-thawed with syAFGP, compared to 2.98 +/- 0.22 without syAFGP (P < 0.05). At a concentration of around 500 microg/ml syAFGP, a strong attenuation of ice crystal growth and formation was observed by cryomicroscopy and these ice crystals did not cause cryoinjury. In conclusion, the attenuation of ice crystallization by syAFGP improves islet survival and function following cryopreservation and thawing.     

WJSC 6th Anniversary Special Issues（2）:Mesenchymal stem cells Mesenchymal stem cells help pancreatic islet transplantation to control type 1 diabetes

Islet cell transplantation has therapeutic potential to treat type 1 diabetes,which is characterized by autoimmune destruction of insulin-producing pancreatic isletβcells.It represents a minimal invasive approach forβcell replacement,but long-term blood control is still largely unachievable.This phenomenon can be attributed to the lack of islet vasculature and hypoxic environment in the immediate post-transplantation period that contributes to the acute loss of islets by ischemia.Moreover,graft failures continue to occur because of immunological rejection,despite the use of potent immunosuppressive agents.Mesenchymal stem cells(MSCs)have the potential to enhance islet transplantation by suppressing inflammatory damage and immune mediated rejection.In this review we discuss the impact of MSCs on islet transplantation and focus on the potential role of MSCs in protecting islet grafts from early graft failure and from autoimmune attack.     

Human bone marrow mesenchymal stem cells differentiate into insulin-producing cells upon microenvironmental manipulation in vitro

It was recently reported that pluripotent mesenchymal stem cells (MSCs) in rodent bone marrow (BM) have the capacity to generate insulin-producing cells (IPCs) in vitro. However, little is known about this capacity in human BM-MSCs. We developed a nongenetic method to induce human BM-MSCs to transdifferentiate into IPCs both phenotypically and functionally. BM-MSCs from 12 human donors were sequentially cultured in specially defined conditions. Their differentiation extent toward β-cell phenotype was evaluated systemically. Specifically, after induction human BM-MSCs formed spheroid islet-like clusters containing IPCs, which was further confirmed by dithizone (DTZ) staining and electron microscopy. These IPCs expressed multiple genes related to the development or function of pancreatic β cells (including NKX6.1, ISL-1, Beta2/Neurod, Glut2, Pax6, nestin, PDX-1, ngn3, insulin and glucagon). The coexpression of insulin and c-peptide was observed in IPCs by immunofluorescence. Moreover, they were able to release insulin in a glucose-dependent manner and ameliorate the diabetic conditions of streptozotocin (STZ)-treated nude mice. These results indicate that human BM-MSCs might be an available candidate to overcome limitations of islet transplantation.     

Mechanism of PDX-1 protein transduction

PDX-1 plays a central role in differentiation of insulin-producing cells. We previously reported that exogenous PDX-1 protein can permeate cells and induce insulin gene expression in progenitor cells. These data suggest a strategy for facilitating differentiation into insulin-producing cells. Here we show the mechanism of PDX-1 protein transduction. Initially, a punctate cytoplasmic distribution of PDX-1 protein transduction domain (PTD), which co-localized with an endosomal marker, was observed in treated cells. However, homogeneous distribution of PDX-1-PTD was observed in some cells, indicating that PDX-1 is transduced by endocytosis and then released. The experiments using inhibitors suggested that the PDX-1 is transported through the Golgi complex and to the endoplasmic reticulum. Moreover, we observed in real-time PDX-1-PTD release from endosomes. These data suggest that mechanism of transduction of PDX-1 protein is by endocytosis and subsequent release from the endosome homogeneously in cytoplasm and nuclei, and that PDX-1 protein transduction could be a valuable strategy for facilitating differentiation of progenitor cells into insulin-producing cells.