Revascularization of Islets to Treat Type I Diabetes

描述（由申请人提供）：朗格汉斯胰岛的移植是治疗1型糖尿病的一个潜在的长期解决方案。在最近的临床试验中，大量用于移植的人类胰岛与高度发达的免疫抑制治疗方案相结合取得了显著的成功。结果表明，治疗对少数患者是多么有效，但捐献者提供的人类胰岛数量远不足以满足人口的需求。猪是最佳的非人类胰岛供体。为了使胰岛移植达到最佳效果，很可能必须通过增加移植胰岛的血液供应来改善其生存。内皮细胞（EC）已被用于在三维胶原凝胶中形成新生微血管床。我们已经证明过表达Bcl-2可以增强血运重建并保护人类EC免受细胞毒性淋巴细胞的破坏。在这些胶原凝胶中，将开发条件来创造血运重建的猪胰岛或“微器官”，以促进胰岛在体内的存活和功能。将人类内皮细胞和胰岛结合起来，并对其结构/功能特性进行表征。我们将通过葡萄糖耐量试验和胰岛素分泌来测试这些移植物的功能。我们将确定人类微血管与猪胰岛的最佳组合。将进行原理实验证明，这些微型器官可以治疗化学诱导的糖尿病。利用来自胰岛微器官受体的同基因EC形成微血管在临床上可能是可取的。因此，我们将尝试从CD34+祖细胞中培养足够的EC来形成微器官。最后，我们将在免疫缺陷小鼠模型中通过重建人类免疫系统来评估移植物的免疫原性。这些研究可能会导致治疗I型糖尿病的新方法，提高胰岛移植的效率，并解决严重缺乏供体胰岛的问题。

DESCRIPTION (provided by applicant): A potential long term solution to type I diabetes is the transplantation of the islets of Langerhans. Notable success in recent clinical trials has been achieved with large numbers of human islets used for transplantation combined with highly developed immunosuppressive treatment protocols. The results show how effective treatment can be for a few patients but there are nowhere near adequate numbers of human islets available from donors to meet the needs of the human population. The best candidate non-human donor for islets is the pig. For islet transplantation to be optimal it is likely that improvements in their survival must be made by increasing the blood supply to the transplanted islet. Endothelial cells (EC) have been utilized to form a de novo microvascular bed in three-dimensional collagen gels. We have shown that overexpression of Bcl-2 enhances revascularization and protects human EC from destruction by cytotoxic lymphocytes. Conditions will be developed to create revascularized porcine islets or "microorgans" in these collagen gels to promote islet survival and function in vivo. Human endothelial cells and islets will be combined and their structure/function properties characterized. We will test the functionality of these grafts by performing glucose tolerance tests and insulin secretion over time. We will determine the optimum combination of human microvessels with pig islets. Proof of principle experiments will be done to show that these microorgans can cure chemically induced diabetes. It might be clinically desirable to utilize syngeneic EC from an islet microorgan recipient for the formation of microvessels. Therefore we will attempt to culture sufficient EC derived from CD34+ progenitor cells to form the microorgans. Finally, we will evaluate the immunogenicity of the microorgan grafts by reconstitution of the human immune system in immunodeficient mouse models. These studies could lead to new methodologies to treat type I diabetes enhancing both the efficiency of islet transplantation and address the severe lack of donor islets.