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1型糖尿病患者接受同种异体胰岛移植的五年随访:伊利诺伊大学芝加哥分校的经验

Five-year follow-up of patients with type 1 diabetes transplanted with allogeneic islets: the UIC experience.

作者信息

Qi Meirigeng, Kinzer Katie, Danielson Kirstie K, Martellotto Joan, Barbaro Barbara, Wang Yong, Bui James T, Gaba Ron C, Knuttinen Grace, Garcia-Roca Raquel, Tzvetanov Ivo, Heitman Andrew, Davis Maureen, McGarrigle James J, Benedetti Enrico, Oberholzer Jose

机构信息

Division of Transplantation, Department of Surgery, University of Illinois at Chicago, 840 South Wood Street CSB (Rm 402), Chicago, IL, 60612, USA.

出版信息

Acta Diabetol. 2014 Oct;51(5):833-43. doi: 10.1007/s00592-014-0627-6. Epub 2014 Jul 18.

Abstract

This report summarizes a 5-year phase 1/2 allogeneic islet transplantation clinical trial conducted at the University of Illinois at Chicago (UIC). Ten patients were enrolled in this single center, open label, and prospective trial in which patients received 1-3 transplants. The first four subjects underwent islet transplantation with the Edmonton immunosuppressive regimen and the remaining six subjects received the UIC immunosuppressive protocol (Edmonton plus etanercept and exenatide). All 10 patients achieved insulin independence after 1-3 transplants. At 5 years of follow-up, 6 of the initial 10 patients were free of exogenous insulin. During the follow-up period, 7 of the 10 patients maintained positive C-peptide levels and a composite hypoglycemic score of 0. Most patients maintained HbA1c levels <6.0 % (42.1 mmol/mol) and a significantly improved β-score. In conclusion, this study demonstrated long-term islet graft function without using T cell depleting induction, with an encouraging outcome that includes 60 % of patients remaining insulin independent after 5 years of initial transplantation.

摘要

本报告总结了在伊利诺伊大学芝加哥分校(UIC)进行的一项为期5年的1/2期同种异体胰岛移植临床试验。10名患者参与了这项单中心、开放标签的前瞻性试验,患者接受了1至3次移植。前4名受试者采用埃德蒙顿免疫抑制方案进行胰岛移植,其余6名受试者接受UIC免疫抑制方案(埃德蒙顿方案加依那西普和艾塞那肽)。所有10名患者在1至3次移植后均实现了胰岛素自主。在5年的随访中,最初10名患者中有6名不再使用外源性胰岛素。在随访期间,10名患者中有7名维持了C肽阳性水平,综合低血糖评分为0。大多数患者维持糖化血红蛋白水平<6.0%(42.1 mmol/mol),β评分显著改善。总之,本研究证明了在不使用耗竭性T细胞诱导的情况下胰岛移植的长期功能,其结果令人鼓舞,包括60%的患者在初次移植5年后仍保持胰岛素自主。

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