Patent Application
20170073641
The application relates to the field of biotechnology, medicine, and cell culture. It specifically relates to, e.g., methods of producing compositions (also identified as “Neo-Islets” or “cell clusters”) that include stem cells and islet cells. It also relates to the utilization of Neo-Islets comprising stem cells and islet cells for treatment of, for example, insulin-dependent diabetes mellitus, noninsulin-dependent diabetes mellitus, or impaired glucose tolerance.
Insulin-producing β-Cells, when isolated from a donor pancreas, generally proliferate very poorly ex vivo, i.e., not sufficiently to generate adequate cell numbers for the treatment of insulin-dependent diabetes mellitus. Current technologies and many preclinical therapies designed to overcome this shortage and provide diabetic patients with a long-lasting, physiologically released insulin replacement therapy (islet and pancreas transplants; precursor cell-derived therapies, etc.) are hampered both by the shortage of donor cells and the need to suppress the patient's immune system, leading to a new set of adverse effects for the patient, such as opportunistic infections and malignancies. The great shortage of suitable pancreas donors combined with the need for repeated islet transplants, requiring up to five donors each, continues to prevent the general availability of these expensive therapies. Micro- and macro-encapsulation systems of insulin-producing cells are tested to facilitate immune isolation and overcome this problem. However, the utilized encapsulation materials represent foreign bodies and can induce an auto-immune response that will result in the failure of the therapy or require prolonged use of anti-rejection drugs.
Described herein are Neo-Islets comprising: a) dedifferentiated islet cells and mesenchymal and/or adipose stem cells; or b) redifferentiated islet cells and mesenchymal and/or adipose stem cells.
Further described herein are methods of generating a Neo-Islet, the methods comprising: culturing a) dedifferentiated islet cells and mesenchymal and/or adipose stem cells; or b) redifferentiated islet cells and mesenchymal and/or adipose stem cells, on a surface that promotes/allows the formation of Neo-Islets. In embodiments, the surface is a hydrophobic and/or ultra-low adhesion surface.
Also described are methods of treating a subject, the methods comprising: providing to the subject the Neo-Islets described herein. Additionally described are methods of treating a subject suffering from Type 1 Diabetes Mellitus or Type 2 Diabetes Mellitus, by, e.g., providing to the subject Neo-Islets as described herein.
The patent or application file contains at least one drawing executed in color. Copies of this patent or patent application publication with color drawing(s) will be provided by the Office upon request and payment of the necessary fee.
The disclosed methods, cells, and Neo-Islets overcome the limited ability to generate sufficient therapeutic doses of isolated and cultured islet cells from a single pancreas donor and provide them to a subject in need thereof.
As used herein, Islets may comprise any of the cells found in mammalian pancreatic islets, including but not limited to Alpha cells, Beta cells, Delta cells, Gamma cells, and Epsilon cells. In one embodiment Islets comprise at least insulin expressing Beta cells.
As used herein, Neo-Islets may comprise Bone Marrow-derived Mesenchymal Stem Cells and/or Adipose-derived Stem Cells, and dedifferentiated islet cells, and/or redifferentiated islet cells. The redifferentiated islets may comprise any of the cells found in mammalian pancreatic islets, including but not limited to Alpha cells, Beta cells, Delta cells, Gamma cells, and Epsilon cells. Thus, the Neo-Islets hereof preferably produce, among other things, insulin, glucagon, somatostatin, pancreatic duodenal homeobox-1, insulin transcription factor mafA, nk6 homeobox-1, etc. (see, e.g.,
Embodiments include Neo-Islets, generated in vitro, which are the approximate size of pancreatic islets. Such Neo-Islets may comprise Bone Marrow-derived Mesenchymal Stem Cells (MSCs) and/or Adipose-derived Stem Cells (ASCs), dedifferentiated islet cells (which do not express insulin), and/or redifferentiated islet cells. Culture-expanded islet cells that are dedifferentiated via Epithelial-Mesenchymal Transition (EMT), then aggregated with MSCs and/or ASCs into the Neo-Islet cell clusters, which will spontaneously redifferentiate and resume regulated insulin secretion when administered to subjects. Pancreatic islets, like all organs, possess small numbers of MSCs and/or ASCs that intrinsically, as pericytes, exert robust anti-inflammatory, complex immune-protective, survival and tissue repair-supporting actions. Neo-Islets containing dedifferentiated cells may be treated to cause redifferentiation, the redifferentiation resulting in the Neo-Islets comprising redifferentiated islet cells that express insulin. In vitro creation of Neo-Islets, composed of culture expanded islet cells and much higher numbers of healthy MSCs and/or ASCs, enable these Neo-Islets, mediated by the pleiotropic actions of MSCs and/or ASCs, to withstand inflammatory, immune and other insults when administered to subjects with impaired glycemic control, such as Type 1 Diabetes Mellitus, Type 2 Diabetes Mellitus, and other types of insulin-dependent diabetes mellitus, or impaired glucose tolerance.
The MSC/ASC component of the Neo-Islets provides immune isolation, protection, and increased survival of the islet-derived component (the dedifferentiated islet cells or redifferentiated islet cells), thereby preventing rejection and enhancing engraftment of the Neo-Islets. Amplification of the potent immune-modulating activities of normal MSCs and/or ASCs in Neo-Islets provide auto- and allo-immune isolation of islet cells, thereby eliminating the need for anti-rejection drugs or encapsulation devices. Moreover, the MSC/ASC component of the Neo-Islet may induce, via the release of hepatocyte growth and other factors, reversal of the Epithelial to Mesenchymal transition, thus facilitating redifferentiation of dedifferentiated islet cells into insulin producing cells in vivo.
It is generally more efficient to create Neo-Islets of dedifferentiated/redifferentiated islet cells with ASCs or MSCs than it is to fuse the islet cells with ASCs or MSCs in order to immune-isolate the islet cell. While fusing cells is effective, it is highly inefficient, with only approximately 30% of cells becoming fused, and the majority of cells being lost during purification processes. Furthermore, fusion of different cell types has been associated with the development of malignancies, and thus fused cells may not be safe for therapeutic use.2
In further embodiments, the Neo-Islets are administered intra-peritoneally (i.p.). The ability of the mammalian omentum to take up foreign bodies and various cell types facilitates the durable and spontaneous engraftment of the Neo-Islets, which then deliver insulin to the subject physiologically, i.e., into the portal vein of the liver, additionally optimized by superior peritoneal glucose sensing to that in the subcutaneous space (see, D. R. Burnett, L. M. Huyett, H. C. Zisser, F. J. Doyle, and B. D. Mensh, “Glucose sensing in the peritoneal space offers faster kinetics than sensing in the subcutaneous space,” Diabetes 63:2498-505 (2014), incorporated herein by this reference). The physiological route of insulin delivery might reduce insulin resistance, insulin-enhanced lipogenesis and potentially harmful exposure of peripheral tissues to high concentrations of insulin. For these reasons the omentum is uniquely suited for implantation of the Neo-Islets, in addition, should the need arise the Neo-Islets can be removed from the subject via an omentectomy (surgical removal of part or all of the omentum).
In further embodiments, should there be evidence for premature rejection of Neo-Islets, a short initial course with rapamycin will be administered to the subject to improve Neo-Islet survival and function. If a recipient of this therapy lacks or has a damaged omentum, an intra portal vein transplant or a suitable encapsulation device would be utilized.
Methods disclosed included methods for the generation of Neo-Islets.
One non-limiting example of such a method comprises:
The dedifferentiated islet cells may be proliferated prior to forming Neo-Islets.
An additional example of such a method comprises:
The dedifferentiated islet cells may be proliferated before culture with the stem cells to form Neo-Islets.
Yet another example of such a method comprises:
The dedifferentiated islet cells may be proliferated before culture with the stem cells to form Neo-Islets.
Another example of such a method comprises:
The dedifferentiated islet cells may be proliferated prior to redifferentiation.
In each of the above examples of methods, Neo-Islets may be coated with hydrogel. Such coating may be performed after any step in which a Neo-Islet is formed or prior to infusing or providing Neo-Islets to a subject.
In each of the above examples of methods, Neo-Islets may be contained within an encapsulation device. Such encapsulation may be performed after any step in which a Neo-Islet is formed or prior to infusing or providing Neo-Islets to a subject
In various embodiments, the Neo-Islets may be immune privileged. As used herein, “immune privileged” refers to Neo-Islets described herein eliciting a less robust immune response than cells or Neo-Islets that are not immune privileged. In various embodiments, the immune response to “immune privileged” cells or Neo-Islets may be 0, 5, 10, 20, 30, 40, 50, 60, 70, 80, 90, 95% or 100% or less than the immune response to non-immune privileged cells or Neo-Islets.
Differentiated islet cells express, e.g., insulin, but do not proliferate, or proliferate only minimally, in vitro. Isolated islet cells may be induced to dedifferentiate in vitro. As used herein, “dedifferentiated” islet cells or islet cell nuclei are cells or nuclei that no longer express or produce insulin when challenged with glucose. The process of dedifferentiation is also referred to herein as an Epithelial-Mesenchymal transition or an “E to M” transition. Dedifferentiated islet cells may proliferate in culture at a rate superior to differentiated islet cells. Dedifferentiation of the islet cells may immediately reduce or silence insulin expression, insulin synthesis, insulin storage, and/or glucose-induced insulin secretion in these cells. Isolated islet cells may be from any suitable host (e.g., rodent, canine, human, or other mammal).
Dedifferentiated islet cells may be allowed to proliferate in vitro to form a large pool of cells that may be co-cultured with other cell types.
Proliferation associated dedifferentiation may be achieved by culturing islet cells in conditions which are adherent for the islet cells. In various embodiments, the islet cells may be cultured on a surface that has been coated with or not coated with laminin 511 or laminin 411. Dedifferentiation may optionally be performed in a dedifferentiation medium. Dedifferentiation medium may include a glucagon-like peptide 1 (GLP-1) receptor agonist. In specific embodiments, the GLP-1 receptor agonist may be GLP-1, exenatide, liraglutide, lixisenatide, albiglutide, taspoglutide, and/or Exendin-4. The GLP-1 receptor agonist may be present in the dedifferentiation culture medium at a concentration from 0.1 to 100 nM, from 1 to 50 nM, or at 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 25, 26, 27, 28, 29, or 30 nM.
Culturing of isolated islets and/or islet cells on laminins (e.g., Laminin 411 and 511), and addition of suitable media, may improve cell adhesion in culture, support cell survival, and moderately boost proliferation. For dedifferentiation, islet cells may be plated on a suitable substrate that allows for attachment. In specific embodiments, the substrate may include Laminin 411 and/or Laminin 511. In a more specific embodiment, β-cells may be plated on tissue culture flasks or wells coated with Laminin-411 and/or Laminin-511 and placed in RPMI, DMEM, alpha MEM, CMRL, PIM, or other suitable culture medium and supplemented with 10% to 20% fetal bovine serum or other species specific serum or platelet lysate, and glutamine/penicillin/streptomycin. The culture medium may also be supplemented with at least 10 nM Exendin-4.
Examples of sera in which the Neo-Islets may be cultured include, but are not limited to, sera available from worldwideweb.sigmaaldrich.com. Specific non-limiting examples include: Fetal Bovine Serum, Bovine Calf Serum, Adult Bovine Serum, Chicken Serum, Goat Serum, Porcine Serum, Rabbit Serum, Sheep Serum, Horse Serum, Canine Serum, Baboon Serum, Coyote Serum, Goose Serum, Mouse Serum, Rat Serum, Rhesus Monkey Serum, Serum Replacement, and Human Serum.
MSCs and ASCs are undifferentiated, adult stem cells that proliferate well, and do not produce insulin.
Dedifferentiated islet cells proliferate well, but do not, or only minimally express or secrete insulin. In some embodiments, dedifferentiated islet cells are allowed to proliferate to generate sufficient numbers for subsequent manipulation. In certain embodiments, once sufficient dedifferentiated islet cells have been generated the cells are treated with an islet cell or beta cell-specific redifferentiation medium. Redifferentiation of the islet cells restores insulin production, resulting in the re-expression of physiological insulin expression, synthesis, storage, and glucose-sensitive insulin release.
Described is the redifferentiation of dedifferentiated islet cells to generate a redifferentiated islet cell. Redifferentiation, as used herein, refers to the treatment of dedifferentiated islet cells to generate a redifferentiated islet cell having restored expression of physiological insulin expression, synthesis, storage, and glucose-sensitive insulin release. In certain embodiments, redifferentiation may be a two-step process.
In a first step, a dedifferentiated islet cell may be exposed to a culture medium containing a low level of glucose. The low level of glucose may be selected from 1, 2, 3, 4, 5, 5.1, 5.2, 5.3, 5.4, 5.5, 5.6, 5.7, 5.8, 5.9, and 6 mM D-glucose. The medium may contain other components such as Insulin/Transferrin/Selenium (ITS), penicillin/streptomycin (Pen/Strep), fetal bovine serum (FBS), dog serum, or human platelet lysate. The first step may include culturing the dedifferentiated islet cell in the culture medium containing a low level of glucose for 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 1 to 14, 2 to 13, 3 to 12, 4 to 10, or 5 to 9 days.
In a second step, the dedifferentiated islet cell may be exposed to a culture medium containing a high level of glucose. The high level of glucose may be selected from 15, 16, 17, 18, 19, 20, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, and 35 mM D-glucose. The medium may contain other components such as insulin/transferrin/selenium (ITS), penicillin/streptomycin (Pen/Strep), fetal bovine serum (FBS), dog serum, or human platelet lysate, N2 supplement, B27 supplement, nicotinamide, Activin A, Alk-5 inhibitor II, triiodothyronine, and a glucagon-like peptide 1 (GLP-1) receptor agonist. Nicotinamide may be present in the culture medium at a concentration from 0.1 to 100 mM, from 1 to 50 mM, or at 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 25, 26, 27, 28, 29, or 30 mM. Activin A may be present in the culture medium at a concentration from 0.1 to 100 mM, from 1 to 50 mM, or at 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 25, 26, 27, 28, 29, or 30 mM. The GLP-1 receptor agonist may be present in the culture medium at a concentration from 0.1 to 100 nM, from 1 to 50 nM, or at 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 25, 26, 27, 28, 29, or 30 nM. The Alk-5 inhibitor II may be present in the culture medium at a concentration from 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 25, 26, 27, 28, 29, or 30 μM. The triiodothyronine may be present in the culture medium at a concentration from 0.1 to 100 μM. The GLP-1 receptor agonist may be Exendin-4. The second step may include culturing the dedifferentiated islet cell in the culture medium containing a high level of glucose for 10, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 10 to 28, 11 to 27, 12 to 26, 13 to 25, or 14 to 29 days.
In some embodiments, a method is provided for generating insulin-producing cells through a substantial expansion in the amount of starting material (dedifferentiated islet cells) for subsequent culturing with proliferating MSCs or ASCs.
Methods are disclosed for the formation of the Neo-Islets as described herein. Such Neo-Islets may be approximately the size of islets found in the pancreas. Neo-Islets may be formed, e.g., by any method known in the art. In a non-limiting example, Neo-Islets are formed by the culturing of cells on hydrophobic, ultra-low adhesion surfaces.
Examples of hydrophobic and/or ultra-low adhesion surfaces include, but are not limited to untreated polystyrene, low attachment hydrogel layers, and uncharged surfaces.
Also described are methods of treating a subject in need of insulin and/or suffering from Type 1 (“T1DM”) or Type 2 Diabetes Mellitus (“T2DM”), or suffering from impaired glucose tolerance or Prediabetes Mellitus, using the described Neo-Islets is disclosed. In some embodiments, Neo-Islets are administered intraperitoneally (i.p.) and/or to the omentum of the subject. In certain embodiments, Neo-Islets are administered s.c., i.v., or otherwise parenterally to the subject. In certain embodiments, administration of the Neo-Islets to the subject increases and/or restores insulin production, secretion, and glucose-responsiveness. In certain embodiments, the Neo-Islets may be coated with hydrogel or other FDA approved material prior to administration to further enhance survival of the Neo-Islets in vivo, such as gelfoam, or a thrombin clot. In embodiments where the Neo-Islets contain dedifferentiated islet cells, these cells may undergo redifferentiation in the subject after treatment of the subject with the Neo-Islets.
Methods of treating subjects with Neo-Islets comprise providing a sufficient dose of the Neo-Islets to a subject suffering from T1DM, T2DM, or impaired glucose tolerance to increase and/or restore insulin production, secretion, and glucose-responsiveness. This dose would be understood by those of ordinary skill in the art to vary depending on the route of administration, the degree of pathology in the subject to be treated, and the subject's response to therapy, see, e.g., Example 5 below discussing the doses of Neo-Islets administered i.p. in animal models. In certain embodiments, subsequent doses of Neo-Islets could be administered to the subject depending on their initial response to therapy.
The high efficiency (i.e. the very small loss of viable cells) of the methods described herein also provides a significant increase in the number of doses that can be obtained from a single pancreas over currently conventional treatment. For example, based on the average number of islets that can be obtained from a canine pancreas, expanding the islet cells to a first passage results, on average, the ability to generate 774 doses of neo-islets for a 10 kg canine. If the islet cells are expanded to a second passage results, on average, the ability to generate 1,550 therapeutic doses of neo-islets for a 10 kg canine. If these numbers are used as the basis for human treatment, it is estimated that 1,000 to 2,000 doses of neo-islets for a 70 kg human can be obtained per human pancreas. In contrast, current human islet transplants require approximately 4 pancreata for a single human dose. Further, repeat doses are often needed to achieve insulin independence.
“Treating” or “treatment” does not require a complete cure. It means that the symptoms of the underlying disease are at least reduced, and/or that one or more of the underlying cellular, physiological, or biochemical causes or mechanisms causing the symptoms are reduced and/or eliminated. Insulin requirements may be reduced. End organ damage may be reduced. The need for anti-rejection drugs may be reduced or eliminated. It is understood that reduced, as used in this context, means relative to the state of the disease, including the molecular state of the disease, not just the physiological state of the disease.
The treatment (especially in the early stages) may be aided by the administration of insulin and/or oral hypoglycemic agents (or drugs). Such drugs include the biguanides (e.g., metformin), sulfonylureas (e.g., glimepiride, glyburide, or glipizide), meglitinides (e.g., repaglinide), diphenylalanine derivatives (e.g., nateglinide), thiazolidinediones (e.g., pioglitazone), DPP-4 inhibitors (e.g., sitagliptin, saxagliptin, linagliptin), alpha-glucosidase inhibitors (e.g., acarbose or miglitol), bile acid sequestrants (e.g., colesevelam), etc. Dosages and administration of such drugs, adjuvants and/or intermediate treatment(s) would be readily determined by a person of ordinary skill in the art and dependent on the subject being treated, and need not be repeated here.
Also described are methods of preparation and packaging the Neo-Islets known in the art to allow for preparation of the Neo-Islets remotely from the subject to be treated while ensuring survival of the Neo-Islets before administration, further enhancing survival of the Neo-Islets in vivo after administration. For instance, various implants are well known to those of ordinary skill in the art. Encapsulation and microencapsulation devices and methods are also well known.
Packaging may be accomplished, for example, by means known in the art, such as packaging fresh or frozen Neo-Islets into, e.g., syringes, sterile bags, infusion bags, bottles, etc., for delivery to a subject or health care practitioner. Plasmalyte A pH 7.4 maybe extremely useful in packaging the Neo-Islets.
The use of animal models, including rodent and canine models, is well understood by those of ordinary skill in the art to provide a useful tool in developing treatments for human diabetes (Aileen J. F. King, “The use of animal models in diabetes research,” Br. J. Pharmacol., 2012 June; 166(3):877-894). Indeed, as King notes, it is ideal to provide more than one animal model to better represent the diversity of human diabetes, as is disclosed herein. The description provided would enable those of ordinary skill in the art to make and use Neo-Islets to treat T1DM, T2DM, and impaired glucose tolerance in humans without any undue experimentation.
In some embodiments, the subject may be a mammal, such as, for example, a rodent, canine, feline, equine, or human. In further embodiments, cells in the Neo-Islet may be allogenic, xenogenic, or a combination of allogenic and xenogenic cells in relation to the subject or other cells in the Neo-Islet.
As used herein, “comprising,” “including,” “containing,” “characterized by,” and grammatical equivalents thereof are inclusive or open-ended terms that do not exclude additional, unrecited elements or method steps, but also include the more restrictive terms “consisting of” and “consisting essentially of.”
The following examples are provided for illustration purposes only and are not to be construed as limiting the disclosure to the embodiments specifically disclosed therein.
Since Pancreatic islets, like all tissues, possess small numbers of Mesenchymal Stem Cells, as pericytes, that exert immune-modulating, anti-inflammatory and other protective trophic effects locally,3-9 we hypothesized and tested whether Neo-Islets (NIs) comprising endocrine islet cells with much higher numbers of MSCs/ASCs could be formed, and whether such Neo-Islets would provide effective: (i) Autoimmune-Isolation without encapsulation devices, (ii) Survival benefits of allogeneic Neo-Islets in vivo, thereby reducing or eliminating the need for anti-rejection drugs, (iii) Redifferentiation in vivo of islet cells, and thereby (iv) Adequate and physiologic insulin secretion and durable maintenance of euglycemia in rodents with T1DM.
The unique and well documented pleiotropic and largely comparable actions of bone marrow-derived Mesenchymal Stromal Cells (MSCs) or adipose tissue-derived Adipose Stem Cells (ASCs), if combined with equal numbers of islet cells in islet-sized cell clusters or “Neo-Islets” (NI), are harnessed to shield administered β-cells from allo- and auto-immune attacks and inflammatory damage, and to enhance β-cell survival and induce angiogenesis. Physiologically, only about 2% of the total cell numbers in islets are thought to represent MSCs, located as pericyte-like cells in microvascular niches. Their cytoprotective functions within the islets likely parallel those in the bone marrow and other organs, i.e., vasculo-protection and stabilization, anti-inflammatory, trophic and immune-modulating activities. Such NIs of approximate islet size were generated in vitro from culture expanded, via Epithelial-Mesenchymal Transition (EMT) and associated dedifferentiation, islet cells and bone marrow-derived MSCs of C57Bl/6 mice. 5×103 NIs, each composed of ˜500 islet cells and ˜500 MSCs, were intraperitoneally (i.p.) administered to spontaneously diabetic, immune-competent NOD mice that develop an auto-immune form of T1DM that largely resembles human T1DM. This allogeneic treatment protocol was chosen as it models the most common clinical situation in recipients of pancreas or islet transplants. By not using anti-rejection drugs or encapsulation devices, we rigorously tested that high numbers of MSCs in NIs do enable islet cells to survive, redifferentiate into normally functioning endocrine cells, and thereby durably establish glycemic control in NOD mice with autoimmune T1DM. While NI treated diabetic NOD mice thrived normally, vehicle treated, diabetic NOD mice remained hyperglycemic and began to die. These initial data implied that NIs survive, engraft, and redifferentiate into functional endocrine cells in vivo, and that both allo- and auto-immune protection is achieved. Importantly, following i.p. administration the NIs were taken up by the omentum where they engrafted long term and redifferentiated into physiologically insulin-producing cells. NOD mice did not mount a humoral allo-immune response to the MSCs and islet cells that are used to form NIs. NI-treated diabetic animals showed a significant increase in regulatory T cell (Treg) numbers in their omenta and spleens compared to animals that were treated with islets. When NIs were injected into nondiabetic animals, they also engrafted and survived in the omentum without causing hypoglycemia, further demonstrating regulated insulin secretion. Insulin secretion from the omentum occurs into the portal system of the liver, as does that from the pancreas, which is physiologic and results in inactivation of ˜50% of the delivered insulin. This limits the post-hepatic exposure of muscle, adipose tissue, the vasculature and other organs to supraphysiological, potentially hypoglycemia-inducing and otherwise harmful insulin levels that are generated when insulin is subcutaneously given. When streptozotocin (STZ) diabetic mice were treated with similarly sized cell clusters composed of either only MSCs or Islet cells, blood glucose levels, compared to NI treated, euglycemic animals, were only minimally lowered compared to vehicle treated controls. This clearly demonstrated that the therapeutic efficacy of NIs depends critically on the collaboration of MCSs and islet cells. Finally, when STZ-diabetic NOD/SCID mice were treated i.p. by identical protocol with canine NIs (cNI), euglycemia was readily and durably induced and intraperitoneal Glucose Tolerance Tests (IP GTT) were normalized. Importantly, the insulin that was released during the IP GTT was canine specific, and when cNIs were surgically removed, hyperglycemia redeveloped. Taken together, the present data demonstrate that the complex pleiotropic actions of MSCs or ASCs (M/ASCs), as hypothesized, can be readily harnessed to protect cultured islet cells, and when combined with them in NIs and administered i.p., facilitate long term glycemic control in mice with autoimmune T1DM. We conclude, therefore, that these observations have significant translational relevance for the treatment of T1DM.
Reagents:
Reagents used and their sources are listed in the following table.
From Rodents: Mice were euthanized with Isoflurane (3-5%) in a sealed chamber, and immediately placed on a surgical board for a sterile midline incision. The pancreas was exposed, the pancreatic duct located. The common bile duct was clamped, and the pancreas was inflated with 5 ml/mouse or 15 ml/rat 1 mg/ml Collagenase P in Dissociation Buffer (Hanks Buffered Saline Solution (HBSS), Ca++, Mg+++25 mM HEPES+NaHCO3) via the common bile duct. The inflated pancreas was removed to a sterile conical tube containing digestion solution (1 mg/ml Collagenase P in Dissociation Buffer.). The tube was placed in a 37° C. shaking water bath (120 rpm) and the contents digested for 15 minutes. The digestion was stopped with an equal volume of cold Dissociation Buffer. The digested tissue was filtered through a 400 μm screen into a fresh tube, and centrifuged at 1200 rpm for 2 minutes at 4° C. with the brake off. The pellet was washed with 20 ml Dissociation Buffer and centrifuged again (1200 rpm for 2 minutes at 4° C. with the brake off). To purify the islets further, the pellet was resuspended in 10 ml Histopaque 1077 solution and overlayed with 10 ml serum free DMEM-F12 to set up a gradient. The gradient was centrifuged at 2000 rpm for 20 minutes at 4° C. with the brake off, and the islets were collected at the interface between the medium and Histopaque into a 50 ml conical tube containing 20 ml Dissociation Buffer. The islets were then centrifuged at 1200 rpm for 2 minutes, washed with 20 ml Dissociation Buffer, spun down again, resuspended in islet culture medium, and placed in a sterile Petri dish. Islets were allowed to recover in a 37° C., 5% CO2 humidified incubator at pH 7.4 overnight.
From Dogs: Fresh pancreata were obtained from euthanized dogs through an NIH sharing agreement and inflated via the common bile duct, using 1 mg/ml Collagenase P solution. Canine islets were isolated from inflated pancreases following modified versions of techniques described by Vrabelova, et al. and Woolcott, et al.10, 11 In brief, the distended dog pancreas was cut in 15 to 20 pieces and placed in a 50 ml tube containing 20 ml of 1 mg/ml Collagenase P solution. The tube was placed into a 37° C. water bath with the shaker set at 120 rpm. Islet content in the solution was monitored by microscopic examination of dithizone stained samples obtained from small samples taken at 5-minute intervals. Digestion was continued until approximately 50% of islets were free of acinar tissue, and stopped with 20 ml of HBSS supplemented with 10 mM HEPES+1% BSA. The tissue was then gently sieved through a 400-μm screen and centrifuged for 10 seconds at 100×g at 4° C. The pellets were washed once and centrifuged for 10 seconds at 200×g (4° C.). Three layer density gradients were created by resuspending the pellets in 10 ml Histopaque-1.119, slowly layering on top 10 ml of Histopaque-1.077 followed by another layer of 10 ml of serum-free medium. The gradient was spun at 750×g for 20 minutes at 4° C. without brake. Islets were collected from the top interface and transferred to a 50 ml tube containing HBSS supplemented with 10 mM HEPES+1% BSA. The purified islet suspensions were washed with serum-free medium and centrifuged for 10 seconds at 200×g (4° C.) twice and passed through a 40-μm cell strainer. Five 50 μl aliquots from each preparation were collected and used to assess the islet yield. Finally, hand-picked (to remove acinar cell content) islets were cultured in 20% FBS supplemented RPMI 1640 medium at 37° C., in a 5% CO2 incubator.
From Humans: Human islets were purchased from Prodo Laboratories (Irvine, Calif.).
Rodent Islet Cells: Recovered mouse islets were hand-picked and further purified by capturing the islets in the top of a 40 μm filter strainer. Islets were cultured as follows: islet cells were cultured by placing whole islets on Laminin-511 coated wells, and allowing the islet cells to outgrow from the islets until 90% confluent in RPMI 1640+20% FBS+GPS, which results in their dedifferentiation via reversible EMT. Culturing in this manner further purifies islet cells and removes remaining exocrine cells. Passaging: Mouse islet cells were allowed to grow to approximately 90% confluence. They were then trypsinized (1× Trypsin-EDTA for 5-10 minutes), pelleted by centrifugation at 600×g for 5 minutes, washed with DMEMF12+20% FBS+GPS, and seeded into T75 flasks. Passaged islet cells were cultured in DMEM-F12+20% FBS+GPS. Culturing in this manner further purifies islet cells and removes acinar and ductal cells.
Canine Islet Cells: Initial Culture: Recovered dog islets were handpicked and further purified by capturing the islets in the top of a 40-μm filter strainer. Cells were cultured as whole islets as described above for mice. Passaging: see as above for rodent islet cells.
Human Islet Cells: Cells were cultured as whole islets and passaged as described above for rodents.
ASCs (mouse and canine): Under sterile conditions, approximately 3-15 g abdominal fat samples were harvested from euthanized, non-diabetic mice or non-diabetic dogs (NIH tissue sharing agreement) and placed on ice in separate, sterile 50 ml conical tubes containing approximately 30 ml of 1×PBS. The fat samples were minced, placed in tubes of PBS containing 3 mg/ml Collagenase 1, and digested approximately 1 hour in a 37° C. shaking water bath. The tubes were centrifuged (600×g, 10 minutes) to pellet the cellular content. The supernatant was carefully removed, and the pellet washed two times with sterile PBS, and then resuspended in 10 ml DMEM F12+GPS+10% FBS for culture. Cells were cultured in a 37° C. humidified 5% CO2 incubator at pH 7.4. Culture medium was changed twice weekly. When primary cultures reached 70-80% confluence, attached cells were passaged by exposure to 1× trypsin/EDTA for 3-5 minutes, and further passaged or cryopreserved in 10% DMSO.
Non-diabetic Human ASCs were purchased at P1 from Lonza (Walkersville, Md.), and cultured as described above.
MSCs (from rodents): Obtained cell suspensions from flushed femurs of euthanized mice were plated in T25 flasks containing DMEM-F12+10% FBS+GPS. Cells were cultured in a 37° C. humidified 5% CO2 incubator. Culture medium was changed twice weekly. When primary cultures reached 70-80% confluence, cells were detached with 1× trypsin/EDTA for 3-5 minutes, and passaged or frozen in 10% DMSO.
Prior to Neo-Islet formation, cultured MSCs or ASCs are characterized (i) by FACS for their expression of CD44 and CD90, and negative expression of CD45, CD34 and DLA-DR antigens, and (ii) by their abilities to undergo trilineage differentiation (adipogenic, osteogenic, chondrogenic) as previously described.15 Prior to Neo-Islet formation, cultured, dedifferentiated canine islet cells are examined by (a) FACS and confirmed to be negative for expression of DLA-DR, CD90 and CD133; and (b) rtPCR for residual islet cell gene expression of insulin, glucagon, somatostatin, pdx-1, and nkx6.1. Cell viability was assessed using Fluorescein diacetate (FDA) and Propidium Iodide (PI) as follows: 1× staining solution (1 μL of 5 mg/ml FDA and 5 μL of 1 mg/ml PI dissolved in 100 μL PBS) was mixed with cells in 100 μL PBS, incubated at room temperature for 30 seconds and cells were imaged using a fluorescence microscope. Four fields were counted for red, green and total cell numbers.
Canine ASCs were tested at P2 for induction of IDO-1 in response to canine interferon gamma (IFNγ) as follows. Eight 35 mm culture dishes were seeded with 0.5×106 canine-derived ASCs each in DMEM F12+10% canine serum. 10 ng/ml canine INFγ was added to four dishes. After overnight culture in a 37° C. humidified 5% CO2 incubator, cells from all dishes were harvested and assayed for IDO-1 gene expression by rtPCR. Results from IFNγ treated cultures were normalized to those of unexposed cells of the same passage number and expressed as Log 10 RQ.
Rationale: (A) To test whether Neo-Islets comprising (i) dedifferentiated, culture expanded islet cells combined with (ii) much higher numbers of MSCs/ASCs than occurs naturally in islets could be formed. (B) To determine whether and to what extent such Neo-Islets express or can be induced to express islet cell associated genes.
Outgrowth of islet cells: Islet cells were either (1) dissociated with trypsin and cells plated in Laminin-511 and/or Laminin-411 (20 μg/ml) pre-coated Tissue Culture (TC) wells or flasks, or (2) whole islets were plated in Laminin-511 and/or Laminin-411 coated TC wells. See
Neo-Islet formation: ASCs (P1 to P4) or MSCs (P1 to P5) and Islet cells (P1 to P2) were co-cultured at a 1:1 ratio in ultra-low attachment surface culture dishes (Corning, Kennebunk, Me.) and allowed to form NIs overnight. Control ASC and Islet cell clusters were formed by the same method. Prior to their in vivo administration, samples of NIs were tested by rtPCR for expression of islet and MSC associated genes (see below).
Staining for confocal microscopy: ASCs or MSCs were stained with Cell Tracker Green (green), and passaged islet cells were stained with Lipophilic Tracer DiI (red) by following the manufacturers' instructions. Post cell staining, NIs were formed, collected, fixed in 10% formalin and stained with 4′,6-diamidino-2-phenylindole dihydrochloride (DAPI) prior to confocal microscopy.
Lipophilic Tracer DiR labeling of Neo-Islets was carried out following the manufacturer's instructions.
Redifferentiation of Neo-Islets: Re-differentiation of Neo-Islets was achieved in vitro using commercially available additives, in a two-step process. Step 1: Neo-Islets of rodent, canine or human origin were cultured for 6-8 days in serum free DMEM containing 5.6 mM D-glucose and supplemented with: (a) 1% BSA fraction V, (b) ITS-G, (c) GPS. Step 2: After 6-8 days, this medium was replaced with Redifferentiation Medium (RDM) and cultured 2 weeks. RDM is DMEM containing 25 mM glucose and supplemented with: (a) N2 supplement A (commercially available), (b) SM-1 supplement (commercially available), (c) 10 mM Nicotinamide (commercially available), (d) 10 nM exendin 4 (commercially available), (e) 2 nM Activin A (commercially available). Redifferentiation tested and confirmed by rtPCR for expression of islet and MSC associated genes as described below.
Neo-Islet cellular ratio assessment: For each species (mouse, dog, human), adherent cultures of ASCs and dog, mouse ICs were harvested as described above. ASCs were stained green with cell tracker green in order to be able to distinguish them from ICs. Staining efficiency was assessed by FACS and determined to be ≧95%. ICs were left unstained. NIs were formed overnight in six-well ultra-low adhesion plates as described above using 0.5×106 ASCs and 0.5×106 ICs per well in 2 ml DMEM/F12+10% FBS. The next day, NIs were collected and dissociated to single cell preparations by 30 minutes incubation with 1 ml Accumax per well. Single cell preparations were then resuspended in 1×PBS+1% BSA and analyzed by FACS (BD FACScan Analyzer, San Jose, Calif.) for percent green (ASC) vs. unstained (IC) cells.
rtPCR: RNA was extracted from 1×106 cell samples using a Qiagen RNeasy Mini Kit, including a DNase digestion step to exclude contaminating DNA, and following the manufacturer's instructions. Reverse transcription was performed using SuperScript II Reverse Transcriptase for 60 minutes at 42° C. Real-time PCR was carried out in duplicate using species-specific TaqMan primers (Applied Biosystems, ABS, Foster City, Calif.) and following the manufacturer's instructions. All reactions were carried out in a total volume of 20 μL with TaqMan Universal Master Mix II with UNG. Reaction conditions were 50° C. for 2 minutes, followed by a 95° C. for 10 minutes start, and 40 cycles of melting at 95° C. for 15 seconds and annealing at 60° C. for 1 minute. All samples were run in duplicate, and the average threshold cycle (Ct) value was used for calculations. The ABS 7500 Real Time PCR System was used to monitor real-time PCR. Relative quantitation (RQ, normalization) of each target gene was calculated with the Ct method using the ABS software provided with the instrument, and by normalization to two internal housekeeping genes, beta actin and beta 2 microglobulin (B2m). RQ was calculated through normalization to external controls as indicated, and by using the software provided with the machine. Results are presented as log 10 (RQ)±log 10 (RQmin and RQmax). Differences greater than log 10 (RQ) 2 or less than log 10 (RQ)−2 were considered significant. Utilized PCR primers are listed in the following table.
Growth and Characterization of ICs and M/ASCs: The NIs' starting materials, i.e., cultured ICs and M/ASCs, were obtained as follows. Freshly isolated islets from non-diabetic mice, dogs and humans were tested for viability, placed in culture, and grown and passaged as described in the above examples. ICs grow out of the islets, proliferate and dedifferentiate as they undergo EMT, a reversible process. Cultured ICs retain residual IC-associated gene expression profiles that decrease with passaging, and exhibit a gene expression pattern distinct from those of M/ASCs (
Neo-Islet formation and imaging:
NIs of approximate islet size of 150 μm were prepared by overnight co-culturing of bone marrow-derived MSCs or their adipose-derived analogs ASCs (M/ASCs) with culture expanded murine islet cells (ICs) at a 1:1 ratio (found to be optimal) in an ultralow cell adhesion system. An example of this process using mouse cells is shown in
Gene expression profiles and Glucose Stimulated Insulin Secretion of murine, canine and human Neo-Islets: While these Neo-Islets do not express significant levels of insulin, as cultured islet cells undergo an Epithelial to Mesenchymal transition when cultured, they may be redifferentiated in vitro using the redifferentiation protocol outlined above, such that they re-express islet cell genes. When the two cell types, ICs and M/ASCs, were combined to form NIs as shown in
Conclusion: Taken together, these results indicate (i) that Neo-Islets of cultured islet cells and either MSCs or ASCs can be readily formed in vitro; (ii) that across species (mouse, dog, human), such Neo-Islets are similar in appearance and gene expression profiles, expressing low levels of islet associated genes; (iii) that across species (mouse, dog, human) such Neo-Islets are capable of being redifferentiated in vitro to re-express pancreatic endocrine associated genes. Furthermore, these results suggest that these Neo-Islets may be of therapeutic use in treating insulin dependent and non-insulin dependent diabetic humans or animals.
All studies involving animals were conducted in adherence to the NIH Guide for the Care and Use of Laboratory Animals, and were supervised and approved by an institutional veterinarian and member of the IACUC. Mice and rats were purchased from either Jackson Laboratory (Bar Harbor, Me.) or Harlan (Haslett, Mich.), and were housed at constant temperature and humidity, with a 12:12-hour light-dark cycle in regular, shoebox type caging. Unless otherwise indicated, all mice and rats had unrestricted access to a standard diet and tap water. All mouse experiments were carried out using female C57Bl/6, female NOD or female NOD/SCID mice weighing between 15 and 35 g. All rat experiments were conducted on male Sprague-Dawley rats weighing between 538 and 650 g.
Polydextran Particle Omental Uptake Protocol
Four, 2-year-old Sprague-Dawley rats weighing between 538-650 g were anesthetized and treated i.p. with 5 ml polydextran particles (PDP; sterile sephadex G-25, particle size 87-510 μm) suspended 1:1 in Normal Saline. On Day 7 post administration, animals were sacrificed, and their omenta and other organs were harvested and examined for the presence of PDP.
Diabetes Models
Streptozotocin (STZ): Non-Obese Diabetic/Severe Combined Immunodeficiency (NOD/SCID) and C57Bl/6 mice were made diabetic with 3-5 i.p. doses (1 dose per day) of 50-75 mg/kg b.w. STZ, freshly dissolved in 20 mM citrate buffer, pH 4.5. Mice were considered to be diabetic when their non-fasting blood glucose levels were >300 mg/dL on 3 separate days.
Spontaneous: Female NOD mice develop T1DM spontaneously between 12-20 weeks of age. Mice were considered to be diabetic when their non-fasting blood glucose levels were >300 mg/dL on 3 separate days. Insulin treatment: Where indicated in Results and the figures, insulin was administered to diabetic animals via slow-release, sub-cutaneous insulin pellets (Linbits). Animals were anesthetized with isoflurane, and 1-3 Linbit pellets were inserted just under the skin following the manufacturer's instructions. Tail vein blood glucose concentrations were monitored for several days to ensure animals were neither hyper- nor hypoglycemic.
Blood Glucose Monitoring: In all animal studies, blood glucose concentrations were assessed twice per week via tail vein sampling, and using a OneTouch Ultra 2 glucometer (level of detection, 20-600 mg glucose/dL). Anesthesia: Animals were anesthetized with isoflurane, 1-5%, using an inhalation rodent anesthesia system (Euthanex, Palmer, Pa.). Rectal temperatures were maintained at 37° C. using a heated surgical waterbed (Euthanex, Palmer, Pa.).
Treatment of Diabetic NOD Mice with Allogeneic NIs from C57Bl/6 Mice:
Diabetic NOD mice′ blood glucose levels were normalized with Linbits, and NIs, composed of P5 eGFP+MSCs and P1 islet cells (2×105 NIs/kg b.wt. suspended in 0.5 ml serum-free DMEM-F12 medium; N=6) or vehicle (0.5 ml serum-free DMEM-F12 medium; N=6) were sterilely administered i.p., using light isofluorane anesthesia on Day 20 post-Linbit administration. No subsequent exogenous insulin was given in either group. At 10 weeks post NI administration, mice were euthanized, and their omenta, livers, spleens, lungs, kidneys and pancreases were harvested and examined by fluorescence microscopy for the presence of eGFP+ NIs. Sera were also collected to test for an allo-IgG response to the cells that make up the NIs. As a positive control for this test, an additional group of 3 NOD mice was given Linbits and treated i.p. with 2×105 freshly isolated, allogeneic islets/kg b.wt. suspended in 0.5 ml serum-free DMEM-F12. These mice were euthanized 14 days post-islet administration, and their sera harvested and examined as above.
STZ Diabetic C57Bl/6 Mouse Treatment with Syngeneic NIs, ASC-Clusters or IC-Clusters:
Four groups of 10-week old, STZ-diabetic, blood glucose controlled (via Linbits) wt C57Bl/6 mice were administered i.p. (i) 0.5 ml vehicle (serum-free DMEM-F12; N=6), or 2×105/kg b.wt. (ii) freshly formed NIs (P5 eGFP+ MSCs and P1 ICs; N=6), (iii) clusters composed of P1 ASCs only (N=5), or (iv) clusters composed of P1 ICs only (N=5). Mice were followed as indicated. Upon euthanization, omenta, pancreata, spleens, livers, lungs and kidneys were harvested and fluoroscopically examined for the presence of eGFP+ NIs. In addition, islet associated gene expression profiles were obtained in all omenta and pancreata.
Treatment of Non-Diabetic Mice with Mouse or Canine NIs:
Mouse NIs: Six groups of 2 to 4, 12-week old C57Bl/6 mice each were administered i.p. either (i) 2×105/kg b.wt. freshly formed syngeneic NIs (P5 MSCs and P1 ICs) suspended in 0.5 ml serum-free DMEM-F12, or (ii) 0.5 ml serum-free DMEM-F12 (vehicle). Mice were followed for up to 12 weeks. Canine NIs: Two groups of 9-week old NOD/SCID mice were treated i.p. with (i) 2×105/kg b.wt. freshly formed cNIs suspended in 0.5 ml DMEM/F12 (N=6) or (ii) 0.5 ml serum-free DMEM-F12 (vehicle; N=3). Mice were followed for 10 weeks.
To test our central hypothesis in a clinically highly informative autoimmune TIDM model, we first examined whether the i.p. administration of in vitro generated allogeneic NIs could reestablish euglycemia in spontaneously diabetic NOD mice as a reflection of (i) their survival, (ii) the redifferentiation of islet cells contained in the NIs into functional insulin-producing cells in vivo, and (iii) the MSC-mediated cyto-, allo- and auto-immune protection of the transplanted cell clusters.
Treatment of spontaneously diabetic NOD Mice with allogeneic Ms. Since others found that islet progenitor cells and dedifferentiated islet beta cells can differentiate into functional endocrine cells in vivo, we tested whether allogeneic murine NIs as described herein which were administered i.p. to spontaneously diabetic NOD mice, which develop a T-cell mediated, autoimmune form of T1DM, would reestablish euglycemia. This protocol was chosen because it closely resembles the most common clinical situation in which a patient with T1DM receives an allogeneic pancreas or islet transplant. To facilitate both in vivo tracking and post-mortem localization, administered NIs were dually labeled with DiR and composed of P5 MSCs derived from C57Bl/6 mice transgenic for the eGFP gene, constitutively expressed in all tissues, and P1 ICs from wild type C57Bl/6 mice (see
These mice were then divided into two groups and treated i.p. either with 2×105/kg b.wt. NIs from allogeneic C57Bl/6 mice (N=6) or with vehicle (N=6;
Together, these data show that (i) the NIs engraft and survive, (ii) the ICs within the NIs redifferentiate in vivo, providing the mouse with a new, endogenous source of insulin, and (iii) the MSCs contained in the NIs effectively provide cyto-protection and allo- and auto-immune-isolation of the insulin producing cells in NOD mice, and apparently establishing glycemic control in this clinically highly relevant T1DM model.
Collaboration of Islet Cells and M/ASCs within NIs is Essential to Establishing Normoglycemia in Diabetic Animals. To further explore the collaboration between ICs and M/ASCs in NIs, two experiments were conducted and are summarized in
In Vivo Redifferentiation.
Data from the NOD mouse experiment (
Rationale: In Example 5, it was shown that freshly formed Neo-Islets of ASCs and dedifferentiated islet cells express low levels of islet associated genes as well as ASC/MSC associated genes. It was also observed that the endocrine derived component of such Neo-Islets have the capacity to redifferentiate in vitro to re-express higher levels of islet associated genes. Others have shown that endocrine precursor cells can redifferentiate in vivo to produce insulin. We therefore tested (i) whether Neo-Islets comprising canine ASCs and dedifferentiated islet cells can dose-dependently reverse hyperglycemia and affect animal survival, and (ii) whether removal of Neo-Islets would result in the return of hyperglycemia, confirming that Neo-Islets are exclusively responsible for the obtained treatment of T1DM.
Methods
Neo-Islets: Neo-Islets were formed from canine ASCs (passage 2) and canine cultured islet cells (passage 1).
Diabetes Model: Non-obese diabetic/Severe Combined Immunodeficiency (NOD/SCID) mice were made diabetic with 5 i.p. doses of 50 mg/kg body weight Streptozotocin (STZ) in citrate buffer. Once blood glucose levels were >300 mg/dL on 3 separate days, they were given, on Day 0, one slow-release insulin pellet s.c. each (Linbit, Linshin, Canada) in order to control blood glucose levels and thereby avoid glucotoxic cell damage. These pellets expire by approximately 36 days (see
Intraperitoneal Glucose Tolerance Tests (GTT): At 55 days post treatment, 3 vehicle-treated and 5 canine Neo-Islet-treated mice were fasted 5 hours, whereupon baseline blood glucose levels were assessed using a OneTouch Ultra 2 Glucometer (Johnson and Johnson, New Brunswick, N.J.; level of detection limit of 600 mg glucose/dL). Animals were then anesthetized, and 2 g glucose/kg bw (dissolved in serum free medium and filter sterilized) were administered via i.p. injection under isoflurane anesthesia. Blood glucose levels were assessed at 30 minutes, 60 minutes and 120 minutes post glucose administration.
Treatment Protocols
NOD allogeneic treatment: Once female NOD mice were confirmed to be hyperglycemic (non-fasting blood glucose >300 mg/dL on 3 separate days), they were treated s.c. with Linbit pellets. Once animals' blood glucose levels were normalized they were anesthetized (isoflurane), and Neo-Islets, composed of P5 gfp+MSCs and P1 islet cells (2×105 Neo-Islets/kg bw suspended in 0.5 ml serum-free DMEM-F12 medium; n=6) or vehicle (0.5 ml serum-free DMEM-F12 medium; n=3), were administered i.p. No subsequent exogenous insulin was given to animals in either group. Blood glucose levels and body weights were assessed twice per week, and mice were followed for 10 weeks. At 10 weeks post Neo-Islet administration, animals were sacrificed, and their sera, omenta, livers, spleens, lungs and kidneys and pancreases were harvested, and examined for the presence of Neo-Islets and insulin. None were found anywhere but the omenta.
C57Bl/6 syngeneic treatment of STZ diabetic animals: STZ-diabetic, blood glucose controlled (via Linbits) C57Bl/6 mice were anesthetized and administered i.p. either (a) 2×105 freshly formed gfp+ mouse Neo-Islets (P5 gfp+MSCs and P1 islet cells) stained with DiR and suspended in 0.5 ml serum free DMEM-F12 (vehicle; n=3), or (b) 2×105 freshly formed gfp+ mouse Neo-Islets stained with DiR and embedded in gelfoam (n=3). Control group animals were anesthetized and treated i.p. with 0.5 ml vehicle (n=3). Blood glucose levels and weights were assessed at baseline and then twice per week in all animals for 18 weeks. Once per week, the animals were examined under isofluorane anesthesia using a Licor, Pearl Impulse imager to track the Neo-Islets. Upon sacrifice, omentum, pancreas, spleen, liver, lungs and kidneys were harvested and examined for the presence of Neo-Islets. None were found anywhere but the omenta.
Treatment of non-diabetic mice: Mouse Neo-Islet administration: Six groups of 2 to 4 non-diabetic, 12 week old female C57Bl/6 mice (average weight of 21.9 g) each were anesthetized and administered i.p. either (a) 2×105 freshly formed mouse Neo-Islets (P5 gfp+MSCs and P1 islet cells) suspended in 0.5 ml serum-free DMEM-F12 (5 groups sacrificed at different time points for tracking purposes), or (b) 0.5 ml serum free DMEM-F12 (vehicle; 1 group). Blood glucose levels and weights were assessed at baseline and then twice per week for up to 12 weeks. Canine Neo-Islet administration: Two groups of non-diabetic, 9 week old, female NOD/SCID mice weighing 19.7 to 24.8 g were anesthetized administered i.p. either (a) 2×105 freshly formed, DiR stained canine Neo-Islets suspended in 0.5 ml DMEM/F12 (N=6) or (b) 0.5 ml serum free DMEM-F12 (vehicle; n=3). Blood glucose levels and weights were assessed at baseline and then twice per week for 10 weeks. Once per week, the animals were examined under isofluorane anesthesia using a Li-Cor, Pearl Impulse imager to track the Neo-Islets. Upon sacrifice, omentum, pancreas, spleen, liver, lungs and kidneys were harvested and examined for the presence of Neo-Islets. None were found anywhere but the omenta.
NOD/SCID recent onset diabetes, xenogeneic treatment: Groups of female, 20 week old, STZ-diabetic NOD/SCID mice weighing 17-29 g (n=5 per group) whose blood glucose levels were controlled with Linbit pellets were anesthetized and treated i.p. with (a) 2×105 or (b) 8×104 freshly formed, unredifferentiated cNeo-Islets/kg bw embedded in gelfoam, or (c) vehicle (DMEM/F12). Neo-Islets were composed of P1 Islet cells and P2 canine ASCs. Blood glucose levels and body weights were assessed twice per week, and mice were followed for 13 weeks. IP GTTs were performed in the high dose group at 55 days post treatment, and Neo-Islets were surgically removed from the high dose group of mice in week 10.
NOD/SCID remote onset diabetes, xenogeneic treatment: 11 week old female NOD/SCID mice weighing 18.4 to 22.8 g were made diabetic with three i.p. doses of 75 mg/kg body weight STZ in citrate buffer. The diabetic state was confirmed by blood glucose levels of >300 mg/dL on 3 separate days. Once the animals were confirmed to be diabetic, their blood glucose levels were controlled for approximately 3 months with insulin therapy using s.c. linbit pellets. To confirm that all animals were still diabetic prior to Neo-Islet or vehicle administration, Linbits were allowed to expire, and mice to re-develop hyperglycemia. Mice were again treated with Linbits (Day 0) to control blood glucose levels and prevent glucotoxic Neo-Islet damage. Anesthetized mice were then treated i.p. with either (i) 2×105 cNeo-Islets/kg b.w. embedded in gelfoam or (ii) vehicle (0.5 ml DMEM/F12). Neo-Islets were composed of P1 Islet cells and P2 canine ASCs. Blood glucose levels and body weights were assessed twice per week, and mice were followed for 11 weeks. IP GTTs: At 55 days post treatment, 3 vehicle-treated and 5 cNeo-Islet-treated mice were fasted 5 hours, whereupon baseline blood glucose levels were assessed. Animals were then anesthetized, and 2 g glucose/kg bw (dissolved in 0.5 ml serum free medium and filter sterilized) were administered via i.p. injection under anesthesia. Tail vein blood glucose levels were assessed at 30 minutes, 60 minutes and 120 minutes post glucose administration.
ELISA for Canine Insulin: Sera from vehicle and Neo-Islet-treated mice that had been collected during the glucose tolerance tests were examined by ELISA for the presence of canine specific insulin that does not cross react with mouse insulin (Mercodia, Uppsala, Sweden), following the manufacturer's instructions. Sera from a dog, as well as from a C56Bl/6 mouse were also analyzed as positive and negative controls, respectively, for cross-reactivity.
Antibody Response Test: Aliquots of ˜5×104 cells (MSCs, ASCs or islet cells that were used to create the Neo-Islets that were administered) were each incubated with ˜500 μl of serum obtained from Neo-Islet or canine ASC-treated NOD mice ≧14 days post Neo-Islet or ASC administration. The cells were incubated with the sera for 30 minutes at room temperature. After 30 minutes cells were centrifuged at 600×g for 5 minutes, resuspended in FACS buffer and incubated with cy3-conjugated goat-anti-mouse (dilution) IgG antibody. The cells were incubated an additional 20 minutes in the dark at room temperature. One ml 1×PBS+1% BSA was then added, the cells vortexed, centrifuged, resuspended in 400 μl fixation buffer (1% Formaldehyde), and analyzed by FACS (BD FACScan Analyzer, San Jose, Calif.). A shift of >7% of the cells was considered a positive response, indicating that the serum contained antibodies to the tested cells. Embedding Neo-Islets in Gelfoam: Individual doses of Neo-Islets were collected in a 15 ml Falcon tube and centrifuge at 200×g for 2 minutes. The supernatants were discarded, and the pellets resuspended in 0.2 ml serum-free DMEM-F12 each. The Neo-Islet suspensions were then loaded into 0.5×0.5×0.5 cm blocks of sterile Gelfoam, which were incubated in a 37° C. incubator for 3 hours prior to i.p. administration to mice. Neo-Islet embedded in Gelfoam were surgically transplanted under sterile conditions and under anesthesia onto the peritoneal fat-pads and omenta of recipient mice. The abdominal incision was closed with two layer sutures.
In vivo Imaging: In vivo imaging of DiR stained Neo-Islets was performed in anesthetized mice using the Li-Cor, Pearl Impulse imager.
Results
A dose of 2×105 Neo-Islets/kg bw administered i.p. 1 month post STZ achieves and maintains euglycemia and promotes animal survival: Three groups of five NOD/SCID mice each were treated i.p. approximately one month after establishment of STZ-induced T1DM diabetes with (a) 200,000 or (b) 80,000 freshly formed, unredifferentiated canine derived Neo-Islets/kg body weight, suspended in 0.5 ml serum free medium (DMEM-F12), or (c) vehicle (0.5 ml serum free medium). Linbits were given once, ˜1 month after STZ administration (Day 0 in
Intraperitoneal glucose tolerance tests (IP GTTs) were normal in 2×105 Neo-Islets/kg bw-treated animals, and a rise in blood glucose was accompanied by release of canine insulin: IP GTTs (2 g glucose/kg bw) were performed at 54 days post canine Neo-Islet treatment (66 days post Linbit therapy) on NOD/SCID mice that had been treated with either the 2×105 canine Neo-Islets/kg body weight dose or vehicle as described in the Methods. As seen in
Sera from vehicle and Neo-Islet-treated mice that had been collected during the glucose tolerance tests were examined by ELISA for the presence of canine specific insulin that does not cross react with mouse insulin as described in Methods. As can be seen in
Retrieval of canine Neo-Islets reestablishes hyperglycemia: On Day 76, the Neo-Islets were removed from the 2×105 Neo-Islets/kg bw treatment group. As
Conclusion: The results presented in Example 6 demonstrate that freshly formed canine Neo-Islets administered i.p. to recent onset diabetic animals redifferentiate in vivo to provide adequate and physiologic insulin secretion and durable, but reversible, maintenance of euglycemia in rodents with T1DM. In addition the ability to remove the clusters via removal of the omentum is a safety feature of this technology when clinically warranted.
Rationale: (A) It is well known that the Omentum accumulates cells and foreign bodies of various sizes. Thus we hypothesized and tested whether the Neo-Islets when delivered i.p. would be taken up by and engraft in the Omentum. Such a location offers two advantages: (i) As is the case for the pancreas, blood from the Omentum drains directly into the liver via the portal system. Thus insulin made by the Neo-Islets would be delivered in physiological fashion. (ii) The Omentum can be removed without significant ill effects, should it be desired for safety or other reasons that the Neo-Islets be removed. (B) As MSCs and ASCs express potent angiogenic and survival factors, we also examined whether the stem cell component of the engrafted Neo-Islets enhanced the development of a blood supply for the Neo-Islets.
Methods
Mouse Neo-Islets were generated from co-culture in low adherence vessels of P2 Islet cells derived from wild-type C57Bl/6 mice and P5 MSCs derived from C57Bl/6 mice transgenic for the GFP+ gene to facilitate tracking of the Neo-Islets in vivo. As indicated below, in one group of experiments, after formation, the Neo-Islets were stained with the Infrared light-excitable carbocyanine probe DiR (Molecular Probes, Eugene, Oreg.) to allow for tracking in vivo.
Dog Neo-Islets were formed from co-culture in low adherence vessels of P2 dog islet cells and P4 dog ASCs that had been stained with DiR to allow for tracking in live animals.
Diabetes model and allogeneic treatment: Female Non-Obese Diabetic (NOD) mice spontaneously develop T1DM at approximately 12-20 weeks of age. Once female NOD mice were confirmed to be hyperglycemic (blood glucose >300 mg/dL on three separate days), they were treated s.c. with Linbit pellets. Once animals' blood glucose levels were normalized, Neo-Islets (2×105 Neo-Islet/kg bw suspended in 0.5 ml serum free DMEM-F12 medium) or vehicle (0.5 ml serum free DMEM-F12 medium) were administered i.p. to groups of five animals each. No subsequent exogenous insulin was given to animals in either group. Blood glucose levels and body weights were assessed twice per week, and mice were followed for 10 weeks. At 10 weeks post Neo-Islet administration, animals were sacrificed, and their sera, omenta, livers, spleens, kidneys and pancreases harvested.
Canine Neo-Islet administration: DiR labeled dog Neo-Islets were administered i.p. to 6 NOD/SCID mice, and the mice were examined weekly for 10 weeks under isoflurane anesthesia using a Li-Cor Pearl Impulse™ imager to track the Neo-Islets.
Syngeneic Neo-Islet administration: Two syngeneic administration experiments were performed, one in non-diabetic animals, and another in diabetic animals.
A) Non-diabetic animals: Six groups of non-diabetic C57Bl/6 mice were administered i.p. either (a) 2×105 freshly formed gfp+mouse Neo-Islets suspended in 0.5 ml serum free DMEM-F12 (5 groups), or (b) 0.5 ml serum free DMEM-F12 (vehicle; 1 group). Blood glucose levels (OneTouch Ultra 2 glucometer) and weights were assessed at baseline and then twice per week in all animals. At various time points up to 12 weeks, groups of animals were sacrificed and their sera, omenta, livers, spleens, lungs, kidneys and pancreases harvested.
B) Diabetic animals: Two groups of STZ-diabetic C57Bl/6 mice were administered i.p. either (a) 2×105 freshly formed gfp+mouse Neo-Islets stained with DiR and suspended in 0.5 ml serum free DMEM-F12, or (b) 0.5 ml serum free DMEM-F12 (vehicle). Blood glucose levels (OneTouch Ultra™ 2 glucometer) and weights were assessed at baseline and then twice per week in all animals for 13 weeks. Once per week, the animals were examined under isoflurane anesthesia using a Licor, Pearl Impulse imager to track the Neo-Islets.
Immunohistochemistry: Omenta and other organs were harvested, fixed and embedded as previously described.13 Omental sections were deparaffinized and stained by immunohistochemistry for DNA with 4′, 6-diamidino-2-phenylindole (DAPI, Molecular Probes, Eugene, Oreg.) and insulin protein using a guinea-pig anti-insulin antibody (Dako, Carpinteria, Calif.), and a cy3-conjugated anti-guinea pig antibody (Jackson ImmunoResearch, West Grove, Pa.) following the manufacturers' instructions.
Results
Neo-Islets spontaneously engraft in the murine Omentum and produce Insulin. We hypothesized that injected NIs would home to, attach to, and engraft in the mice′ well-vascularized omenta, which would offer the advantage of physiologic insulin secretion into the portal system of the liver. Indeed, as shown in
To further assess the intraperitoneal engraftment pattern and function of DiRlabeled, eGFP+ NIs as detected in
Conclusion: Taken together, the foregoing results demonstrate that across species: (i) Neo-Islets that are administered i.p. engraft in the omentum where they remain long term, redifferentiate, secrete insulin in physiologic fashion and are not rejected. (ii) The angiogenic properties of the stem cell component of the Neo-Islet helps vascularize the Neo-Islets, providing them with needed oxygen, nutrition, and optimized delivery of insulin from the Neo-Islets into the portal vein of the liver.
Rationale: We showed in Example 5 that the Neo-Islets are effective in treating recent onset T1DM. We tested here whether Neo-Islets were also effective in treating remote onset T1DM.
Methods
Neo-Islets: Neo-Islets were formed from canine ASCs (passage 2) and canine cultured islet cells (passage 1).
Diabetes Model: Non-obese diabetic/Severe Combined Immunodeficiency (NOD/SCID) mice were made diabetic with 3 i.p. doses of 75 mg/kg body weight Streptozotocin (STZ) in citrate buffer. The diabetic state was confirmed by blood glucose levels of >300 mg/dL on 3 separate days. Once the animals were confirmed to be diabetic, their blood glucose levels were controlled for approximately 3 months with insulin therapy using s.c. linbit pellets. To confirm that all animals were still diabetic prior to the Neo-Islet or vehicle administration, Linbits were allowed to expire, and all mice re-developed hyperglycemia. Mice were again treated with Linbits (Day 0 on
IP GTTs and Insulin ELISAs—were carried out as described in Example 5, and results were combined with those of animals in Example 6 (recent onset) and presented in
Results
Two groups of 5 diabetic NOD/SCID mice each were treated i.p. at 3 months after STZ-induced T1DM with (a) 200,000 freshly formed canine derived Neo-Islets/kg body weight suspend in 0.5 ml serum free medium (DMEM-F12) or (b) vehicle. An overview of the experimental design is given in
Conclusion: The above data demonstrate that, as is the case with recent onset diabetes, Neo-Islets are also effective in establishing euglycemia in remote onset diabetes.
Rationale: We showed in Examples 5 and 7 that canine Neo-Islets can reverse STZ induced diabetes in NOD/SCID mice. While the NOD/SCID data presented above indicate that Neo-Islets generated from canine derived cells are capable of safely and effectively undergoing redifferentiation in vivo to produce insulin and secrete it in physiologic fashion long-term, the NOD/SCID model does not address the issues of protection of the transplanted cells from diabetogenic autoimmune and allo-immune attacks. ASCs and MSCs exhibit powerful immune modulating properties.16 We hypothesized the stem cell component of the Neo-Islets would provide local immune isolation, and tested whether the Neo-Islets could restore euglycemia when administered allogeneically to spontaneously diabetic NOD mice.
Methods
Mouse Neo-Islets were generated from co-culture in low adherence vessels of P2 Islet cells derived from wild-type C57Bl/6 mice and P5 MSCs derived from C57Bl/6 mice transgenic for the GFP+ gene.
Spontaneous diabetes model and allogeneic treatment: Once female NOD mice were confirmed to be hyperglycemic (blood glucose >300 mg/dL on 3 separate days), they were treated s.c. with Linbit pellets. Once animals' blood glucose levels were normalized, Neo-Islets (2×105 Neo-Islet/kg bw suspended in 0.5 ml serum free DMEM-F12 medium) or vehicle (0.5 ml serum free DMEM-F12 medium) were administered i.p. to groups of 5 animals each. No subsequent exogenous insulin was given to animals in either group. Blood glucose levels and body weights were assessed twice per week, and mice were followed long term.
Results
A dose of 200,000 allogeneic Neo-Islets/kg bw administered i.p. achieves and maintains euglycemia in spontaneously diabetic NOD mice. Blood glucose levels of vehicle and Neo-Islet-treated NOD mice are shown in
Conclusion: These data demonstrate that, like the canine Neo-Islets, mouse Neo-Islets (i) redifferentiate in vivo to provide adequate insulin secretion to reestablish and maintain euglycemia, and importantly (ii) that they afford immune isolation against both allo- and auto-immune attacks without encapsulation, as hypothesized.
Rationale: From the previous examples, it is apparent that the Neo-Islets engraft in the omentum where they redifferentiate to produce and secrete insulin. However, if insulin secretion were to be constitutive and non-physiologic, this could potentially lead to episodes of hypoglycemia. We tested, therefore, whether administration of Neo-Islets to non-diabetic animals would result in hypoglycemia.
Methods
Mouse Neo-Islets were generated from co-culture in low adherence vessels of P2 Islet cells derived from wild-type C57Bl/6 mice and P5 MSCs derived from C57Bl/6 mice transgenic for GFP+ gene.
Dog Neo-Islets were formed from co-culture in low adherence vessels of P2 dog islet cells and P4 dog ASCs.
Mouse Neo-Islet administration: Six groups of 2 to 4 non-diabetic C57Bl/6 mice each were administered i.p. either (a) 2×105 freshly formed mouse sNeo-Islets suspended in 0.5 ml serum free DMEM-F12 (5 groups), or (b) 0.5 ml serum free DMEM-F12 (vehicle; 1 group). Blood glucose levels (OneTouch Ultra 2 glucometer) and weights were assessed at baseline and then twice per week for up to 12 weeks.
Canine Neo-Islets: Two groups of NOD/SCID mice were administered i.p. either (a) 2×105 freshly formed dog Neo-Islets (N=6) or (b) 0.5 ml serum free DMEM-F12 (vehicle; N=3). Blood glucose levels (OneTouch Ultra 2 glucometer) and weights were assessed at baseline and then twice per week for 10 weeks.
Results
Neo-Islets do not cause hypoglycemia in non-diabetic mice. As shown in Example 8 and
Conclusion: These data demonstrate that engrafted Neo-Islets formed from either mouse or canine cells release insulin physiologically and not constitutively.
Rationale: The preceding examples indicate the Neo-Islets described herein may be used allogeneically to reestablish normoglycemia in diabetic animals without rejection. The following study was undertaken to further test whether animals treated allogeneically with Neo-Islets produce antibodies to either of the cell types that make up the Neo-Islets.
Methods
Mouse Neo-Islets were generated from co-culture in low adherence vessels of P2 Islet cells derived from wild-type C57Bl/6 mice and P5 MSCs derived from C57Bl/6 mice.
Antibody Response Test: Test sera were incubated with either: (a) 1×105 gfp+C57Bl/6 MSCs, or (b) 1×105 cultured C57Bl/6 islet cells for 30 minutes. Positive control sera were incubated with 1×105 canine ASCs. After incubation with serum, the cells were centrifuged, resuspended in FACS buffer and incubated with Phycoerythrin (PE) labeled anti-mouse IgG antibody (Pharmingen, San Diego, Calif.). The cells were incubated an additional 20 minutes in the dark at room temperature. One ml 1×PBS (Roche, Indianapolis, Ind.)+1% BSA (Sigma, St. Louis, Mo.) was then added. The cells were vortexed, then centrifuged, resuspended in fixation buffer (1% Formaldehyde), and analyzed by FACS (BD FACScan Analyzer, San Jose, Calif.; 10,000 cells counted).
Results
Sera were obtained from:
(i) NOD mice that had been treated i.p. with 2×105 Neo-Islet/kg bw 12 weeks post Neo-Islet treatment (see Example 8),
(ii) NOD mice that had been treated i.p. with vehicle 12 weeks post vehicle treatment (see Example 8), and
(iii) NOD mice that had not been infused (naïve mice).
Mouse MSCs from Neo-Islets and mouse islet cells from the Neo-Islets were incubated with the collected sera, and then with Phycoerythrin (PE) labeled anti-mouse IgG antibody. The serum-exposed cells were then analyzed by FACS as described above in Methods to determine whether any IgG antibodies to administered MSCs or islet cells were present in the sera of treated mice.
As xenogeneic administration of ASCs is known to elicit an immune response, canine ASCs that had been exposed to sera from NOD mice 14 days post canine ASC administration were incubated with PE labeled anti-mouse IgG antibody, analyzed by FACS, and used as positive controls.
If Neo-Islet-treated mice had developed an allo-immune response to the MSCs or the islet cells in the Neo-Islets, then the PE-labeled a-mouse IgG antibody would bind to the serum exposed cells, and the cells would appear shifted (PE positive) on FACS analysis. A shift of >7% of the cells (% of PE positive cells) on FACS was considered a positive allo-antibody response.
As shown in
NOD mice do not mount an allo-immune IgG Response to the MSCs and Islet Cells of NIs. To examine whether islet cells and MSCs contained in the NIs are protected from a humoral immune attack, we assessed whether sera from normoglycemic, NI-treated NOD mice contained IgG antibodies directed against either the MSCs or cultured ICs that were used to generate the administered Ms. Sera from NI-treated, normoglycemic NOD mice contained neither IgG antibodies directed at MSCs nor at cultured ICs, while the i.p. administration of identical numbers of allogeneic (C57Bl/6), freshly isolated islets used as a positive control, elicited a robust antibody response (
Inhibition of Autoimmune Response. Critical to effectively treating autoimmune T1DM with insulin producing cells is the autoimmune isolation of those cells, and the results presented in
Conclusion: The above data indicate that administration of Neo-Islets does not elicit an antibody response to either cell type that composes the Neo-Islet, further supporting the hypothesis that the Neo-Islets provide immune isolation and eliminate the need for anti-rejection drugs and encapsulation devices.
Our extensive in vitro and in vivo data to date and presented above demonstrate that the treatment of experimental T1DM in mice with syngeneic and allogeneic Neo-Islets, and Neo-Islets from multiple species are able to effectively re-establish euglycemia, i.e., treat T1DM, and this during long-term follow-up. No Adverse Events, such as oncogenic transformation or ectopic mal-differentiation of Neo-Islets were observed. This novel therapy can be used as treatment of insulin-dependent diabetes both in companion animals (dogs, cats) and humans with type 1 diabetes mellitus.
Neo-Islets containing human cells are generated as described in the above examples using ASCs and/or MSCs from a human subject identified as suffering from insulin-dependent Diabetes Mellitus and islet cells from an allogeneic source. The resulting Neo-Islets are administered to the subject. Several weeks after treatment, the subject displays improved glycemic control.
Neo-Islets containing human cells are generated as described in the above examples using ASCs and/or MSCs and islet cells where stems cells and islet cells are from a source allogeneic to a human subject identified as suffering from insulin-dependent Diabetes Mellitus. The resulting Neo-Islets are administered to the subject. Several weeks after treatment, the subject displays improved glycemic control.
Neo-Islets containing human cells are generated as described in the above examples using ASCs and/or MSCs and islet cells where stems cells and/or islet cells are from a source xenogeneic to a human subject identified as suffering from insulin-dependent Diabetes Mellitus. The resulting Neo-Islets are administered to the subject. Several weeks after treatment, the subject displays improved glycemic control.
Neo-Islets containing human cells are generated as described in the above examples using ASCs and/or MSCs from a human subject identified as suffering from insulin-dependent Diabetes Mellitus and islet cells from an allogeneic source. The resulting Neo-Islets are administered to the subject, and adjuvant human ASCs/MSCs are also administered to the subject. Several weeks after treatment, the subject displays improved glycemic control.
Neo-Islets containing human cells are generated as described in the above examples using ASCs and/or MSCs and islet cells where stems cells and islet cells are from a source allogeneic to a human subject identified as suffering from insulin-dependent Diabetes Mellitus. The resulting Neo-Islets are administered to the subject, and adjuvant human ASCs/MSCs are also administered to the subject. Several weeks after treatment, the subject displays improved glycemic control.
Neo-Islets containing human cells are generated as described in the above examples using ASCs and/or MSCs and islet cells where stems cells and/or islet cells are from a source xenogeneic to a human subject identified as suffering from insulin-dependent Diabetes Mellitus. The resulting Neo-Islets are administered to the subject, and adjuvant human ASCs/MSCs are also administered to the subject. Several weeks after treatment, the subject displays improved glycemic control.
Neo-Islets containing human cells are generated as described in the above examples using ASCs and/or MSCs and islet cells where stems cells and/or islet cells are from a source allogeneic to a human subject identified as suffering from insulin-dependent Diabetes Mellitus. The Neo-Islets redifferentiated ex vivo. The redifferentiated Neo-Islets are administered to the subject. Several weeks after treatment, the subject displays improved glycemic control.
Neo-Islets containing human cells are generated as described in the above examples using ASCs and/or MSCs and islet cells where stems cells and/or islet cells are from a source allogeneic to a human subject identified as suffering from insulin-dependent Diabetes Mellitus. The Neo-Islets redifferentiated ex vivo. The redifferentiated Neo-Islets are administered to the subject, and adjuvant human ASCs/MSCs are also administered to the subject. Several weeks after treatment, the subject displays improved glycemic control.
Insulin therapy has been used in patients suffering from type 2 diabetes mellitus, see, e.g., K. Horvath, K. Jeitler, A. Berghold, S. H. Ebrahim, T. W. Gratzer, J. Plank, T. Kaiser, T. R. Pieber, and A. Siebenhofer, “Long-acting insulin analogues versus NPH insulin (human isophane insulin) for type 2 diabetes mellitus,” Cochrane Database of Systematic Reviews 2007, Issue 2 Art. No.: CD005613, DOI: 10.1002/14651858.CD005613.pub3, incorporated herein by reference. Neo-Islets containing human cells are generated as described in the foregoing Examples using ASCs and/or MSCs from a human subject identified as suffering from type 2 diabetes mellitus and islet cells from an allogeneic source. The resulting Neo-Islets are administered to the subject. Several weeks after treatment, the subject displays improved glycemic control. In the interim, the subject is treated with an oral hypoglycemic drug and/or insulin.
Neo-Islets containing human cells are generated as described in the foregoing examples using ASCs and/or MSCs and islet cells where stems cells and islet cells are from a source allogeneic to a human subject identified as suffering from type 2 diabetes mellitus. The resulting Neo-Islets are administered to the subject. Several weeks after treatment, the subject displays improved glycemic control. In the interim, the subject is treated with an oral hypoglycemic drug and/or insulin.
Neo-Islets containing human cells are generated as described in the foregoing examples using ASCs and/or MSCs and islet cells where stems cells and/or islet cells are from a source xenogeneic to a human subject identified as suffering from type 2 diabetes mellitus. The resulting Neo-Islets are administered to the subject. Several weeks after treatment, the subject displays improved glycemic control. In the interim, the subject is treated with an oral hypoglycemic drug and/or insulin.
Neo-Islets containing human cells are generated as described in the foregoing examples using ASCs and/or MSCs from a human subject identified as suffering from type 2 diabetes mellitus and islet cells from an allogeneic source. The resulting Neo-Islets are administered to the subject, and adjuvant human ASCs/MSCs are also administered to the subject. Several weeks after treatment, the subject displays improved glycemic control. In the interim, the subject is treated with an oral hypoglycemic drug and/or insulin.
Neo-Islets containing human cells are generated as described in the foregoing examples using ASCs and/or MSCs and islet cells where stems cells and islet cells are from a source allogeneic to a human subject identified as suffering from type 2 diabetes mellitus. The resulting Neo-Islets are administered to the subject, and adjuvant human ASCs/MSCs are also administered to the subject. Several weeks after treatment, the subject displays improved glycemic control. In the interim, the subject is treated with an oral hypoglycemic drug and/or insulin.
Neo-Islets containing human cells are generated as described in the foregoing examples using ASCs and/or MSCs and islet cells where stems cells and/or islet cells are from a source xenogeneic to a human subject identified as suffering from type 2 diabetes mellitus. The resulting Neo-Islets are administered to the subject, and adjuvant human ASCs/MSCs are also administered to the subject. Several weeks after treatment, the subject displays improved glycemic control. In the interim, the subject is treated with an oral hypoglycemic drug and/or insulin.
Neo-Islets containing human cells are generated as described in the foregoing examples using ASCs and/or MSCs and islet cells where stems cells and/or islet cells are from a source allogeneic to a human subject identified as suffering from type 2 Diabetes Mellitus. The Neo-Islets redifferentiated ex vivo. The redifferentiated Neo-Islets are administered to the subject. Several weeks after treatment, the subject displays improved glycemic control. In the interim, the subject is treated with an oral hypoglycemic drug and/or insulin.
Neo-Islets containing human cells are generated as described in the foregoing examples using ASCs and/or MSCs and islet cells where stems cells and/or islet cells are from a source allogeneic to a human subject identified as suffering from type 2 diabetes mellitus. The Neo-Islets redifferentiated ex vivo. The redifferentiated Neo-Islets are administered to the subject, and adjuvant human ASCs/MSCs are also administered to the subject. Several weeks after treatment, the subject displays improved glycemic control. In the interim, the subject is treated with an oral hypoglycemic drug and/or insulin.
Neo-Islets generated as described in any one of the foregoing examples where the Neo-Islet is administered intravenously to the subject suffering insulin-dependent diabetes mellitus. Several weeks after treatment, the subject displays improved glycemic control.
Neo-Islets generated as described in any one of the foregoing examples where the Neo-Islet is administered intravenously to the subject suffering type 2 diabetes mellitus. Several weeks after treatment, the subject displays improved glycemic control.
Neo-Islets generated as described in any one of the foregoing examples where the Neo-Islet is administered subcutaneously to the subject suffering insulin-dependent diabetes mellitus. Several weeks after treatment, the subject displays improved glycemic control.
Neo-Islets generated as described in any one of the foregoing examples where the Neo-Islet is administered subcutaneously to the subject suffering type 2 diabetes mellitus. Several weeks after treatment, the subject displays improved glycemic control.
Neo-Islets generated as described in any one of the foregoing examples are administered to the subject suffering from impaired glucose tolerance or Prediabetes. Several weeks after treatment, the subject displays improved glycemic control.
This application claims the benefit of U.S. Provisional Patent Application Ser. No. 62/216,920, filed Sep. 10, 2015, and U.S. Provisional Patent Application Ser. No. 62/264,238, filed Dec. 7, 2015, the disclosure both of which are hereby incorporated herein in its entirety by this reference.
| Number | Date | Country | |
|---|---|---|---|
| 62264238 | Dec 2015 | US | |
| 62216920 | Sep 2015 | US |
