Kinetics of diabetes-associated autoantibodies after sequential intraportal islet allograft associated with kidney transplantation in type 1 diabetes
| Autor: | Valery Gmyr, Christian Noel, François Pattou, Marie-Christine Vantyghem, Pascal Pigny, Julie Kerr-Conte, I. Fajardy, Brigitte Vandewalle, Charles Proye |
|---|---|
| Rok vydání: | 2003 |
| Předmět: |
Adult
endocrine system medicine.medical_specialty Endocrinology Diabetes and Metabolism medicine.medical_treatment Islets of Langerhans Transplantation Gastroenterology Endocrinology Adrenal Cortex Hormones Internal medicine Diabetes mellitus Immunopathology Insulin Secretion Internal Medicine medicine Humans Insulin Pancreas Kidney transplantation Autoantibodies geography Kidney Type 1 diabetes Islet cell transplantation geography.geographical_feature_category C-Peptide Glutamate Decarboxylase business.industry General Medicine Mycophenolic Acid Prognosis Islet medicine.disease Kidney Transplantation Isoenzymes Transplantation Kinetics Diabetes Mellitus Type 1 medicine.anatomical_structure Cyclosporine business Immunosuppressive Agents |
| Zdroj: | Diabetes & Metabolism. 29:595-601 |
| ISSN: | 1262-3636 |
| Popis: | Summary Objective Presence or occurrence of pancreas auto-antibodies (aAb) has been shown to be of poor prognosis for islet cell transplantation. The aim of the study was to monitor the kinetics of these aAb after sequential intra-portal islet plus kidney transplantation with pre-Edmonton immunosuppressive regimen in order to determine whether the sequential protocol of transplantation was involved in the occurrence of the immune response. Patients and methods Three patients with IDDM and a previous (IAK) or simultaneous (SIK) kidney transplantation received 3 or 4 ABO compatible islet preparations. Islets (> 8 000 IEQ/kg post culture) were sequentially transplanted within a 12 day period via a per-cutaneous catheter. Immunosuppressive treatment included cyclosporine, steroids and mycophenolate. Plasma ICAs, GAD 65, IA2 and C peptide (C-p) levels were monitored. Type II HLA phenotype was determined in donors and recipients. Results Patient #1 had high anti-GAD levels (26.5 UI/l) before the IAK, while anti-IA2 and ICA levels were low. After the transplantation, C-p levels increased to 4.9 ng/ml at one month before becoming undetectable at 2 months. GAD levels remained high, ICA and IA2 aAb were undetectable. Patients #2 and #3 did not have significant levels of aAb before the islet transplantation. A slight increase in GAD was observed with each islet transplantation, followed by an overt but transient increase in ICA. IA2 levels remained undetectable. Three months after the transplantation and 2 weeks after the increase of ICA, C-p levels, that were >3.4 ng/ml at one month, fell below 0.2 (N: 0.5–2). Conclusion The immunosuppressive regimen used in kidney transplantation is unable to control perfectly anti-pancreas aAb production. Moreover, these results seem to indicate that the benefits of sequential islet transplantation lie more in the increased islet mass they provide than in potential immune benefit. |
| Databáze: | OpenAIRE |
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