The establishment of pancreatic islet isolation in India-an update on human pancreatic islet transplantation

Background:Diabetes is a widespread disease with increasing prevalence.Transplantation of islets of Langerhans is a viable treatment for a selected group of patients with repeated hypoglycemic episodes in type 1 diabetes.The countries where islet transplantation has not been explored suffer from insufficient knowledge concerning key elements of the isolation process.Donor and organ procurement parameters impact human islet yield,although for research purposes,islet yield may be secondary in importance to islet function.This paper will analyze the feasibility of research-only human islet isolation and signify parameters underlying a successful yield in the Indian population.This eventually can make islet transplantation a clinical reality in India.Method:After receiving the consent for procuring brain-dead pancreas from the first-degree of relatives,samples were collected and transported in a transportation buffer at 4℃.The procedure consists of a mechanically enhanced enzymatic digestion of the pancreas,after which it was taken for purification using Ficoll method,followed by islet quality testing.Results:Through 15 isolations done over a span of approximately 2 years during the COVID pandemic in India,we confirm that ischemic time and glycated hemoglobin,each have a negative impact on isolation purity and yield.Notably,extending cold ischemic tim beyond the typical clinical isolation cutoff of 12 hours(to≥18 h)had a huge impact on islet function and yield.Age had a negative correlation with islet yield;however other biological parameters(specifically body mass index)and isolation variables appear to make a significant contribution to the heterogeneity of human islet yield.Our current work demonstrates the feasibility of extending acceptable cold ischemic time for research-focused human islet isolation and highlights the biological variation in isolation of human islets from donors with and without diabetes.Conclusion:India requires establishment of an islet transplant program using the current standard methods of“islet isolation”and donor program and process.Research should focus on improving standards in the islet preparation process to increase the number of successful preparations,shorten the isolation time,and increase patient safety so that the theoretical risk involved can become a practical reality.

Protection of human islets from induction of apoptosis and improved islet function with HO-1 gene transduction

Background Islet transplantation represents an ideal therapeutic approach for treatment of type 1 diabetes but islet function and regeneration may be influenced by necrosis or apoptosis induced by oxidative stress and other insults. Heme oxygenase-1 （HO-1） is the rate-limiting enzyme in the catabolism of heme into biliverdin, releasing free iron and carbon monoxide. It has also been reported to be an antioxidant enzyme which can improve the function of grafted islets by cytoprotection via free radical scavenging and apoptosis prevention. In the present study, we investigated whether transduction of HO-1 genes into human islets with an adenovirus vector has cytoprotective action on islets cultured in vitro and discuss this method of gene therapy for clinical islet transplantation. Methods Cadaveric pancreatic islets were isolated and purified in vitro. Transduction efficiency of islets was determined by infecting islets with adenovirus vector containing the enhanced green fluorescent protein gene （Ad-EGFP） at multiplicities of infection （MOI） of 2, 5, 10, or 20. Newly isolated islets were divided into three groups： EGFP group, islets transduced with Ad-EGFP using MOI=20; HO-1 group, transduced with adenovirus vectors containing the human HO-1 gene using MOI=20; and control group, mock transduced islets. Insulin release after glucose stimulation of the cell lines was determined by a radioimmunoassay kit and the stimulation index was calculated. Flow cytometry was used to detect apoptotic cells in the HO-1 group and in the control group after induction by recombinant human tumor necrosis factor-α （rTNFα） and cycloheximide （CHX） for 48 hours. Results Adenovirus vectors have a high efficiency of gene transduction into adult islet cells. Transduction of islets with the Ad-EGFP was most successful at MOI 20, at which MOI fluorescence was very intense on day 7 after transduction and EGFP was expressed in cultured islet cells for more than four weeks in vitro. The insulin release in the control group was （182.36 ± 58.96） mIU/L after stimulation by high glucose media （16.7 mmol/L）,while insulin release from the HO-1 group and the EGFP group were （270.09±89.37） mlU/L and （ 175.95 ± 75.05） mlU/L respectively. Compared to the control group and the EGFP group, insulin release in the HO-1 group increased significantly （P〈0.05）. After treatment with rTNFα and CHX the apoptotic ratio of islet cells was （63.09 ± 10.86）% in the HO-1 group, significantly lower than （90.86 ± 11.25）% in the control group （P〈0.05）. Conclusions Transduction of human islets with Ad-HO-1 can protect against TNF-α and CHX mediated cytotoxicity. The HO-1 gene also appears to facilitate insulin release from human islets. Transduction of donor islets with the adenovirus vector containing an HO-1 gene might have potential value in clinical islet transplantation.