title: Autologous hematopoietic stem cell transplantation modulates immunocompetent cells and improves β-cell function in Chinese patients with new onset of type 1 diabetes.
abstract: BACKGROUND
  Autologous hematopoietic stem cell transplantation (AHSCT) has the potential to induce clinical remission in patients with newly diagnosed type 1 diabetes.
  
  
  OBJECTIVE
  The objective of the study was to examine the impact of AHSCT on lymphocytes and pancreatic β-cell function.
  
  
  METHODS
  This was a nonrandomized, open-label prospective study.
  
  
  METHODS
  Thirteen patients with new onset of type 1 diabetes, 10 of them with diabetic ketoacidosis, were subjected to AHSCT with cryopreserved CD34(+) progenitor cells and followed up for 31-54 months.
  
  
  METHODS
  The numbers of different subsets of lymphocytes and the levels of serum cytokines, islet antibodies, C-peptide, and plasma glycosylated hemoglobin were longitudinally measured.
  
  
  RESULTS
  The numbers of different subsets of lymphocytes, except for CD8(+) T cells, in the patients before AHSCT were significantly lower than those in controls. However, all lymphocytes gradually recovered after AHSCT, accompanied by decreased levels of serum autoantibodies, IL-1, IL-17, and TNF-α. After AHSCT, 11 of 13 patients required significantly reduced doses of insulin for adequate glycemic control, accompanied by reduced levels of glycosylated hemoglobin but increased C-peptide concentrations. Three patients achieved exogenous insulin independence for 7-54 months. The survival of remaining β-cells was associated positively with the preexisting β-cell function but negatively with preexisting autoantibodies (P < 0.05). The numbers of infused CD34(+) cells were positively correlated with the concentrations of serum IL-10, IL-4, TGF-β, and fasting C-peptide but negatively correlated with the levels of serum TNF-α and insulin doses after AHSCT (P < 0.05).
  
  
  CONCLUSIONS
  AHSCT modulated lymphocytes and preserved β-cell function in Chinese patients with new onset of type 1 diabetes and diabetic ketoacidosis.
authors.affiliation: Division of Endocrinology, the Affiliated Drum Tower Hospital of Nanjing University, 321 Zhongshan Road, Nanjing 210008, China.
authors.forename: Lirong
authors.initials: L
authors.lastname: Li
authors.forename: Shanmei
authors.initials: S
authors.lastname: Shen
authors.forename: Jian
authors.initials: J
authors.lastname: Ouyang
authors.forename: Yun
authors.initials: Y
authors.lastname: Hu
authors.forename: Limin
authors.initials: L
authors.lastname: Hu
authors.forename: Weijuan
authors.initials: W
authors.lastname: Cui
authors.forename: Ning
authors.initials: N
authors.lastname: Zhang
authors.forename: Yu-zheng
authors.initials: YZ
authors.lastname: Zhuge
authors.forename: Bing
authors.initials: B
authors.lastname: Chen
authors.forename: Jingyan
authors.initials: J
authors.lastname: Xu
authors.forename: Dalong
authors.initials: D
authors.lastname: Zhu
mesh_terms: D000293:Adolescent; D044466:Asian People; D001786:Blood Glucose / Q000378:metabolism; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007328:Insulin / Q000097:blood; D050417:Insulin-Secreting Cells / Q000502:physiology*; D008297:Male; D011446:Prospective Studies; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007328:Insulin