Evidence for instant blood-mediated inflammatory reaction in clinical autologous islet transplantation.
A nonspecific inflammatory and thrombotic reaction termed instant blood-mediated inflammatory reaction (IBMIR) has been reported when allogenic or xenogenic islets come into contact with blood. This reaction is known to cause significant loss of transplanted islets. We hypothesized that IBMIR occurs in patients undergoing total pancreatectomy followed by autologous islet transplantation (TP-AIT) and tested this hypothesis in 24 patients and in an in vitro model. Blood samples drawn during the peritransplant period showed a significant and rapid increase of thrombin-anti-thrombin III complex (TAT) and C-peptide during islet infusion, which persisted for up to 3 h, along with a decreased platelet count. A concomitant increase in levels of inflammatory proteins IL-6, IL-8 and interferon-inducible protein-10 was observed. An in vitro model composed of pure islets plus autologous blood also demonstrated significantly increased levels of TAT (p<0.05), C-peptide (p<0.05), tumor necrosis factor-alpha (p<0.05) and MCP-1 (p<0.05), as well as strong tissue factor expression in islets. Islet viability decreased significantly but was rescued by the presence of low-molecular-weight dextran sulfate. In conclusion, AIT-induced elevation of TAT and destruction of islets suggests that IBMIR might occur during AIT. Modulating this process may help improve islet engraftment and the insulin independence rate in TP-AIT patients.
Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center at Dallas, Dallas, TX.
B
B
Naziruddin
S
S
Iwahashi
M A
MA
Kanak
M
M
Takita
T
T
Itoh
M F
MF
Levy
D000328:Adult; D015415:Biomarkers / Q000032:analysis; D001792:Blood Platelets / Q000473:pathology*; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000209:etiology*; D018836:Inflammation Mediators / Q000032:analysis; D007515:Islets of Langerhans / Q000503:physiopathology*; D016381:Islets of Langerhans Transplantation / Q000009:adverse effects*; D008297:Male; D010195:Pancreatitis / Q000150:complications* / Q000628:therapy; D011379:Prognosis; D014182:Transplantation, Autologous
D015415:Biomarkers; D018836:Inflammation Mediators
Autologous islet transplantation; IBMIR; islet