Islet transplantation stabilizes hemostatic abnormalities and cerebral metabolism in individuals with type 1 diabetes

  1. Paolo Fiorina, MD,PhD1,2
  1. 1Nephrology Division, Boston Children’s Hospital, Harvard Medical School, Boston, MA;
  2. 2Medicine,
  3. 3Neuroradiology,
  4. 4Anesthesiology,
  5. 5Diabetes Research Institute and
  6. 6Neurology Department, San Raffaele Hospital, Milan, Italy;
  7. 7Pathology Department, Ospedale di Circolo, Varese, Italy;
  8. 8Chromatographic Techniques Service, San Raffaele Hospital, Milan, Italy,
  9. 9Centre for the Study of Atherosclerosis, Bassini Hospital, Cinisello Balsamo, Italy,
  10. 10University of Texas at San Antonio, San Antonio, TX;
  11. 11Universita’ Vita-Salute, Milan, Italy.
  1. Corresponding author: Paolo Fiorina, E-mail: paolo.fiorina{at}childrens.harvard.edu
  2. Corresponding author: Antonio Secchi, E-mail: antonio.secchi{at}hsr.it

Abstract

Objective Islet after kidney transplantation has been shown to positively affect the quality of life for individuals with type 1 diabetes (T1D) by reducing the burden of diabetic complications, but fewer data are available for Islet transplantation alone (ITA). The aim of this study was to assess whether ITA has a positive impact on hemostatic and cerebral abnormalities in individuals with T1D.

Research Design and Methods Pro-thrombotic factors, platelet function/ultrastructure, cerebral morphology, metabolism and function have been investigated over a 15-month follow-up period, with ELISA/electron microscopy and magnetic resonance imaging, nuclear magnetic resonance spectroscopy (1H-MRS) and neuropsychological evaluation (POMS and PASAT tests), in 22 individuals with T1D who underwent islet transplantation alone (n=12) or remained on the waiting list (n=10). Patients were homogeneous at the time of enrolment on the waiting list with regard to metabolic criteria, hemostatic parameters and cerebral morphology/metabolism/function.

Results At 15 months follow-up, the Islet transplantation alone group, but not individuals with T1D remaining on the waiting list, showed: i) improved glucose metabolism; ii) near-normal platelet activation and pro-thrombotic factor levels; iii) near-normal cerebral metabolism and function; and iv) a near-normal neuropsychological test.

Conclusion Islet transplantation alone, despite immunosuppressive therapy, is associated with a near-normalization of hemostatic and cerebral abnormalities.

  • Received July 15, 2013.
  • Accepted August 30, 2013.

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  1. Diabetes Care
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