Tolerogenic dendritic cells pulsed with islet antigen induce long-term reduction in T-cell autoreactivity in type 1 diabetes patients

IntroductionRestoration of immune tolerance may halt progression of autoimmune diseases. Tolerogenic dendritic cells (tolDC) inhibit antigen-specific proinflammatory T-cells, generate antigen-specific regulatory T-cells and promote IL-10 production in-vitro, providing an appealing immunotherapy to intervene in autoimmune disease progression. MethodsA placebo-controlled, dose escalation phase 1 clinical trial in nine adult patients with long-standing type 1 diabetes (T1D) demonstrated the safety and feasibility of two (prime-boost) vaccinations with tolDC pulsed with a proinsulin peptide. Immunoregulatory effects were monitored by antigen-specific T-cell assays and flow and mass cytometry. ResultsThe tolDC vaccine induced a profound and durable decline in pre-existing autoimmune responses to the vaccine peptide up to 3 years after therapy and temporary decline in CD4 and CD8+ T-cell responses to other islet autoantigens. While major leukocyte subsets remained stable, ICOS(+)CCR4(+)TIGIT(+) Tregs and CD103(+) tissue-resident and CCR6(+) effector memory CD4(+) T-cells increased in response to the first tolDC injection, the latter declining thereafter below baseline levels. DiscussionOur data identify immune correlates of mechanistic efficacy of intradermally injected tolDC reducing proinsulin autoimmunity in T1D

A Multicenter Study: North American Islet Donor Score in Donor Pancreas Selection for Human Islet Isolation for Transplantation

Selection of an optimal donor pancreas is the first key task for successful islet isolation. We conducted a retrospective multicenter study in 11 centers in North America to develop an islet donor scoring system using donor variables. The data set consisting of 1,056 deceased donors was used for development of scoring system to predict islet isolation success (defined as post-purification islet yield >400,000 islet equivalents). With an aid of univariate logistic regression analyses, we developed North American Islet Donor Score (NAIDS) ranging 0 through 100 points. The c-index in the development cohort was 0.73 [95% confidence interval 0.70 - 0.76]. The success rate increased proportionally as NAIDS increased, from 6.8% success in NAIDS < 50 points to 53.7% success in NAIDS ≥ 80 points. We further validated NAIDS using a separate set of data consisting of 179 islet isolations. Comparable outcome of NAIDS was observed in the validation cohort. The NAIDS may be a useful tool for donor pancreas selection in the clinical practice. Apart from its utility in clinical decision-making, the NAIDS may also be used in research setting as a standardized measurement of pancreas quality