Report from IPITA-TTS opinion leaders meeting on the future of β-cell replacement

Peer reviewe

The Demise of Islet Allotransplantation in the US: A Call for an Urgent Regulatory Update The ISLETS FOR US Collaborative

Islet allotransplantation in the United States (US) is facing an imminent demise. Despite nearly three decades of progress in the field, an archaic regulatory framework has stymied US clinical practice. Current regulations do not reflect the state-of-the-art in clinical or technical practices. In the US, islets are considered biologic drugs and more than minimally manipulated human cell and tissue products (HCT/Ps). Across the world, human islets are appropriately defined as minimally manipulated tissue which has led to islet transplantation becoming a standard-of-care procedure for patients with type 1 diabetes mellitus and problematic hypoglycemia. As a result of the outdated US regulations, only eleven patients underwent allo-ITx in the US between 2011-2016 and all in the setting of a clinical trial. Herein, we describe the current regulations pertaining to islet transplantation in the United States. We explore the progress which has been made in the field and demonstrate why the regulatory framework must be updated to both, better reflect our current clinical practice and to deal with upcoming challenges. We propose specific updates to current regulations which are required for the renaissance of ethical, safe, effective, and affordable allo-ITx in the United States

The demise of islet allotransplantation in the United States: A call for an urgent regulatory update

Islet allotransplantation in the United States (US) is facing an imminent demise. Despite nearly three decades of progress in the field, an archaic regulatory framework has stymied US clinical practice. Current regulations do not reflect the state-of-the-art in clinical or technical practices. In the US, islets are considered biologic drugs and “more than minimally manipulated” human cell and tissue products (HCT/Ps). In contrast, across the world, human islets are appropriately defined as “minimally manipulated tissue” and not regulated as a drug, which has led to islet allotransplantation (allo-ITx) becoming a standard-of-care procedure for selected patients with type 1 diabetes mellitus. This regulatory distinction impedes patient access to islets for transplantation in the US. As a result only 11 patients underwent allo-ITx in the US between 2016 and 2019, and all as investigational procedures in the settings of a clinical trials. Herein, we describe the current regulations pertaining to islet transplantation in the United States. We explore the progress which has been made in the field and demonstrate why the regulatory framework must be updated to both better reflect our current clinical practice and to deal with upcoming challenges. We propose specific updates to current regulations which are required for the renaissance of ethical, safe, effective, and affordable allo-ITx in the United States

First World Consensus Conference on pancreas transplantation: Part II - recommendations.

Funder: Fondazione Pisa, Pisa, Italy; Id: http://dx.doi.org/10.13039/100007368Funder: Tuscany Region, Italy; Id: http://dx.doi.org/10.13039/501100009888Funder: Pisa University Hospital, Pisa, ItalyFunder: University of Pisa, Pisa, Italy; Id: http://dx.doi.org/10.13039/501100007514The First World Consensus Conference on Pancreas Transplantation provided 49 jury deliberations regarding the impact of pancreas transplantation on the treatment of diabetic patients, and 110 experts' recommendations for the practice of pancreas transplantation. The main message from this consensus conference is that both simultaneous pancreas-kidney transplantation (SPK) and pancreas transplantation alone can improve long-term patient survival, and all types of pancreas transplantation dramatically improve the quality of life of recipients. Pancreas transplantation may also improve the course of chronic complications of diabetes, depending on their severity. Therefore, the advantages of pancreas transplantation appear to clearly surpass potential disadvantages. Pancreas after kidney transplantation increases the risk of mortality only in the early period after transplantation, but is associated with improved life expectancy thereafter. Additionally, preemptive SPK, when compared to SPK performed in patients undergoing dialysis, appears to be associated with improved outcomes. Time on dialysis has negative prognostic implications in SPK recipients. Increased long-term survival, improvement in the course of diabetic complications, and amelioration of quality of life justify preferential allocation of kidney grafts to SPK recipients. Audience discussions and live voting are available online at the following URL address: http://mediaeventi.unipi.it/category/1st-world-consensus-conference-of-pancreas-transplantation/246

Episode 4: Hope for 12-year-old diabetic with allergy to insulin

Runtime 26:18"What would you do if the medication that kept your daughter alive also caused her unbearable pain? 12-year-old Emmy Reeves from Columbia, South Carolina had Type One diabetes, a condition shared by over 1 million Americans. It is usually treatable with insulin medication. But Emmy had an extremely rare problem: An allergy to insulin medication. The Reeves family eventually connected with Dr. Raja Kandaswamy, a transplant surgeon at the University of Minnesota Department of Surgery. Dr. Kandaswamy’s proposal was to make Emmy the youngest pediatric pancreas transplant recipient in the United States in nearly 25 years."Korostyshevsky, David; Kandaswamy, Raja. (2018). Episode 4: Hope for 12-year-old diabetic with allergy to insulin. Retrieved from the University Digital Conservancy, https://hdl.handle.net/11299/218243

Physiological and biochemical alterations in Vigna rdiate L. triggered by sesame derived elicitors as defense mechanism against Rhizoctonia and Macrophomina infestation

Abstract Improving agricultural products by the stimulation of plant growth and defense mechanisms by priming with plant extracts is needed to attain sustainability in agriculture. This study focused to consider the possible improvement in Vigna radiata L. seed germination rate, plant growth, and protection against the natural stress by increasing the defense mechanisms through the incorporation of Sesamum indicum phytochemical compounds with pre-sowing seed treatment technologies. The gas chromatography coupled with mass spectroscopy (GC–MS) analysis revealed that the methanol extract of S. indicum leaf extract contained eight major bioactive compounds, namely, 2-ethylacridine (8.24%), tert-butyl (5-isopropyl-2-methylphenoxy) dimethylsilane (13.25%), tris(tert-butyldimethylsilyloxy) arsane (10.66%), 1,1,1,3,5,5,5-heptamethyltrisiloxane (18.50%), acetamide, N-[4-(trimethylsilyl) phenyl (19.97%), 3,3-diisopropoxy-1,1,1,5,5,5-hexamethyltrisiloxane (6.78%), silicic acid, diethyl bis(trimethylsilyl) ester (17.71%) and cylotrisiloxane, hexamethyl-(4.89%). The V. radiata seeds were treated with sesame leaf extract seeds at concentrations 0, 10, 25, 50, and 100 mg/L. Sesame leaf extract at 50 and 100 mg/L concentrations was effective in increasing the germination percentage and the fresh and dry weights of roots and shoots. The increased peroxidase activity was noticed after treatment with S. indicum extract. In addition, disease percentage (< 60%) of both fungal pathogens (Rhizoctonia and Macrophomina) was significantly reduced in V. radiata plants treated with 100 mg/L of sesame leaf extract. These results revealed that physiochemical components present in S. indicum mature leaf extract significantly enhanced growth and defense mechanism in green gram plants

Mycophenolic acid in kidney transplant patients with diabetes mellitus: Does the formulation matter?

Diabetes mellitus is frequent in kidney transplant recipients and is commonly associated with gastrointestinal (GI) complications. Delayed gastric emptying affects 30% to 50% of patients with type 1 or 2 diabetes and can influence oral drug absorption. Time-to-peak concentration of mycophenolic acid (MPA) from mycophenolate mofetil (MMF) is longer in diabetic kidney transplant patients than patients without diabetes. By retaining gut contents in the stomach for longer, this could increase local GI toxicity in diabetic recipients due to an extended duration of exposure to MPA in the stomach. The enteric-coated mycophenolate sodium (EC-MPS) formulation delays the release of MPA until pH is higher than 5.5, such that absorption takes place more distally compared with MMF. Patient-reported outcomes data have been used to assess the effect of conversion to EC-MPS in maintenance kidney transplant patients with diabetes who were experiencing MMF-related GI symptoms. Results indicated that conversion leads to improved GI symptom burden despite higher MPA exposure under the EC-MPS regimen. Improved GI tolerance using EC-MPS has permitted maintenance of optimal MPA exposure in nondiabetic populations. Comparative trials to evaluate the GI symptom burden and maximum achieved MPA dosing using the EC-MPS and MMF formulations in de novo and maintenance diabetic kidney transplant recipients are merited. © 2011 Elsevier Inc

First world consensus conference on pancreas transplantation: part I - methods and results of literature search

Comprehensive evidence-based guidelines for the practice of pancreas transplantation are yet to be established. The First World Consensus Conference on Pancreas Transplantation was convened for this purpose. A steering committee selected the participants and defined the questions to be addressed. A group of literature reviewers identified 597 studies to be included in summaries for guidelines production. Expert groups formulated the first draft of recommendations. Two rounds of discussion and voting occurred online, using the Delphi method (agreement rate ≥85%). After each round, critical responses of experts were reviewed, and recommendations were amended accordingly. Recommendations were finalized after live discussions. Each session was preceded by expert presentations, and a summary of results of systematic literature review. Up to three voting rounds were allowed for each recommendation. To avoid potential conflicts of interest, deliberations on issues regarding the impact of pancreas transplantation on the management of diabetes were conducted by an independent jury. Recommendations on technical issues were determined by experts and validated using the AGREE II instrument (Appraisal of Guidelines for Research and Evaluation II). Quality of evidence was assessed using the SIGN methodology (Scottish Intercollegiate Guidelines Network). Each recommendation received a GRADE rating (Grading of Recommendations, Assessment, Development and Evaluations)