de Block, Christophe

et al.

Gillard, Pieter

Hilbrands, Robert

van de Velde, Ursule

Abstract: OBJECTIVEPrevious work has shown a correlation between -cell number in cultured islet cell grafts and their ability to induce C-peptide secretion after intraportal implantation in C-peptide-negative type1 diabetic patients. In this cross-sectional study, we examined the minimal functional -cell mass (FBM) in the implant that induces metabolic improvement.RESEARCH DESIGN AND METHODSGlucose clamps assessed FBM in 42 recipients with established implants. C-peptide release during each phase was expressed as percentage of healthy control values. Its relative magnitude during a second hyperglycemic phase was most discriminative and therefore selected as a parameter to be correlated with metabolic effects.RESULTSRecipients with functioning -cell implants exhibited average FBM corresponding to 18% of that in normal control subjects (interquartile range 10-33%). Its relative magnitude negatively correlated with HbA(1c) levels (r = -0.47), daily insulin dose (r = -0.75), and coefficient of variation of fasting glycemia (CVfg) (r = -0.78, retained in multivariate analysis). A correlation between FBM and CVfg 37% exhibited CVfg 50% reduction of their pretransplant CVfg; this occurred in none with FBM 18% reduced CVfg from a median pretransplant value of 46 to 37% of normal control subjects appear needed to reduce glycemic variability in type 1 diabetic recipients. Further studies should examine whether the test can help guide decisions on additional islet cell transplants and on adjusting or stopping immunotherapy

Minimal functional <tex>\beta$</tex>-cell mass in intraportal implants that reduces glycemic variability in Type 1 diabetic recipients

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