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BACKGROUND: The use of immunoisolation to protect transplanted cells from the immune system of the host has broad application to the treatment of major diseases such as diabetes and a wide range of other disorders resulting from functional defects of native cell systems. In most cases, limitations in functional cell longevity will necessitate periodic replenishment of the cells. We describe a hydrogel-based microcapsule that breaks down at a rate that can be adjusted to correspond to the functional longevity of the encapsulated cells. These injectable capsules can be engineered to degrade over several weeks to months for short-term drug delivery, or to remain intact and immunoprotective for more extended periods. When the supply of cells needs to be replenished, no surgery will be required to localize and remove the old capsules. METHODS: Porcine and bovine islets were immobilized in "composite" microcapsules fabricated from alginate and low-relative molecular mass (Mr) poly (L-lysine[PLL]) (Mr exclusion <120 Kd) and implanted into the peritoneum of normal and streptozotocin-induced diabetic rats. In addition to demonstrating long-term islet viability and function, a series of in vitro studies were carried out to determine the permeability and biodegradability of the microcapsules used in the present system. RESULTS: Xenogeneic islets implanted in nonimmunosuppressed rats remained in excellent condition indefinitely (>40 weeks)(viability was comparable to that of preimplant control specimens). In contrast, no islets survived in uncoated alginate spheres after 2 weeks postimplantation. By changing the concentration of the alginate, it was possible to vary the rate of capsule breakdown in rats from mechanically unstable (outer matrix <0.5-0.75% alginate) to stable for >1 year (> or =1.5% alginate). In addition to in vivo breakdown studies, the biodegradability of the capsular components was verified in vitro using a mixture of tritosomes (enzymes isolated from animal cells). CONCLUSIONS: We have designed a microcapsule system with controllable biodegradability which allows breakdown and absorption of implants when the cells die or become functionally inactive. These results may have application to other alginate-PLL encapsulation systems. The ability to cross species lines using these biodegradable microcapsules has the potential to expand dramatically the number of patients and the scope of diseases that can be successfully treated with cellular therapy.

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Studies involving the transplantation of human islets in Type I diabetics have been of significant value both in documenting the potential importance of islet transplantation as a therapeutic modality, and in defining some of the problems which must be overcome before this approach can be used in large numbers of patients. The currently limited supply of adult human pancreatic glands, and the fact that chronic immunosuppression is required to successfully transplant islets into patients, indicate that techniques must be further developed and refined for allo- and xenografting of isolated islets from human and animal sources to diabetic patients. An increasing body of evidence using microencapsulation techniques strongly suggests that this will be achieved during the next few years. Data from our laboratory in rodents and dogs indicate that these systems can function for extended periods of time. In one study, insulin independence was achieved in spontaneously diabetic dogs by islet microencapsulation inside uncoated alginate gel spheres (Mr exclusion >600 kD). No synthetic materials or membrane coatings were employed in this study. Spheres containing canine islets were implanted into the peritoneum of 4 diabetic dogs. The animals received low-dose CsA (levels below readable limits by HPLC at 3 weeks). Implantation of these spheres completely supplanted exogenous insulin therapy in the dogs for 60 to >175 days. Blood glucose concentration averaged 122+/-4 mg/dl for these animals during the first 2 months. The glycosylated hemoglobin (HbAIC) levels during this period dropped from 6.7+/-0.5% to 4.2+/-0.2% (P<0.001). IVGTT K-values at 1 and 2 months postimplantation were 1.6+/-0.1 (P<0.002) and 1.9+/-0.1 (P<0.001), respectively compared with 0.71+/-0.3 before implantation. In a second group of studies, bovine islets were immobilized inside a new type of selectively permeable "microreactor" (Mr exclusion <150 kD) and implanted into the peritoneum of 33 STZ-induced diabetic rats without any immunosuppression. Diabetes was promptly reversed, and normoglycemia maintained for periods of several weeks to months. Immunohistochemical staining of microreactors recovered from these animals revealed well-granulated beta-cells consistent with functionally active insulin synthesis and secretion. To test further the secretory function of the islets, some of the explanted microreactors were incubated in media containing either basal or stimulatory concentrations of glucose. The islets responded with an approximately 3- to 5-fold average increase above basal insulin secretion. These results are encouraging, and may have important implications in assessing the potential role of these microencapsulation systems as therapy for human insulin-dependent diabetes.

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The principle of immunoisolation is to separate transplanted cells from the hostile immunological environment of the host by a selectively permeable membrane. Low-molecular-weight substances such as nutrients, electrolytes, oxygen and biotherapeutic agents are exchanged across the membrane, while immunocytes, antibodies and other transplant-rejection effector mechanisms are excluded. Here, Robert Lanza and William Chick review these systems.

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The currently limited supply of human pancreatic glands, and the fact that multiple glands may be required to isolate sufficient numbers of islets to treat a single patient, indicate that techniques must be further developed and refined for xenografting of isolated islets from animal sources to diabetic patients. An increasing body of evidence using immunoisolation techniques strongly suggests that this will be achieved during the next few years. Several different types of systems employing selectively permeable membranes and matrix supports for cells have been successfully tested in animals, including devices anastomosed to the vascular system as arteriovenous (AV) shunts, tubular membrane chambers, and spherical micro- and macrocapsules. Results in diabetic animals indicate that these systems can function for periods of several months to > year without the use of any immunosuppression. Our data suggest that this approach has the potential not only to allow the transplantation of islets across wide species barriers, but that it can be achieved using injectable microreactors fabricated from biodegradable polymers. The use of these various immunoisolation systems to transplant islets and other cells and tissues offers the opportunity to revolutionize current therapy for many human disease.

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The potential therapeutic applications of encapsulated cells are enormous. In the US alone, it has been estimated that nearly half-a-trillion dollars are spent each year to care for patients who suffer tissue loss or dysfunction. Over 6 million patients suffer from neurodegenerative disorders such as Alzheimer's disease and Parkinson's disease, over 14 million patients suffer from diabetes, and millions more from liver failure, hemophilia, and other diseases caused by the loss of specific vital cellular functions. It appears likely that by the end of the decade clinical trials of encapsulated cells to treat many of these diseases will become a reality. The Food and Drug Administration has already authorized studies to evaluate the safety and biological activity of several types of systems. A number of issues will have to be addressed, including the sourcing of raw materials, the design and building of manufacturing facilities, the scale-up and optimization process, storage and distribution of the product, and quality control.

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Uncoated spherical hydrogel microspheres (calcium alginate, nominal M(r) exclusion of > 600 kD) 800-900 microns in diameter were employed to prevent immune rejection of discordant islet xenografts isolated from pigs and cows. The islets were immobilized in the microspheres and injected into the peritoneum of 14 nonimmunosuppressed streptozotocin (STZ)-induced diabetic C57BL/6J mice. Four recipients received islet grafts from bovine calves, and 10 received islet grafts from pigs. In the control group of 15 diabetic mice implanted with nonencapsulated islets, 6 received i.p. porcine islets and 5 received i.p. bovine islets, whereas remaining 4 received porcine islets under the kidney capsule. Plasma glucose concentrations in recipients of the alginate-encapsulated islets promptly dropped from a preimplantation value of 498 +/- 47 (mean +/- SEM) to 142 +/- 6 (bovine) and 178 +/- 7 mg/dl (porcine) during the first wk. All the animals sustained these levels for at least 1 mo. Two mice implanted with bovine islets subsequently reverted to diabetes (plasma glucose > 250 mg/dl) at 43 days postimplantation. The remaining grafts maintained function for > 10 wk. In contrast, nonencapsulated islets failed to function, or sustained euglycemia for < 4 days. Mice receiving encapsulated islets showed a 23-38% gain in body weight during the first mo after implantation, compared with < 1% (P < 0.002) and 32% (P = 0.84) for the untreated diabetic (n = 6) and normal control (n = 6) groups. Immunohistochemical staining of long-term grafts (> 10 wk) revealed viable islets, with well-granulated alpha, beta, and delta cells; the external surfaces of the microreactors were free of fibrotic overgrowth and exhibited only occasional host cell adherence. Uptake studies with IgG and thyroglobulin (M(r) of 669 kD) suggest that the microreactors were permeable to molecules with a molecular weight of up to > 600 kD (including the various proteins of the complement system, M(r) of 24-570 kD). Spheres implanted in the peritoneum after only 1 wk stained positive for both IgG and for the C3 component of complement. These findings suggest that prolonged survival of discordant xenografts of porcine and bovine islets in the STZ diabetic mouse model can be achieved with uncoated alginate microspheres that are permeable to IgG and complement. The question of whether similar results can be achieved with uncoated alginate microspheres in higher animals remains to be fully determined.

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Encapsulation systems have been developed in which cells are separated from the immune system of the host by permselective barriers. These systems do not require a life-long regimen of high dose immunosuppressive drugs to prevent immune rejection. Furthermore, they offer a solution to the problem of human cell procurement by permitting use of cells and tissues from animal sources. Three major types of immunoisolation devices have been studied by our group. These include perfusion devices anastomosed to the vascular system as atrioventricular (AV) shunts, tubular membrane diffusion chambers, and microreactors. This technology is applicable to treating a number of diseases by transplantation of cells that produce specific bioactive substances. In essence, this approach constitutes a living drug delivery and detoxification system. Our work has focused mainly on developing a new treatment for diabetes using encapsulated pancreatic islets. In the first type of system, canine and porcine islets were distributed in a chamber surrounding a permselective acrylic membrane (nominal M(r) exclusion of 80 kDa), and the devices implanted intraperitoneally as AV shunts into diabetic, totally pancreatectomized dogs without use of immunosuppression. In the second type of system, the islets were sealed within the acrylic membranes and the chambers implanted into the peritoneum of diabetic, pancreatectomized dogs (canine islets), streptozotocin (STZ)-induced diabetic rats (canine, bovine and porcine islets), and spontaneously diabetic BB/Wor rats (canine islets) without use of immunosuppression. In the third type of system (microreactors), the islets were implanted into the peritoneum of STZ-induced diabetic mice without use of immunosuppression, into STZ-induced diabetic rats (bovine and porcine islets) both with and without use of low dose immunosuppression, and into spontaneously diabetic dogs (canine islets) with low dose CsA. Results indicate that all three types of encapsulation systems significantly improve glucose homeostasis and can function for periods of several months to more than a year.

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Isolated porcine islets represent a potential source for discordant islet xenografts in diabetic patients. The authors therefore investigated insulin secretion from isolated porcine islets both in vitro and in vivo. For in vitro studies, islets were maintained in culture or placed in biohybrid perfusion devices consisting of a plastic housing containing a selectively permeable acrylic copolymer tubular membrane. Culture medium was circulated through the devices in a closed loop system. After 3 months the cultured islets secreted insulin at levels of 354 +/- 49 microU/equivalent islet number (EIN)/day (mean +/- standard error of the mean [SEM]; n = 10). They responded to glucose stimulation (5 to 16 mmol/L steps) with significant increases in insulin secretion. The biohybrid devices seeded with islets produced 23 +/- 2 (mean +/- SEM; n = 8) units insulin per day over periods of 83 +/- 8 days. For in vivo studies, islets were sealed within membrane chambers and implanted in the peritoneal cavity of streptozotocin induced diabetic Lewis rats. Chambers with a total of 2 x 10(4) islets per rat normalized the plasma glucose values of 10 rats, with the concentrations decreasing from 487 +/- 18 to 97 +/- 10 mg/dl during the first month. All grafts maintained normoglycemia for longer then 3 months. Histologic studies of long-term chamber implants in rats (1-20 months of age) showed viable islets, with varying degrees of beta cell granulation. These studies suggest the long-term functioning of porcine islets both in vitro and in vivo as discordant xenografts.

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Dithizone (DTZ) is a recognized diabetogenic agent in vivo, and a supravital stain commonly used for identification of islets to be used for transplantation. In the present studies, we compared DTZ staining of freshly isolated and cultured canine, bovine, and porcine islets, and the effect of DTZ on the function and viability of islets. Incubation with DTZ resulted in staining of canine and porcine islets, but no discernible staining with bovine islets. Insulin content of porcine, canine, and bovine islet was 2.0 +/- 0.2, 2.2 +/- 0.3, and 1.9 +/- 0.2 mU/EIN, indicating a lack of correspondence of DTZ staining and insulin content. Seven days of culture with canine islets resulted in > or = 50% reduction of DTZ stained cells. Exposure to DTZ at 50 micrograms/mL resulted in a maximal number of stained cells in preparations of purified islets (80-85%; counted after dispersion), a lower percentage of cells stained faintly at 20 micrograms/mL (50-55%), with no discernible staining at 10 micrograms/mL. Prolonged exposure of islets (4-48 h) to 20 micrograms/mL DTZ led to reduced insulin secretion and islet cell death. Incubation of canine or porcine islets with 100 micrograms/mL of DTZ for 0.5 h resulted in a dramatic loss of viability and diminished insulin secretory function, which was not reversed with continued culture. The concentration dependence of toxic effects paralleled the concentration dependence of cellular staining. The minimally effective staining concentration (20 micrograms/mL) also resulted in a loss of viability. An additional assessment of DTZ toxicity was made using the RIN-38 beta-cell line, which shows no discernible staining with DTZ.(ABSTRACT TRUNCATED AT 250 WORDS)

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It has been hypothesized that chronic antigen leakage from the hybrid artificial pancreas could stimulate a host humoral response. Such antibodies could be induced by antigens shed from the islet cell surface, or by proteins secreted by live cells or liberated after cell death. To determine if this humoral response occurs, porcine (n = 15) or canine (n = 7) islets were seeded (2-5 x 10(4) equivalent islet number, density 30 islets/mm3) into diffusion chambers fabricated from permselective acrylic membranes (nominal M(r) exclusion of 80,000). The chambers were implanted intraperitoneally into streptozotocin-induced diabetic rats. Sera were collected at various intervals (0-12 weeks) and tested against isolated canine and porcine islets, for tissue specificity and interspecies cross-reactivity by fluorescence immunocytochemistry. No immunofluorescence (or only weak background staining) was obtained when islets were exposed to horse sera, or to sera obtained before to xenodevice implantation. Within 2-6 weeks, however, the postimplantation sera showed strong immunoreactivity. The antibodies were found to be reactive to multiple tissues, and to possess little or no interspecies cross-reactivity. The appearance of these xenoantibodies coincided with the appearance of circulating soluble immune complexes. However, none of the respiratory, cutaneous, or gastrointestinal manifestations that are characteristic of an anaphylactic reaction, or of the diseases of immediate-type hypersensitivity, were observed, even after intraperitoneal injection of additional naked islet tissue. Renal glomeruli did not stain for IgG or C3 in islet recipients. These results suggest that islet cell antigens crossed the membrane and stimulated antibody formation in the host, although they did not appear to cause renal or immune complex disease during the course of this study.

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