WO2015159889A1

WO2015159889A1 - Method for transplanting insulin-producing cells

Info

Publication number: WO2015159889A1
Application number: PCT/JP2015/061492
Authority: WO
Inventors: 安波洋一
Original assignee: 学校法人福岡大学
Priority date: 2014-04-14
Filing date: 2015-04-14
Publication date: 2015-10-22
Also published as: JP6300287B2; JPWO2015159889A1

Abstract

　In the present invention, insulin-producing cells are transplanted into the subcutaneous fat tissue of the inguinal region or the like of a diabetic patient, providing a new mechanical cellular transplantation method that can potentially resolve obstacles currently faced in clinical pancreatic islet transplantation, i.e., the evaluation of transplant pancreatic islet cells, the difficulty in harvesting said cells, and the low transplantation efficiency.　Moreover, the present invention is a breakthrough method for treating a diabetic patient merely by transplanting, into a recipient, the same number or a lower number of insulin-producing cells present in one donor. The present invention can alleviate the problem of insufficient transplanted insulin-producing cells. Moreover, the present invention provides evidence that insulin/glucagon double-positive cells only appear in the pancreatic islet cells transplanted to the subcutaneous fat tissue of the inguinal region of mice, and that these insulin/glucagon double-positive cells provide a new in-vivo model of β cell differentiation.

Description

Insulin producing cell transplantation method

The present invention relates to a novel method for transplanting insulin-producing cells. More specifically, the present invention relates to a novel method for transplanting insulin-producing cells in which insulin-producing cells are transplanted into subcutaneous fat tissue.

Diabetes is a typical lifestyle-related disease and is a complex chronic disease in which carbohydrates, lipids and proteins cannot be properly maintained and used. Diabetes is also characterized by abnormally high blood sugar levels due to insulin production deficiency or impaired insulin function caused by various genetic and environmental factors. As the symptoms of diabetes progress, it causes complications such as retinopathy, nephropathy, and neuropathy, causing stroke, cerebrovascular disorder, etc., resulting in a significant decrease in patient quality of life (QOL) Ultimately leading to a fatal prognosis for the patient.

Recently, the number of diabetic patients is estimated to reach about 350 million worldwide (Non-patent Document 1). In addition, the total number of patients with diabetes is enormous, adding to the number of patients who are strongly suspected of having diabetes or the number of patients with diabetes reserves. In addition, the fact that only a limited number of diabetic patients are receiving appropriate treatment is a major problem both medically and economically.

There are two main forms of diabetes: type 1 diabetes (T1DM) and type 2 diabetes (T2DM). Type 1 diabetes (formerly known as insulin-dependent diabetes mellitus (IDDM)) is characterized by specific destruction of insulin-producing pancreatic β-cells and depletion of insulin. This type 1 diabetes often occurs in children and young people. Type 2 diabetes (previously known as non-insulin-dependent diabetes mellitus (NIDDM)) responds appropriately to insulin production deficiency due to dysfunction of insulin-producing pancreatic β-cells or muscle and liver cells produced in the pancreas It develops due to a relative shortage of insulin, such as when it is not possible. It is noted that type 2 diabetes occurs most frequently in adults but is also increasing in young people. Type 2 diabetes accounts for about 90% of all diabetic patients. In particular, the number of type 2 diabetic patients is rapidly increasing due to obesity, lack of exercise, and aging. It should also be noted that many young patients with type 2 diabetes have pancreatic autoimmune abnormalities, increasing the number of cases where it is difficult to distinguish type 2 diabetes from type 1 diabetes or vice versa. It is that.

As mentioned above, patients with type 1 diabetes (T1DM) have a rapid change in blood glucose level due to complete or almost complete destruction of insulin-producing β cells in the islets of Langerhans (islets). Caused by the event that causes complications related to hyperglycemia (hyperglycemia), which is ultimately related to life and death, the ability to produce insulin has been lost. Therefore, patients with type 1 diabetes must rely on insulin therapy by administering insulin injection from one to several times a day or insulin by an insulin pump from the outside (Non-patent Document 2).

However, even if type 1 diabetics receive advanced treatment with insulin, the complications that maintain blood glucose levels stably and continuously and cause chronic long-term organ damage caused by hyperglycemia It is difficult to prevent. Insulin therapy can also cause excessive insulin administration, thereby increasing the risk of developing acute hypoglycemia with significant consciousness modulation that can be fatal. Despite these difficulties and risks, insulin therapy now plays a very important role in saving type 1 diabetes from emergency situations that lead to sudden death. However, insulin therapy is only a coping treatment and cannot completely cure type 1 diabetes, solving extremely difficult problems such as the risk of hypoglycemia and the onset of long-term complications (For example, Patent Document 1 Japanese Patent Publication No. 2008-189574).

As another method of such insulin therapy for treating type 1 diabetes, there is an islet transplantation method in which insulin-producing β cells of Langerhans islet isolated from the pancreas are directly transplanted into a type 1 diabetes patient. This islet transplantation method is theoretically an excellent method for diabetic patients with islet cell disorders, and is an endocrine complement therapy that has been widely attempted in clinical practice since the late 1960s. This islet transplantation is now a very promising approach for the treatment of type 1 diabetes. This islet transplantation is a simple method of transplanting islet cells simply by instilling them into the portal vein of the liver. Therefore, it is extremely safe and dangerous compared to the operation of transplanting all organs. There is an advantage that it can be carried out even for highly peculiar patients. This islet transplantation is also advantageous because there is no need for abdominal surgery or vascular anastomosis. In addition to these, this islet transplantation has an advantage that even if a transplant rejection reaction occurs, removal is not necessary and the burden on the patient is extremely low (see, for example, Patent Document 1).

However, this islet transplantation method is faced with the disadvantage that the engraftment rate of the transplanted islet is extremely low due to early rejection of the graft. Therefore, even if a patient with type 1 diabetes receives transplantation of islet cells from the pancreas of one donor, it cannot become insulin-independent (for example, Non-Patent Documents 3 and 4). The rate of early loss of transplanted islet cells is estimated to be about 60% of the total number of transplanted islet cells. Therefore, in the current islet transplantation, it is necessary to repeatedly transplant islet cells from the pancreas of two or more people in order to treat one diabetic patient in a good condition (for example, non-patent document). 3, 4, 5).

However, this islet transplantation also has the risk that the islet graft forms an embolus in the peripheral portal vein and implants in the liver of a diabetic patient, causing ischemic alterations in the corresponding area. This can result in a post-transplant immune response that releases inflammatory santocaine that is detrimental to islet cell debris. Β cells that secrete insulin are susceptible to in vitro effects when exposed to pro-inflammatory cytokines such as IFN-γ, TNF-α, and IL-1β, for example (see Non-Patent Document 6).

The first clinical transplantation of islet cells for human patients was performed in 1974 at the University of Minnesota. However, its performance has been poor until recently compared to other organ transplants. However, in 2000, insulin was released at a very high rate from the University of Alberta under a clinical islet transplantation protocol called the “Edmonton Protocol” using immunosuppression without any steroids. It was reported that it was made (for example, non-patent document 4). Since then, islet transplantation has been established as a breakthrough for the treatment of type 1 diabetes.

As described above, although islet transplantation has become increasingly useful as a fundamental treatment for diabetes, further improvement is necessary for successful islet transplantation. The reason for this is that, for example, the current islet transplantation has a low engraftment rate of islet cells, the need for infusion of a large amount of islet cells due to such a low engraftment rate, and a small number of donors, etc. This is because they still face a number of problems. In 2006, Shapiro et al. Reported on the results of islet transplant patients using the Edmonton protocol, and 76% of patients who did not need insulin therapy once islet transplants. Insulin therapy was resumed 2 years after transplantation.

Furthermore, a major problem is that current islet transplantation requires a low number of transplanted islet cells transplanted to the liver, so two or more donors are required for one diabetes recipient. This should be urgently solved even from the viewpoint that there are few donors. If this problem is solved and the ratio of donors to recipients has improved to a one-to-one ratio, islet transplantation is expected to spread explosively and make a significant contribution to the treatment of diabetes. The

Thus, although islet transplantation faces several problems, as a result of decades of research to improve intrahepatic islet delivery, the intrahepatic space is nourishing and physical to the islets. It has been found to be a support and play an essential role in maintaining the engraftment and function of transplanted islet cells for a long period of time. Therefore, islet transplantation is an attractive method for the treatment of diabetes, and currently, the liver via the portal vein of diabetic patients is a transplant site in a clinical setting (see, for example, Non-Patent Documents 4 and 7). However, on the other hand, there are reports that the hepatic vascular system is a hostile environment that restricts engraftment and functions (Non-Patent Documents 8 and 9). As a result, many different sites for islet transplantation were investigated to optimize islet engraftment and function, reduce the number of transplanted islet cell mass required, and reduce immunogenicity (non- Patent Documents 9 and 10).

In addition to sites in the liver portal vein, for example, kidney subcapsular sites, spleen, omentum, pancreas, gastrointestinal wall, immune protection sites such as thymus, brain and testis, musculoskeletal sites such as bone marrow, and subcutaneous sites Many other transplant sites have been investigated (eg, Non-Patent Documents 9, 11, and 12). Although many other implantation sites for patients have been tested as described above, until now it has not been possible to make patients non-insulin dependent. As a result, intraportal islet transplantation has been empirically recognized as the best site for use in patients (Non-patent Document 9).

However, the development of new transplantation sites other than the intraportal site of the liver is necessary to reduce the loss of pancreatic islet cells transplanted in diabetics and to overcome problems related to the lack of pancreatic islet cells to be transplanted It is.

Furthermore, the latest study revealed islet cells containing both insulin and glucagon granules. Until now, it has been known that insulin is produced in β cells of the islets of Langerhans and glucagon is produced in the α cells (see Non-Patent Document 13). Furthermore, although insulin deficiency has been considered to be the only problem with diabetes for decades, it has been suggested that glucagon also plays an important role in the pathogenesis of diabetes (Non-Patent Document 14).

Therefore, these islet cells are expected to play some role in secreting these hormones in vivo once transplanted into a diabetic patient.

Based on the background art described above, the present inventors have conducted intensive research. As a result, the present inventor has developed a novel method that is easy to handle when transplanting pancreatic islet cells and can be immediately extracted when a transplanted pancreatic islet cell malfunctions. A subcutaneous implant site was found. Subcutaneous transplantation has been reported in the past to require about 5,000 islet cells from 5 or more donor rats to treat diabetes in one diabetic recipient rat (Non-patent Document 15). Report that the engraftment efficiency is very low. The present inventor reasoned that the engraftment efficiency was so low that the islet cells died of hypoxia after transplantation due to the lack of nutrient blood vessels. The subcutaneous fat part of the heel part is selected as a new subcutaneous transplantation site where improvement of engraftment efficiency can be expected because the nutritional blood vessels of the inferior abdominal wall arteries and veins pass through on both sides (Non-patent Document 16). did.

JP 2008-189574 A

Therefore, the present inventor has achieved that islet cell transplantation into the subcutaneous adipose tissue of the buttocks of diabetic mice reduces the blood glucose level to a normal level and achieves transplantation as efficient as conventional liver transplantation. I found.

Furthermore, the present inventor can cure diabetes of a recipient by simply transplanting the same or a small number of insulin-producing islets to the number of islet cells of one donor into the subcutaneous fat tissue of one diabetes recipient, or for a long period of time. It was found that it can be expected to maintain a normal blood sugar level.

Also, surprisingly, the present inventor has found that insulin / glucagon co-positive cells (insulin / glucagon) in which both insulin and glucagon are expressed in the same transplanted islet cells are transplanted into subcutaneous adipose tissue. glucagon double positive cells).

Therefore, an object of the present invention is to provide a novel method for transplanting insulin-producing cells in which insulin-producing cells are transplanted into subcutaneous adipose tissue in which vegetative blood vessels are widely distributed.

As used herein, the term “subcutaneous adipose tissue” is a subcutaneous adipose tissue of a diabetic recipient, and is a nutrient-supplementing blood vessel that is localized in the body and can supply essential nutrients to the islet cells. Means subcutaneous adipose tissue that is widely circulated and distributed in the region. Examples of such subcutaneous adipose tissue include, but are not limited to, subcutaneous adipose tissue such as the buttocks, armpits, back or abdomen where the lower abdominal wall arteriovenous circulates. Of these tissues, the groin is preferred because blood vessels are distributed throughout the region.

As used herein, the term “nutrient blood vessel” means a blood vessel capable of supplying nutrients essential to transplanted islets to subcutaneous adipose tissue. Such blood vessels can include, for example, arteries, veins and / or capillaries.

The present invention also enables the blood sugar level of a diabetic recipient to be normal blood glucose level for a long period of time simply by transplanting the same or a small number of islet-producing islets as the number of islet cells of one donor to the subcutaneous fat tissue of one diabetic recipient. Another object is to provide a novel method of treating diabetes comprising maintaining and treating diabetes.

Furthermore, an object of the present invention is to provide insulin / glucagon double positive cells which are cells in which insulin and glucagon are expressed in the same cell.

In order to achieve the above object, the present invention provides a novel method for transplanting insulin-producing cells in which insulin-producing cells are transplanted into subcutaneous adipose tissue in which nutrient blood vessels are widely distributed.

In a preferred embodiment of the present invention, the insulin-producing cells are human islet cells, heterologous islet cells such as pigs, insulin / glucagon double positive positive cells, or insulin-producing cells prepared from ES cells or iPS cells. An insulin producing cell transplantation method comprising the above is provided.

Another preferred embodiment of the present invention is an insulin-producing cell comprising a subcutaneous adipose tissue in a site in which nutrient blood vessels such as the buttocks, armpits, and back of a diabetic recipient are widely distributed. Provide a transplantation method.

In another form of the invention, the subcutaneous adipose tissue of one diabetic recipient contains insulin producing pancreatic islets equal to or less than the number of islet cells of one donor, eg, 1/10 of the number of islet cells of one donor, preferably Treats diabetes by maintaining the blood glucose level of the diabetic recipient at a normal blood glucose level for a long period of time simply by transplanting 2/3 to 1/6, more preferably 1/2 to 1/5 islet cells. And a novel method for treating diabetes.

In a preferred embodiment of the present invention, there is provided a method for treating diabetes comprising transplanting insulin-producing cells and producing insulin from the transplanted cells to treat diabetes.

In yet another embodiment of the present invention, insulin / glucagon double positive cells, which are cells in which insulin and glucagon are expressed in the same cell, are provided.

In the present invention, transplantation is performed by selecting a transplantation site for transplanting insulin-producing cells into subcutaneous adipose tissue existing in a site where nutritional blood vessels such as the buttocks, armpits, and back of a diabetic recipient are widely distributed. This is not only easy to implement, but also has the great advantage that once transplanted insulin-producing cells cause transplant rejection, the transplanted insulin-producing cells can be removed.

Furthermore, the present invention can treat a diabetic patient by transplanting an insulin-producing cell of a single donor, for example, a human islet or a porcine islet cell, which is almost the same as or less than a number of islet cells, which has been impossible until now. There is a tremendous advantage of being possible.

FIG. 1 is a view showing a part of mouse hip subcutaneous tissue as a novel islet transplantation site. FIG. 1 (A) shows the subcutaneous adipose tissue of the left buttock in a state lifted with tweezers. In FIG. 1 (A) and 1 (B), the trophic blood vessels of the subcutaneous fat tissue of the buttocks can be seen. Long and short arrows indicate the thigh arteriovenous and the lower abdominal wall arteriovenous, respectively. FIG. 2 is a diagram showing a method of islet transplantation into mouse hip subcutaneous tissue. FIG. 2a is a top view of the left groin skin incision. FIG. 2b shows a small pocket created in the hip subcutaneous tissue. Figures 2c and 2d show islets attached to the tip of the tube placed inside the pocket. In the drawings, arrows indicate islets in the pockets, and arrowheads indicate islets at the tip of the tube. FIG. 2e shows the pocket opening held by tweezers. FIG. 2f shows a pocket opening closed with a stapler. The scale is 1 mm. FIG. 3 is a graph showing the plasma glucose concentration of streptozotocin (STZ) -induced diabetic C57BL / 6 mice in which allogeneic islets were transplanted into the buttock subcutaneous adipose tissue. The upper line graph shows a case where 200 islets were transplanted from a single donor mouse pancreas, and the lower line graph shows a case where 400 islets were transplanted. In the line graph, a line with a mark (+) indicates a mouse that died of severe diabetes, and a line with a mark (*) indicates a case in which the pancreatic islet transplanted to the subcutaneous adipose tissue of a diabetic recipient mouse was removed Indicates. FIG. 4 shows the morphology of transplanted islets into the subcutaneous subcutaneous fat 60 days after transplantation. FIG. 4a shows exposed hip subcutaneous tissue, where the arrows indicate staples with closed pockets. The arrowheads in FIG. 4b show a mass of transplanted islet with new blood vessel formation. In FIG. 4b, the short and long arrows indicate the lower abdominal wall arteriovenous and the femoral arterial vein, respectively. FIG. 5a shows a section of transplanted islets stained for DAP1, insulin and glucagon and an image combining these together. FIG. 5b is the high magnification image of FIG. 5a. Figures 5c, 5d and 5e show stained images for insulin, glucagon and DAP1, respectively. FIG. 5b shows insulin / glucagon co-positive cells. The horizontal lines in FIGS. 5a and 5b indicate 50 μm and 5 μm, respectively. FIG. 6 shows islet graft tissue within the kidney capsule (kc, upper panel) and liver (pv, lower panel) 60 days after transplantation. From left to right in the figure, DAP1, insulin, glucagon, and a panel showing a combination image thereof are shown. However, insulin / glucagon co-positive cells are not observed in this image. FIG. 7 shows the plasma glucose level of STZ-induced diabetic NOD / scid mice transplanted with human islets in the buttock subcutaneous adipose tissue. In the figure, a line with a mark (*) indicates that the pancreatic islet transplanted to the subcutaneous subcutaneous fat tissue of the recipient mouse was removed. FIG. 8 shows a confocal microscopic image of a human islet graft in the hip subcutaneous fat tissue of STZ-induced diabetic NOD / scid mice 60 days after transplantation. FIG. 8 (A) shows a human islet graft stained with HE. 8 (B), 8 (C), and 8 (D) are enlarged images of a portion surrounded by a square in FIG. 8 (A), and show human islet grafts stained for insulin, glucagon, and DAP1, respectively. FIG. 8E shows an image obtained by combining the stained images of the human islet grafts of FIGS. 8B, 8C, and 8D. The arrowheads in FIG. 8 (E) indicate insulin / glucagon simultaneous positive cells. FIG. 9 shows the morphology of transplanted islets 6 hours after transplantation into the subcutaneous subcutaneous adipose tissue of STZ-induced diabetic recipient mice. FIG. 9 (A) shows a HE-stained section of the transplanted islet 6 hours after transplantation. The portion surrounded by the square in the upper left corner is a high-magnification portion of the portion enclosed by the square shown in the right portion of the HE-stained pancreatic islet. In the high-magnification portion, the arrowheads indicate infiltrating neutrophils in the transplanted islets. FIG. 9B shows immunofluorescence images of islet grafts stained for insulin (green) and Gr-1 (red), respectively. The horizontal lines in the left and right figures indicate 100 μm and 10 μm, respectively. FIG. 10 is a line graph showing plasma glucose levels in STZ-induced diabetic Jα18-deficient (NKT cell-deficient) mice transplanted with allogeneic islets in the buttock subcutaneous adipose tissue. In particular, diabetes in STZ-induced diabetic Jα18 deficient (NKT cell deficient) mice was ameliorated after transplanting 50 islets, equivalent to 1/4 of the islets from one donor, into the subcutaneous subcutaneous adipose tissue. This indicates that islet transplantation into the subcutaneous subcutaneous adipose tissue in the absence of recipient NKT cells has improved by a factor of four. FIG. 11 is an immunoelectron micrograph of human transplanted islet cells.

In this invention, insulin-producing cells are transplanted into the subcutaneous fat tissue of a diabetic recipient, the transplanted insulin-producing cells are engrafted in the subcutaneous fat tissue, and insulin is secreted to thereby change the blood glucose level of the diabetic recipient to normal blood glucose level. It consists of reducing and treating diabetes.

The insulin-producing cell transplant site that can be selected in the present invention is a subcutaneous adipose tissue that can be used as a scaffold for engraftment of the transplanted insulin-producing cells and secreting insulin among various body parts where the subcutaneous adipose tissue is localized, In addition, any subcutaneous adipose tissue may be used as long as nutritional blood vessels essential for replenishing the transplanted insulin-producing cells are circulated and distributed in the subcutaneous adipose tissue. Preferable examples of such transplantation sites include the buttocks, armpits, back or abdomen. Of these tissues, the groin is preferred because the circulating lower abdominal wall arteriovenous can replenish the transplanted islet cells.

Insulin producing cells to be transplanted in the present invention include, for example, human islet cells, heterologous islet cells such as pigs, etc., and insulin / glucagon that is first discovered in the present invention and insulin / glucagon expressed in the same cell. Mention may be made of positive cells.

In addition, the insulin-producing cell transplantation of the present invention can transplant insulin-producing islet cells into the subcutaneous adipose tissue of a diabetic recipient by injection from a cell-containing container embedded in the body of the diabetic recipient. The great advantage of using such a container is that once transplanted insulin producing cells cause graft rejection, it can be removed. This is extremely useful in treating diabetes by cell transplantation.

The results of experiments by the present inventors using NKT cell-deficient (Jα18-deficient) mice indicate that the engraftment rate of insulin-producing pancreatic islets transplanted into subcutaneous adipose tissue has been remarkably improved. This means that NKT cells are involved in graft rejection. Therefore, transplantation of insulin-producing cells according to the present invention into subcutaneous adipose tissue has the great advantage that early rejection can be largely prevented and the number of cells to be transplanted can be significantly reduced. As a result, one diabetic patient can be transplanted with the same number or a small number of cells as the number of cells of one donor. In other words, the transplantation method of the present invention can reverse or ameliorate diabetes of a diabetic recipient by transplanting insulin-producing cells of one donor to one or more diabetic recipients. More specifically, the subcutaneous adipose tissue of a 1 diabetic recipient is 1/1 to 1/10, preferably 2/3 to 1/6, more preferably 1/2 to 1/5 of the number of cells of one donor. What is necessary is just to transplant a cell number.

The method for transplanting insulin-producing pancreatic islet cells into subcutaneous adipose tissue according to the present invention is an effective method for the treatment and remission of diabetes. In the present invention, the cell transplantation method is very simple and can be transplanted by a conventional technique, and the number of cells transplanted into subcutaneous adipose tissue can be drastically reduced. However, there is an advantage that it can be removed from the transplanted subcutaneous fat tissue.

In the recent situation, there are an increasing number of cases where it is difficult to distinguish between type 1 diabetes and type 2 diabetes because many young patients with type 2 diabetes have pancreatic autoimmune abnormalities. Therefore, the present invention has been mainly described by taking a type 1 diabetic patient as an example, but it can be applied to a type 2 diabetic patient who requires cell transplantation in substantially the same manner as a type 1 diabetic patient. Also should be noted.

As described above, the insulin / glucagon co-positive cells expressed in the same cells transplanted by both the insulin and glucagon found by the present inventor for the first time are the insulin granules and the glucagon granules separately and independently in the same cells. And stained. This insulin / glucagon co-positive cell could not be found in neither the kidney subcapsular transplanted islet nor the intrahepatic transplanted islet. It is still unclear from which cell this insulin / glucagon co-positive cell is derived, ie, α cell, β cell or other cells.

The present invention will be described in detail by way of examples. However, the following examples are not intended to limit the present invention, and are described only for the purpose of illustration. Accordingly, the present invention includes all modifications and improvements derived from the description of the above specification and the following examples.

[Materials and methods]
(mouse)
Male C57BL / 6 and NOD / scid mice were purchased from Charles Reaver Japan (Kanagawa, Japan). Jα18-deficient (NKT cell-deficient) mice were prepared by literature methods (Cui, J., et al. Science 278, 1623-1626 (1997)) and backcrossed to C57BL / 6 mice. Mice were raised in specific sterile rooms and used for experiments at 8-16 weeks of age. All experiments were performed according to a protocol that had received prior approval from the Fukuoka University Animal Care and Use Committee.

(Mouse islet isolation, transplantation and recovery)
Islets are in accordance with literature procedures (Sutton, R., et al., Transplantation, 42, 689-691 (1986); Okeda, T., et al., Endocrinol. Jpn. 26, 495-499 (1979)). After isolation, mice with a diameter of 150-250 μM were carefully selected for the experiment. The isolated islets were cultured overnight at 24 ° C. in a CO ₂ incubator (5% CO ₂ + 95% air) using 10% FBS-supplemented medium (D-MEM, Nissui) and used as a donor. Islets were transplanted into the left groin subcutaneous adipose tissue of STZ (Sigma) (180 mg / kg) induced diabetic syngenetic recipient mice on day 3 of STZ injection. Non-fasted plasma glucose levels were measured twice before and after STZ injection using a GlucoCard DIA meter (Arkray) and once a week after islet transplantation. When collecting transplanted cells, first check the staples used to close the pockets containing the islets of diabetic recipients, and then cut the base and distal sides of the needles to a length of about 5 mm for the following experiment. used. For comparison, intrahepatic (Kemp., CB, et al. Nature 244, 447 (1973)) or subcapsular (Yasunami, Y., et al., Transplantation 35, 281-284) of STZ-induced diabetic recipients. (1983)).

(Form)
The resected buttocks subcutaneous adipose tissue, liver and kidney of diabetic recipients with islet grafts were fixed in 10% formalin, processed, embedded in barafin and then sectioned for morphological analysis. The sections were stained with hematoxylin and eosin and observed with an immunofluorescence microscope. The antibodies used are as follows: anti-insulin antibody, anti-glucagon antibody, anti-somatostatin antibody and anti-PP antibody. Stained islet transplanted sections were observed with a fluorescence microscope.

(Human islet transplantation)
Human islets were provided by Prodo Lab (Irvine, Calif.) And cultured at 24 ° C. in CMRL1066 medium (Mediatech) containing 2% human albumin for 2-3 days prior to the following experiment.

A total of 3 batches of human islet cells were used for islet transplantation. For each batch, transplantation with islet cells (1500 IEQ) was performed 1-2 times. Human islet cells were transplanted into the subcutaneous subcutaneous fat tissue of STZ (170 mg / kg, iv injection) -induced diabetic male NOD / scid mice or under one kidney capsule. Non-fasting plasma glucose levels and body weights were measured once a week after transplantation. Subcutaneous adipose tissue and kidney of diabetic recipients with human islet grafts were excised, fixed with 10% formalin, embedded in paraffin, and sectioned for morphological analysis.

(Statistical analysis)
Statistical analysis of normoglycemia in STZ-induced diabetic mice after islet transplantation was determined by Fisher's exact test. When p value was less than 0.05, it was judged that there was a significant difference.

In this example, referring to FIG. 1, a technique for islet transplantation into the subcutaneous subcutaneous fat tissue of the mouse will be described.

FIG. 1 shows the anatomical findings of the left groin subcutaneous adipose tissue of the mouse. FIG. 1 (A) and FIG. 1 (B) show a state where the left hip subcutaneous fat tissue in which a nutritional blood vessel is observed is lifted with tweezers (left side). In the figure, the long and short arrows indicate the thigh arteriovenous and the lower abdominal wall arteriovenous, respectively.

FIG. 2 shows a state in which islet transplantation is performed on the mouse subcutaneous subcutaneous adipose tissue. FIG. 2 (a) is a view of the skin incision in the left groin subcutaneous adipose tissue of the mouse as viewed from above. FIG. 2 (b) shows a small pocket provided in the buttock subcutaneous adipose tissue, and the opening is kept open with a suture line. FIGS. 2 (c) and 2 (d) show islet cells present at the tip of the tube placed inside the pocket. In FIGS. 2 (c) and 2 (d), arrows indicate islet cells arranged in the pocket, and arrowheads indicate islet cells at the tip of the tube. FIG. 2 (e) shows the opening of the pocket held by the forceps, and FIG. 2 (f) shows the opening of the pocket closed with a staple. In the figure, the scale is 1 mm.

FIG. 3 shows a graph of plasma glucose levels in streptozotocin (STZ) -induced diabetic C57BL / 6 mice in which allogeneic islet cells were transplanted into the subcutaneous subcutaneous adipose tissue. The upper graph shows a case transplanted with 200 islet cells, and the lower graph shows a case transplanted with 400 islet cells. Each line graph shows the plasma glucose level of each mouse. In the figure, each line represents the plasma glucose level of each animal, the mark (+) indicates a mouse that died of severe diabetes, and the mark (*) is transplanted into the subcutaneous subcutaneous fat tissue of each recipient It shows that the removed islet cells were removed.

The results shown in FIG. 3 show that the hyperglycemia of STZ-induced diabetic mice ameliorated after transplanting 400 allogeneic islet cells into the hip subcutaneous fat tissue, but when 200 allogeneic islet cells were transplanted Indicates that he did not remit. The transplantation efficiency achieved by this transplantation was comparable to the conventional transplantation to the liver reported by the present inventors (Yasunami, Y., et al., J. Exp. Med., 202). , 913-918 (2005); Matsuoka, N., et al., J. Clin. Invest., 120, 735-743 (2010)). In addition to this, however, FIG. 3 shows that once allograft islet cells are transplanted into the buttock subcutaneous adipose tissue and become normoglycemic, hyperglycemia immediately after removal of the islet graft from the buttock subcutaneous adipose tissue It shows that it has returned to symptom. This result shows that normal blood glucose after transplantation depends on transplanted islet cells.

FIG. 4 shows the morphology of islet cells transplanted into the subcutaneous hip adipose tissue 60 days after transplantation. FIG. 4 (a) shows the exposed surface portion of the hip subcutaneous tissue transplanted with islet cells. In the figure, the arrows indicate staples used for closing the pockets. FIG. 4 (b) shows massive transplanted islet cells in which new blood vessels are formed (arrowheads). The long and short arrows shown in FIG. 4B indicate the lower abdominal wall arteriovenous and the femoral arterial vein.

The results of FIG. 4 show microscopically that new blood vessels are formed in some of the islet cells transplanted into the buttock subcutaneous adipose tissue and are formed in a lump of various sizes. Yes. It was also revealed microscopically that the transplanted islet cells were surrounded by adipose tissue where pancreatic endocrine cells were observed.

Surprisingly, when allogeneic islet cells were transplanted into mouse subcutaneous subcutaneous adipose tissue, insulin / glucagon co-positive cells in which insulin was present together with glucagon were formed in the transplanted islet cells. It has been found. FIG. 5b shows a series of panels showing micrographs of insulin / glucagon co-positive cells formed in transplanted islet cells. Transplanted islet cell sections were stained for insulin, glucagon and DAP1, respectively, and observed with a confocal fluorescence microscope.

FIG. 5 shows a state in which insulin / glucagon simultaneous positive cells appear in the transplanted islet cells observed with a confocal fluorescence microscope. 120 days after transplantation, transplanted islet cells stained for DAP1 (blue), insulin (green) and glucagon (red), respectively, are shown for transplanted islet cells stained for insulin, glucagon and DAP1, and these stained images The image which combined is shown. Each horizontal line in the upper and lower combined image panels represents 50 μm and 10 μm, respectively. A portion surrounded by a square in the upper left image is a high magnification image panel, and a high magnification image of the square portion is shown in a lower combination image panel. FIG. 11 shows an immunoelectron micrograph of insulin and glucagon simultaneously expressed in transplanted human islet cells. The left figure of this micrograph was taken by staining tissue sections with anti-insulin antibody and anti-glucagon antibody bound to 18 nm and 12 nm gold particles, respectively. It is the figure which expanded the glucagon granule (a hollow arrowhead mark) and one insulin granule (black arrowhead mark) (right figure).

FIG. 6 shows the tissue analysis of the islet graft under the kidney capsule (kc, upper panel) and in the liver (pv, lower panel) 60 days after transplantation. This result showed no insulin / glucagon co-positive cells. The horizontal line indicates 50 μm.

Interestingly, it was shown that insulin / glucagon co-positive cells appeared in some of the transplanted islet cells as peaks after 30 and 60 days of transplantation. Insulin / glucagon co-positive cells, insulin and glucagon granules were stained separately in the cytoplasm of the same cell as shown in FIG. 5 and FIG. In contrast, it should be noted that no insulin / glucagon co-positive cells were found in FIG. 6 either under the kidney capsule or in the liver of the recipient mouse.

This example relates to a case where human pancreatic islet cells were transplanted into STZ-induced diabetic NOD / scid mice. Surprisingly, it was found that some transplanted islet cells had been converted to insulin / glucagon co-positive cells.

FIG. 7 is a line graph showing plasma glucose levels of STZ-induced diabetic NOD / scid mice transplanted with human islet cells into the hip subcutaneous tissue. The mark (*) means that the islet cells transplanted into the subcutaneous fat tissue of the diabetic recipient were removed.

The results shown in FIG. 7 show that the above findings obtained for mouse islet cells also apply to cases for human islet cells. FIG. 7 shows that after transplanting human islet cells (1500IEQ) into the subcutaneous subcutaneous adipose tissue, the blood glucose in STZ-induced diabetic NOD / scid mice became normal blood glucose, and immediately after the transplanted islet cells were removed, the blood glucose level returned to hyperglycemia again. It shows that.

FIG. 8 shows a confocal microscope image of a human islet graft in the hip subcutaneous tissue of STZ-induced diabetic NOD / scid mice 60 days after transplantation of human islet cells. Indicates. FIG. 8 (A) shows HE-stained transplanted sections of mice 60 days after transplantation, and FIGS. 8 (B), 8 (C), 8 (D) and 8 (E) are shown in FIG. 8 (A). The confocal microscope image of the human islet cell of the part enclosed by the square is shown. FIG. 8B shows a cross-sectional portion stained for insulin, and FIG. 8C shows a cross-sectional portion stained for glucagon. FIG. 8D shows a cross-sectional portion stained for DAP1. FIG. 8E is a combined image obtained by merging the three images of FIGS. 8B to 8D into one image, and the cells indicated by the arrowheads are insulin / glucagon simultaneous positive cells. The lengths of the horizontal bars in the HE stained image and the immunofluorescent stained image are 200 μm and 20 μm, respectively. Surprisingly, FIG. 8 shows that insulin / glucagon co-positive cells appeared in large amounts in islet grafts transplanted into the subcutaneous subcutaneous adipose tissue.

This example evaluates islet transplantation efficiency when a hip subcutaneous tissue is selected as a transplant site because low transplantation efficiency is a major factor that limits the clinical application of islet transplantation. Therefore, a new transplantation site called hip subcutaneous tissue is not practically available unless it can potentially solve this disorder.

FIG. 9 shows a tissue analysis of transplanted islet cells 6 hours after transplantation into the subcutaneous subcutaneous fat tissue of STZ-induced diabetic recipients. FIG. 9 (A) shows a cross section of transplanted islet cells stained with HE. The square part in the upper left corner is a high-magnification image of the square part shown on the left side with HE staining shown in FIG. In the high-magnification image of this square portion, the arrows indicate wet neutrophils in the transplanted islet cells. FIG. 9B is an immunofluorescence image of an islet graft stained for insulin (green) and neutrophil marker Gr-1 (red). The horizontal bars in the images of FIGS. 9A and 9B indicate 100 μm and 10 μm, respectively.

As shown in FIG. 9, histologically, the islet graft transplanted into the hip subcutaneous tissue was wetted with neutrophils 6 hours after transplantation. These findings are exactly similar to the findings seen in transplanted islet cells transplanted into the liver previously reported by the inventor in a paper (Non-Patent Document 8). This suggests that NKT cell-dependent neutrophil activation also plays a fundamental role in the early loss of islet cell transplantation to this site.

FIG. 10 is a line graph showing the plasma glucose level of STZ-induced diabetic Jα18-deficient mice (NKT cell-deficient) mice transplanted with allogeneic syngeneic islet cells into the subcutaneous subcutaneous adipose tissue. The top graph shows a case of transplanting 200 allogeneic islet cells, the second graph from the top shows a case of 100 transplants, the third graph from the top shows a case of 50 transplants, the bottom graph Indicates a case where 25 were transplanted.

From the above results, transplanted islet cells can be easily recovered, and more importantly, transplanting 50 islet cells, that is, 1/4 islet cell of one donor, targeting NKT cells. The ability to reverse or ameliorate diabetes indicates that the hip subcutaneous adipose tissue is a novel functional site for islet cell transplantation. In addition, mice showed insulin / glucagon co-positive cells that were not seen at all after birth, and human islet cell grafts were found only at this site.

In summary, the above findings provide a potential solution to the current obstacle faced by clinical islet transplantation, namely the difficulty in evaluating and recovering transplanted islet cells as well as low transplantation efficiency. Since it has been shown to be a new functional site for islet transplantation, it has a great influence on the clinical application of islet transplantation. Furthermore, the present invention shows that insulin / glucagon co-positive cells appear only in islet cells transplanted into the buttock subcutaneous adipose tissue of mice, and the insulin / glucagon co-positive cells are β cells, α cells or other cell groups or Whether it was derived from an endocrine precursor is undecided, but provides evidence that it provides a new in vivo model of β-cell differentiation.

Claims

An insulin-producing cell transplantation method comprising transplanting insulin-producing cells into subcutaneous adipose tissue where nutrient vessels are distributed.
The insulin-producing cell transplantation method according to claim 1, wherein the insulin-producing cells are human islet cells, heterologous islet cells, insulin / glucagon simultaneous positive cells, or insulin-producing cells prepared from ES cells or iPS cells. An insulin-producing cell transplantation method comprising:
3. The insulin-producing cell transplantation method according to claim 1 or 2, wherein the subcutaneous adipose tissue is a subcutaneous adipose tissue of the buttocks, armpits, back or abdomen.
The insulin-producing cell transplantation method according to any one of claims 1 to 3, wherein the insulin production cell comprises transplanting the same number or a small number of insulin-producing cells as the number of insulin-producing cells of one donor to one recipient. Cell transplantation method.
The insulin-producing cell transplantation method according to any one of claims 1 to 4, wherein the number of insulin-producing cells to be transplanted is from the same number to 1/10, preferably from 2/3 to 1, as the number of islet cells of one donor. / 6, more preferably 1/2 to 1/5, an insulin-producing cell transplantation method.
A method for treating diabetes comprising transplanting insulin-producing cells into subcutaneous adipose tissue in which nutrient vessels are distributed, the transplanted insulin-producing cells secreting insulin, and treating diabetes with secreted insulin.
The method for treating diabetes according to claim 6, wherein the insulin-producing cells are human islet cells, heterologous islet cells, insulin / glucagon simultaneous positive cells, or insulin-producing cells prepared from ES cells or iPS cells. Diabetes treatment method.
The diabetes treatment method according to claim 6 or 7, wherein the subcutaneous adipose tissue is a subcutaneous adipose tissue of the buttocks, armpits, back or abdomen.
A method for treating diabetes according to any one of claims 6 to 8, wherein the method comprises transplanting the same number or a small number of insulin producing cells as the number of insulin producing cells of one individual donor to one recipient.
The method for treating diabetes according to any one of claims 6 to 9, wherein the number of insulin-producing cells to be transplanted is from the same number to 1/10, preferably 2/3 to 1/6, as the number of islet cells of one donor. More preferably, it is 1/2 to 1/5.