Islet Transplantation Stabilizes Hemostatic Abnormalities and Cerebral Metabolism in Individuals With Type 1 Diabetes

Author:

D’Addio Francesca12,Maffi Paola2,Vezzulli Paolo3,Vergani Andrea1,Mello Alessandra4,Bassi Roberto1,Nano Rita5,Falautano Monica6,Coppi Elisabetta6,Finzi Giovanna7,D’Angelo Armando8,Fermo Isabella8,Pellegatta Fabio9,La Rosa Stefano7,Magnani Giuseppe6,Piemonti Lorenzo5,Falini Andrea3,Folli Franco10,Secchi Antonio211,Fiorina Paolo12

Affiliation:

1. Nephrology Division, Boston Children’s Hospital, Harvard Medical School, Boston, MA

2. Department of Transplant Medicine, San Raffaele Hospital, Milan, Italy

3. Department of Neuroradiology, San Raffaele Hospital, Milan, Italy

4. Department of Anesthesiology, San Raffaele Hospital, Milan, Italy

5. Diabetes Research Institute, San Raffaele Hospital, Milan, Italy

6. Department of Neurology, San Raffaele Hospital, Milan, Italy

7. Pathology Department, Ospedale di Circolo, Varese, Italy

8. Chromatographic Techniques Service, San Raffaele Hospital, Milan, Italy

9. Centre for the Study of Atherosclerosis, Bassini Hospital, Cinisello Balsamo, Italy

10. Department of Medicine, Division of Diabetes, University of Texas at San Antonio, San Antonio, TX

11. Department of Medicine, Universita' Vita Salute San Raffaele, Milan, Italy

Abstract

OBJECTIVE Islets after kidney transplantation have been shown to positively affect the quality of life of individuals with type 1 diabetes (T1D) by reducing the burden of diabetes complications, but fewer data are available for islet transplantation alone (ITA). The aim of this study was to assess whether ITA has a positive impact on hemostatic and cerebral abnormalities in individuals with T1D. RESEARCH DESIGN AND METHODS Prothrombotic factors, platelet function/ultrastructure, and cerebral morphology, metabolism, and function have been investigated over a 15-month follow-up period using ELISA/electron microscopy and magnetic resonance imaging, nuclear magnetic resonance spectroscopy, and neuropsychological evaluation (Profile of Mood States test and paced auditory serial addition test) in 22 individuals with T1D who underwent ITA (n = 12) or remained on the waiting list (n = 10). Patients were homogeneous with regard to metabolic criteria, hemostatic parameters, and cerebral morphology/metabolism/function at the time of enrollment on the waiting list. RESULTS At the 15-month follow-up, the group undergoing ITA, but not individuals with T1D who remained on the waiting list, showed 1) improved glucose metabolism; 2) near-normal platelet activation and prothrombotic factor levels; 3) near-normal cerebral metabolism and function; and 4) a near-normal neuropsychological test. CONCLUSIONS ITA, despite immunosuppressive therapy, is associated with a near-normalization of hemostatic and cerebral abnormalities.

Publisher

American Diabetes Association

Subject

Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine

Reference41 articles.

1. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes;Nathan,2005

2. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus,1993

3. Complications of type 1 diabetes;Melendez-Ramirez,2010

4. The clinical impact of islet transplantation;Fiorina,2008

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