J.H. Strubbe

Improved biocompatibility but limited graft survival after purification of alginate for microencapsulation of pancreatic islets

Summary Graft failure of alginate-polylysine microencapsulated islets is often interpreted as the consequence of a non-specific foreign body reaction against the microcapsules, initiated by impurities present in crude alginate. The aim of the present study was to investigate if purification of the alginate improves the biocompatibility of alginate-polylysine microcapsules. Alginate was purified by filtration, extraction and precipitation. Microcapsules prepared from crude or purified alginate were implanted in the peritoneal cavity of normoglycaemic AO-rats and retrieved at 1, 2, 3, 6, 9, and 12 months after implantation. With crude alginate, all capsules were overgrown within 1 month after implantation. With purified alginate, however, the portion of capsules overgrown was usually less than 10 %, even at 12 months after implantation. All recipients of islet allografts in capsules prepared of purified alginate became normoglycaemic within 5 days after implantation, but hyperglycaemia reoccurred after 6 to 20 weeks. With intravenous and oral glucose tolerance test, all recipients had impaired glucose tolerance and insulin responses were virtually absent. After graft failure, capsules were retrieved (80–100 %) by peritoneal lavage. Histologically, the percentage of overgrown capsules was usually less than 10 % and maximally 31 %. This small portion cannot explain the occurrence of graft failure. The immunoprotective properties of the capsules were confirmed by similar if not identical survival times of encapsulated islet allo- and isografts. Our results show that purification of the alginate improves the biocompatibility of alginate-polylysine microcapsules. Nevertheless, graft survival was still limited, most probably as a consequence of a lack of blood supply to the encapsulated islets. [Diabetologia (1997) 40: 262–270]

Glucose tolerance and plasma insulin response to intravenous glucose infusion and test meal in rats with microencapsulated islet allografts

SummaryAlbino Oxford rats made diabetic with 75 mg/kg streptozotocin were intraperitoneally transplanted with 2500–2900 alginate-polylysine microencapsulated Lewis islets (n=9, total islet tissue volume 8.0–11.0 μl), or a similar volume of non-encapsulated Lewis islets (n=5). All rats with microencapsulated islets became normoglycaemic, and remained normoglycaemic for 5–16 weeks. In rats with non-encapsulated islet grafts, only a temporary decrease in blood glucose was observed, and all were again severely hyperglycaemic at 1 week after implantation. At 5–6 weeks after transplantation, glucose tolerance in rats with microencapsulated islets was tested by intravenous glucose infusion (10 mg/min over 20 min) and test meal administration (n=4). During glucose infusion, maximum glucose levels were 13.0±0.4 mmol/l in rats with microcapsules and 8.9±0.4 mmol/l in healthy control rats (p<0.01). Concomitant maximum plasma insulin levels were 215±17 pmol/l in rats with microcapsules and 715±85 pmol/l in controls (p<0.001). After the test meal, maximum blood glucose was 10.6±0.9 mmol/l in rats with microcapsules and 6.2±0.1 mmol/l in controls (p<0.001), with concomitant maximum plasma insulin levels of 247±11 pmol/l and 586±59 pmol/l, respectively (p<0.001). In conclusion, although the glucose tolerance is impaired and plasma insulin responses to intravenous glucose-load and test-meal are reduced, the alginate-polylysine membrane does provide adequate immunoisolation for the prolongation of allograft survival, resulting in prolonged normoglycaemia in streptozotocin diabetic rats.

Neuroendocrine Mechanisms Involved in Regulation of Body Weight, Food Intake and Metabolism

Body weight regulation is the result of food intake and energy expenditure. The central nervous system (CNS), and in particular, the hypothalamus, controls food intake as well as metabolism, the latter mainly by autonomic effects on the islet of Langerhans, hepatocytes and adipocytes. Body weight, more precisely body fat content, is probably controlled by a feedback mechanism in which insulin, released from the B cell of the islet of Langerhans, plays a key role. The islet of Langerhans is an intricate neuroendocrine unit in which the release of glucagon, insulin, and somatostatin from A, B, and D cells, respectively, is controlled by the CNS via a rich autonomic innervation. In addition, the endocrine cells of the pancreas influence each other by paracrine actions. The CNS control of the islets shapes the plasma insulin and blood glucose profiles during the circadian cycle and thereby regulates the nutrient flow to the different tissues in the body. Thus, the CNS structures involved in regulation of body weight and food intake control also metabolism. The mechanisms contributing to match food intake and the needs of metabolism are discussed.

Insulin secretion by the transplanted neonatal pancreas during food intake in fasted and fed rats

SummaryIn order to investigate the physiological role of the autonomic nervous system on insulin secretion, neonatal pancreases were implanted under the kidney capsule of alloxan diabetic rats, resulting in recovery from diabetes, with denervated insulin secreting tissue. Rats were also provided with permanent double cardiac catheters allowing simultaneous infusion and rapid blood sampling with free movement. Intracardiac glucose infusion caused, coincident with the rapid rise of blood glucose, an increase of plasma insulin in the first minute in both controls and transplanted rats. After ingestion of food plasma insulin in normal control rats increased in the first minute, and prior to the first rise of glucose, from 23 ±2 mU/l to 66±4 mU/l in the fed state, and from 9 ±3 mU/l to 34±3 mU/l after 24 h of fasting. In contrast, this response was absent in the transplanted animals. In the fed state maximum insulin responses were attained at 20 minutes and were 63±10 mU/l for controls, 104±15 mU/l for transplants and 20±3 mU/l for rats which recovered from diabetes one week after alloxan. The concomittant glucose responses were 22±2, 34±3 and 45±4 mg/ 100 ml respecitively. Ingestion of a meal after fasting showed a similar decreased insulin response and insulinogenic index at t=20 in both the transplanted and control group. Histology and electronmicroscopy of the transplanted pancreas showed vascularized groups of well granulated B-cells. The data of these experiments suggest that 1) The early insulin response after food intake is under direct control of the autonomic nervous system, 2) Glucose homeostasis is disturbed after transplantation, 3) Mainly humoral factors are responsible for the decreased insulin response after fasting.

Insulin secretion by rat islet isografts of a defined endocrine volume after transplantation to three different sites

SummaryWe have analysed the graft function of rat islet isografts of identical and well-defined endocrine volumes after transplantation to three different sites (kidney, liver and spleen). Graft endocrine mass was determined by measuring the total islet volume prior to transplantation and was chosen to be similar to the endocrine volume in the normal adult rat pancreas. Graft function was tested in unanaesthetized, unstressed rats by the responses to glucose infusion and to a meal. All transplanted animals returned to normoglycaemia within one week after transplantation. At one month, basal glucose and insulin levels were similar to controls in rats with grafts to the spleen, but higher in rats with grafts to the kidney or liver. Irrespective of the transplantation site, recipients had higher glucose and lower insulin levels than controls in response to glucose infusion, but in response to a meal these differences from normal were less obvious. Finally, recipients showed both an acute insulin response to glucose infusion as well as a pre-absorptive insulin release after food ingestion, irrespective of the transplantation site. Our findings indicate that the insulin response to glucose infusion and to a meal is quantitatively reduced, but qualitatively intact after transplantation to the kidney, liver or spleen.

Neuroendocrine Factors Regulating Blood Glucose, Plasma FFA and Insulin in the Development of Obesity

A number of neurotransmitters and neuropeptides in the hypothalamus play a role in the control of food intake, metabolism, and body weight. Particularly, noradrenergic mechanisms in several areas of the hypothalamus are involved. Control of peripheral metabolism by the hypothalamus is achieved via autonomic modulation of the function of hepatocytes, adipocytes, and the endocrine cells in the islets of Langerhans. The autonomic control mechanisms ultimately lead to an appropriate shaping of blood glucose, plasma FFA, and insulin profiles to guarantee an adequate flow of nutrients under different physiological situations. Peripheral insulin and glucose can penetrate into the brain where they might affect the function of those brain structures involved in control of food intake, metabolism, and body weight.

Role of the Sympathoadrenal System in Exercise-Induced Inhibition of Insulin Secretion: Effects of Islet Transplantation

The present study was designed to investigate the mechanism leading to inhibition of insulin release during exercise. To investigate the influence of circulating epinephrine and norepinephrine, these catecholamines were infused intravenously in resting islet-transplanted and control rats. The role of neural influences on insulin release was investigated by a swimming exercise study in islet-transplanted and control rats, before and after adrenodemedullation. Streptozotocin-induced diabetic Albino Oxford rats received 5 μl islet tissue into the portal vein, resulting in return of normal basal glucose and insulin levels. Transplanted and control animals were provided with two permanent heart catheters to sample blood and to give infusions. Infusion of epinephrine and norepinephrine did not result in inhibition of plasma insulin levels. Blood glucose levels, as well as nonesterified fatty acids and insulin levels in plasma, were similar in both groups. After the infusion study, the animals were subjected to strenuous swimming. During exercise, plasma insulin levels decreased not only in controls, but also in the islet-transplanted group. Blood glucose and plasma catecholamine responses were identical in both groups. After adrenodemedullation, epinephrine was not detectable and the exercise-induced decrease of insulin was not affected. These results indicate that circulating epinephrine and norepinephrine in physiological concentrations do not cause inhibition of insulin secretion. Since the exercise-induced inhibition of insulin secretion is still present in rats with islet grafts, it seems reasonable to suggest that sympathetic neural influences are responsible for the inhibition of insulin release during exercise and that transplanted islets are sympathetically reinnervated.

Islet transplantation in diabetic rats normalizes basal and exercise-induced energy metabolism

SummaryTransplantation of islets of Langerhans in diabetic rats normalizes resting glucose and insulin levels, but it remains unclear whether islet transplantation restores resting and exercise-induced energy metabolism. Therefore, we compared energy metabolism in islet transplanted rats with energy metabolism in normal controls and in streptozotocin-induced diabetic rats. Indirect calorimetry was applied before, during, and after moderate swimming exercise. Blood was sampled by means of a heart catheter for determination of nutrient and hormone concentrations. In islet transplanted rats, the results from indirect calorimetry and the nutrient and hormone concentrations were similar to the results in normal controls. In resting diabetic rats, insulin levels were very low, while glucose levels were exaggerated. Compared to resting controls, fat oxidation and energy expenditure were elevated, but carbohydrate oxidation was similar. Exercise increased energy expenditure and was similar in diabetic and control rats. Carbohydrate oxidation was lower and fat oxidation was higher in diabetic than in control rats. Exercise-induced increments in glucose, lactate and non-esterified fatty acid levels were the highest in diabetic rats. Thus, at rest, but not during exercise, insulin influences energy expenditure. Insulin reduces lipolysis and glycogenolysis. It enhances the relative contribution of carbohydrate oxidation and reduces fat oxidation to total energy expenditure, at rest and during exercise. Absence of insulin enhances anaerobic glycolytic pathways during exercise. It is concluded that in diabetic rats, islet transplantation of 50% of the normal pancreatic endocrine volume successfully normalizes insulin levels and hence energy metabolism at rest and during exercise.

Effects of pancreas transplantation on insulin secretion in the rat during ingestion of varying glucose loads

SummaryFollowing alloxan induced diabetes in rats, transplantation of neonatal pancreases under the kidney capsule was successfully carried out. The insulin response to oral ingestion of 150 and 750 mg of glucose was studied. The responses in controls and in rats 40 days after transplantation demonstrated a load-dependent increment of plasma insulin responses which was not related to the similar glucose responses. In control rats a part of the insulin response had occurred at 1 min, i. e. 2 min before the rise in blood glucose. After transplantation in the absence of this nervously triggered response, blood glucose rose faster than in control rats from 3 to 5 min after start of ingestion (p<0.01). In non-transplanted rats regenerating a part of their original pancreas within one week, glucose intolerance was seen 10 min after glucose ingestion, probably due to the lack of adequate secondary phase release. This study shows that maintenance of a normal glucose tolerance curve to glucose ingestion depends on at least two factors. First, an anticipatory nervously triggered insulin secretion. Second, a load dependent humoral potentiation of glucose stimulated insulin release.

Overfeeding, autonomic regulation and metabolic consequences.

SummaryThe autonomic nervous system plays an important role in the regulation of body processes in health and disease. Overfeeding and obesity (a disproportional increase of the fat mass of the body) are often accompanied by alterations in both sympathetic and parasympathetic autonomic functions. The overfeeding-induced changes in autonomic outflow occur with typical symptoms such as adiposity and hyperisulinemia. There might be a causal relationship between autonmic disturbances and the consequences of overfeeding and obesity. Therefore studies were designed to investigate autonomic functioning in experimentally and genetically hyperphagic rats. Special emphasis was given to the processes that are involved in the regulation of peripheral energy substrate horneostasis. The data revealed that overfeeding is accompanied by increased parasympathetic outflow. Typical indices of vagal activity (such as the cephalic insulin release during food ingestion) were increased in all our rat models for hyperphagia. Overfeeding was also accompanied by increased sympathetic tone, reflected by enhanced baseline plasma norepinephrine (NE) levels in both VMH-lesioned animals and rats rendered obese by hyperalimentation. Plasma levels of NE during exercise were, however, reduced in these two groups of animals. This diminished increase in the exercise-induced NE outflow could be normalized by prior food deprivation. It was concluded from these experiments that overfeeding is associated with increased parasympathetic and sympathetic tone. In models for hyperphagia that display a continuously elevated nutrient intake such as the VMH-lesioned and the overfed rat, this increased sympathetic tone was accompanied by a diminished NE response to exercise. This attenuated outflow of NE was directly related to the size of the fat reserves, indicating that the feedback mechanism from the periphery to the central nervous system is altered in the overfed state.