Islet transplantation stabilizes hemostatic abnormalities and cerebral metabolism in individuals with type 1 diabetes
- Francesca D’Addio, MD,PhD1,2,
- Paola Maffi, MD2,
- Paolo Vezzulli, MD3,
- Andrea Vergani, MD1,
- Alessandra Mello, MD4,
- Roberto Bassi, MD1,
- Rita Nano5,
- Monica Falautano, BS6,
- Elisabetta Coppi, MD6,
- Giovanna Finzi7,
- Armando D’Angelo, MD8,
- Isabella Fermo8,
- Fabio Pellegatta, PhD9,
- Stefano La Rosa, MD7,
- Giuseppe Magnani, MD6,
- Lorenzo Piemonti, MD5,
- Andrea Falini, MD3,
- Franco Folli, MD, PhD10,
- Antonio Secchi, MD2,11 and
- Paolo Fiorina, MD,PhD1,2
- 1Nephrology Division, Boston Children’s Hospital, Harvard Medical School, Boston, MA;
- 5Diabetes Research Institute and
- 6Neurology Department, San Raffaele Hospital, Milan, Italy;
- 7Pathology Department, Ospedale di Circolo, Varese, Italy;
- 8Chromatographic Techniques Service, San Raffaele Hospital, Milan, Italy,
- 9Centre for the Study of Atherosclerosis, Bassini Hospital, Cinisello Balsamo, Italy,
- 10University of Texas at San Antonio, San Antonio, TX;
- 11Universita’ Vita-Salute, Milan, Italy.
- Corresponding author: Paolo Fiorina, E-mail:
- Corresponding author: Antonio Secchi, E-mail:
Objective Islet after kidney transplantation has been shown to positively affect the quality of life for individuals with type 1 diabetes (T1D) by reducing the burden of diabetic 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 Pro-thrombotic factors, platelet function/ultrastructure, cerebral morphology, metabolism and function have been investigated over a 15-month follow-up period, with ELISA/electron microscopy and magnetic resonance imaging, nuclear magnetic resonance spectroscopy (1H-MRS) and neuropsychological evaluation (POMS and PASAT tests), in 22 individuals with T1D who underwent islet transplantation alone (n=12) or remained on the waiting list (n=10). Patients were homogeneous at the time of enrolment on the waiting list with regard to metabolic criteria, hemostatic parameters and cerebral morphology/metabolism/function.
Results At 15 months follow-up, the Islet transplantation alone group, but not individuals with T1D remaining on the waiting list, showed: i) improved glucose metabolism; ii) near-normal platelet activation and pro-thrombotic factor levels; iii) near-normal cerebral metabolism and function; and iv) a near-normal neuropsychological test.
Conclusion Islet transplantation alone, despite immunosuppressive therapy, is associated with a near-normalization of hemostatic and cerebral abnormalities.
- Received July 15, 2013.
- Accepted August 30, 2013.
- © 2013 by the American Diabetes Association.
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