This project is based upon the premise that conventional use of the intrahepatic site for islet transplantation is a key factor in abnormal function of beta-cells and alpha-cells during hypoglycemia in transplant recipients. Our approach is to study intrahepatic islet function in patients with chronic pancreatitis who undergo total pancreatectomy and autoislet transplantation (TP/AIT) in both hepatic and nonhepatic sites. Use of autoislet recipients for metabolic studies carries the huge advantage of examining islet function in a setting without the confounding problems of immunosuppressive agents that are beta-cell toxic and the autoimmune state of type 1 diabetes.
The specific aims of this project are:
Specific Aim #1 : To identify the mechanism(s) through which initially successful TP/AIT recipients develop decreased beta-cell function and hyperglycemia over time. We will study TP/AIT recipients who have successfully received autoislets in hepatic and non-hepatic sites through use of measures of islet secretion by stimulation of insulin, C-peptide, and glucagon responses to intravenous (IV) glucose and arginine;functional beta-cell mass by glucose potentiation of arginine-induced insulin secretion;and insulin sensitivity by euglycemic, hyperglycemic clamps.
Specific Aim #2 : To identify the mechanism(s) through which TP/AIT recipients have refractory alpha-cell function and deficient counter-regulation of hypoglycemia. We will study counter-regulatory hormonal responses in TP/AIT recipients using the radio-labeled (3H)-hypoglycemic clamps with glucagon flush to document glycogen depletion after 72 hr. fasts;meal-induced hypoglycemia with and without somatostatin infusion;and exercise- induced hypoglycemia with bicycle at 40% of peak Vo2. We envision the results will provide novel insights that will pertain not only to improving outcomes in TP/AIT recipients but also insights that will improve outcomes in alloislet transplantation for type 1 diabetic patients.

Public Health Relevance

The studies proposed in this competitive renewal focus on identifying mechanisms that are responsible for b- cell and a-cell fates after intrahepatic transplantation in humans. These putative mechanisms primarily involve inappropriate b-cell and a-cell secretory responses during hypoglycemia that occur because the cells are exposed to increased intrahepatic glycogenolysis and consequent increased interstitial glucose flux. Establishment of these mechanisms will provide convincing arguments that inclusion of non-hepatic sites will improve metabolic outcomes of autoislet, and by extension, alloislet, transplantation.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Research Project (R01)
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Study Section
Clinical and Integrative Diabetes and Obesity Study Section (CIDO)
Program Officer
Appel, Michael C
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Pacific Northwest Research Institute
United States
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Robertson, R Paul (2015) Total pancreatectomy and islet autotransplantation for chronic pancreatitis: breaking down barriers. J Clin Endocrinol Metab 100:1762-3
Robertson, R Paul; Bogachus, Lindsey D; Oseid, Elizabeth et al. (2015) Assessment of ?-cell mass and ?- and ?-cell survival and function by arginine stimulation in human autologous islet recipients. Diabetes 64:565-72
Robertson, R Paul (2015) Puzzling about partial glucagon responses to hypoglycemia in intrahepatic islet recipients: missing pieces. Diabetes 64:1511-2
Robertson, R Paul (2015) Islet transplantation for type 1 diabetes, 2015: what have we learned from alloislet and autoislet successes? Diabetes Care 38:1030-5
Bellin, M D; Parazzoli, S; Oseid, E et al. (2014) Defective glucagon secretion during hypoglycemia after intrahepatic but not nonhepatic islet autotransplantation. Am J Transplant 14:1880-6
Bellin, Melena D; Freeman, Martin L; Gelrud, Andres et al. (2014) Total pancreatectomy and islet autotransplantation in chronic pancreatitis: recommendations from PancreasFest. Pancreatology 14:27-35
Robertson, R Paul; Raymond, Ralph H; Lee, Douglas S et al. (2014) Arginine is preferred to glucagon for stimulation testing of ?-cell function. Am J Physiol Endocrinol Metab 307:E720-7
Robertson, R P; Zhou, H; Slucca, M (2011) A role for zinc in pancreatic islet ýý-cell cross-talk with the ýý-cell during hypoglycaemia. Diabetes Obes Metab 13 Suppl 1:106-11
Robertson, R Paul (2009) Beta-cell deterioration during diabetes: what's in the gun? Trends Endocrinol Metab 20:388-93
Zhou, Huarong; Zhang, Tao; Bogdani, Marika et al. (2008) Intrahepatic glucose flux as a mechanism for defective intrahepatic islet alpha-cell response to hypoglycemia. Diabetes 57:1567-74

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