Genetic manipulation of the pancreas: cell and gene therapy approaches for type 1 diabetes.

Abstract

Type 1 diabetes is characterized by progressive destruction of pancreatic ?-cells, resulting in insulin deficiency and hyperglycemia. Insulin replacement therapy allows diabetic patients to lead active lives, but this therapy is imperfect and does not prevent development of severe secondary complications. Transplantation of pancreatic tissue or islets has been performed successfully in a limited numbers of patients. However, the shortage of donors is a primary obstacle that prevents this treatment from becoming more widespread. Therefore, many efforts have been focused on differentiating embryonic or adult stem cells into ß-cells. Bone marrow cells (BMCs) are an important source of easily procurable adult stem cells and have been proposed as an alternative source of ß-cells. Insulin-like growth factor-I (IGF-I) participates in skeletal muscle regeneration and enhances the recruitment of BMCs at the sites of muscle injury. In addition, IGF-I expression in ß-cells of diabetic transgenic mice regenerates pancreatic ß-cell mass. Therefore one of the objectives of this study was to investigate whether IGF-I expression in ß-cells could increase BMC recruitment and differentiation into ß-cells under steady-state conditions or after STZ treatment. To this end, BMCs from ß-actin/GFP transgenic donor mice were transplanted into IGF-I transgenic mice. Our experiments have demonstrated that IGF-I overexpression or STZ-induced pancreatic damage were not sufficient to recruit and differentiate GFP-labelled BMCs into ß-cells in vivo, indicating that these cells did not contribute to the endocrine pancreas regeneration observed in IGF-I transgenic mice. These data suggest that replication of pre-existing ß-cells and/or differentiation from non-BMC precursors is the most likely mechanism for IGF-I-mediated regeneration. Diabetes mellitus has long been targeted, as yet unsuccessfully, as being curable with gene therapy. Recovery from type 1 diabetes requires ß-cell regeneration. One approach to do so is by genetically engineering the endocrine pancreas in vivo to express factors that induce ß-cell replication and neogenesis and counteract the immune response. However, the pancreas is difficult to manipulate and pancreatitis is a serious concern, which has made effective gene transfer to this organ elusive. Thus, new approaches for gene delivery to the pancreas in vivo are required. In this study we have examined different viral vectors and routes of administration in rodents and also in large animals, to determine the most efficient method to deliver exogenous genes to the pancreas. First, we observed that pancreatic ß-cells were efficiently transduced to express ß-galactosidase after systemic injection of adenoviral vectors in mice with clamped hepatic circulation. This was true both for first generation as well as for helper-dependent adenoviral vectors. In addition to adenoviruses, we have compared the ability of AAV vectors to transduce the pancreas in vivo after intravascular, intraperitoneal or intraductal delivery, being the last the most efficient route of administration. Like the human pancreas, the canine pancreas is compact, with similar vascularization and lobular structure. It is therefore a suitable model in which to assess gene transfer strategies. Here we examined the ability of adenoviral vectors to transfer genes into the pancreas of dogs in which pancreatic circulation has been clamped. Adenoviruses carrying the ß-galactosidase (ß-gal) gene were injected into the pancreatic-duodenal vein and the clamp was released 10 min later. These dogs showed ß-gal-positive cells throughout the pancreas, with no evidence of pancreatic damage. ß-gal was expressed mainly in acinar cells, but also in ducts and islets. ß-gal expression in the exocrine pancreas of a diabetic dog was also found to be similar to that observed in healthy dogs. Thus, the methodology described herein may be used to transfer genes of interest to murine and canine pancreas in vivo, both for the study of islet biology and to develop new gene therapy approaches for diabetes mellitus and other pancreatic disorders.

Date of Award	30 Jun 2006
Original language	Undefined/Unknown
Supervisor	Maria Fatima Bosch Tubert (Director)