Making Mature Human Islet Cells from Stem Cells to Model Disease and Treat Diabetes

Transcription

1 University of British Columbia Departments of Surgery and Cellular & Physiological Sciences Making Mature Human Islet Cells from Stem Cells to Model Disease and Treat Diabetes 2016 International Conference on Diabetes and Metabolism (ICDM 2016), Seoul Korea, October 14, 2016 Timothy J. Kieffer, Ph.D. Professor, University of British Columbia, Vancouver Canada

2 Conflict of Interest Disclosure Research Funding Support: BetaLogics, Janssen R&D LLC Patent applications

3 Bruin Strategy et al., Under Review to Coax Stem Cells to Islets Mimic Development JE Bruin et al. Science Translational Medicine 316ps323, 2015

4 1997

5 Human Fetal Co-Expression of PDX1 and NKX6.1 at 9w M.J. Riedel et al., Diabetologia 55(2): , 2012

6 Differentiation of Stem Cells to Endocrine Precursors

7 Rezania, Bruin et al., Diabetes, 61(8): , 2012 Cells Resemble Fetal Pancreas

8 Grafts are Predominantly Endocrine and Ductal, Without Exocrine Recipients = immunodeficient SCID-Beige mice

9 COHORT 1: Blood Glucose Tracking 30 COHORT 2 COHORT 1 Blood Glucose Tracking hesc Transplant Pellet Implant Pellet replaced STZ Pellet replaced Pellet replaced Pellet removed STZ-treated No STZ Control Fasted BG (mmol/l) Day

10 Meal Regulated C-Peptide by 30W

11 Macroencapsulation

12 Device Vascularization

13 Cell Maturation & Containment

14 Maturation of Progenitors Pre-Transplant Post-Transplant

15 Reversal of Diabetes by Macroencapsulated Progenitors Recipients = SCID-beige mice

16 First Patient October 29, 2014

17 Issues with Reliance Upon In Vivo Maturation? JE Bruin et al. Science Translational Medicine Dec 2015

18 SCID-Beige Mice Have Increased BW and BG on HFD

19 SCID-Beige Mice Fed HFD Develop IGT and Insulin Resistance in 7w

20 HFD Did not Effect Meal Induced Human C-Peptide Secretion Human C-Peptide (ng/ml) Human C-Peptide (ng/ml) Human C-Peptide (ng/ml) Time (min) Time (min) Time (min)

21 Cell Transplant Improves Glucose Homeostasis in HFD Mice

22 Addition of Sita or Met Improves Glucose Homeostasis by 12w

23 Addition of Sita, Met, or Rosi Promotes Weight Loss

24 Grafts Contained Predominantly Endocrine Cells

25 Unpublished data Maturation of Pancreatic Progenitors in Rats vs Mice ~5 million cells per mouse ~7 million cells per rat SCID-beige Mice Athymic Nude Rat

26 Unpublished data Accelerated Maturation of Pancreatic Progenitors in Rats vs Mice

27 Rat Grafts Contain More Insulin and Less Glucagon Than Mouse Grafts

28 Increased Thyroid Hormone and MAFA in Rats vs. Mice Insulin Glucagon MAFA Mice Rats Relative Gene Expression (Rats / Mice) INS MAFA T3 (ng/ml) Mice Rats

29 Effect of Thyroid Dysfunction on Graft Maturation in Mice Unpublished data B Plasma T3 (ng/ml) Euthyroid Chronic Hypo Acute Hypo Acute Hyper Day 28 Day 42

30 Unpublished data Impaired C-Peptide Secretion in Hypothyroid Mice

31 Unpublished data Secretion 6 and Glucose 0 Tolerance Time (Minutes) B 5 Euthyroid Time (Minutes) F 22 Weeks 600 Chronic Hypo 4 Euthyroid 4 E Acute Hypo Chronic F Hypo 8 Acute Hyper Acute Hypo 3 3 Acute Hyper inutes) nutes) p= Human Insulin (ng/ml)15 # Area Un D Blood Glucose 500 Human Human C-Peptide C-Peptide (ng/ml) (ng/ml) Blood Glucose (mm) Blood Glucose (mm) G # Weeks Post-Transplant Time (Minutes) Time (Minutes) 1000 p=0.054 # Blood Gl p= Time (Minutes) 0 H# 1000 Hypothyroidism Impairs C-Peptide H Area Under Curve # # # I Glucagon (pg/ml) Human C-Peptide (relative to basal) Human Insulin (ng/ml)15 Area Under Curve Area Under Curve # # # Area Under C # # 0 GLP-1 (pg/ml) # J # I Glucagon (pg/ml) Area Un Blood Glucose Human C-Peptide (relative to basal) 12 # # # # # 0 0 # # T T

32 Hypothyroid Grafts Have Increased Ins+ and Decreased Gluc+ Cells Figure 5 A Synaptophysin CK19 DAPI Euthyroid Hypothyroid Euthyroid Hypothyroid Euthyroid Hypothyroid B Insulin Glucagon DAPI C hesc-derived Grafts D Endogenous Pancreas Gcg DAPI Ins DAPI Ghrelin DAPI Ins Gcg DAPI Ins Ghrl DAPI Glucagon:Insulin Graft Pancreas

33 Rezania, Bruin et al, Nature Biotechnology, 2014 The Development of a More Advanced Protocol

34 Rezania, Bruin et al, Nature Biotechnology, 2014 Stage 4 Cells Versus Stage 6 5M S4 cells 2M S6 cells

35 Characterization of Stage 7 Cells

36 Rezania, Bruin et al, Nature Biotechnology, 2014 Characteristics of Stage 7 Cells C-Peptide (fold over basal) [Glucose (mm)] Hu Islets S7 cells

37 Perifusion Assays Single-cell Calcium Imaging Stage 7 Cells Are Moderately Glucose Responsive

38 Rezania, Bruin et al, Nature Biotechnology, 2014 Stage 7 Cells Rapidly Reverse Diabetes 1.25M cells

39 Insulin Glucagon Somatostatin DAPI Rezania, Bruin et al, Nature Biotechnology, 2014 Graft Analysis 10 weeks post-tx

40 Macroencapsulated S7 Cells 1.5M cells 1.5M cells Macroencapsulated Cells Pre-Transplant Human C-peptide (ng/ml) Wks post Transplant: Fasted S7 KC Glucose S7 KC Fasted S7 TC Glucose S7 TC

41

42 Deviceless Subcutaneous Transplant

43 Deviceless Subcutaneous Transplant 3M cells 3M cells 3M cells 3M cells Stage 4 Cells Stage 6 Cells

44 Conclusions S4 cells in combination with diabetes drugs can improve glucose homeostasis and promote weight loss in a rodent model of type 2 diabetes. S4 cells mature more rapidly in rats than mice. S4 cell maturation to beta cells is impaired in mice with hypothyroidism. S7 cells reverse diabetes in mice ~4 times faster than S4 cells, and with ~1/4 the cell dose. S4 and S7 cells mature in vivo within encapsulation devices into cells that resemble human islets and are capable of reversing diabetes in mice. S6 or S7 cells may provide a more consistent cell source for transplant compared with cadaveric human islets or S4 cells.

45 Acknowledgements University of BC Jenny Bruin Nina Quiskamp Shannon O Dwyer Majid Mojibian Michael Riedel Ali Asadi Blair Gage Travis Webber Collaborators Greg Korbutt Jamie Piret Ziliang Ao Garth Warnock Jim Johnson BetaLogics Janssen R&D Mark Zimmerman Alireza Rezania Janet Davis Francis Karanu Jean Xu Rebecca Gauvin Kavitha Narayan John J. O Neil WB Family Foundation

46 Islet Transplantation for Type 1 Diabetes (Edmonton Protocol)

47 Islet Cell Replacement is Effective for Type 1 Diabetes Before Islet Transplant 9 Months After Islet Transplant Data from Ron Gill, University of Colorado Bruin JE and Kieffer TJ. Differentiation of human embryonic stem cells into pancreatic endocrine cells. Springer. Vol 8, Chapter 18, p , 2012.

48 Bruin et al., Stem Under Review Cells Are Amenable to Large Scale Production JE Bruin et al. Science Translational Medicine 316ps323 Dec 2015