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
Conflict of Interest Disclosure Research Funding Support: BetaLogics, Janssen R&D LLC Patent applications
Bruin Strategy et al., Under Review to Coax Stem Cells to Islets Mimic Development JE Bruin et al. Science Translational Medicine 316ps323, 2015
1997
Human Fetal Co-Expression of PDX1 and NKX6.1 at 9w M.J. Riedel et al., Diabetologia 55(2):372-381, 2012
Differentiation of Stem Cells to Endocrine Precursors
Rezania, Bruin et al., Diabetes, 61(8):2016-2029, 2012 Cells Resemble Fetal Pancreas
Grafts are Predominantly Endocrine and Ductal, Without Exocrine Recipients = immunodeficient SCID-Beige mice
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) 20 10 0-20 0 20 40 60 80 100 120 140 160 180 200 220 240 Day
Meal Regulated C-Peptide by 30W
Macroencapsulation
Device Vascularization
Cell Maturation & Containment
Maturation of Progenitors Pre-Transplant Post-Transplant
Reversal of Diabetes by Macroencapsulated Progenitors Recipients = SCID-beige mice
First Patient October 29, 2014
Issues with Reliance Upon In Vivo Maturation? JE Bruin et al. Science Translational Medicine Dec 2015
SCID-Beige Mice Have Increased BW and BG on HFD
SCID-Beige Mice Fed HFD Develop IGT and Insulin Resistance in 7w
HFD Did not Effect Meal Induced Human C-Peptide Secretion 14 14 14 Human C-Peptide (ng/ml) 12 10 8 6 4 2 Human C-Peptide (ng/ml) 12 10 8 6 4 2 Human C-Peptide (ng/ml) 12 10 8 6 4 2 0 0 30 60 Time (min) 0 0 30 60 Time (min) 0 0 30 60 Time (min)
Cell Transplant Improves Glucose Homeostasis in HFD Mice
Addition of Sita or Met Improves Glucose Homeostasis by 12w
Addition of Sita, Met, or Rosi Promotes Weight Loss
Grafts Contained Predominantly Endocrine Cells
Unpublished data Maturation of Pancreatic Progenitors in Rats vs Mice ~5 million cells per mouse ~7 million cells per rat SCID-beige Mice Athymic Nude Rat
Unpublished data Accelerated Maturation of Pancreatic Progenitors in Rats vs Mice
Rat Grafts Contain More Insulin and Less Glucagon Than Mouse Grafts
Increased Thyroid Hormone and MAFA in Rats vs. Mice Insulin Glucagon MAFA Mice Rats Relative Gene Expression (Rats / Mice) 18 15 12 9 6 3 0 INS MAFA T3 (ng/ml) 3 2 1 0 Mice Rats
Effect of Thyroid Dysfunction on Graft Maturation in Mice Unpublished data B Plasma T3 (ng/ml) 6 4 2 0 Euthyroid Chronic Hypo Acute Hypo Acute Hyper Day 28 Day 42
Unpublished data Impaired C-Peptide Secretion in Hypothyroid Mice
Unpublished data 8 4 200 8 500 Secretion 6 and Glucose 0 Tolerance 4 50 60 70 80 90 0 30 60 4 Time (Minutes) 0 0 10 20 30 40 50 60 70 80 90 B 5 Euthyroid Time (Minutes) F IPGTT @ 22 Weeks 600 Chronic Hypo 4 Euthyroid 4 E Acute Hypo Chronic F Hypo 8 Acute Hyper 600 4 Acute Hypo 3 3 Acute Hyper 400 6 3 2 2 400 inutes) nutes) 500 000 500 p=0.055 25 60 10 5 0 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 10 4 1 02 20 0 16 10 12 8 8 6 4 4 0 2 # 4 8 12 16 25 Weeks Post-Transplant 0 0 30 60 0 30 60 0 Time (Minutes) Time (Minutes) 1000 p=0.054 # Blood Gl p=0.055 0 30 200 60 Time (Minutes) 0 H# 1000 Hypothyroidism Impairs C-Peptide H Area Under Curve 200 0 # # # I Glucagon (pg/ml) 1400 1200 1000 Human C-Peptide (relative to basal) 800 600 400 8 1 10 5 Human Insulin (ng/ml)15 Area Under Curve Area Under Curve # # # Area Under C 200 800 600 400 200 # # 0 GLP-1 (pg/ml) # J 450 350 # 250 150 50 I Glucagon (pg/ml) Area Un 1400 1200 1000 800 600 400 200 Blood Glucose Human C-Peptide (relative to basal) 12 # # # 400 2 1 0 # # 0 0 # # T T
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 20 15 10 5 0.4 0.3 0.2 0.1 0.0 Graft Pancreas
Rezania, Bruin et al, Nature Biotechnology, 2014 The Development of a More Advanced Protocol
Rezania, Bruin et al, Nature Biotechnology, 2014 Stage 4 Cells Versus Stage 6 5M S4 cells 2M S6 cells
Characterization of Stage 7 Cells
Rezania, Bruin et al, Nature Biotechnology, 2014 Characteristics of Stage 7 Cells C-Peptide (fold over basal) 4 3 2 1 0 3.3 16.7 3.3 16.7 [Glucose (mm)] Hu Islets S7 cells
Perifusion Assays Single-cell Calcium Imaging Stage 7 Cells Are Moderately Glucose Responsive
Rezania, Bruin et al, Nature Biotechnology, 2014 Stage 7 Cells Rapidly Reverse Diabetes 1.25M cells
Insulin Glucagon Somatostatin DAPI Rezania, Bruin et al, Nature Biotechnology, 2014 Graft Analysis 10 weeks post-tx
Macroencapsulated S7 Cells 1.5M cells 1.5M cells Macroencapsulated Cells Pre-Transplant Human C-peptide (ng/ml) 6 5 4 3 2 1 0 Wks post Transplant: Fasted S7 KC Glucose S7 KC Fasted S7 TC Glucose S7 TC 2 4 6 8 10 14
Deviceless Subcutaneous Transplant
Deviceless Subcutaneous Transplant 3M cells 3M cells 3M cells 3M cells Stage 4 Cells Stage 6 Cells
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.
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
Islet Transplantation for Type 1 Diabetes (Edmonton Protocol)
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 192-206, 2012.
Bruin et al., Stem Under Review Cells Are Amenable to Large Scale Production JE Bruin et al. Science Translational Medicine 316ps323 Dec 2015