841-P: Scientific Basis for the First-in-Human Trial of “Neo-Islet”–Mediated Functional Cure of T1DM: The Intraperitoneal Administration of “Neo-Islets,” 3-D Organoids of Allogeneic Islet and Mesenchymal Stromal Cells from Rodents, Dogs, and Humans Durably Cures

• Published in: Diabetes (New York, N.Y.) Vol. 71; no. Supplement_1
• Main Authors: WESTENFELDER, CHRISTOF, CHOWDHURY, SABIHA S., GOOCH, ANNA
• Format: Journal Article
• Language: English
• Published: New York American Diabetes Association 01.06.2022
• Subjects: Angiogenesis; Apoptosis; Blood glucose; Cell culture; Clinical trials; Diabetes; Diabetes mellitus; Encapsulation; Immune response; Immunomodulation; Immunosuppressive agents; Inflammation; Insulin; Islet cells; Mesenchymal stem cells; Mesenchyme; Omentum; Organoids; Pets; Progenitor cells; Streptozocin; Stromal cells
• ISSN: 0012-1797; 1939-327X
• DOI: 10.2337/db22-841-P

Initial reports from Clinical Trials with cell-based interventions for the urgently needed therapy of T1DM show: (1) An open, s.c.-placed encapsulation device containing insulin-producing progenitor cells that require anti-rejection drugs has failed to adequately improve glycemic control. (2) The i.v. administration of stem cell-derived insulin-producing cells, requiring anti-rejection drugs, has shown promising results in 1 or 2 subjects. However, their unknown systemic location and inability to retrieve these cells remain a concern. Our approach harnesses the immune-modulating and -isolating, anti-inflammatory, angiogenic, anti-apoptotic and other trophic actions of Mesenchymal Stromal Cells (MSCs) . First, we demonstrated that allogeneic Neo-islets (NIs) , islet-sized organoids composed of equal numbers of MSCs and culture expanded Islet Cells do, when given i.p., omentally engraft, redifferentiate, re-express all islet hormones (Abstract this meeting) and permanently restore euglycemia in auto-immune diabetic NOD mice, i.e., without encapsulation devices or antirejection drugs. The omentum becomes the new endocrine pancreas. Second, i.p. therapy of spontaneously diabetic pet dogs with allogeneic canine NIs significantly improved glycemia and insulin needs (> 3 years) , and this without immune response. Third, human NIs permanently correct streptozotocin-induced diabetes in NOD/SCID mice. Removal of the omentally-engrafted NIs promptly restores the diabetic state. No long-term complications of the NI therapy have been observed. Based on this body of evidence, a successful Pre-IND meeting with the FDA was held and final Proof-of-Concept studies that are expected to lead IND approval are ongoing.