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H G Gooszen

Publications and source records attributed to H G Gooszen.

147 records · Page 9Linked to original sources

Cell preservation in University of Wisconsin solution during isolation of canine islets of Langerhans.

Allogeneic islet transplantation in Type I diabetic patients is considerably hampered by the variable outcome of islet isolation and purification. After collagenase digestion of the pancreas, islet isolation is traditionally performed under hypothermic conditions in physiological solutions such as Hanks and RPMI. The University of Wisconsin solution (UWS) has been shown superior for hypothermic preservation of the pancreas. We, therefore, compared the UWS and RPMI for canine islet isolation and subsequent purification in either a conventional hyperosmotic density gradient of dextran in Hanks, or a novel normosmotic density gradient of Percoll in UWS. The isolation solution did not affect islet yield before purification (51% of the native islet mass). Loss of amylase (30%) and swelling of the acinar cells were observed in RPMI. In contrast, no loss of amylase and slight shrinkage of the acinar cells were observed in the UWS. Cell swelling affected the density separation and viability of the cells. Dextran density separation resulted in a 15% purity and 41% recovery of the islets isolated in RPMI, as compared to a 93% purity and 52% recovery of islets isolated in UWS. Percoll density separation improved the purity (99%) and recovery (74%) of islets isolated in UWS. Islets isolated in UWS demonstrated a superior basal and glucose stimulated insulin release during perifusion. Electron microscopy demonstrated a well-preserved islet ultrastructure after isolation in both solutions--except for slightly swollen mitochondria after isolation in RPMI. Autotransplantation of islets in pancreatectomised dogs was successful both after isolation in UWS and RPMI. We conclude that prevention of cell swelling during isolation and purification in the UWS resulted in an improved yield of viable and consistent virtually pure islets. Prevention of cell swelling during islet isolation should facilitate the analysis and control of other factors affecting outcome in man.

Animals↗

Glucoregulation after canine islet transplantation: contribution of insulin secretory capacity, insulin action, and the entero-insular axis.

The physiological glucoregulatory mechanisms after islet transplantation have been incompletely investigated. We studied the insulin secretory capacity (ISC) by intravenous arginine stimulation during 35-mM glucose clamps, insulin action during hyperinsulinemic euglycemic clamps, and mixed-meal stimulation at 6-9 mo after intrasplenic islet autotransplantation in 8 dogs, as compared with 30 controls. The enteroinsular axis in the recipients was examined by infusion of porcine glucose-dependent insulinotropic polypeptide (GIP) and human glucagon-like peptide-1 (GLP-1) (7-36 amide) under 8.5-mM glycemic clamp conditions in order to mimic the postprandial glycemia after transplantation. The grafts comprised 25% of the native islet mass, and the ISC likewise averaged 25% of the control value. The postprandial insulin response, in contrast, had increased to 140% after transplantation--albeit with a concomitant glucose excursion to approximately 8.5 mM. Insulin action declined on average by 45% posttransplant. The ISC correlated both with the postprandial glucose excursion and insulin action in the grafted dogs. Insulin action did not correlate with the postprandial glucose excursion. Infusion of GIP had no effect, but GLP-1 nearly doubled glucose-stimulated insulin. Thus, a hyperglycemia-enhanced insulinotropic effect of GLP-1, and perhaps other gut hormones, may account for the difference in the insulin response to the intravenous and oral challenges. Because the ISC reflects the engrafted islet mass and appears to be the primary determinant of glucose tolerance, transplantation of higher islet doses should allow prolonged near-normal glucoregulation--at least in the autotransplant setting.

Animals↗

Beneficial effects of ERCP and papillotomy in predicted severe biliary pancreatitis.

BACKGROUND/AIMS: Extensive circumstantial evidence indicates that patients with a predicted severe attack of acute biliary pancreatitis (ABP) should undergo an endoscopic retrograde cholangiography with papillotomy (ERC/PT). However, in clinical practice this procedure is not always performed. This study was conducted to compare outcome in patients with and without ERC/PT. METHODOLOGY: Thirty-five of 80 patients admitted with ABP had a predicted severe attack (three or more Ranson criteria). Only in 24 of these 35 patients was an ERC/PT performed. RESULTS: In the ERC/PT group, significantly less pancreatic necrosis (8 vs. 64%, p<0.001) occurred, hospital stay was shorter (median 22 +/- 5 vs. 51 +/- 19 days, P=0.08) and mortality was lower (8 vs. 36%, P=0.01). Twenty-three patients (66%) underwent cholecystectomy after a median period of 10 weeks (range 0-26 weeks) after discharge. During the waiting period, in the ERC/PT group, two patients developed acute cholecystitis whereas recurrent ABP and common bile duct stones occurred in one patient each. CONCLUSIONS: In patients with a predicted severe attack of ABP, performing ERC/PT is associated with less morbidity and lower mortality.

Acute Disease↗