Editorial 1

Authors

S. R. Bornstein1, 2, 5, 6, S. A. Amiel2, F. Rubino2, G. Mingrone1, 2, 3, V. Kamvissi1, 2, M. Solimena4, 5, E. Bonifacio5, 6, P. Jones2, P. Schwarz1, A. L. Birkenfeld1, A. Behrens1, 2, 8, A. Barthel1, 7, R. Lechler9, M. Peakman10

Affiliations

Affiliation addresses are listed at the end of the article

Bibliography DOI http://dx.doi.org/ 10.1055/s-0034-1394453 Published online: December 5, 2014 Horm Metab Res 2015; 47: 1–3 © Georg Thieme Verlag KG Stuttgart · New York ISSN 0018-5043 Correspondence Prof. Dr. med. S. R. Bornstein Medizinische Klinik und ­Poliklinik III Technische Universität Dresden Universitätsklinikum Carl Gustav Carus Fetscherstraße 74 D-01307 Dresden Tel.:  + 49/(0)351/458 5955 Fax:  + 49/(0)351/458 6398 [email protected]

Currently, we are witnessing a pandemic increase of diabetes on a global level and the disease and its complications constitute a major burden for our modern health care systems. While type 1 diabetes has an autoimmune aetiology, a common denominator of type 2 diabetes and the associated metabolic syndrome is insulin resistance. Type 2 diabetes and the metabolic syndrome are also closely linked to environmental triggers and modern stressors, to the dominance of the western lifestyle with excessive nutrition, to migration and mobility, to the effect of globalisation, as well as socioeconomic factors. Besides these factors, alterations in immune/inflammatory pathways have emerged as major players in the development of obesity-related insulin resistance and type 2 diabetes [1–3]. Given the magnitude and the multidisciplinarity of the health burden posed by diabetes with a large number of unresolved questions and a major scientific workload ahead of us, research in diabetes requires combined efforts and large scale investments. A major aspect is that experts from complementary disciplines need to join forces in diabetes research. It is therefore becoming obvious that this ambitious mission will not be accomplished by single institutions. Breaking new grounds of research and health management in this area requires the cooperative and synergistic bundling of specific competencies and resources based on the development of new structures for the interaction between leading basic research institutions and academic health science centres. Based on this background, we embarked on creating a “Transcampus” for diabetes research and management combining 2 of Europe’s academic institutions, King’s College London in the United Kingdom and Technische Universität Dresden in Germany. This endeavour could create the critical mass for advancing understanding and treatment of diabetes. The unique advantage of

creating such a Transcampus lies in the formation of a “Star Alliance” of 2 centres with a strong focus and tradition of excellence in diabetes research in ▶  Fig. 1). 2 of the biggest European countries (  ● Both, King’s College and the Technische Universität Dresden represent academic science health centres in their respective country and have a particular strength and emphasis in diabetes and metabolic disease. This Transcampus creates synergistic value not only by joined funding and joined research grants but also by the exchange of students and expert staff. It creates a new business model of complimentary portfolios and infrastructures. Joined appointments and affiliations in combination with appropriate recruitment packages for leading scientists and clinicians could foster attractive collaborations to the Transcampus. It will facilitate large-scale industry-academia partnership and help to catalyse more efficiently the transfer of innovative research into society [4]. The Diabetes Transcampus Programme will focus on several facets of diabetes research. In this issue of Hormone and Metabolic Research we present the current research and clinical programmes of the Transcampus pertinent to central aspects of diabetes research, in particular, islet biology and islet transplantation. A specific advantage of this Transcampus with regard to islet replacement therapies is the added value generated by combining the only active human islet transplantation programme in Germany with one of the UK-located programmes. While the Dresden diabetes centre comprises a more homogenous Caucasian population of patients with a strong rural component, the patient population at King’s Health Partners and in particular King’s College Hospital represents a modern urban multiracial society with a strong migratory and non-European background. This provides the advantage to perform joined clinical trials and create diabetes management programmes com-

Bornstein SR et al. Creating a “Transcampus” in …  Horm Metab Res 2015; 47: 1–3

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Creating a “Transcampus” in Diabetes Research Between King’s College London and the Technische Universität Dresden: Update on Islet Biology and Transplantation

2 Editorial

Fig. 1  Unharnessing synergistic potential by combining resources. Summary of the benefits and gains of a transcampus as a novel concept for advancing cutting-edge research projects.

A European British-German Transcampus

A novel business model

Complementary portfolios and infrastructure

Attracting the best students

Creating world leading structures and programs

Enabling more flexible and attractive recruitment packages

Economical advantages New funding opportunities

Catalysing translation and transfer to society

A role model for all leading universities

Catalyzing internal campus identity

paring and integrating the diverse needs of these populations in different social settings. Even more important, the 2 programmes can learn from each other’s experience. Moreover, the complex and diverse ethical and regulatory requirements in the 2 different countries will allow more flexibility and efficiency in the translational process of research results from bench to bedside. Ludwig and co-authors [5, 6] summarize their data on the islet transplantation programme from Dresden, whereas Byrne et al. [7] report on the outcomes of adult patients with type-1-diabetes suffering from severe hypoglyceaemia or that were referred for islet transplantation to King’s College. However, islet transplantation appears not to be widely available on a global scale. While centers offer the opportunity to perform islet isolation and transplantation locally, remote center transplantation, where islet transplantation may occur at a site distinct from the islet isolation unit may help to overcome infrastructural limitations of the procedure. Therefore, Marathe and co-authors from the Royal Adelaide Hospital report their experience from the South Australian remote center transplantation programme [8]. Since immunosuppression is a major problem of allogeneic islet transplantation, novel implantable islet cell containing devices offering an immune barrier between graft and host and, thus, an optimized islet survival environment, may help to circumvent these problems [9, 10]. However, since islets require sufficient oxygenation, novel technological developments like the islet chamber described by Evron et al. [11], providing the oxygen supply by photosynthesis, represents a cutting-edge bio-engineering approach in the field of diabetes technology. Since allotransplantation is limited by the rarity of donor organs, xenotranslantation of islets from other species like pigs may be a potential therapeutic option to treat type 1 diabetes in the future. Reichart and co-authors [12] summarize the latest developments in this field. One of the major limitations of xenogeneic transplantation approaches is immunological graft rejection, which is initiated by interactions between host leukocytes and the graft endothelium. In this respect, Kourtzelis and co-authors [13] describe complement-targeting approaches to potentially attenuate the immune response. Animal models provide excellent tools to advance our knowledge on type 1 diabetes as well as in transplantation medicine and Rahmig et al. [14] provide us an overview on humanized mouse models for type 1 diabetes. Bornstein SR et al. Creating a “Transcampus” in …  Horm Metab Res 2015; 47: 1–3

The T-cell based destruction of islet beta cells is the major pathophysiological event in the development of type 1 diabetes and T regulatory cells may be considered for autologous cell therapy in order to prevent the immune mediated destruction of beta cells. Theil and co-authors [15] summarize their results on cord blood as a source for autologous T regulatory cells. The purity of these T-cells allows for higher expansion and therefore improved effectivity making them excellent candidates for fighting immune mediated beta-cell destruction. In addition to transplantation, regenerative approaches for the treatment of type 1 diabetes also appear to be promising. In this context, the knowledge about the details of endocrine pancreas development during early postnatal life is scarce. Somatostatin has been suggested to play a significant role in the aforementioned process [16]. In this issue, Richardson et al. [17] will introduce the results of a highly relevant study based on somatostatin-deficient mice indicating an important function of somatostatin in beta-cell apoptosis, proliferation and expansion. Also of high interest in embryonic development of the endocrine pancreas is the well-established perinatal maternal increase of the beta-cell mass. Drynda et al. [18] explore the different aspects of this observation, studying the placental vs. non-placental stimulating signals in animal models suggesting that both are playing a significant role in this adaptation process of the islets. Endothelial cells are of major interest in the process of islet revascularisation and survival after transplantation and 2 articles lay their focus on that. While Zhao and co-authors [19] shed light on the potential impact of the islet preparation method on endothelial preservation, King et al. [20] investigate the impact of pharmacological inhibition of the ALK5-signalling pathway, which is critically involved in endothelial cell survival and proliferation, on islet graft revascularization and function. Finally, during the last decade, novel and effective drugs for the treatment of type 2 diabetes have been developed on the basis of the so-called incretin concept [21]. Since incretins are involved in the regulation of physiological islet function, novel aspects in this setting are summarized in a mini-review by Kamvissi et al. [22]. Taken together, this issue provides a comprehensive summary on current research activities on islet biology and transplantation performed in a novel Transcampus concept of 2 leading

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Combining the strengths of 2 leading countries in Europe

European academic institutions in this field – King’s College London (United Kingdom) and Technische Universität Dresden (Germany).

Acknowledgements



Supported by the Deutsche Forschungsgemeinschaft (SFB-TRR 127). We would like to acknowledge T. Chavakis for critical comments on the manuscript. Affiliations 1  Department of Medicine III, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany 2  Diabetes and Nutritional Sciences, Hodgkin Building, Guy’s Campus, King’s College London, London, UK 3  Department of Internal Medicine, Catholic University, School of Medicine, Rome, Italy 4  Molecular Diabetology, Paul Langerhans Institute Dresden, TU Dresden 5  German Center for Diabetes Research (DZD e.V.), Dresden, Germany 6  DFG Research Center for Regenerative Therapies Dresden, Technische ­Universität Dresden, Dresden, Germany 7  Endokrinologikum Ruhr, Bochum, Germany 8  CR-UK London Research Institute, London, UK 9  MRC Centre for Transplantation, King’s College London, Guy’s Hospital, London, UK 10  Department of Immunobiology, King’s College London School of Medicine, London, UK

References

1 Ortega FJ, Fernández-Real JM. Inflammation in adipose tissue and fatty acid anabolism: when enough is enough!. Horm Metab Res 2013; 45: 1009–1019 2 Gregor MF, Hotamisligil GS. Inflammatory mechanisms in obesity. Annu Rev Immunol 2011; 29: 415–445 3 Donath MY. Targeting inflammation in the treatment of type 2 diabetes: time to start. Nat Rev Drug Discov 2014; 13: 465–476 4 Bornstein SR, Licinio J. Improving the efficacy of translational medicine by optimally integrating health care, academia and industry. Nat Med 2011; 17: 1567–1569 5 Ludwig B, Reichel A, Kruppa A, Ludwig S, Steffen A, Weitz J, Bornstein SR. Islet transplantation at the Dresden Diabetes Center: five years’ experience. Horm Metab Res 2014; 47: 4–8 6 Ludwig B, Barthel A, Reichel A, Block NL, Ludwig S, Schally AV, Bornstein SR. Modulation of the pancreatic islet-stress axis as a novel potential therapeutic target in diabetes mellitus. Vitam Horm 2014; 95: 195–222 7 Byrne ML, Hopkins D, Littlejohn W, Beckford R, Srinivasan P, Heaton N, Amiel SA, Choudhary P. Outcomes for adults with type 1 diabetes referred with severe hypoglycaemia and/or referred for islettransplantation to a specialist hypoglycaemia service. Horm Metab Res 2014; 47: 9–15 8 Marathe CS, Drogemuller CJ, Marathe JA, Loudavaris T, Hawthorne WJ, O’Connell PJ, Radford T, Kay TW, Horowitz M, Coates PT, Torpy DJ. Islet cell transplantation in Australia: screening, remote transplantation, and incretin hormone secretion in insulin independent patients. Horm Metab Res 2014; 47: 16–23

9 Ludwig B, Zimerman B, Steffen A, Yavriants K, Azarov D, Reichel A, Vardi P, German T, Shabtay N, Rotem A, Evron Y, Neufeld T, Mimon S, Ludwig S, Brendel MD, Bornstein SR, Barkai U. A novel device for islet transplantation providing immune protection and oxygen supply. Horm Metab Res 2010; 42: 918–922 10 Ludwig B, Reichel A, Steffen A, Zimerman B, Schally AV, Block NL, Colton CK, Ludwig S, Kersting S, Bonifacio E, Solimena M, Gendler Z, Rotem A, Barkai U, Bornstein SR. Transplantation of human islets without immunosuppression. Proc Natl Acad Sci U S A 2013; 110: 19054–19058 11 Evron Y, Zimermann B, Ludwig B, Barkai U, Colton CK, Weir GC, Arieli B, Maimon S, Shalev N, Yavriyants K, Goldman T, Gendler Z, Eizen L, Vardi P, Bloch K, Barthel A, Bornstein S, Rotem A. Oxygen supply by photosynthesis to an implantable islet cell device. Horm Metab Res 2014; 47: 24–30 12 Reichart B, Niemann H, Chavakis T, Denner J, Jaeckel E, Ludwig B, Marckmann G, Schnieke A, Schwinzer R, Seissler J, Tönjes RR, Klymiuk N, Wolf E, Bornstein SR. Xenotransplantation of porcine islet cells as a potential option for the treatment of type 1 diabetes in the future. Horm Metab Res 2014; 47: 31–35 13 Kourtzelis I, Ferreira A, Mitroulis I, Ricklin D, Bornstein SR, Waskow C, Lambris JD, Chavakis T. Complement inhibition in a xenogeneic model of interactions between human whole blood and porcine endothelium. Horm Metab Res 2014; 47: 36–42 14 Rahmig S, Bornstein SR, Chavakis T, Jaeckel E, Waskow C. Humanized mouse models for type 1 diabetes including pancreatic islet transplantation. Horm Metab Res 2014; 47: 43–47 15 Theil A, Wilhelm C, Guhr E, Reinhardt J, Bonifacio E. The relative merits of cord blood as a cell source for autologous T regulatory cell therapy in type 1 diabetes. Horm Metab Res 2014; 47: 48–55 16 Hauge-Evans AC, King AJ, Carmignac D, Richardson CC, Robinson ICAF, Low MJ, Christie MR, Persaud SJ, Jones PM. Somatostatin secreted by islet delta-cells fulfills multiple roles as a paracrine regulator of islet function. Diabetes 2009; 58: 403–411 17 Richardson CC, To K, Foot VL, Hauge-Evans AC, Carmignac D, Christie MR. Increased perinatal remodelling of the pancreas in somatostatindeficient mice: potential role of transforming growth factor-beta signalling in regulating beta cell growth in early life. Horm Metab Res 2014; 47: 56–63 18 Drynda R, Peters C, Jones P, Bowe J. The role of non-placental signals in the adaptation of islets to pregnancy. Horm Metab Res 2014; 47: 64–71 19 Zhao M, Choudhary P, Srinivasan P, Tang H, Heaton N, Fung M, Barthel A, Bornstein SR, Amiel SA, Huang GC. Modification of human islet preparation: an effective approach to improve graft outcome after islet transplantation? Horm Metab Res 2014; 47: 72–77 20 King AJ, Clarkin CE, Austin AL, Ajram L, Dhunna JK, Jamil MO, Ditta SI, Ibrahim S, Raza Z, Jones PM. ALK5 inhibition maintains islet endothelial cell survival but does not enhance islet graft revascularisation or function. Horm Metab Res 2014; 47: 78–83 21 Horie A, Tokuyama Y, Ishizuka T, Suzuki Y, Marumo K, Oshikiri K, Ide K, Sunaga M, Kanatsuka A. The dipeptidyl peptidase-4 inhibitor vildagliptin has the capacity to repair β-cell dysfunction and insulin resistance. Horm Metab Res 2014; 46: 814–818 22 Kamvissi V, Salerno A, Bornstein SR, Mingrone G, Rubino F. Incretins or anti-incretins? A new model for the “entero-pancreatic axis”. Horm Metab Res 2014; 47: 84–87

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Editorial 3

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Creating a "Transcampus" in diabetes research between King's College London and the Technische Universität Dresden: update on islet biology and transplantation.

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