Recruited fibroblasts reconstitute the peri-islet membrane: a longitudinal imaging study of human islet grafting and revascularisation
Rapid and adequate islet revascularisation and restoration of the islet–extracellular matrix (ECM) interaction are significant factors influencing islet survival and function of the transplanted islets in individuals with type 1 diabetes. Because the ECM encapsulating the islets is degraded during islet isolation, understanding the process of revascularisation and engraftment after transplantation is essential and needs further investigation.
Here we apply a longitudinal and high-resolution imaging approach to investigate the dynamics of the pancreatic islet engraftment process up to 11 months after transplantation. Human and mouse islet grafts were inserted into the anterior chamber of the mouse eye, using a NOD.ROSA-tomato.Rag2−/− or B6.ROSA-tomato host allowing the investigation of the expansion of host vs donor cells and the contribution of host cells to aspects such as promoting the encapsulation and vascularisation of the graft.
A fibroblast-like stromal cell population of host origin rapidly migrates to ensheath the transplanted islet and aid in the formation of a basement membrane-like structure. Moreover, we show that the vessel network, while reconstituted by host endothelial cells, still retains the overall architecture of the donor islets.
In this transplantation situation the fibroblast-like stromal cells appear to take over as main producers of ECM or act as a scaffold for other ECM-producing cells to reconstitute a peri-islet-like basement membrane. This may have implications for our understanding of long-term graft rejection and for the design of novel strategies to interfere with this process.
KeywordsAnterior eye chamber Diabetes mellitus Extracellular matrix Fibroblast Human islet Islet transplantation Longitudinal imaging Peri-islet membrane Post-transplantation period Vascularisation
Epithelial cell adhesion molecule
Glial fibrillary acidic protein
Membrane-targeted tomato fluorescence protein
Neuron-glial antigen 2
Platelet-derived growth factor receptor
Stem cell antigen 1
Smooth muscle actin
Vascular endothelial cell
Type 1 diabetes is the result of the autoimmune destruction of insulin-producing beta cells in the pancreas, and usually presents during childhood or young adulthood. Standard treatment of these patients involves exogenous insulin administration, by either (multiple) daily injections or infusions. However, sporadic administration of exogenous insulin often fails to maintain tight glycaemic control, provoking hyperglycaemic and hypoglycaemic episodes that can cause devastating side effects [1, 2]. Beta cell replacement offers the potential to provide physiological glycaemic control, but despite the early promise, islet transplantation as a therapeutic option for type 1 diabetes has had limited clinical impact.
Many factors contribute toward graft failure, including the inflammatory and immunogenic host environment and the loss of cells as a result of ischaemia and inadequate revascularisation [3, 4]. Transplanted islets must adapt to their new surroundings without the internal vascularisation and innervation that they had in the pancreas, and they do not have the benefit of most of their native peripheral extracellular matrix (ECM). An optimal engraftment site requires access to adequate oxygen and nutrient supplies either from endogenous vasculature or from induced or intrinsic neovascularisation . Thus, graft revascularisation plays a critical role in islet viability and function , as well as in restoration of the islet–ECM interactions [7, 8, 9].
The ECM consists of glycoproteins including fibrillar collagens, proteoglycans and other glycoproteins such as laminins and fibronectin formed into a supportive network that generally acts to separate tissue compartments, while providing specific molecular signals that control processes such as cell migration, differentiation and survival [10, 11, 12, 13]. The ECM is present in two forms: basement membrane and interstitial or stromal ECM. Basement membranes predominate in the pancreatic ECM, supporting epithelial acini of the exocrine pancreas and surrounding blood vessels and ensheathing each pancreatic islet (reviewed in ).
The pancreatic tissue-specific microenvironment formed by the ECM is partly lost during the islet isolation process [15, 16, 17]. The local disruption of the ECM and thereby the integrin-mediated adhesion of the ECM to adjacent islet cells results in apoptosis . Survival is promoted by allowing cells to adhere [19, 20], culturing islets on or within solid ECM protein coated scaffolds [10, 21, 22, 23] and coating islets with ECM proteins prior to transplantation [15, 24]. However, the ECM alone may not be sufficient to promote survival. Improvement of ECM regeneration and revascularisation/angiogenesis is crucial for successful islet transplantation.
Here we apply a longitudinal and high-resolution imaging approach to investigate the dynamics of the pancreatic islet engraftment process up to 11 months after transplantation. For the current study, we used the anterior chamber of the mouse eye because it is well suited to study human and mouse pancreatic islet cell biology and revascularisation over time because of the transparency of the cornea, and its high potential to perform continuous repeated recordings on individual islet grafts [25, 26, 27].
B6-albino (B6(Cg)-Tyrc-2J/J; JAX000058) mice were purchased from The Jackson Laboratory (Bar Harbor, ME, USA). These mice were crossed with B6.129(Cg)-Gt(ROSA)26Sortm4 mice (JAX007676) to generate B6(Cg)-Tyrc-2J-Gt(ROSA)26Sortm4 (B6.ROSA-tomato) mice. NOD.(Cg)-Gt(ROSA)26Sortm4 (NOD.ROSA-tomato) mice were generated by speed congenic backcrossing of the B6.129(Cg)-Gt(ROSA)26Sortm4 mice to NOD mice for five generations (see electronic supplementary material [ESM] Methods, ESM Table 1). Finally, NOD.ROSA-tomato mice were crossed to NOD.Rag2−/−  to generate NOD.ROSA-tomato.Rag2−/−. Tg.Cspg4-DsRed.T1.1Akik/J (JAX008241) mice were backcrossed to B6-albino to generate B6.(Cg)-Tyrc-2J-Tg.Cspg4-DsRed.T1.1Akik/J (B6.NG2-DsRed) mice. All animals were bred and maintained in a specific pathogen-free environment at the animal facilities at Lund University.
Islet isolation, anterior eye chamber transplantation and in vivo imaging
Mouse islet isolation and transplantation to the anterior eye chamber of female 6–8 week old B6-albino or B6.ROSA-tomato mice were performed as previously described . Human pancreatic islets of five nondiabetic brain-dead organ donors (ESM Table 2) were obtained from The Nordic Network for Islet Transplantation, through the Human Tissue Laboratory at Lund University Diabetes Center (Malmö, Sweden), cultured as described previously  and transplanted to the anterior eye chamber of female 6–8 week old NOD.Rag2−/− or NOD.ROSA-tomato.Rag2−/− mice. The Regional Ethics Committee in Lund, Sweden, approved the study according to the Act Concerning the Ethical Review of Research Involving Humans. In vivo imaging was performed as previously described [26, 27] using an upright laser scanning microscope (LSM 7 MP; Zeiss, Jena, Germany) equipped with a tunable Ti:sapphire laser (Spectra-Physics Mai Tai; Newport, CA, USA) and a long working distance 20×/1.0× water-dipping lens (Zeiss), specified in more detail in the ESM Methods. A 3D analysis of in vivo images of three to five randomly chosen islets per mouse eye was performed using Imaris 9.1 (Bitplane, Zurich, Switzerland) (ESM Fig. 1).
Kidney transplantation model
Six to eight week old female recipient B6.ROSA-tomato mice were anaesthetised using inhalation anaesthesia (isoflurane; Schering-Plough, Kenilworth, NJ, USA) combined with analgesia using buprenorphine (0.15 mg/kg s.c.; RB Pharmaceuticals, Slough, UK). The islet suspension (30 μl) was injected between the capsule and renal parenchyma of the left kidney using a blunt cannula connected to a gastight syringe (Hamilton, Reno, NV, USA), as described previously .
Adult pancreases or isolated islets from 6–8 week old female mice and graft bearing kidneys (4 weeks after transplantation) and eyes were fixed in 4% paraformaldehyde/PBS (Sigma, St. Louis, MO, USA) for 30 min (islets) or 1.5 h (organs) on ice, equilibrated in 30% sucrose/PBS overnight at 4°C and cryopreserved in an optimum cutting temperature compound (VWR Scientific Products, Willard, OH, USA) at −80°C.
Eight-micron cryosections were permeabalised and blocked in 10% goat serum in TRIS-buffered saline (TBS) 0.1% Triton X-100 for 1 h at room temperature and then incubated with primary antibodies overnight at 4°C (ESM Table 3). Appropriate secondary antibodies conjugated with Alexa 488/594/647 fluorophores from Life Technologies (Carlsbad, CA, USA) were applied for 1 h at room temperature (1:1000). Digital images of the cryosections mounted with fluorescence mounting medium (Dako, Glostrup, Denmark) were acquired with a Zeiss LSM 800 Airyscan confocal laser scanning microscope.
Statistical analysis was performed using SPSS statistical software version 24 (IBM, Armonk, NY, USA) and Prism version 7 (Graphpad Software, San Diego, CA, USA). All the data are presented as median ± 95% CI. Friedman’s test was used to calculate the overall difference in time for repeated measurements and a Wilcoxon’s paired-sample test was used to compare all the different time points with the reference time point (1 week or 2 weeks). A Bonferroni correction was performed on paired-samples tests. We consequently used nonparametric methods since the sample sizes (i.e. the number of islets) associated with the tests were small (n ≤ 20) and thus assumptions regarding normal distribution of our data could not be assured.
Revascularised islet grafts regenerate an ECM capsule similar to the peri-islet basement membrane
Recruited recipient cells are responsible for the secretion of ECM proteins of the peri-islet-like basement membrane
To follow the dynamics of mT+ recipient cells involved in the engraftment process, we repeatedly monitored islet grafts in vivo by two-photon microscopy (Fig. 2i–l). Continuous 3D imaging showed the progressive encapsulation of both human and mouse islets by mT+ recipient cells (median 68% of mouse vs 73% of human islet graft surfaces) until 5 months after transplantation (Fig. 2i, k). Later, the encapsulation process of syngeneic mouse islet grafts plateaued at 8 months, leaving larger islet surfaces uncovered (Fig. 2i, j). In contrast, from 2 months and up to 10 months, the outer host cell-derived capsule expanded and distributed evenly around human islets with a patchy dispersed pattern (Fig. 2k, l), remaining patchy throughout an extended imaging period of up to 11 months (ESM Fig. 2). To test if this patchiness could reflect the invagination of the peri-islet basement membrane together with ingrowing blood vessels, a more detailed 3D image segmentation analysis was performed, showing that the holes in the host cell-derived capsule were not directly connected to ingrowing blood vessels (ESM Fig. 3).
Cryosections of the islet grafts co-stained for ECM proteins demonstrate that only in areas where mT+ host cells have formed a single outer cell layer, a corresponding basement membrane-like structure is also formed, excluding remnant donor peri-islet basement membrane proteins as the possible reason (Fig. 2 m–r, ESM Fig. 4). But perhaps more important, the co-localisation of mT+ recipient cells with basement membrane proteins observed at 3–5 months post transplantation (Fig. 2m–r, ESM Fig. 4) or later (ESM Fig. 5) indicates that the host cells could be the main producers of the restored peri-islet-like basement membrane or possibly act as a scaffold for other ECM-producing cells.
Identification of fibroblasts
Transplanted human islets retain their vessel network density when transplanted into a nonhuman host
Both human and mouse islets displayed a similar initial vessel density increase reaching a plateau at about 2 months post transplantation (Fig. 5e–h). Although mouse islet grafts reached a vessel density of about 18% (Fig. 5e, f), the newly formed vessel network of human islet grafts reached a density of only 9% (Fig. 5g, h). The pancreatic islet grafts showed an intact anatomical organisation in a species-specific manner, with beta cells scattered over the entire human islet volume (Fig. 5i) and most beta-, alpha-, and delta cells closely but randomly associated with the mT+ vascular cells of the mouse recipient (Fig. 5j), similar to human islets in situ . Despite the clear segregation of cell types to different regions of the mouse islet (Fig. 5 k), all endocrine cell types examined in mouse islets were randomly associated with blood vessels without the previously proposed clustering of beta cells (Fig. 5l), similar to mouse islets in situ (Fig. 5m, n). This well-established difference from the anatomical organisation is also illustrated in the homogenous vs nonhomogeneous tissue structure revealed in backscatter images of mouse (Fig. 5b) or human islets (Fig. 5d).
Role of intra-islet endothelial cells differs in syngeneic and interspecies islet transplantations
The progressive replacement of the endothelial cells of donor origin by cells of a recipient origin is a result of cell migration but could potentially also depend on proliferation of cells in situ. Similarly, the gradual disappearance of recipient cells could be because of cell death and/or cell migration out of the islet transplant. To test for the latter hypothesis, we transplanted mT+ labelled islets into nonlabelled recipient mice. Occasionally we observed mT+ cells migrating from the mT+ labelled islet grafts along the blood vessels into the iris of B6-albino recipient mice (Fig. 6d–g). This data supported the notion that the disappearance of donor cells in the engrafted islet was partly a result of cellular migration.
In contrast, human islet grafts did not show purely non-tomato/donor vessel sections at any time point of imaging during the current study (Fig. 6h). Despite a chimeric tendency observed at early time points (median ratio of 0.79 at week 2, Fig. 6i), indicating that human endothelial cells might be present, from 2 months after transplantation, vessels were found to be covered mainly by mT+ recipient cells (median ratio 0.92, Fig. 6h, i, ESM Video 2). Cryosections of human islet grafts (NOD.Rag2−/− recipients) stained with species-specific antibodies to the endothelium-specific marker CD31 demonstrate that human intra-islet endothelial cells survive several days of culture prior to transplantation (Fig. 1a) and even for a couple of months after transplantation as part of vascular-like structures within the revascularised islet grafts (Fig. 6j). However, human endothelial cells disappeared at later time points in established human grafts. Frequent detection of human CD31 positive cells in the iris vasculature of the recipient (Fig. 6j) indicates that at least a part of them migrated out of the graft as seen for transplanted mT+ mouse islets (Fig. 6d–g) and as reported previously for renal islet grafts .
In the present study we applied 3D longitudinal in vivo imaging of human pancreatic islets transplanted into the anterior eye chamber of recipient mice to reveal the involvement of a motile fibroblast population in the reconstitution of the peri-islet basement membrane of transplanted pancreatic islets. The conditions studied here represent a transplantation situation in which the peri-islet basement membrane has been severely damaged or even removed. Following transplantation, we could trace the population of fibroblast-like cells migrating from the host to the periphery of syngeneic or xenogeneic transplanted islets, aiding in the formation of a basement membrane-like structure. In this transplantation situation the fibroblast-like stromal cells appear to take over as main producers of ECM as they reconstitute the peri-islet-like basement membrane. This was observed in syngeneic mouse-to-mouse islet transplantations and was also observed in interspecies human to mouse transplantations. To the best of our knowledge, no study has specifically visualised the association of an ECM-producing cell type with the peri-islet basement membrane. In the current study, the recruited cells could be identified with a surface marker profile as CD31−, CD45−, NG2−, EpCAM−, E-Caherin−, Sca-1−, PDGFRα+ and PDGFRβ+. In combination with the expression of vimentin and gp38—but not αSMA cytoplasmic protein— this excluded them from being myofibroblasts.
The recruited fibroblasts were found to produce ECM proteins such as collagen IV, nidogen-2, laminin γ1, perlecan and fibrillary collagen I as well as laminin α5 chains specifically in human islet grafts . This agrees with the major peri-islet basement membrane components that have been reported for the pancreas. Based on studies with endpoint histological analysis, the re-establishment of basement membrane matrix proteins has been observed for mouse  and human  islet kidney transplantations. One particular study showed that the peri-islet deposition of basement membrane matrix proteins coincided with the localisation of PECAM-1-positive vascular endothelial cells (VECs) that had migrated to the periphery of the syngeneic islets. This is possibly because of the nature of the graft site. Host VECs that accumulate at the renal graft site stroma to initiate the revascularisation process are then resolved when the VECs migrated into the islets to form the intra-islet vascular endothelium. Only occasionally could we observe CD31+ VECs in close proximity to the islet periphery, usually in association with NG2+ pericytes. However, CD31+ VECs were mainly found to be involved in the revascularisation process from the iris.
The recruited fibroblasts accumulated in large quantities and formed a dense fibroblast network of the islet graft fibroblast capsule. In human islet grafts the fibroblasts progressively formed capsules covering the islet graft surfaces almost completely (up to median 91% [95% CI 84, 97] at 10 months post transplantation) leaving only small openings that also remained during the time of observation up to 11 months. In contrast, the encapsulation of mouse islet grafts was progressive but incomplete during the time of observation (median 49% [95% CI 40, 64] at 8 months post transplantation) with larger islet surfaces lacking mT+ recipient cells. Given that recruited fibroblasts were found to co-localise with ECM proteins, we examined those gaps in the islet capsule in more detail. Islet graft surfaces that were not covered by mT+ fibroblasts also lacked peripheral islet ECM proteins. The reason that those larger peripheral areas were lacking a basement membrane remains unclear but the different islet preparation and preculture of human and mouse islets could cause an altered density of ECM ligands contributing to a difference in fibroblast movement and encapsulation. Moreover, while a direct correlation of individual ECM components within the encapsulation could not be evidenced, we speculate that the well-established differences in the interspecies specialisation of islet architecture and islet innervation between mice and humans [40, 41] could contribute to these discrepancies. In this context, our understanding of how important the formation of the peri-islet membrane is in the innervation of the grafts remains largely unknown.
Immediately after transplantation, the islet depends on the diffusion of oxygen and nutrients from the surrounding microenvironment for its survival and function. We found that endothelial cells from the transplant recipient are recruited into the islet graft, already creating new islet vessel networks within several days and reaching islet vessel densities comparable to islets in situ after 2–3 months post transplantation. The newly formed vessel network needs to be stabilised through the recruitment of supporting cells such as pericytes . Pericytes are peri-endothelial cells that cover capillaries and other micro vessels with adaptive plasticity as shown in response to islet injury  or renal islet transplantation in mice . We show that NG2+ pericytes are actively involved in the revascularisation process, progressively accumulating in perivascular domains in transplanted islets up to 5 months after transplantation. Mature pericytes were only rarely detected in the periphery of the islet without being associated with vasculature, suggesting that they were not involved in the reconstitution of the peri-islet basement membrane.
Despite the similar initial vessel density increase in syngeneic and interspecies transplantations, the mouse islet grafts reached a vessel density of about 17%, while the newly formed vessel network of human islet grafts reached a density of only 9%. This is in agreement with the substantially lower capillary density found in human vs mouse endocrine pancreas  and in accordance with the vessel densities of islets previously recorded in situ in mouse pancreas and human live pancreas sections . Several studies have reported that transplanted islets display reduced vessel density compared with pancreatic islets in situ [46, 47]. The involvement of intra-islet and recipient endothelial cells in human islet graft revascularisation is, however, still not completely understood and has not been studied in a longitudinal manner. In the current study, we followed transplanted islets by repetitive imaging for up to 11 months post transplantation. In our model system, endothelial cells from the recipient were the main contributor to the revascularisation of human islets. Initially, intra-islet endothelial cells constituted an alternative vascular source that exists in isolated islets and can account for up to 20% of the endothelial cells lining functional capillaries within the first weeks of revascularised xenogeneic human grafts. However, fully revascularised human islet grafts contained vessels of a purely mouse recipient origin. Human endothelial cells rapidly disappeared and at least parts of them migrated out of the graft. We conclude that even though recipient endothelial cells are mainly involved in the revascularisation process, it is cues produced by the donor islet that determine the structure and density of the vessel network, possibly by providing complex matrices and preformed paths that the recipient cells may navigate along.
In summary, our data provides evidence of a fibroblast population as the main organiser of the ECM encapsulation of transplanted islets of Langerhans and of islet-derived factors acting as cues for the architecture of the revascularisation of these islets. This may have implications for our understanding of long-term graft rejection and for the design of novel strategies to interfere with this process.
Open access funding provided by Lund University.
JN, RF, LH and AS-C obtained research data. JN, DH and AS-C contributed to the conception and design of the study. DH and AS-C wrote the manuscript. JN, HL, KP, DH and AS-C contributed to the analysis and interpretation of the data. All authors revised and approved the final version of the manuscript. AS-C is responsible for the integrity of the work as a whole.
This study was supported by the Swedish Research Council, Strategic Research Area Exodiab, Dnr 2009-1039, the Swedish Foundation for Strategic Research Dnr IRC15-0067 to LUDC-IRC, the Royal Physiographic Society in Lund, Diabetesförbundet and Barndiabetesförbundet.
Duality of interest
The authors declare that there is no duality of interest associated with this manuscript.
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