ICM<strong>in</strong>ner cell massIdInhibitor <strong>of</strong> <strong>differentiation</strong>iPS<strong>in</strong>duced pluripotent stemJAKJanus k<strong>in</strong>aseJDRF Juvenile diabetes research foundationLIFleukemia <strong>in</strong>hibitory factorMAPK Mitogen-activated prote<strong>in</strong> k<strong>in</strong>asem-Cer1 <strong>mouse</strong>-Cerberus 1MEK a MAP k<strong>in</strong>asem<strong>ES</strong> cell s <strong>mouse</strong> embryonic stem <strong>cells</strong>MHC major histocompatability complexMixl1 Mix1 homeobox-likeNgn3 Neurogen<strong>in</strong> 3Nkx6.1 NK homeobox transcription factor 6.1Oct4Octamer-4Otx2 Orthodenticle homeobox 2PCRpolymerase cha<strong>in</strong> reactionPDGFR platelet-derived growth factor receptorPdx1 Pancreatic and duodenal homeobox factor 1PEparietal endodermPLCγ phospholipase CγPPpancreatic polypeptide-produc<strong>in</strong>gPI3Kphospho<strong>in</strong>osityl 3 k<strong>in</strong>asePtf1aPancreas-specific transcription factor 1aqPCR quantitative polymerase cha<strong>in</strong> reactionRAret<strong>in</strong>oic acidRT-PCR reverse transcriptase- polymerase cha<strong>in</strong> reactionS.D.standard deviationS.E.M. standard error <strong>of</strong> <strong>the</strong> meanShhSonic hedgehogSMAD prote<strong>in</strong>s modulat<strong>in</strong>g <strong>the</strong> activity <strong>of</strong> TGFβ ligands; <strong>the</strong> name is a comb<strong>in</strong>ation <strong>of</strong><strong>the</strong> prote<strong>in</strong> homologs ‘SMA’ (C. elegans) and ‘mos<strong>the</strong>rs aga<strong>in</strong>tsdecapentaplegic’ (D. melanogaster)SoxSex determ<strong>in</strong><strong>in</strong>g region Y (SRY)-related HMG boxSPRED Sprouty-related EVH1 prote<strong>in</strong>STAT3 signal transducer and activator <strong>of</strong> transcription 3TBrachyuryTBPTATA-b<strong>in</strong>d<strong>in</strong>g prote<strong>in</strong>TdhThermostable direct hemolys<strong>in</strong> geneTEtrophectodermTGFβ Transform<strong>in</strong>g growth factor βVEvisceral endodermWHO World Health OrganizationWNT3(a) w<strong>in</strong>gless-type MMTV <strong>in</strong>tegration site 3(a)4
1. General <strong>in</strong>troductionDiabetes mellitusDiabetes mellitus (diabetes hereafter) is caused by a lack <strong>of</strong> <strong>in</strong>sul<strong>in</strong>-production or <strong>in</strong>sul<strong>in</strong>responsiveness,result<strong>in</strong>g <strong>in</strong> high blood glucose levels <strong>in</strong> <strong>the</strong> patient. There are two types <strong>of</strong>diabetes, type I and type II, result<strong>in</strong>g <strong>in</strong> an absolute or a relative lack <strong>of</strong> β <strong>cells</strong>, respectively(Donath and Halban 2004). Type II is <strong>the</strong> most common form <strong>of</strong> diabetes, account<strong>in</strong>g for 90 –95% <strong>of</strong> all cases. The World Health Organization (WHO) estimated a worldwide prevalence <strong>of</strong>171 million diabetics <strong>in</strong> 2000 and <strong>the</strong> prognosis is 336 million people by <strong>the</strong> year 2030, call<strong>in</strong>g it apandemic. In Denmark alone, 226.000 people (or 5% <strong>of</strong> <strong>the</strong> total population) had diabetes <strong>in</strong> 2006and it is estimated that <strong>the</strong> Danish health care system spends DKK 22 billion (or app. US$ 4billion) per year on treatment <strong>of</strong> diabetes and diabetes-related illness (Juvenile Diabetes ResearchFoundation homage). Fur<strong>the</strong>rmore, it is estimated that <strong>the</strong> disease costs Denmark an extra DKK 9billion per year due to loss-<strong>of</strong>-production.In type I patients, <strong>the</strong> disease is a result <strong>of</strong> an auto-immune attack on <strong>the</strong> <strong>in</strong>sul<strong>in</strong>-produc<strong>in</strong>g β <strong>cells</strong>,result<strong>in</strong>g <strong>in</strong> <strong>the</strong> loss <strong>of</strong> β cell mass, followed by dependence on <strong>in</strong>sul<strong>in</strong>-treatment for <strong>the</strong> patient(see (Lernmark and Falorni 1998; Madsen 2005) for reviews). This dependency is life-long, as <strong>the</strong>β cell mass does not regenerate to levels where it can susta<strong>in</strong> <strong>the</strong> body’s need for <strong>in</strong>sul<strong>in</strong>. Theonset <strong>of</strong> type I diabetes is due to genetic and/ or environmental factors, but a comprehensiveknowledge <strong>of</strong> <strong>the</strong> aetiology <strong>of</strong> <strong>the</strong> disease is still lack<strong>in</strong>g despite <strong>in</strong>tense studies <strong>the</strong>re<strong>of</strong>. Alongwith <strong>the</strong> primary disease which is treated with <strong>in</strong>sul<strong>in</strong> <strong>in</strong>jections, patients develop severesecondary complications such as bl<strong>in</strong>dness, kidney failure, and amputations due to chronicvascular defects caused by <strong>the</strong>ir blood-glucose levels be<strong>in</strong>g irregular and difficult to stabilize.In type II patients, a gradual <strong>in</strong>sul<strong>in</strong> resistance <strong>of</strong> <strong>the</strong> peripheral tissues leads to an <strong>in</strong>crease <strong>in</strong> βcell mass as a compensation for this condition (Rhodes 2005). This condition is partly reversible,but will ultimately lead to type I diabetes and <strong>in</strong>sul<strong>in</strong>-dependence if not treated. Type II diabetes isma<strong>in</strong>ly caused by genetic predisposition and environmental factors such as obesity, physical<strong>in</strong>activity, excessive calorie <strong>in</strong>take and ag<strong>in</strong>g (L<strong>in</strong>g and Groop 2009).Cell replacement <strong>the</strong>rapy <strong>in</strong> diabetesAlthough <strong>the</strong>re is no cure for diabetes at present, research focus<strong>in</strong>g on <strong>the</strong>rapeutic treatment isenvisioned as a palliative treatment or maybe even a cure for <strong>the</strong> disease. This section will focuson <strong>the</strong>rapies directed aga<strong>in</strong>st type I diabetes.In 2000, Shapiro and co-workers published <strong>the</strong> Edmonton protocol, as it is now referred to,provid<strong>in</strong>g pro<strong>of</strong> <strong>of</strong> pr<strong>in</strong>ciple for cur<strong>in</strong>g diabetes by transplant<strong>in</strong>g donor islets <strong>of</strong> Langerhans andre-establish<strong>in</strong>g eu-glycaemia <strong>in</strong> seven patients suffer<strong>in</strong>g from type I (Shapiro et al. 2000).However, 85% <strong>of</strong> islet recipients needed <strong>in</strong>sul<strong>in</strong> treatment after a 5-year period (Ryan et al. 2005).The obstacles <strong>of</strong> auto-immunity along with <strong>the</strong> scarcity <strong>of</strong> islet donor material, has directed focus<strong>towards</strong> o<strong>the</strong>r sources <strong>of</strong> β cell material to put to use <strong>in</strong> a similar treatment.In type I diabetics, <strong>the</strong>re is evidence <strong>of</strong> a cont<strong>in</strong>uous β cell regeneration tak<strong>in</strong>g place (Meier et al.2005). However, attempts to regenerate <strong>the</strong> β cell mass are most likely overruled by <strong>the</strong> autoimmuneattack, <strong>the</strong> gross result be<strong>in</strong>g no <strong>in</strong>sul<strong>in</strong>-production from <strong>the</strong> islets <strong>of</strong> Langerhans. Thereis evidence that β-<strong>cells</strong> can be generated from exist<strong>in</strong>g <strong>cells</strong>, but it is unclear whe<strong>the</strong>r this isthrough replication <strong>of</strong> exist<strong>in</strong>g β <strong>cells</strong> or by re-<strong>differentiation</strong> <strong>of</strong> o<strong>the</strong>r pancreatic <strong>cells</strong> such as duct<strong>cells</strong> or even from hepatic <strong>cells</strong> (Bouwens and Pipeleers 1998; Yang et al. 2002a; Dor et al. 2004;Hardikar 2004; Xu et al. 2008; Borowiak and Melton 2009). It is debated whe<strong>the</strong>r <strong>the</strong> pancreashosts a pancreatic endocr<strong>in</strong>e stem cell that can be stimulated to proliferate (Madsen 2005). Bypartial pancreatectomy or cellophane wrapp<strong>in</strong>g <strong>of</strong> <strong>the</strong> pancreas, it has been demonstrated that β5
- Page 1: PhD thesisCand.scient. Janny Marie
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5. Paper IIFGFR(IIIc)-activation in
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AbstractProgress in embryonic stem
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variants in their Ig-like domain II
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Cell count and proliferation assayC
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influence on the numbers of Sox17-G
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undifferentiated cells, we found th
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FGF4, 5, FGF8b and FGFR1, are expre
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with EdU-stain (blue sample); and w
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Olsen, S.K., J.Y. Li, C. Bromleigh,
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FiguresFigure 1: Screen for FGFR-is
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Figure 3: Activation of FGFRb or FG
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Opposite, Figure 6: In the absence
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6. General discussionEndoderm diffe
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Overall, the multitude of FGF-signa
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transplantation is the spread of an
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AcknowledgementsThe work presented
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Chambers, I., D. Colby, M. Robertso
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Hawkins, V.J. Wroblewski, D.S. Li,
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Nishikawa, S.I., S. Nishikawa, M. H
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Tanimizu, N., H. Saito, K. Mostov,