Anti-inflammatory Approach With Early Double Cytokine Blockade (IL-1β and TNF-α) Is Safe and Facilitates Engraftment in Islet Allotransplantation

Background: The approach to reducing nonspecific inflammation after islet allotransplantation has been designed to improve engraftment, typically using 1 agent. We report results with the use of combination inflammatory blockade consisting of anti-interleukin (IL)-1beta and tumor necrosis factor (TNF)-alpha. Methods: Nine patients underwent islet allotransplantation under a prospective research protocol using double cytokine blockade with anti-TNF-alpha (etanercept, d 0, 3, 7, 10) and IL-1beta (anakinra, d 0-7) at the time of each islet infusion. The primary endpoint, assessed 2 years after the last islet transplant, was the elimination of severe hypoglycemic events and hypoglycemia unawareness, with proper glycemic control, and detectable serum C-peptide. Results: No thrombotic events or infectious complications were associated with combined IL-1beta and TNF-alpha blockade. Six patients became insulin independent, 2 had partial function, and 1 had primary nonfunction. After 24-month follow-up, 6 of 9 patients had excellent glycemic control, hemoglobin A1c