Allotransplantation of macroencapsulated parathyroid cells as a treatment of severe postsurgical hypoparathyroidism: case report

Abstract

Persistent hypoparathyroidism, a condition associated with major inconvenience and potential morbidity, is more difficult to treat than other hypofunctional endocrine disorders. Therapeutic alternative in severe postsurgical hypoparathyroidism is allotransplantation of macroencapsulated parathyroid cells. With this technique, it is possible to implant cells or tissues of parathyroid origin to replace them in such patients without immunosuppression. At the present time, durable results have only been reported in parathyroid allotransplantation when immunosuppression to prevent rejection is administered. We report an allotransplant of parathyroid cells in a patient with continuous endovenous requirement of calcium to survive. Macrocapsule containing ~(20 to 30)×106 parathyroid cells was constructed with a polyvinylidine difluoride and implanted into the deep femoral artery. The functional activity of the graft, traced for 3 months, allowed to exclude the parenteral administration of calcium and to compensate symptoms of the disease.

Diagnosis and treatment of hypoparathyroidism: a position statement from the Brazilian Society of Endocrinology and Metabolism

“…The use of PTH and its derivatives has been tested with some success in the treatment of hypoparathyroidism, and the use of PTH (1-84) has been approved by American and European agencies (FDA and EMA) and will be discussed in Section 9 (124). Furthermore, perspectives point out to the use of allografts of macroencapsulated parathyroid cells, but studies in this regard are still in experimental phases (125).…”

Tissue‐engineered parathyroid gland and its regulatory secretion of parathyroid hormone

“…Agha et al tried to autotransplant tissue pieces (about 1 to 2 mm; Agha et al, 2016) from hyperparathyroidism patients so that immunological rejection was not worried. Other attempts process the cells or tissue pieces so that they can work well in allogeneic conditions (Khryshchanovich & Ghoussein, 2016; Tibell et al, 2001; listed in Table 2 as pre‐TE‐PTG trials and the conceptual graph shown in Figure 3a).…”

“…Overdosed PTH (1‐34) has the potential to bring hypocitraturia that is harmful to kidneys (Gafni et al, 2018). As for transplantation, allotransplantation was first used in postsurgical hypoparathyroidism but is still not popular enough considering the shortage of safe and functional cell or tissue resources (Agha et al, 2016; Khryshchanovich & Ghoussein, 2016; Tibell et al, 2001). Moreover, Jo et al summarized several attempts combined biomaterial scaffolds and rhPTH alone excepting cells for transplanting to cure hypoparathyroidism, and the lack of feedback regulation means it is not an ideal way for long‐term effect (Jo et al, 2019).…”

Microencapsulated parathyroid allotransplantation in the omental tissue

“…However, hormone replacement therapy is the most expensive treatment option and long‐term effects of kidney functionality is not known yet . Besides, various techniques are defined for PA, such as cultured cell transplantation, tissue transplantation, and microencapsulated cell transplantation . Microencapsulation technique is more successful than other techniques because it avoids the immune system.…”