Macro-encapsulated therapeutic cells and methods of using the same

RELATED APPLICATION This application claims priority under 35 USC §119(e) to U.S. Provisional Application No. 62/482,413, filed April 6, 2017, the entire contents of which are incorporated herein by reference. incorporate into the book.

The present disclosure relates generally to the fields of cell transplantation and therapeutic cell encapsulation. Macrocapsules for encapsulating therapeutic cells, methods of encapsulating therapeutic cells, and related uses for treating diseases such as diabetes are described.

The following discussion is provided to assist the reader in understanding the present disclosure, but is not admitted to describe or constitute prior art thereto.

Diabetes and Insulin Diabetes mellitus (or diabetes) is a disease in which the body's ability to produce or respond to the hormone insulin is impaired, resulting in abnormal carbohydrate metabolism and elevated blood and urine glucose levels. The disease has been subdivided into several subtypes: type 1 diabetes mellitus, insulin-dependent diabetes mellitus (IDDM), maturity-onset diabetes of the young (MODY), latent diabetes mellitus of the young (LADA), unstable diabetes mellitus, and obesity. It is described as type diabetes, type 1.5, type 2, type 3, obesity-related diabetes, gestational diabetes, and other nomenclature accepted in the art.

Subjects with insulin-dependent diabetes mellitus generally need to be administered exogenous insulin to sufficiently lower blood glucose. Non-insulin dependent subjects can have their blood glucose sufficiently lowered by pharmaceutical interventions, including classes of drugs that increase insulin sensitivity or glucose excretion. Subjects with insulin-dependent diabetes mellitus, whether the disease has been classified as type 1, MODY, LADA, unstable, lean, type 1.5, type 2, type 3, obesity-related diabetes, or any combination thereof One can benefit from cell replacement therapy, in which insulin-producing cells are transplanted into a subject, regardless of whether they are.

Type I diabetes is usually diagnosed in children and young adults and was formerly known as juvenile diabetes. Only 5-10% of people with diabetes have this form of the disease. Maturity-onset diabetes is the most common form of the disease and results from impaired or destroyed insulin-producing beta cells, development of insulin resistance, or both impaired insulin-producing beta cells and development of insulin resistance. . Diabetes can occur in nonobese adults and children due to a combination of genetic and environmental factors. In obese adults and children, the pancreas may try to make extra insulin to control blood glucose, but over time it becomes unable to hold and maintain normal levels of blood glucose. The body may also become less sensitive to the insulin produced. Prolonged overactivity of insulin-secreting beta-cells can lead to beta-cell dysfunction and death.

Symptoms of diabetes fluctuate depending on how much the subject's blood glucose rises and falls. Some people, especially those with prediabetes or non-insulin dependent diabetes, may not experience symptoms at first. In type I diabetes, symptoms tend to develop rapidly and are more severe.

Some of the signs and symptoms of type I and type II diabetes are increased thirst, frequent urination, extreme hunger, unexplained weight loss, presence of ketones in the urine fatigue, irritability, blurred vision, pain with slow recovery, frequent infections such as gum or skin infections, and vaginal infections. Not limited.

Encapsulating Cells It has long been a goal of biomedical research to create a system for encapsulating cells within a semi-permeable barrier that allows the survival of foreign cells within an immunocompetent human host (Weir et al. , Diabetologia, 56(7):1458-61 (2013)). To achieve this goal, the encapsulating barrier must allow the passage of gases, nutrients, and wastes, but the barrier is the immune cell and its effectors that target the cell for immune destruction. It must also be impermeable to molecules. The barrier should also avoid stimulating inflammation, fibrosis, or other host defenses against foreign substances.

The most prominent barrier materials reported in the published scientific literature are the carbohydrate polymers sodium alginate and cellulose sulfate (e.g. Tuch et al., Diabetes Care, 32(10):1887-9 (2009); See Basta et al., Diabetes Care, 34(11):2406-9 (2011); Loehr et al., Pharmaceutics, 6(3):447-66 (2014)).

Sodium alginate forms a gel-like matrix in the presence of divalent cations such as calcium or barium. The sodium alginate matrix is frequently supplemented with a layer of poly-L-lysine or poly-L-ornithine to reduce porosity.

Cellulose sulfate can be complexed with the copolymer poly(diallyldimethylammonium chloride) (pDADMAC) to form a membrane. Sodium alginate and cellulose sulfate have also been used in combination to form a mixed barrier with alginate and sodium sulfate (Wang et al., Transplantation, 85(3):331-7 (2008); Weber et al., J. Biotechnol. 114(3):315-26 (2004)).

There are few reports of these barriers that allow foreign cells to survive and function within the body of immunocompetent hosts for extended periods of cell survival (ie, at least 6 months). See Tuch, Basta, Loehr, Ma (Designing a retrievable and scalable cell encapsulation device for potential treatment of type 1 diabetes, PNAS | Published online December 26, 2017). In general, the inability of encapsulated cells to function over a limited period of time is due, at least in part, to poor oxygen diffusion across the barrier, resulting in death or impairment of cell function or fibrous tissue surrounding the barrier. lead to the accumulation of To address this issue, one group produced a form of alginate modified with covalent chemical groups containing triazole analogues, which they claim reduces the attachment of host macrophages to alginate (Vegas et al. al., Nat. Biotechnol., 34(3):345-52 (2016)). The group produced modified alginate microcapsules that enabled human insulin-secreting cells derived from embryonic stem cells to lower blood glucose in diabetic mice up to 6 months after implantation into the peritoneal cavity. (Vegas et al., Nat. Med., 22(3):306-11 (2016).

A major drawback of retrievable microcapsules is that they cannot be fully retrieved from the host if implantation poses a safety risk to the patient or if the implant fails and needs to be replaced. It is generally accepted by the art that an implant intended for human therapeutic use should be retrievable in order to be considered safe and practical for treatment.

A separate group of practical therapeutic doses described a device composed of alginate adhered to the surface of woven nylon threads to create long tubular structures (Ma (Designing a retrievable and scalable cell encapsulation device for potential potential)). treatment of type 1 diabetes. PNAS | Published online December 26, 2017). This shape is reportedly retrievable after implantation into the peritoneal cavity, as long as some of the alginate does not detach from the thread. Another group reported a planar macroencapsulated device for subcutaneous implantation that is retrievable (see D'AMOUR 2015, STEM CELLS TRANSLATIONALMEDICINE 2015;4:1-9). These devices, however, are compromised by their limited capacity to contain therapeutic cells. It would be impractical to deliver therapeutic doses to human patients using the devices described. For example, the therapeutic dose of cells to treat an insulin-dependent diabetic patient weighing 60 kg is 600 million cells (Bruni 2015 Bruni A, et al. Diabetes Metab Syndr Obes. 2014 Jun 23;7:211-23). The tubular device described would require a length of 60 meters to contain its therapeutic dose. A 60 kg diabetic patient would require 40 of the described planar macroencapsulated devices to receive a therapeutic dose.

Insulin release kinetics The pancreas is a highly vascularized organ that achieves rapid systemic distribution of insulin and other pancreatic hormones. Each islet within the pancreas is in close proximity to microvessels. The pancreatic circulation also connects to the liver, which is the main site of action of pancreatic hormones. A healthy pancreas can therefore restore normal blood glucose within minutes of a glucose excursion. Devices implanted in the peritoneal cavity lack proximity to the host vasculature, leading to slow insulin release into the circulation and prolonged hyperglycemia (Ma, Designing a retrievable and scalable cell encapsulation device for potential treatment of type 1 diabetes. PNAS | Published online December 26, 2017).Human skin is poorly vascularized and lacks proximity to the liver.As a result, subcutaneous implantation allows for rapid systemic circulation of pancreatic hormones, resulting in long-term chronic hyperglycemia is a major contributor to the prevalence of diabetes.

Thus, it is possible to support long-term survival of transplanted cells, retrievable, and both can provide rapid distribution of secreted hormones for the treatment of diabetes in general and in particular. There is still a need in the art for encapsulation barriers. The present disclosure meets those needs.

Described herein are macroencapsulating barriers that can be used to prepare therapeutic cell implants, methods of encapsulating therapeutic cells, and methods of using encapsulated cells in the treatment of disease. is. Macroencapsulated cells are retrievable from the host and can contain therapeutic doses of cells in practical volumes, allowing rapid distribution of secreted hormones.

In one aspect, the disclosure provides a composition comprising a macrocapsule containing a plurality of therapeutic cells, the macrocapsule comprising at least one barrier, the barrier comprising cellulose sulfate and glucomannan or glucomannan sulfate. In another aspect, the disclosure provides a composition comprising a macrocapsule containing a plurality of therapeutic cells, the macrocapsule comprising at least one barrier, the barrier comprising sodium alginate.

In another aspect, the disclosure provides a composition comprising a macrocapsule comprising a plurality of therapeutic cells, the macrocapsule comprising at least a first barrier and a second barrier, the first barrier and the macrocapsules have a diameter of at least 1.5 mm.

In another aspect, the disclosure provides a composition comprising macrocapsules containing a plurality of therapeutic cells, the macrocapsules comprising a cylindrical shape and a diameter of at least 1.5 mm.

In some embodiments, therapeutic cells are insulin-producing cells, such as pancreatic islet cells.

In some embodiments, the first barrier can comprise cellulose sulfate and glucomannan or glucomannan sulfate, while in some embodiments the first barrier can comprise sodium alginate. In some embodiments, sodium alginate is the divalent cation barium (BaCl₂) or calcium (CaCl₂).

In some embodiments, the composition can further comprise a second barrier. For example, in some embodiments, the second barrier can include cellulose sulfate and glucomannan or glucomannan sulfate. In some embodiments, the second barrier does not comprise glucomannan or glucomannan sulfate. In some embodiments, both the first and second barriers comprise cellulose sulfate and glucomannan or glucomannan sulfate.

In some embodiments, the diameter of the macrocapsules is at least about 1.5 mm, at least about 1.6 mm, at least about 1.7 mm, at least about 1.8 mm, at least about 1.9 mm, at least about 2.0 mm, at least about 2.1 mm, at least about 2.2 mm, at least about 2.3 mm, at least about 2.4 mm, or at least about 2.5 mm.

In some embodiments, cellulose sulfate was polymerized with poly(diallyldimethylammonium chloride) (pDADMAC). For example, in some embodiments, macrocapsules were washed with polymethylene-co-guanidine (PMCG) after polymerization with pDADMAC.

In some embodiments, the macrocapsules are cylindrical.

In some embodiments, multiple cylindrical macrocapsules are joined at one end.

In another aspect, the present disclosure provides a method of forming non-adherent macrocapsules containing a plurality of therapeutic cells, wherein the plurality of therapeutic cells are encapsulated in a barrier comprising cellulose sulfate polymerized with pDADMAC. washing the barrier with PMCG, wherein the PMCG coats the barrier by binding to the unbound sulfate groups of the cellulose sulfate, forming non-adhesive macrocapsules. offer.

In some embodiments, the method further comprises encapsulating the non-adhesive macrocapsules in a second barrier comprising cellulose sulfate polymerized with pDADMAC, and washing the second barrier with PMCG. , PMCG coats the barrier by binding to the non-bonded sulfate groups of cellulose sulfate, forming a double-barrier, non-adhesive macrocapsule.

In another aspect, the present disclosure provides a method of treating diabetes in a subject in need thereof comprising implanting a composition comprising macrocapsules containing therapeutic cells into the subject with diabetes. , wherein the macrocapsules comprise at least a first barrier and a second barrier, the first barrier being contained within the second barrier, and the macrocapsules having a diameter of at least 1.5 mm.

In some embodiments of the disclosed methods the subject is an adult, while in some embodiments the subject is a child. In some embodiments of the disclosed methods, the subject has type I diabetes, while in some embodiments the subject has type II diabetes.

In some embodiments, each macrocapsule is at least about 10 cm long, at least about 11 cm long, or at least 12 cm long, or at least 13 cm long, or at least 14 cm long, or at least 15 cm long. or at least 16 cm long, or at least 17 cm long, or at least 18 cm long, or at least 19 cm long, or at least 20 cm long.

In some embodiments, the macrocapsules comprise at least about 50,000 cells per cm, at least about 60,000 cells per cm, at least about 70,000 cells per cm, at least about 80,000 cells per cm, at least about 90,000 cells per cm. , containing at least about 1000,000 cells per cm.

In some embodiments, the disclosed macrocapsules may be joined end-to-end.

In some embodiments of the disclosed method, the composition is implanted into the greater omentum or peritoneal cavity of the subject. For example, the composition may be fixed to the omentum or implanted in the omentum pouch.

A composition according to any one of the preceding aspects or embodiments for use in treating diabetes in a subject in need thereof.

Use of a composition according to any one of the preceding aspects or embodiments in the manufacture of a medicament for the treatment of diabetes.

The following detailed description is exemplary and explanatory and is intended to provide further explanation of the invention.

<figref num="1A">A macrocapsule is shown. (A) Brightfield image of spherical macrocapsules composed of cellulose sulfate and konjac glucomannan. The inner capsule contains multiple clusters of therapeutic cells. 100x magnification of the original image.</figref><figref num="1B">A macrocapsule is shown. (B) Immunofluorescence of human antigen-stained macrocapsules removed from normal rats 3 weeks after transplantation at 40× magnification. There are no adherent host cells or evidence of inflammation or fibrosis on the surface of the macrocapsules.</figref><figref num="1C">A macrocapsule is shown. (C) Macrocapsules not formed with konjac glucomannan sulfate, but otherwise identical to those shown in (B), at 24× magnification. Macrocapsules formed without konjac glucomannan sulfate show overgrowth of host cells around the macrocapsules and no viable human cells within the macrocapsules.</figref><figref num="1D">A macrocapsule is shown. (D) Bright field image of cylindrical macrocapsules. The inner capsule is composed of alginate hydrogel and contains multiple clusters of therapeutic cells. The outer capsule is tightly adhered to the inner capsule and is composed of cellulose sulfate and konjac glucomannan.</figref><figref num="2">Figure 2 shows a double layered macrocapsule composed of an inner capsule formed from sodium alginate and an outer capsule formed from cellulose sulfate and konjac glucomannan sulfate. This macrocapsule has a non-spherical shape.</figref><figref num="3">Permeability of macrocapsules to 20 kDa dextran particles. By incorporating konjac glucomannan or konjac glucomannan sulfate into cellulose sulfate membranes, the permeability of the membrane can be increased. Macrocapsules formed without konjac glucomannan sulfate do not allow 20 kDa fluorescent nanoparticles to pass through the interior of the macrocapsules (A). The interior of the macrocapsules is not fluorescent after rinsing. Macrocapsules formed with konjac glucomannan sulfate allow 20 kDa fluorescent nanoparticles to pass through the interior of the macrocapsules (B). The inside of the macrocapsules is fluorescent after rinsing.</figref><figref num="4">Figure 2 shows regulation of blood glucose in diabetic rats. Normal Sprague-Dawley rats were rendered diabetic by injection of streptozotocin on day 0, leading to a rapid rise in blood glucose levels. Slow-release insulin pellets were implanted under the skin on day 13 to keep the animals healthy. On day 67, insulin pellets were removed and macrocapsules containing insulin-producing cells were surgically implanted into the omentum. Blood glucose levels remained controlled.</figref><figref num="5">Shown are explants of macrocapsules from rodents. Three weeks after transplantation into diabetic rats, the omental sac containing the macrocapsules was removed. (A) shows sufficient angiogenesis in the pouch. (B) and (C) represent immunofluorescence analysis showing that the macrocapsules within the explants contain insulin-expressing cells. (B) and (C) show no evidence of host cell attachment or inflammation and fibrosis on the surface of the macrocapsules.</figref><figref num="6">Shown are explants of macrocapsules from rodents. (A) Intracapsular spherical macrocapsules formed from omentum explanted 3 weeks after transplantation into diabetic rats. Macrocapsules are visible as spheres within the transparent retinal membrane. The membrane exhibits a dense network of microvessels in close proximity to macrocapsules. (B, C) Cylindrical macrocapsules were explanted 3 weeks after implantation into diabetic mice. The macrocapsules adhered to the host meshwork. Vasculature from the omentum is evident in close proximity to the macrocapsules.</figref><figref num="7">We show that macrocapsules allow the survival of transplanted xenogeneic cells. Clusters of therapeutic human cells were assessed for cell viability by staining with fluorescent indicators of live (green) and dead (red) cells. Clusters of cells are equally viable before (A), 9 days (B) and 47 days (C) after transplantation into normal immunocompetent mice.</figref><figref num="8">Shown is the membrane arising from the omentum around the explanted macrocapsules 6 months after implantation. (A) Membranes are thin, cellular, and contain collagen. The original magnification is 400x. (B) Macrocapsules contain insulin-expressing cells 6 months after transplantation.</figref>

Described herein are macroencapsulated compositions that can be used in therapeutic cell implants, methods of preparing encapsulated therapeutic cells, and in the treatment of disease in a subject in need thereof. A related usage in

Survival of encapsulated cells is affected by the immunoprotection of the barrier membrane and by the diffusion properties of biomolecules across the membrane. The long-term efficacy of the graft depends on the physical integrity of the graft barrier and the biocompatibility of the graft, or low stimulation of inflammation, fibrosis, and other foreign body reactions of the host, as well as oxygen diffusion, encapsulating cells. density, and the location of engraftment within the host. The ability of cells to actually deliver a therapeutic dose depends on the loading density of therapeutic cells. The ability to rapidly distribute secreted factors depends on their engraftment location within the host and their ability to form proximal connections to the host's vasculature.

The present disclosure describes novel macrocapsule compositions formed from cellulose sulfate that allow the survival and function of the encapsulated cells for over 6 months after transplantation of the cells into an immunocompetent host. This disclosure further describes a novel macrocapsule shape that facilitates capsule retrieval from living hosts. In addition to cellulose sulfate, the disclosed encapsulation barriers can include the carbohydrate polymers konjac glucomannan or konjac glucomannan sulfate, which help control barrier porosity and limit fibrosis. The present disclosure also provides a novel macrocapsule double barrier membrane design with a diameter greater than 1.5 mm that allows for high density engraftment and engraftment of therapeutic cells. The present disclosure also provides for forming non-spherical macrocapsules. Additionally, the method of preparing the disclosed macrocapsules can include sequential polymerization steps involving polymethylene-co-guanidine (PMCG) to improve the mechanical properties of the membrane. Macrocapsules formed using the disclosed materials and techniques can be produced by implanting encapsulated cells into a subject, e.g., a surgically formed pouch into or out of the omentum, or such It can be used to treat diabetes in fully immunocompetent subjects by attachment into other implant sites commonly used for cell-based therapy.

I.<u style="Single">definition</u>As used herein, the term "about" is understood by those skilled in the art and will vary somewhat depending on the context in which it is used. Where usage of the term is not apparent to one of ordinary skill in the art given the context in which the term is used, "about" means up to plus or minus 10% of the specified term.

As used herein, "macrocapsules" refer to polymer-based compositions for encapsulating therapeutic cells. The exact size and shape of the macrocapsules is not particularly limited and can be determined by the methods and materials used to make the macrocapsules. Additionally, the disclosed macrocapsules may include more than one layer (ie, barrier or membrane) of polymer that encapsulates the therapeutic cells.

The term "barrier" or "film" as used herein refers to a layer of macrocapsules composed of at least one polymer. The terms "barrier" and "membrane" may be used interchangeably throughout this disclosure.

As used herein, the term "hydrogel" refers to a porous matrix made of aggregates of carbohydrate polymers such as alginate bound together by ionic bonds with divalent cations such as calcium or barium.

As used herein, "long-term" when used in reference to the survival and function of exogenous therapeutic cells used in cell-based therapy/implantation means a period of time of at least 6 months or longer.

As used herein, the phrase "therapeutically effective amount" refers to the capsule implanted in the subject that provides the specific pharmacological effect to which the cells are implanted, i.e., to produce insulin and regulate blood glucose. It means the amount of metabolized cells. It is emphasized that a therapeutically effective amount of encapsulated cells is not necessarily effective in treating diabetes in a given subject, even though such concentrations are considered therapeutically effective amounts by those skilled in the art. Exemplary quantities are provided below for convenience only.

One of ordinary skill in the art can adjust such amounts according to standard practice as needed to treat a particular subject. A therapeutically effective amount may vary based on the subject's condition, including the site of implantation, the age and weight of the subject, and/or the severity of the subject's disease, the subject's diet, and/or the subject's overall health.

The term "treatment" or "treating" as used herein with respect to diabetes refers to one or more symptoms or co-morbidities of diabetes, such as hyperglycemia and hypoglycemia, heart disease, renal disease, liver disease, retina reducing, ameliorating, or eliminating disease, neuropathy, non-healing ulcers, periodontal disease; reducing a subject's reliance on exogenous insulin to regulate blood glucose; controlling the subject's blood glucose, reducing the subject's percent glycosylated hemoglobin, or HbA1C level, and/or other pharmaceutical interventions, such as insulin sensitizers, glucose efflux agents, and Refers to one or more of reducing a subject's dependence on other therapeutic modalities known in the art.

The terms "individual," "subject," and "patient" are used interchangeably herein to refer to any individual mammalian subject (eg, bovine, canine, feline, equine, or human).

II.<u style="Single">Novel macrocapsules and barriers</u>Disclosed herein are novel macrocapsules and barriers for encapsulating therapeutic cells such as pancreatic islet cells or other insulin-producing cells. The disclosed barriers improve the structural integrity of the capsule over conventional encapsulation techniques, improve permeability over conventional encapsulation techniques to increase passive diffusion of molecules into encapsulated cells, Comprising a novel combination of materials that reduce the incidence of fibrosis and facilitate capsule manufacture, the disclosed macrocapsules increase the survival of the encapsulated cells, reduce the incidence of fibrosis, and increase the availability of host tissue to the graft. It has unique structural features that facilitate recruitment of the vasculature, facilitate implantation into and recovery from the host, and deliver therapeutic doses to large mammals.

Conventional means of encapsulating cells, such as insulin-producing cells, generally include alginate capsules, cellulose sulfate capsules, or hydrogels, each of which is briefly discussed herein.

Conventional alginate capsules that have been used to encapsulate insulin-producing cells are formed by polymerization of sodium alginate around insulin-producing cells in the presence of divalent cations such as calcium or barium. This forms a hydrogel with insulin-producing cells immobilized in situ. Attempts to improve the performance of these hydrogel capsules include: modification of alginate to reduce cell attachment, coating the capsules with synthetic polymers such as poly-L-lysine or poly-L-ornithine. reducing permeability, adjusting the ratio of mannurone or guluron monomeric residues to improve biocompatibility, and rinsing in sodium citrate to liquefy the core of the capsule.

Conventional cellulose sulfate capsules that have been used to encapsulate insulin-producing cells are formed through the polymerization of cellulose sulfate and poly(diallyldimethylammonium chloride) (pDADMAC). These capsules differ from alginate hydrogels in that they consist of a flexible membrane surrounding a hollow core. These capsules are more fragile than alginate hydrogels because they can be easily compressed. These capsules are difficult to manufacture. This is because the unreacted pDADMAC on the surface of newly made capsules will irreversibly polymerize with other capsules that may come into contact.

Conventional alginate hydrogels and cellulose sulfate capsules are microcapsules generally 600 micrometers or less in diameter. It is generally accepted that small capsules are preferred over larger capsules because they have a higher surface area to volume ratio, allowing faster diffusion of gases and molecules.

After these conventional microcapsules are implanted within an animal host, host cells, including macrophages and fibroblasts, adhere to the surface of the capsule. Over several weeks, these cells deposit extracellular matrix proteins that make up the fibrous plaque around the foreign capsule. These fibrosis inhibit diffusion to and from cells within the capsule, leading to loss of function and cell death.

In contrast to conventional microcapsules, the disclosed macrocapsules exhibit dramatically reduced recruitment and adhesion of host macrophages and fibroblasts, and thus reduced fibrous plaque deposition. This property is a result of the high biocompatibility of cellulose sulfate/pDADMAC, konjac glucomannan, or konjac glucomannan sulfate, and the unique combination of macrocapsule size and shape. The cells within these capsules can therefore survive and function for extended periods of time, or at least six months.

In contrast to conventional microcapsules, the disclosed macrocapsules can be attached to the omentum. Attachment to the omentum promotes recruitment of host vasculature from the omentum to the macrocapsule. Proximity to the reticulovascular system allows rapid systemic distribution of secreted factors.

The disclosed macrocapsules can contain at least one barrier formed by mixing a carbohydrate polymer with anti-inflammatory and anticoagulant properties with cellulose sulfate prior to polymerization with pDADMAC. The presence of anti-inflammatory anticoagulants reduces host cell recruitment and adhesion and fibrosis formation. This process also increases the permeability of the barrier membrane, allowing essential biomolecules to diffuse through the membrane. Konjac glucomannan or konjac glucomannan sulfate are non-limiting examples of such carbohydrate polymers. Other examples are heparin sulfate and chondroitin sulfate.

Glucomannan (or konjac glucomannan) is a neutral polysaccharide harvested from the roots of the konjac plant (Amorphophallus konjac). Glucomannan sulfate can be formed by chemical addition of sulfate groups to free hydroxyl groups of glucose monomers. This process can be accomplished, for example, by esterification in the presence of pyridine sulfate in a suitable solvent such as dimethylformamide, dimethylsulfoxide, or one of the classes of ionic solvents. Glucomannan sulfate polymer has a viscosity similar to cellulose sulfate and does not inhibit the formation of cellulose sulfate/pDADMAC macrocapsules at low concentrations. Modified forms of glucomannan are known in the art (eg Reddy et al., Asian-Australas J. Anim. Sci., 17(2): 259-62 (2004); see Chen et al., Immunol Invest., 38(7):561-71 (2009)). Therefore, "glucomannan" can refer to modified or unmodified glucomannan.

In addition, glucomannan and glucomannan sulfate have anticoagulant properties. As shown herein, incorporation of glucomannan into cell-encapsulated macrocapsules reduces fibrosis deposition. This is the first demonstration of glucomannan reducing fibrosis formation when mixed with the cellulose sulfate membrane of macrocapsules. Furthermore, glucomannan provides the added benefit of increasing the porosity of cellulose sulfate/pDADMAC membranes, allowing passive diffusion of molecules of at least 20 kDa through the macrocapsule barrier.

Accordingly, in some embodiments, the disclosed macrocapsules comprise at least one barrier layer comprising cellulose sulfate and glucomannan. In some embodiments, the disclosed macrocapsules comprise at least two barrier layers comprising cellulose sulfate and glucomannan.

Furthermore, it is recognized in the art that it is difficult to form macrocapsules around dense cells. At high densities, cells and cell clusters permeate the membrane, compromising barrier integrity. A high density of cells is preferred to allow implantation of small therapeutic doses of cells in a small volume. High cell density is greater than 2 million cells per milliliter of encapsulating polymer solution.

For example, conventional cellulose sulfate capsules have diameters of 600 μm or less and are formed of a single membrane of cellulose sulfate polymerized by pDADMAC (see, eg, Stiegler et al., Transplant Proc., 38(9):3026). -30 (2006)). As cell density increases, so does the probability that cells will remain within the polymerized membrane during the polymerization step. When this occurs, the membrane becomes defective and causes the immune protective barrier to fail.

Conventional capsules are formed by dropping a mixture of cells and liquid cellulose sulfate or liquid alginic acid into a polymerization bath. Cells are evenly distributed throughout the droplet. A higher density therefore increases the probability of cells being exposed on the surface of the capsule. The cylindrical shapes described herein are formed by extruding a mixture of cells and liquid alginate through a submerged blunt-end syringe needle into a polymerization bath. The kinetics of the liquid flowing through the syringe needle shows cells concentrating towards the center of the cylinder that forms. Therefore, a high density of cells can be encapsulated within this geometry with a low probability of cells being exposed to the surface of the capsule. A second barrier formed around these fixed cells virtually eliminates the possibility of cell exposure on the surface of the capsule.

The disclosed macrocapsules contain a dual barrier structure and have a diameter of at least about 1.5 mm. This design ensures the mechanical integrity of the macrocapsules and contributes to their increased long-term stability in vivo. Furthermore, the size of the macrocapsules allows for high density therapeutic cell encapsulation.

High densities of therapeutic cells can be encapsulated within macrocapsules of 1.5 mm or greater in diameter. In some embodiments, the disclosed macrocapsules can be composed of a first barrier comprising alginate. In some embodiments, the disclosed macrocapsules can be composed of a first barrier comprising cellulose sulfate polymerized with pDADMAC. The first barrier can be rinsed with polymethylene-co-guanidine (PMCG). A second barrier comprising cellulose sulfate and optionally glucomannan or glucomannan sulfate is then formed around the first barrier, optionally followed by a PMCG rinse, thus forming a double barrier macro. Capsules can be formed. Because the first barrier directly encloses the therapeutic cells, a second barrier can be formed without interference from cells and/or cell debris. Furthermore, the second barrier is the only barrier that directly contacts the host after the macrocapsules are implanted.

In some embodiments, the disclosed macrocapsules comprise at least 1, at least 2, or at least 3 barriers. The barriers that make up the macrocapsules may comprise the same or different materials. cellulose sulfate and glucomannan; cellulose sulfate and glucomannan sulfate; sodium alginate; cellulose sulfate and sodium alginate; sodium alginate and glucomannan sulfate; may be formed. In some embodiments, only the external barrier comprises glucomannan or glucomannan sulfate. This is because only this layer of macrocapsules directly interacts with the host after implantation. Other polymers that can be used in place of glucomannan or glucomannan sulfate are heparin sulfate and chondroitin sulfate.

In some embodiments, the disclosed macrocapsules are at least 1.5 mm in diameter. For example, the disclosed macrocapsules have diameters of about 1.5 mm, about 1.6 mm, about 1.7 mm, about 1.8 mm, about 1.9 mm, about 2.0 mm, about 2.1 mm, about 2.2 mm, about 2.3 mm, or about 2.4 mm. can have A diameter of 1.5 mm or greater results in reduced formation of fibrosis after implantation into the host.

In some embodiments, the disclosed macrocapsules are at least 10 cm long. For example, the disclosed macrocapsules are at least about 10 cm, at least about 11 cm, at least about 12 cm, at least about 13 cm, at least about 14 cm, at least about 15 cm, at least about 16 cm, at least about 17 cm, at least about 18 cm, at least about 19 cm, at least about It can have a length of 20 cm or more. Having macrocapsules of sufficient length allows for easier retrieval of the macrocapsules from the subject (ie, increased retrievability) in the event that the macrocapsules need to be removed.

The size and structure of the disclosed macrocapsules also allows the macrocapsules to contain a therapeutically useful number of cells. For example, the disclosed macrocapsules contain at least about 50,000 cells per cm, at least about 60,000 cells per cm, at least about 70,000 cells per cm, at least about 80,000 cells per cm, at least about 90,000 cells per cm, or at least about 90,000 cells per cm. may contain at least about 1000,000 cells or more per cell.

In some instances where more cells are required, the disclosed macrocapsules can be joined end-to-end or woven together.

In some embodiments, the disclosed macrocapsules are not spherical. A preferred shape is a cylindrical tube. Cylindrical tubes have a diameter of at least 1 mm and are of unlimited length. The cylindrical tube has a high surface area to volume ratio to allow sufficient diffusion while facilitating recovery of the capsule from the living host. A small number of tubes are easier to remove than a large number of spherical macrocapsules. A second barrier composed of cellulose sulfate or cellulose sulfate and glucomannan or glucomannan sulfate enhances the physical integrity of the cylindrical tube, thus improving retrievability.

Spherical capsules are formed by dropping a mixture of cells and liquid cellulose sulfate or liquid alginic acid into the polymerization bath. Cells are evenly distributed throughout the droplet. A higher density therefore increases the probability of cells being exposed on the surface of the capsule. The cylindrical shapes described herein are formed by extruding a mixture of cells and liquid alginate through a submerged blunt-ended syringe needle into a polymerization bath. The kinetics of the liquid flowing through the syringe needle shows cells concentrating towards the center of the cylinder that forms. Therefore, a high density of cells can be encapsulated within this geometry with a low probability of cells being exposed to the surface of the capsule. A second barrier formed around these fixed cells virtually eliminates the possibility of cell exposure on the surface of the capsule.

In some embodiments, the substrate has the shape of a rectangular strip that allows for attachment of multiple tubular macrocapsules in juxtaposition or opposite sides of the strip. In some embodiments, the substrate is circular, allowing attachment of multiple tubular macrocapsules radiating from a central point of attachment. In some embodiments, the shape of the substrate has tabs useful for passing sutures to attach the substrate to host tissue. In some embodiments, the substrate has two or more tabs for attaching the substrate to host tissue.

III.<u style="Single">Methods of preparing the disclosed macrocapsules</u>Disclosed herein are methods of more efficiently forming macrocapsules for encapsulating therapeutic cells, such as insulin-producing cells.

Bulk therapeutic cells are suspended in a solution of cellulose sulfate at a density of 2 million cells per milliliter. The cellulose sulfate/cell mixture is dropped into a buffer solution containing the polymerizing agent pDADMAC. The size of the droplets, and thus the macrocapsules, can be carefully controlled using a droplet generator. This capsule represents the inner capsule. This process can produce spherical capsules.

In some embodiments, therapeutic cells are suspended in a solution of sodium alginate to a density of 2 million cells per ml and dripped into a buffered polymerization bath containing divalent cations such as calcium or barium. This process can produce spherical hydrogels.

In some embodiments, therapeutic cells are suspended in a solution of sodium alginate at a density of 2 million cells per ml and loaded into syringes with 1.5 mm inner diameter blunt-ended needles or medical grade tubing. The needle or tube tip is immersed in a buffered polymerization bath containing divalent cations such as calcium or barium. The alginate/therapeutic cell mixture is injected into the polymerization bath to produce a hydrogel in the form of cylindrical tubes. Infusion rate can be carefully controlled using a syringe pump.

A spherical inner capsule composed of cellulose sulfate, a spherical inner capsule composed of sodium alginate, or a cylindrical tube composed of sodium alginate is immersed in a solution of pDADMAC and briefly rinsed in distilled water. The inner capsule is then soaked in a solution of cellulose sulfate and glucomannan to form the outer capsule.

Alternatively, a spherical inner capsule composed of cellulose sulfate, a spherical inner hydrogel composed of sodium alginate, or a cylindrical tube composed of sodium alginate is immersed in a solution of cellulose sulfate and glucomannan. The inner capsule or tube is dropped into a solution of pDADMAC to form the outer capsule.

Macrocapsules containing cellulose sulfate polymerized with pDADMAC have a known tendency to strongly adhere to each other when brought into contact after rinsing off the polymerization buffer containing pDADMAC. This results in agglomeration of macrocapsules or macrocapsules that are physically damaged when separated.

As disclosed herein, this aggregation can be minimized or eliminated by adding polymethylene-co-guanidine (PMCG) in successive washing steps after polymerization of each macrocapsule barrier. For example, polymerization of cellulose sulfate with pDADMAC followed by sequential washing with PMCG eliminates adhesion between macrocapsules and produces physically intact individual macrocapsules. PMCG polymerization additionally provides the benefit of increasing the burst strength of the macrocapsule barrier.

PMCG has previously only been used as an integral polymer during membrane formation (Wang et al., Transplantation, 85(3): 331-7 (2008)). In contrast, the macrocapsule design described herein does not use PMCG as an integral part of the membrane, but instead a coating that binds to and occupies the exposed, unbound sulfate groups of the cellulose sulfate. Used as material.

Thus, in some embodiments, a method of preparing macrocapsules comprising cellulose sulfate includes washing the macrocapsules with PMCG after polymerization with pDADMAC. When preparing macrocapsules containing more than one barrier, the method can include sequential PMCG washing steps after each subsequent polymerization of the barrier.

After the capsules are fully prepared, the macrocapsules can be rinsed and returned to the cell culture medium.

The macrocapsules can be adhered to a piece of surgical mesh by placing the macrocapsules in contact with the surgical mesh. A quantity of cellulose sulfate is added to cover the portions of the macrocapsules and surgical mesh that are in contact. Alternatively, an amount of cellulose sulfate and glucomannan is added to cover the portions of the macrocapsules and surgical mesh that are in contact. A polymerizing solution of pDADMAC is added to bond the macrocapsules and surgical mesh together.

IV.<u style="Single">Method of treatment</u>As noted above, the macrocapsules described herein are capable of encapsulating therapeutic cells (e.g. pancreatic islet cells or insulin-producing cells) and thus the disclosed macrocapsules require Useful in methods of treating diabetes in a subject. In some embodiments, the subject is a human subject with insulin-dependent diabetes.

The method generally comprises implanting a therapeutically effective amount of insulin-producing cells encapsulated in macrocapsules disclosed herein into a subject in need thereof. Thus, in some embodiments, the method involves a therapeutically effective amount of insulin-producing cells encapsulated in macrocapsules comprising at least two barriers and having a diameter of at least 1.5 mm. including the step of implanting into the individual. In some embodiments, the method comprises a therapeutic encapsulated in a macrocapsule, wherein the outer barrier comprises at least one barrier composed of (i) cellulose sulfate and glucomannan or glucomannan sulfate or (ii) sodium alginate. including transplanting an effective amount of insulin-producing cells into an individual in need thereof. In some embodiments, the method produces a therapeutically effective amount of insulin encapsulated in a macrocapsule formed in the shape of a cylindrical tube composed of an inner capsule of alginate and an outer capsule of cellulose sulfate and glucomannan sulfate. including transplanting the cells into an individual in need thereof.

In some embodiments, the method discloses about once every two years, once every three years, once every four years, once every five years or more Implanting a therapeutically effective amount of insulin-producing cells encapsulated in macrocapsules into an individual in need thereof. In some embodiments, the transplanted cells survive for at least 6 months after transplantation. Thus, in some embodiments, a subject may require only one transplant. In some embodiments, the transplantation is once every 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, or 18 months for 1, 2, 3, 4, Or it may need to be replaced once every 5 years or more, or until the subject has recurrent hyperglycemia or reverts to a diabetic state.

In some embodiments, the encapsulated cells are implanted into the omentum of the subject. The greater omentum (also known as the great omentum, omentum majus, gastrocolic omentum, epiploon, or caul) hangs down from the stomach and extends back from the greater cavity of the stomach, and is transverse before reaching the posterior abdominal wall. It is a large apron-like fold of the visceral peritoneum that rises to the colon. Thus, encapsulated cells may be implanted into a pouch surgically created from the omentum.

In some embodiments, the encapsulated cells are attached to the omentum of the subject. In some embodiments, encapsulated cells can be implanted into the omentum without forming a sac from the omentum.

In some embodiments, encapsulated cells are implanted into the peritoneal cavity. In some embodiments, encapsulated cells are implanted into the peritoneal cavity and anchored to the omentum. In some embodiments, encapsulated cells are implanted into the bursa. In some embodiments, the macrocapsules are cylindrical tubes, and in some embodiments, the encapsulated cells are implanted into the peritoneal cavity where one end of the cylindrical tube is anchored to a mesh.

Exemplary doses of encapsulated cells can vary according to the size and health of the individual being treated. For example, in some embodiments, an exemplary graft of cells encapsulated in the disclosed macrocapsules can contain 5-10 million cells per kg of body weight. The disclosed macrocapsules contain a therapeutically effective amount of cells, for example, at least about 50,000 cells per cm, at least about 60,000 cells per cm, at least about 70,000 cells per cm, at least about 80,000 cells per cm, at least about 80,000 cells per cm, It is possible to encapsulate about 90,000 cells/cm, or at least about 1000,000 cells per cm or more.

Furthermore, the disclosed therapeutic methods can additionally comprise administration of a second therapeutic agent in addition to the encapsulated therapeutic cells. For example, in some embodiments, additional therapeutic compounds can include insulin injections, metformin, sulfonylureas, meglitinides, thiazolidinediones, DPP-4 inhibitors, GLP-1 receptor agonists, and SGLT2 inhibitors. but not limited to these.

Certain therapeutic regimens, including implantation of the disclosed macrocapsules, may be evaluated according to whether they improve the outcome of a given patient, whether it stabilizes or normalizes blood glucose levels in the subject. or symptoms or co-morbidities associated with diabetes (hypoglycemia episodes, elevated glycosylated hemoglobin levels (HbA1C levels), heart disease, retinopathy, neuropathy, renal disease, liver disease, periodontal disease, and non-diabetes). (including, but not limited to, healing ulcers).

Thus, for the purposes of this disclosure, a subject is treated when he or she obtains one or more beneficial or desirable results, including desirable clinical results. For example, beneficial or desirable clinical results include, but are not limited to, one or more of the following: reduction in one or more symptoms attributed to diabetes; increased quality of life for people afflicted with diabetes; reducing the dose of other medications required to treat diabetes, delaying or preventing complications associated with diabetes, and/or prolonging an individual's survival.

Furthermore, the subject of the method is generally a subject with diabetes, although the patient's age is not limited. The disclosed methods are useful for treating diabetes across all age groups and cohorts. Thus, in some embodiments the subject may be a pediatric subject, while in other embodiments the subject may be an adult subject.

Those skilled in the art will readily appreciate that the present disclosure is well adapted to carry out the objects and obtain the ends and advantages mentioned, as well as those inherent therein. Modifications therein and other uses will occur to those skilled in the art. These modifications are included within the spirit of this disclosure. The following examples are given to illustrate the invention. However, it should be understood that the invention is not limited to the specific terms or details of these examples.

<p>[Example 1]</p><p>Formation of Macroencapsulated Cells and Sulfation of Test Cellulose: Cellulose was sulfated similarly to the method used by Zhang et al., Cellulose, 17:427-435 (2010). Briefly, cellulose was suspended in anhydrous dimethylformamide (DMF) and slowly mixed with a solution of DMF/acetic anhydride/chlorosulfonic acid and stirred at 50° C. for 5 hours. The mixture was then poured into a saturated solution of anhydrous sodium acetate in ethanol. The precipitate was centrifuged and washed with 4% sodium acetate in ethanol. The precipitate was collected and mixed with 1M ethanolic sodium hydroxide for 15 hours at room temperature. The pH was adjusted to 8 with a 50/50 mixture of acetic acid/ethanol. The precipitate was washed with ethanol and dissolved in DI water. The solution was filtered through a 0.45um filter, dialyzed in DI water and lyophilized.</p><p>Sulfation of glucomannan: Glucomannan was suspended in a solution of dimethylsulfoxide. Pyridine sulfate was added dropwise to the glucomannan solution and the reaction was raised to 60°C over 2 hours. The reaction was cooled to room temperature and adjusted to pH 8 with sodium hydroxide solution. Glucomannan sulfate was precipitated with ethanol and resuspended in water. The solution was dialyzed against distilled water for 48 hours and filtered through a 45um filter.</p><p>Differentiation of glucose-sensing insulin-expressing cells: A stem cell line (SR1423) cultured in E8 medium (Life Technology) on tissue culture dishes coated with geltrex (Life Technology) was removed from the substrate by exposure to 0.5 mM EDTA. Detached and transferred to suspension culture dishes in E8 medium supplemented with 10 nM Rho kinase inhibitor (Y-27632, Sigma). Place the culture dish at 37°C and 6% CO₂placed overnight on an orbital shaker rotating at 70-90 RPM in a humidified tissue culture incubator. Formed clusters were removed from the orbital shaker, collected and added to 0.2% human serum albumin, 0.5X N2 supplement (Life Technology), 0.5X B27 supplement (Life Technology), 1X penicillin/streptomycin (VWR), Activin A (100ng/ ml), and resuspended in DMEM containing Wortmannin (1 nM). Culture medium was changed daily for 3 or 4 days. Collect clusters, 0.2% human serum albumin, 0.5X Contains B27 supplement, 0.5X insulin-transferrin-selenium supplement (VWR), 1X penicillin/streptomycin (VWR), retinoic acid (2uM), KGF (50ng/ml), noggin (50ng/ml), and cyclopamine (250nM) were resuspended in a 50/50 solution of RPMI/F12. Medium was changed daily for 4 days. Clusters were collected and added to glucose (up to 8mM), 0.5% human serum albumin, 0.5X insulin-transferrin-selenium supplement, 1X N2 supplement, 1X penicillin/streptomycin, KGF (50ng/ml), noggin (50ng/ml), and Resuspended in DMEM low glucose supplemented with EGF (50 ng/ml). Medium was changed every other day for 4 days. Collect clusters, add glucose (to 8 mM), 0.5% human serum albumin, 0.5X insulin-transferrin-selenium supplement, 1X Resuspended in DMEM low glucose supplemented with N2 supplement, 1X penicillin/streptomycin, Noggin (50 ng/ml), EGF (50 ng/ml), GSiXXI (1 uM), Alk5i (10 uM), and T3 (1 uM). Medium was changed every other day for 4 days. Clusters were collected and treated with glucose (up to 8 mM), 0.5% human serum albumin, 0.5X insulin-transferrin-selenium supplement, 1X N2 supplement, 1X penicillin/streptomycin, betacellulin (20 ng/ml), retinoic acid (100 nM), Alk5i ( 10 uM), and resuspended in DMEM low glucose supplemented with T3 (1 uM). Medium was changed every other day for 4 days. Collect clusters and add glucose (up to 8 mM), 0.5% human serum albumin, 0.5X insulin-transferrin-selenium supplement, 1X N2 supplement, 1X penicillin/streptomycin, 1X Glutamax (Life Technology), nicotinamide (10 mM]) BMP4 ( 10ng/ml), Alk5i (10uM), and T3 (1uM) Resuspended in 1066.</p><p>Cell encapsulation: A cell population consisting of 1,00,000 glucose-sensing insulin-expressing cells per ml in 130 mM NaCl, 10 mM 3-(N-morpholino)propanesulfonic acid (MOPS), pH 7.4. Suspended in a volume of 1.8% cellulose sulfate/0.1% glucomannan to achieve a density of 2 million cells. Transfer the cellulose sulfate/glucomannan/cell mixture to a non-stick surface composed of polyethylene, 1% poly(diallyldimethylammonium chloride) (pDADMAC), 130 mM NaCl, 10 mM 3-(N-morpholino)propanesulfonic acid (MOPS). (pH 7.4) into a stirred solution. Upon contact, cellulose sulfate polymerizes with pDADMAC, forming a membrane around the cells in the form of spherical macrocapsules over 2 mm in diameter. Macrocapsules were collected with a wide mouth pipette and transferred to a solution of pDADMAC, 130 mM NaCl, 10 mM MOPS containing 0.3% poly(methylene coguanidine) (pMCG) (pH 7.4). Collect macrocapsules, 130 mM NaCl, 10 mM Rinse twice with MOPS (pH 7.4). Macrocapsules were collected and mixed with a 1% solution of pDADMAC and stirred for 2 minutes. The macrocapsules were collected and briefly rinsed in distilled water. The macrocapsules were then soaked in a solution of 1.8% cellulose sulfate/0.1% glucomannan in 130 mM NaCl, 10 mM MOPS (pH 7.4) for 2 minutes. Macrocapsules were collected and transferred into a solution of 130 mM NaCl, 10 mM MOPS, and 0.3% poly(methylene coguanidine) (pMCG) (pH 7.4). Finally, rinse the macrocapsules four times in a solution of 130 mM NaCl, 10 mM MOPS (pH 7.4) and transfer to culture medium at 37 °C and 6% CO.₂was incubated in a humidified incubator.</p><p>This process resulted in the formation of macrocapsules composed of an inner membrane containing insulin-expressing cells and an outer membrane closely associated with the inner membrane (FIG. 1A). A membrane formed with glucomannan limits the accumulation of host cells on the surface, thereby inhibiting fibrosis (Fig. 1).</p><p>In another example, a cell population composed of over 1,000,000 glucose-sensing insulin-expressing cells was treated with 130 mM NaCl, 10 mM 3-(N-morpholino)propanesulfonic acid to achieve a density of 2 million cells per ml. Suspended in a volume of 2% sodium alginate in (MOPS), pH 7.4. The alginate/cell mixture was transferred to a 1 mm inner diameter syringe and dispensed into a bath of 20 mM BaCl, 10 mM MOPS, 100 mM mannitol (pH 7.4) to create hydrogels in the form of cylindrical tubes. Tubular macrocapsules were collected with a wide mouth pipette and rinsed twice with 130 mM NaCl, 10 mM MOPS (pH 7.4). Macrocapsules were collected and mixed with a 1% solution of pDADMAC and stirred for 2 minutes. Macrocapsules were collected and briefly rinsed in distilled water. The macrocapsules were then soaked in a solution of 1.8% cellulose sulfate/0.1% glucomannan sulfate in 130 mM NaCl, 10 mM MOPS (pH 7.4) for 2 minutes. Finally, the macrocapsules were placed in 130mM NaCl, 10mM Rinse four times in a solution of MOPS (pH 7.4) and transfer to culture medium at 37 °C and 6% CO.₂were incubated in a humidified incubator (FIGS. 1 and 2).</p><p>capsule permeability. Macrocapsule permeability was determined by incubating for 1 hour in the presence of FITC-conjugated dextran polymers of defined molecular weight. After 1 hour, the dextran solution was rinsed from the outside of the macrocapsules. FITC-dextran that was able to passively diffuse across the capsule membrane remains inside the capsule during rinsing and fluoresces. Bilayer macrocapsules formed from cellulose sulfate without glucomannan were not permeable to 20 kDa dextran. Bilayer macrocapsules formed from a mixture of cellulose sulfate and glucomannan were permeable to 20 kDa FITC-dextran, but not to 70 kDa dextran (Figure 3).</p><p>Rat model of insulin-dependent diabetes: immunocompetent Sprague-Dawley rats at least 8 weeks old and weighing at least 200 g were fasted for 2-6 hours and given 60-65 mg/kg streptozotocin intravenously into the tail vein. bottom. Animals were considered diabetic if they demonstrated non-fasting glucose levels &gt;300 mg/dl for 3 consecutive days. Glucose levels stabilized after hyperglycemia was confirmed by subcutaneous implantation of insulin slow-release pellets (Linplant; Linshin, Scarborough, Canada). Glucose was monitored by collecting a drop of blood via tail puncture or lateral saphenous vein and applied to a portable glucose meter.</p><p>Implantation of capsules/cells into rats. A midline abdominal skin incision was made in the upper abdomen. The abdominal wall was tented and a sharp incision was made in the midline of the rectus abdominis muscle. The abdomen was accessed and the omentum was isolated and exteriorized. A spherical macrocapsule was placed between two thin sheets of Gelfoam and placed in the center of the mesh. The corners of the isolated portion of the omentum were folded over the graft to create a pouch and then sutured closed. The omental sac was placed back into the abdominal cavity and surgical staples were used to suture the abdominal incision followed by the skin.</p><p>Implantation of non-spherical tubular capsules into rat peritoneum. An abdominal incision was made through the dermis and abdominal wall. A tubular macrocapsule was introduced into a wide-mouthed pipette. A pipette was introduced into the peritoneal cavity and the macrocapsules were slowly expelled. The abdominal wall and dermis were closed with sutures.</p><p>Implantation of non-spherical tubular capsules fixed in rat omentum. An abdominal incision was made through the dermis and abdominal wall. A part of the net was taken out of the body. A piece of surgical mesh attached to the macrocapsules was placed on the mesh. The mesh was connected to the web by sutures. The tube-shaped macrocapsules and the extracorporeal omentum portion were put back into the peritoneum. The abdominal wall and dermis were closed with sutures.</p><p>Regulation of blood glucose: Immunocompetent rats made diabetic by treatment with streptozotocin restored normoglycemia after omental implantation of macrocapsules containing insulin-expressing cells (Fig. 4).</p><p>Macrocapsule explants: Rats were euthanized by sedation with ketamine followed by intracardiac injection of potassium chloride. The omental sac containing the macrocapsules was excised. Alternatively, the attachment of cylindrical macrocapsules to the mesh was cut with scissors to remove the macrocapsules. Explant morphology and evidence of angiogenesis were photographed (Figure 6). Explants were rinsed in PBS and stained for live and dead cells using the Live/Dead Cell Staining Kit (Biovision) according to the manufacturer's instructions (Figure 7). Explanted macrocapsules were preserved in 4% formalin. Macrocapsules were embedded in optimal cutting temperature compound (OCT), frozen, and sectioned with a cryotome at 10 um thickness. Sections were applied to microscope slides and stained for insulin and collagen 1 expression using standard immunohistochemical techniques. Macrocapsules showed only a thin membrane adhered to the surface of the macrocapsules (Fig. 8A). The macrocapsules contained clusters of viable insulin-expressing cells (Fig. 8B; see also Fig. 5).</p><p>[Example 2]</p><p>Treatment of Diabetes with Disclosed Encapsulated Cells This example illustrates a method of treating type I diabetes in adult humans using the macroencapsulated cells described herein.</p><p>An adult human subject with insulin-dependent diabetes mellitus receives a graft containing a therapeutically effective amount of a composition comprising the disclosed macroencapsulated pancreatic islet cells in the omental sac fixed to the omentum of the subject or into the peritoneal cavity. Subjects are evaluated for blood glucose levels. Subjects are monitored after implantation of a therapeutically effective number of macroencapsulated cells to ensure that the subject's blood glucose levels are stable. Subjects are further screened over time for glycosylated hemoglobin and diabetes comorbidities.</p><p>The present invention includes, for example, the following aspects.</p><p>[Item 1]</p><p>A composition comprising macrocapsules containing a plurality of therapeutic cells, wherein the macrocapsules comprise at least one barrier, the barrier comprising (a) cellulose sulfate and glucomannan or glucomannan sulfate, or (b) alginic acid. A composition comprising sodium.</p><p>[Section 2]</p><p>The composition of paragraph 1, wherein the therapeutic cells are insulin-producing cells.</p><p>[Item 3]</p><p>3. The composition of paragraph 1 or 2, further comprising a second barrier.</p><p>[Item 4]</p><p>4. The composition of paragraph 3, wherein the second barrier comprises cellulose sulfate and glucomannan or glucomannan sulfate.</p><p>[Item 5]</p><p>4. The composition of paragraph 3, wherein the second barrier does not comprise glucomannan or glucomannan sulfate.</p><p>[Section 6]</p><p>Item 6. The composition according to any one of Items 1 to 5, wherein the diameter of the macrocapsules is at least 1.5 mm.</p><p>[Clause 7]</p><p>Item 7. The composition according to any one of Items 1 to 6, wherein the macrocapsules have a diameter of at least 2.0 mm.</p><p>[Clause 8]</p><p>Sodium alginate contains the divalent cation barium (BaCl₂) or calcium (CaCl₂), and the composition according to any one of Items 1 to 7.</p><p>[Clause 9]</p><p>Item 8. The composition according to any one of Items 1 to 7, wherein cellulose sulfate is polymerized with poly(diallyldimethylammonium chloride) (pDADMAC).</p><p>[Clause 10]</p><p>10. The composition of paragraph 9, wherein the macrocapsules were washed with polymethylene-co-guanidine (PMCG) after polymerization with pDADMAC.</p><p>[Clause 11]</p><p>11. The composition of any one of items 1-10, wherein the macrocapsules are at least about 11 cm long.</p><p>[Clause 12]</p><p>Item 12. The composition according to any one of Items 1 to 11, wherein the macrocapsules contain at least about 50,000 cells per cm.</p><p>[Clause 13]</p><p>Item 13. The composition according to any one of Items 1 to 12, wherein the macrocapsules are cylindrical.</p><p>[Clause 14]</p><p>A composition comprising a macrocapsule containing a plurality of therapeutic cells, the macrocapsule comprising at least a first barrier and a second barrier, the first barrier contained within the second barrier, has a diameter of at least 1.5 mm.</p><p>[Clause 15]</p><p>15. The composition of paragraph 14, wherein the macrocapsules have a diameter of at least 2.0 mm.</p><p>[Clause 16]</p><p>Item 16. The composition of Item 14 or 15, wherein the therapeutic cells are insulin-producing cells.</p><p>[Clause 17]</p><p>17. The composition according to any one of Items 14 to 16, wherein the second barrier comprises cellulose sulfate and glucomannan or glucomannan sulfate.</p><p>[Clause 18]</p><p>18. The composition of any one of Items 14-17, wherein both the first and second barriers comprise cellulose sulfate and glucomannan sulfate.</p><p>[Clause 19]</p><p>19. The composition of paragraphs 17 or 18, wherein the cellulose sulfate is polymerized with pDADMAC.</p><p>[Section 20]</p><p>20. The composition of paragraph 19, wherein the macrocapsules are washed with PMCG after polymerization with pDADMAC.</p><p>[Section 21]</p><p>17. The composition according to any one of Items 14 to 16, wherein the second barrier does not contain glucomannan or glucomannan sulfate.</p><p>[Section 22]</p><p>18. The composition of any one of Items 14-17, wherein the first barrier comprises sodium alginate.</p><p>[Section 23]</p><p>Sodium alginate is the divalent cation barium (BaCl₂) or calcium (CaCl₂23. The composition of paragraph 22, which is polymerized with ).</p><p>[Section 24]</p><p>24. The composition of any one of paragraphs 14-23, wherein the macrocapsules are at least about 11 cm long.</p><p>[Section 25]</p><p>25. The composition of any one of Items 14-24, wherein the macrocapsules contain at least about 50,000 cells per cm.</p><p>[Section 26]</p><p>Item 26. The composition according to any one of Items 14 to 25, wherein the macrocapsules are cylindrical.</p><p>[Section 27]</p><p>A composition comprising macrocapsules containing a plurality of therapeutic cells, wherein the macrocapsules comprise a cylindrical shape and a diameter of at least 1.5 mm.</p><p>[Section 28]</p><p>28. The composition of paragraph 27, wherein the macrocapsules comprise at least a first barrier and a second barrier, the first barrier being contained within the second barrier.</p><p>[Section 29]</p><p>30. The composition of paragraph 28, wherein the first barrier comprises (a) cellulose sulfate and glucomannan or glucomannan sulfate, or (b) sodium alginate.</p><p>30. The composition of paragraphs 28 or 29, wherein the second barrier comprises cellulose sulfate and glucomannan or glucomannan sulfate.</p><p>[Section 31]</p><p>31. The composition of any one of Items 27-30, wherein the therapeutic cells are insulin-producing cells.</p><p>[Section 32]</p><p>32. The composition of any one of paragraphs 27-31, wherein the macrocapsules are at least about 11 cm long.</p><p>[Section 33]</p><p>33. The composition of any one of paragraphs 27-32, wherein the macrocapsules contain at least about 50,000 cells per cm.</p><p>[Section 34]</p><p>A method of forming a non-adherent macrocapsule containing a plurality of therapeutic cells comprising: a. encapsulating the plurality of therapeutic cells in a barrier comprising cellulose sulfate polymerized with pDADMAC; b. A method comprising washing with PMCG, wherein the PMCG coats the barrier by binding to the unbound sulfate groups of the cellulose sulfate, forming non-adhesive macrocapsules.</p><p>[Section 35]</p><p>further comprising encapsulating the non-adhesive macrocapsules in a second barrier comprising cellulose sulfate polymerized with pDADMAC; 35. The method of Paragraph 34, wherein the barrier is coated by binding groups to form a double-barrier, non-adhesive macrocapsule.</p><p>[Section 36]</p><p>A method of treating diabetes in a subject in need thereof comprising implanting a composition comprising macrocapsules containing therapeutic cells into a subject with diabetes, wherein the macrocapsules are at least a first barrier and a second barrier, wherein the first barrier is contained within the second barrier and the macrocapsules have a diameter of at least 1.5 mm.</p><p>[Section 37]</p><p>37. The method of Paragraph 36, wherein the subject is an adult.</p><p>[Section 38]</p><p>37. The method of Paragraph 36, wherein the subject is a child.</p><p>[Section 39]</p><p>39. The method of any one of paragraphs 36-38, wherein the subject has type I diabetes.</p><p>[Section 40]</p><p>39. The method of any one of paragraphs 36-38, wherein the subject has type II diabetes.</p><p>[Section 41]</p><p>37. The method of Paragraph 36, wherein the therapeutic cells are insulin-producing cells.</p><p>[Section 42]</p><p>42. The method of any one of Items 36-41, wherein the second barrier comprises cellulose sulfate and glucomannan or glucomannan sulfate.</p><p>[Section 43]</p><p>43. The method of any one of paragraphs 36-42, wherein both the first and second barriers comprise cellulose sulfate and glucomannan or glucomannan sulfate.</p><p>[Section 44]</p><p>42. The method of any one of paragraphs 36-41, wherein the second barrier does not comprise glucomannan or glucomannan sulfate.</p><p>[Section 45]</p><p>45. The method of Paragraph 44, wherein the composition further comprises a glucomannan gel.</p><p>[Section 46]</p><p>42. The method of any one of paragraphs 36-41, wherein the first barrier comprises sodium alginate.</p><p>[Section 47]</p><p>Item 46. The method of any one of Items 36 to 45, wherein the composition is implanted into the omentum or peritoneal cavity of the subject.</p><p>[Section 48]</p><p>32. The composition of any one of paragraphs 1-31 for use in treating diabetes in a subject in need thereof.</p><p>[Section 49]</p><p>Item 32. Use of the composition according to any one of Items 1 to 31 in the manufacture of a medicament for treating diabetes.</p>