CASE REPORT Ultra-marathon 100 km in an islet-transplanted runner Roberto Codella 1,2 • Michela Adamo 1,2 • Paola Maffi 3 • Lorenzo Piemonti 4 • Antonio Secchi 3 • Livio Luzi 1,2 Received: 17 September 2016 / Accepted: 28 October 2016 Ó Springer-Verlag Italia 2016 Keywords Islet transplantation Á Ultra-marathon Abbreviations AIR Acute insulin response CGM Continuous glucose monitoring GAD Glutamic acid decarboxylase HbA1c Glycosylated hemoglobin HR Heart rate IA2 Tyrosine phosphatase-related islet antigen 2 IT Islet transplantation LMR Lymphocyte-to-monocyte ratio NLR Neutrophil-to-lymphocyte ratio PLR Platelet-to-lymphocyte ratio T1D Type 1 diabetes mellitus ZnT8 Zinc transporter 8 Introduction Following pancreatic islet transplantation (IT), the major barriers to the long-term insulin independence of type 1 dia- betic patients are the progressive deterioration of b-cell function and the need for immunosuppressive therapy. Within this context, we found favorable effects for physical exercise in several studies [1]. In particular, we monitored metabolic, autoimmune, and inflammatory profiles of an islet-trans- planted marathon runner (10-year transplanted) during his training and participation in a variety of ultra-endurance events. The subject raced in a competitive 100-km ultra- marathon, a 50-km marathon and a half-marathon in less than 70 days. He had a weekly average training volume of 75 km. With respect to the time preceding and following the intense endurance efforts, the hematochemical parameters of the competitive period showed an adequate glycemic control (HbA1c) and unchanged antibody titer (anti-GAD, anti-IA2, anti-ZnT8) despite systemic inflammation (Table 1). The extraordinary aerobic activity was compat- ible with the treatment of this transplanted diabetic patient. Case presentation A 48-year-old Caucasian man (172 cm, 69 kg) with type 1 diabetes mellitus (T1D) for 40 years was considered. In October 2005, he received two b-pancreatic islet infusions (total: 7300 EIQ/kgBW) at San Raffaele Scientific Institute (Milan, Italy). Four weeks before the first islet infusion, he underwent a clinical protocol (ClinicalTrial.gov NCT01060605) in which rapamycin was administered as monotherapy (0.1 mg/kg; therapeutic range 8–10 ng/mL). At the time of islet infusion, the patient received the Edmonton protocol immunosuppression, including anti Managed by Massimo Federici. & Livio Luzi livio.luzi@unimi.it 1 Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, Universita ` degli Studi di Milano, Piazza Edmondo Malan 1, 20097 San Donato Milanese, Milan, Italy 2 Metabolism Research Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy 3 Department of Internal Medicine, Transplant Medicine Unit, San Raffaele Scientific Institute, Milan, Italy 4 Diabetes Research Institute (Sr-DRI), San Raffaele Scientific Institute, Milan, Italy 123 Acta Diabetol DOI 10.1007/s00592-016-0938-x