Autologous islet transplantation

Dunn, Ty B.; Wilhelm, Joshua J.; Bellin, Melena D.; Pruett, Timothy L.

doi:10.1097/mot.0000000000000438

Cited by 11 publications

(12 citation statements)

References 95 publications

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“…The goals of TPAIT are relief from pain, insulin independence, and improved QOL . The total pancreatectomy portion of TPAIT involves the complete resection of the diseased pancreas in an attempt to resolve the associated pain .…”

Section: Robot‐assisted Tpaitmentioning

confidence: 99%

“…9 Therefore, one of the goals of TPAIT is for the patient to achieve insulin independence, which is associated with an improved QOL. 10 In a singlecenter study of 215 patients who underwent TPAIT, 27% achieved insulin independence within one year after the procedure; however, this percentage decreased to 22.3% within five years after the procedure. 7 Most patients who underwent TPAIT reported a marked decrease in pain.…”

mentioning

confidence: 99%

“…Islet transplantation may eliminate the need for the patient to undergo insulin injections to regulate glycemic levels postoperatively . Therefore, one of the goals of TPAIT is for the patient to achieve insulin independence, which is associated with an improved QOL . In a single‐center study of 215 patients who underwent TPAIT, 27% achieved insulin independence within one year after the procedure; however, this percentage decreased to 22.3% within five years after the procedure .…”

mentioning

confidence: 99%

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Robot‐Assisted Total Pancreatectomy With Autologous Islet Cell Transplantation: Perioperative Nursing Considerations

Williams¹

2020

AORN Journal

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Chronic pancreatitis (CP) is an inflammatory disease of the pancreas that causes pain and gastrointestinal problems in patients. Robot‐assisted total pancreatectomy with autologous islet cell transplantation (TPAIT) is a surgical procedure for treating patients with CP that has been unresponsive to other treatments. After performing a total pancreatectomy, the surgical team isolates islet cells and then infuses them into the patient's liver. To provide the best possible care for patients undergoing TPAIT, perioperative nurses should understand the physiological functions of the pancreas, the etiology of and treatment options for CP, and their role in coordinating care for this patient population. This article discusses the disease process for CP, reasons for choosing the robotic approach to TPAIT, preparation of the OR for the procedure, the role of the RN circulator during a robot‐assisted TPAIT, and nursing management of the patient during the postoperative phase of care.

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Section: Robot‐assisted Tpaitmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Robot‐Assisted Total Pancreatectomy With Autologous Islet Cell Transplantation: Perioperative Nursing Considerations

Williams¹

2020

AORN Journal

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“…In allogeneic islet transplantation, alloantigen presentation to the host immune system triggers immune cell infiltration of the graft tissue, resulting in graft rejection. Observations in independent CP and T1D cohorts suggest that an optimal islet yield (>5000 islet equivalents/kg), islet survival in the peri-transplant period and engraftment, and optimal immunosuppressive regimen are important for achieving post-transplant insulin independence (16,17). Despite the advancements made, short-and long-term graft survival and function remain suboptimal and a challenge to be overcome (18,19).…”

Section: Introductionmentioning

confidence: 99%

Role of Exosomes in Islet Transplantation

et al. 2021

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Exosomes are known for their ability to transport nucleic acid, lipid, and protein molecules, which allows for communication between cells and tissues. The cargo of the exosomes can have a variety of effects on a wide range of targets to mediate biological function. Pancreatic islet transplantation is a minimally invasive cell replacement therapy to prevent or reverse diabetes mellitus and is currently performed in patients with uncontrolled type 1 diabetes or chronic pancreatitis. Exosomes have become a focus in the field of islet transplantation for the study of diagnostic markers of islet cell viability and function. A growing list of miRNAs identified from exosomes collected during the process of isolating islets can be used as diagnostic biomarkers of islet stress and damage, leading to a better understanding of critical steps of the isolation procedure that can be improved to increase islet yield and quality. Exosomes have also been implicated as a possible contributor to islet graft rejection following transplantation, as they carry donor major histocompatibility complex molecules, which are then processed by recipient antigen-presenting cells and sensed by the recipient immune cells. Exosomes may find their way into the therapeutic realm of islet transplantation, as exosomes isolated from mesenchymal stem cells have shown promising results in early studies that have seen increased viability and functionality of isolated and grafted islets in vitro as well as in vivo. With the study of exosomes still in its infancy, continued research on the role of exosomes in islet transplantation will be paramount to understanding beta cell regeneration and improving long-term graft function.

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“…Previous clinical research has shed some light on the underlying challenges. For example, the post-surgery survival and functional output of transplanted islets are compromised by the local inflammation, the unfavorable milieu of the renal capsule where the islets were freely injected into, and so forth [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Enhancing the functional output of transplanted islets in diabetic mice using a drug-eluting scaffold

Zhu

Dong²,

Jinbo³

et al. 2018

J Biol Eng

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BackgroundIslet transplantation is increasingly used in the diabetic patients to control the blood glucose level. However, the functional output of transplanted islets remains hampered due to the local inflammation, loss of islets, etc. To that end, in this study we explored to enhance the functional output of transplanted islets in diabetic mice by employing a drug-eluting scaffold with a payload of interleukin 4 (IL-4).ResultsAccording to the in vitro studies, the scaffold showed no cytotoxicity, a rapid release of IL-4 within a week and the IL-4 retained its bioactivity. During the 4-week time window after the islet transplantation, in vivo studies showed that the levels of blood insulin and C-peptide 2 in diabetic mice in the drug-eluting scaffold group significantly increased since week 2, which effectively reduced the blood glucose level. In addition, these mice demonstrated a stronger capability to withstand a rapid glucose spike as evidenced by the tolerance of sudden oral glucose challenge test result. A further mechanistic study suggested that the enhanced functional output could be attributed to the M2 polarization of macrophages as evidenced by the increase of CD163+/CD68+ macrophages in the islet tissues. A M2 polarization of macrophages is widely believed to exert an anti-inflammatory influence on local tissues, which could accelerate the resolution of local inflammation following the islet transplantation.ConclusionOur study shed a new light on the hyperglycemia management of diabetic patients following the islet transplantation.

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Autologous islet transplantation

Abstract: Improving the rate and durability of insulin independence in the often-times marginal dose model of AUTX may provide new insight toward improving the efficiency and durability of single donor islet (allogeneic islet transplant).

Cited by 11 publications

References 95 publications

Robot‐Assisted Total Pancreatectomy With Autologous Islet Cell Transplantation: Perioperative Nursing Considerations

Robot‐Assisted Total Pancreatectomy With Autologous Islet Cell Transplantation: Perioperative Nursing Considerations

Role of Exosomes in Islet Transplantation

Enhancing the functional output of transplanted islets in diabetic mice using a drug-eluting scaffold

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