Current status of islet cell transplantation

Abstract

Despite substantial advances in islet isolation methods and immunosuppressive protocol, pancreatic islet cell transplantation remains an experimental procedure currently limited to the most severe cases of type 1 diabetes mellitus (T1DM). The objectives of this treatment are to prevent severe hypoglycemic episodes in patients with hypoglycemia unawareness, and to achieve a more physiological metabolic control. Insulin independence and long term-graft function with improvement of quality of life have been obtained in several international islet transplant centers. However, experimental trials of islet transplantation clearly highlighted several obstacles that remain to be overcome before the procedure could be proposed to a much larger patient population. This review provides a brief historical perspective of islet transplantation, islet isolation techniques, the transplant procedure, immunosuppressive therapy, and outlines current challenges and future directions in clinical islet transplantation.

β-cell transplantation in diabetes mellitus

“…Пересадка цельного органа поджелудочной же-лезы является очень эффективным способом в дости-жении и поддержании длительного физиологического контроля уровня глюкозы в крови. Однако вследствие различных рисков, связанных с выполнением хирурги-ческого вмешательства, данный метод довольно редко используется для лечения СД [5]. В отличие от этого пересадка островков поджелудочной железы требует минимального инвазивного хирургического вмешатель-ства, поскольку она проводится в рамках чрескожного вмешательства под рентгенологическим контролем и за-ключается во введении препарата, содержащего остров-ковые клетки, в печень реципиента через воротную вену [6].…”

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“…Candidates for islet cell transplant are patients with unstable type 1 diabetes mellitus, who have a history of severe hypoglycemia unawareness, despite attempts to correct the condition by meticulous medical treatment. 5 The first report of an islet transplant was reported by Dr. in that initial attempt. 6 Protocols improved slowly during the 1990s, until 1999, when Shapiro and associates reported insulin independence in 7 out of 7 consecutive type 1 diabetes mellitus patients treated with an islet transplant using a glucocorticoid-free immunosuppressive regimen.…”

“…3 In contrast, islet transplanting does not require any significant surgery or general anesthesia. 5 In this article, we briefly describe our experience in islet cell isolation at the Shiraz University of Medical Sciences in Shiraz, Iran.…”

Correction of Hyperglycemia in Type 1 Diabetic Models by Transplantation of Encapsulated Insulin-producing Cells Derived from Mouse Embryo Progenitor

“…Islet or pancreas transplantation is a promising approach to treat type 1 diabetes (Shapiro et al 2000, Halban 2004, Vaithilingam et al 2008, Ichii & Ricordi 2009). However, the limited supply of cadaveric pancreata and the need for longterm immunosuppression have limited the use of this approach.…”