Current state and future evolution of pancreatic islet transplantation

Abstract

Pancreatic islet transplantation provides an effective treatment option for patients with type 1 diabetes (T1D) with intractable impaired awareness of hypoglycemia and severe hypoglycemic events. Currently, the primary goal of islet transplantation should be excellent glycemic control without severe hypoglycemia, rather than insulin independence. Islet transplant recipients were less likely to achieve insulin independence, whereas solid pancreas transplant recipients substantially had greater procedure‐related morbidity. Excellent therapeutic effects of islet transplantation as a result of accurate blood glucose level–reactive insulin secretion, which cannot be reproduced by current drug therapy, have been confirmed. Recent improvement of islet transplantation outcome has been achieved by refinement of the pancreatic islet isolation technique, improvement of islet engraftment method, and introduction of effective immunosuppressive therapy. A disadvantage of islet transplantation is that donors are essential, and donor shortage has become a hindrance to its development. With the development of alternative transplantation sites and new cell sources, including porcine islet cells and embryonic stem/induced pluripotent stem (ES/iPS)‐derived β cells, “On‐demand” and “Unlimited” cell therapy for T1D can be established.

Donor-Specific Regulatory T Cell-Mediated Immune Tolerance in an Intrahepatic Murine Allogeneic Islet Transplantation Model with Short-Term Anti-CD154 mAb Single Treatment

“…Allogeneic islet transplantation is a promising therapy for patients with type I diabetes 1 – 3 . To date, more than 1,500 patients have undergone β-cell replacement therapy at 40 different international centers, and 50% to 70% of them have shown insulin independence at 5 yr 4 .…”

Bioengineering a pre-vascularized pouch for subsequent islet transplantation using VEGF-loaded polylactide capsules

“…The replacement of failed cells by transplantation is one of the most promising approaches that have been already tested and applied in clinical practice. Over the last several decades the transplantations of parathyroid glands, 1 thyroid gland, 2 adrenal cells, 3 thymus 4 and pancreatic islets 5 have been introduced and tested under experimental and clinical conditions. In addition, cellular transplantation can be theoretically used for the therapy of haemophilia, liver failure, Parkinson's disease, transversal spinal cord injuries and others.…”

Pancreatic Islet Transplantation: State of the Art and Future Perspectives

“…Currently IT is made by transportal infusion [2][3][4]. The portal vein can be accessed by percutaneous transhepatic approach by an interventional radiologist or by open surgical technique when the first modality is not possible either for anatomical limitations of the liver (angiomas or intrahepatic vascular anomalies) or lack of experienced radiologists [2][3][4]. Although standardized intraportal IT harbour some risk as post-procedure bleeding, portal thrombosis, mild transaminase elevation, biliary tree lesion [2][3][4].…”

“…Human pancreatic islet transplantation (IT) became an effective therapy in selected patients with type 1 diabetes (T1D) [1][2][3][4]. Usually this procedure is reserved to those who present unstable T1D with impaired awareness of hypoglycaemia (IAH), severe hypoglycaemic episodes (SHE) and glycemic lability which cannot be controlled by current medical treatment [2][3][4][5][6][7][8][9][10][11][12][13]. Nevertheless, insulin independence was present after 1 year in less than 10% of all patients treated between 1980 and 1999 [2][3][4][5].…”

“…Usually this procedure is reserved to those who present unstable T1D with impaired awareness of hypoglycaemia (IAH), severe hypoglycaemic episodes (SHE) and glycemic lability which cannot be controlled by current medical treatment [2][3][4][5][6][7][8][9][10][11][12][13]. Nevertheless, insulin independence was present after 1 year in less than 10% of all patients treated between 1980 and 1999 [2][3][4][5]. Since the introduction of the Edmonton protocol in 2000 it improved to 44% from 2007 to 2010 [5,14,15].…”