Endoscopic Islet Autotransplantation Into Gastric Submucosa—1000-Day Follow-up of Patients

Wszoła, Michał; Berman, Andrzej; Górski, Łukasz; Ostaszewska, Agata; Serwańska-Świętek, Marta; Krajewska, Monika; Lipińska, Anna; Chmura, A.; Kwiatkowski, A.

doi:10.1016/j.transproceed.2018.02.138

Cited by 16 publications

(5 citation statements)

References 14 publications

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“…Currently, the liver is the preferred location for clinical Allo Beta Cell Transplantation, despite recent suggestions of alternative implantation sites that might be more advantageous for graft survival (173)(174)(175)(176)(177)(178)(179)(180)(181). The intrahepatic site offers benefits: it is a well-established procedure accepted by regulatory agencies and associated with minimal morbidity and a negligible risk of adverse events, such as bleeding and portal thrombosis.…”

Section: The Influence Of Liver Site and Its Significance In The Cont...mentioning

confidence: 99%

Allo Beta Cell transplantation: specific features, unanswered questions, and immunological challenge

Caldara,

Tomajer,

Monti

et al. 2023

Front. Immunol.

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Type 1 diabetes (T1D) presents a persistent medical challenge, demanding innovative strategies for sustained glycemic control and enhanced patient well-being. Beta cells are specialized cells in the pancreas that produce insulin, a hormone that regulates blood sugar levels. When beta cells are damaged or destroyed, insulin production decreases, which leads to T1D. Allo Beta Cell Transplantation has emerged as a promising therapeutic avenue, with the goal of reinstating glucose regulation and insulin production in T1D patients. However, the path to success in this approach is fraught with complex immunological hurdles that demand rigorous exploration and resolution for enduring therapeutic efficacy. This exploration focuses on the distinct immunological characteristics inherent to Allo Beta Cell Transplantation. An understanding of these unique challenges is pivotal for the development of effective therapeutic interventions. The critical role of glucose regulation and insulin in immune activation is emphasized, with an emphasis on the intricate interplay between beta cells and immune cells. The transplantation site, particularly the liver, is examined in depth, highlighting its relevance in the context of complex immunological issues. Scrutiny extends to recipient and donor matching, including the utilization of multiple islet donors, while also considering the potential risk of autoimmune recurrence. Moreover, unanswered questions and persistent gaps in knowledge within the field are identified. These include the absence of robust evidence supporting immunosuppression treatments, the need for reliable methods to assess rejection and treatment protocols, the lack of validated biomarkers for monitoring beta cell loss, and the imperative need for improved beta cell imaging techniques. In addition, attention is drawn to emerging directions and transformative strategies in the field. This encompasses alternative immunosuppressive regimens and calcineurin-free immunoprotocols, as well as a reevaluation of induction therapy and recipient preconditioning methods. Innovative approaches targeting autoimmune recurrence, such as CAR Tregs and TCR Tregs, are explored, along with the potential of stem stealth cells, tissue engineering, and encapsulation to overcome the risk of graft rejection. In summary, this review provides a comprehensive overview of the inherent immunological obstacles associated with Allo Beta Cell Transplantation. It offers valuable insights into emerging strategies and directions that hold great promise for advancing the field and ultimately improving outcomes for individuals living with diabetes.

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Section: The Influence Of Liver Site and Its Significance In The Cont...mentioning

confidence: 99%

Allo Beta Cell transplantation: specific features, unanswered questions, and immunological challenge

Caldara,

Tomajer,

Monti

et al. 2023

Front. Immunol.

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“…Another difficulty is an instant blood-mediated reaction observed after transplantation into a portal vein which diminishes the number of living islets. Developing new implementation sites, such as gastric submucosa [ 37 , 38 , 39 ], led to some improvement but could not solve a problem. There is a need to develop a technique as efficient as pancreas transplantation but with a complication rate close to the CITx procedure, thus to produce an organ with extracellular matrix and vasculature around islets, but one which is not complicated like in the native pancreas.…”

Section: Available Treatments For Patients With Type 1 Diabetesmentioning

confidence: 99%

Section: Available Treatments For Patients With Type 1 Diabetesmentioning

confidence: 99%

Stem Cells as a Source of Pancreatic Cells for Production of 3D Bioprinted Bionic Pancreas in the Treatment of Type 1 Diabetes

Wszoła¹,

Nitarska²,

Cywoniuk³

et al. 2021

Cells

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Type 1 diabetes (T1D) is the third most common autoimmune disease which develops due to genetic and environmental risk factors. Often, intensive insulin therapy is insufficient, and patients require a pancreas or pancreatic islets transplant. However, both solutions are associated with many possible complications, including graft rejection. The best approach seems to be a donor-independent T1D treatment strategy based on human stem cells cultured in vitro and differentiated into insulin and glucagon-producing cells (β and α cells, respectively). Both types of cells can then be incorporated into the bio-ink used for 3D printing of the bionic pancreas, which can be transplanted into T1D patients to restore glucose homeostasis. The aim of this review is to summarize current knowledge about stem cells sources and their transformation into key pancreatic cells. Last, but not least, we comment on possible solutions of post-transplant immune response triggered stem cell-derived pancreatic cells and their potential control mechanisms.

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“…62 Two initial procedures were performed in 2013 and 2014 to endoscopically implant autologous islet cells into the gastric mucosa; after three-year followup, both patients had improved C peptide from 0.1 ng/mL to 3.0 and 0.6 ng/mL with improvement in pain from chronic pancreatitis. 63 A third patient from the same Polish research group received an endoscopic islet transplant after failed pancreas transplant and due to persistent portal hypertension making the portal vein a dangerous site. After four-year followup, her insulin requirements decreased from 60 to 27 U/day, showing promise for the safety and efficacy of the gastric wall as a site for transplantation.…”

Section: Bowel Wallmentioning

confidence: 99%

Considerations for an Alternative Site of Islet Cell Transplantation

Addison

Fatakhova

Rilo

2019

J Diabetes Sci Technol

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Islet cell transplantation has been limited most by poor graft survival. Optimizing the site of transplantation could improve clinical outcomes by minimizing required donor cells, increasing graft integration, and simplifying the transplantation and monitoring process. In this article, we review the history and significant human and animal data for clinically relevant sites, including the liver, spleen, and kidney subcapsule, and identify promising new sites for further research. While the liver was the first studied site and has been used the most in clinical practice, the majority of transplanted islets become necrotic. We review the potential causes for graft death, including the instant blood-mediated inflammatory reaction, exposure to immunosuppressive agents, and low oxygen tension. Significant research exists on alternative sites for islet cell transplantation, suggesting a promising future for patients undergoing pancreatectomy.

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Endoscopic Islet Autotransplantation Into Gastric Submucosa—1000-Day Follow-up of Patients

Cited by 16 publications

References 14 publications

Allo Beta Cell transplantation: specific features, unanswered questions, and immunological challenge

Allo Beta Cell transplantation: specific features, unanswered questions, and immunological challenge

Stem Cells as a Source of Pancreatic Cells for Production of 3D Bioprinted Bionic Pancreas in the Treatment of Type 1 Diabetes

Considerations for an Alternative Site of Islet Cell Transplantation

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