Islet cell transplantation for Type 1 diabetes

Abstract

Islet transplantation is an attractive concept for the treatment of Type 1 diabetes because of its potential high efficacy and minimal invasion to patients. The treatment may effectively control blood glucose for brittle Type 1 diabetes, resulting in a marked reduction in hypoglycemic episodes and improvements in HbA1c. In addition, approximately 70% of transplanted Type 1 diabetic patients have achieved insulin independence. However, there are still important issues to be addressed before this treatment is widely applicable, including difficulty in maintaining insulin independence, low islet isolation success rate, multiple donor requirements, and side effects associated with the use of immunosuppressants. Donor shortage is another dilemma. To address the issue of donor shortage, living donor islet transplantation and bioartificial islet transplantation using pig islets are being evaluated. Bioartificial islet transplantation could be the ultimate solution of the donor shortage. Currently, overcoming immunological hurdles, establishing reliable islet isolation methods, and controlling porcine endogenous retrovirus are the primary obstacles to the implementation of this treatment. If bioartificial islet transplant becomes a clinical reality, it may even be applicable in the treatment of select Type 2 diabetic patients. β‐Cell regeneration from naïve pancreas and β‐cell generation from embryonic stem cells or induced pluripotent stem cells are the next‐generation treatments for Type 1 diabetes.

Improving Efficacy of Clinical Islet Transplantation with Iodixanol-Based Islet Purification, Thymoglobulin Induction, and Blockage of IL-1β and TNF-α

“…A SUITO index value indices of all three patients were more than 26.0 after greater than 10 is associated with reduced insulin rethe second islet infusion in the first protocol. quirement with excellent glycemic control (13) and There was no significant difference of period for ingreater than 26 is associated with insulin independence sulin free after final islet infusion between the two pro- (12,18). tocols (Table 3).…”

“…The SUITO indices of all three patients cretory unit of islet transplant objects (SUITO) index were more than 26.0 at 1 month posttransplantation with was calculated during the first month after islet transthe second protocol. One month after a second islet infuplantation (12,13,18). The formula of the SUITO index sion using the first protocol, patients achieved an averis: [fasting C-peptide (ng/ml)]/[fasting glucose (mg/dl) − age SUITO value similar to the SUITO index value at 1 63] × 1500 (12,18).…”

“…One month after a second islet infuplantation (12,13,18). The formula of the SUITO index sion using the first protocol, patients achieved an averis: [fasting C-peptide (ng/ml)]/[fasting glucose (mg/dl) − age SUITO value similar to the SUITO index value at 1 63] × 1500 (12,18). The SUITO index reflects the funcmonth reached by patients who received a single islet tional islet mass; the SUITO index for normal healthy infusion with the second protocol ( Table 3).…”

“…The SUITO index reflects the funcmonth reached by patients who received a single islet tional islet mass; the SUITO index for normal healthy infusion with the second protocol ( Table 3). The SUITO people is set at 100 (12,18). A SUITO index value indices of all three patients were more than 26.0 after greater than 10 is associated with reduced insulin rethe second islet infusion in the first protocol.…”

“…Recently, we demonstrated that pancreatic ductal preservation significantly improved our success Islet transplantation is a promising treatment for type 1 diabetic patients; however, several issues need to be rate in clinical islet isolation; however, two islet transplantations were still necessary to achieve insulin inderesolved (12,24,25). Poor islet efficacy is one of the clinical issues of islet transplantation (11).…”