Transplant strategies for type 1 diabetes: whole pancreas, islet and porcine beta cell therapies

Abstract

Whole-organ pancreas and islet transplantations are performed in a highly selected group of patients with diabetes mellitus, primarily those with type 1 diabetes mellitus, complicated by recurrent severe hypoglycaemia or renal failure requiring kidney transplantation. Clinical accessibility to pancreases or islets, and patient characteristics and therapeutic goals, may dictate choice of procedure. Pancreas transplantation is most often performed simultaneous with a kidney transplant, but patients with particularly labile type 1 diabetes may be considered for a pancreas transplant alone. While highly successful at restoring insulin independence, pancreas transplants carry the significant risks of major surgery and immunosuppression. Islet transplantation is a relatively minor procedure, usually performed for labile type 1 diabetes with severe hypoglycaemia. It is highly successful at resolving hypoglycaemia, but more than one pancreas donor may be required for insulin independence. Both pancreas and islet transplantation are limited in applicability by a paucity of deceased donors. Pigs provide one promising replenishable source of islets. Porcine islets can successfully reverse diabetes mellitus in non-human primates under the appropriate immunosuppressive conditions, with promise for eventually translating this success to a larger population of patients with diabetes mellitus in the future.

Magnetic Resonance Imaging of Transplanted Porcine Neonatal Pancreatic Cell Clusters Labeled with Chitosan-Coated Superparamagnetic Iron Oxide Nanoparticles in Mice

“…However, most successful cases need two or more transplants [1][2][3]. To solve the problem of limited pancreas donors, several alternative β-cell sources are currently being explored, particularly xenogeneic islets and pluripotent stem cells [4,5]. Pigs are promising replenishable source of islets.…”

Current treatment options and challenges in patients with Type 1 diabetes: Pharmacological, technical advances and future perspectives

“…New immunosuppressant agents have improved organ survival with a 5 years organ survival rate between 55 and 70%. The survival rate is increased when the pancreas is transplanted simultaneously to the kidney [150]. However, surgical intervention and immunosuppression effects, limit this option to a relatively small number of subjects.…”

The Feasibility and Applicability of Stem Cell Therapy for the Cure of Type 1 Diabetes

“…Islet transplantation reportedly reduced hypoglycaemic events and improved glycaemic control in T1D patients, compared with insulin injection therapy [ 8 ]. Islet transplantation has a lower risk of surgical complications than pancreas transplantation, but repeated transplantations are often required to enable withdrawal from insulin therapy [ 9 ]. Thus, the transplantation of both pancreas and islets has problems associated with donor shortage, immunosuppressive therapy, and graft rejection.…”