Current Status of Pancreatic İslet Transplantation Studies

Year 2017, Volume: 5 Issue: 4, 16 - 20, 10.04.2017

Doç. Dr. Süleyman Hilmi İpekçi

Abstract

Abstract

Type 1 diabetes mellitus is a disease that occurs increasing in frequency around theworld, resulting in the destruction of pancreatic beta-cells. Currently, the treatment oftype 1 diabetes mellitus is multiple insulin injection, but it does not seem possible to getrid of the acute and chronic complications of diabetes because the regimen can not exactlymimic physiological insulin activity. For this reason, beta-cell replacement therapy isbeing studied. Solid pancreas transplantation is an invasive surgical procedure as wellas the need for long-term immunosuppressive treatment and the risk of organ rejection.For this reason, although islet cell transplantation is considered as a more ideal treatment regimen, the difficulties of finding adequate cadaver in applying for both methods, other beta-cell replacement therapy options into consideration. These include xenotransplantation, encapsulation, and stem cell treatments. Each treatment option has its own advantages and disadvantages. The aim of this study is to talk about islet cell transplantation and beta-cell replacement therapy options and to monitor current developments.

Keywords

islet cell transplantation, pancreas transplantation, type 1 diabetes mellitus

Pankreas Adacık Transplantasyonu Çalışmalarındaki Son Durum

Abstract

Öz

Tip 1 diabetes mellitus, sıklığı tüm dünyada giderek artan, pankreas beta-hücrelerinin yıkımı sonucu oluşan bir hastalıktır. Günümüzde tip 1 diyabet yaygın tedavisi çoklu insülin enjeksiyonudur. Ancak bu tedavi rejimi fizyolojik insülin aktivitesini tam olarak taklit edemediğinden diyabetin akut ve kronik komplikasyonlarından korunmak mümkün görünmemektedir. Bu nedenle beta-hücre replasman tedavisi üzerine çalışmalar yapılmaktadır. Solid pankreas transplantasyonu, uzun dönem immünsupresif tedavi gereksinimi ve organ rejeksiyon riskinin yanı sıra invaziv bir cerrahi girişimdir. Bu nedenle adacık hücre nakli daha ideal bir tedavi rejimi olarak düşünülse de iki yöntemde de yeterli kadavra bulmaktaki güçlükler diğer beta-hücre replasman tedavi seçeneklerini gündeme getirmiştir. Bunlar arasında ksenotransplantasyon, enkapsülasyon ve kök hücre tedavileri bulunmaktadır. Her tedavi seçeneğinin kendine özgü avantajları ve dezavantajları mevcuttur. Bu çalışmanın amacı, adacık hücre transplantasyonu ve beta-hücre replasman tedavi seçeneklerinden bahsetmek ve güncel gelişmeleri gözden geçirmektir.

Keywords

adacık hücre transplantasyonu, pankreas transplantasyonu, tip 1 diabetes mellitus

References

• Kaynaklar 1.Williams P. Notes on diabetes treated with extract and by grafts ofsheep’s pancreas. Br Med J. 1894;2:1303-4. 2.Kelly WD, Lillehei RC, Merkel FK, Idezuki Y, Goetz FC. Allotransp-lantation of the pancreas and duodenum along with the kidney in dia-betic nephropathy. Surgery. 1967;6:827-37. 3.Hickey DP, Bakthavatsalam R, Bannon CA, O’Malley K, Corr J, Litt-le DM. Urological complications of pancreatic transplantation. J Urol.1997;157:2042-8. 4.Sutherland DE, Gruessner RW, Dunn DL, Matas AJ, Humar A, Kan-daswamy R, et al. Lessons learned from more than 1,000 pancreastransplants at a single institution. Ann Surg. 2001;233:463-501. 5.Odorico JS, Voss B, Munoz DR. Kidney function after solitary pan-creas transplantation. Transplant Proc. 2008;40:513-5. 6.Farney AC, Cho E, Schweitzer EJ. Simultaneous cadaver pancreasliving-donor kidney transplantation: a new approach for the type 1diabetic uremic patient. Ann Surg. 2000;232:696-703. 7.Israni AK, Skeans MA, Gustafson SK, Schnitzler MA, Wainright JL,Carrico RJ, et al. OPTN/SRTR 2012 Annual Data Report: Pancre-as. Am J Transplant. 2014;14(Suppl 1):45-68. 8.Speight J, Reaney MD, Woodcock AJ, Smith RM, Shaw JA. Patient-reported outcomes following islet cell or pancreas transplantation(alone or after kidney) in Type 1 diabetes: a systematic review. Dia-bet Med. 2010;27:812-22. 9.Kleinclauss F, Fauda M, Sutherland DER, Kleinclauss C, Gruess-ner RW, Matas AJ, et al. Pancreas after living donor kidney transp-lants in diabetic patients: impact on long-term kidney graft functi-on. Clin Transplant. 2009;23:437-46. 10.Ballinger WF, Lacy PE. Transplantation of intact pancreatic isletsin rats. Surgery. 1972:175-86. 11.Kemp CB, Knight MJ, Scharp DW, Ballinger WF, Lacy PE. Effectof transplantation site on the results of pancreatic islet isografts indiabetic rats. Diabetologia. 1973;9:486-91. 12.Scharp DW, Lacy PE, Santiago JV, McCullough CS, Weide LG, Fal-qui L, et al. Insulin independence after islet transplantation into typeI diabetic patient. Diabetes. 1990;39:515-8. 13.Mittal S, Johnson P, Friend P. Pancreas Transplantation: Solid Or-gan and Islet. Cold Spring Harb Perspect Med. 2014;4:a015610. 14.Bertuzzi F, Verzaro R, Provenzano V, Ricordi C. Brittle type 1 dia-betes mellitus. Curr Med Chem. 2007;14:1739-44. 15.Shapiro AM, Lakey JR, Ryan EA, Korbutt GS, Toth E, Warnock GL,et al. Islet transplantation in seven patients with type 1 diabetes mel-litus using a glucocorticoid-free immunosuppressive regimen. N EnglJ Med. 2000;343:230-8. 16.Ryan EA, Lakey JR, Rajotte RV, Korbutt GS, Kin T, Imes S, et al. Cli-nical outcomes and insulin secretion after islet transplantation withthe Edmonton protocol. Diabetes. 2001;50:710-9. 17.Shapiro AM. State of the Art of Clinical Islet Transplantation and No-vel Protocols of Immunosuppression. Curr Diab Rep. 2011;11:345-54. 18.Bellin MD, Barton FB, Heitman A, Harmon JV, Kandaswamy R, Ba-lamurugan AN, et al. Potent induction immunotherapy promotes long-term insulin independence after islet transplantation in type 1 dia-betes. Am J Transplant. 2012;12:1576-83. 19.Thompson DM, Meloche M, Ao Z, Paty B, Keown P, Shapiro RJ, etal. Reduced progression of diabetic microvascular complications withislet cell transplantation compared with intensive medical therapy.Transplantation. 2011;91:373-8. 20.Gruessner RW, Gruessner AC. What defines success in pancreas andislet transplantation-insulin independence or prevention of hypogly-cemia? A review. Transplant Proc. 2014;46:1898-9. 21.Collaborative Islet Transplantation Registry (CITR) Ninth AnnualReport, 2016. (http://www.citregistry.org/). 22.Bellin MD, Barton FB, Heitman A, Harmon JV, Kandaswamy R, Ba-lamurugan AN, et al. Potent induction immunotherapy promotes long-term insulin independence after islet transplantation in type 1 dia-betes Am J Transplant. 2012;12:1576-83. 23.Kandaswamy R , Skeans MA , Gustafson SK , Carrico RJ , Tyler KH, Israni AK , et al. OPTN/SRTR 2013 Annual Data Report: pancre-as. Am J Transplant. 2015;15(Suppl 2):1-20. 24.Dunn TB, Kirchner V, Bellin MD. Beta-cell replacement therapy: cur-rent outcomes and future landscape. Curr Opin Organ Transplant.2015;20:681-90. 25.Collaborative Islet Transplantation Registry (CITR) Seventh Annu-al Report, 2011. (http://www.citregistry.org/). 26.Yang HK, Yoon KH. Current status of encapsulated islet transplan-tation. J Diabetes Complications. 2015;29:737-43. 27.Dufrane D, Gianello P. Macro- or microencapsulation of pig isletsto cure type 1 diabetes. World J Gastroenterol. 2012;18:6885-93. 28.Groth CG, Korsgren O, Tibell A, Tollemar J, Möller E, Bolinder J,et al. Transplantation of porcine fetal pancreas to diabetic patients.Lancet. 1994;344:1402-4. 29.Sun Y, Ma X, Zhou D, Vacek I, Sun AM. Normalization of diabetesin spontaneously diabetic cynomologus monkeys by xenografts of mic-roencapsulated porcine islets without immunosuppression. J Clin In-vest. 1996;98:1417-22. 30.Neufeld T, Ludwig B, Barkai U, Weir GC, Colton CK, Evron Y, etal. The efficacy of an immunoisolating membrane system for islet xe-notransplantation in minipigs. PLoS One. 2013;8:e70150. 31.Bottino R, Trucco M. Use of genetically-engineered pig donors in is-let transplantation. World J Transplant. 2015;5:243-50. 32.Okere B, Lucaccioni L, Dominici M, Iughetti L. Cell therapies forpancreatic beta-cell replenishment. Ital J Pediatr. 2016;42:62. 33.Thomson JA, Itskovitz-Eldor J, Shapiro SS, Waknitz MA, SwiergielJJ, Marshall VS, et al. Embryonic stem cell lines derived from hu-man blastocysts. Science. 1998;282:1145-7. 34.Hansson M, Tonning A, Frandsen U, Petri A, Rajagopal J, EnglundMC, et al. Artifactual insulin release from differentiated embryonicstem cells. Diabetes. 2004;53:2603-9. 35.D’Amour KA, Bang AG, Eliazer S, Kelly OG, Agulnick AD, Smart NG,et al. Production of pancreatic hormone-expressing endocrine cellsfrom human embryonic stem cells. Nat Biotechnol. 2006;24:1392-401. 36.Gittes GK. Developmental biology of the pancreas: a comprehen-sive review. Dev Biol. 2009;326:4-35. 37.Domínguez-Bendala J, Lanzoni G, Klein D, Álvarez-Cubela S, Pas-tori RL. The Human Endocrine Pancreas: New Insights on Replace-ment and Regeneration. Trends Endocrinol Metab. 2016;27:153-62. 38.Pagliuca FW, Millman JR, Gurtler M, Segel M, Van Dervort A, RyuJH, et al. Generation of functional human pancreatic beta cells invitro. Cell. 2014;159:428-39. 39.Andersen DK, Frey CF. The Evolution of the surgical treatment ofchronic pancreatitis. Ann Surg. 2010;251:18-32. 40.Gachago C, Draganov P. Pain management in chronic pancreati-tis. World J Gastroenterol. 2008;14:3137-48. 41.Walsh RM, Saavedra JR, Lentz G, Guerron AD, Scheman J, StevensT, et al. Improved quality of life following total pancreatectomy andauto-islet transplantation for chronic pancreatitis. J Gastrointest Surg.2012;16:1469-77. 42.Sutherland DE, Radosevich DM, Bellin MD, Hering BJ, Beilman GJ,Dunn TB, et al. Total pancreatectomy and islet autotransplantationfor chronic pancreatitis. J Am Coll Surg. 2012;214:409-26