Limits...
Islet transplantation a decade later and strategies for filling a half-full glass.

Robertson RP - Diabetes (2010)

Bottom Line: Alloislet transplantation for the treatment of type 1 diabetes enjoyed highly favorable status in the first half of the last decade but declined in favor during the second half.In this Perspective, I will briefly review the literature published in this area from 2000 to 2010 for the purposes of extracting lessons we have learned, considering whether the procedure should be deemed a partial success or a partial failure, and offering several strategies to improve alloislet transplantation outcomes in the future.In the end, I hope to strike a positive note about where this procedure is going, and how it will be applied to establish insulin independence in patients with type 1 diabetes.

View Article: PubMed Central - PubMed

Affiliation: Division of Endocrinology and Metabolism, Departments of Medicine and Pharmacology, University of Washington, Seattle, Washington, USA. rpr@pnri.org

ABSTRACT
Alloislet transplantation for the treatment of type 1 diabetes enjoyed highly favorable status in the first half of the last decade but declined in favor during the second half. In this Perspective, I will briefly review the literature published in this area from 2000 to 2010 for the purposes of extracting lessons we have learned, considering whether the procedure should be deemed a partial success or a partial failure, and offering several strategies to improve alloislet transplantation outcomes in the future. In the end, I hope to strike a positive note about where this procedure is going, and how it will be applied to establish insulin independence in patients with type 1 diabetes.

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General method of intrahepatic islet transplantation. Islets are removed from a donated pancreas by collagenase digestion, followed by purification to separate the islets from exocrine tissue. Islets are then infused by gravity into a catheter lodged in the hepatic portal vein. Blood flow within the vein carries the islets into the liver tributaries where they lodge within the sinusoids and establish vascular connections. Reproduced with permission from ref. 3.
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Figure 1: General method of intrahepatic islet transplantation. Islets are removed from a donated pancreas by collagenase digestion, followed by purification to separate the islets from exocrine tissue. Islets are then infused by gravity into a catheter lodged in the hepatic portal vein. Blood flow within the vein carries the islets into the liver tributaries where they lodge within the sinusoids and establish vascular connections. Reproduced with permission from ref. 3.

Mentions: The consensus father of islet transplantation is Paul Lacy. His vision, leadership, and hard work established the procedure of using the liver as a site for successful islet transplantation. The transplants normalized glycemia in rats previously made diabetic by streptozotocin injection (2). As he and his colleagues began publishing manuscripts, it did not take long for the surgical community to apply this technique to humans (Fig. 1) (3). This proved to be a much more ambitious task than first imagined. Transporting pancreata isolated from brain-dead donors on life support, the inherent delays in islet isolation, the presence of autoimmune disease in the recipients, and the need to use powerful immunosuppressive drugs with significant side effects all presented significant barriers.


Islet transplantation a decade later and strategies for filling a half-full glass.

Robertson RP - Diabetes (2010)

General method of intrahepatic islet transplantation. Islets are removed from a donated pancreas by collagenase digestion, followed by purification to separate the islets from exocrine tissue. Islets are then infused by gravity into a catheter lodged in the hepatic portal vein. Blood flow within the vein carries the islets into the liver tributaries where they lodge within the sinusoids and establish vascular connections. Reproduced with permission from ref. 3.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2874688&req=5

Figure 1: General method of intrahepatic islet transplantation. Islets are removed from a donated pancreas by collagenase digestion, followed by purification to separate the islets from exocrine tissue. Islets are then infused by gravity into a catheter lodged in the hepatic portal vein. Blood flow within the vein carries the islets into the liver tributaries where they lodge within the sinusoids and establish vascular connections. Reproduced with permission from ref. 3.
Mentions: The consensus father of islet transplantation is Paul Lacy. His vision, leadership, and hard work established the procedure of using the liver as a site for successful islet transplantation. The transplants normalized glycemia in rats previously made diabetic by streptozotocin injection (2). As he and his colleagues began publishing manuscripts, it did not take long for the surgical community to apply this technique to humans (Fig. 1) (3). This proved to be a much more ambitious task than first imagined. Transporting pancreata isolated from brain-dead donors on life support, the inherent delays in islet isolation, the presence of autoimmune disease in the recipients, and the need to use powerful immunosuppressive drugs with significant side effects all presented significant barriers.

Bottom Line: Alloislet transplantation for the treatment of type 1 diabetes enjoyed highly favorable status in the first half of the last decade but declined in favor during the second half.In this Perspective, I will briefly review the literature published in this area from 2000 to 2010 for the purposes of extracting lessons we have learned, considering whether the procedure should be deemed a partial success or a partial failure, and offering several strategies to improve alloislet transplantation outcomes in the future.In the end, I hope to strike a positive note about where this procedure is going, and how it will be applied to establish insulin independence in patients with type 1 diabetes.

View Article: PubMed Central - PubMed

Affiliation: Division of Endocrinology and Metabolism, Departments of Medicine and Pharmacology, University of Washington, Seattle, Washington, USA. rpr@pnri.org

ABSTRACT
Alloislet transplantation for the treatment of type 1 diabetes enjoyed highly favorable status in the first half of the last decade but declined in favor during the second half. In this Perspective, I will briefly review the literature published in this area from 2000 to 2010 for the purposes of extracting lessons we have learned, considering whether the procedure should be deemed a partial success or a partial failure, and offering several strategies to improve alloislet transplantation outcomes in the future. In the end, I hope to strike a positive note about where this procedure is going, and how it will be applied to establish insulin independence in patients with type 1 diabetes.

Show MeSH
Related in: MedlinePlus