Islet cell transplant

Altman JJ, Legrelle M, Penformis A, Mallegol S, Fakir M, Chapa O, Capron F (1992) In Ricordi C (ed) Pancreatic islet cell transplantation. RG Landes, Austin, TX, p 215... 

Inogudii T, Battan R, Handler E, Sportsman JR, Heath W, King GL (1992) Preferential elevation of protein kinase C isoform pll and diacyl ycerol levels in the aorta and heart of diabetic rats differential reversibility to ycemic control by islet cell transplantation. Proc Natl Acad Sd USA 89 11059-11063... 

The islet cells transplanted into humans are obtained from pancreatic tissue of deceased human donors (Figure 8.9). Implantation of these cells in recipients displaying a competent immune system would, at best, be of transient therapeutic benefit. The ensuing immune response would quickly destroy the foreign cells. Studies conducted thus far in humans have utilized diabetic patients who have received kidney transplants, as these are already subject to immunosuppressive therapy. However, a major stumbling block to the widespread adoption of this therapeutic approach is, predictably, the requirement to induce concurrent immune suppression. 

For the foreseeable future, the source of choice for islet cell transplantation will be allogeneic pancreas donors. By definition, there is a disparity at the major histocompatibility complex... 

The ability to transfer genes into islets and perhaps the insulin producing fl cells appears to represent an excellent opportunity to utilize gene therapy for improving the clinical efficacy of islet cell transplantation. Unlike the case of other organ transplants... 

Outstanding questions for gene therapy in islet cell transplantation... 

Which gene or genes will be most effective in preventing and/or delaying islet cell transplant rejection ... 

Kapturczak, M. H., Flotte, T. and Atkinson, M. A. (2001). Adeno-associated virus (AAV) as a vehicle for therapeutic gene delivery Improvements in vector design and viral production enhance potential to prolong graft survival in pancreatic islet cell transplantation for the reversal of type 1 diabetes. Curr. Mol. Med. 1, 245-258. 

Monitoring Therapy. Measurement of C-peptide can be used to monitor patients response to pancreatic surgery. C-peptide should be undetectable after a radical pancreatectomy and should increase after a successful pancreas or islet cell transplant. 

Islet cell and whole pancreas transplantation are occasionally used in patients, nsually renal transplants, who reqnire immunosnp-pressive therapy for other reasons. There has been considerable interest in islet cell transplantation since investigators in Edmonton reported snccess without using glucocorticoids as immunosuppressive agents. Some of these patients are able to come off insnlin altogether. 

Whole pancreas and islet cell transplantation are still relatively experimental procedures in patients with type 1 DM those with end-stage renal disease also receive kidney transplantation. " ... 

Chaikof EL (1999) Engineering and material considerations in islet cell transplantation. Annu Rev Biomed Eng 1 103... 

Mackie JD, Pankewycz OG, Bastos MG, Kelley VE, Strom TB. Dose-related mechanisms of immunosuppression mediated by murine anti-CD3 monoclonal antibody in pancreatic islet cell transplantation and delayed-type hypersensitivity. Transplantation 1990 49(6) 1150-1154. 

Lacy P. Status of islet cell transplantation. Diabetes Rev 1993 1 76-92. 

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