DOI QR코드

DOI QR Code

Is islet transplantation a realistic approach to curing diabetes?

  • Jin, Sang-Man (Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Kwang-Won (Division of Endocrinology and Metabolism, Department of Internal Medicine, Gachon University Gil Medical Center)
  • Received : 2016.06.30
  • Accepted : 2016.12.19
  • Published : 2017.01.01

Abstract

Since the report of type 1 diabetes reversal in seven consecutive patients by the Edmonton protocol in 2000, pancreatic islet transplantation has been reappraised based on accumulated clinical evidence. Although initially expected to therapeutically target long-term insulin independence, islet transplantation is now indicated for more specific clinical benefits. With the long-awaited report of the first phase 3 clinical trial in 2016, allogeneic islet transplantation is now transitioning from an experimental to a proven therapy for type 1 diabetes with problematic hypoglycemia. Islet autotransplantation has already been therapeutically proven in chronic pancreatitis with severe abdominal pain refractory to conventional treatments, and it holds promise for preventing diabetes after partial pancreatectomy due to benign pancreatic tumors. Based on current evidence, this review focuses on islet transplantation as a realistic approach to treating diabetes.

Keywords

Acknowledgement

Supported by : Ministry of Health and Welfare

References

  1. Shapiro AM, Lakey JR, Ryan EA, et al. Islet transplantation in seven patients with type 1 diabetes mellitus using a glucocorticoid-free immunosuppressive regimen. N Engl J Med 2000;343:230-238. https://doi.org/10.1056/NEJM200007273430401
  2. Kim JH, Kim KW. History, current status and perspective of islet transplantation. Korean J Med 2008;75:274-279.
  3. Kim KW. Islet transplantation: a realistic alternative for the treatment of insulin deficient diabetes mellitus. Diabetes Res Clin Pract 2004;66 Suppl 1:S11-S17. https://doi.org/10.1016/j.diabres.2003.10.025
  4. Dunn TB, Kirchner V, Bellin MD. Beta-cell replacement therapy: current outcomes and future landscape. Curr Opin Organ Transplant 2015;20:681-690. https://doi.org/10.1097/MOT.0000000000000245
  5. Choudhary P, Rickels MR, Senior PA, et al. Evidence-informed clinical practice recommendations for treatment of type 1 diabetes complicated by problematic hypoglycemia. Diabetes Care 2015;38:1016-1029. https://doi.org/10.2337/dc15-0090
  6. Venstrom JM, McBride MA, Rother KI, Hirshberg B, Orchard TJ, Harlan DM. Survival after pancreas transplantation in patients with diabetes and preserved kidney function. JAMA 2003;290:2817-2823. https://doi.org/10.1001/jama.290.21.2817
  7. Barton FB, Rickels MR, Alejandro R, et al. Improvement in outcomes of clinical islet transplantation: 1999-2010. Diabetes Care 2012;35:1436-1445. https://doi.org/10.2337/dc12-0063
  8. Hering BJ, Clarke WR, Bridges ND, et al. Phase 3 trial of transplantation of human islets in type 1 diabetes complicated by severe hypoglycemia. Diabetes Care 2016;39:1230-1240. https://doi.org/10.2337/dc15-1988
  9. Matsumoto S. Clinical allogeneic and autologous islet cell transplantation: update. Diabetes Metab J 2011;35:199-206. https://doi.org/10.4093/dmj.2011.35.3.199
  10. Jin SM, Oh SH, Kim SK, et al. Diabetes-free survival in patients who underwent islet autotransplantation after 50% to 60% distal partial pancreatectomy for benign pancreatic tumors. Transplantation 2013;95:1396-1403. https://doi.org/10.1097/TP.0b013e31828c0c29
  11. Ryan EA, Paty BW, Senior PA, et al. Five-year follow-up after clinical islet transplantation. Diabetes 2005;54:2060-2069. https://doi.org/10.2337/diabetes.54.7.2060
  12. Bellin MD, Barton FB, Heitman A, et al. Potent induction immunotherapy promotes long-term insulin independence after islet transplantation in type 1 diabetes. Am J Transplant 2012;12:1576-1583. https://doi.org/10.1111/j.1600-6143.2011.03977.x
  13. Lehmann R, Graziano J, Brockmann J, et al. Glycemic control in simultaneous islet-kidney versus pancreas-kidney transplantation in type 1 diabetes: a prospective 13-year follow-up. Diabetes Care 2015;38:752-759. https://doi.org/10.2337/dc14-1686
  14. Lablanche S, Borot S, Wojtusciszyn A, et al. Five-year metabolic, functional, and safety results of patients with type 1 diabetes transplanted with allogenic islets within the Swiss-French GRAGIL network. Diabetes Care 2015;38:1714-1722. https://doi.org/10.2337/dc15-0094
  15. Yang TY, Oh SH, Jeong IK, et al. First human trial of pancreatic islet allo-transplantation in Korea: focus on re-transplantation. Diabetes Res Clin Pract 2002;56:107-113. https://doi.org/10.1016/S0168-8227(01)00366-7
  16. Yang HK, Ham DS, Park HS, et al. Reversal of hypoglycemia unawareness with a single-donor, marginal dose allogeneic islet transplantation in Korea: a case report. J Korean Med Sci 2015;30:991-994. https://doi.org/10.3346/jkms.2015.30.7.991
  17. Forlenza GP, Nathan BM, Moran AM, et al. Successful application of closed-loop artificial pancreas therapy after islet autotransplantation. Am J Transplant 2016;16:527-534. https://doi.org/10.1111/ajt.13539
  18. Jung HS, Choi SH, Kim SJ, et al. A better yield of islet cell mass from living pancreatic donors compared with cadaveric donors. Clin Transplant 2007;21:738-743.
  19. Jung HS, Ahn YR, Oh SH, et al. Enhancement of beta-cell regeneration by islet transplantation after partial pancreatectomy in mice. Transplantation 2009;88:354-359. https://doi.org/10.1097/TP.0b013e3181b07a02
  20. Oh BJ, Oh SH, Choi JM, et al. Co-culture with mature islet cells augments the differentiation of insulin-producing cells from pluripotent stem cells. Stem Cell Rev 2015;11:62-74. https://doi.org/10.1007/s12015-014-9554-8
  21. Jung HS, Choi SH, Noh JH, et al. Healthy twin birth after autologous islet transplantation in a pancreatectomized patient due to a benign tumor. Transplant Proc 2007;39:1723-1725. https://doi.org/10.1016/j.transproceed.2007.03.068

Cited by

  1. Islet transplantation promotes podocyte regeneration in a model of diabetic nephropathy vol.47, pp.6, 2017, https://doi.org/10.3906/sag-1704-102
  2. Effect of resveratrol treatment on graft revascularization after islet transplantation in streptozotocin-induced diabetic mice vol.10, pp.1, 2017, https://doi.org/10.1080/19382014.2017.1414764
  3. Establishment of Insulin-Producing Cells From Human Embryonic Stem Cells Underhypoxic Condition for Cell Based Therapy vol.6, pp.None, 2018, https://doi.org/10.3389/fcell.2018.00049
  4. Who Will Win: Induced Pluripotent Stem Cells Versus Embryonic Stem Cells for β Cell Replacement and Diabetes Disease Modeling? vol.18, pp.12, 2017, https://doi.org/10.1007/s11892-018-1109-y
  5. Potential Benefits of Nrf2/Keap1 Targeting in Pancreatic Islet Cell Transplantation vol.9, pp.4, 2017, https://doi.org/10.3390/antiox9040321
  6. Beta Cell Imaging—From Pre-Clinical Validation to First in Man Testing vol.21, pp.19, 2017, https://doi.org/10.3390/ijms21197274
  7. Development of a Bioartificial Vascular Pancreas vol.12, pp.None, 2017, https://doi.org/10.1177/20417314211027714