Islet transplantation: present and future perspectives.
Islet cell transplantation can potentially normalize blood glucose levels and stop the progression of clinical complications, and if the transplant is done early in the course of the disease complications may be prevented. Remarkable progress has been made in recent years and islet cell transplantation has resulted in normalization of metabolic control in several patients with Type 1 diabetes in the absence of hypoglycemia. Only a few patients, however, have achieved insulin independence. Issues relating to islet cell engraftment within the liver, prevention of rejection and recurrent autoimmunity, and identification of alternative immunosuppressive drugs that do not adversely affect islet cell function remain to be solved. Thus far, the need for chronic, generalized immunosuppression to prevent rejection of the islets has limited the indication to those patients who have already received another transplant or to those who simultaneously receive islets and another organ (generally a kidney). Identification of immunointervention protocols that allow for engraftment in the absence of deleterious effects on the islets and prevent rejection and recurrent autoimmunity would make this procedure suitable for all patients, including children who have not yet developed long-term complications of the disease.
Kenyon
N S
NS
Diabetes Research Institute, University of Miami School of Medicine, FL 33136, USA.
Ranuncoli
A
A
Masetti
M
M
Chatzipetrou
M
M
Ricordi
C
C
D002986:Clinical Trials as Topic; D016572:Cyclosporine / Q000009:adverse effects; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery*; D006084:Graft Rejection / Q000276:immunology* / Q000503:physiopathology; D006146:Guanidines / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016381:Islets of Langerhans Transplantation / Q000009:adverse effects / Q000276:immunology* / Q000502:physiology; D016559:Tacrolimus / Q000009:adverse effects; D014019:Tissue Donors
D006146:Guanidines; D007166:Immunosuppressive Agents; D016572:Cyclosporine; C037258:gusperimus; D016559:Tacrolimus