Three-yr follow-up of a type 1 diabetes mellitus patient with an islet xenotransplant.
In order to alleviate the shortage of human donors, the use of porcine islets of Langerhans for xenotransplantation in diabetic patients has been proposed as a solution. To overcome rejection, we have developed a procedure for protecting the islets by combining them with Sertoli cells and placing them in a novel subcutaneous device, that generates an autologous collagen covering. A type 1 diabetic woman was closely monitored for 10 months, and then transplanted in two devices with two months of difference and a third time after 22 months. Here we present a three-yr follow-up. The close monitoring induced a rapid decrease in exogenous insulin requirements, which stabilized between 19 and 28 IU/d for nine months. After transplantation, the requirements reduced further to below 6 IU/d and for some weeks she was insulin free. Glycosylated hemoglobin levels decreased concomitantly. Porcine insulin could be detected in the serum after a glucose challenge and insulin positive cells inside a removed device after two yr. No complications have arisen and no porcine endogenous retrovirus infection has been detected through PCR and RT-PCR. This case demonstrates the feasibility of using the xenotransplantation of porcine cells to alleviate metabolic complications and insulin requirements in type 1 diabetic patients.
Valdés-González
R A
RA
Department of Surgery, Faculty of Medicine, National Autonomous University of Mexico, Children's Hospital of Mexico, Federico Gomez, México City, Mexico. rvaldes@xenomexico.org
White
D J G
DJ
Dorantes
L M
LM
Terán
L
L
Garibay-Nieto
G N
GN
Bracho-Blanchet
E
E
Dávila-Pérez
R
R
Evia-Viscarra
L
L
Ormsby
C E
CE
Ayala-Sumuano
J T
JT
Silva-Torres
M L
ML
Ramírez-González
B
B
D000293:Adolescent; D000818:Animals; D054304:Anti-Mullerian Hormone; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000032:analysis; D006023:Glycoproteins / Q000032:analysis; D006801:Humans; D007150:Immunohistochemistry; D007328:Insulin / Q000008:administration & dosage; D016381:Islets of Langerhans Transplantation / Q000379:methods*; D013552:Swine; D013735:Testicular Hormones / Q000032:analysis; D014183:Transplantation, Heterologous
D054304:Anti-Mullerian Hormone; D006442:Glycated Hemoglobin; D006023:Glycoproteins; D007328:Insulin; D013735:Testicular Hormones; C517652:hemoglobin A1c protein, human