Islet Transplants

The islets of Langerhans are clusters of cells in the pancreas that contain beta cells, which make insulin. In a medical procedure that is still experimental, these islets are carefully removed from a deceased person's pancreas and transplanted into the pancreas of a person with severe type 1 diabetes. The results are promising but by no means perfect. "The ultimate goal of islet cell transplantation is to normalize blood glucose levels and prevent secondary complications of diabetes, such as kidney failure, heart disease, nerve damage and loss of vision,"38 says Alan C. Farney, a transplant surgeon at the University of Maryland Medical Center.

In one study in Canada, sixty-five people with type 1 diabetes that was difficult to control received islet transplants. Five years later, only about 10 percent of those people no longer had to inject insulin. Most of the other people had to begin using insulin again after the transplanted islets gradually lost their ability to make their own. However, many of these same people had been able to reduce their use of insulin, have more stability in their levels of blood glucose, and reduce problems with hypoglycemia, or low blood sugar.

In another study of 225 patients from the United States, Canada, Europe, and Australia who received islet transplants, nearly two-thirds were able to stop injecting insulin for at least two weeks at a time during the first year after the operation. However, that number fell to only one-third two years after the surgery. Even so, many of the 225 people still required less insulin than before the transplant, had improved control of blood glucose, and greatly reduced their risk of becoming severely hypoglycemic.

However, says Farney, the islet transplant "is not a cure. It is a treatment. Patients will still have to take medicine to prevent rejection of the transplanted cells."39 As with any transplant, rejection is the greatest risk and problem. When the body senses something inside it that it believes does not belong there, the immune system will attack it in an effort to get rid of it. With type 1 diabetes, the immune system often mistakenly destroys the person's own beta cells, and this can happen again with new islets from someone else.

That is why people who receive any kind of transplant, including islets, must take special drugs, called immunosuppressive drugs, to prevent the body from attacking and destroying the transplanted islets. These drugs must be taken for life. Unfortunately, these drugs can have terrible side effects, including mouth sores, digestive problems, anemia, and high blood pressure and cholesterol levels. Because they suppress the immune system, they make the person more likely to have infections, and

An illustration shows an islet of Langerhans, a group of pancreas cells involved in insulin production. Experimental islet transplants are showing promise as a possible treatment for diabetes.

they also increase the risk of cancer. Therefore, people who undergo islet transplantation must first understand the possible severe side effects. Researchers are continuing to look for new and better immunosuppressive drugs with fewer side effects. Their main goal is to help people who receive islet transplants to achieve immune tolerance, which would enable them to keep the new islets functioning normally without all the drugs.

As islet transplants become safer and more common, more people with type 1 diabetes will want to have the surgery. However, a great shortage of donated pancreases prevents more of these surgeries from being done. Researchers are looking for solutions to this problem, too. One possibility is to use a portion of a pancreas from a living donor, rather than from a deceased one. Not enough pancreases to meet the need are donated after death, so the hope is to find more living donors. Researchers have also experimented with injecting pig islets into other animals. Since pig organs are very similar to humans', the researchers are hoping to someday use pig islets as an abundant source for human transplants. Perhaps islet cells could also be created from stem cells or other kinds of cells, and then they could be grown in a lab.

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