PANCREATIC ISLET TRANSPLANTATION: A REVOLUTIONARY TREATMENT FOR DIABETES?

Diabetes mellitus is a lifelong chronic condition that causes your blood sugar levels to become too high. Sugar or glucose is your body’s main source of fuel, and it comes from the food you eat. Having excess sugar in your blood can cause serious health problems.

Although diabetes mellitus has no actual cure, lifestyle changes, constant sugar level monitoring, insulin, and oral diabetic medication can go a long way. Scientists have recently started investigating a promising futuristic approach of diabetes treatment: Pancreatic Islet Transplantation. So, could this be the final cure for diabetes?

What Causes Diabetes Mellitus?

The cause of diabetes varies by type:

• Type 1 diabetes is an autoimmune disease, and it happens when your body’s immune system attacks and destroys your pancreatic cells. This prevents your pancreas from producing insulin, the hormone responsible for lowering your blood sugar. Type 1 diabetes occurs mainly in children and young adults, and its treatment centers around insulin injections or pumps to replace the absent hormone.
• Type 2 diabetes, the more common type, is more related to genetics and lifestyle. It occurs when your body cells become unable to properly respond to insulin and your pancreas eventually starts failing. Type 2 diabetes can occur at any age; however, it mainly affects middle-aged or older people, or those suffering from obesity. Type 2 diabetes' mainstay of treatment is lifestyle changes, diabetic medication, insulin, or both.

What Is Pancreatic Islet Transplantation and How Can It Treat Type 1 Diabetes?

Pancreatic islet transplantation, also known as “islet allotransplantation”, is one of the latest treatments aiming to cure type 1 diabetes, and it has been showing some encouraging results.

The “Islets of Langerhans” are groups of pancreatic beta cells that normally produce insulin. In pancreatic islet transplantation, your surgeon will take healthy islets from a deceased person’s pancreas and inject them into the vein that carries blood to your liver. The islets will then settle and begin to produce insulin in your body.

Several islet transplantations might need to be performed so that a person with type 1 diabetes can stop being dependent on insulin injections.

How Is Pancreatic Islet Transplantation Performed?

Pancreatic islet transplantation requires the removal of islets of Langerhans from the pancreas of a deceased donor. In each transplantation procedures, around 400,000 islets are extracted by special enzymes.

During implantation, you will receive a local anesthetic, and your doctor will insert a catheter (thin flexible tube) through a small cut made in your upper abdomen. With the assistance of x-ray and ultrasound imaging, the catheter is guided into your liver’s portal vein, and the islets are slowly infused there to take their place.

Another islet allotransplant method includes minimally invasive open surgery. In this method, a small incision will be made in your open abdomen, and your surgeon will directly visualize the portal vein for the catheter to be inserted without the aid of radiographic imaging.

After implantation, the islets will begin to produce and release insulin into your blood circulation. During the next two weeks following your procedure, new blood vessels will form and the implanted islets will have their independent blood supply and will settle in place.

What Are the Risks of Pancreatic Islet Transplantation?

Unlike a whole pancreas transplant, pancreatic islet transplantation carries fewer complications, but it’s still not risk free. Here are some of the risks faced in islet allotransplantation:

• Bleeding, blood clot formation, and post-op pain
• The transplanted islets of Langerhans not functioning
• Development of antibodies against the donor cells, which may limit your ability to find another pancreatic islet donor in the future

Like any transplant, anti-rejection medications (called immunosuppressants) need to be taken after the procedure. Immunosuppressants can cause some serious side effects, this includes but is not limited to:

• Increased risk of infections and cancer
• Digestive tract upset (vomiting, nausea, diarrhea)
• High blood pressure, glucose, cholesterol, triglycerides
• Kidney damage and failure

Who Are the Best Candidates for Pancreatic Islet Transplantation?

Not all type 1 diabetes patients are good candidates for islet cell transfer. Your doctor will only consider you for a transplant surgery procedure if the possible benefits outweigh the risks of islet allotransplant. This includes immunosuppressant side effects. You’re eligible for transplant surgery if you:

• Have difficulty controlling your blood sugar levels
• Experience serious episodes of low blood sugar (hypoglycemia, usually due to insulin injections)
• Have a condition that renders you unaware of your hypoglycemic episodes
• Had or plan on having a kidney transplant surgery (meaning you are or will be taking immunosuppressants either way)

Can Pancreatic Islet Transplantation Successfully Treat Diabetes?

Clinical trials done by the National Institutes of Health (NIH) show that nearly nine out of ten transplant patients have hemoglobin A1c (HbA1c) below 7% one year after their procedure. This HbA1c level is usually the target goal for many diabetic patients.

Even two years after their transplant surgery, 70% of patients still maintain such low HbA1c levels with minimal episodes of low blood sugar. 

Current data also shows that more than half of the patients who undergo pancreatic islet transplantation don’t require insulin injections anymore after their procedure.

Transplant recipients also report overall improvement in their quality of life, as well as better health status after pancreatic islet transplantation. Even those still on insulin after islet transplantation still find that they’ve experienced similar improvements.

Pancreatic Islet Transplantation – Future Outlooks

Pancreatic islet cell transfer is an emerging treatment for type 1 diabetes patients that’s been showing a lot of promise. However, its current format makes it only suitable for a limited number of patients.
Ongoing research efforts to develop better immunosuppressive agents and protocols are necessary to achieve better long-term results in islet transplantation. Other attempts to find the perfect islet isolation method are also being made to increase islet viability. Another major limitation of islet cell transfer is the scarcity of donors. Researchers are pursuing various options like islet transplantation from single deceased donors, living donors, pigs, or stem cells. All these measures need to be made to further improve the outcome of pancreatic islet transplantation into “non-experimental” territory.

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Sources:

• https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes
• https://www.mayoclinic.org/diseases-conditions/diabetes/symptoms-causes/syc-20371444
• https://www.mayoclinic.org/diseases-conditions/diabetes/diagnosis-treatment/drc-20371451
• https://www.niddk.nih.gov/health-information/diabetes/overview/insulin-medicines-treatments/pancreatic-islet-transplantation#:~:text=In%20islet%20auto%2Dtransplantation%2C%20doctors,healthy%20islets%20that%20make%20insulin.
• https://www.sciencedirect.com/topics/medicine-and-dentistry/islet-cell-transplantation
• https://dmsjournal.biomedcentral.com/articles/10.1186/1758-5996-1-9
• https://transplantsurgery.ucsf.edu/conditions--procedures/islet-transplant-for-type-1-diabetes.aspx

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