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Islet Cell Transplant: Still Promising?

This experimental pancreas procedure might eliminate the need for insulin injections in some people with diabetes. But it isn't easy, so other islet-cell alternatives are being researched.
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WebMD Feature

Although the name may conjure images of wind-swept outcroppings off the northern coast of Scotland, the islets of Langerhans, or "beta-islet cells of the pancreas" as they are more commonly called, are the body's natural store of insulin-secreting cells.

It is these cells that are destroyed or severely damaged in type 1 diabetes and deficient in some cases of type 2 diabetes. Lacking a natural source of insulin, a hormone essential for controlling blood sugar, people with type 1 diabetes must take daily insulin injections.

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But throughout the last decade, researchers have been investigating and fine-tuning techniques for replacing beta islet cells, with the goal of restoring natural insulin production and release and eliminating the need for insulin injections in people with type 1 diabetes. People with type 2 diabetes, which is caused by a different disease process, would generally not benefit from this type of therapy.

One proven method of islet-cell transfer is through transplantation of the pancreas, the large gland (located behind the stomach) where beta-islet cells live. Studies have shown that pancreas transplantation can eliminate the need for injected insulin in approximately half of all cases for at least five years.

Yet because of the risks of transplant surgery and the necessity for taking anti-rejection drugs after the transplant, this procedure is primarily an option for patients who are also receiving kidney transplants due to advanced kidney disease. According to the American Diabetes Association (ADA), simultaneous kidney and pancreas transplants in select patients do not increase the risk for the patient, may improve survival of the transplanted kidneys, and will restore normal control of blood sugar.

The ADA diabetes guidelines also note, however, that pancreas transplantation is only partially successful at reversing some of the serious long-term side effects of diabetes. The procedure does reverse kidney problems and the need for daily and sometime multiple injections of insulin. But chronic conditions like eye disease and nerve abnormalities frequently continue to be a problem in these transplant patients.

At the time this article was written, there were 1,389 people on the national waiting list for a pancreas transplant, and an additional 2,409 people waiting for a combined kidney and pancreas transplant, according to the United Network for Organ Sharing (UNOS).

Islet-cell Transplants

A slightly less invasive alternative to pancreas transplantation is islet-cell transplantation alone. In this experimental procedure, beta-islet cells are identified, isolated, and removed from donor pancreases and are injected into a major vein connected to the liver. The injected islets find their way into microscopic blood vessels and become surrounded and fixed in place by liver tissue. Once there, the cells take over insulin production and secretion, effectively turning the liver into a substitute pancreas.

One problem with this approach is that human beta-islets are few and hard to find; they actually comprise only 1% of all cells in the pancreas (most of the remaining cells produce and secrete enzymes that aid in digestion). In addition some of the islets are inevitably damaged or destroyed during the harvesting process, explains a diabetes researcher in an interview with WebMD.

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