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Transplant Advance for Type 1 Diabetes: Report

Used in single patient, special chamber may allow implantation of insulin-producing cells without rejection

WebMD News from HealthDay

By Serena Gordon

HealthDay Reporter

MONDAY, Oct. 28 (HealthDay News) -- Using a specially designed chamber, an international research team has transplanted islet cells into a patient with type 1 diabetes.

The new technique avoided having to use immune-suppressing medications, while still allowing the islet cells to function and make insulin. In theory, the chamber "hid" the transplanted islet cells from the patient's immune system, the researchers explained.

Islet cells are normally found in the human pancreas. One critical function of these cells is producing insulin -- a hormone crucial for metabolizing the carbohydrates in food. In people with type 1 diabetes, an autoimmune disease, the islet cells have been destroyed by the body's own immune system.

"In order to transplant replacement cells, heretofore, the immune response to the foreign cells has had to be controlled with immunosuppression," explained study co-author Dr. Norman Block.

Now, he said, senior study author Dr. Stefan Bornstein "has found a way to implant foreign cells and protect them without using immunosuppression" -- drugs to dampen the immune system.

Medications used to suppress the immune system can come with significant risks and side effects.

The study was released online Oct. 28 in the Proceedings of the National Academy of Sciences.

Because their bodies lack working islet cells, people with type 1 diabetes no longer produce enough insulin to survive. They must take daily insulin injections or receive their insulin through a small catheter underneath the skin that's attached to an insulin pump.

Maintaining the proper levels is a difficult task. Too much insulin, and blood sugar levels can drop to dangerously low levels that at their worst can cause seizures and even death. Too little insulin, and blood sugar levels run high. Over time, these high levels can put someone with diabetes at risk of complications, such as vision problems and kidney disease.

Needed levels of insulin vary from person to person, and according to the types of food someone eats, how much they eat, how much they exercise and what type of stress they face.

Because islet cells can currently only be transplanted with the use of immune-suppressing drugs, the implant procedure is limited to patients who have difficult-to-control diabetes and experience repeated episodes of life-threatening low blood sugar levels. Immune-suppressing drugs have potential side effects, including the risk of infection and certain cancers.

To try to make the implant procedure available to more people, the researchers designed a semi-permeable chamber to house the islet cells, with the hope that the immune system wouldn't be able to "see" the new foreign cells.

However, when islet cells are first transplanted, they haven't established their own blood supply and aren't able to get oxygen when they're hiding in the chamber. For that reason, the current version of the device had an oxygen port on the outside of the body attached via tubing that had to be refilled daily by the patient for as long as a month or two, Block explained.

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