What was only a dream for diabetics a few months ago became a fact today. A team from Institute and Clinic of General and Transplant Surgery of Baby Jesus Clinical Hospital in Warsaw had conducted revolutionary surgery of autogenous transplantation of islet cells under stomach’s mucosa(1).
Diabetes is a metabolic disease which slowly but significantly affects every organ of the body. Retinopathy, nephropathy or diabetes neuropathy are only capstones of long-lasting process of cells functioning disorder. There are many causes of diabetes: autoimmune, chronic pancreatitis, injuries, tumours or pancreatectomy. Because of the fact that not many patients are able to control progression of the disease and organs failure, improvements in diabetes therapy are significant.
A solution to the problem may be pancreas transplant which is 4th most commonly conducted transplant in the world just after kidney, liver and heart. The obvious threats of this treatment may be intra abdominal abscesses, clots and long-lasting immunosuppressant treatment.
Another method used in chronic pancreatitis treatment so far was resection of the organ with isolation of Langerhans’ islets and intrahepatic transplant through portal vein. It allowed about 30% of the patients to be completely non-insulin-dependent and in remaining group the symptoms of insulin-dependency had not occurred for almost 2 years(2). Drawbacks of the method are thrombi, haemorrhages and topical inflammatory reaction destroying beta cells(5). After pancreas injuries the islets may be transplanted even to the region of forearm especially if the tail of pancreas, which is the most abundant in insulin producing cells, is destroyed (3).
In cases of allotransplant the difficulty is to gather few donors who are tissue compatible – in order to acquire complete non-insulin-dependency, 8-9 thousand of allogenic cells per 1 kilogram of body weight are necessary. The very isolation of the islets reduced their number by half. All of this and high risk of transplant rejection lead to initial situation which is insulin therapy (4).
The team from Institute and Clinic of General and Transplant Surgery of Baby Jesus Clinical Hospital in Warsaw has conducted groundbreaking surgery by removing pancreas of the patient suffering from chronic pancreatitis. Then they isolated islet cells, prepared them properly for transplantation and conducted the transplant of the cells under stomach’s mucosa using endoscopy. Because of the fact that it was autogenous transplant, the patient would not require using immunosuppressant drugs. This method is very promising, especially among the patients who previously underwent pancreas transplant, are in bad general condition or there are any anesthesiological contraindications. Additionally, comparing to the whole organ transplantation, the risk seems to be lower (1).
The method of the team from Institute and Clinic of General and Transplant Surgery of Baby Jesus Clinical Hospital in Warsaw is insomuch innovative that research on guinea pigs proved minimal damage of the islet cells in stomach’s submucosis layer. Furthermore, the islets placement is specific what, if in doubt about functioning, allows to examine them using endoscopic USG or even biopsy. On the other hand, research showed higher risk of hypoglycaemia in guinea pigs with lower body weight (5).
The success of Polish transplantology group sounds very promising, especially because of the fact that it was done for the first time in the world. Hopefully it would be a breakthrough for many patients.
Written by: Edyta Sawicka-Glazer, Grzegorz Glazer
Source:
1.http://www.naukawpolsce.pap.pl/aktualnosci/news,394727,pierwszy-na-swiecie-endoskopowy-przeszczep-wysp-trzustkowych.html
2.Bellin MD, R Sutherland DE, Robertson RP.: Pancreatectomy and autologous islet transplantation for painful chronic pancreatitis: indications and outcomes. Hosp Pract (1995). 2012 Aug;40(3):80-7.
3.http://www.serena.unina.it/index.php/jop/article/view/634/919
4.http://www.mojacukrzyca.pl/articles.php?article_id=122
5.http://onlinelibrary.wiley.com/doi/10.1111/j.1600-6143.2009.02815.x/full
Would you like to know more? Watch on MEDtube.net: Hyalinized islets – Histopathology of pancreas
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Endoscopic transplant of islet cells – a success of Polish surgeons
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