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Islet-cell Transplants: The End of Insulin Shots?


Diabetes is a leading cause of blindness, end-stage kidney failure, and leg amputations. It also increases the risk for heart disease. Diabetes mellitus causes high blood sugar levels because of the body's inability to produce or effectively use insulin. Insulin is a hormone secreted by the pancreas that aids in storing or converting glucose from food into energy. Diabetes is not curable, but it can be managed with lifestyle changes and medications.

There are two main types of diabetes. People with type 1 diabetes produce little or no insulin. The main treatment regimen for type 1 diabetes is insulin injections throughout the day, measuring blood sugar levels, watching one's diet, and planning structured meals and activities. People with type 2 diabetes either do not produce enough insulin or their bodies have difficulty putting the available insulin to work. Some people with type 2 diabetes require insulin injections.

One hope for cure of diabetes lies in transplanting the islet cells that are in the pancreas. Islet cells produce and secret insulin into the bloodstream.

A Possible Treatment

Doctors have attempted to transplant insulin-producing islet cells from donated pancreases into people with severe, unstable diabetes. The results were that these recipients were able to maintain normal blood sugar levels without taking insulin shots. So can islet-cell transplants mean the end of daily insulin injections for people with diabetes?

One type of islet-cell transplant method follows a procedure called the Edmonton protocol. This includes transplanting cells immediately after removal from the donated pancreas after removing foreign proteins from the cells. Removing foreign proteins from the cells reduces the risk of transplant rejection. In most cases, islet cells from a second donor pancreas are needed for improved blood glucose control. Doctors infuse the cells into the patient's liver during a simple procedure, and the process carries less risk than an organ transplant.

Does Transplant Work?

Several small studies have looked at islet-cell transplantation in those with type 1 diabetes. The studies overall showed mixed support for transplantation. A study of 36 people that used the Edmonton protocol found that transplantation did restore insulin production in the body, as well as keep blood sugar levels stable. However, the transplant did not make it able for most people to be free from their insulin regimen over time. But another small study using the Edmonton protocol was able to report its people as achieving insulin independence. Overall, the transplanted cells allow people to avoid life-threatening episodes of hypogycemia. Hypoglycemia is abnormally low blood sugar. People who take insulin are at risk of experiencing these dangerous blood sugar crashes. Over the course of several years even people achieving insulin independence may still end up taking insulin.

Doctors also note that islet-cell transplant is not the end of all treatment. Even if insulin is not needed after surgery, antirejection medications are required so thebody does not reject the new pancreatic cells. There are side effects to antirejection medications which suppress the immune system. Immune suppression increases the risk of cancer and potentially serious infections. People who have the islet transplant need tosee their doctors for regular check-ups. They are necessary to monitor for rejection, and any new changes in insulin regimens.

Remaining Hurdles

Lack of donated pancreases will limit the number of people who can receive islet-cell transplants. With limited available organs, scientists are still searching for new sources of islet cells. Some researchers are cultivating human islet cells in the laboratory, while others are developing cell lines that produce insulin. Until these or other new methods prove to be expedient, safe and effective, transplants will rely on donated organs.

With limited available organs, scientists are still searching for new sources of islet cells. Some researchers are cultivating human islet cells in the laboratory, while others are developing cell lines that produce insulin. Until these or other new methods prove to be expedient, safe and effective, transplants will rely on donated organs.

RESOURCES:

Juvenile Diabetes Foundation
http://www.jdf.org

Organ and Tissue Donation Initiative
http://www.organdonor.gov

CANADIAN RESOURCES:

Canadian Public Health
http://www.phac-aspc.gc.ca

The College of Canadian Family Physicians
http://www.cfpc.ca

References:

Agarwal A, Brayman KL. Update on islet cell transplantation for type 1 diabetes. Semin Intervent Radiol. 2012;29(2):90-98.

Bromberg JS, LeRoith, D. Diabetes cure—is the glass half full? NEJM. 2006;355:1372-1374.

Diabetes mellitus type 1. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed.ebscohost.com/about/about-us. Updated August 9, 2013. Accessed September 4, 2013.

Markmann JF, Deng S, Huang X, et al. Insulin independence following isolated islet transplantation and single islet infusions. Ann Surg. 2003 Jun;237(6):741-749.

Pancreatic islet transplantation. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.diabetes.niddk.nih.gov/dm/pubs/pancreaticislet/. Updated August 1, 2012. Accessed September 4, 2013.

Shapiro AMJ, Ricordi C, Hering BJ, et al. International Trial of the Edmonton Protocol for Islet Transplantation. NEJM. 2006;355:1318-1330.



Last reviewed September 2013 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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