Tuesday, January 29, 2008

Islet of Langerhorns transplant

Islet Cell Transplants Take Another Step Forward

Today Researchers at the University of Minnesota showcased a new, minimally invasive technique to implant islet cells. Islet cells are located in the pancreas and are responsible for producing insulin. Thirty days after the procedure, every one of the thirteen test subjects were producing insulin without any follow-up injections! There were no major complications. Ultimately, doctors hope that the procedure will not require an overnight stay at the hospital.

The procedure uses a steroid-free method of suppressing the bodies immune response and using an ultrasound guidance monitor to inject donor cells through the patient's skin. The access site is then sealed with a newly developed "sandwich technique" where gel foam and coils are applied in layers. Apparently, previous methods had complications arising from how the access site was protected. Unfortunately, the article doesn't elaborate on this point.

Transplants, including those designed specifically for diabetics, have been around for a while. Occasionally, we hear about new techniques for transplants that seem to make the process better.However, there is a huge problem with transplants of any kind, regardless of the technique used: the recipient's immune system must be permanently shut down, or at least permanently weakened or it will destroy the transplant. The only way around this problem that I have heard about is to create a transplantable organ or islet cell which matches the recipient's DNA. Medical science is still going to have to progress a long way before this technique becomes practical.
A friend of mine was a long-term, Type 1 diabetic as I am. But, this friend had to have a kidney transplant, and she got a pancreas transplant at the same time. That was about five years ago.
At first, she was very happy with the results. It was great not to be a diabetic anymore, even though she did have to take, and still does take literal handfuls of immune suppressant drugs.
But after a couple of years, she began to have huge problems with the side effects of the immune suppressant drugs. She now has constant and debilitating colon problems, including diarrhea so bad that she can rarely leave her house. He transplant clinic doctors tell her that she should look on the glass-half-full side and just be thankful for not being a diabetic anymore. But in reality, the side-effects of her immune suppressant drugs have made her a virtual invalid, tied to her bathroom and hiding from anyone who might possibly have any kind of infection such as a cold or flu.
As for me, I say no thanks to an islet cell transplant. At least until the day comes when the transplanted tissue will be invisible to my immune system, and no immune suppressant drugs will be needed.
In my opinion (based on 29 years of being a Type 1 diabetic), if you are careful you can live with Type 1 diabetes. But if your immune system must be crippled by drugs, your quality of life is worse than a diabetic's.

Michael James, I think you're right to focus on the tremendous risks and side effects of transplants. The experience of your friend sounds absolutely horrible. I would hope that no one would ever have to go through something like that.

It's important to distinguish between transplanting a full organ and just islet cells. The latter should be a lot less traumatic on the body. But doctors still haven't found an easily deployable solution. Yet.

There are a few developments that give me hope for the future.

1. I read about researchers that were placing islet cells inside of a semi-permeable membrane. This allowed nutrients to get in and kept attacking cells out. This kind of artificial protection could limit the need for immunosuppressant drugs. Unfortunately I can't find a link to this article now.

2. New drugs may be able to specifically target the immune cells that attack the islet cells. This would be much better than shutting down the whole immune system. It's like the difference between using a 500 ton bomb and a sniper rifle to take out the bad guy. Here's an example.

3. We may find a more plentiful source of stem cells with less risk of rejection. They may come from an animal like a pig (where your insulin probably comes from) or from an immortalized human cell line that is more resistant to rejection.

In the end, it will probably take a combination of artificial protections, more targeted drugs or drug cocktails with micro-doses, and a plentiful source of islet cells so injections can be given more often. We're not there yet, but we're taking strong strides in each of these areas.

Islet transplants may never be the magic bullet, but it may be the big breakthrough before the really big breakthrough, when we can teach the body to stop attacking its own cells. Maybe I'm being too much of an optimist. The pace of technological advancement is accelerating all the time, especially in the field of new materials, and it's hard not to think that in 20 years it will be a completely different landscape.

I'm 66 years old. I had a liver transplant 2 and a half years ago. Since then I've have gained over 65 pounds and am borderline diabetic. The immune suppressants are "doing a number on me." I'm sure they are the cause of my peripheral neuropathy, increased hypertension, skin rashes, diarrhea, non-healing wounds, insomnia, shingles, tendonitis, basal cell carcinoma, nervousness, irritability......Shall I go on? It seems I get almost every bad side effect of the suppressants. I'm waiting for lymphoma which is a side effect I have yet to experience. I'm on rapamune, myfortic, and prograf. I now have Stage 3 kidney disease. I was on dialysis for four months after the original surgery. Is there any help for people like me who seem to experience every negative side effect of these drugs? I feel my life is close to a living hell. Please don't say, "Just be grateful you're alive."

Well John, I can understand some of what you are saying as I too am a kidney transplant receipent. I have gained a huge amount of weight and I became type 2 diabetic which I take two different pills for. My diabetes is under control as that is a daily struggle due to each time they increase my immono's my sugar takes a leap. All I can say is stay encouraged...I have not experienced all of what you have but there have been changes in my body. Me, personally...I would rather keep fighting the tides that be than to have to go back to a life confined to dialysis. Which I was for nearly four years. Lately the most common complaint is twitching in the nerves in my eyes. By the way I take prograf and cellcept. I know they explained some twitching disorders could happen but it is really nerve racking in my eyes. I wear glasses and could wear my contacts if the twitching were not so bad some days.I received my transplant January 20, 2006 so I am still farely new at this. Also because I am a fair skinned African American, the steroids cause me to bruise very easily. Usually the slightest bump causes awful bruises. Even in places I didn't know I could bruise. For a minute my family members thought I was secretly attacking myself...(laughing) All I can say is we must stay encouraged and keep posting comments to keep each other encouraged as you have done for me. After reading your story, here I was getting aggravated by the weight gain,bruising and twitching and compared to what your going through it seems like a drop in the bucket. I pray you find some comfort and relief that works for you.


I'm a Type 1 diabetic who received an Islet Cell transplant Jan 2007. I had developed brittle diabetes. I had really looked after myself for 35 years but in the last 5 had become completely unaware of hypos and was having debilitating ones 6-7 times a week. So for me, it was a last ditch attempt of getting my life back.
I still have a few low blood sugars but nothing like before. I can live my life again. Sure, I have to take immune suppressants, but for me, this is minor inconvenience, so far. I still need another top-up transplant and I can't wait to have it. Also the digestive problems I used to have as a result of my diabetes have disappeared since the transplant.
I thank the Drs and nurses at the University of Chicago for letting me into their research program and I advise any Type 1 diabetic who is having great difficulties, specifically with hypo unawareness to consider an Islet cell Transplant as an option.

See testimonies from real people at http://www.springwell.biz; www.dbethics.com


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