Pancreatic Islet Transplantation

Pancreatic Islet Transplantation

The pancreas, an organ about the size of a hand, is located

behind the lower part of the stomach. It makes insulin and
enzymes that help the body digest and use food. Spread all over
the pancreas are clusters of cells called the islets of
Langerhans. Islets are made up of two types of cells: alpha
cells, which make glucagon, a hormone that raises the level of
glucose (sugar) in the blood, and beta cells, which make
insulin.

Islet Functions
Insulin is a hormone that helps the body use glucose for
energy. If your beta cells do not produce enough insulin,
diabetes will develop. In type 1 diabetes, the insulin shortage
is caused by an autoimmune process in which the body's immune
system destroys the beta cells.

Islet Transplantation
In an experimental procedure called islet transplantation,
islets are taken from a donor pancreas and transferred into
another person. Once implanted, the beta cells in these islets
begin to make and release insulin. Researchers hope that islet
transplantation will help people with type 1 diabetes live
without daily injections of insulin.

Research Developments
Scientists have made many advances in islet transplantation in
recent years. Since reporting their findings in the June 2000
issue of the New England Journal of Medicine, researchers at
the University of Alberta in Edmonton, Canada, have continued
to use a procedure called the Edmonton protocol to transplant
pancreatic islets into people with type 1 diabetes. According
to the Immune Tolerance Network (ITN), as of June 2003, about
50 percent of the patients have remained insulin-free up to 1
year after receiving a transplant. Researchers use specialized
enzymes to remove islets from the pancreas of a deceased donor.
Because the islets are fragile, transplantation occurs soon
after they are removed.

During the transplant, the surgeon uses ultrasound to guide

placement of a small plastic tube (catheter) through the upper
abdomen and into the liver. The islets are then injected
through the catheter into the liver. The patient will receive a
local anesthetic. If a patient cannot tolerate local
anesthesia, the surgeon may use general anesthesia and do the
transplant through a small incision. Possible risks include
bleeding or blood clots.
 Pancreatic Islet Transplantation

It takes time for the cells to attach to new blood vessels and
begin releasing insulin. The doctor will order many tests to
check blood glucose levels after the transplant, and insulin
may be needed until control is achieved.

Transplantation: Benefits, Risks, and Obstacles

The goal of islet transplantation is to infuse enough islets to
control the blood glucose level without insulin injections. For
an average-size person (70 kg), a typical transplant requires
about 1 million islets, extracted from two donor pancreases.
Because good control of blood glucose can slow or prevent the
progression of complications associated with diabetes, such as
nerve or eye damage, a successful transplant may reduce the
risk of these complications. But a transplant recipient will
need to take immunosuppressive drugs that stop the immune
system from rejecting the transplanted islets.
Researchers are trying to find new approaches that will allow
successful transplantation without the use of immunosuppressive
drugs, thus eliminating the side effects that may accompany
their long-term use.
Rejection is the biggest problem with any transplant. The
immune system is programmed to destroy bacteria, viruses, and
tissue it recognizes as "foreign," including transplanted
islets. Immunosuppressive drugs are needed to keep the
transplanted islets functioning.

Immunosuppressive Drugs
The Edmonton protocol uses a combination of immunosuppressive
drugs, also called antirejection drugs, including dacliximab
(Zenapax), sirolimus (Rapamune), and tacrolimus (Prograf).
Dacliximab is given intravenously right after the transplant
and then discontinued. Sirolimus and tacrolimus, the two main
drugs that keep the immune system from destroying the
transplanted islets, must be taken for life.

These drugs have significant side effects and their long-term

effects are still not known. Immediate side effects of
immunosuppressive drugs may include mouth sores and
gastrointestinal problems, such as stomach upset or diarrhea.
Patients may also have increased blood cholesterol levels,
decreased white blood cell counts, decreased kidney function,
and increased susceptibility to bacterial and viral infections.
Taking immunosuppressive drugs increases the risk of tumors and
cancer as well.

Researchers do not fully know what long-term effects this

procedure may have. Also, although the early results of the
Edmonton protocol are very encouraging, more research is needed
to answer questions about how long the islets will survive and
 Pancreatic Islet Transplantation

how often the transplantation procedure will be successful.

Before the introduction of the Edmonton Protocol, few islet
cell transplants were successful. The new protocol improved
greatly on these outcomes, primarily by increasing the number
of transplanted cells and modifying the number and dosages of
immunosuppressants. Of the 267 transplants performed worldwide
from 1990 to 1999, only 8 percent of the people receiving them
were free of insulin treatments one year after the transplant.
The CITR's second annual report, published in July 2005,
presented data on 138 patients. At six months after patients'
final infusions, 67 percent did not need to take insulin
treatments. At one year, 58 percent remained insulin
independent. The recipients who still needed insulin treatment
after one year experienced an average reduction of 69 percent
in their daily insulin needs.

A major obstacle to widespread use of islet transplantation

will be the shortage of islet cells. The supply available from
deceased donors will be enough for only a small percentage of
those with type 1 diabetes. However, researchers are pursuing
avenues for alternative sources, such as creating islet cells
from other types of cells. New technologies could then be
employed to grow islet cells in the laboratory.
Title: Pancreatic Islet Transplantation
Read the text and select the best answer for each of the
questions below.
1. The pancreas is

a) in the hand
b) in the stomach
c) above the stomach
d) behind the lower part of the stomach

2. What is the main purpose of insulin?

a) It is a hormone
b) to destroy beta cells
c) to assist in energy production
d) to stimulate the auto immune process

3. According the article, is islet transplantation common

practice?

a) Yes, it’s frequently used

b) No, it’s still being trialled
c) Not stated in the article
d) Yes, but only in Canada
 Pancreatic Islet Transplantation

4. What is the Edmonton Protocol?

a) A trade agreement
b) The journal of Alberta University
c) A way to transplant pancreatic islets
d) Not stated in the article

5. What’s the source of the pancreatic islets that are used

in the transplant operation?

a) They are donated by relatives

b) They come from people who have recently died
c) They are grown in a laboratory
d) They come from foetal tissue

6. Which one of the sentences below is true?

a) A local anaesthetic is preferred where possible

b) A general anaesthetic is preferred where possible
c) A general anaesthetic is too risky due to the possibility
of blood clots and bleeding.
d) An anaesthetic is not necessary if ultrasound is used
7. How soon after the operation can the patient abandon
insulin injections?

a) Immediately
b) After about two weeks
c) When the blood glucose levels are satisfactory
d) After the first year

8. How many islets are required per patient?

a) About a million
b) 70 kg
c) Whatever is available is used
d) it depends on the size of the patient

9. Immediately after the operation the patient must take

a) insulin
b) immunosuppressive drugs
c) both a and b
d) nothing

10. Patients on immunosuppressive drugs may experience

a) mouth sores
 Pancreatic Islet Transplantation

b) gastro-intestinal problems
c) increased cholesterol levels and decreased kidney function
d) All of the above

11. Twelve months after the operation, how many more patients
were still independent of insulin after the introduction of
the Edmonton Protocol compared with before its introduction?

a) 8%
b) 50%
c) 58%
d) 67%

Now check your answers.

ANSWERS

1. D
2. C
3. B
4. C
5. B
6. A
7. C
8. D
9. B (Insulin MAY be needed until control is achieved)
10. D
11. B (58% - 8% = 50%)