1
|
Yoon JW, Jung HS, Jang JY, Kim MJ, Kim JH, Ohn JH, Kim JH, Lee HM, Kim HC, Lee KB, Choi SA, Kim SW, Park KS. Improved Insulin Secretion by Autologous Islet Transplantation, Compared to Oral Antidiabetic Agents, after Distal Pancreatectomy. Cell Transplant 2015; 24:1615-26. [DOI: 10.3727/096368914x682440] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
In this study, the effects of autologous islet transplantation (ITx) were compared to those of oral antidiabetic drugs (OAD) after distal pancreatectomy (NCT01922492). We enrolled nondiabetic patients who underwent distal pancreatectomy for benign tumors. In the ITx group, islets were isolated from the normal part of the resected pancreas and implanted via the portal vein. Patients who did not receive ITx were regularly monitored and were enrolled in the OAD group if diabetes mellitus developed. The OAD group was treated with metformin with or without vildagliptin. Metabolic parameters were monitored for 12 months postoperatively. Nine patients in the ITx group and 10 in the OAD group were included in the analysis. After 12 months, hemoglobin A1c significantly increased by 5% of the baseline in each group. Area under the curve for blood glucose (AUCglucose) of the 75-g oral glucose tolerance test increased similarly in the immediate postoperative period in both groups but significantly reduced only in the ITx group thereafter. Insulinogenic index (INSindex) significantly decreased from 25.6 ± 18.9 to 4.7 ± 3.7 in the OAD group, while no significant change was observed in the ITx group (from 15.0 ± 4.5 to 11.0 ± 8.2). In the multiple regression analysis, ITx was an independent factor for changes in AUCglucose and INSindex. In addition, changes in INSindex in the ITx group after postoperative 6 months were associated with the efficacy of islet isolation, amount of grafts, and peak serum HMGB1 and VEGF levels after ITx. ITx was superior to OAD in maintaining insulin secretory capacity and glucose tolerance after distal pancreatectomy.
Collapse
Affiliation(s)
- Ji Won Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Hye Seung Jung
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Innovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
| | - Jin Young Jang
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Min Joo Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Hee Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Hun Ohn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Hyeon Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hak Mo Lee
- Innovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
| | - Hyo Cheol Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoung Bun Lee
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Seung A Choi
- Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Sun-Whe Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kyong Soo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Innovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
3
|
Bucher P, Mathe Z, Buhler LH, Andres A, Bosco D, Berney T, Morel P. [Diabetes Type I therapy through transplantation]. ACTA ACUST UNITED AC 2005; 130:374-83. [PMID: 15992762 DOI: 10.1016/j.anchir.2005.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2004] [Accepted: 06/01/2005] [Indexed: 11/25/2022]
Abstract
Diabetes is one of the most common chronic diseases in our society. While insulin treatment for diabetes type I could delay and reduce the incidence of diabetic complications, it is associated with an increased risk of severe hypoglycemia. To restore physiologic insulin metabolism, transplantation of insulin producing cells (pancreatic Beta cells) represent the sole available therapy. It could be done either through pancreas or islet of Langerhans transplantation. In this paper, we review actual knowledge regarding these two types of transplantations.
Collapse
Affiliation(s)
- P Bucher
- Département de chirurgie, service de chirurgie viscérale et de transplantation, hôpitaux universitaires de Genève, 24 rue Micheli-Du-Crest, 1211 Geneva 14, Switzerland.
| | | | | | | | | | | | | |
Collapse
|
4
|
Berney T, Mathe Z, Bucher P, Demuylder-Mischler S, Andres A, Bosco D, Oberholzer J, Majno P, Philippe J, Bühler L, Morel P. Islet autotransplantation for the prevention of surgical diabetes after extended pancreatectomy for the resection of benign tumors of the pancreas. Transplant Proc 2004; 36:1123-4. [PMID: 15194391 DOI: 10.1016/j.transproceed.2004.04.026] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of this article is to report a single-center experience with islet autotransplantation after extensive pancreatic resection for benign tumors of the pancreas. MATERIALS AND METHODS Seven patients underwent extensive left pancreatectomy for benign lesions located at the neck of the pancreas. Once an unequivocal diagnosis of a benign nature was ascertained, the rest of the specimen was processed and the unpurified pancreatic digest was infused into the portal vein. The results were compared with those of 8 autotransplantations performed for chronic pancreatitis over the same period. RESULTS Tumors were 4 cystadenomas, 2 insulinomas and 1 neuroendocrine tumor. Mean islet yields were 275,000 islet equivalents (IEQ) versus 129,000 in chronic pancreatitis (P =.04) or 6700 IEQ/g of tissue versus 1900 (P =.002), resulting in transplantation of 4200 IEQ/kg body weight vs 2150 in chronic pancreatitis (P =.03), respectively at 4-month to 7.5-year follow-up, all patients are alive and 6 of 7 are off insulin. All patients off insulin after at least 1 year currently have a normal IVGTT, with K values ranging between -1.19 and -2.36 (normal < -1.00). All patients, including 1 on insulin, display positive basal and glucagon-stimulated C-peptide levels. CONCLUSIONS Compared with chronic pancreatitis tissue resected for benign tumors is more likely to achieve good islet yields, and thus insulin independence after autotransplantation. Islet autotransplantation should be considered when extensive pancreatectomy is required for resection of a benign tumor, and only if the benign nature of the lesion is demonstrated unequivocally.
Collapse
Affiliation(s)
- T Berney
- Cell Isolation and Transplantation Center, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Abstract
Current hormonal replacement therapy for endocrine disorders cannot, unfortunately, reproduce the complex metabolic interactions of hormones. The organ or cell transplantation would be a more physiological approach to the treatment of endocrine disorders. For decades, remarkable progress in organ or cell transplantation in endocrine disorders has been made, especially in recent years. But there are many limitations in the widespread application of allotransplantation because of rejection. Various methods of immunomanipulations designed to overcome rejection have been proposed, which include immunosuppression, immunomodulation and immunoisolation. The transplantation of immunoisolated cells and some clinical results of the transplants were reviewed. Also a perspective for future directions on endocrine cell transplantation was provided in this review. Human islet cell transplantation for the cure of diabetes was emphasized in this chapter and other cell transplantation for endocrine disorders was also discussed briefly, including parathyroid tissue transplantation, bioartificial thyroid transplantation and adrenal cell transplantation.
Collapse
Affiliation(s)
- M K Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 135-710, Seoul, South Korea.
| | | |
Collapse
|
6
|
Abstract
For decades, the inability of insulin therapy to physiologically control glycemia in type I diabetic patients has motivated the search for insulin-delivering grafts. Islet autotransplantation is such a therapeutic approach to prevent diabetes mellitus following a major pancreatectomy, whereas allotransplantation is generally prescribed for type I diabetic patients with a functional solid organ graft, or for patients awaiting one. As of today, over 150 patients have been autotransplanted world-wide, following total or subtotal pancreatectomy, permitting an insulin-independence in nearly 40% of patients. Furthermore, more than 350 islet allotransplantations have been performed. Recent results show improved metabolic control in over 50% of cases and insulin-independence in approximately 20%. This chapter presents a literature review including preliminary human islet transplantation data from the University of Geneva.
Collapse
Affiliation(s)
- J Oberholzer
- Department of Surgery, University Hospital, Geneva, Switzerland.
| | | | | | | |
Collapse
|