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Contributed by Andrew V. Schally, September 20, 2013 (sent for review August 15, 2013)
Significance
Diabetes mellitus type 1 is an autoimmune disease that results in irreversible destruction of insulin-producing beta cells. Substantial advances have been made in beta cell replacement therapies over the last decades. However, lack of eligible donor organs and the need for chronic immunosuppression to prevent rejection critically limit a widespread application of these strategies. In this paper we present the clinical success of using a bioartificial pancreas for the transplantation of insulin-producing islets without affecting the immune system. In a patient with long-standing type-1 diabetes we could demonstrate persistent graft function and regulated insulin secretion without the need for immune-modulating medication. This strategy opens up avenues for more widespread and safe application of various cell-based therapies.
Abstract
Transplantation of pancreatic islets is emerging as a successful treatment for type-1 diabetes. Its current stringent restriction to patients with critical metabolic lability is justified by the long-term need for immunosuppression and a persistent shortage of donor organs. We developed an oxygenated chamber system composed of immune-isolating alginate and polymembrane covers that allows for survival and function of islets without immunosuppression. A patient with type-1 diabetes received a transplanted chamber and was followed for 10 mo. Persistent graft function in this chamber system was demonstrated, with regulated insulin secretion and preservation of islet morphology and function without any immunosuppressive therapy. This approach may allow for future widespread application of cell-based therapies.
Footnotes
↵1B.L. and A. Reichel contributed equally to this work.
- ↵2To whom correspondence should be addressed. E-mail: andrew.schally{at}va.gov.
Author contributions: B.L., A. Reichel, A.S., B.Z., C.K.C., S.L., S.K., E.B., M.S., Z.G., A. Rotem, U.B., and S.R.B. designed research; B.L., A. Reichel, A.S., B.Z., C.K.C., S.L., S.K., E.B., M.S., A. Rotem, U.B., and S.R.B. performed research; B.L., A. Reichel, A.S., B.Z., A.V.S., N.L.B., E.B., M.S., Z.G., A. Rotem, U.B., and S.R.B. analyzed data; and B.L., A. Reichel, A.S., B.Z., A.V.S., N.L.B., E.B., M.S., Z.G., A. Rotem, U.B., and S.R.B. wrote the paper.
The authors declare no conflict of interest.
Transplantation of macroencapsulated islets
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