A new way to treat diabetes
Researchers from the University of Miami, working under the guidance of Professor Camillo Ricordi, have obtained the first clinical results demonstrating the ability of pancreatic islet cells transplanted within the framework of a new tissue engineering platform to successfully take root and ensure the patient's independence from injectable insulin in type 1 diabetes mellitus.
Transplantation of pancreatic islet cells allows restoring the natural production of insulin and eliminating severe hypoglycemia in people with type 1 diabetes mellitus. Traditionally, insulin-producing cells are implanted inside the liver, but this procedure has a number of limitations that prompted researchers to search for other areas for transplantation. The authors turned their attention to the omentum – the fatty tissue covering the abdominal organs. In addition to the fact that the omentum can be reached by minimally invasive surgery, according to the characteristics of the blood supply system and the outflow of biological fluids, it is very similar to the pancreas.
The study conducted by the authors, which involved a 43-year-old patient with type 1 diabetes mellitus and a 25-year history of insulin therapy, for the first time demonstrated the possibility of long-term maintenance of insulin independence in type 1 diabetes with the help of a tissue-engineered "mini-pancreas". The approach proposed by the authors consists in combining donor insulin-producing pancreatic islets with the patient's own (autologous) blood plasma in a ratio of 1:2 and applying the resulting mixture to the surface of the omentum as part of a laparoscopic procedure. On top of the mixture of cells with autoplasm, a layer of thrombin was applied, covered with another layer of autoplasm on top. The mixing of these substances ensured the formation of a gel-like material that adheres firmly to the surface of the omentum and holds the insulin-producing islands at the implantation site. Over time, the body absorbs the gel without damaging the islets.
The design of the intervention made it possible to minimize the inflammatory reaction that usually develops when donor insulin-producing islets are injected into the liver and other regions where they immediately come into contact with blood.
As part of this study, the transplantation of islets to the surface of the omentum allowed to restore and stabilize the patient's blood glucose level, as well as maintain a state of independence from insulin. Insulin injections were canceled 17 days after the operation. After 12 months, there was a slight decrease in the functionality of the graft and an increase in the sensitivity of tissues to insulin, presumably due to the change of the immunosuppressive drug (replacement of tacrolimus with sirulimus due to hair loss in the patient). However, this did not affect the stability of glycemic control without the introduction of exogenous insulin and the development of episodes of hypoglycemia. The authors note that this could have been facilitated by regular exercise and a low-carb diet.
Currently, this study, the purpose of which is to assess the safety and long-term effectiveness of the developed strategy, is ongoing. However, experts note that the results obtained to date indicate the possibility of using the omentum as a zone for transplantation of pancreatic islet cells using a new strategy.
Article by David A. Baidal et al. Bioengineering of an Intraabdominal Endocrine Pancreas is published in the New England Journal of Medicine.
Evgeniya Ryabtseva
Portal "Eternal youth" http://vechnayamolodost.ru based on the materials of the University of Miami Miller School of Medicine: Research Findings Show Tissue-Engineered Islet Transplant Achieves Insulin Independence.
16.05.2017