Skip to main content
Log in

Islet transplantation in the twenty-first century

  • Published:
Immunologic Research Aims and scope Submit manuscript

Abstract

Isolated islet transplantation is poised for clinical application to treat insulin-dependent diabetes. Unlike exogenous insulin therapy, islet transplantation has promise for preventing and/or reversing the dismal secondary complications of diabetes. Islet transplants are arguably the most unique type of allografts, and we discuss their properties, limitations, and potential in this overview. The induction of immunologic tolerance to allow islet grafts to endure and prevail, without the hardship of chronic immunosuppressive therapy, is a major goal in this field. In this context, we discussour successful results in preclinical models of primate allogeneic and xenogeneic islet graft tolerance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Bliss M: Banting: A Biography. Toronto, McClelland and Stewart 1996.

    Google Scholar 

  2. Ballinger WF, Lacy PE: Transplantation of intact pancreatic islets in rats. Surgery 1972;72:175–186.

    PubMed  CAS  Google Scholar 

  3. Ricordi C, Lakey JR, Hering BJ: Challenges toward standardization of islet isolation technology. Transplant Proc 2001;33: 1709.

    Article  PubMed  CAS  Google Scholar 

  4. Weir GC, Bonner-Weir S: Scientific and political impediments to successful islet transplantation. Diabetes 1997;46:1247–1256.

    Article  PubMed  CAS  Google Scholar 

  5. Sutherland DE, Gores PF, Hering BJ, Wahoff D, McKeehen DA, Gruessner RW: Islet transplantation: an update. Diabetes Metab Rev 1996;12:137–150.

    Article  PubMed  CAS  Google Scholar 

  6. Jindal RM, Sidner RA, Milgrom ML: Post-transplant diabetes mellitus: the role of immuno-suppression. Drug Safety 1997;16:242–257.

    PubMed  CAS  Google Scholar 

  7. Schulak JA, Franklin W, Reckand CR: Morphological and functional changes following intraportal islet allograft rejection: irreversibility with steroid pulse therapy. Surg. Forum 1977;28:296–299.

    PubMed  CAS  Google Scholar 

  8. Shapiro AM, Hao EG, Lakey JR, Yakimets WJ, Churchill TA, Mitlianga PG, Papadopoulos GK, Elliott JF, Rajotte RV, Kneteman NM: Novel approaches toward early diagnosis of ilset allograft rejection. Transplantation 2001; 71:1709–1718.

    Article  PubMed  CAS  Google Scholar 

  9. Giannoukakis N, Rudert WA, Ghivizzani SC, Gambotto A, Ricordi C, Trucco M, Robbins PD: Adenoviral gene transfer of the interleukin-1 receptor antagonist protein to human islets prevents IL-beta-induced beta-cell impairment and activation of islet cell apoptosis in vitro. Diabetes 1999; 48:1730–1736.

    Article  PubMed  CAS  Google Scholar 

  10. Bennet W, Sundberg B, Lundgren T, Tibell A, Groth CG, Richards A, White DJ, Elgue G, Larsson R, Nilsson B, Korsgren O: Damage to porcine islets of Langerhans after exposure to human blood in vitro, or after intraportal transplantation to cynomologus monkeys: protective effects of scR1 and heparin. Transplantation 2000;69:711–719.

    Article  PubMed  CAS  Google Scholar 

  11. Bennett W, Groth CG, Larsson R, Nilsson B, Korsgren O: Isolated humanis lets triggeran instant blood mediated inflammatory reaction: implications for intraportal islet transplantation as a treatment for patients with type 1 diabetes. Upsala J Med Sci 2000;105:125–133.

    Google Scholar 

  12. Nussler AK, Carroll PB, Di Silvio M, Rilo HL, Simmons RL, Starzl TE, Ricordi C: Hepatic nitric oxide generation as a putative mechanism for failure of intrahepatic islet cell grafts. Transplant Proc 1992; 24:2997.

    PubMed  CAS  Google Scholar 

  13. Stevens RB, Ansite JD, Lokeh A, Rossini TJ, Mills CD, Sutherland DE: Expression of intrahepatic inducible nitric oxide synthetase mRNA correlates with production of nitric oxide during intraportal isogeneic and allogeneic rat islet transportation. Transplant Proc 1995;27:615, 616.

    PubMed  CAS  Google Scholar 

  14. Stevens RB, Ansite JD, Mills CD, Lokeh A, Rossini TJ, Saxena M, Brown RR, Sutherland DE: Nitric oxide mediates early dysfunction of rat and mouse islets after transplantation. Transplantation 1996; 61:1740–1749.

    Article  PubMed  CAS  Google Scholar 

  15. Xenos ES, Stevens RB, Sutherland DE, Lokeh A, Ansite JD, Casanova D, Gores PF, Platt JL: The role or nitric oxide in IL-1 beta-mediated dysfunction of rodent islets of Langerhans: implications for the function of in trahepatic islet grafts. Transplantation 1994;57:1208–1212.

    Article  PubMed  CAS  Google Scholar 

  16. Thomas F, Contreras J, Bilbao G, Invarardi L, Thomas J: An improved technique for isolating pig islets: the importance of tensegrity in islet long-term culture viability. Transplant Proc 1999;31:633, 634.

    Article  PubMed  CAS  Google Scholar 

  17. Thomas F, Wu J, Thomas JM: Apoptosis and organ transplantation. Curr Opin Organ Transplant 2000;5:35–41.

    Article  Google Scholar 

  18. Thomas F, Wu J, Contreras JL, Smyth C, Bilbao G, He J, Thomas J: A tripartite anoikis-like mechanism causes early isolated islet apoptosis. Surgery 2001;130: 333–338.

    Article  PubMed  CAS  Google Scholar 

  19. Contreras JL, Bilbao G, Smyth CA, Jiang XL, Eckhoff DE, Jenkins SM, Thomas FT, Curiel DT, Thomas JM: Cytoprotection of pancreatic islets before and soon after transplantation by gene transfer of the anti-apoptotic Bcl-2gene. Transplantation 2001; 71:1015–1023.

    Article  PubMed  CAS  Google Scholar 

  20. Contreras JL, Bilbao G, Smyth C, Eckhoff DE, Xiang XL, Jenkins S, Cartner S, Curiel DT, Thomas FT, Thomas JM: Gene transfer of the Bcl-2 gene confers cytoprotection to isolated adult porcine pancreatic islets exposed to xenoreactive antibodies and complement. Surgery 2001;130:166–174.

    Article  PubMed  CAS  Google Scholar 

  21. Ryan EA, Lakey JR, Rajotte RV, Korbutt GS, Kin T, Imes S, Rabinovitch A, Elliott JF, Bigam D, Kneteman NM, Warnock GL, Larsen I, Shapiro AM: Clinical outcomes and insulin secretion after islet transplantation with the Edmonton protocol. Diabetes 2001;50:710–719.

    Article  PubMed  CAS  Google Scholar 

  22. Shapiro AM, Lakey JR, Ryan EA, Korbutt GS, Toth E, Warnock GL, Kneteman NM, Rajotte RV: Islet transplantation in seven patients with type I diabetes mellitus using a glucocorticoid-free immunosuppressive regimen. N Engl J Med 2000;343:230–238.

    Article  PubMed  CAS  Google Scholar 

  23. Thomas JM, Contreras JL, Smyth CA, Lobashevsky A, Jenkins S, Hubbard WJ, Eckhoff DE, Stavrou S, Neville DM Jr, Thomas FT: Successful reversal of streptozotocin-induced diabetes with stable allogeneic islet function in a preclinical model of type I diabetes. Diabetes 2001;50:1227–1236.

    Article  PubMed  CAS  Google Scholar 

  24. Thomas FT, Ricordi C, Contreras JL, Hubbard WJ, Jiang XL, Eckhoff DE, Cartner S, Bilbao G, Neville DM Jr, Thomas JM: Reversal of naturally occurring diabetes in primates by unmodified islet xenografts without chronic immunosuppression. Transplantation 1999;67:846–854.

    Article  PubMed  CAS  Google Scholar 

  25. Thomas JM, Hubbard WJ, Sooudi SK, Thomas FT: STEALTH matters: a novel paradigm of durable primate allograft tolerance. Immunol Rev 2001;183:223–233.

    Article  PubMed  CAS  Google Scholar 

  26. Thomas JM, Neville DM, Contreras JL, Eckhoff DE, Meng G, Lobashevsky AL, Wang PX, Huang ZQ, Verbanac KM, Haisch CE, Thomas FT: Preclinical studies of allograft tolerance in rhesus monkeys: a novel anti-CD3-immunotoxin given peritransplant with donor bone marrow induces operational tolerance to kidney allografts. Transplantation 1997;64:124–135.

    Article  PubMed  CAS  Google Scholar 

  27. Hubbard WJ, Moore JK, Contreras JL, Smyth CA, Chen ZW, Lobashevsky AL, Nagata K, Neville DM Jr, Thomas JM: Phenotypic and functional analysis of T-cell recovery after anti-CD3 immunotoxin treatment for tolerance induction in rhesus macaques. Hum Immunol 2001;62:479–487.

    Article  PubMed  CAS  Google Scholar 

  28. Thomas JM, Contreras JL, Jiang XL, Eckhoff DE, Wang PX, Hubbard WJ, Lobashevsky AL, Wang W, Asiedu C, Stavrou S, Cook WJ, Robbin ML, Thomas FT, Neville DM Jr: Peritransplant tolerance induction in macaques: early events reflecting the unique synergy between immunotoxin and deoxyspergualin. Transplantation 1999;68:1660–1673.

    Article  PubMed  CAS  Google Scholar 

  29. Thomas JM, Eckhoff DE, Contreras JL, Lobashevsky AL, Hubbard WJ, Moore JK, Cook WJ, Thomas FT, Neville DM Jr: Durable donor-specific T and B cell tolerance in rhesus macaques induced with peritransplantation anti-CD3 immunotoxin and deoxyspergualin: absence of chronic allograft nephropathy. Transplantation 2000;69:2497–2503.

    Article  PubMed  CAS  Google Scholar 

  30. Kenyon NS, Chatzipetrou M, Masetti M, Ranuncoli A, Oliveira M, Wagner JL, Kirk AD, Harlan DM, Burkly LC, Ricordi C: Longterm survival and function of intrahepatic islet allografts in rhesus monkeys treated with humanized anti-CD154. Proc Natl Acad Sci USA 1999;96:8132–8137.

    Article  PubMed  CAS  Google Scholar 

  31. Montgomery SP, Hale DA, Hirshberg B, Harlan DM, Kird AD: Preclinical evaluation of tolerance induction protocols and islet transplantation in non-human primates. Immunol Rev 2001;183: 214–222.

    Article  PubMed  CAS  Google Scholar 

  32. Laskowski I, Pratschke J, Wilhelm MJ, Gasser M, Tilney NL: Molecular and cellular events associated with ischemia/reperfusion injury. Ann Transplant 2000;5:29–35.

    PubMed  CAS  Google Scholar 

  33. Thomas F, Contreras J, Ricordi C, Ranuneolia A, Cartner S, Eckhoff D, Huang Z, Neville D, Thomas J: Reversal of naturally occurring insulinopenic dia betes and induction of isolated islet xenograft tolerance in a preclinical study. Transplant Proc 1999;31:637, 638.

    Article  PubMed  CAS  Google Scholar 

  34. Sun Y, Ma X, Zhou D, Vacek I, Sun AM: Normalization of diabetes in spontaneously diabetic cynomologus monkeys by xenografts of microencapsulated porcine islets without immuno suppression. J Clin Invest 1996;98:1417–1422.

    Article  PubMed  CAS  Google Scholar 

  35. Contreras JL, Eckhoff DE, Cartner S, Bilbao G, Ricordi C, Neville DM Jr, Thomas FT, Thomas JM: Long-term functional islet mass and metabolic function after xeno islet transplantation in primates. Transplantation 2000;69: 195–201.

    Article  PubMed  CAS  Google Scholar 

  36. Joziasse DH, Oriol R: Xeno-transplantation: the importance of the Gal alpha 1,3 Gal epitope in hyperacute vascular rejection. Biochim Biophys Acta 1999;1455: 403–418.

    PubMed  CAS  Google Scholar 

  37. Bach FH: Xeno transplantation: problems and prospects. Annu Rev Med 1998;49:301–310.

    Article  PubMed  CAS  Google Scholar 

  38. Henretta J, McFadden T, Pittman K, Thomas J, Thomas F: Six- to eight-monthsurvival of discordant pig islet xeno grafts documented by differential species, insulin, and C-peptide in animals given short-term immunosuppression. Transplant Proc 1994;26:1138, 1139.

    PubMed  CAS  Google Scholar 

  39. Wennberg L, Song Z, Bennet W, Zhang J, Nava S, Sundberg B, Bari S, Groth CG, Korsgren O: Diabetic rats transplanted with adult porcine islets and immuno-suppressed with cyclosporine A, mycophenolate mofetil, and leflunomide remain normoglycemic for up to 100 days. Transplantation 2001;71:1024–1033.

    Article  PubMed  CAS  Google Scholar 

  40. Benoist C, Mathis D: Cell death mediators in autoimmune diabetes—no shortage of suspects. Cell 1997;89:1–3.

    Article  PubMed  CAS  Google Scholar 

  41. Bosi E, Braghi S, Maffi P, Scirpoli M, Bertuzzi F, Pozza G, Secchi A, Bonifacio E: Autoantibody response to islet transplantation in type 1 diabetes. Diabetes 2001;50:2464–2471.

    Article  PubMed  CAS  Google Scholar 

  42. Sutherland DE, Gruessner RW, Dunn DL, Matas AJ, Humar A, Kandaswamy R, Mauer SM, Kennedy WR, Goetz FC, Robertson RP, Gruessner AC, Najarian JS: Lessons learned from more than 1000 pancreas transplants at a single institution. Ann Surg 2001;233:463–501.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Frank T. Thomas MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Thomas, F.T., Hutchings, A., Contreras, J. et al. Islet transplantation in the twenty-first century. Immunol Res 26, 289–296 (2002). https://doi.org/10.1385/IR:26:1-3:289

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1385/IR:26:1-3:289

Key words

Navigation