Studies of Fetal Porcine Islet-Like Cell Clusters—A Tissue Source for Xenotransplantation in Insulin-Dependent Diabetes Mellitus?
Insulin-dependent diabetes mellitus (IDDM) is an autoimmune disease characterized by the selective destruction of the insulin-producing β-cells from the pancreatic islets (Gepts, 1965; Eisenbarth, 1986). The disease is insidious, and does not become manifest until approximately 90% of the β-cells are lost. The disease can be treated with insulin which, despite its prolongation of life of the patients, cannot succesfully prevent long-term complications of the disease, such as blindness, nephropathy, neuropathy and cardiovascular disease. To obtain a strictly physiological minute-to-minute regulation of the glucose metabolism, the only possible treatment today is replacement of the lost pancreatic β-cells. This can be accomplished by transplantation of the whole pancreas, meaning that only 1% of the transplanted organ, i.e. the islets, are really necessary. This treatment is hampered by technical complications (Robertson, 1992), and to transplant only the needed endocrine component of the pancreas would therefore be preferable. The isolation and purification of islets from adult cadaveric human donors has now become sufficiently successful to warrant clinical trials (Gray et al., 1984, Ricordi et al., 1988), and a few patients have been, at least temporarily, cured of their disease (Scharp et al., 1991; Warnock et al., 1991). These results are encouraging since they demonstrate that this surgically simple procedure may offer a new treatment modality for IDDM. One major drawback with transplantations in IDDM is the immunogenicity of the implanted islets, which may result both in graft rejection and disease recurrence with the development of the underlying disease also in the graft (Gill and Lafferty, 1989).
KeywordsNeuropathy Glutamine Dexamethasone Cyclosporine Cyclophosphamide
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