Scientists in Miami have made an excellent advance in transplanting islet (pronounced “eye-let”) cells into people with Type 1 diabetes. Here’s the interesting work they’re doing and the major issues they still have to overcome.
Beta Cell Transplant
The Diabetes Research Institute (DRI) at the University of Miami looks just for a cure for Type 1. They’re not looking to manage it with better drugs or equipment. They wish to make it go away.
Up until now, the only people who have been “cured” of Type 1 diabetes are those who received a donor pancreas or donor islet cells to restore their insulin production. There are not many of these people, however such a transplant can be done. Frequently it does not work, however, and DRI is trying to fix that.
What is an islet cell transplant?
Islet cells are clusters of cells scattered throughout the pancreas that produce and release hormonal agents to help manage blood glucose. Most of the islets are beta cells, which produce insulin to get glucose into other cells. In Type 1 diabetes, a person’s beta cells are damaged, so no insulin can be produced. A person with Type 1 has to inject insulin for the rest of his life, with all the risks, costs, and effort that includes.
In theory, this problem could be fixed by transplanting new beta cells into the body, and in some fortunate people, transplanted beta cells have begun working. Some of these individuals have not had to inject insulin for many years. It’s a promising approach, however it has major restrictions.
Islet cell transplants have actually been around for more than 40 years, first in animals, then in human topics. Most of the time, the brand-new islet cells do not last long. Islet cells are delicate. They require a lot of oxygen and blood supply, and they require defense from immune attack and waste items. Just popping them in and leaving them doesn’t generally work.
Also read: Type 1 Diabetes Life Expectancy
A big problem is where to transplant them. Typically, researchers put them in the liver. Livers are simple to obtain to and have an excellent blood supply. But according to DRI, when islets are taken into the liver, inflammation establishes and threatens the life of the cells. Since the liver processes the majority of our wastes, the new islet cells are continuously exposed to harmful wastes and toxins processed there.
For these reasons, islet cell transplantation into the liver doesn’t work long-term for many people. DRI has been working on a concept they call the BioHub. The BioHub will be a “mini-organ” made out of a piece of omentum, a layer of fat that covers the organs in the lower abdomen. The omentum has a very good blood supply and can be quickly customized since it’s close to the surface area.
In the present version of the BioHub, DRI begins with a gel made out of blood plasma and an enzyme called thrombin. Thrombin assists blood clot. The transplanted beta cells are positioned in this gel, which is connected to a piece of omentum that is then folded over into a pouch. This develops a good, safe space for the beta cells to grow. The gel is gradually taken in by the body, leaving the healthy cells in place in their pouch.
Since beta cells require a lot oxygen, DRI researchers figured out how to supply it momentarily. They crafted a material that launches a lot of oxygen for the approximately six weeks it lasts. Meanwhile, the beta cells cause new blood vessels to grow and supply them with nutrients and oxygen. By the time the implanted oxygen is used up, the beta cells are being effectively provided by the body.
DRI happily announced last week that the first patient to get this procedure had the ability to stop all insulin after just two weeks, record time for a transplant patient. Hopefully, this improvement will last and she will be treated.
However will it last, or will her body immune system ruin the new cells, an issue called transplant rejection? Like almost all transplant receivers, she is presently on immune-suppressing drugs to prevent rejection, which might work however which also have numerous side effects and threats. DRI’s objective is to develop a BioHub that will not need immunosuppressants, but they haven’t achieved this yet.
One thought is that they might deliver very-low-dose immune-suppressing drugs directly into the pouch, hence avoiding the side effects of taking the drugs by mouth or IV. Another concept is to discover a method to “coat” the islet cells with protection from immune attack without obstructing their insulin production. DRI is working on both of these tracks, but for now, they still use the immune-suppressing drugs.
Even if this BioHub or a later version affects a treatment or near-cure of diabetes, it won’t be available to many individuals, unless the supply issue is solved. Where do we get these donor cells? So far, they are originating from dead donors. They cannot come from live donors due to the fact that the process of getting them out of the pancreas would damage or eliminate the donor.
A recipient needs millions of islets for a successful transplant. It normally takes two donor pancreases to obtain enough beta cells for one transplant. That’s a major obstacle for the BioHub.
It is hoped that stem cells can change donor cells at some time, however not yet. DRI and numerous other centers are dealing with turning stem cells into beta cells. They’re taking a look at stem cells from embryos, from bone marrow, and other sources.
It’s all amazing; it’s great, however unless you can get into a transplant research study, it’s quite far away.
For more information visit The Diabetes Research Institute (DRI) website.