Has the promise of islet transplantation to treat diabetes been fully realised? Not yet, according to a Viewpoint article to be published in the diabetes-themed January 2007 issue of Nature Clinical Practice Endocrinology & Metabolism, in which Piotr Witkowski and Kevan Herold discuss current practice and conclude that the procedure remains far from perfect. They highlight several areas of research that could yield beneficial results for patients.
Type 1 - or insulin-dependent - diabetes mellitus occurs when the insulin-producing islet cells of the pancreas are destroyed by the patient's own immune system. The condition often occurs at a young age and requires life-long treatment with insulin. Islet transplantation aims to replace the damaged cells with healthy donor tissue, allowing recipients to live without daily insulin injections. But as Witkowski and Herold point out, the beneficial effects of islet transplantation are rarely sustained. The procedure is also associated with harmful effects, such as kidney failure, and is not suitable for all patients.
Intensive efforts are underway to improve the outcome for transplant recipients. Shortage of donor tissue is a major hurdle and researchers are seeking alternative sources, such as islet cells grown in the laboratory. Although the long-term benefits of islet transplantation have fallen short of initial expectations of a cure, Witkowski and Herold conclude that the prospects look good as the National Institutes of Health are committed to establishing dedicated islet isolation and resource centres.
Kevan C Herold (Yale University School of Medicine, New Haven, CT, USA)
Vicky Heath (Associate Editor, Nature Clinical Practice Endocrinology & Metabolism)
(C) Nature Clinical Practice Endocrinology & Metabolism press release.
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