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Question:

From Portland, Oregon, USA:

My 6 year old son who is solidly in his honeymoon stage. Is there any research for those in the honeymoon stage in regard to their islets? Since in that stage the pancreas is producing its own insulin, and there must be some healthy islets left, can't those healthy ones be cloned for future transplantation so the body won't reject them?

Answer:

The possibility of prolonging the honeymoon period has been the subject of intense research over the last decade or so. There have been trials of a variety of compounds that were successful in averting diabetes in the NOD mouse, cortisone, BCG vaccine and nicotinamide to name just three. None of these were successful in a series of properly conducted trials. For a time a drug called cyclosporine looked very promising and was much in favour in Europe, especially in France; but it turned out that after two years it had the potential to damage the kidneys.

The emphasis at this stage is on screening first degree relatives of people with Type 1 Diabetes to find those who have certain antibodies that indicate that they are at high risk for clinical diabetes. Trials still have a long way to go; but preliminary reports indicate oral nicotinamide may have some effect and that either oral or small doses of subcutaneous insulin may also be of value. All this of course is at a stage before the honeymoon period.

The possibility that you suggest would at the present time not be possible. In the first place you would want to obtain a sufficiency of a person's own islets. This would be a challenge from just a biopsy; but if the system could be made to work it would be worth a partial resection of the pancreas. At the moment though it has not proved possible to multiply islet cells in culture. They can be kept alive for relatively short periods; but cannot yet be cultivated. Even if you could grow and harvest a sufficient number of 'iso-islets' for a transplant these would still be vulnerable to the basic autoimmune disorder that had triggered the damage in the first place. I wish I could be more encouraging; but an enormous amount of work is going on to improve the prospects of islet cell transplants, particularly of xenotransplants (i.e., islets from another species, a pig for example) which would be in plentiful supply. There has been some success with encapsulating the transplants in membranes that protect them from the recipient's immune system and also with preincubating the transplant cells in nicotinamide or in modifying their surface antigens.

DO'B

Original posting 15 Feb 98
Modified 21 Feb 1998


                 
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Last Updated: Tuesday April 06, 2010 15:08:56
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