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Question:

From Russia:

I would kindly ask you to inform me about the new methods of the medical treatment of diabetes by transplantation of beta cells and by transplantation of genes. What are the contents, results and clinical applications of both of new methods?

Answer:

Even recognising the tiresome burden of daily medication and home blood glucose monitoring, the optimum treatment for the great majority of people with diabetes is still to try to achieve good blood glucose control with insulin or oral medications plus a regimen of diet and exercise combined of course with appropriate blood sugar checks and the supervision of an experienced team.

Gene therapy continues to be an enticing concept; but without a great deal more research it is not, at this time, a clinical possibility.

To review the status of islet cell transplantation in any detail you would have to make a search of the medical literature in PubMed; but very briefly, the current position is as follows. Whole organ cadaveric transplants with immunosuppression now have a success rate of 80% or so after five years. The procedure is usually reserved for Type I Diabetics who already have end stage kidney complications and of course the availability of organs is limited which would create a problem for someone domiciled in Russia.

Until recently islet cell allografts (i.e., from another person) had had a survival rate of around 25%. However, with new technics for isolating islet cells that are more viable, with intraportal implantation, and with more refined immunosuppressive regimens, the success rate has been substantially improved. With the addition of donor bone marrow transplants, which increases tolerance to the graft, immunosuppression can usually be discontinued within a year. The procedure is still considered experimental; but you might wish to write to The Diabetes Research Institute, Miami, Florida, USA. for further details.

To get around the problem of a limited supply of pancreatic donor tissue there have been many attempts to use xenograft (mostly porcine) islets that have been protected against rejection by the recipient's immune system by enclosing them in a variety of membranes. Short term survival in animals has been repeatedly demonstrated; but for a number of reasons experience in man has been very limited indeed and the procedure is not yet approved in the USA.

DO'B

Original posting 10 May 1998
Posted to Research: Cure

  
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Last Updated: Tuesday April 06, 2010 15:08:58
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