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Insulin Independence Following Isolated Islet Transplantation and Single Islet Infusions
Open accessAbstract
Objective To restore islet function in patients whose labile diabetes subjected them to frequent dangerous episodes of hypoglycemic unawareness, and to determine whether multiple transplants are always required to achieve insulin independence. Summary background data The recent report by the Edmonton group documenting restoration of insulin independence by islet transplantation in seven consecutive patients with type 1 diabetes differed from previous worldwide experience of only sporadic success. In the Edmonton patients, the transplanted islet mass critical for success was approximately more than 9,000 IEq/kg of recipient body weight and required two or three separate transplants of islets isolated from two to four cadaveric donors. Whether the success of the Edmonton group can be recapitulated by others, and whether repeated transplants using multiple donors will be a universal requirement for success have not been reported. Methods The authors report their treatment with islet transplantation of nine patients whose labile type 1 diabetes was characterized by frequent episodes of dangerous hypoglycemia. Results In each of the seven patients who have completed the treatment protocol (i.e., one or if necessary a second islet transplant), insulin independence has been achieved. In five of the seven patients only a single infusion of islets was required. To date, only one recipient has subsequently lost graft function, after an initially successful transplant. This patient suff…
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“Assuming a similar dose as with human islets from deceased donors,175,176 on the order of 109 cells will be required per patient.”
From Developments in stem cell-derived islet replacement therapy for treating type 1 diabetes (2023) · cites this paper as [175]
Citations
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“The only way at present to restore sustained normoglycemia without the risk associated with hypoglycemia (as seen with intensive insulin therapy), and without procedural complications (as seen in pancreas transplantation), is to perform an isolated pancreatic islet transplant (PIT) (Bertuzzi et al. 1999; Bretzel et al…”
BackgroundPharmacologically regulated regeneration of functional human pancreatic islets.
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“Pancreatic islets were isolated using a modification of the automated Ricordi method [24].”
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“It has been suggested that treatments that reverse hyperglycemia may retard or even reverse these diabetic complications (Markmann et al., 2003).”
The spleen--a potential source of new islets for transplantation?
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“The volume of infused islets correlates to the duration of insulin independence post-transplant.(20) Therefore, a barrier to islet transplantation has been the need for recurrent islet infusions due to decreasing graft function over time.”
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“At present, clinical trials rely on blood glucose levels and metabolic tests before and after transplantation to gauge the therapeutic performance (8, 9).”
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“Despite significant advances in the islet isolation protocol, islets isolated from more than one donor pancreas are often required to achieve insulin-independent status (86), and a majority of islet transplant recipients return to some form of exogenous insulin usage within a few years of transplantation due to chroni…”
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“27,28 It would be useful to investigate the impact of infused islet mass, number of transplants and time between transplants on post-transplant insulin requirement further, in order to shed light on this.”
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“Because single donor insulin independence has also been reported in the absence of exenatide (8, 9), randomizedcontrolled trials remain necessary to determine whether exenatide use may be associated with long-term beneficial effects on islet graft function or survival.”
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“Generally, multiple islet donors are required in a single transplantation to achieve insulin independence (Shapiro et al , 2000; Markmann et al , 2003), primarily because a substantial portion of the transplanted islets undergo apoptosis due to the exposure to a toxic environment of hyperglycemia,…”
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Metadata
- Authors
- Markmann, J. F., Deng, S., Huang, X., Desai, N. M., Velidedeoglu, E. H., Lui, C., Frank, A., Markmann, E., Palanjian, M., Brayman, K., Wolf, B., Bell, E., Vitamaniuk, M., Doliba, N., Matschinsky, F., Barker, C. F., & Naji, A.
- Affiliations
- Hospital of the University of Pennsylvania (US)
- University of Pennsylvania (US)
- Children's Hospital of Philadelphia (US)
- University of Pennsylvania Health System (US)
- Corresponding author
- Markmann, James F.
- Deng, Shaoping
- Huang, Xiaolun
- Desai, Niraj M.
- Lui, Chengyang
- Frank, Adam
- Markmann, Eileen
- Palanjian, Maral
- Brayman, Kenneth
- Barker, Clyde F.
- Naji, Ali
- ORCID
- Venue
- Annals of Surgery
- Published
- 2003-06
- Volume
- 237
- Issue
- 6
- Pages
- 741-750
- ISSN
- 0003-4932 (ISSN-L)
- PMC
- PMC1514687
- OpenAlex
- W2324941813
- Cited by
- 175
- References
- 0
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 4 · 2023: 5 · 2021: 3 · 2019: 2 · 2018: 2 · 2017: 5 · 2016: 6 · 2015: 7 · 2014: 3 · 2013: 7 · 2012: 5
- FWCI
- 19.18
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Annals of Surgery (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of Pennsylvania
- National Center for Research Resources (M01-RR-00040, 1U42 RR 16600, M01RR000040, U42RR016600)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pancreatic function and diabetes
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- islet transplantation, insulin independence, type 1 diabetes, hypoglycemia, hypoglycemia unawareness, graft function, islet mass
- MeSH terms
- Adult, Blood Glucose, C-Peptide, Diabetes Mellitus, Type 1, Humans, Immunosuppressive Agents, Islets of Langerhans Transplantation, Recovery of Function
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