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Auto-islet Transplant

Michael Quartuccio, Erica Hall, Vikesh Singh, Martin A Makary, Kenzo Hirose, Niraj Desai, Christi Walsh, Daniel Warren, Zhaoli Sun, Ellen Stein, Rita R Kalyani
CONTEXT: Total pancreatectomy with islet auto transplantation (TPIAT) is a treatment for medically refractory chronic pancreatitis that can prevent postsurgical diabetes in a subset of patients. Predictors of insulin independence are needed for appropriate patient selection and counseling. OBJECTIVE: To explore glycemic predictors of insulin independence after TPIAT. DESIGN: A prospective cohort of patients undergoing TPIAT from 2011-2016...
November 21, 2016: Journal of Clinical Endocrinology and Metabolism
Cornelis R van der Torren, Arnaud Zaldumbide, Gaby Duinkerken, Simone H Brand-Schaaf, Mark Peakman, Geert Stangé, Laura Martinson, Evert Kroon, Eugene P Brandon, Daniel Pipeleers, Bart O Roep
AIMS/HYPOTHESIS: To overcome the donor shortage in the treatment of advanced type 1 diabetes by islet transplantation, human embryonic stem cells (hESCs) show great potential as an unlimited alternative source of beta cells. hESCs may have immune privileged properties and it is important to determine whether these properties are preserved in hESC-derived cells. METHODS: We comprehensively investigated interactions of both innate and adaptive auto- and allo-immunity with hESC-derived pancreatic progenitor cells and hESC-derived endocrine cells, retrieved after in-vivo differentiation in capsules in the subcutis of mice...
January 2017: Diabetologia
Cornelis R van der Torren, Jessica S Suwandi, DaHae Lee, Ernst-Jan T van 't Wout, Gaby Duinkerken, Godelieve Swings, Arend Mulder, Frans H J Claas, Zhidong Ling, Pieter Gillard, Bart Keymeulen, Peter In 't Veld, Bart O Roep
Transplantation of islet allografts into type 1 diabetic recipients usually requires multiple pancreas donors to achieve insulin independence. This adds to the challenges of immunological monitoring of islet transplantation currently relying on surrogate immune markers in peripheral blood. We investigated donor origin and infiltration of islets transplanted in the liver of a T1D patient who died of hemorrhagic stroke four months after successful transplantation with two intraportal islet grafts combining six donors...
October 10, 2016: Cell Transplantation
Chirag S Desai, Khalid M Khan, Wanxing Cui
Total pancreatectomy and islet auto transplantation is a good option for chronic pancreatitis patients who suffer from significant pain, poor quality of life, and the potential of type 3C diabetes and pancreatic cancer. Portal vein thrombosis is the most feared complication of the surgery and chances are increased if the patient has a hypercoagulable disorder. We present a challenging case of islet auto transplantation from our institution. A 29-year-old woman with plasminogen activator inhibitor-4G/4G variant and a clinical history of venous thrombosis was successfully managed with a precise peri- and post-operative anticoagulation protocol...
June 24, 2016: World Journal of Transplantation
Paolo Magistri, Sara Andreani, Domenico Lo Conte, Giovanni Carlo Ferrari, Antonello Forgione, Raffaele Pugliese
INTRODUCTION: Islets auto-transplantation (IAT) is a well-known procedure that may improve glycemic control after total or completion pancreatectomy compared to insulin therapy alone. CASE REPORT: We herein report our experience in IAT with the case of a sixty years old woman underwent completion pancreatectomy for recurrent pancreatitis. She received IAT by percutaneous trans-hepatic intra-portal injection. The patient recovered well, except for a surgical wound infection that was treated with vacuum therapy...
2016: Annali Italiani di Chirurgia
Walter G Park
PURPOSE OF REVIEW: To summarize observations in clinical chronic pancreatitis in the past year. RECENT FINDINGS: A predisposing genetic mutation was identified in 67% of cases of pediatric chronic pancreatitis. A novel susceptibility gene involving a hybrid allele is associated with idiopathic chronic pancreatitis. ABO blood type B and FUT2 nonsecretor status is associated with asymptomatic hyperlipasemia and chronic pancreatitis. Alcohol consumption impairs cystic fibrosis transmembrane conductance regulator (CFTR) activity leading to decreased bicarbonate secretion and patients with susceptible CFTR mutations can develop clinical pancreatitis...
June 22, 2016: Current Opinion in Gastroenterology
Massimo Venturini, Claudio Sallemi, Caterina Colantoni, Giulia Agostini, Gianpaolo Balzano, Antonio Esposito, Antonio Secchi, Francesco De Cobelli, Massimo Falconi, Lorenzo Piemonti, Paola Maffi, Alessandro Del Maschio
OBJECTIVE: Islet allotransplantation is a less invasive alternative to surgical pancreas transplantation for Type 1 diabetes, while percutaneous intraportal islet autotransplantation (PIPIAT) is usually performed after pancreatic surgery to prevent diabetes. Our aim was to assess the feasibility, radiological aspects, complications and clinical outcome of PIPIAT following pancreatic surgery for not only chronic pancreatitis but also benign and malignant nodules. METHODS: From 2008 to 2012, 41 patients were enrolled for PIPIAT 12-48 h after pancreatic surgery (extended pancreatic surgery for chronic pancreatitis and benign/malignant neoplasms)...
August 2016: British Journal of Radiology
Sofie De Groef, Willem Staels, Naomi Van Gassen, Marie Lemper, Yixing Yuchi, Mozhdeh Sojoodi, Leen Bussche, Yves Heremans, Gunter Leuckx, Nico De Leu, Mark Van de Casteele, Luc Baeyens, Harry Heimberg
The generation of beta(-like) cells to compensate for their absolute or relative shortage in type 1 and type 2 diabetes is an obvious therapeutic strategy. Patients first received grafts of donor islet cells over 25 years ago, but this procedure has not become routine in clinical practice because of a donor cell shortage and (auto)immune problems. Transplantation of differentiated embryonic and induced pluripotent stem cells may overcome some but not all the current limitations. Reprogramming exocrine cells towards functional beta(-like) cells would offer an alternative abundant and autologous source of beta(-like) cells...
September 2016: Diabetologia
Edgardo D Rivera Rivera, Ankur Chugh, Jonathon Cordova, Sona Young
A 13-year-old boy with a strong family history of hereditary pancreatitis was found to have a PRSS1 mutation after being tested at age 5 years during his first documented incident of pancreatitis. Since then, a multidisciplinary team has been treating him for the diagnosis of hereditary pancreatitis. His pain episodes increased in severity over the past several months such that the pain began to severely interfere with his daily life. After extensive discussion, a total pancreatectomy with auto islet cell transplant was performed...
February 2016: Pediatric Annals
Younghoon Kwon, Ryan J Koene, Caroline Cross, Jennifer McEntee, Jaime S Green
BACKGROUND: Factitious fever is extremely challenging to diagnose in patients with complicated chronic medical problems, and represents as much as 10% of fevers of unknown origin. Factitious fever caused by self-injecting oral medications through indwelling central catheters is a diagnostic challenge. CASE PRESENTATION: We present a 32-year-old Caucasian female with history of short gut syndrome, malnutrition requiring total parental nutrition, and pancreatic auto-islet transplant with fever of unknown origin...
July 12, 2015: BMC Research Notes
George K John, Vikesh K Singh, Pankaj J Pasricha, Amitasha Sinha, Elham Afghani, Daniel Warren, Zhaoli Sun, Niraj Desai, Christi Walsh, Rita R Kalyani, Erica Hall, Kenzo Hirose, Martin A Makary, Ellen M Stein
BACKGROUND: The prevalence and factors associated with delayed gastric emptying (DGE) in patients undergoing total pancreatectomy with islet auto transplantation (TP-IAT) for chronic pancreatitis are unknown. METHODS: A retrospective study of all patients who underwent TP-IAT at Johns Hopkins Hospital (JHH) from August 2011 to November 2014 was performed. The International Study Group of Pancreatic Surgery (ISGPS) clinical grading of DGE was used in this study. KEY RESULTS: A total of 39 patients with chronic pancreatitis underwent TP-IAT during the study period...
July 2015: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Massimo Venturini, Paola Maffi, Giulia Querques, Giulia Agostini, Lorenzo Piemonti, Sandro Sironi, Francesco De Cobelli, Paolo Fiorina, Antonio Secchi, Alessandro Del Maschio
Percutaneous intra-portal islet transplantation (PIPIT) is a less invasive, safer, and repeatable therapeutic option for brittle type 1 diabetes, compared to surgical pancreas transplantation. Hepatic steatosis is a consequence of the islet engraftment but it is curiously present in a limited number of patients and its meaning is controversial. The aims of this study were to assess hepatic steatosis at ultrasound (US) after PIPIT investigating its relationship with graft function and its role in predicting the clinical outcome...
August 2015: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
Michal Radomski, Amer H Zureikat
Chronic pancreatitis is a challenging disease; the constellation of chronic abdominal pain and metabolic derangements present unique difficulties to the treating physician. Initial treatment revolves around lifestyle modification, pain control, and management of exocrine insufficiency. In refractory cases, total pancreatectomy with islet cell auto transplantation (TP-IAT) is an option for patients with diffuse disease not amenable to subtotal pancreatectomy or a decompressive (drainage) operation. This procedure aspires to alleviate pain and avoid surgically induced brittle diabetes, a morbid complication of total pancreatectomy alone...
January 2015: JOP: Journal of the Pancreas
Annika C Sun, Dawei Ou, Dan S Luciani, Garth L Warnock
Auto- and alloreactive T cells are major culprits that damage β-cells in type 1 diabetes (T1D) and islet transplantation. Current immunosuppressive drugs can alleviate immune-mediated attacks on islets. T cell co-stimulation blockade has shown great promise in autoimmunity and transplantation as it solely targets activated T cells, and therefore avoids toxicity of current immunosuppressive drugs. An attractive approach is offered by the newly-identified negative T cell co-signaling molecule B7-H4 which is expressed in normal human islets, and its expression co-localizes with insulin...
December 15, 2014: World Journal of Diabetes
Nathan W Zammit, Shane T Grey
A20 is most characteristically described in terms relating to inflammation and inflammatory pathologies. The emerging understanding of inflammation in the etiology of diabetes mellitus lays the framework for considering a central role for A20 in this disease process. Diabetes mellitus is considered a major health issue, and describes a group of common metabolic disorders pathophysiologically characterized by hyperglycemia. Within islets of Langherhans, the endocrine powerhouse of the pancreas, are the insulin-producing pancreatic beta-cells...
2014: Advances in Experimental Medicine and Biology
Noaman S Ali, R Matthew Walsh
Chronic pancreatitis is the result of irreversible damage to pancreatic acinar cells, and can result in debilitating chronic pain for patients. Treatment centers on pain relief, often with chronic narcotic use. Surgical therapy consists of both resection procedures to remove affected pancreatic parenchyma and drainage procedures to facilitate drainage of the main pancreatic duct. Total pancreatectomy historically was utilized in extreme cases due to the brittle glucose control that followed from the total loss of islet cells...
September 2014: Current Treatment Options in Gastroenterology
Amer H Zureikat, Trang Nguyen, Brian A Boone, Martin Wijkstrom, Melissa E Hogg, Abhinav Humar, Herbert Zeh
BACKGROUND: Total pancreatectomy (TP) is a morbid but sometimes necessary operation. Robotic TP is not often reported but may harbor some advantages compared to the open approach. This manuscript details a single institution's outcomes and technique of robotic TP. An accompanying video demonstrates a robotic TP with auto islet cell transplantation (IAT) in which (1) the arterial blood supply and venous drainage are kept intact until the last step of the TP to minimize warm ischemia time and (2) extirpation of the entire pancreas is performed without dividing the pancreatic neck to maximize islet recovery...
January 2015: Surgical Endoscopy
Srinath Chinnakotla, David M Radosevich, Ty B Dunn, Melena D Bellin, Martin L Freeman, Sarah J Schwarzenberg, A N Balamurugan, Josh Wilhelm, Barbara Bland, Selwyn M Vickers, Gregory J Beilman, David E R Sutherland, Timothy L Pruett
BACKGROUND: Chronic pancreatitis is a debilitating disease resulting from many causes. The subset with hereditary/genetic pancreatitis (HGP) not only has chronic pain, but also an increased risk for pancreatic cancer. Long-term outcomes of total pancreatectomy (TP) and islet autogeneic transplantation (IAT) for chronic pancreatitis due to HGP are not clear. STUDY DESIGN: We reviewed a prospectively maintained database of 484 TP-IATs from 1977 to 2012 at a single center...
April 2014: Journal of the American College of Surgeons
Neil H Bhayani, Laura M Enomoto, Jennifer L Miller, Gail Ortenzi, Jussuf T Kaifi, Eric T Kimchi, Kevin F Staveley-O'Carroll, Niraj J Gusani
BACKGROUND: In pancreatitis, total pancreatectomy (TP) is an effective treatment for refractory pain. Islet cell auto-transplantation (IAT) may mitigate resulting endocrinopathy. Short-term morbidity data for TP + IAT and comparisons with TP are limited. METHODS: This study, using 2005-2011 National Surgical Quality Improvement Program data, examined patients with pancreatitis or benign neoplasms. Morbidity after TP alone was compared with that after TP + IAT. RESULTS: In 126 patients (40%) undergoing TP and 191 (60%) patients undergoing TP + IAT, the most common diagnosis was chronic pancreatitis...
June 2014: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
J R F Abreu, B O Roep
Type 1 diabetes (T1D) is an autoimmune disease in which the insulin-producing beta-cells are destroyed. Islet or pancreas transplantation can restore insulin secretion and are established therapies for subgroups of T1D patients. Long-term insulin-independence is, however, hampered by recurrent autoimmunity and rejection. Accurate monitoring of these immune events is therefore of critical relevance for the timely detection of deleterious immune responses. The identification of relevant immune biomarkers of allo- and autoreactivity has allowed a more accurate monitoring of disease progression and responses to therapy at early stages, allowing proper therapeutic intervention, and possibly improvements in the success rate of islet and pancreas transplantation...
October 2013: Current Diabetes Reports
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