Hering Bernhard J
Diabetes Institute for Immunology and Transplantation, Department of Surgery, University of Minnesota, Minneapolis, Minnesota 55455, USA.
Transplantation. 2005 May 27;79(10):1296-7. doi: 10.1097/01.tp.0000157321.55375.86.
For islet transplants to complete the transition from clinical research to clinical care restoration of insulin independence must be achieved--as with pancreas transplants--with a single donor. To achieve this critical milestone more consistently it will be imperative to pursue the following complementary strategies simultaneously: 1) enhancing the metabolic potency, inflammatory resilience, and immune stealth of isolated islets; 2) inhibiting the thrombotic and inflammatory responses to transplanted islets; and 3) achieving immune protection with strategies lacking diabetogenic side effects. Maintaining insulin independence will be a different challenge requiring us to clarify whether failure of initially successful islet allografts in type 1 diabetes is related: to 1) failure of immunosuppressive regimens to control alloimmunity and autoimmunity; 2) failure of islet regeneration in the presence of currently applied immunosuppressive regimens; and/or 3) failure of islet neogenesis in the absence of an adequate mass and viability of co-transplanted/engrafted islet precursor cells.
对于胰岛移植而言，要实现从临床研究到临床治疗的转变，必须像胰腺移植一样，通过单一供体实现胰岛素自主性的恢复。为了更持续地达成这一关键里程碑，迫切需要同时推行以下互补策略：1）增强分离胰岛的代谢能力、炎症耐受性和免疫隐身性；2）抑制对移植胰岛的血栓形成和炎症反应；3）采用无致糖尿病副作用的策略实现免疫保护。维持胰岛素自主性将是一项不同的挑战，这要求我们明确1型糖尿病中最初成功的胰岛同种异体移植失败是否与以下因素有关：1）免疫抑制方案未能控制同种免疫和自身免疫；2）在当前应用的免疫抑制方案存在的情况下胰岛再生失败；和/或3）在共移植/植入的胰岛前体细胞数量不足且活力不佳的情况下胰岛新生失败。
