Ridgway Daniel M, White Steven A, Nicholson Michael L, Kimber Rachel M
Division of Transplantation Surgery, Department of Surgery, University Hospitals of Leicester, Leicester, UK.
Treat Endocrinol. 2003;2(3):173-89. doi: 10.2165/00024677-200302030-00004.
Pancreatic islet cell transplantation as a treatment for diabetes has hitherto been confined to small patient cohorts with limited success. This article summarizes the results of islet cell transplantation before and after the advent of the new 'Edmonton protocol' of immunosuppression and management of the donor pancreas. Adopting this regimen has achieved unprecedented success and renewed interest in this potential cure for diabetes. Central to recent improvements in the technique has been the transplantation of an adequate islet mass. Improved methods to procure, isolate, and purify islets for clinical use are now being adopted as a new 'gold standard'. The use of new immunosuppressive drugs has further improved clinical results. Corticosteroid sparing-based regimens, and agents such as humanized monoclonal antibodies, are likely to form the mainstay of immunosuppressive protocols with the aim of achieving donor-specific tolerance. Alternative sources of islet cells are also required to expand the technique in an era of reduced numbers of donor pancreata. Manipulation of stem cells and xenotransplantation may yet yield sufficient islets to overcome the problem of donor shortage. Islet cell transplantation now forms the basis of a prospective multicenter trial under the aegis of the Immune Tolerance Network. The results of this are awaited, but it appears that islet cell transplantation may yet emerge as an effective treatment option for some members of the diabetic population.
胰岛细胞移植作为治疗糖尿病的方法，迄今为止仅限于小规模患者群体，且成效有限。本文总结了在新的免疫抑制及供体胰腺管理的“埃德蒙顿方案”出现前后胰岛细胞移植的结果。采用该方案已取得了前所未有的成功，并重新激发了人们对这种糖尿病潜在治愈方法的兴趣。近期技术改进的核心在于移植足够数量的胰岛。目前，为临床使用而获取、分离和纯化胰岛的改进方法正被采纳为新的“金标准”。新型免疫抑制药物的使用进一步改善了临床结果。以减少皮质类固醇使用为基础的方案，以及如人源化单克隆抗体等药物，可能会成为免疫抑制方案的主要支柱，旨在实现供体特异性耐受。在供体胰腺数量减少的时代，还需要胰岛细胞的替代来源来推广这项技术。干细胞操作和异种移植或许能产生足够的胰岛以克服供体短缺问题。胰岛细胞移植目前是在免疫耐受网络支持下的一项前瞻性多中心试验的基础。试验结果尚待揭晓，但胰岛细胞移植似乎可能会成为部分糖尿病患者的有效治疗选择。
