Narang Ajit S, Mahato Ram I
Department of Pharmaceutical Sciences, University of Tennessee Health Science Center, 26 S. Dunlap St., Feurt Building, Room 413, Memphis, TN 38163, USA.
Pharmacol Rev. 2006 Jun;58(2):194-243. doi: 10.1124/pr.58.2.6.
Islet transplantation may be used to treat type I diabetes. Despite tremendous progress in islet isolation, culture, and preservation, the clinical use of this modality of treatment is limited due to post-transplantation challenges to the islets such as the failure to revascularize and immune destruction of the islet graft. In addition, the need for lifelong strong immunosuppressing agents restricts the use of this option to a limited subset of patients, which is further restricted by the unmet need for large numbers of islets. Inadequate islet supply issues are being addressed by regeneration therapy and xenotransplantation. Various strategies are being tried to prevent beta-cell death, including immunoisolation using semipermeable biocompatible polymeric capsules and induction of immune tolerance. Genetic modification of islets promises to complement all these strategies toward the success of islet transplantation. Furthermore, synergistic application of more than one strategy is required for improving the success of islet transplantation. This review will critically address various insights developed in each individual strategy and for multipronged approaches, which will be helpful in achieving better outcomes.
胰岛移植可用于治疗I型糖尿病。尽管在胰岛分离、培养和保存方面取得了巨大进展，但由于移植后胰岛面临的挑战，如未能实现血管再生和胰岛移植的免疫破坏，这种治疗方式的临床应用受到限制。此外，对终身强效免疫抑制剂的需求将该治疗方案的使用限制在有限的患者亚组中，而大量胰岛的需求未得到满足进一步限制了其应用。再生疗法和异种移植正在解决胰岛供应不足的问题。人们正在尝试各种策略来防止β细胞死亡，包括使用半透性生物相容性聚合物胶囊进行免疫隔离和诱导免疫耐受。胰岛的基因改造有望补充所有这些策略，以实现胰岛移植的成功。此外，需要协同应用多种策略来提高胰岛移植的成功率。本综述将批判性地探讨每种单独策略以及多管齐下方法中产生的各种见解，这将有助于取得更好的结果。
