Agarwal Avinash, Brayman Kenneth L
Department of Surgery, University of Virginia, Charlottesville, Virginia.
Semin Intervent Radiol. 2012 Jun;29(2):90-8. doi: 10.1055/s-0032-1312569.
Despite modern medical breakthroughs, diabetes mellitus is a worldwide leading cause of morbidity and mortality. Definitive surgical treatment of diabetes mellitus was established with the advent and refinement of clinical pancreas transplantation in the 1960s. During the following decades, critical discoveries involving islet isolation and engraftment took place. Clinical islet cell transplantation represents the potential for reduced insulin requirements and debilitating hypoglycemic episodes without the morbidity of surgery. Unfortunately, islet cell transplantation was unable to achieve comparable results with solid organ transplantation. This was until the Edmonton protocol (steroid-free immunosuppression) was described, which demonstrated that islet cell transplantation could be a viable alternative to pancreas transplantation. Significant advances in islet purification techniques and novel immunomodulatory agents have since renewed interest in islet cell transplantation. Yet the field is still challenged by a limited supply of islet cells, inadequate engraftment, and the deleterious effects of chronic immunosuppression. This article discusses the history and the current status of clinical islet cell transplantation.
尽管现代医学取得了突破，但糖尿病仍是全球发病和死亡的主要原因。20世纪60年代，随着临床胰腺移植的出现和完善，确立了糖尿病的确定性外科治疗方法。在随后的几十年里，发生了涉及胰岛分离和移植的重大发现。临床胰岛细胞移植显示出减少胰岛素需求和严重低血糖发作的可能性，且无手术相关并发症。不幸的是，胰岛细胞移植未能取得与实体器官移植相当的效果。直到埃德蒙顿方案（无类固醇免疫抑制）被描述出来，该方案证明胰岛细胞移植可以成为胰腺移植的可行替代方案。此后，胰岛纯化技术和新型免疫调节药物的重大进展重新激发了人们对胰岛细胞移植的兴趣。然而，该领域仍然面临着胰岛细胞供应有限、植入不足以及慢性免疫抑制的有害影响等挑战。本文讨论了临床胰岛细胞移植的历史和现状。
