Islet Transplantation Unit, Diabetes Research Institute, Ospedale San Raffaele, Milan, Italy.
Diabetes. 2013 Oct;62(10):3523-31. doi: 10.2337/db13-0465. Epub 2013 Jun 3.
The liver is the current site of choice for pancreatic islet transplantation, even though it is far from being ideal. We recently have shown in mice that the bone marrow (BM) may be a valid alternative to the liver, and here we report a pilot study to test feasibility and safety of BM as a site for islet transplantation in humans. Four patients who developed diabetes after total pancreatectomy were candidates for the autologous transplantation of pancreatic islet. Because the patients had contraindications for intraportal infusion, islets were infused in the BM. In all recipients, islets engrafted successfully as shown by measurable posttransplantation C-peptide levels and histopathological evidence of insulin-producing cells or molecular markers of endocrine tissue in BM biopsy samples analyzed during follow-up. Thus far, we have recorded no adverse events related to the infusion procedure or the presence of islets in the BM. Islet function was sustained for the maximum follow-up of 944 days. The encouraging results of this pilot study provide new perspectives in identifying alternative sites for islet infusion in patients with type 1 diabetes. Moreover, this is the first unequivocal example of successful engraftment of endocrine tissue in the BM in humans.
肝脏是目前胰岛移植的首选部位，尽管它远非理想选择。我们最近在小鼠中表明，骨髓（BM）可能是肝脏的有效替代物，在这里我们报告了一项初步研究，以测试将 BM 作为胰岛移植部位在人类中的可行性和安全性。四名在全胰切除术后发生糖尿病的患者是接受自体胰岛移植的候选者。由于患者门静脉内输注存在禁忌症，因此将胰岛输注到 BM 中。在所有接受者中，胰岛成功植入，表现为移植后可测量的 C 肽水平和 BM 活检样本中存在产生胰岛素的细胞的组织病理学证据或内分泌组织的分子标志物，在随访期间进行分析。到目前为止，我们没有记录到与输注过程或 BM 中存在胰岛相关的不良事件。胰岛功能持续了最长 944 天的随访时间。这项初步研究的令人鼓舞的结果为 1 型糖尿病患者确定胰岛输注的替代部位提供了新的视角。此外，这是首例在人类中明确证明内分泌组织在 BM 中成功植入的例子。
