
Allogene Inseltransplantation bei Diabetes mellitus Typ 1 - Aktueller Stand
Die Inseltransplantation stellt eine Therapieoption für eine sehr ausgewählte Gruppe von Patienten mit Typ 1 Diabetes mellitus (T1DM) dar, die trotz optimaler Insulintherapie nicht befriedigend behandelbar sind und unter häufigen und schwer kontrollierbaren Hypoglykämien leiden. Dabei ist das primäre Therapieziel der Inseltransplantation eine gute und stabile Glykämiekontrolle und die Vermeidung schwerer Hypoglykämien. Eine daraus resultierende weitere wichtige Zielstellung ist die Vermeidung bzw. Stabilisierung Diabetes-assoziierter Spätfolgen und die Verbesserung der Lebensqualität.
PD Dr. Barbara Ludwig gibt im Folgenden eine Übersicht über das Therapieverfahren, das am Universitätsklinikum Dresden durchgeführt wird:
Literatur
- Steffes MW, Sibley S, Jackson M, et al. Beta-cell function and the development of diabetes-related complications in the diabetes control and complications trial. Diabetes Care 2003; 26: 832-836
- Bjorgaas MR. Cerebral effects of severe hypoglycemia in young people with type 1 diabetes. Pediatr Diabetes 1111; 13: 100-107
- Zoungas S, Patel A, Chalmers J, et al. Severe hypoglycemia and risks of vascular events and death. N Engl J Med 1410; 363: 1410-1418
- Federlin K, Pozza G. Indications for clinical islet transplantation today and in the forseeable future--the diabetologist's point of view. J Mol Med (Berl) 1999; 77: 148-152
- Sollinger HW, Odorico JS, Becker YT, et al. One thousand simultaneous pancreas-kidney transplants at a single center with 22-year follow-up. Ann Surg 2009; 250: 618-630
- Gerber PA, Pavlicek V, Demartines N, et al. Simultaneous islet-kidney vs pancreas-kidney transplantation in type 1 diabetes mellitus: a 5 year single centre follow-up. Diabetologia 2008; 51: 110-119
- Ballinger WF, Lacy PE. Transplantation of intact pancreatic islets in rats. Surgery 1972; 72: 175-186
- Ryan EA, Paty BW, Senior PA, et al. Five-year follow-up after clinical islet transplantation. Diabetes 2005; 54: 2060-2069
- 2007 update on allogeneic islet transplantation from the Collaborative Islet Transplant Registry (CITR). Cell Transplant 2009; 18: 753-767
- Bromberg JS, Kaplan B, Halloran PF, et al. The islet transplant experiment: time for a reassessment. Am J Transplant 2007; 7: 2217-2218
- Cravedi P, Mannon RB, Ruggenenti P, et al. Islet transplantation: need for a time-out? Nat Clin Pract Nephrol 2008; 4: 660-661
- Lehmann R, Spinas GA, Moritz W, et al. Has time come for new goals in human islet transplantation? Am J Transplant 2008; 8: 1096-1100
- Cantarelli E, Piemonti L. Alternative transplantation sites for pancreatic islet grafts. Curr Diab Rep 2011; 11: 364-374
- Ciceri F, Piemonti L. Bone marrow and pancreatic islets: an old story with new perspectives. Cell Transplant 2010; 19: 1511-1522
- Maffi P, Balzano G, Ponzoni M, et al. Autologous pancreatic islet transplantation in human bone marrow. Diabetes 2013; 62: 3523-3531
- Schubert U, Schmid J, Lehmann S, et al. Transplantation of pancreatic islets to adrenal gland is promoted by agonists of growth-hormone-releasing hormone. Proc Natl Acad Sci U S A 2013; 110: 2288-2293
- Sterkers A, Hubert T, Gmyr V, et al. Islet survival and function following intramuscular autotransplantation in the minipig. Am J Transplant 2013; 13: 891-898
- Antosiak-Iwanska M, Sitarek E, Sabat M, et al. Isolation, banking, encapsulation and transplantation of different types of Langerhans islets. Pol Arch Med Wewn 2009; 119: 311-317
- Barkai U, Weir GC, Colton CK, et al. Enhanced oxygen supply improves islet viability in a new bioartificial pancreas. Cell Transplant 2013; 22: 1463-1476
- Dufrane D, Goebbels RM, Gianello P. Alginate macroencapsulation of pig islets allows correction of streptozotocin-induced diabetes in primates up to 6 months without immunosuppression. Transplantation 2010; 90: 1054-1062
- Dufrane D, Goebbels RM, Saliez A, et al. Six-month survival of microencapsulated pig islets and alginate biocompatibility in primates: proof of concept. Transplantation 2006; 81: 1345-1353
- Elliott RB, Escobar L, Calafiore R, et al. Transplantation of micro- and macroencapsulated piglet islets into mice and monkeys. Transplant Proc 2005; 37: 466-469
- Elliott RB, Escobar L, Tan PL, et al. Live encapsulated porcine islets from a type 1 diabetic patient 9.5 yr after xenotransplantation. Xenotransplantation 2007; 14: 157-161
- Ludwig B, Reichel A, Steffen A, et al. Transplantation of human islets without immunosuppression. Proc Natl Acad Sci U S A 2013; 110: 19054-19058
- Ludwig B, Rotem A, Schmid J, et al. Improvement of islet function in a bioartificial pancreas by enhanced oxygen supply and growth hormone releasing hormone agonist. Proc Natl Acad Sci U S A 2012; 109: 5022-5027
- Ludwig B, Zimerman B, Steffen A, et al. A novel device for islet transplantation providing immune protection and oxygen supply. Horm Metab Res 2010; 42: 918-922
- Neufeld T, Ludwig B, Barkai U, et al. The efficacy of an immunoisolating membrane system for islet xenotransplantation in minipigs. PLoS One 2013; 8: e70150
- Fiorina P, Gremizzi C, Maffi P, et al. Islet transplantation is associated with an improvement of cardiovascular function in type 1 diabetic kidney transplant patients. Diabetes Care 2005; 28: 1358-1365
- Lee TC, Barshes NR, O'Mahony CA, et al. The effect of pancreatic islet transplantation on progression of diabetic retinopathy and neuropathy. Transplant Proc 2005; 37: 2263-2265
- Leitao CB, Tharavanij T, Cure P, et al. Restoration of hypoglycemia awareness after islet transplantation. Diabetes Care 2008; 31: 2113-2115
- Thompson DM, Meloche M, Ao Z, et al. Reduced progression of diabetic microvascular complications with islet cell transplantation compared with intensive medical therapy. Transplantation 2011; 91: 373-378
- Toso C, Shapiro AM, Bowker S, et al. Quality of life after islet transplant: impact of the number of islet infusions and metabolic outcome. Transplantation 2007; 84: 664-666
- Thompson DM, Begg IS, Harris C, et al. Reduced progression of diabetic retinopathy after islet cell transplantation compared with intensive medical therapy. Transplantation 2008; 85: 1400-1405
- Warnock GL, Thompson DM, Meloche RM, et al. A multi-year analysis of islet transplantation compared with intensive medical therapy on progression of complications in type 1 diabetes. Transplantation 2008; 86: 1762-1766
- Ludwig B, Reichel A, Kruppa A, et al. Islet transplantation at the Dresden diabetes center: five years' experience. Horm Metab Res 2015; 47: 4-8
Autor: PD Dr. med. Barbara Ludwig
PD Dr. med. Barbara Ludwig
Universitätsklinikum Carl Gustav Carus
Medizinische Klinik und Poliklinik III und Zentrum für Regenerative Therapien Dresden
Technische Universität Dresden
und
Paul Langerhans Institut Dresden des Helmholtz Zentrum München am Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden
Medizinische Fakultät
DZD - Deutsches Zentrum für Diabetesforschung
Disclosures
Es besteht kein Interessenskonflikt.
Kommentare (0)
Keine Kommentare gefunden!