TY - JOUR
T1 - Advances in β-cell replacement therapy for the treatment of type 1 diabetes
AU - Vantyghem, Marie-Christine
AU - de Koning, Eelco J P
AU - Pattou, François
AU - Rickels, Michael R
N1 - Copyright © 2019 Elsevier Ltd. All rights reserved.
PY - 2019/10/5
Y1 - 2019/10/5
N2 - The main goal of treatment for type 1 diabetes is to control glycaemia with insulin therapy to reduce disease complications. For some patients, technological approaches to insulin delivery are inadequate, and allogeneic islet transplantation is a safe alternative for those patients who have had severe hypoglycaemia complicated by impaired hypoglycaemia awareness or glycaemic lability, or who already receive immunosuppressive drugs for a kidney transplant. Since 2000, intrahepatic islet transplantation has proven efficacious in alleviating the burden of labile diabetes and preventing complications related to diabetes, whether or not a previous kidney transplant is present. Age, body-mass index, renal status, and cardiopulmonary status affect the choice between pancreas or islet transplantation. Access to transplantation is limited by the number of deceased donors and the necessity of immunosuppression. Future approaches might include alternative sources of islets (eg, xenogeneic tissue or human stem cells), extrahepatic sites of implantation (eg, omental, subcutaneous, or intramuscular), and induction of immune tolerance or encapsulation of islets.
AB - The main goal of treatment for type 1 diabetes is to control glycaemia with insulin therapy to reduce disease complications. For some patients, technological approaches to insulin delivery are inadequate, and allogeneic islet transplantation is a safe alternative for those patients who have had severe hypoglycaemia complicated by impaired hypoglycaemia awareness or glycaemic lability, or who already receive immunosuppressive drugs for a kidney transplant. Since 2000, intrahepatic islet transplantation has proven efficacious in alleviating the burden of labile diabetes and preventing complications related to diabetes, whether or not a previous kidney transplant is present. Age, body-mass index, renal status, and cardiopulmonary status affect the choice between pancreas or islet transplantation. Access to transplantation is limited by the number of deceased donors and the necessity of immunosuppression. Future approaches might include alternative sources of islets (eg, xenogeneic tissue or human stem cells), extrahepatic sites of implantation (eg, omental, subcutaneous, or intramuscular), and induction of immune tolerance or encapsulation of islets.
KW - Diabetes Mellitus, Type 1/surgery
KW - Graft Rejection/prevention & control
KW - Humans
KW - Immunosuppression
KW - Insulin-Secreting Cells/transplantation
KW - Treatment Outcome
U2 - 10.1016/S0140-6736(19)31334-0
DO - 10.1016/S0140-6736(19)31334-0
M3 - Article
C2 - 31533905
SN - 0140-6736
VL - 394
SP - 1274
EP - 1285
JO - The Lancet
JF - The Lancet
IS - 10205
ER -