Friday, January 13, 2012

Mayo Clinic Islet Cell Transplants to Improve Diabetes after Partial Pancreas Removal


ROCHESTER, Minn.  Sometimes doctors have to surgically remove a portion, or a person's entire pancreas. Infections and inflammation can shut down the pancreas. The natural result when the pancreas fails is diabetes &mdash often called pancreatogenic diabetes. The Mayo Clinic has been experimenting with pancreatic islets in select patients undergoing partial pancreas removal. Its most recent report on the progress of the procedure has found that the procedure shows promise for reducing the effects of diabetes related to pancreatogenic diabetes.

As you know, the pancreas is a gland organ that secretes hormones to regulate blood sugar levels and produces enzymes that break down digestible foods. Pancreatitis causes painful inflammation in the abdomen that occurs when digestive enzymes attack the pancreas, affecting digestion and the hormones that help control blood sugar levels. Severe inflammation of the pancreas can cause separation of the pancreatic duct between the right and left portions of the gland, a condition known as disconnected pancreatic duct syndrome.

"After attempts to control pain and improve malabsorption problems have been exhausted, total or near-total removal of the pancreas is recommended for patients with severe cases of pancreatitis in which pancreas tissue dies," says Santhi Swaroop Vege, M.D., a gastroenterologist at Mayo Clinic. "Such surgery, however, often results in a type of diabetes known as pancreatogenic diabetes."

Pancreatic islet autotransplantation (a transplant using a person's own tissue) is one treatment option to prevent pancreatogenic diabetes caused by pancreatic surgery. The procedure involves isolation and purification of insulin-producing cells (islets) after the pancreas, or a portion of the pancreas, is surgically removed in patients for whom pancreatic cancer is not a concern. The purified islets are then infused in the patient's portal vein, a large vein that carries blood from the digestive tract to the liver. The islets gradually implant in the liver and begin producing insulin.

Approximately 30 medical centers in North America have islet isolation laboratories. At these centers, pancreatic islet autotransplantation is a recommended procedure for patients undergoing total or near-total pancreatectomy. But according to Dr. Vege, half of patients undergoing distal or extended distal pancreatectomy (removal of 50 percent to 70 percent of the pancreas) will also develop pancreatogenic diabetes.

The Mayo Clinic islet autotransplantation team studied whether pancreatic islet autotransplantation is a feasible treatment option for patients undergoing distal or extended distal pancreatectomy after severe pancreatitis and disconnected pancreatic duct syndrome. The team attempted pancreatic islet autotransplantation on seven patients who were undergoing removal of 50 percent to 70 percent of their pancreas. In four patients, the removed portion of the pancreas contained insufficient insulin-producing islets. The remaining three patients received the procedure. Of those, two did not develop pancreatogenic diabetes and one developed a less-complicated case of pancreatogenic diabetes.

"Our initial experience with pancreatic islet autotransplantation in this patient population shows that the procedure is a feasible treatment option," says Dr. Kudva. "Long-term follow-up, expansion to additional patients and research studies will help us better understand the full utility of this procedure."
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Why does this matter to people with diabetes?

If a diabetic person's pancreas is partially or completely failing, islet cell transplantation may be able to help restore some insulin production. As physicians learn how to have higher success rates with islet transplantation, it may be able to help millions of people. However, if insulin resistance is contributing to a person's diabetes, islet transplantation does not directly address the problem. A person confronting diabetic insulin resistance should work with exercise, diet and medication to help their muscles and fat tissue re-energize its ability to use insulin properly.

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