Pancreatic islet auto-transplantation

So, I was talking to a woman today whom was in a bad car accident, destroying 80% of her pancreas, had it removed and had an auto-islet cell transplant, transplanting them into her liver. she required insulin initially but now has normal blood sugars. I've never been told about this, does anyone have more information? Would this work for a type 1, as I looked on web and it said it would be considered 'experimental'. Why wouldn't this work for a type 1, is it due to the autoimmune disease which would continue to destroy any new or transplanted islet cells? Also, this got me wondering if our islet cells are dead, non functioning, are the still floating around in the Langerhans?

Happy Thanksgiving to everyone. Oh, how I'd love to have a piece of pie, apple pie, a big frickin piece of apple pie top with vanilla ice cream, maybe in some lifetime, not this one. I wouldn't even dare..ha! :)

Your assumptions are correct, Sarah. Although there have been great strides made in cultivating and replicating beta cells, this becomes a futile exercise for T1's because the immune system will destroy them. This can be addressed with powerful immunosuppressants, but that then exposes the patient to a host of other risks. There has been considerable progress made in encapsulation - whereby the transplanted beta cells are held within a synthetic container that blocks immune cells from entering. This is showing considerable promise and is the closest thing we can hope for as a "cure" within the near to medium term.

well, apparently this worked for her because her islet cells were not destroyed. thus, she used her own still functioning islet cells and then transplanted them into her liver after removing her pancreas due to 80% of being destroyed during a horrible car accident. type 1's don't have viable islet cells to harvest and transplant. so, it's not simply the autoimmune attack.

That's not always the case. The research I've read suggests that even longstanding T1's can have nominal residual beta cell function. Regardless, the leading research uses stem-cells and hence is not necessarily dependent on the ability to harvest functioning beta cells.

There is a large difference between an islet transplant and an auto-islet transplant. Auto islets are for non-diabetic people who have pancreas issues. I met several when I had my pancreas transplant. My one roommate had had chronic pancreatitis for years. Completely debilitating her and causing her to become addicted to pain killers. They removed her pancreas, removed the islet cells, and then reinserted her own islets. I don't believe she was on anti-rejection meds but may have required minimal insulin. I know that harvesting technologies have improved, so newer recipients may not need insulin at all. For a T1, the majority of of islets have been destroyed, so there is no point in taking out a functional pancreas (which does other things outside of insulin production), harvesting the few islets that may still be working, reinject those, and then still require lots of insulin.

A straight islet cell transplant involves islet donors from usually 2 people who have passed, and then injecting them. This requires the use of anti-rejection medication and is typically only done when a kidney is also required or the person suffers from dangerous hypo unawareness. Otherwise it's not worth the risk of the transplant meds.

Here's a little more information on this process. It looks very encouraging:

i dont have any answers to your questions, but i do have to tell you this: eat that pie tomorrow! a bit of swag...

Hi Cora, thanks. I read a bit more about the differences. yeah, this is what this woman had done, too. she wasn't on any anti-rejection medications. they don't do this auto islet with type 1's as we have destroyed islet cells (beta-alpha cells, enzymes, etc..). your friend and this woman weren't type 1's so I guess that's why it worked.

As far as I know Jason Turner is the only person with type 1 who has had this done(not auto though) who is completely off insulin(This was first done in Winnepeg). He has been off insulin for 7-8 years now I believe. Other type 1 who have had this done have been able to go off insulin or greatly reduce insulin for 1-2 years. But they still need anti- rejection drugs. Trials in humans are starting in CA now for encapsulated beta cells, maybe made from stem cells, not from a donor, and this will hopefully override the need for anti- rejection drugs, whether the body will continue to attack them if they come from stems cells vs. a donor isn't clear or not yet, but if not that could really be a cure. As Cora mentioned I think the donor transplant is only done if you are in jeopardy due to kidney failure and other issues. Maybe the encapsulation will help with protecting the cells from the autoimmune attack. I think since we still have small levels of c peptide and some residual production varying from person to person, the attack is ongoing throughout life. I don't know what happens to the cells- I will look that up and see what I can find. I assume they may decay after they die and then the body keeps trying to make more which are in turn attacked. I doubt we have enough cells to do this.