It is estimated that in Poland, the lives of over two hundred thousand patients depend on the daily intake of insulin. It includes patients with type 1 diabetes, but also people who have had their pancreas removed due to injury or chronic inflammation. Despite carefully selected treatment and proper diet, not everyone is able to successfully control the level of glucose in the blood. Meanwhile, frequent fluctuations in glycemia lead to serious complications – kidney failure, vision loss, severe atherosclerosis, and even death.
An alternative for insulin
What to do when insulin is not enough? A solution for some patients may be pancreatic transplantation. Unfortunately, patients who have been struggling with diabetes and its numerous consequences for years are often not eligible for surgery because it is associated with a relatively high risk of complications, and in about one-third cases with the need to undergo surgery again. In such situations, the alternative is pancreatic islets transplantation. Standardly, they are introduced through the portal vein, however, this method has several contraindications and risks, and its initially excellent results decrease over time. That’s why scientists and transplantologists are still looking for new solutions.
An innovative method of pancreatic islet transplantation
In 2009, the Foundation of Research and Science Development was pleased to finance and conduct, together with a team from the Department and General and Transplant Surgery of the Jesus Child Hospital and the Warsaw University of Life Sciences, pioneer research on endoscopic pancreatic islet transplantation under the gastric mucosa. It was the first such venture in the world, which a few years later resulted in successful transplantations in several patients.
What is this innovative method based on? From the pancreas taken are so-called Langerhans islets, i.e. clusters of cells secreting insulin and other hormones that regulate blood glucose. The obtained cells are placed in a special solution, aimed at, among others, preventing infections and thrombosis. The endoscope (device with the appearance of a flexible tube, used, for example, for gastroscopy or colonoscopy) is inserted through the mouth, throat and esophagus to the stomach. There, pancreatic islet cells are injected into the so-called submucosa, i.e. the layers of the stomach between the mucous membrane lining its light and the muscles responsible for stomach cramps.
The procedure is performed quickly, usually in short-term anesthesia, so even patients with contraindications for long-term anesthesia may have it. The problem is also not portal hypertension, which prevents the introduction of the graft the classic way – through the portal vein to the liver. Placement of pancreatic islets in the submucosa is a convenient solution for two reasons. First, in case of any doubts, cells can be easily examined by transplanted cells by means of endoscopic ultrasound or biopsy and histopathological examination can be performed. Secondly, in this location, the islets’ destructive reaction of the recipient organism is much weaker than in the liver, so the graft effect lasts longer.
The procedure is performed quickly, usually in short-term anesthesia, so even patients with contraindications for long-term anesthesia may have it. The problem is also not portal hypertension, which prevents the introduction of the graft the classic way – through the portal vein to the liver.
Acquiring pancreatic islets
The pancreatic islets are obtained from two sources: from the pancreas of the patient undergoing transplantation (the so-called autotransplantation) or from the deceased organ donor (the so-called allotransplantation). The first method is used in patients with chronic pancreatitis causing such severe pain that it is necessary to remove the organ. The pancreatic islets usually produce insulin properly, so it is just needed to take them out and put them in another organ to protect the patient from the need to inject high doses of insulin for the rest of your life. Because the transplanted cells come from the patient’s own body, he or she does not have to take any immunosuppressive drugs.
Unfortunately, in people with long-lasting type 1 diabetes, the pancreatic is usually destroyed and does not produce insulin. In this case, the cells are taken from the deceased donor, and after the transplant the patients must take immunosuppressive drugs. Usually, the number of cells from one donor is not enough to completely become independent of insulin, but it can significantly reduce its dose. Among the patients of the Department and General and Transplant Surgery of the Jesus Child Hospital undergoing endoscopic pancreatic islet transplantation, the insulin requirement under the gastric mucosa dropped even four times per day! Thanks to this, it was possible to significantly reduce fluctuations in blood glucose and stop the development of diabetes complications, such as kidney and nerve damage, vision loss and atherosclerosis.
Transplantation of pancreatic islets can save lives
Most importantly, transplantation of pancreatic islets can save lives. It reduces the risk of hypoglycaemia, which in up to 5% of patients with long-lasting type 1 diabetes runs unnoticed and sometimes leads to diabetic coma or even death. We are therefore extremely proud that we could contribute to the development of a new and much more effective and safer method of carrying out this procedure, thanks to which even more patients will benefit from it.