Friday, February 22, 2008

Islet Cell Transplantation

We discussed pancreatic islet cell transplantation at our Friday fellow's journal club today. It may sound kind of strange that a group of kidney doctors would be discussing the pancreas, but since the #1 cause of kidney failure in the United States is due to diabetes (a defect in insulin production, which occurs in the islet cells of the pancreas), it does actually have some relevance.

The procedure sounds like something out of science fiction. When a suitable donor dies, their pancreas is harvested, then treated with enzymes to break down the extracellular glue which holds the cells together. A big gamish of pancreatic tissue is then spun down in a centrifuge in order to isolate just the pancreatic islets. Then, the recipient (somebody with diabetes who hopes to be able to get off insulin) has the islet cells injected directly into their portal vein, the vein which carries blood to the liver. The islets lodge themselves within the portal venous system, set up shop, and, with a little luck, start pumping out insulin!

The technology is really just in its developing stages, and at this stage is still controversial. It only works about half the time, and requires the islet cell recipient to take multiple new medications, many of which may be quite toxic (often to the kidney--booo!) leading to a host of other medical problems which may be worse than having to inject insulin. So there's a lot of room for improvement, but also a lot of promise.

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