Abstract
Background and Objective: Islet autotransplantation is performed to preserve endocrine function in patients undergoing pancreatic resections for painful chronic pancreatitis. We characterized islets isolated from chronic pancreatitis patients (CP) of tropical region. Patients and Methods: Pancreatic tissues were obtained from CP patients with and without diabetes undergoing pancreatic resections (n = 35) and brain-dead multi organ donors (n = 6; considered as controls). Islets isolated were assessed for yield, purity, viability and in vitro islet function (Glucose stimulated insulin release, GSIR) as per standard protocols. Results: Islets from CP patients without diabetes were similar to controls in yield (control 4120 - 6100 IE/g, CP 3550 - 5660 IE/g), purity (control 78% ± 12%, CP 70% ± 8.2%) and viability (control 85% ± 8%, CP 81% ± 10%) and islets from CP patients with diabetes showed decreases in yield (3002 - 2300 IE/g), purity (61% ± 16%) and viability (62% ± 21%). Islets measuring 50 - 200 μ were similar in abundance in controls (94.74% ± 3.2%) and CP patients with and without diabetes, 86.31% ± 4.9%, 91.03% ± 3.8%. GSIR of islets from CP patients and controls were similar at 5.5 mM glucose (2.8 - 3.1 μU/ml). However, GSIR at 16.5 mM glucose was decreased in CP patients (control 18.5 ± 0.6, CP without diabetes 11.8 ± 0.3, CP with diabetes 4.3 ± 0.3 μU/ml). Conclusion: Our results demonstrate suitability of islets isolated from CP patients of tropical region for autotransplantation.
Highlights
Islet autotransplantation (IAT) is an accepted treatment option for chronic pancreatitis (CP) patients undergoing pancreatic resections [1]-[12]
Total pancreatectomy followed by islet autotransplantation (TPIAT) is performed in many western countries to relieve intractable pain, preserve endocrine function and improve quality of life in patients with chronic pancreatitis [13], with autografts being more durable than allografts [14]
Out of the 35 chronic pancreatitis patients (CP) patients included for characterization of islets, 12 patients who had fasting blood glucose 114 ± 16 mg/dl, decreased C- peptide 0.91 ± 0.52 ng/ml and HbA1C 8.63% ± 1.87% were diagnosed to have severe CP with diabetes; the remaining 23 patients with fasting blood glucose 81 ± 17 mg/dl, C-peptide 1.6 ± 0.95 ng/ml and HbA1C 6.11% ± 0.95% levels were considered to be CP patients without diabetes
Summary
Islet autotransplantation (IAT) is an accepted treatment option for chronic pancreatitis (CP) patients undergoing pancreatic resections [1]-[12]. Several issues including timing of TPIAT, identification of patients who may benefit from TPIAT, predictable islet isolation outcomes, etc., need to be addressed to improve long term functions of transplanted islets [1] [15]. Despite such limitations, improvements in isolation techniques to increase islet yield for better clinical outcomes have been reported [16]. Islet autotransplantation is performed to preserve endocrine function in patients undergoing pancreatic resections for painful chronic pancreatitis. Conclusion: Our results demonstrate suitability of islets isolated from CP patients of tropical region for autotransplantation
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