Is There a Possibility of a Bioartificial Pancreas?

Abstract

The use of pancreatic living tissue, namely the transplantation of the pancreas or of isolated islets, for the cure of diabetes mellitus is extremely attractive. It is the only way to obtain in type 1 diabetic patients a perfect normalization of glycosylated hemoglobin, a marker of metabolic control. However, there are two major obstacles which limit this approach: The immune rejection of the transplanted tissue and the scarcity of pancreas donors in the face of a common disease. These two obstacles explain that a relatively small number of trials have been performed, most of them in patients with end stage renal failure and in conjunction with a kidney transplant. So far, islet transplantation, although able to correct hyperglycemia in experimental models of diabetes in animals, has consistently failed in man, certainly due to the fact that there is no method for isolating an adequate number of intact islets from a single human donor pancreas. A recent paper demonstrated a need to transplant 5000 islets/kg body weight to correct hyperglycemia in diabetic dogs (1). This would yield 300,000 islets for a human adult, which would represent about one third of the islets of a human pancreas.