Islet transplantation in the future: Use of a bioartificial pancreas

Abstract

Tight glycemic control effectively delays the onset and slows the progression of diabetic complications in patients with insulin-dependent diabetes mellitus. Successful pancreas transplantation corrects abnormal glucose metabolism but subjects patients to morbidity and mortality associated with chronic immunosuppression. Immune exclusion devices containing pancreatic islets (bioartificial pancreas devices) are designed to provide glycemic control through islet transplantation without immunosuppression. The immune exclussion is achieved by separating allogeneic or xenogeneic islets from the host by semipermeable membranes that allow only small molecules, such as glucose, insulin, and nutrients, to pass through. Immune lymphocytes and immunoglobulins are excluded by the membrane and are unable to cause destruction of the islets. This report provides a brief review of three types of bioartificial pancreas devices used for the treatment of diabetes, i.e., perfusion-based vascular devices, diffusion-based chambers and microcapsules, and describes recent progress in each area.