Endoscopic Gastric Submucosal Transplantation of Islets (ENDO‐STI): Technique and Initial Results in Diabetic Pigs

The results of transplantation of human donor islets into the portal vein (PV) in patients with diabetes are encouraging. However, there are complications, for example, hemorrhage, thrombosis and an immediate loss of islets through the ‘instant blood‐mediated inflammatory reaction’ (IBMIR). The gast...

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Bibliographic Details
Published in:American journal of transplantation 2009-11, Vol.9 (11), p.2485-2496
Main Authors: Echeverri, G. J., McGrath, K., Bottino, R., Hara, H., Dons, E. M., Van Der Windt, D. J., Ekser, B., Casu, A., Houser, S., Ezzelarab, M., Wagner, R., Trucco, M., Lakkis, F. G., Cooper, D. K. C.
Format: Article
Language:English
Subjects:
Animals
Biological and medical sciences
Blood Glucose - metabolism
C-Peptide - blood
Combined Modality Therapy
Diabetes Mellitus, Experimental - drug therapy
Diabetes Mellitus, Experimental - surgery
Diabetes. Impaired glucose tolerance
Endocrine pancreas. Apud cells (diseases)
Endocrinopathies
Endoscopy
Endoscopy - methods
Epidemiology. Vaccinations
Etiopathogenesis. Screening. Investigations. Target tissue resistance
Female
Gastric Mucosa - surgery
gastric submucosal space
General aspects
Graft Rejection - drug therapy
Graft Rejection - immunology
Graft Rejection - pathology
Graft Survival
Hypoglycemic Agents - pharmacology
Immunosuppressive Agents - pharmacology
Infectious diseases
Insulin - pharmacology
islets
Islets of Langerhans Transplantation - immunology
Islets of Langerhans Transplantation - methods
Medical sciences
Mycophenolic Acid - analogs & derivatives
Mycophenolic Acid - pharmacology
Pancreatectomy
pig
portal vein
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Sus scrofa
Tacrolimus - pharmacology
transplantation
Transplantation, Homologous
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Summary:The results of transplantation of human donor islets into the portal vein (PV) in patients with diabetes are encouraging. However, there are complications, for example, hemorrhage, thrombosis and an immediate loss of islets through the ‘instant blood‐mediated inflammatory reaction’ (IBMIR). The gastric submucosal space (GSMS) offers potential advantages. Islets were isolated from adult pigs. Recipient pigs were made diabetic by streptozotocin. Donor islets were injected into the GSMS through a laparotomy (Group 1A, n = 4) or endoscopically (Group 1B, n = 8) or into the PV through a laparotomy (Group 2, n = 3). The pigs were followed for a maximum of 28 days. Monitoring of C‐peptide in Group 1 indicated that there was minimal immediate loss of islets whereas in Group 2 there was considerable loss from IBMIR. In Group 1, there were significant reductions in mean blood glucose and mean exogenous insulin requirement between pretransplantation and 20 days posttransplantation. In Group 2, there was no significant reduction in either parameter. Insulin‐positive cells were seen in the GSMS in Group 1, but not in the liver in Group 2. Endoscopic gastric submucosal transplantation of islets (ENDO‐STI) offers a minimally invasive and quick approach to islet transplantation, avoids IBMIR and warrants further exploration. Allotransplantation of adult islets in pigs into the gastric submucosal space by endoscopy was followed by better engraftment and function than after transplantation into the portal vein
ISSN:1600-6135
1600-6143
DOI:10.1111/j.1600-6143.2009.02815.x