Advances in β-cell replacement therapy for the treatment of type 1 diabetes
Vantyghem, Marie Christine; de Koning, Eelco J.P.; Pattou, François; Rickels, Michael R.
(2019) The Lancet, volume 394, issue 10205, pp. 1274 - 1285
(Article)
Abstract
The main goal of treatment for type 1 diabetes is to control glycaemia with insulin therapy to reduce disease complications. For some patients, technological approaches to insulin delivery are inadequate, and allogeneic islet transplantation is a safe alternative for those patients who have had severe hypoglycaemia complicated by impaired hypoglycaemia
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awareness or glycaemic lability, or who already receive immunosuppressive drugs for a kidney transplant. Since 2000, intrahepatic islet transplantation has proven efficacious in alleviating the burden of labile diabetes and preventing complications related to diabetes, whether or not a previous kidney transplant is present. Age, body-mass index, renal status, and cardiopulmonary status affect the choice between pancreas or islet transplantation. Access to transplantation is limited by the number of deceased donors and the necessity of immunosuppression. Future approaches might include alternative sources of islets (eg, xenogeneic tissue or human stem cells), extrahepatic sites of implantation (eg, omental, subcutaneous, or intramuscular), and induction of immune tolerance or encapsulation of islets.
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Keywords: General Medicine
ISSN: 0140-6736
Publisher: Elsevier Limited
Note: Funding Information: No financial support was provided specifically for the writing of this manuscript. MRR is supported in part by Public Health Services Research Grant R01 DK091331 . M-CV and FP are, or have been, supported by the French Ministry of Health, Programme Hospitalier de Recherch Clinique, the European Community (Fond Européen de Développement Régional), Conseil Régional du Nord-Pas-de-Calais, Programme d'investissements d'avenir Labex European Genomic Institute for Diabetes ANR-10-LABX-46, the Société Française d'Endocrinologie, the Association de Recherche pour le Diabète, Santelys, and the Agence de la Biomédecine. Funding Information: M-CV reports non-financial support from Novartis and Ipsen; personal fees from Sanofi, Aegerion, and GlaxoSmithKline; and participation in drug investigation trials supported by Shire and HRA Pharma, all outside the submitted work. MRR reports grants and personal fees from Xeris Pharmaceutical, personal fees from Hua Medicine, and non-financial support from Merck, all outside the submitted work. EJPdK and FP declare no competing interests. Funding Information: No financial support was provided specifically for the writing of this manuscript. MRR is supported in part by Public Health Services Research Grant R01 DK091331. M-CV and FP are, or have been, supported by the French Ministry of Health, Programme Hospitalier de Recherch Clinique, the European Community (Fond Europ?en de D?veloppement R?gional), Conseil R?gional du Nord-Pas-de-Calais, Programme d'investissements d'avenir Labex European Genomic Institute for Diabetes ANR-10-LABX-46, the Soci?t? Fran?aise d'Endocrinologie, the Association de Recherche pour le Diab?te, Santelys, and the Agence de la Biom?decine. Publisher Copyright: © 2019 Elsevier Ltd
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