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Verhoeff K, Marfil-Garza BA, Czarnecka Z, Cuesta-Gomez N, Jasra IT, Dadheech N, Senior PA, Shapiro AMJ. Stem Cell-Derived Islet Transplantation in Patients With Type 2 Diabetes: Can Diabetes Subtypes Guide Implementation? J Clin Endocrinol Metab 2023; 108:2772-2778. [PMID: 37170783 DOI: 10.1210/clinem/dgad257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 04/13/2023] [Accepted: 05/04/2023] [Indexed: 05/13/2023]
Abstract
Historically, only patients with brittle diabetes or severe recurrent hypoglycemia have been considered for islet transplantation (ITx). This population has been selected to optimize the risk-benefit profile, considering risks of long-term immunosuppression and limited organ supply. However, with the advent of stem cell (SC)-derived ITx and the potential for immunosuppression-free ITx, consideration of a broader recipient cohort may soon be justified. Simultaneously, the classical categorization of diabetes is being challenged by growing evidence in support of a clustering of disease subtypes that can be better categorized by the All New Diabetics in Scania (ANDIS) classification system. Using the ANDIS classification, 5 subtypes of diabetes have been described, each with unique causes and consequences. We evaluate consideration for ITx in the context of this broader patient population and the new classification of diabetes subtypes. In this review, we evaluate considerations for ITx based on novel diabetes subtypes, including their limitations, and we elaborate on unique transplant features that should now be considered to enable ITx in these "unconventional" patient cohorts. Based on evidence from those receiving whole pancreas transplant and our more than 20-year experience with ITx, we offer recommendations and potential research avenues to justify implementation of SC-derived ITx in broader populations of patients with all types of diabetes.
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Affiliation(s)
- Kevin Verhoeff
- Department of Surgery, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta T6G 2R3, Canada
| | - Braulio A Marfil-Garza
- National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Department of Medicine Division of Endocrinology, University of Alberta, and CHRISTUS-LatAm Hub-Excellence and Innovation Center, Monterrey, Mexico
| | - Zofia Czarnecka
- Department of Surgery, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta T6G 2R3, Canada
| | - Nerea Cuesta-Gomez
- Department of Surgery, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta T6G 2R3, Canada
| | - Ila Tewari Jasra
- Department of Surgery, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta T6G 2R3, Canada
| | - Nidheesh Dadheech
- Department of Surgery, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta T6G 2R3, Canada
| | - Peter A Senior
- Clinical Islet Transplant Programme, Department of Medicine Division of Endocrinology, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta T6G 2R3, Canada
| | - A M James Shapiro
- Department of Surgery, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta T6G 2R3, Canada
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Czarnecka Z, Dadheech N, Razavy H, Pawlick R, Shapiro AMJ. The Current Status of Allogenic Islet Cell Transplantation. Cells 2023; 12:2423. [PMID: 37887267 PMCID: PMC10605704 DOI: 10.3390/cells12202423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 10/28/2023] Open
Abstract
Type 1 Diabetes (T1D) is an autoimmune destruction of pancreatic beta cells. The development of the Edmonton Protocol for islet transplantation in 2000 revolutionized T1D treatment and offered a glimpse at a cure for the disease. In 2022, the 20-year follow-up findings of islet cell transplantation demonstrated the long-term safety of islet cell transplantation despite chronic immunosuppression. The Edmonton Protocol, however, remains limited by two obstacles: scarce organ donor availability and risks associated with chronic immunosuppression. To overcome these challenges, the search has begun for an alternative cell source. In 2006, pluripotency genomic factors, coined "Yamanaka Factors," were discovered, which reprogram mature somatic cells back to their embryonic, pluripotent form (iPSC). iPSCs can then be differentiated into specialized cell types, including islet cells. This discovery has opened a gateway to a personalized medicine approach to treating diabetes, circumventing the issues of donor supply and immunosuppression. In this review, we present a brief history of allogenic islet cell transplantation from the early days of pancreatic remnant transplantation to present work on encapsulating stem cell-derived cells. We review data on long-term outcomes and the ongoing challenges of allogenic islet cell and stem cell-derived islet cell transplant.
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Affiliation(s)
- Zofia Czarnecka
- Department of Surgery, University of Alberta, Edmonton, AB T6G 2RW3, Canada; (N.D.); (H.R.); (R.P.); (A.M.J.S.)
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