diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/2072-0351-5603diaendo-5603Research ArticleСтатьиArticlesТрансплантация островков: прорыв в новый мирIslet cell transplantationРикордиКамиллоRICORDICAMILLO-Diabetes Research Institute, University of Miami School of Medicine, Miami, Florida, USADiabetes Research Institute, University of Miami School of Medicine, Miami, Florida, USA20041506200472№2 (2004)1419Copyright © Рикорди К., 20042004Рикорди К.RICORDI C.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.dia-endojournals.ru/jour/article/view/5603

В работе представлены основные этапы развития трансплантации островков - от разработки гипотезы до клинического применения. Главной целью является лечение диабета. Это заболевание было хорошо известно еще много сотен лет назад и потребовалось 3500 лет, чтобы установить связь между диабетом и поджелудочной железой, но до открытия инсулина он оставался изнуряющей болезнью со смертельным исходом. Открытие инсулина Бантингом и Бестом в 1922 г. изменило ход истории лечения диабета и дало детям с этим заболеванием новую надежду сохранить жизнь. Лечение инсулином не в состоянии полностью предотвратить хронические осложнения диабета, а интенсивная инсулинотерапия с целью нормализации обменных процессов чревата повышенным риском тяжелой гипогликемии. Идея пересадки инсулинпродуцирующей ткани для коррекции дефекта эндокринного компонента поджелудочной железы как более физиологичного способа устранения инсулиновой недостаточности по сравнению с введением экзогенного гормона отнюдь не нова. Трансплантированные панкреатические островки нормализуют метаболический контроль и предотвращают развитие хронических осложнений. Они не только сами вырабатывают инсулин, но и обеспечивают его точно контролируемую во времени секрецию. Если трансплантат не разрушается иммунной системой реципиента, инсулинпродуцирующие клетки способны поддерживать нормальный уровень глюкозы в крови и остаются функционально активными на протяжении всей жизни пациента.

The discovery of insulin changed the course of history in the treatment of diabetes. However, despite tremendous progress in insulin formulations and treatment strategies, insulin treatment still cannot fully prevent chronic complications and intensive insulin treatment to improve metabolic control, has often paralleled an increased risk of severe hypoglycemia. A cure for Type 1 diabetes should include: ? Restoration of self tolerance, to prevent recurrence of autoimmunity ? Restoration of physiologic metabolism by replacement of the biologic function (insulin producing cells) that was partially of completely impaired as a result of the disease process. ? Prevention of destruction of the new insulin producing cells by the recipient immune system in the absence of any treatment that could introduce an additional risk to the patient, which could be comparable to, or higher than the risk imposed by disease progression under exogenous insulin treatment. Pancreatic islets could be considered an ideal and more physiologic alternative to insulin, as they can restore metabolic control after transplantation, preventing the development of chronic complications. In fact, islets are capable of perfectly timed insulin release and can keep glucose levels in the normal range, functioning for an entire lifetime, if they are not destroyed by the recipient's immune system. Significant progress has been recently reported in the translational research approach towards the development of a cure for Type 1 diabetes. There is now strong evidence for the technical feasibility of human islet isolation and purification procedures. Proof of function of isolated human islets has been clearly established both in animal models and in pilot clinical trials of human islet allotransplantation in patients with surgical and Type 1 diabetes. Additional research in now needed to improve the current clinical results in terms of long term prevention of rejection and recurrence of autoimmunity, the development of safe, non diabetogenic immunomodulation strategies and ultimately the achievement of donor specific immune tolerance. If success will be achieved in these areas, then we will face the critical challenge of identifying sufficient and suitable sources of insulin producing tissue to treat the increasing number of patients who could benefit from this form of therapy and which would not be limited to Type 1 diabetes. That is why the work on xenogeneic islets, embryonic and adult stem cells, islet regeneration and proliferation, as well as engineering of insulin producing cells must be continued, to identify the most ideal source of insulin producing tissue that could be utilized on a large scale once the impediments and limitations of immunosuppression will be resolved.

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The authors declare that there are no conflicts of interest present.