Keywords
transplante de islotes pancreáticos
diabetes tipo 1
protocolo de Edmonton
esquema de inmunosupresión libre de corticoesteroides
diabetes tipo 1
protocolo de Edmonton
esquema de inmunosupresión libre de corticoesteroides
How to Cite
Sabogal, A., Casas, L. A., Arango, L. G., Feriz, K., Guzmán, G., Gutiérrez, O., Durán, C., Jerez, A., Serrano, O., Caicedo, L., & Echeverri, G. J. (2017). Presente y futuro del trasplante de islotes pancreáticos, un tratamiento innovador para la diabetes tipo 1. Revista Colombiana De Endocrinología, Diabetes &Amp; Metabolismo, 2(1), 20–32. https://doi.org/10.53853/encr.2.1.67
Abstract
Introducción
El trasplante de islotes pancreáticos (TI*) se ha convertido en una opción terapéutica prometedora para algunos pacientes diabéticos con historia de hipoglicemia frecuentemente no percibida y labilidad glicémica severa. A pesar de ser un procedimiento relativamente joven en el área de trasplante de órganos y células, en las dos últimas décadas el TI pasó de ser una curiosidad quirúrgica en el área de trasplantes a posicionarse como una realidad terapéutica. esto gracias al desarrollo de novedosos protocolos de TI que proponen una nueva terapia de inmunosupresión, preparación de islotes de alta calidad, recepción de tejido proveniente de múltiples donantes y selección cuidadosa de candidatos para trasplante.
Los principales avances obtenidos en la década pasada en el TI fueron introducidos por el Protocolo de edmonton en el año 2000, el cual incluyó varias modificaciones, entre ellas el uso de un esquema de inmunosupresión libre de corticoesteroides y una masa de trasplante de 11.000 Ie/kg (Ie: islotes equivalentes), mejorando significativamente los resultados hasta entonces obtenidos en pacientes sometidos a TI. De los datos evaluados en los 65 pacientes sometidos a TI bajo este protocolo, se destaca que la mayoría logró independencia de la insulina durante el primer año y mejoría en la inestabilidad glicémica a los cinco años postrasplante. sin embargo, sólo 7,5% de los pacientes adquirieron independencia de la insulina luego de cinco años.
Estos resultados permitieron revelar el TI al ámbito científico como un campo investigativo promisorio, con grandes necesidades de avances futuros para conseguir una preservación de la función de los islotes trasplantados a largo plazo(4), lo que promovió ampliamente la investigación sobre el tema y la creación de centros especializados desde entonces alrededor del mundo.
References
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3. shapiro AM, Lakey JR, Ryan eA, Korbutt Gs, Toth e, Warnock GL, Kneteman NM, Rajotte RV: Islet transplantation in seven patients with type 1 diabetes mellitus using a glucocorticoid-free immunosuppressive regimen. N Engl J Med 2000, 343(4):230-238.
4. Corrêa-Giannella ML, Amara AsRd: Pancreatic islet transplantation. Diabetology & Metabolic Syndrome 2009, 1(9).
5. Shapiro AM, Ricordi C, Hering BJ, Auchincloss H, Lindblad R, Robertson RP, Secchi A, Brendel MD, Berney T, Brennan DC, et al: International trial of the edmonton protocol for islet transplantation. N Engl J Med 2006,355(13):1318-1330.
6. Barton FB, Rickels MR, Alejandro R, Hering BJ, Wease S, Naziruddin B, Oberholzer J, Odorico JS, Garfinkel MR, Levy M, et al: Improvement in Outcomes of Clinical Islet Transplantation: 1999-2010. In Diabetes Care. Volume 35;2012: 1436-1445.(vol 7).
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8. Ryan EA, Paty BW, Senior PA, Bigam D, Alfadhli E, Kneteman NM, Lakey JR,shapiro AM: Five-year follow-up after clinical islet transplantation. Diabetes 2005, 54(7):2060-2069.
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10. Senior PA, Zeman M, Paty BW, Ryan EA, Shapiro AM: Changes in renal function after clinical islet transplantation: four-year observational study. Am J Transplant 2007, 7(1):91-98.
11. Fung MA, Warnock GL, Ao Z, Keown P, Meloche M, Shapiro RJ, Ho S, Worsley D, Meneilly Gs, Al Ghofaili K, et al: The effect of medical therapy and islet cell transplantation on diabetic nephropathy: an interim report. Transplantation 2007, 84(1):17-22.
12. Poggioli R, Faradji RN, Ponte G, Betancourt A, Messinger S, Baidal DA, Froud T, Ricordi C, Alejandro R: Quality of life after islet transplantation. Am J Transplant 2006, 6(2):371-378.
13. Paty BW, Koh A, Senior P: Pancreas and Islet Transplantation. Canadian Journal of Diabetes 2013, 37:s94-s96.
14. shapiro AMJ, Ryan eA, Lakey JRT: Clinical islet transplant—state of the art.Transplantation Proceedings 2001, 33(7–8):3502–3503.
15. Vantyghem MC, Marcelli-Tourvieille s, Fermon C, Duhamel A, Raverdy V, Arnalsteen L, Kerr-Conte J, Noel C, Fontaine P, Pattou F: Intraperitoneal insulin infusion versus islet transplantation: comparative study in patients with type 1 diabetes. Transplantation 2009, 87(1):66-71.
16. IDF Diabetes Atlas sixth edition (www.idf.org/diabetesatlas)
17. simon Knight TV, Peter Friend: Pancreas transplantation. 2014, 32(7):383–388.
18. Aschner P: epidemiología de la diabetes en Colombia. Av Diabetol 2010,26:95-100.
19. Niclauss N, Morel P, Berney T: Has the Gap Between Pancreas and Islet Transplantation Closed? Transplantation 2014.
20. Zinger A, Leibowitz G: Islet transplantation in type 1 diabetes: hype, hope and reality - a clinician’s perspective. Diabetes Metab Res Rev 2014, 30(2):83-87.
21. Chaib e, Gama-Rodrigues J, MARJ, saad WA, Cecconello I: Human islet transplantation - state of the art. Einstein 2005; 3(4):281-28 2005, 3(4):281-285.
22. Najarian Js, sutherland De, Matas AJ, steffes MW, simmons RL, Goetz FC: Human islet transplantation: a preliminary report. Transplant Proc 1977, 9(1):233-236.
23. Cravedi P, Ruggenenti P, Remuzzi A, Remuzzi G: Chapter 40 - Current status of Islet Transplantation. In Regenerative Medicine Applications in Organ Transplantation. Edited by Orlando G, Lerut J, Soker S, Stratta RJ. Boston: Academic Press; 2014: 583-598.
24. Anazawa T, saito T, Goto M, Kenmochi T, s.Uemoto, Itoh T, Yasumani Y, Kenjo A, Kimura t, K.Ise, et al: Long-Term Outcomes of Clinical Transplantation of Pancreatic Islets With Uncontrolled Donors After Cardiac Death: A Multicenter experience in Japan. Transplantation Proceedings 2014, 46:1980-1984.
25. Thompson DM, Meloche M, Ao Z, Paty B, Keown P, Shapiro RJ, Ho S, Worsley D, Fung M, Meneilly G, et al: Reduced progression of diabetic microvascular complications with islet cell transplantation compared with intensive medical therapy. Transplantation 2011, 91(3):373-378.
26. Naziruddin B, Wease S, Stablein D, Barton FB, Berney T, Rickels MR, Alejandro R: HLA class I sensitization in islet transplant recipients: report from the Collaborative Islet Transplant Registry. Cell Transplant 2012,21(5):901-908.
27. Borot S, Niclauss N, Wojtusciszyn A, Brault C, Demuylder-Mischler S, Muller Y, Giovannoni L, Parnaud G, Meier R, Badet L, et al: Impact of the number of infusions on 2-year results of islet-after-kidney transplantation in the GRAGIL network. Transplantation 2011, 92(9):1031-1038.
28. Bellin MD, Barton FB, Heitman A, Alejandro R, Hering BJ: Potent induction immunotherapy promotes long-term insulin independence after islet transplantation in type 1 diabetes. Am J Transplant 2012, 12(6):1576-1583.
29. Koulmanda M, Qipo A, Fan Z, Smith N, Auchincloss H, Zheng XX, Strom TB: Prolonged survival of Allogeneic Islets in Cynomolgus Monkeys After short- Term Triple Therapy. Am J Transplant 2012, 12(5):1296-1302.
30. Posselt AM, szot GL, Frassetto LA, Masharani U, Tavakol M, Amin R, Mcelroy J, Ramos MD, Kerlan RK, Fong L, et al: Islet transplantation in type 1 diabetic patients using calcineurin inhibitor-free immunosuppressive protocols based on T-cell adhesion or costimulation blockade. Transplantation 2010, 90(12):1595-1601.
31. Turgeon NA, Avila JG, Cano JA, Hutchinson JJ, Badell IR, Page AJ, Adams AB, Sears MH, Bowen PH, Kirk AD, et al: Experience with a novel efalizumab- based immunosuppressive regimen to facilitate single donor islet cell transplantation. Am J Transplant 2010, 10(9):2082-2091.
32. Rickels MR, Mueller R, Teff KL, Naji A: ?-Cell secretory Capacity and Demand in Recipients of Islet, Pancreas, and Kidney Transplants. In J Clin Endocrinol Metab. Volume 95; 2010: 1238-1246.(vol 3).
33. Johansson H, Lukinius A, Moberg L, Lundgren T, Berne C, Foss A, Felldin M, Kallen R, salmela K, Tibell A, et al: Tissue factor produced by the endocrine cells of the islets of Langerhans is associated with a negative outcome of clinical islet transplantation. Diabetes 2005, 54(6):1755-1762.
34. Meeting Report: 14th World Congress of the International Pancreas transplantation and Islet Transplantation Association (IPITA) 2013 | Cellr4 (http://www.cellr4.org/article/625)
35. Casanova D: Pancreatic islets transplantation in the treatment of diabetes mellitus: present and future. Cir Esp 2009, 85(2):76-83.
36. Cowan PJ, Robson sC, d’Apice AJ: Controlling coagulation dysregulation in xenotransplantation. Curr Opin Organ Transplant 2011, 16(2):214-221.
37. Bottino R, Wijkstrom M, van der Windt DJ, Hara H, Ezzelarab M, Murase N, Bertera S, He J, Phelps C, Ayares D, et al: Pig-to-Monkey Islet Xenotransplan- tation Using Multi-Transgenic Pigs. Am J Transplant 2014, 14(10):2275-2287.
38. Dwyer KM, Mysore TB, Crikis S, Robson SC, Nandurkar H, Cowan PJ, D’Apice AJ: The transgenic expression of human CD39 on murine islets inhibits clotting of human blood. Transplantation 2006, 82(3):428-432.
39. Phelps CJ, Koike C, Vaught TD, Boone J, Wells KD, Chen SH, Ball S, Specht SM, Polejaeva IA, Monahan JA, et al: Production of alpha 1,3-galactosyltransferase-deficient pigs. Science 2003, 299(5605):411-414.
40. Miwa Y, Yamamoto K, Onishi A, Iwamoto M, Yazaki s, Haneda M, Iwasaki K, Liu D, Ogawa H, Nagasaka T, et al: Potential value of human thrombomodulin and DAF expression for coagulation control in pig-to-human xenotrans- plantation. Xenotransplantation 2010, 17(1):26-37.
41. van der Windt DJ, Bottino R, Kumar G, Wijkstrom M, Hara H, Ezzelarab M, Ekser B, Phelps C, Murase N, Casu A, et al: Clinical islet xenotransplantation: how close are we? Diabetes 2012, 61(12):3046-3055.
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