Islet Cell Transplantation

Islet Cell Transplantation

Is the Chief's research REALLY that unique to be stalking him outside of the men's restroom? By the way, that's definitely one of my favorite moments from this week's episode 717, "This Is How We Do It"...

But, yes. It IS that unique. And awesome. Especially for the millions of people who suffer from Type I Diabetes.

But unfortunately, we are only given roughly forty-three minutes of television per episode, and we obviously can't spend that entire forty-three minutes on the medicine, so... Raise your hand if you're confused by what Richard is actually doing?

First, let's refresh ourselves on Type I Diabetes.

Diabetes is a disease in which the body's blood sugar is too high. Type I Diabetes means that the body does not produce enough of a hormone in order to control these high blood sugar levels. This hormone is insulin. Usually produced in the pancreas within a special group of cells called "islets," insulin works to allow glucose in the blood to enter the body's cells to provide them energy. Without an adequate amount of insulin, the glucose remains in the blood, leading to serious health problems in the heart, kidneys, nerves, eyes, gums, and teeth.

Type I Diabetes can also be known as Juvenile Diabetes because many people receive their diagnosis as children. According to the National Institute of Health, common symptoms include:

- Weight loss for unknown reasons.
- Dry, itchy skin.
- Frequent urination.
- Feeling very hungry or tired.
- Having blurry eyesight.
- Having sores that heal slowly.
- Thirst.
- Loss of feeling in the feet or tingling.

Due to the irreversible destruction of the cells that produce insulin (islets), people with Type I Diabetes must take insulin for the rest of their lives in order to survive.

What kind of treatment is currently available to control these complications?

Treatment is extremely important and essential for survival. If one takes in too MUCH insulin compared to glucose, the patient may pass out due to the lack of sugar. If not treated quickly, the person can descend into a coma and even die. Yet, if one does not have ENOUGH insulin for the amount of glucose, then the sugar can build up in the blood, clogging blood vessels, and have long-term consequences such as heart and kidney failure, blindness, or limb amputation.

Most diabetic patients keep track of their blood glucose levels very regularly by taking multiple daily blood glucose readings with finger sticks and monitors. By knowing what their levels read at any given moment, these patients know when to give themselves (and at what dosages) insulin.

Some patients, who have had continuing problems controlling their disease, have opted for a complete pancreas transplant in order to jumpstart their body's insulin production. However, similar to other organ transplants, the patient must undergo major surgery and resign themselves to taking immunosuppressive drugs for the rest of their life to reduce risk of rejection.

Yet research in the last few decades have pointed to newer ways at controlling the disease.

One of the more recent yet experimental treatments for patients with Type I Diabetes has been islet cell transplantation. Rather than transplanting the ENTIRE pancreas, surgeons have just been taking the islet cells to replace the diabetic's original and damaged insulin-producing cells. The process involves harvesting an available pancreas from a deceased organ donor (the donor must have died from brain death) and putting the organ into a specialized device called a Ricordi chamber along with chemicals that free the islet cells from the rest of the pancreas. Once processed, these islet cells are inserted into the recipient's liver, and hopefully, begin to produce insulin in reaction to the presence of glucose in the patient's blood.

Some patients immediately start to produce their own insulin with the transplant and even discontinue taking insulin injections. However, the main drawback to the procedure is that it still is... a transplant. Therefore, the recipient must take immunosuppressive drugs for the rest of their life to protect the islets from rejection by the immune system. And these drugs leave the patient vulnerable to further illness such as cancer and other serious infections. For example, the patient in tonight's episode, Clara Green, cannot take these drugs due to the risk of her tumor growing back.

Other disadvantages to islet cell transplantation include the limited availability of donor pancreases, problems with cell survival/function post-transplant (the transplants frequently do not last), and difficulties isolating enough islet cells from the actual pancreas.

And this is where Richard's research enters the story!

Richard's clinical trial involves a device that will hopefully address all of these limitations that islet cell transplantation currently faces, ensuring a more permanent outcome with these procedures. This device, also known as a 'Biohybrid Device,' is a cylindrical shape and small enough to be implanted into a patient's abdomen through a minimally invasive procedure (the device can also easily be removed if necessary).

The device contains the islet cells, but it consists of a strong outer frame to protect the cells. Within the frame, a scaffold holds the cells, keeping them from clumping together. The device also maintains a system in which drugs may be released (such as steroids) to reduce the inflammation caused by the body's immune response. Also, the device works to provide oxygen to the islets to help their survival until they form their new blood supply within the abdomen. Ideally, with these new components, islet cell transplantation may be much more successful and considered a more permanent solution to diabetic complications.

However, as promising as Richard's research may seem, we must remember that his work must still be considered experimental and in its testing phase...

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