This chapter reviews the current status, challenges, and perspectives in clinical islet transplantation for treatment of diabetes and the progress of selected areas of stem cell and β-cell regeneration. Islet transplantation is performed using minimally invasive interventional radiology techniques consisting of percutaneous, trans-hepatic cannulation of the portal vein and infusion of the islets by gravity. After infusion, the islet cell clusters remain trapped at the pre-sinusoidal level of the portal tree. The purification procedure substantially reduces the volume of tissue to be infused, therefore minimizing the risk of portal thrombosis and portal hypertension consequent to the intrahepatic embolization of the islet grafts. Transplantation of β-cells is currently performed as vascularized pancreas or isolated islet cell grafts. Both procedures can result in improved glycemic control in patients with diabetes. Expansion of fully differentiated, adult β-cells is reported in vitro. The induction of β-cell proliferation is generally associated with loss of mature cell phenotype and of functional competence that is only partially recovered after redifferentiation. Many adult tissues also have stem cells involved in their physiologic maintenance and repair mechanisms. Tissue-specific stem cells are elusive and difficult to culture in vitro, and their differentiation potential is much more restricted than that of embryonic stem (ES) cells. One possible exception to this rule is the bone marrow (BM)-derived multipotent adult progenitor cells (MAPCs). These cells proliferate extensively in vitro and are able to give rise to the three embryonal layers when injected into mouse blastyocysts.
|Original language||English (US)|
|Title of host publication||Principles of Regenerative Medicine|
|Number of pages||24|
|State||Published - Dec 1 2011|
ASJC Scopus subject areas
- Biochemistry, Genetics and Molecular Biology(all)