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Daughter cured of diabetes with cells taken from mother
Three months after the operation both women are well and the recipient is free from daily insulin injections, the team reports today in the online edition of The Lancet.
This is the first time that a pancreas cell transplant from a living donor has succeeded: two previous attempts in the US ended in failure.
The operation was carried out at Kyoto University Hospital on January 19. A team led by Shinichi Matsumoto removed half of the pancreas of the 56-year-old mother, isolated from it the islet cells that make insulin, and injected them into the liver of her 27-year-old diabetic daughter.
Twenty-two days later, for the first time in 12 years, the daughter was free from the need of daily doses of insulin, as the cells donated by her mother took over the task. The mother, who risked becoming diabetic by donating half her pancreas, was also well. "Our recipient has achieved insulin independence and remains insulin-free with excellent glycaemic control," the team reports.
Islet-cell transplants began in 2000, and scores have been carried out since then. The first entirely successful one in the UK was reported last month.
The cells are injected into the liver because it is easily accessible through the portal vein and it has been found that islet cells survive there and produce insulin, enabling the liver to serve as a back-up pancreas.
Until now the cells have come from cadavers and to provide enough for a successful transplant two or even three donors have been needed. Many doctors doubted that half a pancreas would ever be sufficient.
But the Japanese team, assisted by James Shapiro, a pioneer of the technique from the University of Alberta in Canada, hoped that cells from a living donor would work better than those from a cadaver, and that fewer of them would be needed. Their optimism appears to have been justified.
The new transplant technique is yet not considered a cure and requires refinement, said Dr Matsumoto. "Living donor islets can be an additional option," he said. Long-term follow-up is necessary and another transplant may be needed within five years.
Normally in type 1 diabetes, in which the patient cannot make insulin, the body's immune system destroys the islet cells. This case was different because the recipient had suffered from chronic pancreatitis, an inflammation of the pancreas, from the age of 4. Eventually this destroyed her islet cells, and she became diabetic at the age of 15. One reason why the transplant proved a success may be that her immune system was not primed to destroy the transplanted cells.
The British specialists Professor Stephanie Amiel and Mohamed Rela, of King's College London, urged caution, saying that islet survival in transplant recipients may not be indefinite, for reasons that were still unclear. So Dr Matsumoto's patient may not be typical of type 1 diabetics.
And if she still loses her new islet cells for other reasons, the short-term benefit to her must be weighed against the health risk to her mother.
The charity Diabetes UK described the operation as a "significant breakthrough" but questioned whether it would be a way forward for many people because of the risks involved.Published on this website on Thu, 04 Nov 2010