It pays to keep those islet cells

Every year in the United States, more than 50,000 people suffer from painful inflammation of the pancreas. Most patients recover completely. But some develop chronic pancreatitis, which is marked by deep pain and gradual destruction of the organ. Many of these people eventually undergo an operation that removes their damaged pancreas, including the insulin-making islet cells, and thus results in diabetes.

Salvaging these cells and implanting them into the liver can avoid diabetes, researchers at the Pacific Northwest Research Institute in Seattle report in the January Diabetes.

The scientists tracked six patients who had had their pancreas removed. During these surgeries over the last 13 years, physicians minced the pancreas into small pieces and then dissolved away some of the tissue with chemicals that leave islet cells unharmed. The surgeons gradually injected about a tablespoon of these cells into each patient’s portal vein, which leads into the liver. There, the islet cells dispersed and took up residence throughout the organ, says study coauthor R. Paul Robertson, an endocrinologist at the institute.

None of the six patients needed insulin during recovery from surgery. After less than a week, the islet cells seemed to be thriving and making insulin, Robertson says.

“It’s pretty remarkable that [the islet cells] can function so quickly after transplantation. We don’t fully understand it,” says Robertson.

The researchers report that five patients in the new study have avoided full-blown diabetes for an average of 6 years-one for 13 years-although the patient in whom the fewest cells were transplanted did eventually develop diabetes.

Because attempts at islet-cell transplantation from cadavers have had poor success in people with diabetes, physicians might have been discouraged from transplanting cells between the organs of pancreatitis patients, Robertson says.

These islet cell transplants “represent a promising new technique” that could help patients with chronic pancreatitis, says Norton J. Greenberger, a gastroenterologist at Kansas University Medical Center in Kansas City.

Pancreatitis can result from alcohol abuse, damage from gallstones, abdominal injury, or a variety of other health problems. Once a pancreas is lost, a person suffers not only from diabetes but also from severe diarrhea unless given insulin and drugs that make up for digestive enzymes normally produced by the organ.

Pancreas removal usually occurs “late in the game,” Robertson says, after a patient has endured considerable pain that radiates from behind the stomach to the back. Although pancreas transplants are often successful, the recipients usually must take immune-suppressing drugs for the rest of their lives.

The new study suggests that instead of waiting for a donor organ, surgeons could perform the cell transplant and remove the inflamed pancreas early in the disease to spare patients months of suffering. Robertson says that the success of the procedure should be highest soon after diagnosis when there are still plenty of healthy islet cells in the patient’s pancreas.

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