Mellitus type

Hope for the healing of patients with diabetes mellitus type I gives the transplant donor cells in the pancreas. Who will help this operation?
A new method of treating diabetes tells PhD, endocrinologist Division of Organ Transplantation Research Center of Surgery RAMS (Moscow), Alexander V. Podshivalin.

- Is the treatment of diabetes can not do drugs and diet, why need more and operation? - Surgery - this is an extreme measure. It is conducted when the pancreas rapidly destroyed cells that produce insulin, the patient's plight. In deciding on the operation, we proceed from the possibility of qualitatively improve the patient's life, always correlate favor of our intervention and the expected complications. - What is the surgery itself, as with its help can help the patient? - The operation is to transplant the donor cells in the pancreas. The fact is that when you are running a diabetes type-I's own cells that can produce insulin, usually there is very little.

And since no cells, no insulin. Without it, other cells in our body does not metabolize glucose and, therefore, deprived of one of the main sources of supply. Unclaimed glucose accumulates in the blood, which is very dangerous. Transplanted the cells if not in full, but reduced the production of essential hormones. Implantation procedure itself is technically difficult: the patient under local anesthesia makes a small incision. Through it in one of the veins injected donor cells in the pancreas. Once in the vein of the liver cells are fixed, take root and begin to produce insulin. - Do all patients can be transplanted pancreas cells? - Unfortunately, no. Now this operation is carried out only with type I diabetes, or as it is called insulin-dependent diabetes. - Does the operation completely abandon the insulin injections? - While not allow it. Injections of insulin a patient still has to do, but certainly not as often and as many as before the operation. At the same time change greatly facilitates the general condition of the patient, slow or even prevent the terrible complications of diabetes - kidney failure, blindness, heart disease. - And why do have to brand name viagra compensate for the lack of insulin donor cells, rather than injections of the insulin? - Those who receive insulin in the syringe, and the cells inside his body, much more immune to the complications of diabetes. The very course of the disease becomes more stable. Here is just one example. In women with diabetes, there are serious problems with childbirth. Often patients can not get pregnant, and if pregnancy occurs, it occurs with many complications. Transplantation of donor cells in most cases, normalizes during pregnancy reduces the risk of birth of dead children, prevents disease of the fetus, stops the development of diabetes complications. - How long is helping the operation?

- Theoretically enough of a single transplant. Donor cells of the pancreas are viable for many years. They also contain insulin-producing so-called B-cells and progenitor cells from which new form instead of dead B cells. But in practice, the positive effect of the operation is stored for long - so far only for one year. Then he needed a second operation. - And why is this happening?
- Clarity on this issue no. It is known that type I diabetes occurs because of failures in the immune system. Perhaps the immune system mistakenly adopt its own pancreas cells for the alien and starts to destroy them. It is this situation can significantly shorten the life of transplanted cells. So now scientists are looking for ways to protect the donor cells. For example, what they enter into a special capsule with a porous membrane. At right sized since the glucose will penetrate into the capsule, and synthesized insulin molecule - to go outside. Much larger in size lymphocytes and antibodies can not penetrate through the pores, which protects transplanted cells from rejection. - How do you take the donor material for transplantation?

- Now we use the cells in the pancreas of pigs and newborn rabbits, and fetal human cells. After their transplant rejection problems are rare. Therefore, patients do not need to take powerful drugs that suppress the immune system. Of course, the donor cells of animals helped us a lot. After all, they are readily available and inexpensive. The number of operations has increased several times, and their efficiency now exceeds 90%. By the way, the donor cells in the pancreas can be transplanted not only in the liver, but also in the eye tissue. Such experiences have also available. Due to this surgery can prevent one of the most serious complications of diabetes - diabetic blindness. Positive result - increase of visual acuity - says almost 80%. - Why do you use for cell transplantation is pigs and rabbits? - The fact that insulin in animals and humans is not the same. According to their structure and composition, he is a little different. The human hormone insulin is most similar to pig and rabbit. Our legislation does allow the use of such biological material for transplantation to man. In Europe and America do not. - By the way, as well as the problem of transplantation of the pancreas is solved abroad? - Do our foreign colleagues a slightly different approach. They went on more complicated and costly way.

Transplanted pancreas The rush of love misplaced entirely and often with kidneys. And the donor can only be a people. After a successful operation results clearly higher cell transplantation, which is used in our country. In many cases, can fully compensate for diabetes, normalize insulin. However, it is quite frequent complications. Due to receiving immunosuppressive drugs inevitably lowered immunity, resistance to infection, increased risk of tumors. Duration of therapeutic effect, too small - just one - a maximum of two years. As with any transplantation of human organs, we have to wait long for a suitable donor. - It turns out that transplantation of the pancreas is even worse than, say, heart? - You're right. In general, the transplantation of the pancreas until the inferior results of transplantation of kidney, heart and liver. But still, such operations are performed. Now the world is about 1000 pancreas transplants each year, with 80% - in the U.S.. - And we have a pancreas transplant did not try?

- Pancreas Transplant in Russia have only four patients. Unfortunately, all operations were unsuccessful. But it is not associated with low skills of our specialists. Rather, we are simply left behind in this regard. And the operation is very complicated. If you recall the story, then all 14 of the first transplants of pancreas were unsuccessful. - How do you assess the prospects for pancreas transplantation? - Of course they are. And related, primarily, with a transfer of transgenic organs. In this case would be solved almost all problems, including graft rejection, lack of donor organs and their high cost. But as long experience in transplants of transgenic human pancreas does not exist anywhere in the world. Also of interest are attempts to create "artificial pancreas - a compact automatic device that will enter the patient is strictly required amount of insulin in response to changes in blood sugar levels. But this is the future. - And what - the traditional treatment of diabetes with insulin injections become unnecessary? - Not at all. Probably for decades to insulin will faithfully serve the people with diabetes. The more that scientists and doctors create more efficient forms of this medication, constantly being improved technique of administration.