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Tag: diabetes

Islet Cell Transplant 

Islet Cell Transplant 

The FDA has recently approved the first pancreatic islet cell transplant for some type I diabetics.  By way of clarification, type I diabetes is due to loss of the pancreatic islet cells and therefore a lack of insulin.  Whereas; type II diabetes is due to insulin resistance because the islet cells are over producing insulin due to obesity.   

Most type I diabetics can be treated with insulin, either by injection or continuous infusion.  But in a small minority safe control cannot be established with insulin.  It is this group of fragile diabetics where the transplant has value.   

The islet cells are obtained from a single deceased donor pancreas and infused into the portal vein of the liver.  Since they are from an unrelated donor, immunosuppressant drugs are required as in other organ transplants.  So far, the procedure has had long term (>5 years) success in only 1/3 of recipients.  But the concept is a novel one and improvements are likely to occur.   

Yin and yang of inflammation – play opposite roles in infection and serious diseases

Yin and yang of inflammation – play opposite roles in infection and serious diseases

Get an infected cut or sprain an ankle and you will experience the healing benefit of inflammation. However, with the benefit also come the redness, swelling, heat and pain that are inflammation’s hallmarks. Although unpleasant, these symptoms dissipate rapidly and are reassuring that the immune system is doing its job to clear infection and guide repair of damaged tissue.
The journal  Science  had a recent review of inflammation as it pertains to chronic diseases. The review looked at new research in three major areas: Type 2 diabetes, cardiovascular disease and neurodegenerative disease. A common factor to all three is the inability of the immune system to clear away the stimulus that triggers the inflammation. Hence, there is a chronic inflammatory state that causes the disease to progress. In the case of Type 2 diabetes, obesity with the resultant saturated fatty acids is the “nonclearable” stimulus to inflammation which leads to insulin resistance, and thereby elevated blood sugars.  In the case of cardiovascular disease it is apolipoprotein B, containing lipoproteins which can’t be cleared by the immune system. The resulting chronic inflammation can be measured by a test called C-reactive protein, and it leads to laying down of arteryblocking plaque or atherosclerosis. And in the case of the neurodegenerative disease (Alzheimer’s disease, Parkinson’s, prion disease and traumatic brain injury), it is the formation of protein aggregates that can’t be cleared.
In Alzheimer’s the protein that aggregates is B amyloid, and its presence stimulates immune cells unique to the brain called microglial cells. The chronic inflammation leads to loss of brain cells and thus, dementia.  Luckily, understanding these mechanisms is leading to fruitful research. One example is altering JNK molecules. These are the enzymes that cause the diabetes-related inflammation. Drugs to modify these JNK enzymes have proven very successful in curing diabetes in mice models.