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Auto Islet
Some Patients May Avoid
Future Diabetes
Using Cells Normally Discarded During Surgery
Chronic pancreatitis is an inflammatory disease
that causes recurrent episodes of pain and
increases the risk for developing pancreatic cancer.
Gallstones and excess alcohol use are common
causes of chronic pancreatitis among adults,
while genetic disorders are most often associated
with the condition in children. When drugs are
no longer effective in managing the symptoms of
chronic pancreatitis, partial or total removal of the
pancreas (pancreatectomy) may become the last
resort to alleviate patients’ debilitating pain.
“Surgery is very effective in eliminating pain and
cancer risk in patients with chronic pancreatitis,”
explains Howard A. Reber, MD, director of the
UCLA Center for Pancreatic Diseases. “The
problem is that patients lose the ability to produce
insulin with the removal of all or part of their
pancreas, and those patients will develop diabetes.”
In some patients, however, diabetes may be
avoided by using a procedure called auto-islet
transplantation. During the procedure, islets,
which are clusters of pancreatic cells that sense
blood-sugar levels and release insulin to maintain
normal levels, are saved during pancreatectomy,
isolated in the laboratory and then infused back
into the patient’s body through a catheter inserted
into the liver. Islet cells can then continue to
produce insulin. Because islets are generated by
the patient’s own pancreas, rejection does not
occur and immunosuppressive drugs are not
required. Surgery to remove all or part of the
pancreas is common, but the final step is the key
to preventing diabetes.
“We’re preserving islets cells that would normally
be discarded and using them to potentially prevent
future diabetes,” Dr. Reber says. At UCLA, patients
who have undergone partial pancreatectomy
followed by auto-islet transplantation have avoided
both diabetes and insulin dependence. Those who
have undergone total pancreatectomy followed by
auto-islet transplantation have developed insulin
dependence but avoided severe “brittle” diabetes,
or unstable diabetes, characterized by dramatic
and recurrent swings in glucose. All UCLA patients
who have undergone auto-islet transplantation are
now pain-free and living normal lives.
While other programs in Los Angeles and across
the U.S. can surgically remove the pancreas,
UCLA, in an innovative collaboration with a
UC San Francisco lab that facilitates isolation of
the islets, is one of only a few centers in the United
States with the potential to prevent diabetes by
performing auto-islet transplantation. Still, just a
handful of auto-islet transplantations have been
performed at UCLA to date.
“We have good evidence that auto-islet
transplantation can free patients from relentless
pain and may prevent future diabetes, but people
don’t know about the procedure,” says Gerald
Lipshutz, MD, surgical director of the Pancreas
Transplant Program at UCLA. In addition to
improving the prognosis for patients with chronic
pancreatitis, the technique also holds the promise
for helping patients with related conditions,
according to Dr. Lipshutz.
The islet of Langerhans (center), found
in the pancreas, secretes the hormones
“In part, we are learning how to perform
procedures that will be necessary for stem-cell
therapies five or 10 years in the future,” Dr.
Lipshutz says. “Theoretically, we could biopsy the
skin of diabetic patients, isolate and reprogram
fibroblasts into stem cells and deliver them safely
to the liver so that auto-generated islet cells can be
used to produce insulin to overcome diabetes,” Dr.
Lipshutz explains. Fibroblasts are cells commonly
found in connective tissue that play an important
role in healing wounds. Patients with inherited
liver disorders (urea cycle or other metabolic
disorders) may also benefit from knowledge gained
through auto-islet-transplantation procedures.
insulin and glucagon, which control
blood-sugar levels.
“Each time we perform auto-islet transplantations,
we learn more about how many cells patients can
tolerate, refine our transplantation techniques and
improve how we monitor patients for current and
future procedures related to preventing diabetes
and related conditions,” Dr. Lipshutz says.
For more information go to:
pancreas.ucla.edu 3
UCLA Physicians Update