inolog Office
Organ Transplant Research Center of Surgery RAMS (Moscow), Alexander V.
Podshivalin.
- Is the treatment of diabetes can not be
dispense medications and diet, and why need another operation? -
Surgery - this is an extreme measure. Her conduct, when
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
operation itself, as with its help can help the patient? -
Operation is to transplant the donor cells in the pancreas.
The fact is that when you are asnning a diabetes type-I own
cells able to produce insulin, usually remains very
little. And since no cells, no insulin. But without other cells
our body does not metabolize glucose and, therefore, deprived of one
major source of nutrition. Unclaimed glucose builds up in
blood, which is very dangerous. Transplanted the cells if not in full,
but reduced the production of essential hormones. The procedure itself
implantation is technically difficult: the patient under local anesthesia
make a small incision. Through it in one of the veins injected donor cells
pancreas. Once in the vein of the liver cells are fixed,
take root and begin to produce insulin. - Do all patients can
transplanted cells in the pancreas? - Unfortunately, no. Now
similar operation is carried out only with type I diabetes, or, as it
called insulin-dependent diabetes. - Does the operation is completely
refuse insulin injections? - While not allow it. Injections of insulin
patient still has to do, but certainly not as often and not
as much as before surgery. At the same time change significantly
facilitates the overall condition of the patient, inhibits or even prevents
threatening complications of diabetes - kidney failure,
blindness, heart disease. - And why do have to compensate for the lack of insulin
donor cells, but not very
injections of insulin? - Those who receive insulin in the syringe, and the cells inside
his body, muchmoreimmune to the complications of diabetes
. The very course of the disease becomesmorestable. Here is just one example
. In women with diabetes, there
serious problems with childbirth. Often patients can not
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
dead children, prevents disease of the fetus, stops the development of
complications of diabetes. - How long is helping the operation?
-
Theoretically enough of a single transplant. Donor cells
pancreas viable for many years. They contain and
insulin-producing so-called B-cells, and
progenitor cells from which are formed instead of dead new
B cells. But in practice, the positive effect of the operation remains
short - so far only for one year. Then need to re-
operation. - And why is this happening?
- Clarity on this issue there.
Known that type I diabetes occurs because of failures in the immune system.
Perhaps the immune system mistakenly
own cells of the pancreas for the alien and starts to destroy them. That
this situation can significantly shorten the life of the 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 glucose is
penetrate the capsule, and synthesized insulin molecule -
go out. Much larger in size lymphocytes and antibodies can not penetrate through the pores
that 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 dasgs that suppress the immune system. Of course,
donor cells of animals helped us a lot. After all, they are easily accessible and
cheap. The number of operations has increased several times, and their
efficiency now exceeds 90%. By the way, the donor cells
pancreas can be transplanted not only in the liver, but also in tissue
eyes. Such experiences have also available. Thanks to this operation
possible to prevent one of the most severe complications
diabetes - diabetic blindness. Positive result -
increase of visual acuity - says almost 80%. - Why did you
use for transplantation is cell piglets and rabbits? - The fact
that insulin in animals and humans is not the same. According to their stascture and composition
he is a little different. The human hormone most like
insulin pig and rabbit. Our legislation still allows
use such biological material for transplantation to man. In
Europe and America do not. - By the way, as well as the problem
transplant pancreas is solved abroad? - Our
foreign counterparts a somewhat different approach. They went on themorecomplex and costly
way. Transplanted pancreas entirely and often
only with the kidneys. And the donor can only be a people. After
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
receiving immunosuppressive dasgs inevitably lowered immunity,
resistance to infection, increased risk of tumors.
Duration of therapeutic effect is also small - only one -
maximum of two years. As with any organ transplants
rights, have long wait for a suitable donor. - It turns out that
pancreas transplantation is even worse than, say,
heart? - You're right. In general, the transplantation of pancreatic
yet yield results of transplantation of kidney, heart and liver. But all the same
such operations are conducted. Now the world is about 1000
pancreas transplantation each year, with 80% - in the U.S.. - And we
pancreas transplant did not try?
-
Pancreas transplant in Russia have only four patients. By
Unfortunately, all operations were unsuccessful. But that is not associated with
low qualifications of our professionals. Rather, we are just behind in
this direction. And the operation is very complicated. If you recall the story,
then all 14 first transplants of pancreas were unsuccessful. - How do you assess the prospects
pancreas transplantation? -
Certainly they are. And related, primarily, with a transfer of transgenic
bodies. In this case would be solved almost all problems, including
with graft rejection, lack of donor organs and their
high cost. But as long experience in transplants human transgenic
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
the future. - And what - the traditional treatment of diabetes with insulin injections
become unnecessary? - Not at all. Certainlymore
decades insulin will faithfully serve the patients with diabetes mellitus
. Themorethat scientists and doctors create amoreeffective
forms of this medication, constantly improving technology of its introduction.


T Where do transplants of pancreatic cells: l Moscow Research Institute of Transplantation and Artificial Organs.
l Russian Children's Clinical Hospital.
l St. Petersburg Scientific Research Centre of the State Medical University.
t insulin can be inhaled

Inhalation of insulin are not worse than the injections. With their help patients
mellitus type I was able to reduce the number of injections from two or three to one in
day, and in diabetes mellitus type II inhaled insulin generally
replace injections. According to experts, insulin inhalation
still can not completely replace the conventional insulin. But they are, without doubt,
very useful for children with diabetes type I and in emergency situations,
when urgently required large doses of insulin.

Vladimir Shcherbakov