Transplantation for the treatment of diabetes remains an ever-evolving goal. As success rates improve with experience and research, the bar for success is set higher and higher.
“The two key questions are: How do we do better in terms of getting transplanted cells to survive, and how do we source cells for transplantation?” said Melena Bellin, MD, Associate Professor of Pediatric Endocrinology and Director of Research for the Islet Autotransplant Program at the University of Minnesota Medical Center. “The first question is all about transplanting cells into a healthier environment and protecting them with less toxic immunosuppression. The second question is about improving cell supplies so we can apply cell transplantation and cell replacement therapy to a broader audience. That’s where we are focusing our attention at the Scientific Sessions this year.”
Dr. Bellin is member of the Scientific Sessions Meeting Planning Committee in the area of transplantation. There are several transplantation symposia planned as part of the Immunology/Transplantation track at this year’s meeting.
On Friday, June 9, the session Primer on Transplantation for the Clinician (2:00 p.m.–4:00 p.m.) will provide an introduction to pancreas/islet transplantation and islet autotransplant following total pancreatectomy.
“Our speakers will deal with the state of transplant today for various indications, including patients with recurrent severe hypoglycemia and diabetic kidney disease,” Dr. Bellin said. “We will also talk about the psychosocial aspects of transplant and the management of islet transplantation and autotransplantation. As more people live longer with diabetes, transplantation is being discussed more often. It’s an area that every diabetes clinician needs to know about.”
Another reason transplantation is growing in importance is the realization that immunosuppression techniques can inform the treatment of type 1 diabetes. On Saturday, June 10, the session Beta Cells Under Attack—Lessons from Transplantation for New-Onset Type 1 Diabetes (4:00 p.m.–6:00 p.m.) will explore the growing overlap between transplantation and type 1 diabetes treatment.
“A lot of the newest research on immunosuppression in new-onset type 1 diabetes is very similar to the things we deal with every day in the transplant field,” Dr. Bellin said. “We want to address areas of overlap between these two communities of researchers and clinicians.”
One of the major barriers to successful transplantation is cellular immunity. Cellular immunity leading to beta cell destruction by reactive T cells is also a key component in new-onset type 1 diabetes.
Innate immunity is another common problem in transplantation and type 1 diabetes. Another Saturday session, Therapies to Preserve Beta Cells in Type 1 Diabetes (1:45 p.m.–3:45 p.m.), will explore different strategies to protect beta cells from innate immune responses.
Biomarkers that measure islet and beta cell function and destruction were initially developed for type 1 diabetes but are finding use in transplantation as well. The plasticity of islet cell function also applies to both transplantation and islet regeneration in type 1 diabetes.
The cutting edge of islet transplantation will be explored during a session on Sunday, June 11, titled Technical Innovations in Islet Transplantation—Novel Approaches (4:30 p.m.–6:30 p.m.). The session’s presenters will review: the latest efforts to bioengineer the transplant site to improve outcomes; new devices to better oxygenate beta cells and deliver them to the transplant site; novel encapsulation platforms; the need for more robust assessment of beta cells created using stem cell or xenotransplants technologies; and lessons in immunosuppression from the kidney transplant world.
“We know that transplantation can work in diabetes. The challenge now is making transplantation work more effectively, more reliably, and in patients with diabetes,” Dr. Bellin said.