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Pancreatic Islet Transplantation Into the Anterior Chamber of the Eye

2016-07-28 03:38:21 | BioPortfolio

Summary

The treatment in this trial consists of intraocular islet transplantation. A single dose of 1000 - 2000 Islet Equivalents (IEQ)/kg recipient body weight (BW) will be infused into the anterior chamber of the eye through a self-sealing incision of the peripheral cornea. The procedure is projected to take approximately 20-30 minutes. Subject will remain flat on their back for 45-60 minutes after islet infusion to maximize adhesion of the islets to the iris.

Description

The impact of Type 1 Diabetes. In the U.S. alone, approximately 1.3 million people, including children and adolescents, suffer from type 1 diabetes (T1D); the disease incidence is increasing in many countries, also in children and adolescents. Chronic autoimmune T cell responses against pancreatic ß-cells are considered the primary cause of T1D, leading to loss of beta cell mass and insulin secretion and in turn life-long dependence on insulin injections. The disease severely impacts quality of life and confers risk for both acute and chronic complications linked to significant morbidity and mortality, such as end stage renal disease, blindness, cardiovascular disease, diabetic ketoacidosis and hypoglycemia. The economic burden caused by T1D amounts to approximately $14.4 billion in medical costs and lost income. There is a significant need to develop new therapies of improve existing ones to prevent, treat, and cure T1D. Diabetes socioeconomic impact primarily stems from the serious complications associated with this devastating disease. Such complications include blindness, amputations, kidney failure, heart and vascular disease, stroke, nerve damage, and even birth defects during pregnancy.

Although the specific etiology of T1D remain unknown, it is well established that T1D results from the autoimmune destruction of the insulin-producing beta cells in the endocrine pancreas (i.e., the islets of Langerhans). Consequently, treatment options in T1D are limited to insulin supplementation. Insulin supplementation can be either in the form of multiple insulin injections daily or biological replacement of the insulin-producing beta cells which provide a natural source of insulin. On the one hand, conventional insulin supplementation via injection has saved countless lives of diabetic patients since the discovery of insulin in the early 1900s. However, it is well established that exogenous insulin injection therapy is suboptimal in preventing hyper and hypoglycemia fluctuations. On the other hand, it has been shown that even a partial level of endogenous insulin secretion protects from chronic diabetic complications, hypoglycemia and diabetic ketoacidosis, which can all lead to death.

Therefore, beta cell replacement therapy through transplantation of isolated pancreatic islets offers a great therapeutic option in T1D. Several approaches of beta cell replacement have been pursued in the last few decades. Regenerative approaches such as regeneration of existing mature beta cells, differentiation of stem cells and/or trans-differentiation of other endocrine or non-endocrine (e.g., ductal and exocrine) cells into insulin-producing cells hold great promise in treating T1D. However, these approaches have yet to materialize into safe and reliable clinical application. Transplantation is also another option of biological replacement but has limitations as well. Limited availability of donor tissue remains a significant obstacle in transplantation therapies in general, including pancreatic islets. Other limitations of transplantation therapy are associated with the mandatory use of systemic anti-rejection immunosuppressive drugs. Chronic systemic immunosuppression exposes transplant recipients to serious and potentially deadly side-effects and complications such as increased susceptibility to infections/sepsis and cancer. Therefore, immunosuppressive agents are continuously being improved and new ones are being developed to better protect transplanted tissues (e.g., pancreatic islets) while reducing undesired side-effects of systemic immunosuppression and its associated complications.

T1D patients currently receive transplant therapy either in the form of whole pancreas or isolated pancreatic islets. On the one hand, whole pancreas transplantation has been shown to achieve insulin independence in T1D patients, but it is also very invasive and is associated with high risk of complications and adverse events including mortality. On the other hand, transplantation of isolated pancreatic islets is minimally invasive and has significantly less complications compared to whole pancreas transplant, but survival of the islet graft might be severely limited due to complications associated with the current clinical transplant site, the portal system of the liver. Nevertheless, hundreds of T1D patients have received islet transplants in the liver in the last two and a half decades of clinical trials of islet transplantation. These studies have demonstrated that islet transplant recipients benefit from improved glycemic control, reduced hypoglycemia episodes, and prevention of diabetes-associated complications. This improves the patients' quality of life significantly. Importantly, it has been shown in transplanted T1D patients that restored hypoglycemia awareness following transplant is maintained even after the patients have to get back on insulin therapy due to rejection or loss of the islet graft. Therefore, transplantation of isolated pancreatic islets has emerged as a promising therapy for T1D. Consequently, islet transplantation is on the verge of becoming standard-of-care in the United States and other countries.

Study Design

Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Conditions

Diabetes

Intervention

Human Pancreatic Islet Transplantation

Location

Bascom Palmer Eye Institute
Miami
Florida
United States
33136

Status

Not yet recruiting

Source

University of Miami

Results (where available)

View Results

Links

Published on BioPortfolio: 2016-07-28T03:38:21-0400

Clinical Trials [3541 Associated Clinical Trials listed on BioPortfolio]

Pancreatic Islet Transplantation in the Anterior Chamber of the Human Eye - a Pilot Study

The overall objective is to establish that transplantation of allogeneic pancreatic islet cells into the anterior chamber of a severely visual impaired diabetic human eye is safe and does ...

Human Islet Transplantation in Brittle Type 1 Diabetes Mellitus. The GRAGIL 2 Study.

This research project is supported by a multicentric network of collaborators whose goal is to assess the efficacy of transplanting allogenic pancreas islets to restore insulin secretion i...

Islet Transplantation in Type 1 Diabetes

Type 1 diabetes is an autoimmune disease in which the insulin-producing pancreatic beta cells are destroyed, resulting in poor blood sugar control. The purpose of this study is to determin...

Minimal Islet Transplant at Diabetes Onset

This is a prospective phase 2, single-arm, mono-center pilot study. It has been designed to investigate whether giving the combination therapy consisting of minimal islet transplantation (...

A Study in Type 1 Diabetic Patients With Repeated Doses of E1 in Combination With G1

The purpose of the study is to determine whether E1 and G1 are safe and effective in the treatment of type 1 diabetes. Type 1 diabetes is an autoimmune disease, in which the immune system...

PubMed Articles [16338 Associated PubMed Articles listed on BioPortfolio]

Therapeutic Strategies for Modulating the Extracellular Matrix to Improve Pancreatic Islet Function and Survival After Transplantation.

Extracellular matrix (ECM) components modulate the interaction between pancreatic islet cells. During the islet isolation prior to transplantation as treatment for type 1 diabetes, the ECM is disrupte...

Tissue engineering approaches in pancreatic islet transplantation.

Pancreatic islet transplantation is a promising alternative to whole-pancreas transplantation as a treatment for type 1 diabetes mellitus. This technique has been extensively developed during the past...

Dynamics of Changes in Metabolic and Hematological Parameters after Transplantation of Pancreatic Islet Cells on TiNi Scaffold in Experimental Diabetes Mellitus.

The dynamics of the development of the pancreatic islet cells in the porous TiNi scaffold was studied by electron microscopy. Changes in the metabolism of glucose and glycosylated hemoglobin and param...

Clinical islet transplantation: is the future finally now?

Clinical pancreatic islet transplantation has evolved into a routine means to restore glycemic control in patients with type 1 diabetes mellitus (T1DM) suffering from life-threatening hypoglycemia and...

Islet Allotransplantation in the Bone Marrow of Patients With Type 1 Diabetes: A Pilot Randomized Trial.

Results in murine and nonhuman primate suggested that the bone marrow (BM) might be an alternative site for pancreatic islet transplantation.

Medical and Biotech [MESH] Definitions

A primary malignant neoplasm of the pancreatic ISLET CELLS. Usually it involves the non-INSULIN-producing cell types, the PANCREATIC ALPHA CELLS and the pancreatic delta cells (SOMATOSTATIN-SECRETING CELLS) in GLUCAGONOMA and SOMATOSTATINOMA, respectively.

A benign tumor of the pancreatic ISLET CELLS. Usually it involves the INSULIN-producing PANCREATIC BETA CELLS, as in INSULINOMA, resulting in HYPERINSULINISM.

A pancreatic beta-cell hormone that is co-secreted with INSULIN. It displays an anorectic effect on nutrient metabolism by inhibiting gastric acid secretion, gastric emptying and postprandial GLUCAGON secretion. Islet amyloid polypeptide can fold into AMYLOID FIBRILS that have been found as a major constituent of pancreatic AMYLOID DEPOSITS.

Autoimmune diabetes in adults with slowly progressive PANCREATIC BETA CELL failure and the presence of circulating autoantibodies to PANCREATIC ISLETS cell antigens.

A group of islet cells (10-35%) which secrete PANCREATIC POLYPEPTIDE, a hormone that regulates APPETITE and FOOD INTAKE.

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