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The Future of Diabetes Treatments

Thursday, April 25, 2013

Found this video today on TED and now I have hundreds of papers to read through concerning the bioengineering of bioartificial endocrine glands like the pancreas.

www.ted.com/talks/anthon
y_atala_printing_a_human_k
idney.html


Here is a nice summary from another paper with Dr. Atala as co-author: Porcine pancreas extracellular matrix as a platform for endocrine pancreas bioengineering

"The treatment of diabetes mellitus remains inadequate. Although exogenous insulin therapy is effective at preventing acute metabolic decompensation in type 1 diabetes, less than 40% of patients achieve and maintain therapeutic targets [1]. As a result, hyperglycemia-related organ damage remains a significant cause of morbidity and mortality among the diabetic population. Intensive glycemic control achieved through dietary modification, physical activity, oral hypoglycemics and exogenous insulin can significantly reduce, but not eliminate, the microvascular and macrovascular complications of diabetes mellitus."

"Current best-practice guidelines for the management of diabetes are centered upon life-long lifestyle and pharmaceutical intervention. While these measures reduce the incidence of diabetic emergency and complication, they do not offer the possibility of remission or cure. b-cell replacement, through pancreas or islet cell transplantation, is the sole treatment capable of establishing long- term, stable euglycemia in type 1 diabetic patients."

"Regenerative medicine promises to contribute to the advance- ment of islet transplantation through the development and imple- mentation of microencapsulation technology and the exploitation of bioengineered microenvironments. Encapsulation is a means of immunoisolation, which serves to ‘camouflage’ the foreign antigens of the islet allo- or xeno-graft from host immune surveillance [2]. Encapsulation protocols involve packaging islets within semi- permeable, bio-inert membranes that selectively allow the pas- sage of oxygen, glucose, nutrients, waste products and insulin while preventing penetration by immune cells [2,3]. Theoretically, successful encapsulation eliminates the need for aggressive, life-long immunosuppression, with consequent improvements in b cell viability and host morbidity. However, although promising results have been obtained in early animal studies, the clinical value of islet encapsulation has been limited by the following obstacles, recently reviewed by Vaithilingam and Tuch [3]: 1) poor biocompatibility of capsule materials; 2) inadequate immunoisolation due to the penetration of small immune mediators, like chemokines, cytokines and nitric oxide; 3) hypoxia secondary to failed revascularization."


-- www.ncbi.nlm.nih.gov/pub
med/23583038
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