Abstract
Pancreatectomy and autologous islet transplantation (AIT) are performed in highly specialized centers to alleviate abdominal pain and preserve endocrine function in patients with chronic pancreatitis. We aimed at initiating AIT studies in India for the first time in patients undergoing distal pancreatectomy (DP) to prevent development of diabetes. Four out of 14 chronic pancreatitis patients screened underwent DP with AIT. Pancreatectomy specimen preserved in Wisconsin solution was subjected to islet isolation employing standard protocol using collagenase V. Isolated islets were infused into the liver through portal vein after quality assessment and the four patients were followed for 1 year. During the study period, blood glucose, fasting insulin, and C-peptide were analyzed and glucose tolerance was assessed. Three patients could be infused with islets (4363 Islet equivalents, IEQ/kg, 3860 IEQ/kg, 3600 IEQ/kg) into liver without any infusion-related complications. Two of these patients maintained glucose tolerance and glycemic control (HbA1c: 6.0%) and one became diabetic at the end of 1 year (HbA1c: 7.5%). Circulating fasting insulin increased (2.7–24.4 μU/mL and 4.0–21.2 μU/mL) and C-peptide levels increased (2.2 to 3.6, 3.4–5.6 ng/mL) in these two patients. Circulating insulin was 2.7 μU/mL and C-peptide was 2.4 ng/mL in the patient who became diabetic at the end of 1 year, while insulin was 2.3 μU/mL and C-peptide was 1.2 ng/mL in the patient who could not be infused with islets after DP. Safety and feasibility of autologous islet transplantation is established in India for the first time.
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Acknowledgments
The authors wish to convey their gratitude to AN Balamurugan for his guidance in standardizing the clinical islet isolation protocols and initiating islet transplant program in India. The authors are thankful to Mr. B. Chimpa Reddy and Mr. Paparao B. for their technical assistance in maintaining GMP grade islet isolation facility and clinical grade islet isolation.
Funding
This study received financial support from the Asian Healthcare Foundation.
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Authors and Affiliations
Contributions
Rao GV, Praddep R: participated in research design, performance of research and writing the manuscript.
Mahesh Shetty G: performed distal pancreatectomy, pancreas preservation, and transport to islet laboratory.
Sasikala M: participated in research design, clinical grade islet isolation, and quality testing, supervised the research, wrote first draft of the paper.
Pavan Kumar P: clinical grade islet isolation, participated in performance of research.
Krishna V.V: technical help in isolating clinical grade islets.
Talukdar R: participated in research design, patient screening, recruitment, patient follow up, and paper writing.
Manu Tandan: participated in research design.
Jagadeesh R: islet infusion into liver, paper writing.
Nageshwar Reddy D: participated in research design and contributed to establishment of islet transplantation studies in India.
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The study protocol was approved by Institutional ethics committee of Asian Institute of Gastroenterology, Hyderabad.
Conflict of interest
GVR, RP, MS, PPK, VVK, GMS, RT, MT, RJ, and DNR declare that they have no conflict of interest.
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The authors are solely responsible for the findings and the content of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, and the printer/publishers are responsible for the results/findings and the content of this article.
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Rao, G.V., Pradeep, R., Sasikala, M. et al. Distal pancreatectomy with autologous islet transplantation in chronic pancreatitis patients: First case series from India. Indian J Gastroenterol 37, 452–456 (2018). https://doi.org/10.1007/s12664-018-0881-6
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DOI: https://doi.org/10.1007/s12664-018-0881-6