Clinical improvement after first-trimester fetal whole pancreas transplant at a heterotopic site in uncontrolled diabetes with varying degrees of skin ulceration of the leg and emaciation

Abstract

Despite the best efforts of physicians and diabetic patients in the use of insulin for control of juvenile-onset (insulin-deficient) diabetes, vascular complications do occur in most patients. There are several claimed advantages in scientific circles about the transplantation of the whole fetal pancreas as a donor organ in cases of end-state diabetes when the patient is totally dependent on insulin. Other options have also been suggested like the use of fetal stem cells with relatively low immunogenic and tumorigenic nature. These cells are also attractive candidates for transplantation. Apart from this option, use of specifically isolated pancreatic progenitor cells (PPCs) derived from the human fetal pancreas, which are amenable to growth and differentiation into transplantable insulin-producing islet-like cell clusters (ICCs) have been reported recently; however, the immunological nature of these cells has yet to be characterized [1]. The human fetal pancreas has a remarkable capacity to grow and differentiate in vivo and has been shown to reverse diabetes in rodents. However, it is well known that human fetal pancreas obtained from the second trimester of gestation is immunogenic and is rejected after transplantation. Tissue obtained from earlier stages may prove to be immune privileged, as has been shown for other tissues [2].