Prolonged immunosuppression and euglycaemia with beta-cell allograft, does not dramatically improve native beta-cell function, according to a report in the journal Diabetologia.

A number of studies support persistent beta-cell survival years after Type 1 diabetes onset.

To test the hypothesis that long-term treatment for autoimmunity and beta-cell failure would provide the best environment for native islet recovery, David Harlan (National Institutes of Health, Bethesda, Maryland, USA) and colleagues measured native pancreatic C-peptide production in people with Type 1 diabetes who had undergone islet or whole-pancreas transplantation.

C-peptide levels were measured in 141 potential participants for the islet transplant study.

Three islet and four whole pancreas allograft recipients with successful clinical outcomes (insulin-independent euglycemia for at least 1 year following the procedures) underwent selective arginine stimulation (SAS), which can discriminate between the C-peptide produced by the native pancreas and that produced by the beta-cell allograft.

A basal or arginine-stimulated C-peptide level of at least 0.167 nmol/l (normal range in healthy individuals is 0.30??”1.33 nmol/l) was reported in 54 of 141 (38%) potential study participants.

“These data suggest that pancreatic insulin function persists in over a third of individuals with long-standing Type 1 diabetes, but is minimal and often detectable only after appropriate stimulation and with sensitive C-peptide assays,” write the authors.

Following the SAS technique all three islet allograft recipients displayed some evidence of native pancreatic C-peptide production at least 2 years after their last islet allograft infusion.

To determine whether longer term (at least 4 years) immunosuppression and euglycemia might promote clinically significant regeneration, the SAS technique was repeated in four successful pancreas allograft recipients.

While all recipients displayed evidence that their native pancreas secreted C-peptide, the magnitude of the effect was very small, similar to that seen in the islet recipients.

“Our present study suggests that vigorous beta-cell regeneration does not occur in patients with long-term Type 1 diabetes after islet or pancreas transplantation,” conclude the authors.

“While beta-cell regeneration cannot be completely ruled out, these data suggest that the process is not robust given allograft-mediated restoration of glucose metabolism and currently available immunosuppression,” they add.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

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