缺氧致早期胰岛移植失败的原因及对策

Early islet graft failure due to hypoxia： review and our experimental experience

胰腺移植和胰岛移植是目前惟一能治愈Ⅰ型糖尿病的方法.相对前者,胰岛移植是一种微创的技术,在手术操作及免疫抑制等方面更具有针对性,这使其成为近年Ⅰ型糖尿病治疗中令人瞩目的 焦点.然而现今的胰岛分离和提纯技术会导致低氧应激,这会严重损害胰岛β细胞的功能.同时,只有在重建血供的条件下,才能保证移植的胰岛细胞得到充足的氧供和营养底物以成功地定植于受体组织.这个过程需要7～14 d.在这期间,由于对缺氧有较强敏感性,β细胞会大量死亡（＞50%）,特别是位于胰岛中心的细胞.文章综合文献及作者的实验经验,回顾了影响胰岛细胞定植的缺氧相关的因素以及减少缺氧诱导的细胞凋亡的可行对策.

Pancreas and islet transplantation is the only treatment that can cure type 1 diabetes mellitus. Less invasive and more targeted surgical and immunosuppressive regimens make islet transplantation a more attractive treatment for type 1 diabetes. Current methods of islet isolation and purification cause hypoxic stress to which β cells are extremely vulnerable. Transplanted islets need to re-establish their vascular system in order to obtain sufficient oxygen and nutrient supply for stable engraftment. However, this process takes at least 7- 14 days to complete. Massive （〉50%） β cells are dead before revascularization due to hypoxia, especially the core of the islets. Therefore, the obvious critical problem is the circulatory deficit to which the islets are susceptible in the immediate post-transplant period.In the current study, we reviewed various hypoxic-related insults to islets before complete engraftment, and feasible strategies to reduce hypoxic-induced apoptosis based on our experimental experiences together with that of others and investigated the possibility of revascularization in islet transplantation.