Pancreas and islet preservation

Pancreatic islets contain endocrine beta and alpha cells that produce insulin and glucagon, respectively, two hormones key to regulating blood sugar. Recent technological advances in human islet transplantation (ITx) have triggered renewed interest in whole organ and islet preservation methods aimed at protecting the structural and functional integrity of islets during the process of islet manufacturing, from the point of organ procurement to the point of islet infusion into the recipient. Islet isolation is a complex, multistep and laborious procedure influenced by numerous factors that require highly trained and skillful personnel. Due to a high islet attrition rate during isolation and limited islet viability after purification, most current ITx protocols require islets from more than one pancreas. The need for multiple donors represents a major economical and clinical barrier to expand the number of diabetic patients that could benefit from ITx. Ischemia and hypoxia have been identified as prominent factors contributing to islet losses during isolation and after ITx. Delivery of appropriate amounts of oxygen and other preservation measures must be implemented at the organ, tissue and cellular level to improve islet viability and preserve beta and alpha cell function. The current chapter reviews the mechanistic impact of ischemia and hypoxia on islet function and viability, as well as current methods of islet preservation prior, during and after islet isolation, purification, culture, and distribution.