1. Prof Dr Mohamed A. BADR Consultant of Internal Med Diabetology Member Of Mouwasat Internal Med Department Team Cell Transplantion

2. Tree of embryonic development

3. Cell transplantation Now: It is not just transplantation of organs & tissues Prevent & Cure diseases

4. STEM CELLS Capable of both self renewal and differentiation Into at least one or more mature cell types Totipotent Pluripotent

6. Stem cs on mice ovary

10. STEM CELLS

11. Second Character of plasticity , transform to different types Neural to hematopoietic Dolly fertilized oocyte by a mammary gld cs nucleus 1977

14. DOLLY

16. in November of 1998 when researchers first reported the isolation of human embryonic stem (ES) cells. The discovery, made by Dr. James A. Thomson, a biologist at the University of Wisconsin, Madison, offers great promise for new ways of treating disease. ES cells, which are derived from several-day-old embryos, can theoretically differentiate into virtually any type of human cell, from blood cells to skin cells. Reseachers first reported

17. Third Human embryonic stem cells Totipotent Unlimited replication (appropriate tissue culture )

20. Pluripotent stem cells

30. Characteristics of Human HSC Cell surface antigen expression CD 34 Dye exclusion Syngeneic, allogeneic, autologous

31. Indication for HSC transplantation After myeloablation Hematological malignancies Replace diseased tissues of hematologic or immunologic origins

32. Our absence

38. Cytokines, chemotherapy, monoclonal antibodies specific to the adhesion molecules Mobilization of HSC

39. Eliminate all malignant cells Create space for donor cells Suppress the host immune system Have limited severe nonhematopoietic toxicity By TBI alone or in combination with cyclophosphamide conditionning

40. GVHD Acute Chronic

42. Islet Transplantation:

43. EDMONTON CANADA

44. University of Minnesota

47. Pancreas and Islet-cell Transplantation In 1987, the University of Chicago Hospitals established the first pancreas transplant program in Illinois and now performs about 25 pancreas or kidney/pancreas transplants each year. The transplant team performed their first successful islet-cell transplant in 1998.

49. Pancreatic islet cells Ductal cells hepatocytes Allograft, autograft

61. Non specific inflammation Immune-mediated destruction Direct pathway Indirect pathway Recurrence of autoimmunity

62. Limited supply of human islet tissue Immunosuppressive protocols Inadequate knowledge regarding islet function after transplantation Primary non function and ischemia

63. Immune reaction

66. Induction of tolerance Donor specific blood transfusion called linked epitope suppression Implantation into thymus when combined with peripheral T cell depletion

75. xenotransplantation Use of fetal porcine pancreas

76. http :// www . expertreviews . org / 00001861h . htm Ethical implications of farming genetically engineered animals for human clinical applications Planned in advance zoonotic infection modify donor in vivo Donor species must have islets with compatible function they can be freshly isolated when needed Xenoreaction, hyperacute rejection Supply of islets is potentially unlimited Disadvantages Advantages

80. immunoisolation

94. ARGUMENTS AGAINST GENE &STEM CELL THERAPIES 1. Uncertainity & Clinical risks, long term effect 2.Altering human traits not diseases 3.Research on early embryos, unconsenting 4. Expensive, never cost effective, no priority 5. Violate the rights of subsequent genertations ETHICAL CONSIDERATION ?

95. April 20, 2005 — Editor's Note: For the first time, Japanese investigators have successfully reversed a woman's diabetes by transplanting islets from a living donor's pancreas, according to a research letter published online on April 18 by The Lancet . The donor was a healthy 56-year-old woman, and the recipient was her 27-year-old daughter, who had developed brittle, insulin-dependent diabetes at 15 years of age. Before transplantation, the recipient required daily insulin injections, and she had been admitted to the hospital to control her frequent hypoglycemic episodes. Living-Donor Islet Transplantation: A Newsmaker Interview With Shinichi Matsumoto, MD, PhD Laurie Barclay, MD

96. TRANSPLANT AVERAGE COST The following chart provides the 1996 national average one year cost per transplant type Heart Liver Kidney Kidney-Pancreas Pancreas Heart-Lung Lung Bone Marrow Cornea Hospital 155800 188900 50600 67300 76200 160400 160400 134500 4000 Immunosuppresants 10300 10300 11300 12500 5100 10300 10300 4100 0 Total 253200 314500 116100 141300 125800 271400 265900 217000 8000