A simple screening method for individuals at risk of developing type 1 diabetes: measurement of islet cell autoantibodies (GADA, IA-2A, and IAA) on dried capillary blood spots collected on filter paper.

There is limited information regarding the use of dried capillary blood spots collected on a filter paper (FP) to test for islet cell antibodies. The aim of this study was to validate the use of dried capillary blood spots collected on a FP for the analysis of islet cell antibodies. FP eluates were tested using both single and combined assay for antibodies to glutamic acid decarboxylase (GADA) and/or to the protein tyrosine phosphatase like IA-2 (IA-2A), and a single assay for antibodies to insulin (IAA). The results were compared with those of serum assays. Ninety-one subjects were studied. Forty had Type 1 diabetes mellitus (T1DM) and 51 were first-degree relatives (FDR) of patients with T1DM. The GADA and IA-2A were measured by radio-binding assays, which utilize 35S-labeled GAD65 and IA-2. IAA was measured by a microtiter plate assay using 125I-labeled insulin. Twenty-six of those with T1DM (65%) and 5 of the FDRs (10%) had at least 1 positive test on the single serum assays. The FP combi-assay for GADA and IA-2A had 97.8% concordance rate when compared with serum single assays for GADA and IA-2A. The concordance rate for individual assays were 96.7% for GADA, and 100% for both IA-2A and IAA There was significant correlation of the antibody levels between FP and serum specimen for all 3 antibodies. We conclude that antibody screening performed using dried capillary blood spots collected on a FP correlates well with serum assays, and provides an easy alternative for population screening.

Spontaneous idiopathic arteritis of the testicular artery in raccoons (Procyon lotor).

The testes and the spermatic cord of raccoons (Procyon lotor, kits to adult breeders; n = 48) were examined. Segmental arteritis confined to the extratesticular portions of the testicular artery was present in raccoons of all ages. The arterial changes were seen in laboratory-confined experimental and control animals as well as in wild-caught raccoons. The lesions consisted of proliferative endarteritis with presence of inflammatory cells within the intima, media, and the adventitial regions of most affected vessels. Some aspects of the proliferative arterial lesions were reminiscent of systemic necrotizing vasculitis (polyarteritis nodosa), an immunologically mediated condition of animals and humans. Etiologic agents were not identified at the affected sites. Arteritis was not attributed to the administration of infectious agents because it was present in raccoons of all age and origin. To our knowledge multifocal arteritis confined to the testicular artery has not previously been documented in raccoons.

Septicemia associated with Stenotrophomonas maltophilia in a West African dwarf crocodile (Osteolaemus tetraspis subsp. tetraspis).

A 17-year-old male captive West African dwarf crocodile (Osteolaemus tetraspis subsp. tetraspis) died 1 month after fighting with a penmate. Abrasions were present on the head and mandible. Necropsy revealed a vegetative valvular lesion of the left atrioventricular valve, miliary foci of necrosis in the endocardium and myocardium, multiple duodenal and rectal ulcers, and serous atrophy of body fat. Stenotrophomonas maltophilia was isolated in pure culture from lung, liver, and kidney. Gram-negative bacilli were seen histologically in the valvular lesion and in foci of necrosis in the myocardium, liver, spleen, pancreas, kidney, and intestine. Septic thrombi in multiple tissues, arteritis, and pneumonia were additional histologic lesions. Findings indicated that the crocodile died from acute S. maltophilia septicemia, although the primary site of infection was not determined. Stenotrophomonas maltophilia is ubiquitous in the environment and is recognized as an important nosocomial pathogen in humans.

Evidence of point-source exposure to Neospora caninum and protective immunity in a herd of beef cows.

OBJECTIVE: To determine whether cows with evidence of previous infection with Neospora caninum were less likely to abort or give birth prematurely during an outbreak of neosporosis, compared with herdmates with evidence of primary infection. DESIGN: Cohort study. ANIMALS: 208 pregnant beef cows. PROCEDURES: Aborted fetuses and calves born prematurely were examined during an outbreak of neosporosis in a herd of beef cows. Sera were collected from all cows during the outbreak and again 71 days later. Cows were classified into groups on the basis of normal and abnormal reproductive outcomes. Sera were examined, using an avidity ELISA procedure for N caninum, and results were compared between groups and among time points. RESULTS: Antibody concentrations decreased significantly and IgG avidity values increased significantly over time. During the outbreak, cows with normal reproductive outcomes were significantly more likely to have high IgG avidity values than cows with abnormal reproductive outcomes. CONCLUSIONS AND CLINICAL RELEVANCE: The herd had numerous abortions and premature births with evidence of recent point-source exposure to N caninum. Therefore, to reduce risk of transmission of N caninum to cattle, attempts should be made to prevent canine feces from contaminating feed, especially feedstuffs used to prepare mixed rations for cattle. Cows with evidence of previous exposure to N caninum were less likely to abort or give birth prematurely during the outbreak than cows with primary infections with N caninum; this finding suggests development of protective immunity in previously infected cows.

A patient with de Morsier and Duane syndromes.

de Morsier syndrome, or septo-optic dysplasia, is a developmental malformation complex characterized by optic nerve hypoplasia, dysgenesis of the septum pellucidum, and hypothalamic-pituitary dysfunction. (1,2) In Duane retraction syndrome, there is absence of the sixth nerve nucleus with congenital retraction of the globe and narrowing of the lid fissure in adduction, frequent abduction deficiency, and variable limitation to adduction of the affected eye. (3) The purpose of this report is to present a patient with the uncommon and previously unreported concurrence of both of these congenital malformation complexes, presumably because of a common disturbance of neuronal development.

Intestinal lesions caused by a strain of Chlamydia suis in weanling pigs infected at 21 days of age.

The objective of this study was to determine whether a strain of Chlamydia suis shown previously to be an intestinal pathogen in gnotobiotic piglets could cause diarrhea and intestinal lesions in young weanling pigs. Pigs from 2 sows were randomly assigned to 2 groups. Group 1 included 13 pigs that were weaned at 24 hours of age and then housed in isolator units and fed milk replacer and unmedicated starter ration. Group 2 included 8 pigs that nursed their respective sows, consumed unmedicated starter ration, and were weaned at 21 days of age. Ten pigs in group 1 and 6 pigs in group 2 were inoculated orally with 4 x 108 inclusion-forming units of C. suis strain R27 at 21 days of age. Control pigs were inoculated with sham inoculum. The pigs were necropsied 5-14 days postinoculation (DPI). None of the Chlamydia-infected pigs developed diarrhea. Villus atrophy was seen histologically in sections of ileum from Chlamydia-infected pigs in both groups 5 and 7 days DPI. Lymphangitis and multiple lymphohistiocytic and neutrophilic aggregates were seen in the submucosa, tunica muscularis, and serosa of the distal jejunum, ileum, and colon from Chlamydia-infected pigs in both groups 5-14 DPI. Immunostaining of sections of distal jejunum, ileum, and colon from infected pigs revealed chlamydial antigen in intestinal epithelium and in foci of lymphangitis/inflammation. The results indicated that C. suis strain R27 can cause intestinal lesions in young weanling pigs, and the lesions are similar to those seen in gnotobiotic piglets. The results also indicated that strain R27 causes asymptomatic intestinal infections in young weanling pigs, at least under the conditions of this study.

Serum prostate specific antigen, sex hormone binding globulin and free androgen index as markers of pubertal development in boys.

OBJECTIVE: Prostate specific antigen (PSA) expression in the prostate gland is regulated by androgens. Serum levels of PSA are undetectable by routine assays in normal boys. Measurable values could serve as a marker for pubertal development. In order to explore this question, we measured serum PSA levels in normal boys throughout puberty and examined the interrelationships with various hormonal and physical developmental changes. DESIGN: Sera from 77 normal boys in Tanner stages I to V (T-I to T-V) were analysed for PSA levels by a sensitive time-resolved fluoro-immunometric assay (sensitivity: 0.012 microgram/l). In addition, sex hormone binding globulin (SHBG), insulin like growth factor I (IGF-I), IGF binding protein 3(IGFBP-3) and testosterone were measured. RESULTS: PSA was detectable in 0% of Stage T-I (n = 16), 33% of T-II (n = 18), 65% of T-III (n = 17) and 100% of T-IV (n = 10) and T-V (n = 16) boys. PSA levels rose significantly according to stage (P < 0.05). Also, there were significant (P < 0.05) increments in serum testosterone, IGF-I and IGFBP-3 levels from stages T-I to T-IV. PSA showed a positive correlation with testosterone (r = 0.86, P < 0.001), IGF-I (r = 0.66, P < 0.001), and IGFBP-3 (r = 0.34, P = 0.004) levels. Both PSA and these analytes, however, showed significant overlap between stages T-I and T-II with only 6/18 (33%) and 12/18 (66%) of T-II subjects having PSA and testosterone levels, respectively, above the T-I range. In contrast, serum SHBG levels decreased markedly from stages I to II (P < 0.001). At the calculated best cut-off point for SHBG of 50 nmol/l, 16/18 T-II subjects had values below the T-I range (sensitivity = 89%). Because of this decrement of SHBG and the increasing testosterone secretion in early puberty, the Free Androgen Index (FAI = Testosterone/SHBG) could even better differentiate the onset of puberty with all except one of the T-II subjects having FAI levels above the T-I range (sensitivity = 94.4%). The decrease of SHBG in T-II subjects coincided with an increase in total body weight (P = 0.001) and body mass index (BMI, P = 0.0003). Despite the continuing pubertal rise in testosterone, SHBG levels showed a rebound increment from T-II-T-III subjects (P = 0.02) with a concomitant decrease in BMI (P = 0.0014). CONCLUSIONS: Prostate specific antigen closely reflects serum free androgen activity during puberty. However, it was unable to differentiate the earliest pubertal development. In comparison, SHBG levels and Free Androgen Index are more sensitive markers for the onset of puberty in boys. The inverse association between SHBG levels and BMI in pubertal stages Tanner stages, I to III suggests that body fatness, via its effect on insulin sensitivity, may play an important role in the regulation of SHBG production during early pubertal development.

Conjunctivitis caused by a swine Chlamydia trachomatis-like organism in gnotobiotic pigs.

The objective of this study was to determine whether a chlamydial strain recovered from growing and finishing swine with conjunctivitis or keratoconjunctivitis could cause the same infections in gnotobiotic pigs. The strain shares biological characteristics with Chlamydia trachomatis. After propagation in Vero cells and preparation of the inoculum (10(7) inclusion-forming units/ml), chlamydial strain H7 was instilled into the ventral conjunctival sac (0.15 ml/sac) of 12 anesthetized 3-day-old gnotobiotic piglets. Four age-matched gnotobiotic piglets were anesthetized and sham infected with uninfected cell culture lysates. None of the principal piglets developed clinical symptoms of conjunctivitis or keratoconjunctivitis. Principal piglets necropsied 7 days postinfection (DPI) had histologic lesions of mild or moderate conjunctivitis; immunohistochemical evaluation revealed chlamydial antigen in conjunctival epithelium. A majority of principal piglets necropsied at 14-28 DPI had histologic lesions of mild conjunctivitis, but chlamydial antigen was not detected by immunohistochemistry. The results indicated that chlamydial strain H7 can cause mild or occasionally moderate conjunctivitis in gnotobiotic pigs, but the conjunctival infection is asymptomatic.

Isolation of cilia-associated respiratory (CAR) bacillus from pigs and calves and experimental infection of gnotobiotic pigs and rodents.

Filamentous, gram-negative bacteria morphologically similar to cilia-associated respiratory (CAR) bacillus of rodents and rabbits were isolated from the tracheas of 5 pigs and 4 calves. All pigs but none of the calves had histologic lesions of chronic tracheitis. In silver-stained histologic sections, CAR bacilli were adhered to the tracheal epithelium of each pig but were not found in the calves. Like CAR bacillus of rats, the bacteria displayed gliding motility and grew only in cell culture or cell culture medium supplemented with fetal serum. Initially, all isolates were contaminated by Mycoplasma spp. This contamination was eliminated from 4 pig isolates by limiting dilutions, and mycoplasma-free isolates were used to intranasally inoculate gnotobiotic pigs and CAR bacillus-free mice and rats and to immunize guinea pigs. The gnotobiotic pigs remained healthy, and when they were necropsied 4 and 7 weeks after infection no macroscopic or microscopic lesions were found in the respiratory tract. However, CAR bacillus was isolated at both times from the nasal cavities and tracheas of inoculated pigs, and the ciliated tracheal epithelium of infected pigs necropsied 7 weeks after infection was colonized by low numbers of CAR bacillus-like bacteria. The rats and mice remained healthy through week 12 postinoculation, and evidence of short- or long-term colonization was not detected by histologic examination or culture. When used as primary antibody for immunohistochemical staining, sera from guinea pigs immunized with pig CAR bacillus specifically stained CAR bacilli colonizing the respiratory epithelium of naturally infected pigs, whereas sera collected prior to immunization failed to react with the bacteria. These results indicate that CAR bacilli are unlikely to be primary pathogens of pigs or cattle and that rodents do not act as reservoirs.

In situ hybridization for the detection and localization of swine Chlamydia trachomatis.

Gnotobiotic piglets were inoculated intralaryngeally with swine Chlamydia trachomatis strain R33 or orally with swine C. trachmatis strain R27. Archived formalin-fixed, paraffin-embedded tissues from piglets euthanatized 4-7 days postinoculation were examined by in situ hybridization for C. trachomatis nucleic acid using a nonradioactive digoxigenin-labeled DNA probes that targeted specific ribosomal RNA or omp1 mRNA molecules of the swine C. trachomatis strains. Positive hybridization signals were detected in bronchial epithelial cells, bronchiolar epithelial cells, pneumocytes, alveolar and interstitial macrophages, and jejunal and ileal enterocytes. Chlamydia-infected cells had a strong signal that was confined to the intracytoplasmic inclusions. Positive hybridization signals were not detected in tissue sections from an uninfected control piglet or in C. psittaci-infected sheep placenta. The morphology of host cells was preserved despite the relatively high temperature required in parts of the incubation procedure. The data indicate that in situ hybridization can be used to detect swine C. trachomatis in formalin-fixed, paraffin-embedded tissue specimens.

Intestinal lesions caused by two swine chlamydial isolates in gnotobiotic pigs.

The objective of this study was to determine whether 2 distinct chlamydial isolates recovered from the intestines and feces of diarrheic nursery pigs could cause intestinal lesions in gnotobiotic pigs. Both isolates share biological characteristics with Chlamydia trachomatis. Chlamydial isolates R27 and R19 were propagated in Vero cells or embryonated eggs, respectively, and suspended in sucrose-phosphate-glutamine buffer with 10% fetal bovine serum for inoculation. Sham inocula were prepared from uninfected cell culture lysates and from uninfected eggs. Each piglet was fed 1 ml of inoculum or sham inoculum at 3-4 days of age. Ten piglets were each fed 10(9) inclusion-forming-units (IFU) and 14 piglets were each fed 10(6) IFU of isolate R27; 5 control piglets were fed sham inoculum. Twenty piglets were each fed 10(5) IFU R19; 5 control piglets were fed sham inoculum. All infected piglets developed diarrhea 4-5 days postinfection (DPI). Most piglets fed 10(9) IFU R27 became anorexic, dehydrated, and weak and were necropsied 4-7 DPI. Piglets fed 10(6) IFU R27 or 10(5) IFU R19 were necropsied 4, 7, 10, 14, and 18 DPI. Diarrhea, although never profuse, persisted in the piglets fed 10(6) IFU R27 or 10(5) IFU R19 through 12 DPI. At necropsy, all diarrheic piglets had watery colonic contents with flecks of undigested curd. In small intestine, histologic lesions were seen most consistently in distal jejunum and ileum. Distal jejunum and ileum from piglets fed 10(9) IFU R27 and necropsied 4-5 DPI were characterized by villus atrophy and multifocal necrosis of villi; necrosis was limited to the tips or apical one half of villi. Mild to severe villus atrophy, lymphangitis, and perilymphangitis were seen in the distal jejunum and ileum from all infected piglets 7 and 10 DPI. Colon from 1 infected piglet necropsied 10 DPI had mild focal serositis; significant colonic lesions were not seen in the other infected piglets. Immunostaining done on sections of distal jejunum and ileum revealed chlamydial antigen in villus enterocytes, occasional goblet cells, and occasional cryptal enterocytes and in foci of lymphangitis and perilymphangitis; the amount of detectable chlamydial antigen decreased after 4 DPI. In colon, sparse positive staining was seen in surface enterocytes and cryptal enterocytes. Ultrastructural examination of ileal villus enterocytes revealed chlamydiae, often together with glycogen particles, in vacuoles or occasionally free in the cytoplasm. The results indicated that the swine chlamydial isolates used in this study are intestinal pathogens in gnotobiotic pigs.

Prevention of insulin-dependent diabetes mellitus: an overview of three trials.

Genetic, immune, and metabolic testing can reveal a person's risk of developing insulin-dependent diabetes mellitus (IDDM), and three large clinical trials are planned or underway to see if interventions can prevent IDDM in persons at risk. Researchers in diabetes prevention trials are screening first- and second-degree relatives of probands with IDDM for islet-cell antibodies. In the Cow's Milk Avoidance Trial, infant siblings of probands with IDDM will be randomized to receive either a baby formula containing a non-antigenic protein hydrolyzate or a standard cow's milk-based formula. The Diabetes Prevention Trial-Type I is randomly assigning subjects at high risk (more than a 50% probability of developing IDDM) to either receive insulin injections or undergo observation alone; subjects at intermediate risk (25% to 50%) will receive either oral insulin or placebo. In the European Nicotinamide Diabetes Intervention Trial, subjects receive either nicotinamide or placebo. If any of these trials show that IDDM can be prevented, then large-scale screening of children for IDDM risk factors may prove beneficial.

Lung and nasal lesions caused by a swine chlamydial isolate in gnotobiotic pigs.

The objective of this study was to determine whether a chlamydial isolate recovered from nasal swabs from swine with pneumonia could cause pneumonia and rhinitis in gnotobiotic pigs. The identity of the isolate currently is unknown, but it shares characteristics with Chlamydia trachomatis. After propagation in Vero cells and preparation of the inoculum (2.5 x 10(10) inclusion-forming units/ml), chlamydiae were instilled into nostrils (1.0 ml/nostril) and lungs (2.0 ml intralaryngeally) of 15 anesthetized 3-day-old gnotobiotic piglets. Five age-matched gnotobiotic piglets were anesthetized and sham infected with uninfected cell culture lysates. Two treated piglets were moribund and 2 were severely dyspneic prior to necropsy 7 days postinfection (DPI), whereas remaining treated piglets showed mild dyspnea upon exertion throughout the study. All treated piglets developed diarrhea. All treated piglets necropsied 7-21 DPI had extensive consolidation in cranial, middle, and accessory lung lobes; a majority of these piglets also had extensive consolidation in the caudal lobes. Treated piglets necropsied 28 and 35 DPI had a lobular pattern of consolidation in all lung lobes. Histologically, lesions in lungs from treated piglets necropsied 7, 14, and 21 DPI were characterized by bronchointerstitial pneumonia with foci of type II pneumocyte hypertrophy and hyperplasia; pneumocytes and bronchial and bronchiolar epithelial cells were markedly vacuolated. Alveolar macrophages, peribronchitis, peribronchiolitis, and perivasculitis were seen in lungs from treated piglets necropsied 28 and 35 DPI; those necropsied 28 DPI also had foci of lymphohistiocytic and plasmacytic infiltrates. Turbinate lesions in all treated piglets were characterized by mild multifocal lymphoplasmacytic and occasionally neutrophilic rhinitis. Immunohistochemistry detected chlamydial antigen in bronchial and bronchiolar epithelial cells, pneumocytes, and inflammatory cells in treated piglets necropsied 7, 14, and 21 DPI. Positive staining was limited to alveolar macrophages in treated piglets necropsied 28 and 35 DPI. Chlamydial antigen was detected in turbinate epithelial cells at all necropsy intervals. Ultrastructurally, chlamydiae were seen with glycogen particles in vacuoles or free in the cytoplasm of bronchial and bronchiolar epithelial cells and pneumocytes. The results indicated that the chlamydial isolate used in this study is a pathogen in gnotobiotic pigs.

Partial characterization of a Moraxella bovis cytolysin.

Moraxella bovis (M. bovis) is the etiologic agent of infectious bovine keratoconjunctivitis and M. bovis hemolysin is believed to be an important virulence factor. Two strains of M. bovis were compared, Epp 63(300) (Epp), a known virulent and hemolytic strain, and IBH 63 (IBH), a known avirulent and nonhemolytic strain. Sterile 10-fold (10x) supernatant concentrates were obtained from cultures grown in TSB broth with 10 mM CaCl2. Supernatant hemolysin titers for Epp, were 1:1024 and 1:8192 for unconcentrated (1x) and 10x, respectively. Supernatant cytotoxin titers to bovine mononuclear cells were 1:32 and 1:128 for 1x and 10x, respectively, for Epp. Cytolytic (hemolytic and cytotoxic) activities declined 10-fold but were still measurable for > 1 wk at 4 degrees C. Both activities were inactivated by trypsin and by heating at 56 degrees C for 20 min. A cytotoxic effect was observed on cultured bovine and ovine corneal epithelial cells with Epp. All cytolytic effects were neutralized with antiserum to 10x Epp. No cytolytic activities were detected for 10x IBH. SDS-PAGE electrophoresis and related immunoblots indicate a high molecular weight protein at 110 kDa for the 10x Epp preparation when stained with silver or probed with monoclonal antibodies to the E. coli alpha hemolysin. No 110 kDa band is observed for 10x IBH. These data suggest that hemolytic and cytotoxic activities are important in the pathogenesis of infectious bovine keratoconjunctivitis and identify the protein as a possible RTX related toxin of 110 kDa. Stability of the M. bovis cytolysin for > 1 week should allow further characterization and purification of the protein.

Thyroid disease in children.

Among thyroid diseases occurring in children are congenital hypothyroidism, acquired hypothyroidism, Graves' disease, subacute thyroiditis and thyroid nodules. Evaluation for suspected hypothyroidism or hyperthyroidism can be accomplished efficiently with a serum free thyroxine level and the new, highly sensitive thyroid-stimulating hormone assays. Rarely, measuring various thyroid antibody titers may be required to better define a particular thyroid disease. Solitary thyroid nodules in children occasionally represent malignancy. Evaluation of such lesions with radioisotope scanning and ultrasonography is helpful. In children, however, surgical excision is still required to definitively determine whether a nodule is malignant.

Dyskinesias following treatment with 5-HT re-uptake inhibitors.

Three cases of dyskinesia attributable to selective serotonergic antidepressant drugs are presented. The patients were not on other medication nor had they been in preceding weeks. The movement disorder disappeared on cessation of the drug within a time period corresponding to the expected wash-out for the different preparations. The emergence of dyskinesic symptoms coincided with a significant deterioration in mental state after an initial good response to the particular medication. Considering the apparently selective action of the serotonin re-uptake inhibitors, these cases suggest that movement disorders and psychiatric symptoms are unlikely to be due to single neurotransmitter mechanisms and that a disturbance of the balance between the different systems is a more likely hypothesis.

Conjunctivitis and keratoconjunctivitis associated with chlamydiae in swine.

Two swine herds housed in confinement had high prevalences of conjunctivitis and keratoconjunctivitis. Necropsies were performed on 7 pigs (2 to 8 weeks old) with mucopurulent conjunctivitis from one farm and on 1 sow with keratoconjunctivitis from another farm. Histologically, the small pigs had lymphoplasmacytic conjunctivitis with mild lymphofollicular hyperplasia. The sow had marked conjunctival lymphofollicular hyperplasia and ulcerative keratitis with neovascularization. Ultrastructural examination of conjunctival specimens from the pigs and sow revealed chlamydiae, often associated with glycogen within intracytoplasmic vacuoles in conjunctival cells. The identity of the chlamydiae isolated from 2 necropsied pigs as well as from conjunctival swab specimens from other pigs on the same farm was unknown. It is possible that the chlamydiae seen ultrastructurally within intracytoplasmic vacuoles containing glycogen in conjunctival cells were Chlamydia trachomatis. Results of this investigation suggested an etiologic role, at least in part, for chlamydiae in the disease process of these swine. On the basis of ultrastructural findings, mycoplasmal coinfection could not be ruled out. Several pigs also had cytomegalic inclusion virus rhinitis.

Pancreatic and islet replacement therapy for insulin-dependent diabetes mellitus.

The only known cure for insulin-dependent diabetes mellitus is transplantation of functioning islet cells, either alone or via transplantation of the entire pancreas in sufficient mass to restore normal carbohydrate metabolism. Such therapy may also ameliorate or eliminate certain long-term consequences of diabetes. More than 3,000 patients have received pancreas transplants at 150 centers worldwide since 1966. Urinary drainage of pancreatic exocrine secretions has dramatically improved long-term survival, especially when a kidney was transplanted at the same time. Metabolic control then resumes normal function for up to six years, in some cases preventing or reversing long-term complications of diabetes. While nephropathy and neuropathy can be prevented and even somewhat reversed, retinopathy and neuropathy resist improvement. The large number of islets that must be harvested makes islet cell transplantation difficult to achieve, although the process has been accomplished in humans with limited success.