Islet Cell Transplants: Continued Success

A Year After Islet Cell Transplants, Most Recipients Are Insulin Free

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March 28, 2003 (Salt Lake City) -- Joan Husband of Edmonton, Alberta, was a captive of her disease: She couldn't work, drive a car, or even take a stroll around the block without the possibility of losing consciousness. But a year after undergoing an experimental procedure, Husband says, "I'm driving, I've returned to work part time. I'm planning a life with my husband."

Husband's disease is type 1 diabetes, also called insulin-dependent or juvenile-onset diabetes. After years of controlling her disease with insulin injections, Husband's disease was out of control. The insulin was no longer able to regulate the level of sugar in her blood, and her disease was so unstable that she could lose consciousness with no warning, she says.

Just over a year ago she received an islet cell transplant at the University of Alberta Hospital in Edmonton. "And my world changed," says Husband. Richard Owen, MD, assistant clinical professor of radiology at the University of Alberta, transplanted hundreds of thousands of islet cells into her liver.

Islet cells produce insulin, which allows the body to take sugar from the blood and supply it to cells, which in turn use sugar for fuel. At birth, a healthy pancreas has about 2 million islet cells, but when a person develops type 1 diabetes these cells are killed, which drastically reduces insulin levels and causes the sugar imbalance seen in diabetic people.

Though the cells are transplanted into the liver rather than the pancreas, once the cells become embedded in the liver they immediately begin producing insulin, says Owen.

To date, about 250 to 300 patients worldwide have undergone islet cell transplantation using the technique developed in Edmonton. Speaking at the 28th Annual Scientific Meeting of the Society of Interventional Radiology, Owen presented results from the first 48 patients.

Twenty-six of those patients -- including Husband -- have reached the one-year mark and 21 of them are completely insulin free (no longer taking insulin). Husband is one of those insulin-free patients. Seven patients were transplanted at least two years ago and four of them are insulin free, while three of four patients who reached the three-year mark are still insulin-free.

"There are no miracles in medicine, but this is a significant step forward in the treatment of diabetes. Someday we will have a cure," Owen tells WebMD.

Michael Darcy, MD, president of the society and a professor of radiology at Washington University School of Medicine in St. Louis, says that the "Edmonton protocol," as the islet cell transplants are known, represents a significant breakthrough in treatment of insulin-dependent diabetes. But Darcy, who was not involved in the Canadian study, cautions that islet cell transplantation is still experimental and should be considered only for patients who are unable to control their diabetes with insulin.

Owen and his colleagues harvest islet cells from the pancreas of brain-dead donors and inject these cells into the liver of the diabetic patient. In the liver the islet cells "immediately begin producing insulin." But the key to success is the ability to transfer a sufficient number of islet cells. Owen says that more than 850,000 islet cells need to be transplanted before the patient can be insulin free. "This usually takes more than one transplant procedure," he says.

In this study, 90 islet cell transplants were performed in the 48 patients: 22 patients had two transplants, 10 had three transplants and 16 patients had a single transplant. "The transplant or infusion takes about 15 to 30 minutes," says Owen.

After the transplant all patients are placed on drugs that suppress the body's immune system so the transplanted islet ells won't be rejected.

Owen says that islet cell transplantation appears to help these patients even if they cannot stay off insulin. "When they have to take insulin again, they are able to maintain good metabolic control, which suggests that the goal of this therapy might be either insulin independence or good metabolic control," he says. He says that about half of the patients who still need insulin are taking "about as much as they were before the transplant, while half are taking much lower levels."

The study was funded by grants form the Juvenile Diabetes Research Foundation, the Alberta Foundation and Health Service Innovation Fund, and the Canadian Diabetes Association.

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SOURCES: 28th Annual Scientific Meeting of the Society of Interventional Radiology, abstract 127. Joan Husband, Edmonton, Alberta. Richard Owen, MD, assistant clinical professor of radiology. University of Alberta, Edmonton.
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