If you are reading this article, chances are you are among the 1 in every 10 people in the U.S. who has diabetes.2 That means you are just one of 30.3 million people who struggle with the daily challenges of maintaining healthy insulin levels. Nobody has to tell you about the hassles that range from constant finger pricks and insulin injections to truly frightening health crises when your condition is out of control.
There is a very exciting breakthrough that has come out of work at the University of Miami’s Diabetes Research Institute that promises to change the lives of people with serious diabetes. Doctors there have reported success with a new and safer way to transplant islet cells into a 43-year-old patient, Wendy Peacock, whose type 1 diabetes was so severe that she and her five-year-old son, John Paul, moved in with her parents because when her blood sugar would start dropping she could barely take care of herself and feared for John Paul’s safety.3 Today Wendy no longer needs insulin injections.
Pancreatic islets are tiny clusters of cells scattered throughout the pancreas. Pancreatic islets contain several types of cells, including beta cells, that produce insulin. In type 1 diabetes, the beta cells of the pancreas no longer make insulin because the body’s immune system has attacked and destroyed them.4
Islet transplantation has been used in patients with severe type 1 diabetes. The procedure has involved injecting the donor cells into the portal vein that transports blood to the liver. This may cause serious bleeding during the procedure and requires immunosuppression drugs to prevent the body from rejecting the foreign cells.5
There are several problems with the way the procedure has been done until now. Basically, many of the islet cells do not survive when injected into the liver via the portal vein.6 While the procedure has improved, this is how experts at the Baylor University Transplant Institute sum up current problems, “lack of effective strategies to maintain long-term islet function and insufficient sources of donor tissue still impose limitations to the widespread use of islet transplantation.”7
Back to Wendy who no longer needs to use her insulin pump after battling type 1 diabetes for 25 years. The doctors at the University of Miami transplanted pancreatic islet cells into her omentum—a fatty membrane in the belly.
According to Camillo Ricordi, M.D., Director of the Diabetes Research Institute, they inserted the cells into the omentum because “the site is easily accessed by minimally invasive surgery, and more importantly, has the same blood supply and drainage characteristics of the pancreas — where islets are originally found before they are destroyed in type 1 diabetes.”6
In an ingenious move, the research team developed a “biodegradable scaffold” (they called it a “BioHub”) out of the Wendy’s own blood plasma and thrombin (an enzyme in blood plasma that causes blood to clot). This formed a gel-like material that held the islets in place within the omentum. Wendy’s body formed new blood vessels to enable the islet cells to survive at the same time her body absorbed the gel and the islet cells essentially created a new insulin producing factory.
Here is how the Diabetes Research Institute described the outcome:
“The initial result that we had is quite spectacular. We did not plan to withdraw insulin for the first month because typically when you transplant islets in the liver, it takes weeks for them to begin working.”3 In Wendy’s case, insulin was discontinued 17 days after the transplantation.”8
Here is how Wendy described the outcome:
“It’s surreal to think that I can go to sleep at night and not worry that my blood sugar is going to drop. It’s almost like a weight has been lifted. I can breathe knowing that I’m not going to have those hypoglycemic incidents again.”3
When the results of this work were published, the researchers were able to share that one year later, Wendy remains stable and healthy: “The patient exercised regularly and followed a low-carbohydrate diet, which probably contributed to her stable glycemic control.”8
This work continues to demonstrate the safety and long-term feasibility of bringing this new form of islet transplantation to more people.
1Gordon, Serena. Transplant of Insulin-Producing Cells Offers Hope Against Type 1 Diabetes. Patient Still Off Injections A Year After Receiving Cells in Area Near Stomach. Health Day. May 10, 2017.
2Centers for Disease Control and Prevention (CDC). National Diabetes Statistics Report, 2017. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2017.
3Diabetes Research Institute (DRI). Diabetes Research Institute’s First Patient in BioHub Pilot Trial Free from Insulin Injections. Press Conference, October 19, 2015.
4National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Health Information: Pancreatic Islet Transplantation. September 2013. https://www.niddk.nih.gov/health-information/diabetes/overview/insulin-medicines-treatments/pancreatic-islet-transplantation
5Hering BJ, Clarke WR, Bridges ND, et al. Phase 3 trial of transplantation of human islets in type 1 diabetes complicated by severe hypoglycemia. Diabetes Care. 2016; 39:1230–40.
6University of Miami Health System. News. Diabetes Research Institute Successfully Transplants First Patient in Pilot BioHub Trial. September 1, 2015.
7Chang CA, Lawrence MC, Naziruddin B. Current issues in allogeneic islet transplantation. Current Opinion in Organ Transplantation. 2017;22(5):437-443.
8Baidal DA, Ricordi C, Berman DM, et al. Bioengineering of an Intraabdominal Endocrine Pancreas. The New England Journal of Medicine. 2017;376(19):1887-1889.
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