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Realistic Next Step? Islet Transplantation


20 March 2006

Realistic Next Step? Islet Transplantation

A friend traveling between the UK and Minneapolis (she is a pumper and a continuous glucose monitor user!) submitted this news flash to the UK pumpers group. I remember hearing about the Edmonton Protocol first in the 1990’s, and was asked by my former (and well missed) doctor in NYC to think about participating. My doctor wanted me “in,” but my husband and I decided it was too risky, and I declined. Read about how the group started here.

Researchers at the University of Alberta in Edmonton, Canada, use this procedure (named the Edmonton protocol) to transplant pancreatic islets into people with type 1 diabetes. The lead researcher, founder and current Director is James Shapiro, MD. A multicenter clinical trial of the Edmonton protocol for islet transplantation is currently under way. According to the Immune Tolerance Network (ITN), as of June 2003, about 50 percent of the patients have remained insulin-free up to 1 year after receiving the transplanted islets. A clinical trial of the Edmonton protocol is also being conducted by the ITN, funded by the National Institutes of Health and the Juvenile Diabetes Research Foundation International. The article above refers to this particular arm of the trial.

What is interesting to note is:

-researchers remove the islets from the pancreas of a deceased donor. Because the islets are fragile, transplantation occurs soon after they are removed, much like any organ transplantation, with all the similar barriers and failures
-a typical transplant requires about 1 million islets, extracted from two donor pancreases
- the recipient needs to take immunosuppressive drugs that stop the immune system from rejecting the transplanted islets and this doesn’t always work. The side effects are tough, including mouth sores and gastrointestinal problems, increased blood cholesterol levels, decreased white blood cell counts, decreased kidney function, and increased susceptibility to bacterial and viral infections – the drugs may also increase the risk of cancer.
-One setback is the shortage of islet cells. The supply available from deceased donors is not sufficient to offer this treatment to all T1’s. As this article states they are looking at other means to increase supply and demand such as cloned cells produced on a large scale in computer-controlled bioreactor which would eventually could be given through booster shots.

Read about the clinical trials or one person’s personal experience before you decide if the risks outweigh the benefits? And who qualifies? Diabetes UK initiated the Islet Transplantation Consortium (Diabetes UKITC) which was formed in 2001 in the hope of replicating the ‘Edmonton’ protocol in the UK and carrying out collaborative research on the domestic and international arena. The Consortium is made up of medical researchers interested and/or involved in islet cell research in the UK. But it isn't clear how far they have progressed. Last year, Dr. Stephanie Amiel of Kings College lead the team that performed the first successful islet transplantation. This was funded by Kings College, I believe. Here is a study which is currently recruiting for the procedure.


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