New ray of hope for Type 1 diabetics

Research conducted revealed that patient’s suffering form severe diabetes will gain some benefits from transplanting insulin producing pancreatic cells, though complete cure has been winnowed out by experts.

The study which shows that patients with Type 1 diabetes will live a life free from insulin injections was published yesterday, in The New England Journal of Medicine. It is being cited as a progressive step towards human islet cell transplants.

A treatment for diabetes mellitus type 1, islet cell transplantation is the transplantation of islet cells from a donor pancreas into another person. The cells once grafted, actively produces insulin, boosting the level of glucose in the body.

The studies show that islet cell transplants have marched on to the point, that 44% of the patients were insulin independent one year after the operation.

Thousand and millions of people all over the world are suffering from Type 1 diabetes, a condition which is characterized by loss of the insulin-producing beta cells of the islets of Langerhans of the pancreas.

Autoimmune destruction, accompanied by antibodies directed against insulin and islet cell proteins is the most widespread cause of beta cell loss leading to Type 1 diabetes.

The method of implantation of pancreatic islets for the treatment of diabetes is known as Edmonton Protocol, primarily developed by Dr James Shapiro, an Edmonton transplant surgeon, as well as Dr Jonathan Lakey, Director of the Human Islet Isolation Laboratory at the University of Alberta in the late 1990’s.

The method involves obtaining fresh islets from the pancreas of brain dead donors. Each recipient receives islets from one or as many as five donors.

The cells are infused into the patient via the portal vein, and are then kept from being destroyed by the recipient's immune system through the use of two immunosuppressants, sirolimus and tacrolimus as well as a monoclonal antibody drug used in transplant patients called daclizumab.

It was in 2000 that the procedure made headlines, when eight Canadian Type 1 diabetics were freed from daily insulin injections after the transplantation. Over the last six years, International researchers are trying to figure out if such a procedure can be potentially used worldwide. The results were published yesterday.

The study, conducted on 36 patients with severe Type 1 diabetes, who were given islet cell transplants, showed that 44% no longer needed insulin injections, one year after the procedure. Of the remaining patients, 28% had partially working islet cells and another 28% had no working islet cells.

James Shapiro said that the procedure has climbed the ladder in a very short period of time.

However, the procedure is bound with short comings as well. The immunosupression used has serious side effects including mouth ulcers, diarrhea, anemia, and ovarian cysts.

Besides these, immunosupression results in an increased need of anti-hypertensive (high blood pressure) medication, as well as an increase in cholesterol-lowering statin therapy from 6% pre-transplant to 42% post-transplant and 23% to 83% post-transplant respectively.

Jeffrey Bluestone of the University of California, San Francisco, and director of the Immune Tolerance Network, said that the researchers should ameliorate the quality and quantity of islet cells garnered for the transplant.

He also added that the major problem holding back islet transplantation therapy from becoming a treatment option for diabetic individuals is the need for harsh immunosupression therapies. Once this has been resolved, Edmonton Protocol will become much more useful for the reversal of diabetes.

He also warned the researchers against the number of transplant recipient outnumbering the donors, suggesting them to improve their procedures in the times to come.