type 1 islet cells infusion

Type 1 diabetes patient Wendy Peacock is insulin-free after taking part in an islet cell transplant trial.

The trial, conducted by the Diabetes Research Institute (DRI) at the University of Miami, implanted the islet cells within a biological scaffold.

Wendy Peacock, 43, underwent the procedure on August 18, 2015.  Wendy can now produce her own insulin without injections, for the first time since her diagnosis at the age of 17.

How does the islet cell trial work?

This trial builds on previous research from the field of islet cell transplantation. The end goal is the development of a “mini-organ” that mimics the function of a healthy pancreas, allowing people with type 1 diabetes to produce their own insulin. The mini-organ is known as the DRI BioHub.

“The first subject in our Phase I/II pilot BioHub trial is now completely off insulin with an excellent glucose profile,” said Camillo Ricordi, MD, director of the DRI.

“These are the best post-transplant results we’ve seen in an islet recipient.”

“This was the first tissue engineered islet transplant using a ‘biodegradable scaffold’ implanted on the surface of the omentum. The technique has been designed to minimise the inflammatory reaction that is normally observed when islets are implanted in the liver or in other sites with immediate contact to the blood.”

Islet cell transplants and immunosuppressant therapy

People with type 1 diabetes who lose their dependency on insulin injections have to take immunosuppressant drugs to prevent the immune system from targeting the newly functional islet cells. Immunosuppressant drugs are useful in this respect, but they also, less positively,  prevent the immune system from performing useful functions, thereby increasing the risk of illness and infection.

Dr. Ricordi is hopeful that further technological developments will remove the need for immunosuppressant therapy:

“If these results can be confirmed, this can be the beginning of a new era in islet transplantation. Our ultimate goal is to include additional technologies to prevent the need for life-long anti-rejection therapy.”

For Wendy Peacock, the sacrifice is worth it.

“As any type 1 knows, you live on a very structured schedule,” she said. “I do a mental checklist every day in my head…glucose tabs, food, glucometer, etc., and then I stop and say, ‘Wow! I don’t have to plan that anymore.'”

Wendy was eligible for the trial because she had severe hypoglycemia unawareness, a condition characterised by an inability to notice when blood glucose levels are low.

“Laying down at night and going to sleep and not having to worry about lows is something that is so foreign to me. It’s surreal to me…I’m still processing the fact that I’m not taking insulin anymore.”

A unique approach

Islet transplantation is a very promising area of research. In many cases, islet cell transplants remove the need for insulin for more than a decade. In August 2015, 33-year-old schoolteacher Gina Marchini was able to produce her own insulin after an islet cell transplant from City of Hope, a non-profit research centre in California.

Unlike other islet cell transplants, which are infused into the liver, DRI researchers are implanting islet cells using a gel-like material that can be applied to the omentum, a highly vascularised tissue that covers abdominal organs.

Rodolfo Alejandro, MD, Professor of Medicine and director of the DRI Clinical Cell Transplant Program, explained:

“We’re quite excited. This has been the best outcome we have seen at this stage. It’s a unique site, the surgery is very simple and the patient recovers very quickly. We will continue until our final goal – islet transplantation without immunosuppression.

“The liver is a very simple site to access, but we have known for years that it’s not the ideal site. And the liver will not accommodate a device for housing the islets.”