World’s largest islet transplant program celebrates 20 years of changing lives for people with diabetes

James Shapiro heads the team that has developed the Edmonton Protocol for islet cells transplants. It has been an incredible success in improving the quality of life of people with difficult-to-control diabetes over 20 years. Credit: Richard Siemens

The team behind the largest Ilet Cell Transplant Program in the World has spent 20 years perfecting their technique. They report that the procedure is safe, reliable, and life-changing for people with diabetes.

Results published this week The Lancet Diabetes & EndocrinologyThe researchers report on patient survival, transplant survival, insulin independence, and protection against life-threatening low blood glucose for 255 patients who received more than 700 infusions of insulin at the University of Alberta Hospital in the past 20 years.

“We have demonstrated very clearly that islet-transplantation is an effective therapy in patients with difficult to control type 1 diabetes,” states James Shapiro, professor of surgical at the University of Alberta and Canada Research Chair in transplant surgery and regenerative medicine. He was also the leader of the team that created the Edmonton Protocol. “This long-term safety data gives confidence that we are doing what is right.”

“These data show really strong proof that cell based therapies can deliver meaningful and transformative impacts for people with diabetes,” says Peter Senior at the U of A. Charles A. Allard Chair of Diabetes Research and director of Alberta Diabetes Institute. “We are delivering something which all other treatments for diabetes don’t deliver—there’s a comfort, a predictability, a stability to blood sugar levels that don’t exist with anything else.”

Islets are clusters cells that produce insulin. This hormone allows the body control the flow and energy from food. It stores excess energy after meals and then releases it to allow the body function between meals. The immune system mistakenly destroys cells in type 1 diabetes. Patients are required to inject insulin. Patients with “brittle” or difficult-to-control diabetes can be at risk of serious complications and low blood sugars.

Between March 1999 and October 2019, 255 people received islet transplants via infusion into their livers. Seventy percent of the transplants survived for a median of almost six years. Researchers found that two anti-inflammatory drugs administered within the first two weeks after transplant significantly improved long-term islet function.

The transplant recipients must take lifelong immunosuppression medications, which can sometimes lead to skin cancer or infection. However, most of these complications were not fatal during the study period.

Seventy-nine per cent of transplant recipients were able stop taking insulin after two or three insulin infusions, a median of 95 days, and after their first transplant. Researchers found that sixty-one percent of the recipients were still insulin-independent one year later. This was compared to 32 percent at five and eight percent at 20 years. Patients had to be given insulin injections again. However, the doses were smaller than they needed and their diabetes control was better.

Shapiro says that “being completely free from insulin is not the primary goal.” “It’s a big bonus, obviously, but the biggest goal for the patient—when their life has been incapacitated by wild, inadequate control of blood sugar and dangerous lows and highs—is being able to stabilize. It is transformative.”

The largest islet transplant center in the world is Edmonton’s. However, these transplants are also performed in other Canadian cities, Australia, France and Australia. Shapiro hopes that the results will inspire confidence in the procedure, which is currently only available in an experimental setting like the United States.

Shapiro will keep his focus on finding more islet cell donors to replace the current dependence of deceased donors. Human trials have shown success with stem cells that produce insulin. Just recently, trials began to transplant cells that were genetically modified to be invisible to the immune system.

Shapiro states, “Islet transplant as it is today isn’t suitable for everyone but it shows very clear proof that if we fix the supply problem or minimize or eliminate anti-rejection drug, we will be in a position to move this treatment forward, and make it much more accessible for children with type 1 diabetes and adults with type 2 diabetes in future.”

Leading-edge diabetes treatment program hits milestone

More information:
Braulio A Marfil Garza et. al. Pancreatic islet transplantation for type 1 diabetes: 20-years experience from a single-centre cohort of Canadians. The Lancet Diabetes & Endocrinology (2022). DOI: 10.1016/S2213-8587(22)00114-0

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University of Alberta

The 20th anniversary of the largest international islet transplant program celebrates 20 year’s worth of improving lives for people living with diabetes (2022, May 19,)
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