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    Update on Islet Cell Transplants

    With the news of successful islet transplants breaking just days before the American Diabetes Association's Annual Scientific Session in San Antonio, Texas, you can imagine that the place was buzzing with excitement. Lead researcher Dr. James Shapiro and several other experts in this highly technical field held a press conference to update and expand upon the article published June 6th on the Web site of The New England Journal of Medicine.

    Of 400 previous attempts at islet cell transplantation, noted Shapiro, only 12 percent were effective after one week, and only eight percent after one year. He termed the record "abysmal". Yet he and his colleagues at the University of Alberta in Edmonton have performed their successful version of the operation on eleven patients - one received surgery the day before the briefing - and eight out of eight have remained insulin-free for over a year.

    "These patients are as close to normal as one might expect," noted moderator Dr. Chris Saudek of Johns Hopkins Medical Center and current vice president of the Association. "They achieved average glycosylated hemoglobin levels of 5.7 within three to six months." This is within normal levels for this test, which measures a person's average blood sugar level for the previous two to three months.

    Ray V. Rajotte, who heads up the islet cell transplantation at the University of Alberta, explained that the transplanted cells, which are injected into the blood stream near the liver, "begin to recognize glucose within a few days." In people without diabetes, islet cells produce insulin when they recognize glucose in the blood.

    Rajotte pointed out that despite all the excitement over its success, "this is really a very simple transplant procedure." Shapiro agreed: "It's the easiest transplant procedure in the world." He explained that patients are "awake and chatting" during the operation, and some go home within 24 hours. Shapiro showed a photo of one patient back in his office the day after his transplant.

    Several factors make the Edmonton procedure successful, explained Rajotte. Donated pancreases are processed upon arrival and transplantation is done immediately. No non-human proteins are used to prepare the islet cells, and the immunosuppresant drugs were not steroid-based. (The immune system must be suppressed so that the patient's body will not reject the new cells.)

    In addition, explained Shapiro, the Edmonton group transplanted many more islet cells than previous efforts -- more than 10,000 for each patient. The need for large numbers of cells, he explained, may prove to be the biggest sticking point for this procedure. Dr. Fred Levine, an islet cell researcher at the University of California in San Diego, agreed: "We just don't have enough organs." Levine's research focuses on trying to grow human beta cells that will produce insulin. His group has been able to do this in the lab and has been successful in transplanting these cells into mice. If the process can be safely and successfully applied to humans, Levine said, "it holds the potential for an unlimited source of cells for transplantation."

    The researchers explained that 10 centers will begin carrying out this research in the near future, and, certainly, researchers, patients and physicians will be watching their progress with great interest. As Shapiro concluded: "If successful, this will really prevent the devastating complications of diabetes - that's what it's all about."



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