(10-March-2005/MedicalnewsToday)A multidiscip-linary team at King's College Hospital has successfully achieved islet cell¹ transplantation in a Type 1² diabetes patient. This breakthrough has major implications for diabetes sufferers and has never before been achieved in the United Kingdom. The patient, a 61 year old man, now no longer needs insulin injections, following three transplants of islet cells isolated from cadaveric donor pancreases.

 

Historically, islet transplants have only been partially successful, in that they have reduced the amount of insulin required, but the need for regular injections still remained. The first reports of insulin independence came recently from a programme in Canada. The King's programme is the first to report a comparable result for the UK. This patient has proved that it is possible for islet transplants to lead to freedom from administered insulin and diabetes treatment associated problems.

The patient suffered from Type 1 diabetes for over 30 years, experiencing increasing problems with his diabetes therapy. Prior to the islet transplant he endured severe, potentially life threatening hypoglycaemic³ attacks, which profoundly affected his quality of life. Following the islet transplant he is now producing his own insulin and is completely free from hypoglycaemia.

 

The King's team, a collaboration between the Department of Diabetes and the Liver Unit's transplantation team, has to date transplanted three Type 1 diabetes patients with pancreatic islet cells. The first two patients achieved partial success, achieving relief of hypoglycaemia problems, but still requiring small doses of insulin.

Islet cells are obtained from donor pancreases and are transplanted by injection, into the liver of the recipient. Once in the liver, the cells develop their own blood supply and begin producing insulin. This procedure is minimally invasive and only takes around 45 minutes to complete.

There are around 250,000 people in the UK currently suffering from Type 1 diabetes. The patients live with the constant need to be aware of their blood glucose levels and the threat of long term complications such as blindness, renal failure, amputation and cardiovascular disease. Hypoglycaemia is also an ever-present threat. Hypoglycaemia can vary from being mildly uncomfortable to life threatening. People with Type 1 diabetes often live extremely regimented lives, requiring self blood testing four times or more times per day, injecting insulin five times per day and constantly being aware of the food they eat, level of exercise and levels of alcohol consumption.

 

Professor Stephanie Amiel, Consultant in Diabetes commented: “This breakthough is hugely exciting. The implications for the future are enormous. Eventually, this could mean the end of insulin dependence for all Type 1 diabetes sufferers. In its current state of technology though, islet transplantation is not perfect. We do not have enough organ donors, therefore we cannot extract enough islets to help all Type 1 patients. More research needs to be done to perfect the islet isolation procedures and the drugs we use to prevent rejection of the islets and recurrence of the diabetes. At present we can therefore only offer this treatment to patients, in whom conventional treatments are failing in a major way. However, it is our aim that ultimately all people with Type 1 diabetes would become eligible for islet transplantation and free from insulin dependence.”

Mr Nigel Heaton, Consultant Liver Surgeon, commented: “This breakthrough in islet transplantation is remarkable. King's is the first centre in the UK to achieve insulin independence in Type 1 patients. The research approach at King's is totally multidisciplinary, with experts across specialities in diabetes, liver transplantation, cell isolation and radiology all working together.

“The result of this work will have far reaching implications, not only for Type 1 diabetes patients, but also in the wider area of cell research. We have shown that cell transplantation, with both pancreatic islet cells and previously with hepatocyte cells, can offer patients a valuable alternative to conventional treatments.”

The islet cell research has been funded by King's College Hospital Charitable Trust and Dixons Charitable Foundation. The clinical costs are supported by Diabetes UK.

Jo Brodie, Islet Project Coordinator, Diabetes UK commented: ‘We're delighted this procedure has been such a success. To have someone with Type 1 diabetes completely insulin free is a fantastic achievement. Diabetes UK has always believed that islet research could provide a cure for Type 1 diabetes. We continue to fund islet research in the UK and hope many more people will be able to have this pioneering treatment.'

Notes to Editors

1. Islet cells are found in the pancreas and produce insulin

2. Type 1 diabetes often starts in childhood and once present is irreversible. It occurs as a result of the cells in the pancreas that produce insulin being destroyed. Usually, the destruction of the insulin making cells is the result of an autoimmune process, in which the body fails to recognise the cells as its own and destroys them. This destruction results in total insulin deficiency. Prior to this breakthrough the only treatment for Type 1 diabetes was insulin injections.

3. Hypoglycaemia is a condition where by blood glucose falls to a dangerously low level during the daily course of insulin therapy. If the blood glucose falls until it reaches a point where it is too low to support normal brain function, then confusion, abnormal behaviour, and aggression can result. If nothing is done, eventually glucose levels fall so low and brain function is so abnormal that unconsciousness and seizures can occur, ending in coma. Such episodes of severe hypoglycaemia are more common in people who have suffered from diabetes in excess of 15 years and in people who are attempting very tight glucose control in order to prevent the other long term complications of diabetes.

4. In 2003 a breakthrough in hepatocyte (liver) cell research was announced at King's. Hepatocyte cells transplanted into the diseased livers of patients with particular conditions were found to act as a bridge to transplantation - keeping the patient alive until a suitable donor liver could be found. Hepatocyte transplants were also found to negate the need for a whole organ transplants in some patients by creating healthy new cells in failing livers. There is an important link with the islet research programme in that both require the precise and controlled isolation of cells from donated organs so that the recipient patient receives only an infusion of active cells rather than needing to undergo the major surgery of full organ transplant. This research continues.