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New treatment for diabetes major step forward in the fight against the disease

June 06, 2000
New England Journal of Medicine publishes on-line version of research on islet cell transplantation treatment pioneered at University of Alberta

EDMONTON - Researchers at the University of Alberta today unveiled details of their new treatment for diabetes and--for the first time since the new treatment was announced at scientific conferences late last month--recipients of the new treatment spoke about how the new treatment has changed their lives.

"My life has totally changed," said Robert Teskey, an Edmonton Type 1 diabetic who no longer requires insulin injections and is one of eight recipients of the new treatment. "Gone is the need to think about how much insulin to take at every meal. Gone is the need to test my blood endlessly. Gone is the need to mentally calculate the nutritional, and particularly the complex carbohydrate and simple sugar, content of every meal or snack. Most of all, gone is the fear of an incapacitating insulin reaction."

Junior high school teacher Mary Anna Kralj-Pokerznik said, "I can now do things I never dreamed I would do, like teaching an entire morning or afternoon without stopping to eat a snack or testing my blood glucose, going for walks when I want, gardening for hours, shovelling the walks or mowing the lawn."

Diabetes researchers around the world say the new treatment is a major step forward in treating Type 1 diabetes. The treatment pioneered in the clinical trials at the University of Alberta--now referred to as the Edmonton Protocol--was designed by Dr. James Shapiro, Director and Head of the Clinical Islet Transplant Program. It uses a novel steroid-free combination of three drugs, Tacrolimus, Sirolimus, and Daclizumab, which together prevents rejection of the transplanted islets and also prevents the autoimmune diabetes from returning. The protocol depends on a greatly improved method of isolating and transplanting the isolated pancreatic islets.

Dr. Jonathan Lakey, Director of the Human Islet Isolation Laboratory at the University of Alberta, completes the challenging task of extracting the islet cells from the pancreases of organ donors. Dr. Greg Korbutt, Director of the Quality Control Unit, analyzes the islet grafts. Dr. James Shapiro transplants the islets into patients with Type 1 diabetes using an injection procedure which does not require surgery. The cells are placed into the liver through the portal vein. The cells then settle in the liver where, even though they are in a different organ, take root and produce sufficient insulin and almost perfect control of blood sugar. The patients return home the next day. Dr Edmond Ryan, Professor of Medicine at the University of Alberta, performs the pre-transplant diabetes assessment and the post-transplant metabolic monitoring.

This recent success builds on substantial achievements by the research team at the U of A, led by Dr. Ray Rajotte, Director of the Islet Transplantation Group, who together with Dr. Garth Warnock and Dr. Norman Kneteman carried out the first clinical islet transplants in Canada in 1989.

"This is a dream come true after 28 years of research in islet cell transplantation," says Dr. Rajotte.

Diabetes is a chronic, genetically determined, debilitating disease affecting many organ systems. It is the leading cause of kidney failure, adult blindness, and non-traumatic amputations and a major cause of nerve damage. Life expectancy of people with Type 1 diabetes averages 15 years less than people without it. Life expectancy of people with type 2 is shortened 5-10 years. The disease is enormously costly to the health care system.

There are two major types of diabetes: Type 1 and Type 2. Type 1, previously called juvenile onset diabetes, is caused by the autoimmune destruction of the insulin-producing cells in the pancreas and is usually, though not always, diagnosed in childhood. People with Type 1 must take insulin to live. People with Type 2 produce insulin, but their bodies do not use it effectively. Type 2 is usually diagnosed in adulthood, can be controlled with exercise, diet and oral drugs and does not always require insulin injections.

Research teams around the world are expected to begin replicating the Edmonton Protocol and intensifying further related work. That work, headed by Dr. Shapiro and members of the U of A team, will be funded by a $5 million National Institutes of Health/Juvenile Diabetes Foundation Immune Tolerance Network grant. The NIH/JDF Immune Tolerance Network is a $144 million initiative devoted to clinical research and testing immune tolerance protocols in kidney transplantation, islet transplantation and autoimmune diseases.

The research team at the University of Alberta is supported by the Alberta Foundation for Diabetes Research, the Medical Research Council of Canada, the Alberta Heritage Foundation for Medical Research, the University Hospital Foundation, the Juvenile Diabetes Foundation International, the Capital Health Authority, the Muttart Diabetes Research and Training Centre, Canadian Diabetes Association, Alberta Health Services Innovation Fund and the Edmonton Civic Employees Charitable Assistance Fund.

For more information contact:

Dr. James Shapiro
Director and Head of Clinical Islet Transplant Program
780-407-7330

Dr. Jonathan Lakey
Director of Human Islet Isolation Laboratory
780-492-3077

Dr. Ray Rajotte
Director of Islet Transplantation Group
780-492-3386

Dr. Greg Korbutt
Director of Human Islet Quality Control Laboratory
780-492-4657

Dr. Edmond Ryan
Director of Metabolic Monitoring and Diabetologist, Clinical Islet Transplant Program
780-407-6011

Doug Nelson, Director of Development and Alumni Affairs, Faculty of Medicine and Dentistry
University of Alberta
780-492-4063

For world wide web site information:
http://www.med.ualberta.ca/islet/
http://www.nejm.org

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