The cell to end diabetics' hell

A Canadian team is using a non-surgical procedure to enable severely diabetic people to throw away their insulin. Philip Fine reports.

A Canadian team has successfully treated ten severely diabetic people so that they no longer require daily insulin injections. The team uses a procedure that neutralises the effects of hypoglycemia.

The eight University of Alberta researchers have developed a method that transplants insulin-producing cells, called islets, into the livers of severe diabetics.

The ten type-I diabetics who underwent the non-surgical procedure have been off insulin for an average of a year. The longest time any of them has been free from injections is 15 months so far.

The team, which is headed by James Shapiro, the director of Alberta's islet transplant programme, has made a significant advancement in the cell transplantation work developed over the past 20 years. Their advance differs in several ways from past attempts to try to implant insulin-producing cells.

The islets they used were not stored but taken directly from the pancreas of brain-dead patients; the procedure allowed them to deliver the islets non-surgically through the portal vein in a similar way to a blood transfusion. The cocktail of anti-rejection drugs administered did not include steroids, often a problematic element of immunosuppressives.

George Fantus, director of the Diabetes Core Laboratory at the University of Toronto and editor-in-chief of the Canadian Journal of Diabetes Care, applauds the team for having a 100 per cent success rate. Until now, only 8 per cent of islet recipients have gone beyond a year without insulin. However, he says that 15 months is considered a short period in this field:

"We don't know if these islets will survive ten years."

Dr Fantus, whose work is concentrating more on pancreatic transplants for severely ill diabetics, says it is unclear whether all diabetics would benefit from the islet transplants. He says that he has seen healthy diabetics able to manage their care for 50 years without experiencing major complications and says the long-term effects of the immunosuppressives may be a worse alternative for them than watching their diet and taking injections.

Jonathan Lakey, one of the co-authors of the study, is playing down comparisons to Sir Fredrick Banting, Charles Best and James Bertram Collip, the three Canadians who developed insulin 80 years ago. "It's not at that point yet," he says, "It's still preliminary. But it's a good start at 15 months."

More details on the study can be found at the New England Journal of Medicine at: www.nejm.org