Development of Immunosuppression Regimens to Facilitate Single Donor Islet Transplantation Using Abatacept
More than 1 million North Americans have type 1 diabetes. Each year, approximately 30,000
new cases of type 1 diabetes are diagnosed in the United States. Type 1 diabetes destroys
islets, a cluster of cells within the pancreas that produce insulin. Insulin is a hormone
with many effects. However, the most important effect of insulin is to control the level of
sugar in the blood. People with Type 1 diabetes no longer produce insulin and must take
insulin injections to live. Despite steady improvements in the management of this disease,
its victims remain at increased risk for stroke, heart attack, kidney failure, amputation,
blindness, nerve damage and premature death. The life expectancy of a teenager is reduced by
thirty years from the time of onset of the disease [1]. Unfortunately, many type 1
diabetics cannot control their blood sugars in spite of very careful monitoring and the
frequent injection of insulin. This group of patients is considered to have labile or
"brittle" diabetes. These "brittle" diabetics can often have wide swings in their blood
sugar levels that can be life threatening. Hypoglycemia, or low blood sugars occur when too
much insulin is in the bloodstream. When this occurs, it is vital that patients eat or
drink something right away that will increase their blood sugars. Many diabetics lose the
ability to recognize when their blood sugars are getting dangerously low. These episodes of
hypoglycemia can lead to coma, and possibly death, if not recognized and treated right away.
Patients can also experience extreme increases in blood sugars, or hyperglycemia, as a
result of emotional or physical stress. Hyperglycemia can result in dehydration, confusion,
and a condition called ketoacidosis, which can lead to death. When this happens, insulin
must be given as soon as possible.
Islet transplantation can restore the body's ability to make insulin and, in turn, restore
normal blood sugar levels.
Since the 1960's, doctors and scientists have attempted to replace this islet function by
performing whole organ pancreas transplantation. While the results of pancreas
transplantation have improved dramatically in recent years, this approach has largely been
limited to patients with kidney disease who have also needed a kidney transplant. This is
because of the risks associated with the surgical procedure and the immunosuppressive drugs
required to prevent rejection or the destruction of the transplanted pancreas by the body's
immune system [2]. Transplantation of a whole pancreas requires a major operation that is
done through an incision in the abdomen. The patient must be under general anesthesia, or
asleep, for the entire procedure. Recent clinical experience suggests that islet
transplantation may be a useful approach to correct diabetes in humans [3].
Islet transplantation offers a direct approach to the treatment of type 1 diabetes. A large
number of experimental studies carried out in many laboratories over the last decade have
documented the beneficial effects of islet transplants in experimental animals. These
experiments have confirmed both the efficiency and safety of islet transplantation [4,5].
The inability to isolate enough islets from a single pancreas has been one obstacle to
successful islet transplantation. A certain number of islets must be isolated, or
separated, from a single pancreas in order to use them for transplant. If this minimum
number of islets is not obtained, then the islets do not effectively reverse diabetes.
Progress in isolating the islets from a human pancreas has been dramatic in the last several
years. Advances in equipment and technology have lead to increases in the number of islets
that can be isolated from a single pancreas.
After successful isolation, the islets can be injected through a catheter into the patient's
liver during a thirty-minute procedure. A group of doctors at the University of Alberta in
Edmonton, Canada has had promising results in human islet transplantation. Normal sugar
levels have been documented after human islet transplants. Also, recent improvements in
immunosuppressive drug treatments have resulted in sustained insulin-independence in
selected type 1 diabetic patients [6-9,10,11,12]. The traditional method of transplant
immunosuppression includes using some form of a steroid drug. Steroids have been found to
injure or kill the islets after transplant. The doctors in Edmonton, Canada established an
immunosuppression formula that does not use steroids. The objective of the study here at
Emory University is to reproduce the successful results of human islet transplantation that
have been achieved by the doctors at the University of Alberta using steroid free
immunosuppression.
The Emory Islet Transplant Program will enroll up to 20 participants, ages 18 to 65, in this
study. Each of the twenty patients will receive up to 3 islet infusions from three
different cadaver donors. Each patient will be placed on immunosuppressive drugs to prevent
the body from rejecting or destroying the transplanted islets. In this study we are using a
medication, abatacept, to help prevent organ rejection. This medication has been previously
used in people to treat psoriasis. The participants will also receive basiliximab and
sirolimus as immunosuppressant medications.
Each patient will have his/her blood sugar levels and insulin requirements monitored very
closely after each transplant. The patients will also have various tests to determine if
their diabetic complications improve, remain the same, or become worse. The patients will
be asked to record any episodes of hypoglycemia or low blood sugars while participating in
this study. Emory will examine whether or not there is a decrease in how often the episodes
occur. Patients will also undergo regular eye exams to document retinal changes or
improvements that may occur after transplant. At this time it is not known whether islet
transplantation slows or stops the progression of common diabetic complications. More
experience and research is needed before this can be determined. One focus of our research
will be to study diabetic complications in patients who receive islet transplants.
The major goal of the Emory Islet Transplant Program is for patients participating in this
study to be free of the need for insulin injections after 2 islet transplants. Because many
advances have been made in islet transplantation, the transplant team at Emory would like to
participate in this promising treatment of type 1 diabetes and, most importantly, help those
who suffer from this disease become free from daily insulin injections and avoid the
devastating complications that happen as a result of diabetes.
Interventional
Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
The proportion of insulin-independent subjects at day 75 (± 5 days) following the first islet cell infusion
day 75 after first transplant
No
Christian P Larsen, MD, D.Phil
Principal Investigator
Emory University
United States: Food and Drug Administration
1136-2005
NCT00276250
December 2005
December 2014
Name | Location |
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Emory University | Atlanta, Georgia 30322 |