Islet Cell(s): cells in the pancreas that make and release insulin
Stem Cell(s): According to Mayo Clinic, stem cells are the body’s raw materials — cells from which all other cells with specialized functions are generated. Under the right conditions in the body or a laboratory, stem cells divide to form more cells called daughter cells that either become new stem cells (self-renewal) or become specialized cells (differentiation) with a more specific function, such as blood cells, brain cells, or islet cells. No other cell in the body has the natural ability to generate new cell types.
Allogenic: Allo means other, different. The stem cells in allogeneic transplants are from a person other than the patient, either a matched related or unrelated donor.
Autologous: Auto means self. The stem cells in autologous transplants come from the same person who will get the transplant, so the patient is their own donor.
Immunosuppression Therapy: medications used to suppress the body’s immune system to reduce the risk of rejecting a transplanted organ.
Proof of Concept Study: a pilot study, usually small in size, done in order to show an idea or treatment is feasible, or possible.
N of 1: Number of test subjects = 1 person.
Why discuss islet cell transplants today?
A recent article published by the NY Times provided a nice overview of a proof of concept study demonstrating that stem cell islet cell transplantation is a possible (cure) treatment for people with type 1 diabetes.
It is important to review the included terms to know in this article to ensure the meaning of the now-viral NY times article is well understood.
As a person with long-standing type 1 diabetes, I can’t tell you how many times over the years I’ve heard mention of a new possible cure for type 1 diabetes. It has been cured in mice about 1 million times. Well, according to this article, it may be more like 125 times. Regarding the latest NY Times article, I received a copy of it in my e-mail accounts, in all social media accounts that I review, through phone calls and text messages. While I do love to review newly published research, this particular NY Times article really seemed to resonate with people. Which means I received more than the usual amount of notifications about it.
Let’s pause to explore a brief history of islet cell transplantation.
The earliest recorded islet-cell-related transplant occurred in 1893 when Drs. Watson-Williams and Harshant transplanted chopped-up sheep pancreata and injected it into a person with type 1 diabetes’ thigh (OUCH!). The procedure did purportedly result in a 24-hour cure. Although I’m not convinced measuring urine glucose post-injection should really count!
Most islet cell transplant history summaries jump ahead to the 1960s to 1970s when there was a renewed focus on experimental pancreas and islet cell transplants in mice. Ongoing research and progress over the next 30 years continued. In 1999 the Edmonton Protocol was published in July 2000 and became a widely accepted best practice, and hope, for the transplantation of islet cells.
In 2004 I worked at a Clinical Research Center that was participating in Islet Cell Transplantation. I will wholeheartedly admit that it was an amazing experience to learn about the process, the clinical parameters being measured, and interacting with the amazing staff, physicians, surgeons, and especially, the study participants for this particular trial! However, I also learned about what defined islet cell transplants as “successful,” how few islet cells were available from cadaver donors, how many cells were lost (on average) from each cadaver pancreas compared to how many cells were usable, and how very few people with Type 1 Diabetes would be able to receive adequate transplanted islet cells to experience insulin INdependence long term.
Over the last 15+ years, several hundred more people have received Islet Cell Transplants through research studies or at a small number of specialized transplant centers.
Back to the present NY Times article.
Why all the attention? Frankly, because who DOESN’T want a cure?!?! Some important factors to consider regarding this N of 1 article:
The article describes ONE PERSON’S experience. One person’s outcomes do not represent and cannot predict the success or failure rate of a larger population of people.
Islet cell transplantation currently requires immunosuppressive medications.
The article provides an overview of a Proof-of-Concept trial. This is NOT a summary article of a Phase 3 Clinical Trial.
Islet cell transplantation has been researched and considered for over 100 years as a potential treatment-based cure for Type 1 Diabetes.
Islet cells have been transplanted in several different places in mice and humans to try to identify the most ideal location to avoid an auto-immune attack and to ensure the transplanted cells receive adequate blood flow and oxygen supply. Some interesting sites include: the hepatic (liver) portal vein, the back of the eye, subcutaneous (under the skin), and in bone marrow.
Many strides have been made down the path of successful and meaningful islet cell transplantation as a therapy to reduce the severity of hypoglycemia, hypoglycemia unawareness, glycemic variability, and to reduce the risks of long-term complications of poorly managed diabetes.
Islet cell transplants generally require repeat “doses” of islet cell transplants over time in order to continue to achieve insulin independence.
At about 5 years post-transplant, only around 10% of islet cell transplant recipients remain insulin-independent.
There are limited amounts of islet cells available for transplant from cadaver donors.
This proof of concept study does show it is POSSIBLE that islet cells could be generated from stem cells. After several more years of research, and after finalizing and publishing a Phase 1, Phase 2, then Phase 3 study(studies), this potentially could allow for a much larger bank of islet cells which would allow more people to receive a transplant.
In summary, it is exciting that research is being focused on different potential cures or treatments that may improve the quality of life for people currently living with Type 1 Diabetes. Small studies, especially proof of concept studies, do provide a glimpse of what the future may hold. However, these types of studies are not meant to be interpreted as valid for a larger group of diverse people living with Type 1 Diabetes. I encourage you to continue to read about, and support funding of, diabetes treatment and cure research. Until there is a cure, we must continue to strive to take excellent care of our diabetes-related health.
Tavia Vital BSN, BA, RN, CDCES
Director of Intensive Diabetes Management
Tavia is a Registered Nurse, Certified Diabetes Care and Education Specialist, and Certified Trainer on most makes/models of insulin pumps and continuous glucose monitoring systems. She earned a Bachelor of Science degree in Nursing from Regis University in Denver, Colorado after receiving a Bachelor of Arts degree in Spanish from the University of Iowa. Tavia’s professional experience includes inpatient and outpatient nursing in endocrinology, diabetes, and metabolism, as well as a high-risk diabetes and pregnancy clinic.