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Houston Methodist surgeons prevent diabetes in pancreatitis patients using Houston's first islet laboratory
With innovative islet transplant, Houston Methodist creates functioning pancreas in patient's arm
Sept. 22, 2008 – A 55-year-old grandmother is producing insulin on her own after her islet cells were removed from her pancreas and implanted into her forearm a few weeks ago at Houston Methodist Hospital in Houston.
After surgeons removed Wanda Prouty’s pancreas, they implanted the islet cells into her left arm to help prevent brittle diabetes that often occurs after this surgery. This is the first time this has been done in North America, and early results are very promising.
Prouty is still taking a small amount of insulin while the transplanted cells are given time to become fully functional.
Islets, small clusters of cells that produce insulin to regulate blood sugars, reside in the pancreas. With the total removal of the pancreas due to chronic pancreatitis, patients lose all islets and their bodies cannot produce insulin, resulting in an immediate and advanced, “brittle” stage of type I diabetes.
“In the past, patients who had their pancreases removed had to learn to manage the resulting brittle diabetes, which comes with a 25 percent death rate over five years,” said Dr. Craig Fischer, Houston Methodist surgeon specializing in diseases of the pancreas.
Last month Fischer removed Prouty’s pancreas due to painful chronic pancreatitis. From the operating room, the pancreas was brought to Houston Methodist Hospital’s islet lab, where the islets were extracted, then Dr. Osama Gaber, head of the transplant division at Houston Methodist, implanted the islets into the patient's arm, where they will function naturally, preventing diabetes altogether. This procedure is called an “autologous” islet transplant because a donor organ is not used, but rather the patient’s own islets. Islets are typically injected into a patient’s liver, however this patient had indications of slight liver damage prior to surgery, so the arm was chosen as a stronger alternative site for the islets.
“Because Houston Methodist Hospital opened the region’s only islet lab late last year, we can now extract insulin-producing islets from the patient’s own damaged pancreas, inject the islets back into the patient, and prevent brittle diabetes for this group of patients,” said Dr. Osama Gaber, director of the Houston Methodist islet lab.
Houston Methodist Hospital opened Houston’s first islet laboratory in late 2007 for patients who suffer from diabetes and other pancreatic diseases. Islet transplants—the transplantation of cells that produce insulin from a donor’s pancreas into a patient—offer a promising cure for diabetes. The lab is among fewer than 25 like it in the nation, and offers both clinical and research components.
“Islet transplants offer a promising cure for diabetes,” Gaber said. “We are thrilled to bring a laboratory for this innovative treatment to Houston.”
The islet is an organelle—or miniature organ—made up of thousands of cells and microscopic blood vessels. Islets reside in the pancreas and secrete insulin that is necessary for burning glucose and other sugars in the body. Islet destruction by immune cells or by loss of pancreatic tissue leads to insulin deficiencies and diabetes. Diabetic patients can also develop serious secondary complications including blindness, kidney failure, heart disease and blood vessel disease.
In addition to clinical treatments, research conducted in the lab will help advance knowledge about the function of islet cells and their possibilities for patient care.
Clusters of cells in the pancreas called the Islets of Langerhans are the source of the insulin that our bodies need to process the blood sugar our cells need in order to survive. In Type 1 diabetes, an autoimmune reaction destroys these cells, causing the body to cease production of insulin.
The typical treatment for Type 1 diabetes is a combination of dietary therapy, changes in diet and eating habits, insulin-replacement therapy, and daily injections. But even when these treatments are carefully and consistently applied, Type 1 diabetes can still have far-reaching health impacts, including increased risk of heart disease, kidney failure, vision problems, nerve damage and other complications.
The transplantation of islets from a donor pancreas into the recipient’s liver has the potential to provide a long-term cure for Type 1 diabetes. While the procedure remains experimental, it has had promising results in a number of clinical trials—and the islet transplantation program within the Transplant Center is led by some of the nation’s leaders in the development of new techniques for the preparation and implantation of donor islet.
Islet transplantation remains an experimental treatment. The development of the islet transplantation program within the Methodist J.C. Walter Jr. Transplant Center is focused on advancing the science of islet transplantation, and on eventually developing research protocols that will make clinical trials of islet transplantation available through the center. At present, there are two main areas of activity:
When a patient’s pancreas is removed, as in treatment for acute pancreatitis, the result is diabetes. But islet from the patient’s own pancreas can in some cases be extracted and transplanted into the patient’s liver—enabling continuing insulin production without the need for immunosuppressive drugs.
Patients can also receive islets that are isolated from a donor's pancreas. In these cases, patients must take immunosuppressive drugs to prevent rejection of the donor islets.
For more information about the islet program at the Methodist J.C. Walter Jr. Transplant Center, please call 713-441-5451. To learn about our current transplant clinical trials, click here.
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