by
Phoebe Dey
These diabetics are now insulin-injection free, thanks to the U of A-developed Edmonton Protocol.
June 6, 2000 -
Dr. James Shapiro recalls the pivotal moment when he realized he was close to a monumental medical discovery.
He was sitting in his hotel room on a rainy day in Baltimore, Md., when he sat down and wrote the protocol for what would be a major step in the fight against diabetes. He had been asked to return to the U of A after a hiatus at the University of Maryland, and he needed to come up with a new method of forcing the human body to produce its own insulin.
"I told myself I was going to give it one last try," said Shapiro. For years, there were failed attempts to transplant islets to severe insulin-dependent patients. "At first the researchers were quite resistant, and I managed to convince everybody to give it one last chance. That was the moment for me that stands out."
Now known as the Edmonton Protocol and published online in the New England Journal of Medicine, Shapiro's treatment has been successfully used to free patients from insulin by transplanting donor-pancreatic cells--cells needed to produce insulin--into eight people from Alberta, Saskatchewan and the Northwest Territories. All needed up to 15 self-injected insulin shots a day before the study, which took place more than a year ago.
The therapy uses a novel steroid-free combination of three drugs--Tacrolimus, Sirolimus and Daclizumab--which together prevent rejection of the transplanted islets and also stops the autoimmune diabetes from returning. Besides avoiding steroids, which are commonly used during transplants, the U of A team also made several other changes. They used more islets and transplanted them immediately--rather than putting them in an incubator for several days--after they were removed, said Shapiro.
One of the patients involved in the clinical trials was anxious about the transplant, but decided the risk was worth it, considering the long-term complications from diabetes.
"I remember thinking, 'If someone could give me a present, I would ask for just one day that I wasn't a diabetic," said junior high-school teacher Mary Anna Kralj-Pokerznik, 30. "Now I've had 13 months. It's like being released from a prison you've been in for years and years."
Don Cammidge, a diabetic for 23 years, can't believe the difference the transplant has made to his life. "At times it was terrifying, wondering if you would come out of these reactions, if you could find that chocolate bar or fruit juice that you needed, or if you were going to pass out," he said.
The research team, led by Dr. Ray Rajotte, will now teach the Edmonton Protocol to centres around the world.
"The response to our work has been a bit surprising and a little overwhelming," said Rajotte, who has been working on islet-cell transplantation for 28 years. "But the response is good. For people who have been living with this deadly disease for so long, to know there is hope is personally very satisfying."
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For more information see
http://www.med.ualberta.ca/research/groups/islet/
Address of this ExpressNews article:
http://www.expressnews.ualberta.ca/article.cfm?id=732
