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[IPk] Interesting URL re Edmonton Protocol on islet transplant successes
These diabetics are now insulin-injection free, thanks to the U of
A-developed Edmonton Protocol.
One step closer to a cure for diabetes
By Phoebe Dey
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."
For more information see http://www.med.ualberta.ca/research/groups/islet/
(c) 2003 University of Alberta
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