Innovative treatment for type 1 diabetes marks first step towards vision of regional network for islet cell isolation and transplant
ISletThe MUHC has conducted the first islet cell transplant in Quebec. The breakthrough was made at the Glen site of the MUHC after the complex process of isolating islet cells from a donor pancreas was achieved at the MUHC Human Islet Transplant Laboratory. The procedure, which does not require surgery and reduces hospital stays ten-fold, is a significant advancement in the treatment of type 1 diabetes, and marks the first step in what researchers hope will be the development of a regional network for this novel therapy.

Type 1 diabetes (T1D), sometimes referred to as autoimmune or juvenile diabetes, results from the pancreas’ failure to produce enough insulin, causing disruption to blood sugar regulation in the body. The disease cannot be prevented and requires lifelong monitoring of blood sugar, and daily insulin injections, in order to prevent serious long-term complications, such as blindness, stroke, kidney failure and cardiovascular disease.

“For some patients, pancreas transplantation maybe an option, but there are significant risks, and the surgery often involves specialized care in the ICU (Intensive Care Unit) and a hospital stay that could be as long as a month,” says Dr. Steven Paraskevas, Director of the Pancreas and Islet Transplant Program at the MUHC. The infusion of islets – the clusters of pancreatic cells that produce insulin – is a non-surgical technique that is being explored in some academic medical centres as an alternative to the transplantation of the whole pancreas organ.

“As the procedure is minimally invasive, it represents an incredible improvement for patients, as well as the healthcare system, through reductions in risk and infection rates, improved recovery time, and hospital stays measured in hours to days, rather than weeks,” says Dr. Paraskevas, who is also an Associate Professor of Surgery at McGill University.

For patient, Zohra Nabbus, from Pointe Claire, Quebec, life with type 1 diabetes had become increasingly challenging. After kidney transplantation and unsuccessful pancreas transplantation, she was suffering more frequent episodes of hypoglycemia. “It had got to point where I couldn’t be left alone anymore, so when I heard that islet cell transplant had been developed at the MUHC, there was no doubt in my mind that I wanted to be a candidate,” she said.

The procedure began in May at the Human Islet Transplant Laboratory where islet cells were separated from a suitable donor pancreas – a delicate process that has required years of investment in technology and medical expertise. Two days later, the isolated islets were infused into the patient’s liver through a small catheter in the abdomen, without the need for surgery. The entire procedure was conducted in the interventional radiology suite at the Glen site of the MUHC.

“Once the cells were transfused into the liver, we monitored the patient and waited,” says Dr. Benoit Gallix, Director of Radiology at the MUHC and Chair of the Department of Diagnostic Radiology at McGill University, who conducted the procedure with MUHC radiologist Dr. Tatiana Cabrera, who is also an Assistant Professor at McGill. “Within a few days the patient began producing insulin on her own, and after several weeks she was completely insulin independent – the entire procedure could not have gone better.”

Additionally, the entire process only required one infusion, rather than the two or three that the researchers had expected. “Our team advanced the established protocol by using a Giner Portable Pancreas Persufflation™ System – a new piece of technology that keeps the pancreas oxygenated after it is recovered from the donor and before the islets are isolated,” says Craig Hasilo, Manager of the Human Islet Transplant Laboratory. “We believe this resulted in better quality cells being transplanted, thereby reducing the need for multiple infusions.”

Life has changed rapidly for Zohra Nabbus. “After living with type 1 diabetes for 35 years, it’s hard to get out of the habit of planning your meals, monitoring your blood sugar, and preparing your insulin, but finally I can,” she said. “I have more freedom and flexibility to live my life and I feel much more secure.”

The MUHC has been developing the expertise to conduct this procedure for the past decade, and is the only centre in eastern Canada, and one of only a dozen in North America, ISLet groupcapable of isolating and transplanting human islet cells. “Our vision is to establish a network, where islet cells are processed at our institution for infusion at healthcare facilities across the region,” says Dr. Paraskevas. “Quebec is the perfect place to build a network such as this because of our higher than average donor rates.”

“Transplant Québec welcomes the experienced team at MUHC, led by Dr Steven Paraskevas, and is delighted that Quebec can count on the Human Islet Transplant Laboratory in providing innovative treatment to patients whose health and quality of life will be greatly improved. We will continue to be at the forefront to support the work of the Laboratory as we have done in the research phase. This collaboration is at the heart of the mission of Transplant Québec, which coordinates organ donation in the province of Quebec,” acknowledged Louis Beaulieu, CEO of Transplant Québec.

Islet cell transplantation is currently considered a novel therapy in Canada, and has been assessed for expanded use by the MUHC’s Technology Assessment Unit (TAU), as well as the FDA (Food and Drug Administration) for approval in the United States. The procedure is already a recognized therapy for diabetes in the UK and Europe. There are approximately three million people afflicted with diabetes in Canada, over 300,000 of which have type 1 diabetes.

Support for this project was provided by The Royal Victoria Hospital Foundation, The Montreal General Hospital Foundation, the Research Institute of the MUHC, Transplant Quebec and the Canada Foundation for Innovation.

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PHOTO: Courtesy Dave Sidaway, The Gazette (L to R: Dr. Benoît Gallix,Director of Radiology at the MUHC and Chair of the Department of Diagnostic Radiology at McGill University, Svetalna Bityutskaya, Interventional Radiology Technologist, Maria Renzullo,   Interventional Radiology Technologist, Zohra Nabbus, Patient, Dr. Steven Paraskevas, Director of the Pancreas and Islet Transplant Program at the MUHC, Marco Gasparrini, Research Assistant, Islet Transplant Program, Craig Hasilo, Manager of the Human Islet Transplant Laboratory)

Illustration: Giovanni Maki – Naftanel MA, Harlan DM (2004) Pancreatic Islet Transplantation. PLoS Med 1(3): e58 (image link)