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Woman Breaks Free from Insulin--and Constant Fear

Susan Cuthbert with the team of specialists involved in her islet cell transplant Susan Cuthbert (center, in black) with the team of specialists involved in her islet cell transplant. Behind Cuthbert is Piotr Witkowski, MD, PhD, who leads clinical trials on islet cell transplantation at the University of Chicago.

Susan Cuthbert knows she needs help to manage her type 1 diabetes. On her own, she will never produce enough of the hormone insulin, which helps the body use blood sugar (or glucose) for energy. But as a participant in one the University of Chicago Medicine's clinical trials, Cuthbert underwent a unique non-surgical procedure: Islet cells from the pancreata of deceased donors were injected into a major blood vessel of her liver.

Now Cuthbert, whose home is in England, is free not only from the need for insulin, but also from hypoglycemic unawareness--dangerous episodes when the body, becoming used to low blood sugar levels, fails to trigger warning signs (sweating and palpitations, for example). Since the diabetic does not have a physical prompt to correct the problem by eating, he or she continues with physical activity and can suffer sudden seizures, loss of consciousness or brain damage.

Cuthbert had more than 100 of these episodes before she started the study, resulting in many broken bones and a long interruption of her lecturing job at Loughborough College. “This is the first time since my diabetes was diagnosed when I was 12 years old that I’m not worried that I’ll wake up in the hospital,” she said.

Receiving an islet cell transplant may help prevent other diabetes-related problems, such as kidney and heart disease. “Being part of this study is a way of looking after myself,” Cuthbert said. “The last seven years have been really difficult for me. I’m now missing my family, friends and garden. It will be good to get home again to catch up. I couldn’t get the treatment in England, as they hadn’t fully opened their Islet Cell Transplant Program. So, I applied to the University of Chicago, was accepted, and came to participate in this study, and I feel really lucky to be here.”

Now that the initial clinical trial on islet cell transplantation that began in 2003 is nearing completion, the University of Chicago Medicine is launching more studies under the leadership of Piotr Witkowski, MD, PhD, associate professor of surgery and director of the Pancreatic Islet Transplant Program. “We want this treatment to be available to all patients with Type 1 diabetes who have unawareness episodes. If we can select patients carefully and do the procedure effectively, the donor pool should be sufficient,” Witkowski said.

One of Witkowski’s goals is to optimize the process of isolating islet cells, so a patient with diabetes will remain free of the need for insulin injections after only one infusion. He also is spearheading improvements in warding off infection and the attack of the immune system on new cells or organs.

“Our hope is to get even better results by increasing effectiveness of immunosuppressive medicines and limiting bothersome side effects,” he said.

Witkowski said the environment for doing successful research and transplants is among the reasons he came to the University of Chicago in September 2009, citing in particular the exceptional laboratory at the medical center where islet cells are isolated. This is the place where collaboration of different specialists in immunology, diabetology, surgery and basic science research is tight and may provide progress in the field improving the effectiveness of the procedure.

Of the approximately 40 medical centers in the world performing islet cell transplants, the University of Chicago Medicine is one of about 15 in the United States. Although it is an established treatment in Europe, it is considered clinical research in the United States. The efforts of Witkowski’s team are being used as an impetus to obtain approval from the U.S. Food and Drug Administration for these protocols so islet cell transplantation will be covered by U.S. insurance companies.

One obstacle to making islet cell transplants more widespread is that the families of some potential donors are not willing to allow the organs of their loved ones to be used for “research.” However, Kathy Singraber, RN, MSN, islet cell transplant coordinator, pointed out that the procedure is already improving many lives by eliminating the need for insulin injections and preventing hypoglycemic episodes without major side effects “It has been very gratifying to help people like Sue Cuthbert feel so much better,” Singraber said.

Cuthbert remembers trying out new equipment and types of insulin even as a child. “There have been phenomenal advances in diabetes treatment in my 54 years of life, and it’s people like me who have been the first to use them,” she said. “But at The University of Chicago, I don’t feel like it’s just about the research. Even though diabetes has interfered with some parts of my life, being in this clinical trial has made it possible for me to be more of who I am.”

Witkowski’s team is also recruiting patients who are getting a liver transplant or who already have had a kidney transplant for further islet cell research. He also works with patients with chronic pancreatitis who receive a transplantation of their own islet cells to prevent them from becoming diabetic when their pancreas is removed because of the untreatable pain. “We, as a medical center, are growing and getting more protocols, so we can offer islet cell transplantation to more kinds of patients,” he said.

December 2010

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