The year before Lori Martin received an experimental islet cell transplant that enabled the type 1 diabetic to get off insulin, she was found unresponsive twice — first on an airplane and then in her hotel room.
“My family was on constant alert,” said the 49-year-old Orlando mother.
Today, Martin is one of fewer than 1,000 type 1 diabetics worldwide who have received a pancreatic islet cell transplant, an experimental cure for diabetes.
“My family can stop worrying now,” said the hospital software saleswoman. “That’s the biggest gift I could have given them.”
Martin received her donor islet cells through a clinical trial under way at the Diabetes Research Institute, a branch of the University of Miami. Under the direction of Dr. Camillo Ricordi, the center is one of only a handful in the country offering this procedure. Ricordi is chair of the National Institutes of Health’s Clinical Islet Transplant Consortium, a multi-center initiative in North America and Europe.
First performed successfully in 1990, pancreatic islet cell transplantation involves harvesting the fragile insulin-producing islet cells from a deceased donor’s pancreas and transfusing them into the liver of the recipient. The procedure takes less than two hours and requires patients to have only a local anesthetic and a light sedative.
Islet cells are transfused into the liver because the pancreas is very sensitive, said Ricordi. The slightest insult inflames it. The liver is more approachable, plus it’s “a huge filter and has a great blood supply,” making it a more welcoming site for donor islet cells.
Why the pancreas?
An organ about the size of your hand located just under the stomach, the pancreas houses islet cells, some of which make insulin.
In patients with type 1 diabetes, an autoimmune disease damages the islet cells so they don’t make insulin. Already surgeons perform complete pancreas transplants on patients who have severe type 1 diabetes.
“Whole pancreas transfer is a clinically acceptable procedure, while islet cell transplantation is still experimental,” said Dr. Thomas Eggerman, director of the clinical islet transplantation program for the National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health.
While cell transplantation is safer and less invasive, whole organ transplants are considered more durable, he said. But researchers are working to change that.
Currently approved for the most severe cases, the transplant procedure has a 70 percent success rate after seven years, said Ricordi, who defines success as being insulin free and experiencing no transplant rejection.
“We’ve made a huge improvement in the last 10 years,” said Cristiana Rastellini, director of cellular transplantation and transplant research at the University of Texas Medical Branch, in Galveston, who did her first islet cell transplant in 1993. “But we still have a lot of questions to answer.”
Not for every diabetic
Martin first learned she had diabetes when she was 29 and pregnant with twins. However, her diabetes wasn’t the gestational variety, a version of type 2 brought on by pregnancy, but was adult-onset type 1, probably triggered by a virus.
A former intensive care nurse, Martin took charge of her care with precision. Despite her vigilance, her sugar levels were volatile. “About six times a year my children had to call 911 because I would collapse,” she said of the times her disease threw her into a life-threatening state of low blood sugar.
She suffered from hypoglycemic unawareness, a condition where diabetics don’t sense that their blood sugar is dangerously low.
When Martin first heard about islet cell donor transplantation 10 years ago, she signed up. That study was halted because the medication patients had to take to prevent rejection proved too dangerous. In 2008, she tried again, and contacted the Diagnostic Research Center.
She also did her homework. “I did a search, and found islet cell transplant patients and talked to them about their procedures. They all had great success.”
