Clinical islet transplantation
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Diabetes Research Group. Clinical islet transplantation. Stephanie A Amiel, BSc, MD, FRCP RD Lawrence Professor of Diabetic Medicine King’s College London School of Medicine. INSU U100. Treatment of organ failure?. Renal failure Liver failure Heart failure Islet failure.

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Clinical islet transplantation

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Diabetes

Research

Group

Clinical islet transplantation

Stephanie A Amiel, BSc, MD, FRCP

RD Lawrence Professor of Diabetic Medicine

King’s College London School of Medicine


INSU

U100

Treatment of organ failure?

  • Renal failure

  • Liver failure

  • Heart failure

  • Islet failure

  • Kidney transplant

  • Liver transplant

  • Heart transplant


Case Histories

  • Born 1944; T1DM 1966; keen runner

  • Born 1965; T1DM 1987; HCA on locked ward

  • Born 1985; T1DM 1994; mother of two

“afraid to be in charge of my granddaughter”

“threatened with medical redundancy”

“you just drove across a red light, Mummy”


GLUCOSE-RESPONSIVEINSULIN DELIVERY

Bionics vs nature?


Nature – whole pancreas or islets?


Islet Transplantation

  • 1998 established laboratory

  • 2000 proof of concept

  • 2002 1st UK patient

  • 2008 NCG funded programme


CITR Islet Alone Recipients outcome

From all infusions

Insulin Independence, Insulin Dependence, Graft failure

*C-peptide data not available at Day 75

**Year 3 status independent of re-infusion


SEVERE HYPOGLYCEMIA FOLLOWING LAST TRANSPLANT

CITR 2007


Clinical Outcomes: Diabetes UK patients

  • 3 people achieved insulin independence

  • 1 person with 4% reduction in HbA1c

  • 2 people back in work

  • 1 woman resumed running and babysitting her grandchildren

  • 2 children safely back on school run


UK ITC

NCG:

April 2008

2 isolation centres

6 Transplant centres

Intractable hypoglycaemia

Islet after kidney

Local and remote

Shaw, Manus, Amiel, Huang


Problems to be solved

  • Current

    • Organ supply/distribution

    • Sub-optimal immunosuppression

  • Research

    • Prevent loss of islets on administration

    • Improve immunosuppression

    • Make new islets to give greater loads and re-transplant if required


  • Meanwhile

    • Whatever cell therapy we devise, it will need to be safer than insulin therapy

    • For a small number of patients, it already is


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