Presentation on theme: "Clinical islet transplantation Stephanie A Amiel, BSc, MD, FRCP RD Lawrence Professor of Diabetic Medicine Kings College London School of Medicine Diabetes."— Presentation transcript:
Clinical islet transplantation Stephanie A Amiel, BSc, MD, FRCP RD Lawrence Professor of Diabetic Medicine Kings College London School of Medicine Diabetes Research Group
Case Histories 1.Born 1944; T1DM 1966; keen runner 2.Born 1965; T1DM 1987; HCA on locked ward 3.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-RESPONSIVE INSULIN DELIVERY Bionics vs nature?
Nature – whole pancreas or islets?
Islet Transplantation 1998 established laboratory 2000 proof of concept 2002 1 st UK patient 2008 NCG funded programme
Insulin Independence, Insulin Dependence, Graft failure *C-peptide data not available at Day 75 **Year 3 status independent of re-infusion CITR Islet Alone Recipients outcome From all infusions
CITR 2007 SEVERE HYPOGLYCEMIA FOLLOWING LAST TRANSPLANT
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 3 people achieved insulin independence Clinical Outcomes: Diabetes UK patients
UK ITC Shaw, Manus, Amiel, Huang NCG: April 2008 2 isolation centres 6 Transplant centres Intractable hypoglycaemia Islet after kidney Local and remote
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