Airman `cured' of diabetes following transplant

Posted on Tue, Dec. 15, 2009
Airman `cured' of diabetes following transplant

BY FRED TASKER
ftasker@MiamiHerald.com

Twenty-one-year old Tre F. Porfirio was sent to Afghanistan as a U.S. airman, but now that he's back, he's a medical pioneer.

His pancreas was riddled by enemy bullets, destroying most of its ability to produce insulin, and potentially turning him into an instant, full-blown diabetic.

But now doctors have removed the insulin-producing islet cells from what was left of his pancreas and transplanted them into his liver, which has taken over the function of producing the insulin.

It's the first time the procedure has been used on a pancreas damaged by injury rather than having deteriorated from diabetes.

``The doctors say his insulin production is within a normal range,'' said Dr. Camillo Ricordi, chief of the University of Miami Medical School's Diabetes Research Institute, who pioneered the procedure and performed it on the young airman. ``We're excited.''

The history-making procedure may be a near-permanent cure for Porfirio, Ricordi says. And it could presage near-permanent cures for diabetics all over the world within 10 years or so, he says.

``This could become an unlimited cure available for everyone.'' It would be a major step against the epidemic that sees 23.6 million U.S. children and adults, or 7.8 percent of the population, with diabetes, according to the American Diabetes Association.

Diabetes is the seventh-leading cause of death in the U.S., costing $174 billion in health care each year, and is growing rapidly along with the surge in obesity. It often causes serious health problems to the eye, heart, kidney and other organs.

In a whirlwind set of procedures that began the day before Thanksgiving, doctors at Walter Reed removed what was left of Porfirio's pancreas, packed it into a special container that held it at 32.3 degrees Fahrenheit and couriered it to the University of Miami. Ricordi and his team received it at 11 p.m. and spent the next six hours removing the insulin-producing islet cells.

Using enzymes and gentle heat, they extracted thousands of the cells, which range from .002 inches to .02 inches across, put them in a plastic bag similar to those used in blood donations, put them back in the container, this time at 46 degrees -- and, by 6:30 Thanksgiving morning -- couriered it back to Walter Reed.

There, doctors hoisted the bag on a pole and, by gravity, fed the islet cells into a duct in the airman's liver, with Dr. Ricordi and his team coordinating the procedure via an Internet connection with surgeons at Walter Reed. By Monday, the new cells in his liver were producing insulin, although doctors also were giving him extra insulin to avoid stressing the new cells.

``The cells are lodged in his liver now, and they will develop their own new blood vessels there within weeks,'' Ricordi says.

Ricordi is optimistic about Porfirio's prognosis, even long-term.

``There's no reason to think they [the cells] will fail at any time. He has a very good chance for long-term health.''

Ricordi says that, since only about half of Porfirio's pancreas was left from which to remove islet cells, the remaining cells in the liver might not be able to produce as much insulin as he needs -- and might need to be supplemented.

``We've never done this before. We don't want to be over-optimistic.''

While today's case is the first with a war-injured pancreas, the procedure for transplanting islet cells into the liver was developed by Ricordi and colleagues in 1990. It was used primarily in worst-case patients, often those with Type 1 diabetes, in which the pancreas produces no insulin, which happens mostly in children and young adults.

In many cases patients were able to stop injecting insulin, at least temporarily.

But in such cases, the cells were extracted from cadaver donors, meaning the recipients had to stay on powerful anti-rejection drugs their whole lives, as if they had had an organ transplant. This caused stress on the transplanted cells, and as recently as 2005 only about 10 percent of such patients remained insulin-free five years after the operation.

Because of this, only about 700 such operations have been done worldwide, Ricordi said.

Recently, more-sophisticated anti-rejection drugs are prolonging the lives of the transplanted cells, Ricordi says.

``In the past five years we're seeing tremendous progress,'' Ricordi says. ``In the most recent trials, 70 percent of patients were showing success at five years -- the same as with an organ transplant.''

Several experiments going on now might improve outcomes even more, he said.

Also at the UM Diabetes Research Institute, biomedical engineer Cherie Stabler is using nano-technology to coat insulin-producing cells with an ultra-thin layer of seaweed, laid down molecule by molecule, to disguise them from the body's immune system.

Other experiments are using cells from pigs. Still other are using stem cells from the patient's own bone marrow, which also would avoid the rejection problem.

Within five to seven years, Ricordi believes islet cell transplantation can also be used to fight Type 2 diabetes. Within 10 years he believes stem cell transplantation could be in use for everyone in need.

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