By Bill Zeeble, KERA 90.1 Reporter
Dallas, TX –
Bill Zeeble, KERA 90.1 reporter: Jennifer Shannon, a 26 year-old elementary teacher in Saginaw, has had insulin-dependent diabetes since she was three. Her body doesn't make insulin, which processes carbohydrates - sugars - necessary for survival. It's the pancreas that holds insulin - or, more specifically, the islet cells there that make it. After decades of injecting insulin, Shannon's now on an operating table in Baylor Hospital's Radiology Suite. Director of the Islet Cell Transplant Program Dr. Marlon Levy says this procedure is so minimal, it doesn't even officially qualify as surgery.
Marlon Levy, M.D., Medical Director, Islet Cell Transplant Program, Baylor Health Care System: It's a procedure that's done by a radiologist in an interventional radiology suite. So the patient is on a radiology table.
Zeeble: Where a tube's inserted between Shannon's lower ribs. It's connected to the portal vein, which feeds the liver. Soon, a quarter million insulin-making islet cells will be transplanted into the patient.
Levy: So the cells are in suspension in the bag, which you saw being brought in the cooler there. Then we'll hang the suspension of cells, connect it to plastic tubing, and let gravity drip the cells in.
Zeeble: This is Shannon's second and last infusion of Islet cells, harvested from a cadaver and shipped here from Miami, 1300 miles away. This evening's transplant, from start to finish, will take about an hour.
Bashoo Naziruddin, M.D., Dialysis Lab Director, Baylor University Medical Center: The beauty of this procedure is the patient gets only a stick into the vein.
Zeeble: Dr. Naziruddin is the Dialysis Lab Director at Baylor University Medical Center. He says this procedure is nearly the opposite of major, complicated liver, kidney, or other transplant surgery than can last five, six, seven hours or more.
Uddin: There's no major surgery, not much blood, not much open wounds. Nothing of that sort. Minimal pain, minimal surgery procedure. That's the beauty of this whole thing.
Zeeble: The other revolutionary part of this process is that it works. For years, doctors knew islet cells could lodge in the liver and make insulin, even though they really live in the pancreas. But the liver's easier to reach than the pancreas, is more hospitable, and in diabetes patients, islet cells have mistakenly been destroyed there by the body. Still, most cell transplant attempts failed. Then, a few years ago, Canadian doctors changed the procedure with stunning outcomes.
Levy: Prior to four years ago, the success rate - as defined by whether patients could come off insulin - was about 10% at one year. Now it's closer to 80% or more.
Zeeble: Levy attributes that dramatic reversal - from almost no success to nearly total triumph - to three changes. The Canadian doctors stopped using steroids, which, while used for immunosuppression, are toxic to islets. They also used a human, not animal, protein for cell preparation. And they treated the islets like living organs. No freezing, no waiting, no culturing - they applied a just-in-time protocol.
Levy: As if life depended on it, which it does of course. And it turns out doing things immediately really did make a difference.
Zeeble: Jennifer Shannon's grateful for the improvements.
Jennifer Shannon, islet cell transplant recipient: I was definitely ready. Really, as far as convincing, I didn't need a lot.
Zeeble: Since early childhood, Shannon needed daily insulin injections to live. Though the transplant's not a cure, her body now makes insulin. As a result, the dangerous up and down blood sugars of diabetes - which damage organs over the long term - are gone. She still wears a pump, but her injected insulin needs continue falling as her transplanted cells kick in. Good blood sugar control's the immediate goal. She saw her uncle die from kidney failure, a diabetes complication, after he spent years on dialysis.
Shannon: Of course, heart trouble; he was blind. He had seen it all, had it all. If you've got control, and you don't have to worry about eyesight and kidney damage, and nerve damage and that kind of stuff, I almost feel like those are bigger, 'cause I've seen what it can do to you.
Zeeble: In time, Shannon could be completely free from insulin, just like 60% of those transplanted so far. Another 20 to 25% or more still need some insulin, but are far better controlled. Anti-rejection drugs, and the small chance of cancer they could cause, are minor worries to her. They are to Shan Wolff too, who's on the cell transplant waiting list. He's as concerned about immediate, low blood sugars as he is of long-term problems. Lows - sometimes undetectable - can prompt a patient to pass out or have a seizure.
Shan Wolff, transplant hopeful: Let's say I'm at home, and my wife leaves before I do to go to work, and my son can't wake me up. Or I'm driving down the street with a bunch of Boy Scouts. Or I'm out working, no else is at home, and it's hot summer day, in our secluded back yard, and I fall down, low blood sugar, unable to fix it myself.
Zeeble: Some of these have happened to Wolff, but, so far, there's always been somebody around. The symptoms though helped qualify him for Baylor's transplant program, which plans to infuse islet cells into a total of 15 patients. Still an experimental procedure, Baylor's Transplant Chief, Dr. Goran Klintmalm, says the potential to ease other diseases is huge.
Goran Klintmalm, M.D., Chief, Baylor Transplant Program: A third of patients needing kidney transplants are because of Type 1 diabetes. Imagine if we can eradicate a third of the kidney waiting list? That would be in itself an absolutely miraculous change.
Zeeble: Klintmalm says this could also apply to the liver.
Klintmalm: Here we can actually potentially also infuse healthy liver cells in a patient with certain liver diseases, and cure them without big dangerous surgery. The list goes on and on.
Zeeble: And Klintmalm says cell transplantation must be seen as a first step, as a tool that'll let doctors open up that box, to see what possible cures could be inside.
Shannon: I feel incredibly blessed and lucky I get to be the one to do it. There's no reason I deserve it - almost feel guilty that I get to see this 'cause it's so incredible and has so much promise, I guess.
Zeeble: For KERA 90.1, I'm Bill Zeeble.
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