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New MUSC cellular therapy center expands, improves transplants

A new and unique facility at MUSC uses a patient’s own cells to perform life-saving procedures while erasing the problem of rejection and reducing the need for full organ transplants.
The Center for Cellular Therapy (CCT) is the first center in South Carolina to perform an autologous islet cell transplant for chronic pancreatitis. The first patient, a woman from Aiken, underwent a CCT procedure  on March 9 that enabled insulin-producing islet cells to be removed from her diseased pancreas and transplanted into her liver.
Dr. Katherine Morgan and visiting consulting islet scientist Dr. Horacio Rilo of Tucson, Ariz., check on the infused islet cells harvested from a patient suffering from chronic pancreatitis. Interventional radiologist Dr. Renan P. Uflacker prepares to reintroduce the patient’s own insulin-producing cells into her liver using a catheter and flouroscopy via the portal vein. The March 9 breakthrough procedure, known as an autologous islet cell transplant, was performed to help a 48-year-old patient from Aiken and others diagnosed with chronic pancreatitis.

This breakthrough procedure is the first in a series of innovative therapies from the new CCT, which is a collaboration between MUSC, Hollings Cancer Center (HCC), Department of Surgery, General Clinical Research Center, Digestive Disease Center (DDC), Interventional Radiology and Department of Pediatrics.
“The important work going on in this new center will include advanced cellular transplants for patients with chronic pancreatitis and pancreatic disease as well as cancer vaccine clinical trials,” said Andrew S. Kraft, M.D., HCC director. “One of the most difficult steps in translational cancer research is moving a therapeutic strategy from the lab into human clinical use in a structured and safe manner. Having this facility will greatly speed up the testing of state-of-the-art cancer treatments.”
One of the reasons that HCC was able to attain the recent prestigious National Cancer Institute cancer center designation is through the development and support of innovative facilities such as the CCT.
CCT features a sterile facility called a clean lab in which researchers produce clinical-grade cellular and tissue products for patient therapies. This allows MUSC researchers to process anything from stem cells to whole organs with the goal of fighting diseases such as cancer, pancreatic disease and diabetes.
Cellular transplantation, used at only a handful of specialized centers in the country, is used to treat chronic pancreatitis.
Patients with chronic pancreatitis suffer from numerous medical complications and severe pain. When medication is no longer effective, patients often require surgery to remove part of the entire pancreas. Removal of the pancreas also removes the ability to produce insulin, leaving the patient with no glucose control and, ultimately, severe type 1 diabetes.
In its maiden procedure, the MUSC CCT team achieved a breakthrough with its first autologous transplant of islet cells. In this procedure, the inflamed pancreas was removed in the operating room and taken to the “clean” laboratory where specially-trained technicians used a microscope and extracted the patient's  insulin-producing islet cells. Then an interventional radiologist and his team used fluoroscopy to guide a catheter through the patient’s upper abdomen and into the main blood vessel in the liver. The islet cells were infused back into the liver where they are expected to lodge in blood vessels and begin functioning like a miniaturized pancreas, producing and releasing insulin. By infusing the patient's islet cells into the liver, they will start producing insulin for the body and eliminate the onset of diabetes.
“Being able to work in specialized teams in a coordinated effort was very important to the success of this procedure,” said Renan P. Uflacker, M.D., professor of radiology and director of Vascular-Interventional Radiology. “It gives hope to this patient and many other individuals diagnosed with chronic pancreatitis and other diseases requiring specialized tissue and cell therapies. It is the first step in a long-lasting, collaborative effort to provide novel therapies for cancer patients and other important diseases such as diabetes.”
Ordinarily, a severely or chronically inflamed pancreas is removed by a surgical team. With islet cell autotransplantation, surgeons remove the whole pancreas and use the patient’s own insulin-producing islet cells by extracting and purifying them for injection later into the patient’s liver where they create a new blood supply and perform their normal function. Most patients do not need immunosuppressant drugs, because they essentially receive their own tissue.
“The work and expertise of many individuals have come together in the development of this program,” said Katherine Morgan, M.D., assistant professor of surgery, DDC, who was part of the procedure team. “Each part was absolutely essential, and I am amazed at the enthusiasm and diligence shown from all parties including physicians (surgeons, anesthesiologists, endocrinologists, radiologists), islet scientists, nursing staff, physician assistants, residents and administrative staff.”

Cancer vaccine clinical trials
Historically, cancer treatment primarily has relied on surgery, radiation and chemotherapy. However, in the last decade scientists have realized that cancer occurs because a patient’s immune system fails to recognize cancer cells as foreign and does not attack them as it would bacteria, for example.
“Using the body’s ability to defend against disease and heal itself is an exciting frontier in treatment and research for many diseases,” said Michael Nishimura, Ph.D., professor of surgery, microbiology and immunology, CCT scientific director and HCC Immunology Program leader. “In this lab we are, in essence, equipping a patient’s immune cells to recognize and destroy cancer cells. We’ll be developing vaccines and other kinds of cellular therapies to use now against various kinds of cancer.”
MUSC Center for Cellular Therapy scientific director Dr. Michael Nishimura quickly transports the patient’s pancreas after it was removed to the center’s clean lab for islet cell harvesting. The Center is a sterile facility where islet researchers extract the islet cells from the pancreas and later, place them back in the patient’s body.

Nishimura said the CCT already is running two FDA-approved trials—one designed to prevent type 1 diabetes in patients who had a pancreatectomy; and another designed to develop a therapeutic cancer vaccine for patients with metastatic colon cancer. There are other trials on the horizon, including breast cancer and pancreas cancer vaccines as well as T-cell therapies for patients with melanoma and liver cancer.
More than $3.5 million dollars was provided to create the CCT by HCC, MUHA, GCRC and Department of Surgery. Additionally, the clean cell facility from which the CCT was created initially was made possible with a $1 million gift from the Abney Foundation to treat juvenile diabetes via allogenic islet cell transplants.


Friday, March 27, 2009

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