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Islet cell transplant offers promising lifeline

by Dawn Brazell
Public Relations

Thrilled that MUSC’s pioneering efforts led to the milestone of the 50th islet cell transplant Jan. 31, David Adams’ mission is to end the suffering of patients with chronic pancreatitis.
Interventional radiologist Renan Uflacker (right), registered nurses Monica Mallory, center, and Hedy Fagan oversee islet cells being infused into a patient’s liver. Watch a Video: visit

MUSC holds the distinction of being the second busiest autologous islet cell transplant center in the country, behind the University of Minnesota, which started doing the procedure in the 1970s. MUSC, the only place in the state to offer the procedure, treated its first patient March 2009, and performs about 25 cases a year to treat chronic pancreatitis. The condition afflicts thousands of patients and is characterized by debilitating pain and suffering that frequently is unresponsive to traditional medical and surgical treatments, said Adams, M.D.
“Chronic pancreatitis causes severe, knife-like pain that is unimaginable to most of us and results in these patients being stigmatized and marginalized by doctors and health care providers, who are frustrated by an inability to help these long-suffering patients. Total pancreatectomy with transplantation of the patients' own insulin-producing cells offers patients the chance to remove the source of the pain and at the same time prevent the side-effects of brittle diabetes.”

“What drew me to this field is the need to take care of these patients who are in so much pain.” Dr. David Adams

Adams, chief of the Division of Gastrointestinal and Laparoscopic Surgery, said he’s seen the condition reduce war-toughened veterans to tears. He recalls a patient who had suffered having his jeep blown up in Vietnam, but said that his pancreatic pain topped that experience to the point he couldn’t move to even turn around. He related how he had gone to emergency rooms in intense pain and the staff would think he had just come in for drugs.

Adams often sees patients after they’ve been referred through the system by health professionals who don’t know what to do to help them. The five-year survival rate for patients with chronic pancreatitis is 25 percent.
“What drew me to this field is the need to take care of these patients who are in so much pain. They’ve always been shunned in the past. You can’t cure everybody, but you can care for them—always.”

Dr. Katherine Morgan

Katherine Morgan, M.D., a surgeon who also treats these patients, agrees. It’s gratifying to be able to have had the opportunity to have such an impact on so many people’s lives, she said. “We have evolved into a strong, experienced team which enables us to take care of people most effectively.”

The islet cell transplant procedure is reserved for those patients who have failed all medical and endoscopic interventions. The goal is to achieve optimal pain control and improve quality of life, she said.
“We have seen a significant decrease in the need for narcotic analgesics in most patients, an overall 57 percent reduction in median daily oral morphine requirements, with about 30 percent of patients being able to be narcotic free. Most impressively, patients note a dramatic improvement in quality of life.”

Research specialist Kelly Moxley performs sterility testing on the final islet preparation.

One of the key duties of the pancreas is to produce the hormones insulin and glugagon to metabolize sugars in the blood, a job done by islet cells in the pancreas. When the pancreas is removed, the body loses its ability to produce insulin, so diabetes will occur often in the form of “brittle diabetes” that is very severe and difficult to control. In the islet cell transplant, the patients own cells are extracted and infused into their livers with the hope that patients will be able to remain insulin independent or at least have a less severe form of insulin-dependent diabetes.

Adams said MUSC has a long history of being a center of excellence for pancreatic care. He trained under Marion Anderson, M.D., a former department chairman who was a highly-respected national leader in the operative treatment of chronic pancreatitis. Another positive influence is Peter Cotton, M.D., who initiated the Digestive Disease Center at MUSC in 1994, with a focus on facilitating multidisciplinary collaboration.
Collaboration is a key factor to success for the islet transplant program, which receives support from MUSC’s Center for Cellular Therapy’s (CCT) clean lab, where islet cells are harvested to be infused back into the patient’s liver by an interventional radiologist.

Michael Nishimura, Ph.D., CCT scientific director, said the lab, the only one of its kind in the state, is the future of regenerative medicine because of the sterile environment created by a special air-handling system that leaves the lab almost particle free. It prevents spores, dust mites, mold, bacteria, pollen, viruses and other particles from contaminating what’s being processed.

For example, the lab gets particle counts of 0 to 1 as compared to a normal room that would have billions, he said. “That’s the environment required to do these islet isolations. It enables the institution to do the cutting-edge of medicine, which is regenerative medicine–giving back people their own cells to treat diseases. Regenerative medicine is the future of medicine,” he said, citing a few examples.

“In the future, if you have heart disease, we hope to be able to inject your own cells back into your heart to help it to remodel the heart. Similarly, if you have joint problems, we hope to inject your cells into whatever joint. The goal will be to have your own cells help participate in your own tissue or organ repair. You need a facility like the clean cell lab to do that.”

Islet cell transplants are just the beginning of very exciting research–from treating juvenile diabetes to Alzheimer’s disease – that eventually will be done in the lab, he said. “It’s waiting for someone in the scientific community at MUSC to invest the time and effort.”
Meanwhile, research continues on islet cell transplants.

Adams said MUSC is in the process of evaluating the effectiveness of islet cell transplantation for the quality of life and pain relief for patients, but it’s too early to identify long-term outcomes, he said. Inflammation of the pancreas causes changes resulting in the production of extra nerve pain stimulators in the nerves around the pancreas.

Another area of interest is how the disease causes a remodeling of the pain centers in the brain, something that can be hard to reverse, he said. The goal is to remove the pancreas before it sets up irreversible brain pathways and to develop better medications that interfere with those pathways.
Patients with chronic pancreatitis never know when they’re going to end up in the emergency room with pain and sometimes vomiting because of these debilitating attacks, he said. He’s excited MUSC will be continuing its pioneering efforts.  “By intervening early in pancreatic disease, we can return these people to a somewhat normal life.”

Autologous Islet Cell Transplant

1. Patient goes in for surgery to remove the pancreas. An islet cell transplant can help patients who are suffering from the pain of chronic pancreatitis.
2. The pancreas is put on ice and placed in a special fluid.

3. The organ undergoes a four-to-five hour process in the Center for Cellular Therapy’s clean lab where specially trained technicians extract insulin-producing islet cells.

4. The islet cells go into an IV bag and are infused into the patient during a procedure done by an interventional radiologist who uses ultrasound to guide a catheter into the main blood vessel in the liver.

5. The islet cells are infused into the liver where they are expected to begin functioning as a miniaturized pancreas, producing and releasing insulin. About 25 to 40 percent of patients who have islet cell transplants will not require insulin treatment. For the remaining patients who are insulin dependent, their diabetes typically is much more easily managed.

Friday, Feb. 4, 2011

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