- The Washington Times - Wednesday, June 7, 2000

A team of Canadian researchers has succeeded in eliminating the need for insulin-dependent diabetics to take the drug a remarkable breakthrough that signals a cure for the disease is possible.

Scientists at the University of Alberta in Edmonton, led by doctors James Shapiro and Jonathan Lakey, transplanted insulin-producing cells harvested from donated pancreases into seven severely diabetic patients. Almost as soon as a sufficient number of cells was injected into the patients' bloodstreams, they settled in the patients' livers and started producing life-preserving insulin.

The seven patients then stopped their insulin injections. They began eating normal diets and discarding the rigid regimes that dominated their lives as Type 1 diabetics.

In a phone interview, Dr. Shapiro said he considered the team's results "a truly major step forward. They show transplant works works effectively and controls many of the difficulties diabetics experience. These patients were having devastating comas. The transplant completely eliminated them. It reversed the disease's complications."

The New England Journal of Medicine reported the experiment's results and details of the Canadians' achievement yesterday. In arresting fashion, it announced the article was being presented almost two months before its July 27 publication date because of its "potential therapeutic implications."

Still, says Dr. Stephen Clement, director of Georgetown University's Diabetes Center: "It is not a cure. It's close, and it's a big, dramatic leap, but it's not a cure. It doesn't translate into a therapy we can do in every medical center in the United States overnight. And there are issues to overcome."

Dr. David M. Harlan, a National Institutes of Health specialist in transplantation and immunology, says Drs. Shapiro and Lakey have us "sailing beyond the horizon. We don't know what's out there. We don't know if we have a cure."

Dr. Harlan says: "It's important to realize that diabetes rules the diabetic's life, and victims are desperate for a cure. Yet they shouldn't be unduly enthusiastic at this important development. The cure isn't there yet. The Edmonton group's breakthrough is experimental with risks and costs."

Physicians explain that the transplant therapy raises several issues yet to be resolved. It could be, for instance, that the transplanted cells could fail in months to come, necessitating renewed insulin injections until a new supply of cells becomes available.

That's a significant factor because it takes two pancreases the donated organs from two recently deceased persons to supply enough cells to treat one diabetic, and donated organs are notoriously difficult to come by.

Also, diabetics receiving the transplanted cells must take drugs to prevent their bodies from rejecting the foreign cells. The drugs suppress the patients' immune systems. That might stop the rejection, but it makes the patient susceptible to infection.

It's a risk many diabetics would be willing to take. Moreover it's a risk that is gradually dissipating.

Type 1 diabetes is the most severe form of the ailment. It normally strikes before 35 years of age, often between the ages of 10 and 16. It hampers the pancreas' ability to produce insulin, which the body must have in sufficient amounts at the appropriate time. The insulin enables glucose (a type of sugar) to move from the bloodstream into the body's cells, where it is needed to provide energy.

The disease is a leading cause of death in the United States. It affects the patient's heart, eyes, kidneys, circulatory system, nerves, liver and skin. The afflicted can experience excessive urination, thirst, vomiting, stomach pain, trembling, sweating, headache, confusion, fainting and coma.

Most, if not all, of the symptoms can be controlled through medication plus relentless, wearying adherence to dietary and exercise programs that are especially hard on children.

Thus researchers for decades have been striving to find a diabetes cure.

"I personally have been working on this problem for 16 years," said Dr. Shapiro. "I stopped for a time and came back at it in 1993 and almost gave up."

Now, almost suddenly, explains Dr. Clement, a number of breakthroughs are occurring.

"There is research coming out next week that reports researchers have developed ways to produce pancreatic cell lines in the lab. A lot of things are coming together all at once."

Lab-produced cells would eliminate the need for donor pancreases and could alter the body's tendency to reject the transplanted cells.

The point is, Dr. Clement concludes, "it is possible to cure diabetes. There is no question about that. What we don't know is when we'll be confident enough that the cure is completely safe for a large number of folks. That might be a matter of a few years."

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