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Clinical islet transplantation

Diabetes Research Group. Clinical islet transplantation. Stephanie A Amiel, BSc, MD, FRCP RD Lawrence Professor of Diabetic Medicine King’s College London School of Medicine. INSU U100. Treatment of organ failure?. Renal failure Liver failure Heart failure Islet failure.

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Clinical islet transplantation

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  1. Diabetes Research Group Clinical islet transplantation Stephanie A Amiel, BSc, MD, FRCP RD Lawrence Professor of Diabetic Medicine King’s College London School of Medicine

  2. INSU U100 Treatment of organ failure? • Renal failure • Liver failure • Heart failure • Islet failure • Kidney transplant • Liver transplant • Heart transplant

  3. Case Histories • Born 1944; T1DM 1966; keen runner • Born 1965; T1DM 1987; HCA on locked ward • Born 1985; T1DM 1994; mother of two “afraid to be in charge of my granddaughter” “threatened with medical redundancy” “you just drove across a red light, Mummy”

  4. GLUCOSE-RESPONSIVEINSULIN DELIVERY Bionics vs nature?

  5. Nature – whole pancreas or islets?

  6. Islet Transplantation • 1998 established laboratory • 2000 proof of concept • 2002 1st UK patient • 2008 NCG funded programme

  7. CITR Islet Alone Recipients outcome From all infusions Insulin Independence, Insulin Dependence, Graft failure *C-peptide data not available at Day 75 **Year 3 status independent of re-infusion

  8. SEVERE HYPOGLYCEMIA FOLLOWING LAST TRANSPLANT CITR 2007

  9. Clinical Outcomes: Diabetes UK patients • 3 people achieved insulin independence • 1 person with 4% reduction in HbA1c • 2 people back in work • 1 woman resumed running and babysitting her grandchildren • 2 children safely back on school run

  10. UK ITC NCG: April 2008 2 isolation centres 6 Transplant centres Intractable hypoglycaemia Islet after kidney Local and remote Shaw, Manus, Amiel, Huang

  11. Problems to be solved • Current • Organ supply/distribution • Sub-optimal immunosuppression • Research • Prevent loss of islets on administration • Improve immunosuppression • Make new islets to give greater loads and re-transplant if required

  12. Meanwhile • Whatever cell therapy we devise, it will need to be safer than insulin therapy • For a small number of patients, it already is

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