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. Last Updated: 07/27/2016

Transplants Give Hope to Diabetics




One day five years ago, Charlene Faltermeier fell to the floor, had a convulsion and hit her head on the stove while her two young sons watched. Her terrified 3-year-old punched a programmed button on the telephone and told the person who answered, "Mommy's dead.''


Faltermeier was alive, but her hard-to-manage diabetes had sent her blood sugar plummeting without warning. It was these perilous dives into unconsciousness f which Faltermeier suffered frequently, at home and at work, that made the supermarket cashier accept an offer last year to receive an experimental transplant of insulin, producing cells.


"It was a better risk than passing out and not knowing what's going to happen to you,'' she said.


Now, Faltermeier, 30, of Edmonton, Canada, no longer needs the four daily insulin shots she began taking as a teenager. She no longer worries she'll be fired for fainting on the job. Like all but one of the 12 patients who in the past 16 months have received transplanted islets (clusters of insulin-producing cells) at the University of Alberta in Edmonton, Faltermeier is completely off insulin. For now, she is no longer diabetic.


"Cure'' is a word no one is yet willing to apply to the transplants, since the islets, which are taken from donated pancreases, could still be rejected or the patients' diabetes could recur for other reasons. Nevertheless, medical experts are elated by the results so far.


"For these people, this is a miracle,'' said Robert Goldstein, chief scientific officer of the Juvenile Diabetes Foundation.


Experts caution that the long-term outcome and risks of the treatment are still unknown. "It's a unique breakthrough in the field because, for the first time, you can consistently achieve insulin independence in diabetics," said Camillo Ricordi, director of the Diabetes Research Institute at the University of Miami. "At the same time, we are all aware that it is just another step toward the big challenges that we have ahead to make this a reality for all.''


Currently, the transplants are being tested only in people with type 1 diabetes, who produce no insulin and who account for about 1 million of the 16 million diabetics in the United States. The others, who have type 2 diabetes, produce some insulin but not enough for their bodies' needs. Some type 2 diabetics may eventually be candidates for the treatment. Because of the risks, children are not now being considered for such transplants.


Although the transplant is relatively simple, isolating the insulin-making islets from the pancreas is complex and labor-intensive, and the number of people who may benefit is limited by a severe organ shortage. Islets cannot be obtained from living donors. Only about 5,800 people in the United States and about 600 in Canada donated organs after death last year.


"Right now, even if we could use every single pancreas, we could transplant less than 1 percent of the patients that might benefit,'' Ricordi said.


To prevent rejection of transplanted islets, recipients must remain on drugs that suppress their immune systems, putting them at risk of infections and cancer. Researchers hope that, in time, they will be able to increase the availability of islets, perhaps by growing them in the laboratory or cloning them. They are also optimistic about developing a treatment that would make the immune system "tolerant'' of the transplants, so that future patients may not have to take anti-rejection drugs.


"We have a virtually limitless number of patients waiting for the procedure,'' said James Shapiro, director of the University of Alberta's transplant program. "We're all of us trying and striving to take this to the next level. We want to be able to do it without needing the potent drugs.''