Device-Less Technique in Islet Transplantation
Type 1 DiabetesIslet transplantation is an effective modality for treating type 1 diabetes. Despite marked progress in clinical islet transplantation with the achievement and maintenance of insulin independence in over half of recipients up to 5 years, transplant approaches are limited to those that struggle to control their diabetes. Furthermore, this approach remains restricted due to the scarcity of human pancreas donors. While transplanting insulin-producing cells into the liver has been demonstrated as an efficacious means of restoring glycemic control to patients with T1D, the procedure often results in cell loss, and carries risks. Moreover, transplant in to the liver does not permit imaging or retrieval of donor islets. The ability to retrieve the cells is also important for safety reasons.
In theory, the space under the skin is an attractive alternate site for transplanting insulin producing cell, due to ready access, and potential for monitoring cellular transplant function through novel imaging techniques. However, transplantation of insulin producing cells into an unmodified site under the skin universally fails to reverse diabetes in research animal models, or in human studies. Other techniques using devices with different type of technologies and biomaterials have been explored with variable success. Unfortunately, the foreign body and inflammatory reaction persist in the implant. Shapiro Lab, has developed a novel technique called 'device-less' (DL) transplant modality. This approach was designed to harness an innate foreign body response in a favorable and controlled manner, to induce growth of new blood vessels to allow the survival of the insulin producing cells without the natural body response to foreign body. Briefly, this site transforms the inhospitable under the skin site into a viable location through the temporary implantation of a small tube called angiocatheter.
For this study, 5 patients will received transplant in to the modified site under the skin using the DL transplant technique.
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Participation Requirements
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Sex:
ALL -
Eligible Ages:
18 to 68
Participation Criteria
Inclusion Criteria:
* Reduced awareness of hypoglycemia, as defined by the absence of adequate autonomic symptoms at plasma glucose levels \< 3.0 mmol/L, indicated by, 1 or more episodes of severe hypoglycemia requiring third-party assistance within 12 months, a Clarke score ≥4, HYPO score ≥1,000, lability index (LI) ≥400 or combined HYPO/LI \>400/\>300.
* Metabolic instability, characterized by erratic blood glucose levels that interfere with daily activities and/or 1 or more hospital visits for diabetic ketoacidosis over the last 12 months.
* Participants must be capable of understanding the purpose and risks of the study and must sign a statement of informed consent.
Exclusion Criteria:
* Significant skin conditions involving the area(s) targeted for implantation. Examples include but are not limited to recurrent boils/furuncles, extensive surgery or scarring, or lipodystrophy.
* History of enrollment in any other islet transplant trials and islet transplant under standard of care (at the discretion of the investigator).
* Severe co-existing cardiac disease, characterized by any one of these conditions: (a) recent (within the past 6months) myocardial infarction; (b) left ventricular ejection fraction \<30%; or (c) evidence of ischemia on functional cardiac exam.
* Active alcohol or substance abuse, including cigarette smoking (must be abstinent for 6 months prior to listing for transplant).
* Psychiatric disorder making the subject not a suitable candidate for transplantation (e.g., schizophrenia, bipolar disorder, or major depression that is unstable or uncontrolled on current medication).
* History of non-adherence to prescribed regimens.
* Active infection including Hepatitis C, Hepatitis B, HIV, or TB (subjects with a positive PPD performed within one year of enrollment, and no history of adequate chemoprophylaxis).
* Any history of, or current malignancies except squamous or basal skin cancer.
* BMI \> 35 kg/m2 at screening visit.
* Age less than 18 or greater than 68 years.
* Measured glomerular filtration rate (GFR) \<60 mL/min/1.73 m2.
* Presence or history of macroalbuminuria (\>300 mg/g creatinine).
* Clinical suspicion of nephritic (hematuria, active urinary sediment) or rapidly progressing renal impairment (e.g. Increase in serum creatinine of 25% within the last 3-6 months).
* Baseline Hb \< 105 g/L (\<10.5 g/dL) in women, or \< 120 g/L (\<12 g/dL) in men.
* Baseline screening liver function tests outside of normal range, with the exception of uncomplicated Gilbert's Syndrome. An initial LFT panel with any values \>1.5 times the upper limit of normal (ULN) will exclude a patient without a re-test; a re-test for any values between ULN and 1.5 times ULN should be made, and if the values remain elevated above normal limits, the patient will be excluded.
* Untreated proliferative retinopathy.
* Positive pregnancy test, intent for future pregnancy or male subjects' intent to procreate, failure to follow effective contraceptive measures, or presently breast-feeding.
* Evidence of significant sensitization on PRA (at the discretion of the investigator).
* Insulin requirement \>1.0 U/kg/day
* HbA1C \>12%.
Study Location
University of Alberta Clinical Islet Transplant Program
University of Alberta Clinical Islet Transplant ProgramEdmonton, Alberta
Canada
Contact Study Team
- Study Sponsored By
- University of Alberta
- Participants Required
- More Information
- Study ID:
NCT05073302