“A godsend”: 20 years of the “Edmonton Protocol” for the treatment of diabetes

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Following a diagnosis of type 1 diabetes in 2003, Nina Greene said her life had become a revolving door of hospital visits.

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Living in Fort McMurray, about 430 kilometers northeast of Edmonton, Greene suffers from a particularly difficult-to-control variety of the condition known as ‘fragile diabetes’, where patients struggle to control their blood sugar levels. . Formerly on an insulin pump, she had to switch to insulin injections after complications with the device led to stomach infections.

“But every time I took insulin, my sugar would drop, so I had to eat sugar, and then my sugar would skyrocket, so I had to take more insulin,” Greene, 54, told Postmedia during of a telephone interview. . “I have never been a stable diabetic.”

This condition made her an ideal candidate for a treatment offered at the University of Alberta Hospital which involves transplanting insulin-producing islet cells into a patient’s liver via infusion.

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After getting the “call” late one night in January 2017, Greene recalled, she was in Edmonton at 3 a.m. the next day, anticipating a procedure that effectively changed her life. She became “insulin-free” about a year after receiving the transplant, she added, and has been since.

Dr. James Shapiro, a professor of surgery at the University of Alberta’s faculty of medicine and dentistry, leads the team behind the procedure known as the Edmonton Protocol.

He is also one of the authors of a May article published in The Lancet that reports 20 years of data from 255 patients who received the treatment between March 1999 and October 2019. According to the results, almost 80% of patients transplant recipients have achieved insulin independence. for a certain period of time.

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“We’ve learned that it’s very effective,” Shapiro said in a phone interview, “and now we’re focused on how to make it more accessible to all patients who could benefit from it.”

The islet cells, although originating from the pancreas, are transplanted into the liver because it has a good blood supply, whereas interference with the pancreas can lead to complications, explained Shapiro, also holder of the Chair of Canada’s research in regenerative medicine and transplant surgery.

So far, the procedure has only been used on people with the fragile form of diabetes because of the “fragile control” patients have over their blood sugar, Shapiro said.

“When blood sugar drops below a certain level, the brain immediately shuts down,” Shapiro said. “Neurons stop working and people can die.”

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Additionally, the immunosuppressive drugs needed to prevent the body from rejecting the transplant have in some cases led to cancers and life-threatening infections, he added. Therefore, considering the risks and benefits, the team sought out candidates for whom the treatment provided good health. switch to the latter.

That’s not to say other forms of diabetes aren’t in his sights. Shapiro was careful to note that while the Edmonton protocol does not cure diabetes, given the need for anti-rejection drugs and the supply problem due to donor dependence, the research goes into the right way.

These days, his lab is looking to create islet cells from stem cells using blood from patients with type 1 and type 2 diabetes.

“It can be done quite routinely now with a lot of hard work and skill, because of the permitted scientific advances that have happened over the last 20 years,” he said.

But for now, Greene is grateful to Edmonton Protocol and the team behind him for the stability they’ve given him in life.

A far cry from the days when her husband had to regularly rush her to the hospital, she has since enjoyed “perfect” blood sugar levels, Greene said, adding that she still monitors them with regular blood tests.

“It was a godsend,” she added. “They definitely saved my life.”

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@hamdiissawi

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