Procedure May Save Patients From Developing Diabetes

An autologous islet cell transplant is performed when the pancreas must be removed due to chronic pancreatitis. There is no risk of rejection, unlike other organ transplants, because the patient's own islet cells are used in the procedure.

Chronic pancreatitis, a life-threatening condition that destroys the pancreas and other tissues, often causes severe abdominal pain, weight loss, fever, nausea and vomiting. Gallstones, heavy alcohol use, or a combination of environmental and hereditary factors can cause the disease. Sometimes the cause is unknown.

Treatment for chronic pancreatitis includes removal of the pancreas to alleviate the pain. Without a pancreas to produce insulin, these patients develop "surgical diabetes" and must take insulin for the rest of their lives.

"One of the major benefits of the procedure is that I don't need to take insulin," said 57-year-old Zenon Jezerski, a single father of three who received an autologous islet cell transplant on April 12 at the medical center. "I had the procedure and it's working."

"I've always been in the best of health until this past year," said Jezerski, who has been hospitalized several times for complications related to pancreatitis, including pancreatic pseudocysts, compression of other organs, narrowing of the bile ducts, jaundice, an abscess of the spleen and substantial weight loss.

After removing Jezerski's pancreas, physicians prepared the gland in the hospital's state-of-the-art lab designed to isolate the insulin-producing cells of the pancreas. The islet cells were then taken back to the operating room where they were injected through a catheter into a vein in the patient's liver. The cells lodged in the liver and began making insulin immediately.

"Autologous islet cell transplantation is most successful in patients who have not lost too many of their insulin-producing cells and who have not yet developed pre-diabetes," said Dr. José Oberholzer, associate professor of surgery and bioengineering at UIC and director of cell and pancreas transplantation at the medical center.

"In this group of patients, approximately 80 percent will have a successful transplant and will not develop diabetes. In patients who have already developed pre-diabetes due to advanced pancreatitis, the success rate is lower and diabetes can only be prevented in 30 to 50 percent."

Approximately 150 autologous islet transplants have been performed in the United States and abroad. Seven of these cases have been performed at UIC.

The procedure is not considered experimental and is often covered by insurance.

Islet cell transplantation has been performed since the 1970s but is still relatively uncommon. It requires a highly skilled team to perform the difficult surgery and extract the delicate islet cells, which make up only one to two percent of pancreatic tissue.

"Most patients who require a pancreatectomy are not aware they can possibly avoid diabetes with an islet cell transplant," said Oberholzer. "I believe that more patients would have the procedure if it were offered to them."

The incidence of chronic pancreatitis is approximately 6-8 per 100,000 in the United States.

Oberholzer is coordinator of "The Chicago Project: An International Effort to Create the Functional Cure for Diabetes." The project is the first collaborative initiative of its kind and brings together the top researchers from three continents. This group of 13 scientists and their contributing teams have committed to achieving a functional cure for diabetes in the next five years.

Chicago Project team leaders believe that the scientific community now has all the necessary ingredients to make cell-based therapy of diabetes an option for the majority of diabetic patients. Team members will freely exchange knowledge, and the Chicago Project will provide direct and noncompetitive funding to accelerate finding a functional cure.

For more information about the medical center, http://visit www.uillinoismedcenter.org