U.Va. doctors perform major diabetes procedure


First islet cell transplant in Virginia

CHARLOTTESVILLE, Va., June 14 A Charlottesville area woman may no longer need the insulin shots she's been giving herself every day for 32 years. In a procedure at the University of Virginia Health System, Lori Ratliff of Ivy became Virginia's first recipient of an islet cell transplant.

Islet cells are cells in the pancreas that secrete insulin, a hormone that turns glucose (a form of sugar) into energy. Insufficient insulin causes diabetes. People with Type 1 diabetes, like Ms. Ratliff, inject insulin to regulate their blood sugar levels.

Ms. Ratliff received the islet cell transplant at U.Va. in a one-hour procedure June 3. Five days later, she needed to inject only about half the insulin she did before.

"I am already enjoying the benefits of requiring a lot less insulin by injection, less risk of low blood sugar and a smoother level of blood sugar throughout the day," Ms. Ratliff said. "I am fortunate for being helped by this procedure now. And I hope that my participation will contribute answers to important questions and advance the research to make this sort of thing available to many, many others with diabetes, children and adults, with and without complications."

The procedure requires first isolating over 700,000 islet cells from the pancreases of two donors. Then the cells were injected into a vein in her liver. If all goes well, the islet cells attach themselves to blood vessels in her liver and begin producing insulin.

Though U.Va. doctors were expecting a two-week to four-week wait for the cells to begin producing insulin, they are encouraged that improvement has already begun.

"She is doing as well as anybody could imagine," said Dr. Kenneth Brayman, a professor of surgery at U.Va. who injected the cells. "Her insulin deficiency has already gone down significantly, and wide swings of insulin levels haven't occurred. So there is some function of the cells already, and that's a hopeful sign."

Ms. Ratliff, who coincidentally is a nurse at U.Va. in the nephrology division, was considered an excellent candidate for the transplant because she suffered from hypoglycemic unawareness, or an inability to recognize low blood sugar, which can be life-threatening.

"She met all the entry criteria," Brayman said. "She's extremely insulin sensitive and also has a low body mass, so the likelihood of success for complete independence from insulin for her is high." In addition, Ratliff did not have any other complications such as heart disease, cancer or kidney disease. Still, she will have to take two immunosuppressant drugs for the rest of her life to keep her body from rejecting the islet cells.

Brayman is leading a new Islet Cell Transplant Center at U.Va. with grant funds from the University of Virginia Ward Buchanan Fund and support from the Islet Replacement Research Foundation of Gordonsville, Va. He plans three to five more islet cell transplant cases like Ratliff's in the next year. Dr Jerry Nadler at U.Va., an endocrinologist and associate director of the program, and his team are collaborating with Brayman to research new ways to improve islet cell transplants.

Physicians and nurses from the departments of surgery, radiology, endocrinology/ metabolism and the General Clinical Research Center at U.Va. cooperated to make Virginia's first islet cell transplant a reality.

Source: Eurekalert & others

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