Thursday, June 15, 2000

Doctor seeks $1 M for diabetes-cure effort

UC sought to duplicate Canadian experiment

By Tim Bonfield
The Cincinnati Enquirer

        Last month in Canada, doctors announced that eight diabetic patients who received islet cell transplants have lived free of insulin shots for up to 14 months and counting.

        Today in Cincinnati, Dr. Horacio Rilo is launching an effort to raise $1 million to start doing the same type of work here.

        “The only limitation preventing us from doing the same thing they're doing in Canada is money,” Dr. Rilo said.

        Using today's technology, islet cell transplants plus anti-rejection medications would cost about $100,000 per patient. But the experimental treatment generally is not covered by health insurance.

        With help from UC, Dr. Rilo plans to establish a nonprofit foundation to support more islet cell transplants. The next step would be seeking approval from the UC Institutional Review Board to begin a clinical trial for up to 10 patients.

        Dr. Rilo came to the University of Cincinnati last year from Chicago to launch the Tristate's first cell transplantation program. The effort involves extensive lab research and early plans to begin human clinical trials.

        “We have a great clinical team here. What I want to do is help this center become one of the best (cell transplantation) centers in the Midwest,” Dr. Rilo said.

        Diabetes is caused when the pancreas fails to produce enough insulin. The disruptions to body chemistry can increase risk of heart disease, blindness, kidney failure and limb amputations.

        Islet cell transplantation has been hailed by experts as a potential cure for Type I diabetes — the most severe form, which affects about 1 million Americans.

        Islet cells are insulin-producing cell clusters found within the pancreas. In recent years, researchers have learned that islet cells injected into the bloodstream will collect in the liver, which in turn will start producing insulin as if it were a pancreas.

        That means transplanting islet cells would be a much simpler procedure than a full-blown pancreas transplant, which a few seriously ill diabetics receive each year in conjunction with kidney transplants.

        The double catch has been finding ways to overcome the body's natural resistance to foreign cells and finding ways to increase the supply of islet cells for transplant.

        In May, experts at the University of Alberta in Edmonton reported all eight patients treated still had functioning islet cells, two to 14 months following transplant.

        If such a success rate can be duplicated in larger numbers of patients, it would be a “quantum leap” in diabetes treatment, said Dr. Judith Fradkin, of the National Institutes of Health, in an interview last month with the New York Times.

        After transplanting islet cells from cadavers, the Canadian researchers were able to protect the cells with nonsteroidal anti-rejection medications — an important advance, Dr. Rilo said. They also extended the treatment by using cells collected from at least two cadavers per patient — a serious limiting factor, Dr. Rilo said.

        The approach used in Canada — and proposed to begin here — is fundamentally limited by the con stantly short supply of human organ donors.

        While thousands of Tristate diabetics depend on insulin shots, only 41 people became organ donors last year, according to a recent LifeCenter report. That's down from 45 in 1998 and 50 in 1997.

        Long term, Dr. Rilo and other researchers worldwide are racing to find better ways to protect islet cells from rejection. Ideas include wrapping the cells in ultra-thin polymer sheets, capsules or coatings.

        If successful, such efforts would open the door to transplanting islet cells harvested from pigs, which in turn would make the treatment much more widely available.


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