Transplants - Are We Missing Out?

My mother-in-law occasionally asks me if they’ve made advances in curing Type 1, and I invariably mumble something about transplants, but also say nothing major has happened of that I know.

Am I wrong in thinking a transplant ‘cure’ isn’t there yet?

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I attended a screening of “The Human Trial” last night. The stem cell implant research journey is alive and very, very well. It is moving along and they have achieved success with several patients being "functionally off insulin as of last year. I believe there are clinical trials currently happening that are without the need for anti-rejection medication, which is MOST exciting.

I highly recommend watching “The Human Trial” (available on Apple + and Google Play, right now, I believe.

Also, in Canada, this is exciting news (posted May 2022)

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With a pancreatic transplant, it feels like you are trading a known and sort of manageable problem for a host of possible other problems with suppressing the immune system from drugs.

If the stem cel research comes through without those drugs it would be great!

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I sense we are not missing out. I know a lady who has had two pancreatic transplants. Both failed after 5 and 6 years respectively. Twice cured, twice successful, twice failed. Is she better or worse off than before? You can judge.

In reality the immunosupressants are expensive and there are no guarantees. Someday the science will determine how to produce enough islets in bulk that that large scale encapsulation will be possible. When that happens I will be first in line. Yes 2, 5 or 20 times will be a small hindrance.

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Any transplant means drugs for the rest of your life. Many people do it very well with kidney, heart, lung etc. You do what you must to stay alive. Just like we do with our daily management plans for our diabetes.
Most people getting a pancreas transplants also get a kidney. Because you need the kidney and will be taking the drugs to protect the kidney, might as well do the pancreas.

As most of you know, I was part of the ViaCtye stem cell study at the very beginning. It didn’t go well but every trial gives people more information. But I am more hopeful than ever since they have merged with another company working with the CRISPER technology. I believe this is going to be the answer. I am amazed that we can make cells that actually make insulin! Now they just have to figure out how to keep them safe. And with CRISPER technology the keeping them safe not so important.

I do have hope for the future! It is just things move slowly and a big frustration for me is that no one talks about what they are doing. The lack of sharing what works and what doesn’t makes this so much longer. Yes, I get it’s all about the money but come on guys!

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Sally, bravo for volunteering. No I am sure it is not perfect, but we have to recall that the first insulin pump barely fit in a car. It takes the first to have a second. Thank you for being first, may we have many seconds, thirds, tenths and hundreds. .

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Given all the issues with transplanted organs, including cost, the anti-rejection drugs, and (in Canada anyway) a critical shortage of organs for transplants, my own personal belief is that I can’t see transplants ever routinely taking the place of easily produced/procured insulin. I think this is especially true with the continuing development of smarter pumps and different versions of long acting insulins for those on MDIs. My immune would likely attack transplanted organs, or stem cells just the way it attacked my own insulin-producing cells and the way it attacked fetal tissue when I was trying to have a baby many years ago. For me, I don’t think artificially produced cells would be any different. I absolutely believe that there will be better technology/pumps/etc., as time goes on, but I personally don’t hold out much hope for the transplant route.

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It is important to remember that the islet cells being inserted are are designed to be resistant to the autoimmune storm. Yes in most cases putting back unprotected insulin cells creates the same outcome. Hence my friend who has had two pancreas transplants, then experienced remission and relapse both times.

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Yes, I agree transplants are very problematic which is why most pancreas transplants are done with kidney, since you would need drugs to protect the necessary kidney.
And yes, stem cell transplants would have the same problem, needing drugs to stop the body from destroying them. Which was a big issue and problem with the early studies. Trying to find a device that could hold and keep the cells safe from the antibodies and also allowing the blood flow to,happen to keep the cells alive.

Which is why I am so excited about the CRISPER aspect to the stem cell studies now. And as hard as that first study was, 5 full surgeries was not easy and the testing done was nightmarish, I would sign up again if I was getting enough of these modified cells. Just think, even if it was for a couple months, I would be all in. No diabetes for a few months, yes. Please, yes! But for me, I am probably aging out for this kind of trial. But I am hopeful this is the answer and that I might actually see it in my lifetime.

For years, I always thought I would never see a cure in my lifetime but now, WOW! It could happen! Very exciting times!

As many of you know and others have said, and I quote from the article, “The tradeoff is that it [pancreatic transplant] is a major surgical procedure and requires patients to take medications to partially suppress their immune system for the rest of their lives.”

That is not a statement to be taken lightly. Due to another, rare autoimmune disease, I am already one of those people who is taking medication to suppress my immune system. What does that mean? It means that in this day and age, I need to get every vaccine I can get my hands on. I must wear a mask whenever I am around other people at the grocery store, drug store, doctor’s office, or other public places. I must avoid crowds at all costs, thus giving up going to concerts, plays, indoor sporting events, and even church. I must be selective in gathering even with family members. (I skipped a family gathering at my sister’s house last year, and I am glad I did since five of the eleven people who attended got Covid.) I must isolate, not travel more than necessary, and not interact with others much since Covid would probably hospitalize me and could potentially kill me.

So is taking an immunosuppressant drug the rest of a person’s life worth it just to “maybe” have a permanent cure to diabetes? You be the judge.

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Yeah, I agree with what seems to be pretty much the consensus here, only an option if say like my father-in-law who had T1D with renal failure, on dialysis for 3 plus years and ultimately was able to get a kidney transplant. The donors pancreas was also a viable option and match so he went for it. In his case he was lucky and ultimately was successful but like others said, lots of drugs for the rest of one’s life.

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Rejection wouldn’t be a problem if the recipient was also the source of the stem cells. T1’s would still have the antibodies attacking and destroying islet cells, though.

It was 8 years between mis-diagnosis as T2 and when I should have started insulin. That’s possibly slow enough to make implanting islet cells derived from my stem cells worthwhile.

…or if they had you on insulin earlier, it might have preserved more beta cell function.

Progression of diabetes continued after starting insulin. So maybe slow the progression of diabetes, but definitely not preserve.