DRWF Research Manager Dr Eleanor Kennedy reports from the International Pancreas and Islet Transplantation Association Congress, in Lyon, France. Day 3
The last day of the conference is similarly hot and sunny but notably quieter. People have peeled off early to get home for the weekend but they miss some great sessions!
One of the more unusual sessions is about bariatric surgery, a metabolic procedure that is more often associated with type 2 diabetes. However, because of the way that we can now categorise diabetes, we’re aware that there is a spectrum of conditions within the umbrella terms of type 1 diabetes and type 2 diabetes from Latent Autoimmune Diabetes in Adults (LADA) and Maturity Onset Diabetes of the Young (MODY) to gestational diabetes and drug-induced diabetes. This means that there have undoubtedly been bariatric surgery procedures carried out on people with these other forms of diabetes including, of course, type 1 diabetes.
But, of course, type 2 diabetes has also appropriated some surgical procedures from type 1 diabetes! Whole pancreas transplant - either as simultaneous pancreas and kidney transplant, pancreas after kidney transplant or pancreas transplant alone – is well-known as an effective treatment for type 1 diabetes and superior to intensive insulin therapy. But people with type 2 diabetes also benefit from pancreas transplant.
So much so that the United Network for Organ Sharing (UNOS) in the USA which is the private, non-profit organisation that manages the nation's organ transplant system under contract with the federal government has altered its criteria for simultaneous pancreas and kidney transplant in people with type 2 diabetes with quite specific body mass indices (BMI) to a new position where there is now no BMI restriction.
Currently around 40% of patients on the UNOS waiting list for kidney transplants have diabetes and the majority have type 2 diabetes which means that demand for whole pancreas donation is going to increase as they are going, perhaps, to be spread out across both the type 1 and type 2 populations. And, if that increases, then, arguably, there may be fewer pancreases available for islet cell transplantation.
So, where does all of this leave us? Well, still in desperate need of beta cell replacement therapies if we’re going to circumvent this increased requirement for whole pancreases.
In a good humoured debate, four researchers argue about the future of islet cell transplantation. A very recent press release has announced that Semma Therapeutics, a biotechnology company based in Cambridge, Massachusetts, has preclinical, proof-of-concept data from non-human primates demonstrating that, six weeks after infusion with human embryonic stem cell-derived beta cells, there was still clear function.
The studies showed that such stem cell-derived islets successfully engraft and are highly functional, persisting for over six weeks in the non-human primate liver. These cells reduced the requirement for insulin by more than 60%. In another pre-clinical study, pigs received encapsulated stem cell-derived islets. These cells also demonstrated cell survival with minimal immune attack.
However, the rebuttal is that history is littered with islet encapsulation companies that have tried and failed to reach the Holy Grail of protecting islet cells from the immune system along with many stem cell-focussed biotech companies who have similarly hit the buffers. But this did not seem to deter a number of other researchers talk animatedly about their own experiences with human embryonic stem cell-derived insulin-producing cells as they work towards clinical trials.
As the conference draws to a close, the mood is ebullient – researchers continue to perfect techniques for whole pancreas and islet cell transplantation and to work towards a place where the efficacy of these procedures can be maximised. In parallel to this, islet cell and cell replacement therapy research continues. And this has been a brilliant platform for the up and coming researchers to showcase their research and the first recipient of the International Pancreas and Islet Transplantation Association’s (IPITA) prestigious Derek Gray Distinguished Traveling Scholarship Award updates us on his award.
Professor Derek Gray was Professor of Experimental Surgery at the University of Oxford who made many contributions to the experimental islet transplantation literature advancing our scientific knowledge. As a strong proponent of pursuing the goal of perfecting islet transplantation, IPITA set this award up in his memory to be awarded to a single research fellow based on demonstrated research merit and future potential for both scholarly academic research and a commitment to the training of research scientists in the fields of islet and/or pancreas transplantation. And the second of these awards was then made and the recipient given rapturous applause.
As the delegates disperse back to their home countries and institutions, it’s clear that the future of this kind of research is in very good hands!