US scientists have demonstrated a method of achieving insulin
independence within type 1 diabetes.
A 43-year-old single mother with dangerously
difficult-to-control diabetes had insulin-producing islet cells
transplanted into her omentum* - a fatty membrane in the
The cells began producing insulin faster than expected, and
after one year she is doing well and doesn't need insulin
injections, researchers from the Diabetes Research Institute (DRI)
at the University of Miami Miller School of Medicine said.
"We're exploring a way to optimize islet cell therapy to a
larger population. This study gives us hope for a different
transplant approach," said the study's lead author, Dr. David
Baidal. He is an assistant professor at the DRI.
Currently, islet cells from deceased donors are transplanted
into the liver, but that's not an ideal option.
When the liver is used for islet cell transplants, only a
limited amount of islet cells can be transplanted. There's also a
risk of bleeding when the transplant is done and the possibility of
other complications, the researchers said.
Also, with islet cell transplants in the liver, the underlying
autoimmune condition is still there. And, if people didn't take
immune-suppressing medication, the new islet cells would likely be
The woman in the study had a 25-year history of type 1 diabetes.
She also had severe hypoglycemia unawareness.
"Her quality of life was severely impacted. She had to move in
with her parents. And, if she traveled, she had to travel with her
father" in case her blood sugar levels dropped dangerously low,
The surgery was minimally invasive, and the islet cells were
placed on a "scaffold" that eventually dissolved. There were no
complications, the researchers said.
"We were happily surprised when her glucose [blood sugar]
profile improved quite dramatically," Baidal said.
This new research was a proof-of-concept study expected to be
the first step on a path toward developing a mini-organ called the
DRI BioHub would be a biological platform made by a combination
of donor islets with a patient's own blood plasma. When a molecule
called thrombin is added to the mixture, a gel-material is created
that sticks to the omentum and holds the islets in place. Over
time, the body absorbs the gel and leaves the islets intact.
In its final stages, the BioHub would mimic a pancreas and act
as a home for transplanted islet cells, providing them with oxygen
until they could establish their own blood supply.
Baidal said the study results need to be replicated in other
patients, and the researchers want to see what happens
post-treatment over a longer time. The researchers plan to test the
omentum as a site in five more patients.
From the research paper:
- A total of 602,395 islet equivalents from one deceased donor
were combined with autologous plasma and laparoscopically layered
onto the omentum.
- Recombinant thrombin (Recothrom) was layered over the islets,
followed by another layer of autologous plasma to generate a
degradable biologic scaffold.
- Insulin was discontinued 17 days after the
"In this patient, islet transplantation onto the omentum
restored euglycemia and insulin independence. A functional decline
was observed at 12 months with an increase in insulin sensitivity,
which we speculate may have been due to the switch from tacrolimus
to sirolimus. The patient continued to have stable glycemic control
without exogenous insulin and without episodes of
*The omentum, an apron-like tissue covering abdominal
organs, which is easily accessed with minimally invasive surgery
and has the same blood supply and physiological drainage
characteristics as the pancreas.
England Journal of Medicine