Diabetes Dateline

NIH Tests Ways To Prevent Transplant Rejection

Researchers have recently begun a clinical trial using new immune modulation treatments in patients receiving a kidney transplant. In trials scheduled for later this year, the researchers plan to give immune modulation therapy to adult patients with type 1 diabetes who are receiving an islet transplant. The aim of the research is to develop ways of reducing or eliminating the need for immunosuppressive drugs after transplantation.

The research is taking place at the National Institutes of Health (NIH) Organ/Tissue Transplant Research Center, which opened in May 1999. Located in the NIH Clinical Center in Bethesda, Maryland, the center is a collaborative project of the NIH, the Walter Reed Army Medical Center, the Naval Medical Research Center, and the Diabetes Research Institute of the University of Miami. The center contains a state-of-the-art clinical transplant ward, operating facility, and outpatient clinic, and is staffed by highly qualified surgeons, clinicians, and nursing and support staff.

The first islet transplant trial will be in patients whose diabetes was caused by a pancreatectomy or who have maturity onset diabetes of youth (MODY). Islets will be infused via a tube inserted through the skin into the portal vein of the liver. If this study shows that immune modulation methods can prevent the immune system from rejecting transplanted islets, the study will be expanded to determine whether people with type 1 diabetes can also benefit.

Past experience has shown that at least two hurdles must be overcome before islet transplantation can be developed into a viable curative therapy for type 1 diabetes. One hurdle is the immune response all patients generate against transplanted organs or tissues. Another is that people with type 1 diabetes have the disease because their immune system has already destroyed their islet cells. Research suggests that if islets are transplanted into patients with type 1 diabetes, not only are those islets subjected to the usual immune response, but the autoimmune response is also reactivated. Therefore, the NIH protocol will first test whether new techniques can overcome the first hurdle by excluding patients with beta cell autoimmunity.

Enrollment has begun for clinical trials involving patients with renal failure who need a kidney or kidney-pancreas transplant, or patients with diabetes who need a pancreatic islet transplant. Trials involving patients who have already received a transplant are planned as well. If you are interested in enrolling in one of these clinical studies, call the NIH Clinical Center's Patient Recruitment and Public Liaison Office at 1–800–411–1222. For more information, see the National Institute of Diabetes and Digestive and Kidney Diseases at www.niddk.nih.gov/welcome/releases.htm on the internet.