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Edmonton Protocol Working Toward a Cure Promising advances in diabetes care Photo: Richard Siemens ©University of Alberta Dr. Shapiro currently holds the Dr. James Shapiro is best known for his Canada Research Chair in Trans- ground-breaking research that led to the internationally acclaimed plantation Surgery and Regenera- tive Medicine at the University of Edmonton Protocol. His research team has successfully trans- Alberta. His busy research lab is planted islet cells from donated human pancreases into the liver of currently working on more than patients with type 1 diabetes. These transplanted islet cells, which 30 projects involving mice, and 15 human clinical trials. One is an make insulin, allow patients to be free from insulin injections. For immune reset trial. In this study, some patients, the results have lasted for years. people newly diagnosed with type 1 diabetes are given a combination The Edmonton Protocol is now an accepted treatment for people with of targeted medications designed type 1 diabetes who have very serious problems controlling their blood glu- to reset their immune system and cose levels. These people may have frequent or severe hypoglycemia (low repair the pancreas. So far, early re- blood glucose). They may be unable to sense that their blood glucose is get- sults are promising. Two of the first ting very low. This can be dangerous. patients in this trial currently do not This treatment does have risk. Patients must stay on anti-rejection drugs need insulin injections. for life. The drugs keep a patient’s immune (defence) system from attacking Dr. Shapiro is most excited about the transplanted cells. Anti-rejection drugs increase the risk of cancer and his research that places human pan- infection, and have other side effects. creas progenitor cells (stem cells) For this reason, Dr. Shapiro and his team continue to work on new treat- into a semi-porous plastic implant ments that will hopefully have fewer risks for patients. The hope is to free that is put under the skin. These sacs more people with type 1 diabetes from insulin injections. (called the Encaptra cell delivery MANAGING DIABETES 4 FALL/WINTER 2018 system) are designed to protect the the patient’s immune system. The Dr. Shapiro’s ultimate hope is that implanted cells from attack by the patient would still need to take anti- a patient’s own cells, such as skin, body’s immune system. This means rejection drugs. cheek lining or blood stem cells, that patients do not require anti- Dr. Shapiro does not look at this can be reprogrammed into pan- rejection drugs. As well, since the discovery as a setback. Instead, he creas type cells that make insulin. stem cells are made in the labora- explains that any approach that is In type 1 diabetes, the person’s own tory rather than being from a donor going to be successful must alter immune system attacks pancreas pancreas, there is an unending sup- what is done next based on what cells. These cells would still need to ply. As a result, more people can be is learned from each change made be changed in some way to protect treated. Another benefit is that the in the procedure. The next step them from this attack. If this is pos- implant is placed under the skin – a with this study will be to increase sible, anti-rejection drugs would not much easier procedure than trans- the number of stem cells being im- be needed. Since the patient’s own planting cells into the liver, as in the planted to see if this will improve cells are being used, every person Edmonton Protocol. diabetes control. could be treated. Once the cells are placed under Changing the material that the “I am very optimistic that we can the skin in the Encaptra device, sac is made of is also being explored. develop a treatment for patients who they take a few months to mature The hope is to improve the length have diabetes that is more effective into cells that can make insulin. of time that the cells can survive, than what we have today,” says Dr. The first study done by Dr. Shap- and better protect the cells from Shapiro. “Patients struggle with glu- iro’s team looked at how long these attack from the immune system. cose monitoring and insulin injec- implanted cells could survive. The Gore-Tex is one of the materials tions. Even with all the brand new team discovered that in order for the being researched. technologies, we still cannot get blood cells to survive, they needed a good Stealth technology may also be a glucose control anything like we can blood supply. Then, they found solution. Research is being done to with a cell transplant. I am very opti- that making small laser holes in see if stem cells can be developed mistic that the areas that we and oth- the Encaptra device allowed blood that can hide from the immune sys- ers globally are working on to cure vessels to grow into the unit to sup- tem. This would be done by remov- diabetes are making huge progress.” ply the implanted cells with blood. ing markers on the cell membranes WRITTEN BY: Rami Chowaniec, This helped the cells to last longer. that can trigger the immune system BScPharm, CDE, a pharmacist at Unfortunately, the laser holes also to attack. Southgate Safeway in Edmonton, AB. allowed the cells to be attacked by How can I get involved? • Volunteer for a study. Dr. Shapiro’s lab is always looking for patients for all of his lab’s clinical trials. If you are an adult with type 1 diabetes who is interested, please visit * islet.ca for more information. • Donate to fund the cure. The mission of the Diabetes Research Institute Foundation Canada (DRIFCan) is to end type 1 diabetes by directly funding cure-based diabetes researcher Dr. James Shapiro and his team at the University of Alberta in Edmonton, Alberta. All funds raised stay at the University of Alberta. Ongoing, sustainable funding is critical to keep DRIFCan’s exciting and promising research projects moving forward. For more information or to donate, please visit * drifcan.com. Photo: Richard Siemens ©University of Alberta MANAGING DIABETES 5 FALL/WINTER 2018.
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