Ask Mr. Metabolism

This month Mr. Metabolism considers the case of Dr. Hu (pronounced “Dr. Who”), prompted by a reader’s inquiry.

Dear Mr. Metabolism:

I have been corresponding with Dr. Hu, a surgeon in China who has been performing fetal cell transplants, apparently with some success. I read your article in the most recent DIABETES HEALTH with great interest. Since this apparently is an area in which you have a good deal of expertise, I would very much appreciate your opinion on Dr. Hu’s work.

Marty Dirks
New York, NY

Well Marty, the topic of transplantation to treat diabetes is always an interesting one which I have followed a long time. Dr. Yuan Feng Hu’s work was quite famous several years ago when he reported “curing” several diabetics, but he has been less in the medical eye following the failure of Hana Biologics, among other research companies, to reproduce his results in type I diabetics.

I noted from the correspondence you enclosed that Dr. Hu is interested in your C-peptide and your islet antibody levels. The reason is that Dr. Hu is trying to establish if you are a type I diabetic (very advanced type 2 diabetes can sometimes look like type I). Your lack of C-peptide following a meal shows that you have no islet function. And the presence of certain antibodies is an indication that you have islet autoimmunity-that is, your body destroys transplanted islet tissue. Thus, you certainly have type I diabetes!

As you know from your investigations, islet implants in the United States are limited to tissue obtained from adults and are only implanted into diabetics who have received kidney transplants and are on immunosuppressive drugs. The immunosuppressive drugs are needed to prevent kidney rejection, and also help prevent rejection of the implanted islets. (Interestingly, islets seem to be more easily rejected than kidneys.)

Dr. Hu does not use chronic immune suppression drugs, although sometimes he uses antibody therapy with steroids at the time of the implants. The reason U.S. surgeons, such as Dr. Scharp in St. Louis, do not implant islets into diabetics is that, without powerful immune suppression drugs, islets are rejected, and medically such a procedure is unjustified because the side effects of immune suppression are considered worse than the complications of insulin therapy for type I diabetes.

It is commonly thought that the immune suppression that accompanies organ transplantation is relatively harmless. This is not true. These drugs are powerful, and affect many body functions. For instance, the immune suppression leads to greater susceptibility to infection, and an increase risk of lymphoma. All in all, I would rather take insulin.

Dr. Hu related to you that, “insulin requirements of most recipients were reduced significantly and their diabetes was controlled well following the operation, and only a few patients could stop the insulin injection and become insulin [independent].” The problem is that diabetics, as you know, frequently change their doses of insulin. Dr. Hu failed to establish whether or not his patients were full-blown type I diabetics, at least in his published reports. Thus, in the absence of laboratory evidence that the implanted islets are functioning including a complete cessation of insulin injections, it is not reasonable to believe that these implants are doing much.

In well controlled studies performed in the United States, implants of human islet tissue that were prepared similarly to the Chinese tissue failed to produce C-peptide in a single recipient of which there were dozens. Thus, in the opinion of Mr. Metabolism, this procedure does not work and I cannot recommend that you go to China for this procedure.

Mr. Metabolism (S. Robert King) has a masters degree from Harvard in Biochemistry and is a former biotechnology analyst with Montgomery Securities. Besides having type I diabetes, Mr. Metabolism is currently V.P., Technology for Metabolex, a biotechnology research firm in Hayward, CA.

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