I was thrilled to hear President Clinton had allocated $300 million more to diabetes research. It felt like diabetes was finally getting some of the attention it deserved. Still, it feels like the battle is only half won. I firmly believe that the research community should be held accountable to us – the people with diabetes who will eventually benefit from their work. Unfortunately, the average person with diabetes has very little say in what sort of research gets funded.
If we are ever to make this accountability a reality, we need to know what questions to ask, because asking the right questions can help us become our own advocates and will keep us informed as to which projects are likely to provide “tangible” benefits.
Islet cell transplantation is one avenue of research that could be promising. Below is a list of questions I would like to ask researchers working on islet cell transplantation. Armed with the appropriate information we can evaluate the wisdom of funding one researcher’s work over another’s.
If you are a professional working in this area with some answers or are a person who might someday benefit from this work with additional questions, I’d like to hear from you. Please write, fax or e mail me (see page 6).
If a clinical trial has been done:
- Is a trial without immunosuppression a realistic possibility? Is so, when?
- Is immunosuppression justified in diabetics not otherwise receiving such drugs for a kidney transplant?
- Which method do you favor to isolate the transplant from the immune system?
- Was your trial done on a dog (or other higher mammal) or just rodents?
- What drugs were used at the time of the transplant? What was used as the trial continued?
- How many islets (islets/kg) were needed?
- Was the implant repeated?
- Was the transplant recipient given a glucose tolerance test? If so, how normal was the response?
- Does the implant cause fibrosis (i.e. a foreign body reaction) that would starve the transplant of nutrients?
- Are all the islets functional in the recovered implant?
- How many islets were lost during the fabrication of the implant?
- Were all the islets completely covered?
- What is maximum thickness of the implant? If the thickness is over 300 micrometers (0.3 millimeters), aren’t the islets starved for oxygen?
- How quickly does insulin appear when the implant (either in the lab or in the animal) is stimulated with glucose?
- How quickly does insulin production stop when the glucose drops to normal? If greater than ten minutes, won’t this cause hypoglycemia?
- How often will the implant have to be replaced or supplemented?
- Can the implant be removed easily if there is trouble?
- How big is the implant projected for human transplants?
- If your work relies on xenotransplantation (transplants from another species), is there any risk of infection?
- Will the FDA allow a person not receiving immune system suppression to get an islet transplant?
Fewer than 5,000 cadavers provide organs of any kind every year, and only 1,000 pancreases are recovered each year. Is this enough to make your work a viable option?
We hope to present the answers to these questions and more on islet cell transplantation in future articles.