09:22pm Sunday 19 November 2017

First Transplant Patient in BioHub Trial No Longer Needs Insulin Therapy

No more. Peacock, the first transplant recipient in the clinical trial being conducted by the Diabetes Research Institute of its BioHub — a bioengineered mini-organ containing islet cells that mimics the native pancreas to restore natural insulin production in people with type 1 diabetes — now has normal glucose levels and has been taken off the supplemental insulin that she gave herself by injection several times daily for the past 26 years.

Appearing with a panel of physicians from her UHealth transplant team at a press briefing on September 9, Peacock, 43, from San Antonio, Texas, talked about the rapid change in her life that has occurred in the short time since her surgery on August 18.

“As any type 1 knows, you live on a very structured schedule,” she said. “I do a mental checklist every day in my head — glucose tabs, food, glucometer, etc., and then I stop and say, ‘Wow! I don’t have to plan that anymore.’ Laying down at night and going to sleep and not having to worry about lows is something that is so foreign to me. It’s surreal to me. I’m still processing the fact that I’m not taking insulin anymore.”

“Today is a great opportunity for us to learn about the remarkably positive effects of cell-based therapies,” said Pascal J. Goldschmidt, M.D., Senior Vice President for Medical Affairs and Dean of the Miller School of Medicine and CEO of UHealth. “The BioHub has the potential to be a game-changer for millions of people living with type 1 diabetes, and we are so proud to be a leader in the efforts to give hope to people around the world.”

“Islet transplantation has been around for many years, but only in the liver,” said Camillo Ricordi, M.D., Director of the Diabetes Research Institute and the Stacy Joy Goodman Professor of Surgery, Distinguished Professor of Medicine, Professor of Biomedical Engineering, Microbiology and Immunology, and Director of the DRI’s Cell Transplant Center. “It is not the ideal site, and there is an inflammatory reaction that kills the islets.”

The BioHub, he explained, was instead transplanted into Peacock’s omentum, a highly vascularized area of tissue covering abdominal organs. The donor islets are implanted within a biodegradable scaffold made by combining the patient’s own blood plasma with thrombin, a commonly used, clinical-grade enzyme. Together, these substances create a gel-like material that sticks to the omentum and holds the islets in place. The omentum is then folded over around the scaffold mixture. Over time, Peacock’s body will absorb the gel, leaving the islets intact, while new blood vessels are formed to provide critical oxygen and other nutrients that support the cells’ survival.

“Wendy is doing remarkably well,” said Rodolfo Alejandro, M.D., professor of medicine and Director of the DRI Clinical Cell Transplant Program. “Her response is better than we expected, and she is tolerating the anti-rejection drugs with no side effects. Her blood glucose is normal — probably better than for many of us here.”

“This is a new surgical procedure, and we practiced it for months,” said Gaetano Ciancio, M.D., M.B.A., professor of surgery and urology, and Associate Director of Kidney and Pancreas Transplantation. “You only get one chance with a patient to do it right. We’re very proud to be in Miami changing history today.”

Peacock, who was diagnosed with type 1 diabetes at 17, first approached the DRI about a transplant in 2002. At the time, she was not considered a candidate because her pancreas was still producing a small amount of insulin. She contacted the DRI again in January 2014 after learning about the development of the BioHub. Tests revealed her to be a good candidate for the trial, but there was a wait for a donor pancreas.

Finally one was obtained, and she arrived in Miami on August 16, two days before the surgery.

“It’s a minimally invasive procedure, requiring only three small incisions,” said Ricordi, who expects to see 20 to 30 more BioHub transplants performed in Miami this year, depending on donor availability. And, he said, good news travels quickly.

“We have also heard from diabetes centers in other countries that want to join the trial,” he said.

“We will continue to monitor Wendy closely,” said Alejandro. “Hers is the first BioHub procedure in the world, so we have to be careful.”

Despite the careful attention, however, Peacock has no restrictions — just the healthy diet and lifestyle physicians would recommend to any patient. For her, the biggest change is no longer having to deal with the hypoglycemic attacks and other complications that caused her to move in with her parents and made her worry that her small son might not be able to wake her one morning.

“I feel like a great weight has been lifted, and I can breathe again,” she said.

A video telling more of Wendy Peacock’s story and more about the BioHub can be found here.

Miller School Departments, Centers and Institutes


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