Pancreatic Islet Cell Transplantation - A Novel Approach to Immunosuppression and Validation of Remote Site Islet Cell Processing, Islet Cell Culture and Two-Layer Preservation
试验速览
- 阶段
- 1 期
- 状态
- 已完成
- 入组人数
- 4
- 试验地点
- 2
- 主要终点
- Achievement of Insulin Independence at 12-month Post Transplant
研究概览
简要总结
The purpose of this study is to assess a novel approach to immunosuppression in allogenic pancreatic islet cell transplant recipients. In addition, the study aims to assess remote site islet processing with culture for pancreatic islet cell transplantation in human subjects.
详细描述
The purpose of this study is to assess a novel approach to immunosuppression in allogenic pancreatic islet cell transplant recipients. In addition, the study aims to assess remote site islet processing with culture for pancreatic islet cell transplantation in human subjects.
Detailed Description: Diabetes mellitus (DM) type I is a disease that has significant social and economical impact. The prevalence of the disease in the United States is about 120,000 in individuals aged 19 or less and 300,000 to 500,000 at all ages and 150 million worldwide.
So far there are no mechanical devices able to effectively adjust the dose of insulin injected according to the serum glucose in patients with DM. This leads to less than perfect sugar control, with episodes of hypoglycemia. Successful pancreas transplantation averts the need of insulin administration.
The emerging alternative to whole organ pancreas transplantation is pancreatic islet cell transplantation (ICT). The process is based on the enzymatic isolation of the pancreatic islets from an organ procured from a cadaver donor. The islets obtained are injected into the liver in the recipient via percutaneous catheterization of the portal venous system. This procedure allows the selective transplantation of the insulin-producing cell population avoiding open surgery as well as the transplantation of the duodenum and the exocrine pancreas and their related morbidity.
The initial efforts with ICT had only modest results. The immunosuppression regimen was similar to the one used in solid organ transplantation, based on high dose steroids and calcineurin inhibitors - both agents with diabetogenic effects. The results improved markedly with the changes in the manipulations of the islets, and the change in immunosuppression thus avoiding the higher doses of steroids and using sirolimus, tacrolimus and daclizumab initiated by the investigators group at the University of Alberta in Edmonton, Canada. Their protocol requires in general two islet cell infusions in order to attain the critical cell mass necessary to achieve insulin-independency. The changes in treatment were adopted as the Edmonton Protocol, which is used in several transplant centers, worldwide.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 65 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patient has been fully informed and has signed an Institutional Review Board (IRB) approved informed consent form and is willing and able to follow study procedures for the full 2 years
- •Patient is expected to receive an islet cell transplant (up to 3 infusions) for type I diabetes mellitus
- •Type I diabetes of more than 5 years duration
- •Age between 18 and 65
- •Unstable diabetes mellitus control, as defined by glucose measurements above 200 mg/dL and/or below 80 mg/dL despite adequate medical care
- •Hypoglycemia unawareness, as defined by episodes of loss of cognitive function
- •Incapacitating signs and symptoms, as defined by the referring physician
- •Poor control of HbA1c > 8%
- •Psychogenically able to comply, in the opinion of the investigator
- •Female patients of childbearing potential must have a negative urine or serum pregnancy test upon hospitalization or within 7 days prior to enrollment and have agreed to utilize effective birth control throughout the study as well as for 6 weeks following study completion.
排除标准
- •Patients meeting any of the following criteria will be excluded from study participation.
- •Patient has previously received or is receiving an organ or bone marrow transplant
- •Patient has a known hypersensitivity to Tacrolimus, sirolimus, daclizumab, or CellCept
- •Patient is pregnant or lactating
- •Patient has participated in a blinded trial or participated in a trial involving a non-marketed (investigational) drug within 3 months of enrollment
- •Patient has participated in a trial involving a marketed drug or an infusion device within 30 days of the start of the trial
- •Glomerular filtration rate (GLOFIL) < 60 mL/min
- •Serum Creatinine > 1.6 mg/dL consistently
- •Body mass index > 30
- •Autoimmune thyroiditis
- •Malignancy other than basal cell carcinoma or squamous cell carcinoma
- •Radiographic evidence of pulmonary infection
- •Evidence of liver disease
- •Portal hypertension
- •Active infections
- •Hypercoagulable states (history of recurrent venous thrombosis, defined thrombophilia)
- •Bleeding / coagulation disorders
- •Basal insulin C-Peptide > 0.3 ng/dL
- •Insulin C-peptide > 0.3 ng/dL during stimulation test
- •HbA1c > 12%
- •Insulin requirement > 1 IU/kg/day
- •Seropositivity for Human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), Human T-cell leukemia virus-1 (HTLV-1)
- •Abnormal Pap smear in the last two months, active gynecological infection
- •Positive exercise or chemical tolerance test
- •Steroid dependence
- •Substance/alcohol abuse
- •Untreated proliferating diabetic retinopathy aa) Purified protein derivative (PPD) conversion or positive PPD without isonicotinic acid hydrazide (INH) bb) No Primary care physician or primary care physician less than 6 months cc) Smoking in the last 6 months dd) Abnormal Complete Blood Count (CBC) / Hemoglobin < 12 g/dL ee) Macroalbuminuria > 300 mg/24 hours ff) History of thyroid disease other than autoimmune disease gg) Untreated hyperlipidemia - Total Cholesterol (TC) > 240 mg/dL, Triglycerides (TGC) > 200 mg/dL, Low Density Lipoprotein (LDL) > 140 mg/dL hh) Untreated hyponatremia, hypokalemia, hypercalcemia, hypocalcemia ii) Iodine contrast allergy jj) Prostate Specific Antigen (PSA) > 4 kk) Panel Reactive Antibody (PRA) > 20% ll) Active peptic ulcer disease/gallstones/hemangioma mm) Abnormal mammogram
结局指标
主要结局
Achievement of Insulin Independence at 12-month Post Transplant
时间窗: 12 months post transplant
To assess the number of patients who achieve insulin independence at 12-month after islet cell transplantation
次要结局
- Presence or Absence of Hypoglycemic Unawareness(12 months after transplantation)
- Incidence of Hypoglycemic Episodes(12 months after transplantation)
- Change of Insulin Requirements in Patients Who Did Not Become Insulin Independent(12 months after transplantation)
- Islet Cell Mass Obtained After Remote Site Processing(At transplantation)
- The Number of Islet Cell Infusions Needed to Achieve Insulin Independence(12 months after transplantation)
- Renal Function(12 months after transplantation)
- Morbidity Related to the Immunosuppression Regimen(12 months after transplantation)
- Morbidity Related to the Islet Cell Infusion(12months after transplantation)
- The Quality of Life of the Recipients Measured With the RAND 36-item Short Form Health Survey(12 months after transplantation)