Hoping to cure diabetes through the Edmonton Protocol

Hundreds of thousands of people live with diabetes. Diabetes causes people to have high blood sugar because their bodies either don’t produce the right amount of insulin or are resistant to the insulin they're making. For us to understand diabetes, we must start with understanding insulin and how it works in people without diabetes.

Insulin is a very critical hormone that regulates the amount of glucose that is in our bloodstream from the carbohydrates and sugars we eat. Glucose comes from breaking down the carbohydrates and sugars we eat to provide energy for our bodies; however, insulin is needed to move the glucose from the bloodstream to the cells. Insulin allows the liver and muscle cells to accept glucose from the bloodstream and keep the blood glucose level at a healthy level. Cells will use the glucose to either store energy as fats or glycogen (glucose molecules linked together in long chains) or to use it for energy right away through glycolysis.

Now we will consider a diabetic. Type 1 Diabetes (T1D) is when a person has stopped making insulin completely. T1D is commonly called “Juvenile Diabetes” and requires insulin to be manually taken, usually as an injection. Type 2 Diabetes (T2D) is when a person has become resistant to insulin and sometimes isn’t making enough insulin. T2D can develop from being unhealthy, overweight, elderly, or having a genetic predisposition (meaning it can “run in the family”). Sometimes T2D can be treated by diet or medication alone, but ~40% of T2D patients will also use injected insulin to manage their diabetes as well.

For myself, I consider T1D and T2D very different diseases. Mainly because of when and how they develop and are treated. But for now, I will talk about one treatment that was first tried to treat T1D.

The EDMONTON PROTOCOL was developed at the University of Alberta in Edmonton, Canada and was first published in 2000. The procedure was used by doctors to cure T1D by transplanting insulin-producing cells into patients with T1D. Islet cells produce insulin and grow on the pancreas of non-diabetic people, but people with T1D don’t have islet cells because of an autoimmune response that has destroyed all of their islet cells and caused their T1D. By transplanting new islet cells from deceased donors, doctors from the University of Alberta hoped to give patients a new way to produce insulin and hopefully cure them of diabetes.

The protocol was to give donor islet cells to recipient diabetics through an infusion using the portal vein. The portal vein is a special vein that is not connected to the heart, but rather runs through the abdomen and ends at the liver. There the transplanted islet cells attach and continue to grow and produce insulin from the liver (see picture, from NIDDK). Of the original recipients, 10% of them are still free from requiring insulin shots and most of the others require much less insulin than before the transplant. The doctors believe that the reason islet cells didn’t continue working for many of the patients was because their bodies attacked the islet cells as foreign material (a common transplant problem) or that they slowly lost the islet cells through the same process that caused their T1D originally.

To overcome the transplant problems, doctors had patients take immunosuppressant drugs to reduce transplant rejection. After the initial trial, doctors added an antibody treatment to prevent rejection. The antibody treatment (daclizumab) blocks the body’s immune system from creating new antibodies that would attack the islet cells. By preventing the attack, doctors believe the islet cells were allowed to attach and begin growing without being rejected by the patient’s immune system.

The addition of the antibody treatment seems to have worked very well and from several dozen procedures, ~74% of the patients that received the antibody treatment are still free from diabetes after 5 years or more. This is incredible news for people with T1D! The Edmonton protocol has many advantages including minimally invasive surgery and relatively high curative rates past 5 years. Doctors hope to improve the Edmonton protocol by using improved anti-rejection techniques or using the patient’s own stem cells to create islet cells identical to the patient, which could prevent rejection entirely.

Overall, the Edmonton protocol is an incredible example of the powerful possibilities of curing diabetes and ending a terrible disease that costs our medical system millions of dollars and thousands of lives.

Read more about the Edmonton Protocol online...
Global News – Toronto
2006 International Trial of the Edmonton Protocol for Islet Transplantation