Cell transplants stop diabetes in some patients.

Injecting insulin-making cells into diabetes patients can reverse the disease in some cases, according to the technology's most promising test to date.

Scientists obtained clusters of cells that include insulin-making beta cells from pancreases of cadavers. After removing extraneous proteins and immune cells from these so-called islets of Langerhans, physicians injected them into diabetes patients via a large vein in the liver. In some patients, the islets take up residence in the liver and thrive.

The 36 patients in the multicenter trial all had a volatile form of type 1, or juvenile-onset, diabetes that was marked by huge swings in blood sugar that insulin injections had failed to stabilize, says James Shapiro of the University of Alberta in Edmonton, who presented the findings.

In 19 of the patients, islet cells grafted to the liver so successfully that the newcomer beta cells are producing enough insulin so that the recipients no longer need insulin injections. Five of the 19 had received only one infusion of islets, while the rest had received two or three.

Of the other 17 patients, 7 need less insulin now than they did before the treatment.

"It's becoming very clear that [transplanted] islet cells can reverse diabetes," says Shapiro's colleague Bernard J. Hering of the University of Minnesota Medical School in Minneapolis.

Until recently, islet transplants have routinely failed because rejection processes or harsh immune-suppression drugs killed them off. Drugs that have come into use in the last 5 years are improving success rates, Hering says.

For the moment, islet transplants should be reserved for diabetes patients with troublesome, unstable forms of the disease, Shapiro says. He notes that those who undergo successful islet transplants enjoy an improved quality of life, but they still need drugs to keep their immune systems from attacking the transplanted cells.

Shapiro and his colleagues in Edmonton pioneered use of the new drugs with islet transplantation several years ago (SN: 9/2/00, p. 156). Since then, there have been more than 350 such transplants worldwide, but the outcomes haven't been tallied.--N.S.