ABOUT THE PROJECT

Nephrologist Dr. Miguel Carlos Riella, founder of the Pro-Renal Foundation, with vast professional experience, and always keeping in mind the well being of his patients, is bringing this new method of treatment for type 1 diabetes patients to Brazil, through the transplant of the insulin-producing cells (Islets of Langerhans).

With this initiative, the Pro-Renal Foundation, the Pontific al Catholic University of Paraná (PUC-PR) and the Science and Technology Secretariat of the State of Paraná are now in the process of renovating a building to house the Tissue Engineering Center, in which the islet isolation laboratory will operate. This laboratory will be located inside PUC-PR, on its Curitiba campus, in the building where the pharmacology laboratory has been located.

In 2001, two biochemists went through training in two of the foremost centers in the world in the study of diabetes. Tânia Madalozzo studied at the Diabetes Research Institute – DRI, in Miami , USA . Elaine Doff Sotta trained at Alberta University in Edmonton , Canada , closely following the work of this group which is responsible for the currently adopted protocol for islet transplants. With the vital collaboration of these two centers, it is now possible to implement the necessary processes for islet isolation for the transplant here in Brazil .

Owing to the necessity of forming a multidisciplinary team in order to fully implement the project, in May 2002, nephrologist Dr. Luciana Soares Percegona started her training with the DRI team at The University of Miami, USA.

The Science and Technology Secretariat of Paraná, as a participant in this project, has provided financial support for the purchase of part of the necessary equipment for the operation of the laboratory, now awaiting the conclusion of renovation work to be installed.

Cell Transplant for Diabetics - a Reality in Brazil

In developed countries, roughly half the patients who are on chronic dialysis find themselves in this situation due to loss of kidney function caused by diabetes. In our country, about 30% of patients on dialysis have diabetes. If we consider that 55 thousand patients are currently on dialysis in Brazil , we can have an idea of the enormity of the problem.

Insulin-dependent Type 1 diabetes patients are the most affected in the long run by the fearful vascular complications of diabetes: retinopathy, which may lead to blindness ; kidney failure, requiring dialysis and/or a transplant ; and peripheral vascular insufficiency, which may lead to lower limb amputation. Regarding the latter, the search for healing and preventive alternatives has been the subject of intense investigation. Unfortunately, measures that seek to prevent the progression of diabetes have not been very successful, owing to the fact that, at the onset of the disease, the insuling-producing cells (islets) have already been destroyed by an immunological process which is yet to be fully understood.

Currently there are two alternatives: total transplant of the pancreas (the organ which harbors the islets) and transplant of the insulin-producing cells (islets).

The success rate of total pancreas transplants is undisputed at around 90% at the best centers in the world. Restrictions on the procedure are due to the fact that it is a major surgical procedure, requiring immunosupressing drugs and carrying inherent complications.

Cell (islet) transplant:

This is an attractive alternative, because it does not involve major surgery, there is less intense immunosupression (use of anti-rejection drugs) and the procedure is limited to the mere infusion of cells through the portal vein of the liver. It can even be performed in an out-patient environment, under local anesthesia.

Candidates for this procedure are basically insulin-dependent Type 1 diabetes patients who are not faring well, who have difficulty in controling blood sugar levels and who are prone to life-threatening hypoglycemia. Also, patients who receive a kidney may benefit from receiving islets from the same donor (a cadaveric donor provides kidney and pancreas for transplantation to the same recipient).

Brazilian Reality:

On December 1, 2002, The Chemistry Laboratory at The University of São Paulo isolated islets from a human pancreas. The cells were then trasplanted in a female patient at Albert Einstein Hospital. This procedure was a landmark in Brazilian medicine, for it heralded a new era for diabetes patients, a more positive outlook.

On December 26, 2002, the Pontifical Catholic University of Paraná inaugurated its Cell Engineering and Transplant Laboratory, the second Human Islet Isolation Laboratory in Brazil. It intends to initiate implantation of these cells in diabetes patients. This project has been made possible thanks to a partnership among the government of the State of Paraná , the Paraná Technology Program of the Secretariat of Science and Technology, PUC-PR and the Pro-Renal Foundation. Technicians and physicians have been trained abroad and equipment has already been purchased. Thus, everything is ready for the laboratory to initiate transplant procedures in the near future.