June 30, 2023 – The treatment of difficult-to-treat type 1 diabetes with transplanted pancreatic cells is progressing on two fronts: one product has been newly approved and the opposite is making progress in a clinical trial.
Type 1 diabetes is an autoimmune disease during which insulin-producing beta cells within the pancreas (often called “islet cells” because they’re situated within the pancreas' islets of Langerhans) are destroyed by the body's own immune response. People with the disease must inject or pump insulin to remain alive, and must commonly check their blood sugar levels and adjust their insulin dose.
However, some individuals with type 1 diabetes often have very low blood sugar levels (hypoglycemia) and don’t experience the symptoms that signal a drop in blood sugar, resembling shaking and sweating. These people (called unconscious hypoglycemia) are the one candidates for islet cell therapy, partially because in addition they have to take drugs to suppress their immune systems to stop rejection – as is required for some other transplanted organ, resembling a kidney – and this also carries risks. Researchers are working to finish the necessity for immunosuppressants.
The FDA on Wednesday approved Lantidra, a drug produced from pancreatic islet cells from deceased donors who, or whose families, have agreed to donate their organs after their death. Lantidra, manufactured by CellTrans, is approved for individuals with type 1 diabetes who cannot control their blood sugar levels with insulin.
In clinical trials of Lantidra, 21 of 30 patients didn’t have to take insulin for not less than a yr, while 10 were still insulin independent greater than five years after treatment. However, in five patients, the treatment had no effect in any respect.
Meanwhile, an early clinical trial of one other form of stem cell-derived pancreatic islet, Vertex Pharmaceuticals' VX-880, has helped two individuals with type 1 diabetes and severe hypoglycemia to completely stop using insulin for not less than a yr, and three more are on the right track to achieve this. The results were presented June 23 on the American Diabetes Association's annual Scientific Sessions.
Both kinds of islet cells are infused into the portal vein, which in people without type 1 diabetes carries blood from several organs to the liver and likewise carries insulin from the pancreas to the liver.
“For decades, pancreatic islet transplantation as a treatment for a small subset of the most difficult-to-control type 1 diabetes patients – and particularly those with frequent and severe hypoglycemia – has faced two major hurdles,” said David M. Harlan, MD, co-director of the University of Massachusetts Diabetes Center of Excellence.
“First, there are not enough islet cells for transplantation, and second, sometimes toxic immunosuppression is required to prevent immune rejection of the transplanted islet cells,” he said.
The recent results with VX-880 “hold the promise of overcoming both hurdles because stem cell-derived islets can be grown in the laboratory, opening the possibility of a virtually unlimited supply,” said Harlan, who can also be a professor of drugs on the University of Massachusetts Chan Medical School in Worcester.
There were no major issues of safety within the VX-880 study. The study is now being expanded to incorporate more people in several European countries and the United States.
Side effects of Lantidra included nausea, fatigue, anemia and abdominal pain. Most study participants had not less than one serious side effect, either as a result of the intravenous administration into the portal vein or to the immunosuppressive drugs. In some cases, patients needed to stop taking the drugs and the transplanted cells lost their function.
“These side effects should be considered when evaluating the benefits and risks of Lantidra for each patient,” the FDA said in a press release.