'A Godsend': Study on 20 years of the Edmonton Protocol highlights its effectiveness in treating diabetes

Hamdi Issawi 3 minute read May 23, 2022

Dr. James Shapiro, a professor of surgery with the University of Alberta's faculty and medicine and dentistry, leads the team behind the procedure known as the Edmonton Protocol. Richard Siemens / Supplied

Following a Type 1 diabetes diagnosis in 2003, Nina Greene said her life became a revolving door of hospital visits.

Living in Fort McMurray, about 430 kilometres northeast of Edmonton, Greene has a particularly difficult-to-control variety of the disease known as “brittle diabetes,” where patients struggle to keep their blood-sugar levels in check. Formerly on an insulin pump, she had to switch to insulin injections after complications with the device led to stomach infections.

“But every time I would take insulin my sugar would drop, so I’d have to eat sugar, and then my sugar would spike, so I’d have to take more insulin,” Greene, 54, told Postmedia in a phone interview. “I was never a stable diabetic.”

The condition made her an ideal candidate for a treatment offered at the University of Alberta hospital that involves transplanting insulin-producing islet cells to a patient’s liver by infusion.

After getting “the call” late one night in January 2017, Greene recalled, she was in Edmonton by 3 a.m. the following day, anticipating a procedure that effectively changed her life. She went “insulin-free” about one year after receiving the transplant, she added, and has been ever since.

Dr. James Shapiro, a professor of surgery with the University of Alberta’s faculty of medicine and dentistry, leads the team behind the procedure known as the Edmonton Protocol.

He’s also one of the authors of a May paper published in The Lancet that reported 20 years of data from 255 patients who received the treatment between March 1999 and October 2019. According to the results, nearly 80 per cent of the transplant patients achieved insulin independence for some period of time.

“We’ve learned that this is very effective,” Shapiro said in a phone interview, “and now we’re focusing on how to make it more available for all patients who could benefit.”

Islet cells, while originating in the pancreas, are transplanted to the liver because it has a good blood supply, whereas interfering with the pancreas can cause complications, explained Shapiro, also the Canada Research Chair in regenerative medicine and transplant surgery.

So far, the procedure has only been used on those with the brittle form of diabetes because of the “fragile control” patients have over their blood sugar levels, Shapiro said.

“When the blood sugar drops below a certain level, the brain immediately shuts down,” Shapiro said. “Neurons don’t function anymore, and people can die from that.”

Moreover, the immunosuppression drugs needed to keep the body from rejecting the transplant have in some cases led to cancers and life-threatening infections, he added, so on a balance of risks and benefits, the team sought candidates for whom the treatment offered a healthy tip toward the latter.

That’s not to say other forms of diabetes aren’t in his sights. Shapiro was careful to note that while the Edmonton Protocol isn’t a cure for diabetes, given the need for anti-rejection drugs and supply problem due to reliance on donors, the research is headed in the right direction.

These days his lab is looking at creating islet cells from stem cells by using blood from patients with both Type 1 and Type 2 diabetes.

“That can be done fairly routinely now with a lot of work and skill, because of enabling science advances that have happened in the last 20 years,” he said.

But for now, Greene is grateful for the Edmonton Protocol and the team behind it for the stability they’ve afforded her life.

Far from the days when her husband had to regularly rush her to hospital, she has since enjoyed “perfect” blood sugar levels, Greene said, adding that she’s still keeping an eye on them with regular blood tests.

“It’s been a Godsend,” she added. “They definitely saved my life.”




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