In the face of diabetes, pancreatic islet transplantation ‘changes lives’

This treatment has long been awaited by patients suffering from particularly unstable type 1 diabetes: after years of experimentation, pancreatic islet transplantation, recently approved by the health authorities, is “life-changing” for patients.

“It’s revolutionary. Valerie Rodriguez does not hide her satisfaction. On October 24 at the Regional Hospital of Strasbourg, this former banking coach became one of the first patients in France to receive such a transplant as part of a conventional treatment (outside of a pilot project and with the support of the “Medical Insurance”).

Before the operation, she tried all the treatments that were offered to regulate blood sugar levels, but with no definite success. “I lived constantly with the sword of Damocles over my head,” explains this energetic fortieth. “There is a fear of hypoglycemic coma: for example, I had a chance to oversugar (quickly consume carbohydrates – ed.) while driving on the highway. “After the transplant, she is ‘living again’. “I don’t have those blood sugar fluctuations anymore, my body is much less tired. I have a killer peach, I’m lucky. This technique is brilliant,” she admits. This “technique” involves implanting in the patient’s liver the islets of Langerhans, pancreatic cells responsible for insulin secretion, taken from a brain-dead non-diabetic donor.

If Valerie Rodriguez has not experienced any particular adverse effect, she nonetheless stresses that, as with any transplant, this intervention requires lifelong anti-rejection treatment. Or, in his case, “seven tablets in the morning and six in the evening.” “Faced with recurring hypoglycemia and discomfort, I prefer my breakfast to pills, there is no comparison,” she says.

Twenty years of research

The first clinical trials of this treatment took place in 1999 in Canada and then in Europe and continued for two decades. In 2020 in France, the Higher Authority for Health gave the green light to the practice for some “chronically unstable” patient profiles.

Thus, the Regional Hospital Center of Lille (North) became in December 2021 the first French institution to carry out such a transplant as part of an elective care, followed by the institution in Strasbourg.

“It was very solemn, there were 15 people in the operating room, everyone wanted to get in! recalls Valerie Rodriguez.

For patients, “this is a very big step forward. And for us doctors, this is the culmination of very high-level interdisciplinary clinical research, this is a very strong recognition,” says Lawrence Kessler, Professor of Diabetology at the Strasbourg Hospital and member of the French Diabetes Society.

“On a career scale, after animal studies, then human studies, and finally the transition to routine care, it’s very nice,” says one who already received a master’s degree in rat pancreatic islets in 1988.

According to Lawrence Kessler, this therapy is indicated for several hundred patients a year, a small minority of the 370,000 type 1 diabetics counted by the French Diabetes Federation.

“This is a small number, but it is fundamental, since these are patients for whom we do not have a therapeutic alternative,” the diabetologist insists. “And we are only at the beginning: this treatment may be indicated for other patients whose treatment has not worked, for example, in the case of pancreatic disease or cystic fibrosis.”

Deployment phase

Since authorization, processing has been deployed in France. In addition to the CHRUs in Lille and Strasbourg, several hospitals in Paris, Grenoble and Montpellier have been approved by the Regional Health Agencies (ARS) on the recommendation of the Biomedical Agency to perform transplants. Toulouse and Nantes are also candidates.

Since authorization, processing has been deployed in France. In addition to the CHRUs in Lille and Strasbourg, several hospitals in Paris, Grenoble and Montpellier have been approved by the Regional Health Agencies (ARS) on the recommendation of the Biomedical Agency to perform transplants. Toulouse and Nantes are also candidates. “Permits meet safety and quality requirements for patients. Know-how today can be found in those who have already been involved in this activity in the context of research, but it is available to a large number of laboratories,” emphasizes Professor Michel Tsimaratos, Deputy Director General of the Biomedical Agency. “With islet transplantation, the therapeutic arsenal at the service of patients is enriched, and this should certainly be remembered,” he concludes.

Antoine POLLEZ and Katherine FABING/AFP