image: Dr. Jingjing Wang, postdoctoral scholar, works in the Medical University of South Carolina's clean cell facility, the second largest autologous islet transplantaion center in the nation. view more
Credit: Sarah Pack/MUSC
MUSC researchers received a $1.68 million National Institutes of Health grant to explore a better treatment for chronic pancreatitis, with the hopes that it also may shed light on a future cure for patients with type 1 diabetes.
Hongjun Wang, Ph.D., of the Medical University of South Carolina's Department of Surgery, is leading a collaborative team to study ways to increase the survival of the islet graft following islet cell transplantation for chronic pancreatitis patients. Islets are tiny clusters of cells in the pancreas that produce insulin.
Researchers in Wang's lab earlier piloted a smaller study looking at the protective effects of Alpha 1 anti-trypsin (AAT) in mice islet transplantation using human islets from cadaveric donors. The results showed that infusion with AAT prevented the mice from getting diabetes and improved liver implantation.
AAT is a protein made in the liver. Normally, the protein travels through the bloodstream, helping to protect the body's organs from the harmful effects of other proteins.
The five-year NIH grant involves infusing AAT into patients who have had their pancreas removed for one month by a weekly IV infusion. The study will examine whether humans will replicate the success seen in the mouse model. "The goal is to lessen the number of patients who are diabetic at the end of 1 year," Wang said.
How the anti-inflammatory properties of AAT work remains unknown. "Through studies like this, the investigators seek to understand how AAT works in the body to lessen cellular stress," she said.
"AAT, most commonly used for the treatment of emphysema for more than 25 years, has an excellent safety record," Wang said. "The islet autotransplantation model offers a unique opportunity to assess the direct effect of AAT on human islets in the absence of an immune response.
"While much of the work associated with AAT has been directed at lung and liver disease, it may help in the treatment of other diseases, including chronic pancreatitis, which can be incredibly painful," Wang said.
Chronic pancreatitis is caused by inflammation of the pancreas gland, an organ that has a duct connecting it to the intestine. The pancreas gland is responsible for excreting many of the enzymes that allow us to digest food. These enzymes are inflammatory if they get into the body's tissues. The pancreas gland also secretes hormones into the blood. The most important of these is insulin.
Inflammation and destruction of the pancreas gland is caused by a variety of conditions including some common drugs, high levels of triglycerides and too much alcohol. The duct that leaves the gland can become scarred and blocked and the pancreas enzymes can further destroy the gland. The result is a painful condition that has few cures.
One of the treatments is a pancreatectomy or surgical removal of the pancreas. "But the surgery creates problems, too," Wang said. "It means all of the patient's islet cells also are removed, taking away the patient's insulin and making the patient diabetic, which creates other lifelong complications."
Wang is putting to good use her research expertise in islet cell transplantation, gained at the Beth Israel Deaconess Medical Center at Harvard Medical School. That's where she worked as instructor and assistant professor for almost 10 years before coming to MUSC, where she serves as co-scientific director of the Center for Cellular Therapy. The clean cell facility is the second largest autologous islet transplantation center in the United States.
Islet cell transplantation is a technique in which the pancreas gland is taken to a laboratory after removal while the cells are still alive. The gland is then gently digested to break it into different cell types. The islet cells are separated and injected back into the patient to go the liver in the hope that they will stay in the liver and continue to secrete insulin.
"In the best outcomes, the patient would not be diabetic at all," Wang said. The number of cells that survive determines the severity of a patient's diabetes after removal of the pancreas. This surgery is done at only a small number of specialty centers because of the detail and expertise involved.
According to Wang, the value of working in islet cell transplantation research at MUSC is the expertise of the clinicians. MUSC is a designated National Pancreas Foundation center, focusing on the multidisciplinary approach to the treatment of pancreatitis, including access to expert surgeons in the field of chronic pancreatitis.
"This study is half basic science and half clinical. At MUSC, we have the some of the best pancreatic surgeons in the country, and if we have questions in the research environment, we can work directly with the surgeons to find solutions," said Wang.
"We are excited to be at the cutting edge of translating basic science research into clinical outcomes that will change the way we treat not only patients who suffer from chronic pancreatitis but eventually patients with type 1 diabetes," Wang said. "Just imagine a day when people with type 1 diabetes no longer need to take their insulin. That's the future. That's the direction we are going."
Co-investigators for this study from the Department of Surgery include Katherine Morgan, M.D., chief of the Division of Gastrointestinal and Laparoscopic Surgery and David B. Adams, M.D., professor of Surgery in the Division of Gastrointestinal and Laparoscopic Surgery.
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