20 Years Later: The Impact of the Edmonton Protocol

Management and treatment of type 1 diabetes have advanced over the years, but it is interesting to see what has withstood the test of time. For instance, islet cell transplantation (ICT) was first used in humans in 1989. Though the protocol changed a bit in 2000, the concept has remained relatively the same ever since. It is known as the Edmonton Protocol.

Researchers have followed the Edmonton Protocol since 1999, tracking factors such as the number of procedures, adverse events, and insulin independence. Studies have shown that insulin independence rates have been fairly consistent from 1999 through 2015 with around 50% of patients maintaining insulin independence after one year, and 25% maintaining insulin independence after five years. In addition, fewer patients have experienced adverse events over the years, and whole-body immunosuppression has become more localized. However, the number of centers performing ICT and the number of patients receiving this treatment have also declined.

The Protocol continues to rely on the use of cadaver islet cells which are inserted into the body of a patient with T1D.  The transplanted cells are protected by immune suppression or some type of encapsulation to reduce the risk of the body attacking and destroying these cells.

One challenge that has persisted over the years is identifying a sustainable source of islet cells aside from cadavers. Researchers have been testing methods for using human stem cells or animal islet cells, but more tests are needed to potentially make these options feasible. Furthermore, the issue remains of protecting cells in the long-term. Currently, the best option is immunosuppression, but even that has limited effectiveness. While there have been advances made in the medications and encapsulation devices used, there is still work that needs to be done to address undesirable side effects such as decreased ability of the body to fight off diseases or infection.

It is interesting to see how the Edmonton Protocol has remained the standard for ICT for 20 years, and the Diabetes Research Connection (DRC) continues to follow progress and changes related to this type of treatment for T1D. T1D continues to affect around 1.25 million Americans, and researchers are always looking for improved options for treating, managing, and potentially curing this disease.

The DRC provides necessary funding to early career scientists to conduct novel research studies related to type 1 diabetes. These projects are aimed at preventing and curing T1D as well as minimizing complications and improving quality of life for those living with this disease. To learn more about current research projects and support these efforts, visit http://diabetesresearchconnection.org.

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