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Transplant studies at CC could lead to diabetes cure

Close to 100 people gathered in May to celebrate the opening of the new Organ and Tissue Transplant Research Center in the freshly remodeled 11-East patient care unit.

In opening remarks, Dr. Allen Spiegel, director of intramural research for NIDDK, called the new unit "a venue to test the newest, most innovative ways of overcoming transplant rejection for patients with type 1 diabetes and end-stage renal failure, and ultimately other diseases."

Patients on this new unit will receive transplants of either insulin-producing islet cells or kidneys, followed by novel therapies to prevent their immune systems from rejecting the transplants. If the therapies are successful, these patients could be cured of their diabetes or renal disease.

Rejection is a major hazard of organ or tissue transplantation. Powerful drugs are given to suppress the patient's immune response, but side effects can be unpleasant enough to cause patients to stop taking the drugs. This step can mean almost certain organ rejection.

"Very rarely a patient that stops taking antirejection medicine does not reject the transplanted organ," said Dr. David Harlan, head of the new unit. "So we do know that it's possible to achieve a state of peaceful coexistence between the transplanted organ and the recipient's immune system."

Recent research in rhesus monkeys has lead to immunologic strategies using antibodies to block the rejection process and essentially fool the body into thinking that the transplanted tissue is its own.

This research has been spearheaded by Dr. Harlan and Dr. Allan Kirk, of the Naval Medical Research Center. In partnership with the Clinical Center, NIDDK, Walter Reed Army Medical Center, and the University of Miami's Diabetes Research Institute, Drs. Harlan and Kirk plan to test their promising therapy, and others, in patients here at the Clinical Center.

"With these new therapies, we are trying to manipulate the immune system so that this peaceful coexistence happens more often," said Dr. Harlan.

At the ribbon cutting, Dr. Kirk explained the team's vision for the new unit: "The common goal is to cure people with diabetes and renal failure -- and every other end-stage organ disease that is amenable to transplantation -- and to do so without giving the patient another disease, that is, immunosuppression. I truly believe that we are extraordinarily close to being able to do that."

"This is among the most exciting scientific opportunities I've seen for the Clinical Center in the last 10 years," said Dr. David Henderson, deputy director for clinical care. "It's what this building was built for--to translate these wonderful basic science findings [in animals] to humans."

Each of the other collaborating entities brings special resources to the enterprise:

Dr. Henderson lead the team that brought the 11-East unit renovation and other preparations to a remarkably speedy completion.

"The uniqueness of the Clinical Center gives us the organizational flexibility to create something like this practically overnight," he said. "This was only a concept in someone's mind just late last summer."

Once the decision to move forward was made, work proceeded quickly. A prerequisite was to become certified as a transplant center by the United Network for Organ Sharing (UNOS), an organization that ensures compliance with all the rules that are associated with transplanting human organs and tissues.

"We started in the fall [of 1998] trying to get [UNOS] certification; we had to renovate a unit; we had to assemble a transplant team; we had to figure out what resources were necessary to support it-across our whole organization. Plus we had to find people who have that expertise and get them hired. And literally from the time we started-in late August or early September-until now, it's all done," said Dr. Henderson.

A nucleus of stakeholders met every Wednesday. "The group worked unbelievably well together," Dr. Henderson explained. "Everyone participated, paid attention, recognized when we'd hit a minor obstacle, and people had creative ideas about how to solve it."

Dr. Henderson also credits the staff of the Division of Engineering Services for their diligence in seeing that the unit renovation proceeded smoothly and at a record-setting pace. A process that normally takes 18 months was collapsed into 4 to 6 months, he said. "Scott Robinson and Dyal Sharma headed the effort. They delivered the project on time, and under budget," Dr. Henderson said.

At the ribbon cutting, Dr. Harlan summed up: "While it is well and good that we celebrate the wonderful achievement that this ward represents-- and we should savor this moment --we must then quickly roll up our sleeves and get back to the work designed to relieve the suffering of those we have pledged to serve. That's why the NIH is here. We really can't rest until we've achieved that mission."

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