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Sponsors and Collaborators: |
National Institute of Allergy and Infectious Diseases (NIAID) National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) |
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Information provided by: | National Institute of Allergy and Infectious Diseases (NIAID) |
ClinicalTrials.gov Identifier: | NCT00434811 |
Type 1 diabetes is an autoimmune disease in which the insulin-producing pancreatic beta cells are destroyed, resulting in poor blood sugar control. The purpose of this study is to determine the safety and effectiveness of islet transplantation, combined with immunosuppressive medications, for treating type 1 diabetes in individuals experiencing hypoglycemia unawareness and severe hypoglycemic episodes.
Condition | Intervention | Phase |
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Type 1 Diabetes Mellitus |
Procedure: Islet transplant |
Phase III |
Study Type: | Interventional |
Study Design: | Treatment, Non-Randomized, Open Label, Uncontrolled, Single Group Assignment, Safety/Efficacy Study |
Official Title: | Islet Transplantation in Type 1 Diabetes |
Estimated Enrollment: | 48 |
Study Start Date: | October 2006 |
Estimated Study Completion Date: | January 2011 |
Estimated Primary Completion Date: | May 2010 (Final data collection date for primary outcome measure) |
Arms | Assigned Interventions |
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1: Experimental
Participants will receive up to three separate islet transplants and a regimen of immunosuppressive medications consisting of antithymocyte globulin (ATG), sirolimus, and low-dose tacrolimus. They will begin receiving ATG and sirolimus 2 days prior to the first islet transplant. ATG will continue to be given until Day 2 post-transplant, and sirolimus will be given for the duration of the study. On Day 1 post-transplant, participants will receive tacrolimus, which will also be taken for the duration of the study. Etanercept will be taken on the day of transplant and Days 3, 7, and 10 post-transplant.
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Procedure: Islet transplant
200 ml suspension of allogenic human purified islets
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Type 1 diabetes is commonly treated with the administration of insulin, either by multiple insulin injections or by a continuous supply of insulin through a wearable pump. Insulin therapy allows long-term survival in individuals with type 1 diabetes; however, it does not guarantee constant normal blood sugar control. Because of this, long-term type 1 diabetic survivors often develop vascular complications, such as diabetic retinopathy, an eye disease that can cause poor vision and blindness, and diabetic nephropathy, a kidney disease that can lead to kidney failure. Some individuals with type 1 diabetes develop hypoglycemia unawareness, a life-threatening condition that is not easily treatable with medication and is characterized by reduced or absent warning signals for hypoglycemia. For such individuals, transplantation of pancreatic islets is a possible treatment option. Unfortunately, insulin independence among islet transplant recipients tends to decline over time. New strategies aimed at promoting engraftment of transplanted islets are needed to improve the clinical outcomes associated with this procedure. The purpose of this study is determine the safety and efficacy of islet transplantation, when combined with an immunosuppressive medication regimen, for treating type 1 diabetes in individuals experiencing hypoglycemia unawareness and severe hypoglycemic episodes. This study will also seek to improve the understanding of determinants of success and failure of islet transplants for type 1 diabetes.
Eligible participants will be randomly assigned to this study or a site-specific Phase 2 islet transplantation study. Participants in this study will receive up to three separate islet transplants and a regimen of immunosuppressive medications consisting of antithymocyte globulin (ATG), sirolimus, and low-dose tacrolimus. They will begin receiving ATG and sirolimus 2 days prior to the first islet transplant. ATG will continue to be given until Day 2 post-transplant, and sirolimus will be given for the duration of the study. On Day 1 post-transplant, participants will receive tacrolimus, which will also be taken for the duration of the study. Etanercept will be taken on the day of transplant and Days 3, 7, and 10 post-transplant.
Transplantations will involve an inpatient hospital stay and infusion of islets into a branch of the portal vein. Participants who do not achieve or maintain insulin independence by Day 75 post-transplant will be considered for a second islet transplant. Participants who remain dependent on insulin for longer than 1 month after the second transplant and who show partial graft function will be considered for a third islet transplant. Daclizumab or basiliximab will be used in place of ATG for the second and third transplants, if they are necessary. Participants who do not meet the criteria for a subsequent transplant and do not have a functioning graft will enter a reduced follow-up period.
There will be up to 15 study visits following each transplant. A physical exam, review of adverse events, and blood collection will occur at most visits. A chest x-ray, abdominal ultrasound, electrocardiogram, quality of life questionnaires, urine collection, and glomerular filtrating rate (GFR) testing will occur at some visits. Participants will also test their own blood glucose levels at least five times per day throughout the study. A 12-month follow-up period will take place after the participant's last transplant.
Ages Eligible for Study: | 18 Years to 65 Years |
Genders Eligible for Study: | Both |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
Involvement of intensive diabetes management, defined as:
Exclusion Criteria:
Severe coexisting cardiac disease, characterized by any one of the following conditions:
Any medical condition that, in the opinion of the investigator, might interfere with safe participation in the trial
United States, California | |
University of Callifornia, San Francisco | Not yet recruiting |
San Francisco, California, United States, 94143 | |
Contact: Debbie Ramos, RN, BSN 415-353-8615 debbie.ramos@ucsfmedctr.org | |
Principal Investigator: Peter Stock, MD, PhD | |
United States, Florida | |
University of Miami | Recruiting |
Miami, Florida, United States, 33136 | |
Contact: Eva Herrada, RN, BSN 305-243-6070 eherrada@med.miami.edu | |
Principal Investigator: Camillo Ricordi, MD | |
United States, Georgia | |
Emory University | Not yet recruiting |
Atlanta, Georgia, United States, 30322 | |
Contact: Marti Sears, RN, BSN 404-712-2004 islets@emoryhealthcare.org | |
Principal Investigator: Chris Larsen, MD, D.Phil | |
United States, Illinois | |
Northwestern University | Recruiting |
Chicago, Illinois, United States, 60611 | |
Contact: Elyse Stuart, RN, CCRC 312-503-1060 e-stuart@northwestern.edu | |
Principal Investigator: Dixon Kaufman, MD, PhD | |
University of Illinois, Chicago | Recruiting |
Chicago, Illinois, United States, 60612 | |
Contact: Joan Martelloto, RN, PhD 312-996-6087 jmartell@uic.edu | |
Principal Investigator: Jose Oberholzer, MD | |
United States, Minnesota | |
University of Minnesota | Recruiting |
Minneapolis, Minnesota, United States, 55455 | |
Contact: Jayne Pederson 612-624-8402 peder059@umn.edu | |
Principal Investigator: Bernhard Hering, MD | |
United States, Pennsylvania | |
University of Pennsylvania | Recruiting |
Philadelphia, Pennsylvania, United States, 19104 | |
Contact: Eileen Markmann, RN, BSN 215-662-4449 Eileen.Markmann@uphs.upenn.edu | |
Contact: Maral Palanjian, RN 215-615-3727 maral.palanjian@uphs.upenn.edu | |
Principal Investigator: Ali Naji, MD, PhD | |
Canada, Alberta | |
University of Alberta | Recruiting |
Edmonton, Alberta, Canada, T6G028 | |
Contact: Parastoo Dinyari, BSc, CCRP 780-407-3904 Parastoo@islet.ca | |
Principal Investigator: James Shapiro, MD, PhD |
Study Chair: | Bernhard Hering, MD | University of Minnesota |
Study Chair: | Olle Korsgren, PhD | Uppsala University Hospital |
Study Chair: | Ali Naji, PhD | University of Pennsylvania |
Study Chair: | Camillo Ricordi, MD | University of Miami |
Study Chair: | James Shapiro, MD, PhD | University of Alberta |
Responsible Party: | DIAT/NIAID ( Associate Director, Clinical Research Program ) |
Study ID Numbers: | DAIT CIT-07 |
Study First Received: | February 9, 2007 |
Last Updated: | November 10, 2008 |
ClinicalTrials.gov Identifier: | NCT00434811 |
Health Authority: | United States: Food and Drug Administration |
Insulin dependence Hypoglycemia Hypoglycemia unawareness |
Autoimmune Diseases Metabolic Diseases Diabetes Mellitus, Type 1 Diabetes mellitus type 1 Diabetes Mellitus Endocrine System Diseases |
Endocrinopathy Metabolic disorder Glucose Metabolism Disorders Hypoglycemia Insulin |
Immune System Diseases |