A World Diabetes Day, this Monday, to mark with a white stone. A long-awaited treatment for patients with particularly unstable type 1 diabetes has recently been authorized by the health authorities: after years of experimentation, pancreatic islet transplantation “changes the life” of beneficiaries. “It’s revolutionary” assures Valérie Rodriguez, a forty-year-old who does not hide her satisfaction. On October 24, at the Strasbourg CHRU, she was one of the first patients in France to receive such a transplant as part of routine care (outside an experimental project and covered by health insurance).
Before the operation, she had tried all the treatments offered to regulate her blood sugar level, without conclusive success. “I lived permanently with a sword of Damocles over my head”. “There is the fear of a hypoglycemic coma: for example, I happened to re-sugar (consume carbohydrates quickly) while driving on the highway”. Since her transplant, she “lives again”. “I no longer have these blood sugar variations, my body gets much less tired. I have a killer peach, I feel lucky. This technique is brilliant,” she confides.
Cells taken from a non-diabetic donor
This “technique” consists in implanting, in the patient’s liver, islets of Langerhans, cells of the pancreas responsible for the secretion of insulin, taken from a non-diabetic donor in a state of brain death. If Valérie Rodriguez did not feel any particular adverse effect, she nevertheless emphasizes that, as with any transplant, this intervention requires lifelong anti-rejection treatment. Or, in his case, “seven tablets to take in the morning and six in the evening”. “Faced with repeated hypoglycemia and discomfort, I prefer my breakfast to pills, there is no comparison,” she says.
The first clinical trials for this treatment took place in 1999, in Canada, then in Europe, and continued for two decades. In 2020, the High Authority for Health gave the green light to this practice for certain “chronically unstable” patient profiles. Thus, the Lille CHRU became, in December 2021, the first French establishment to perform such a transplant in routine care, before being imitated by that of Strasbourg. “It was very solemn, there were 15 people in the operating room, everyone wanted to attend! “recalls Valérie Rodriguez.
For patients, “this is a very big step forward. And for us doctors, it is the culmination of very high-level, multidisciplinary clinical research, it is very strong recognition”, concedes Laurence Kessler, professor of diabetology at the University Hospital of Strasbourg and member of the Société francophone du diabetes.
A therapy indicated for a few hundred patients per year
“On the scale of a career, following studies in animals, then in humans, and finally the transition to routine care, is very satisfying”, says the one who, in 1988, was already pursuing a master’s degree. on rat pancreatic islets. This therapy is indicated for a few hundred patients per year, according to Laurence Kessler, i.e. a tiny minority of the 370,000 type 1 diabetics counted by the French Diabetic Federation. “It’s a small number, but it’s fundamental since these are patients for whom we have no therapeutic alternative”, insists the diabetologist. “And we are only at the beginning: this treatment may be indicated for other patients whose treatment has failed, in the event of pancreatic disease or cystic fibrosis” for example.
Since its authorisation, the processing has been deployed in France. In addition to the CHRUs of Lille and Strasbourg, a few hospitals, in Paris, Grenoble and Montpellier, have obtained, from the Regional Health Agencies (ARS) after advice from the Biomedicine Agency, approval to carry out transplants. Toulouse and Nantes are also candidates.
“Authorizations meet safety and quality requirements for patients. The know-how can be found today among those who have already carried out this activity in the context of research, but it is accessible to a large number of laboratories”, emphasizes Professor Michel Tsimaratos, Deputy Director General of the Agence de la biomedicine. “With islet transplantation, the therapeutic arsenal at the service of patients is enriched, and this is undoubtedly what should be remembered”, he concludes.