“Her childlike joy in life was just gone,” said Leonie’s mother, describing the emotional state of her daughter at the age of ten. At that time she had already undergone 26 operations. Since she was two years old Leonie had suffered from recurrent inflammation of the pancreas. To gain control over the inflammation, surgeons in a hospital in Dresden and then specialists in a North German university hospital performed surgery on the child. However, the surgical interventions did not stop the inflammation for long. Once the next inflammation occurred on the day she was released from the hospital. The pain was very distressing and could only be alleviated by strong painkillers. “I often lay in my bed and thought I was outside of myself, sitting next to me,” said Leonie. And even during the inflammation-free periods she felt pressure in her so frequently operated stomach.
Media reports about the first transplantation in Germany of autologous islet cells in an accident victim drew Leonie’s mother’s attention to the special expertise of Dresden University Hospital. In 2013 Professor Grützmann removed the pancreas of a forklift driver which had been severed in a work accident. Dr. Ludwig prepared the islet cells found therein so that these continue to produce the vital insulin after transplantation into the liver. While it is quite common in adults after a severe pancreatitis to remove the organ and thus to turn the patient into a diabetic, this option initially did not come into question for Leonie’s physicians. But when it turned out that all other treatment options were exhausted and a removal of the pancreas could probably not be avoided, the Dresden doctors formed an expert team and considered whether after removing the pancreas, islet cell transplantation would be possible in this girl. They were encouraged by reports of U.S. colleagues, who had published scientific articles about successful transplantations of this kind in children.
Prior to this, Professor Grützmann himself made one last attempt and removed part of Leonie’s pancreas. In adult patients this can often stop the inflammation – but unfortunately not in the nine-year-old. Despite the possible consequences, Leonie was glad that the pancreas had been removed in what was the 27th operation. The subsequent 28th procedure was less serious because then only her prepared islet cells were injected into her liver. Leonie was released from the hospital at the end of September 2014 with a height of 134 centimeters and a bodyweight of 27 kilograms. Today her height is 144 centimeters and her weight is 36 kilograms. But what is more important for the now eleven-year old: “I no longer have any pain,” she said. And instead of 70 days of absence during the school year 2012/2013, she was only absent three days after her release from Dresden University Hospital – and these were only for important follow-up check-ups. The last check-up took place in late August. Leonie was injected a sugar solution and afterwards had to have blood tests every minute. Thus, the diabetologists were able to determine how the transplanted islet cells react to the glucose administration – as expected they secreted increased insulin to utilize the nutrient in the body. To supplement her body’s own insulin, Leonie wears an insulin pump through which she is continually administered a very small amount of insulin to assist the transplanted cells. Fortunately she presently does not need any additional insulin prior to eating, and she can live life without any major restrictions. “It is very fortunate,” Dr. Ludwig said, “that the transplanted islets function well and take over a major part of the blood glucose regulation. Nevertheless, it is important that –just like patients with type 1 diabetes mellitus – Leonie is aware of what influences her blood glucose levels and knows how her insulin pump with external insulin works and how to handle it.“ Since the transplanted islet cells originate from her own body, they are not rejected. For that reason, she does not need any drugs to suppress her immune system which would thereby burden the organism.
“The successful re-implantation of islet cells in a child once again illustrates the intensive work, which the hospital and faculty has accomplished in recent years also in the field of diabetology,” said Professor Michael Albrecht, medical director of Dresden University Hospital. Internationally renowned scientists came to Dresden to advance basic research and medical care in this field. It all began when DZD board member Professor Michele Solimena moved from Yale University to Dresden and established the research field “Experimental Diabetology” here. He subsequently founded the Paul Langerhans Institute Dresden of Helmholtz Zentrum München, of which he is currently the director. Dr. Barbara Ludwig also works in this partner institute of the DZD. She acquired her expertise for removing islet cells from the pancreas and preparing them for transplantation during a multi-year stay in the U.S. She then moved to Dresden to the Medical Clinic III headed by Professor Stefan Bornstein, where she helped establish the Islet Transplantation Center.
Further information
on the procedure for preparing islet cells:
www.uniklinikum-dresden.de
on Leonie’s pancreatectomy with islet auto-transplantation: https://www.youtube.com