A quarter-sized device created at Houston Methodist could drastically alter the course of treatment for Type 1 diabetes, a chronic condition that impacts millions of Americans and does not have a cure.

In a study published in the journal Nature Communications, a research team delivered islet cells and immunotherapy directly into a 3D printed device akin to a bioengineered pancreas, called the NICHE. The treatment restored healthy glucose levels and eliminated Type 1 diabetes symptoms in animal models for more than 150 days while avoiding severe adverse effects of anti-rejection therapy by administering immunosuppressive drugs only where the transplanted islet cells were located.

Type 1 diabetes is caused by an autoimmune reaction that destroys the cells in the pancreas that make insulin. It can also cause kidney failure. Daily insulin injections are the most conventional treatment but attaining tight control of glucose levels remains challenging and cumbersome for patients. Further, in more severe cases, patients may need pancreas and kidney transplants, or they may qualify for an islet cell transplant, where the islet cells of a deceased pancreas donor are harvested, processed and then transplanted into the Type 1 diabetes patient’s liver.

These transplants can help improve a patient’s symptoms; however, as with all organ transplants, one of the biggest challenges is the need for immunosuppressive drugs for the rest of their lives to avoid transplant rejection. Lifelong immunosuppression can lead to patients being vulnerable to infectious diseases and increases the risk of certain types of cancer.

The NICHE, created is a flat device placed under the skin comprised of a cell reservoir for the islets and a surrounding drug reservoir for localized immunosuppression therapy. It is the first platform to combine direct vascularization and local immunosuppression into a single, implantable device for allogeneic islet transplantation and long-term Type 1 diabetes management. Direct vascularization is fundamental for supplying nutrients and oxygen for maintaining the viability of transplanted islet cells.

“A key result of our research is that local immunosuppression for cell transplantation is effective,” said the corresponding author. “This device could change the paradigm of how patients are managed and can have massive impact on treatment efficacy and improvement of patients’ quality of life.”

The NICHE incorporates ports for the refilling of drugs as needed. The researchers refilled the drug reservoirs every 28 days, which is comparable to other long-acting drugs clinically available for migraine prevention or HIV treatment.

The team is working on scaling up the NICHE technology for clinical deployment, for which drug refilling may only be needed once every six months. The ability to refill the NICHE technology allows for long-term use in patients. Further, changes in drug formulations or concentration could extend refill intervals to once each year, aligning with routine physician visits.

The researchers will expand this research over the next few years, with the end goal of testing the NICHE’s safety in humans in about three years.

https://www.nature.com/articles/s41467-022-35629-z

http://sciencemission.com/site/index.php?page=news&type=view&id=publications%2Fimplantable-niche-with&filter=22