From Bali bombings and islet transplants to a type 1 diabetes cure

Serendipity saw an RAH kidney doctor and RAH burns specialist swap stories — and conceive a plan to cure type 1 diabetes. Their world-first trial starts this month.

A breakthrough born out of the tragedy of the Bali bombings and a chance pairing of research by two gregarious doctors at the Royal Adelaide Hospital has led to a world-first trial this month aiming to cure type 1 diabetes.

Toby Coates was working on kidneys, pancreases and how to control type 1 diabetes; John Greenwood was working on burns victims including Bali survivors and went on to ­develop an artificial skin.

If Adelaide is a town where everyone seems to know each other, the RAH is a village.

Together, the doctors realised combining their work could turbocharge the path to a cure for a condition in which patients need daily insulin ­injections.

The science on both sides is complex but the idea is simple: make a wound on the upper arm of a patient with type 1 ­diabetes, put in the artificial dermis, give it time to settle in and make a blood-rich bed, then transplant insulin-producing islets from a donor pancreas into this cosy new home.

If all goes well, the islets will produce insulin, effectively curing the type 1 diabetes and ending the need for daily insulin injections.

RAH Kidney and Islet Transplantation director Professor Coates will start the trial this month on patients ­including Danielle Kerin and Alec ­Tibbitts.

The plan’s pedigree includes the aftermath of the Bali bombings, when the then head of the RAH Burns Unit, Professor Greenwood – SA Australian of the Year 2016 – treated victims and went on to develop an artificial skin graft.

Professor Toby Coates demonstrates the position of the skin graft on Alec Tibbitts, with Dannielle Kerin who will both nn a trial starting soon. Picture: Mark Brake

On the islet side, about 30 transplants have been performed in SA in just over a ­decade but these went directly into the liver – as The Advertiser reported, Margaret Hannigan ended 40 years of daily insulin injections after an islet transplant into her liver 11 years ago. These procedures were on people whose severe conditions were not well controlled by standard medication.

However, Prof Coates believes the new method will pave the way for a universal cure, eventually using stem cells that will end the need for rare donor islets.

“We’ve repurposed the artificial dermis John Greenwood developed for burns to create a beautiful vascular bed,” he said. “We make the bed, then seed it.

“This trial will be the first in the world – John Greenwood and I developed it together and ultimately we hope to use it for everyone with type 1 diabetes.

“This is ­potentially the gateway for using stem cell islets, which would mean an infinite source of cells. As this goes in the skin rather than the liver it can easily be removed if there are problems. This innovative treatment is less invasive and provides the transplanted cells with their own blood supply, making them more likely to survive than current transplantations into the liver.”

Describing the plan as a “game-changer”, Prof Coates noted the islet transplant could be done under local anaesthetic, was easy to monitor or remove and was significantly less expensive.

“This year is the 100th anniversary of the discovery of ­insulin, and I want to mark it with the development here in Adelaide of what could ultimately be used on everyone with type 1 diabetes,” he said.

The first two patients are excited about the trial.

Alec Tibbitts, 55, the principal at Gawler East Primary, ­described type 1 diabetes as “an insidious disease.”

Day 0

Day 30

Day 100

“Anything that can be done to ease the suffering of people is a step in the right direction,” he said. “My daughter also has diabetes, so I’m doing this for her and hoping it will help make a difference to all children with diabetes and take away the stress it causes.”

Danielle Kerin, 51, a primary school teacher, has had multiple daily insulin injections since she was aged five.

“I’m excited about how this may change my life and that of other type 1 diabetics,” she said. “To have balanced blood sugar levels would be a dream come true and would stop the daily anxiety of managing high and low blood sugar levels.”

The trial is funded through the JDRF Pilot and Innovation Awards, with research done at the renal laboratories in the University of Adelaide, located in the BioMed City. In a neat twist this is “RAHsearch Week”, highlighting its best and boldest research.

Prof Coates will give a presentation on the trial and other leading researchers will showcase their work on heart disease, diabetes and cancer.

Central Adelaide Local Health Network chief executive Lesley Dwyer said it was an opportunity for South Australians to learn first-hand about the transformative and life-impacting research taking place on some of the most common diseases and conditions.

“Our RAH operates within a unique research ecosystem in the BioMed City which ­enables our researchers to ­translate their cutting-edge ­research outcome into a clinical setting,” Prof Dwyer said.

“This means patients have access to the latest clinical trials and medical advancements at their bedside.”

The three-day event at the RAH will be live streamed via Facebook from Monday.