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Globe and Mail
20-06-2025
- Health
- Globe and Mail
Islet cell transplant trial outcome ‘major milestone' toward cure for diabetes
When Amanda Smith learned at the age of 25 that she had late-onset Type 1 diabetes, she considered the diagnosis a death sentence. The nurse, from London, Ont., had a particularly dim view of the disease because she grew up watching her mother struggle with it. Her mother would slur her words and lose consciousness when her blood sugar bottomed out. Once, Ms. Smith's grandfather had to break a window to reach her mother, who was passed out in her home holding a banana she had tried to consume to raise her blood sugar. 'It literally eats you from the inside out,' said Ms. Smith, now 36. 'It rots your teeth, it destroys your body, your vision. The complications that come with Type 1 diabetes are so extreme.' Ms. Smith is confident now that those complications won't be in her future. In February of 2023, she became the first Canadian to receive a transplant of islet cells – the cells in the pancreas that make insulin – derived from embryonic stem cells. The transplant freed her from insulin and gave her blood sugar control akin to a non-diabetic. It was performed at Toronto General Hospital, the institution where insulin was first tested more than 100 years ago. On Friday, the results of the clinical trial in which Ms. Smith participated were published in the New England Journal of Medicine. The early-phase trial was small, and the procedure has a significant downside in that patients must take anti-rejection drugs for life, just like recipients of organ transplants. For people living with diabetes, the push for medical coverage isn't political, it's personal Nonetheless, the study's outcome counts as 'spectacular,' according to James Shapiro, who holds the Canada Research Chair in transplant surgery and regenerative medicine at the University of Alberta and was not involved in the study. Ten of the 12 participants who received a full dose of the cells were insulin-independent one year later. 'This is a major advance and a major milestone along the journey towards a cure,' he said. Dr. Shapiro was himself responsible for an earlier breakthrough on that path. In 2000, he and his colleagues at the University of Alberta published a seminal paper on a method they developed for safely and effectively transplanting islet cells from deceased donors into patients with Type 1 diabetes. They dubbed their regimen the 'Edmonton Protocol.' 'We used to call it the drive-through transplant,' Dr. Shapiro said, because giving patients islet cells was less risky and burdensome than a whole pancreas transplant. The cells are infused into patients under mild sedation with an IV-drip into the portal vein of the liver. The breakthrough described in the new paper is that the islet cells transplanted into Ms. Smith were derived not from deceased donors but from embryonic stem cells, which function as a type of source code that scientists can coax into becoming any cell in the human body. The supply of such lab-created islets could, in theory, be limitless, unlike the supply of deceased donor islets. Semaglutide, or Ozempic, reduces symptoms of feared diabetes' complication, study finds Trevor Reichman, director of the pancreas and islet transplant program at the University Health Network's Ajmera Transplant Centre, said the most encouraging result is that the islet-cell transplants eliminated dangerous blood sugar 'lows' that can cause confusion, seizures and unconsciousness. He ran the study site at UHN and is an author of the new paper. 'All of them, essentially, were able to get rid of their hypoglycemic episodes,' Dr. Reichman said, 'so all of the real risks to them, all of the lows, were essentially eliminated.' Still, the international trial, funded by Boston-based Vertex Pharmaceuticals, wasn't without its challenges. The company paused it temporarily last year after two participants died, though not from taking Zimislecel, the brand name of the new islet therapy. Vertex expects to apply for regulatory approval of Zimislecel starting next year. One participant died of severe dementia 30 months after the infusion. That patient had pre-existing neurocognitive impairment and, before joining the trial, had suffered a brain injury during a motor-vehicle accident caused by a severe blood sugar low. The other died of cryptococcal meningitis, a fungal infection caused by a sinus surgery. The death was related to the immunosuppressant medication that the participant was taking to preserve the islet transplant, the study said. That death underscores the tradeoff that people with Type 1 diabetes would have to make with Zimislecel, said Rémi Rabasa-Lhoret, director of the Metabolic Diseases Research Unit and The Diabetes Clinic at the Montreal Clinical Research Institute. He wonders how many people with Type 1 would be willing to take anti-rejection drugs for life, especially now that advances such as insulin pumps have made diabetes easier to manage for some patients. 'It's probably going to be a very narrow population,' Dr. Rabasa-Lhoret said. The next step for scientists is finding a way to genetically engineer or encapsulate islets so the immune system won't view them as hostile invaders. In the meantime, Ms. Smith said taking three pills, three times a day to suppress her immune system is a breeze compared with the round-the-clock work of keeping her blood sugar in check. Her 10-year-old daughter, Draya, used to say she wanted to become a doctor to cure diabetes. Now, she talks of being a pilot or engineer. 'I would do this a million times over compared to the maintenance I used to have to do to keep myself alive,' Ms. Smith said.

CTV News
13-06-2025
- Health
- CTV News
What's the risk of catching measles at airports? Here's what travellers need to know
With the busy summer travel season approaching, some Canadians may be worried about catching measles in public places, such as airports and other indoor settings, amid a resurgence of the highly contagious disease in Canada and around the world. 'We live in an unprecedented time of human mobility at a global level, and we will see inevitable cases of measles imported into Canada,' Dr. Isaac Bogoch, infectious diseases specialist at the Toronto General Hospital, said in a video interview with on Thursday. 'It's happening and it will continue to happen. And while we can't necessarily control what happens outside of our borders, we certainly can have influence of what happens within our borders, and it's our duty to lower barriers to routine childhood immunizations.' Here's what Canadians need to know about the chances of catching it. Measles in Canada and globally Within Canada's borders, the disease has been spreading, with an ongoing outbreak that began in New Brunswick last October affecting a total of 2,088 people as of May 31. This outbreak is the largest in the country since 1998, with related cases in Ontario, Alberta, British Columbia, Manitoba, Northwest Territories, Nova Scotia, Prince Edward Island, Quebec and Saskatchewan. Measles has been 'eliminated' in the country since 1998, which indicates it's no longer found in a large area, according to the Canadian government's latest monitoring report. However, measles cases occur sporadically, typically coming from other affected regions. Cases have climbed to a 27-year peak in Canada, with 2,698 confirmed this year compared to only 17 in 1998. One death was reported in Ontario this year. 'We are in the midst of an outbreak in parts of Canada right now, and there are potential exposures in public places, airports, community centres, restaurants, public places where people may visit,' Bogoch said. 'But if people are immune to this infection, preferably through vaccination but also through recovery from infection, the risk is negligible.' Many parts of the world are experiencing a growing number of measles cases. For instance, data from the European Centre for Disease Prevention and Control show the number of measles cases in the European Union and European Economic Area have risen since 2013. In the United States, more than 1,100 measles cases were reported this year, and the U.S. Centers for Disease Control and Prevention recently updated its travel notice to warn people that they can get the disease from many travel settings such as airports, train stations, crowded events and tourist attractions, CNN reported on June 5. Even with the outbreak in Canada, the country's travel health notice says the risk is at the lowest level. The level 1 advisory encourages travellers to practise health precautions, including avoiding insect bites, properly washing their hands and having updated vaccinations. It said vaccination is the best way to protect yourself and others from the disease. 'My main concern is that there may be people who are non-immune who can receive a free, widely available vaccine that has decades of safety data and decades of effectiveness data associated with it and that it's a preventable disease,' Bogoch said. How do you get measles? The virus is spread through coughing, sneezing or breathing the same air as an infected person. It can remain contagious in the air or on infected surfaces for up to two hours, according to the World Health Organization. Who is most at risk? Most people are immune to measles, but the virus will circulate more in certain cases, with those who are unvaccinated and not immune to it mainly getting infected, Bogoch said. He noted that pockets of Canada may have under-vaccinated communities. He listed an example of many cases in Ontario occurring in a largely unvaccinated Mennonite Christian community in the southwestern part of the province. 'It sadly spreads like wildfire, and that's exactly what we're seeing happening right now,' Bogoch said. People who get infected with the virus are typically those under age 20, he added. 'It's primarily, almost exclusively … people who have not received two doses of vaccine,' Bogoch said. 'You can significantly lower risk of infection by receiving a routine childhood immunization. Two doses of a measles vaccine is extraordinarily effective in preventing measles infections.' Where are people more likely to get measles? While people can contract measles at airports, train stations and other crowded public areas, Bogoch said there isn't one primary place of infection. 'Measles is transmitted primarily in indoor settings through the air,' he said. 'It's a virus that is able to stay suspended in the air for a prolonged period of time, and the infectious dose is tiny. 'So if someone is non-immune and is exposed to the virus in an indoor setting, there's a very high likelihood that that person will get infected with measles.' With the disease mostly transmitted in indoor settings, the risks aren't necessarily higher during the peak summer travel season. 'It can be transmitted at any time of year,' Bogoch said. 'For example, in the winter months, there might be more people crowding in indoor settings because it's cold outside.' Symptoms and treatment Symptoms can show up as a fever, cough, runny nose and watery eyes before a rash with red and blotchy spots appears. There isn't any specific antiviral treatment for measles. People can be treated with medications to help relieve symptoms. Most people recover, but severe cases may require hospitalization. Bogoch said the vast majority of those born before 1970 were already infected with measles since the virus was common back then, so they generally won't have to worry about getting it and have 'lifelong protection.' Most who have received two doses of the measles-mumps-rubella (MMR) vaccine, which is routinely given to children, have a 'very, very small' risk of infection, Bogoch added. Advice for travellers If you're travelling anywhere outside Canada where the measles risk may be higher, Bogoch recommends getting health advice before leaving the country. 'There's measles, but of course, there's a lot of other things that you can be mindful of and take precautions to ensure you have a healthy, safe and happy trip,' he said.

CTV News
12-06-2025
- Health
- CTV News
What's the risk of catching measles at airports and crowded areas? Here's what travellers need to know
Amid a resurgence of measles in Canada and around the world, some Canadians may be worried about catching the highly contagious disease in public places while travelling, such as airports and other indoor settings. 'We live in an unprecedented time of human mobility at a global level, and we will see inevitable cases of measles imported into Canada,' Dr. Isaac Bogoch, infectious diseases specialist at the Toronto General Hospital, said in a video interview with on Thursday. 'It's happening and it will continue to happen. And while we can't necessarily control what happens outside of our borders, we certainly can have influence of what happens within our borders, and it's our duty to lower barriers to routine childhood immunizations.' While Canada's travel advisory currently has measles at the lowest risk level, here's what Canadians need to know about the chances of catching it during the busy summer travel season. Measles in Canada and globally Within Canada's borders, the disease has been spreading, with an ongoing outbreak affecting a total of 2,088 people as of May 31. It began in New Brunswick in October 2024, with related cases in Ontario, Alberta, British Columbia, Manitoba, Northwest Territories, Nova Scotia, Prince Edward Island, Quebec, and Saskatchewan. Measles has been considered 'eliminated' in the country since 1998, according to the Canadian government's latest monitoring report. However, measles cases occur sporadically, typically coming from other affected regions. Cases have climbed to a 27-year peak in Canada, with 2,698 confirmed this year compared to only 17 in 1998. One death was reported in Ontario this year. 'We are in the midst of an outbreak in parts of Canada right now, and there are potential exposures in public places, airports, community centres, restaurants, public places where people may visit,' Bogoch said. 'But if people are immune to this infection, preferably through vaccination but also through recovery from infection, the risk is negligible.' As many parts of the world experience an increase in measles cases, Canada's travel health notice says the risk is at the lowest level. The level 1 advisory encourages travellers to practise health precautions, including avoiding insect bites, properly wash their hands and have updated vaccinations. It said vaccination is the best way to protect yourself and others from the disease. Data from the European Centre for Disease Prevention and Control show the number of measles cases in the European Union and European Economic Area have risen since 2013. 'My main concern is that there may be people who are non-immune who can receive a free, widely available vaccine that has decades of safety data and decades of effectiveness data associated with it and that it's a preventable disease,' Bogoch said. How do you get measles? The virus is spread through coughing, sneezing or breathing the same air as an infected person. It can remain contagious in the air or on infected surfaces for up to two hours, according to the World Health Organization. Who is most at risk? Most people are immune to measles, but the virus will circulate more in certain cases, with those who are unvaccinated and not immune to it mainly getting infected, Bogoch said. He noted that pockets of Canada may have undervaccinated communities. He listed an example of many cases in Ontario occurring in a largely unvaccinated Mennonite Christian community in the southwestern part of the province. 'It sadly spreads like wildfire, and that's exactly what we're seeing happening right now,' Bogoch said. People who get infected with the virus are typically those under age 20, he added. 'It's primarily, almost exclusively … people who have not received two doses of vaccine,' Bogoch said. 'You can significantly lower risk of infection by receiving a routine childhood immunization. Two doses of a measles vaccine is extraordinarily effective in preventing measles infections.' Where are people more likely to get measles? While people can contract measles at airports, train stations and other crowded public areas, Bogoch said there isn't one primary place of infection. 'Measles is transmitted primarily in indoor settings through the air,' he said. 'It's a virus that is able to stay suspended in the air for a prolonged period of time, and the infectious dose is tiny. 'So if someone is non-immune and is exposed to the virus in an indoor setting, there's a very high likelihood that that person will get infected with measles.' With the disease mostly transmitted in indoor settings, the risks aren't necessarily higher during the peak summer travel season. 'It can be transmitted at any time of year,' Bogoch said. 'For example, in the winter months, there might be more people crowding in indoor settings because it's cold outside.' Symptoms and treatment Symptoms can show up as a fever, cough, runny nose and watery eyes before a rash with red and blotchy spots appear. There isn't any specific antiviral treatment for measles. People can be treated with medications to help relieve symptoms. Most people recover, but severe cases may need to go to the hospital. Bogoch said the vast majority of those born before 1970 were already infected with measles since the virus was common back then, so they generally won't have to worry about getting it and have 'lifelong protection.' Most who have received two doses of the measles-mumps-rubella (MMR) vaccine, which is routinely given to children, have a 'very, very small' risk of infection, Bogoch added. Advice for travellers If you're travelling anywhere outside Canada where the measles risk may be higher, Bogoch recommends getting health advice before leaving the country. 'There's measles, but of course, there's a lot of other things that you can be mindful of and take precautions to ensure you have a healthy, safe and happy trip,' he said.