Dr. Camillo Ricordi is acknowledged by his peers as one of the world’s leading diabetes researchers. He spent 1986 to 1988 working at Washington University where he invented what is now known as the Ricordi Chamber, an internationally used technology that isolates large numbers of insulin-producing cells from the human pancreas for transplantation into diabetic patients. Ricordi now serves as scientific director of the University of Miami Diabetes Research Institute and spoke Sept. 29 at an event sponsored by the Missouri Cures Education Foundation.
LN: Having trained as a surgeon, how did you become interested in diabetes as a research topic?
CR: I graduated from medical school with a thesis on diabetes and spent two years volunteering as a medical student in the major diabetes institute in Italy. After I switched to surgery, my cousin, Serena, was diagnosed with Type 1 diabetes. Transplantation in diabetes and curefocused research quickly became my professional life’s mission.
LN: The device you invented, the Ricordi Chamber, isolates islet cells from the pancreas for transplantation, thus allowing people with diabetes to begin producing insulin. How did you first envision this method?
CR: My early research focused on isolating large numbers of insulin-producing cells from the pancreas to obtain enough to reverse diabetes after transplantation of these cells. I soon realized that all methods used then (in the 1980s) were very traumatic. The idea to separate pancreatic islets, which are microscopic structures containing insulin-producing cells, using a nontraumatic technology came to me when I was still in Italy after medical school. My hospital did not have the resources to support the development of the idea, but they allowed me to go to the world’s number one center in this field—Washington University—to work with the ‘father’ of islet isolation and transplantation, Dr. Paul Lacy.
LN: When it became clear that the Ricordi Chamber was effective, what did you consider as next steps toward its wider use?
CR: When I realized the utility of the chamber, and we made the first successful clinical islet transplants, I begin to distribute the blueprints of the system to all scientists, physicians and groups willing to join the battle toward curing diabetes. This allowed everyone to freely access the technology with an ‘open source,’ collaborative approach.
LN: How many patients have been treated with the Ricordi Chamber to date and what progress are you making with the issues surrounding rejection of the implanted cells?
CR: Around 1,000 patients worldwide have been treated with this method. Longterm function of the transplanted islets is now similar to that achieved through a whole pancreatic transplant. A multicenter FDA trial is underway in North America and Europe, and we anticipate that islet transplantation will become an approved, reimbursable procedure for patients with the most severe cases of Type 1 diabetes. However, treatment with anti-rejection drugs limits the number of patients that can benefit from this procedure due to the possible risks and side effects of suppressing the immune system so it doesn’t attack the implanted cells. Research now concentrates on methods to avoid this problem.
LN: One possible source of cells for transplantation are embryonic stem cells, yet there are many ethical issues surrounding their use. How do you approach this?
CR: Once transplantation is successful, it will be impossible to meet the demand for insulin-producing cells to treat patients worldwide. There are now only about 1,500 suitable pancreases per year available from deceased organ donors and about 24 million patients in the U.S. alone. Human stem cells have been successfully converted into insulin-producing cells and used to treat experimental models of diabetes. With a patient dying every four seconds, any deliberate obstacle to cure-focused research could be considered criminal. The reason some people still oppose stem-cell research is because they are not informed appropriately or do not think of the consequences of their actions.
LN: You’ve been very vocal about ultimately curing diabetes. What’s your prediction for making this happen?
CR: I have no doubt that the cure for diabetes is within our reach. However, I am aware of an increasing number of regulatory, political, religious, economic, academic and institutional impediments creating barriers to innovation and the development of cures. To overcome these barriers, we have formed the Cure Focus Research Alliance. A cure could be found within the next five years, or it could take more than 10 years. The difference will largely depend on overcoming the barriers to innovation.