A new on-site islet laboratory at the Cincinnati Children’s Pancreas Care Center further improves care for pediatric patients who receive a total pancreatectomy with islet autotransplantation (TPIAT) procedure to treat pancreatitis.

The laboratory is part of the Cincinnati Human Islet Program (CHIP) and brings cell preparation in-house, says Maisam Abu-El-Haija, MD, MS, medical director of the Pancreas Care Center and medical director of the CHIP initiative.

“This is the next step forward and upward for improving islet production and clinical outcomes for our patients,” Abu-El-Haija says.

Benefits of an In-House Lab

Cincinnati Children’s has performed more than 100 TPIAT procedures. The first TPIAT procedure using on-site cell isolation at Cincinnati Children’s was in January 2023.

TPIAT eases the severe pain caused by relapsing pancreatitis. The procedure involves removing the chronically inflamed pancreas and reconstructing the gastrointestinal tract. The resected pancreas is sent to the new islet lab, where islet cells are isolated. Once that process is complete, the surgeon transplants the islet cells into the liver to allow the body to make insulin when the cells engraft. This mitigates the risk of brittle diabetes.

The advantages the new facility provides include:

• High-quality islet cell products.

• Reduced operating time.

• Faster recovery time for the patients.

Published research studies that compare on-site and off-site islet cell isolation find that patients who receive TPIAT with on-site islet cell preparation show less dependence on exogenous insulin after surgery. “Having the TPIAT program and islet lab all in one place is a dream come true,” Abu-El-Haija says.

Building the Cincinnati Human Islet Program (CHIP)

The Pancreas Care Center team spent more than a year preparing and building its islet lab, partnering with cell therapy experts at Cincinnati Children’s and beyond. One key contributor was Rita Bottino, PhD, director of islet products at Imagine Pharma in Pittsburgh, a global leader in human islet cell isolations. Bottino is a world-renowned expert in the field with more than two decades of experience using the highest-quality standards.

Bottino consults with Cincinnati Children’s and is on-site during every islet isolation procedure. She works closely with Carolyn Lutzko, PhD, laboratory director for the CHIP program and director of cell manipulations in the Translational Core Laboratory at Cincinnati Children’s.

Personalized Protocols

The CHIP team knows how to assess the health of pancreas tissue and adjust their process accordingly to provide the patients with the best islet cell yield possible. “The pancreatic tissue’s response to the digestion process varies, so we have to balance enzymatic and mechanical digestion to recover as many islets as possible,” Dr. Abu-El-Haija says. “We follow rigorous qualitative standards but must decide ‘in the field’ which digestion approach to use to achieve the best results.”

In addition, Abu-El-Haija says, “We strive to choose the best time for intervention. We don’t want to operate too soon or wait too long and do multiple ERCPs [endoscopic retrograde cholangiopancreatographies], only to have the islet cells burn out. It is a fine line that we walk and a balance that we have to keep.”

The Pancreas Care Center team works with families—many of whom come from outside of Cincinnati—to find the best time for them to schedule a TPIAT procedure. Having the islet lab in-house increases the scheduling flexibility and options.

Research Opportunities

The new islet lab also provides opportunities for research and future care improvements. The team tracks data, outcomes and protocols and uses the information to decide when research is needed to improve an outcome or a step in the process.

Cincinnati Children’s was the first pediatric medical center in the United States to have a pancreas center of excellence, as designated by the National Pancreas Foundation, for children. The Pancreas Care Center at Cincinnati Children’s remains one of the few centers globally where pediatric-trained physicians and surgeons perform pediatric TPIAT procedures in patients as young as 3 years old when indicated.