AT ONE O'CLOCK ON A SUNNY AFTERNOON, LOUIS DYKES AWOKE IN HIS CAR AT A GAS STATION PARKING LOT 50 MILES NORTH OF CHATTANOOGA. He remembered leaving his North Georgia home early that morning, but he had lost almost five hours. “It’s unnerving not to know where you were or what you did,” says the athletic 49-year-old. He had developed a condition called hypoglycemic unawareness—meaning he no longer experienced trembling or other warning signs when his blood sugar began sinking to dangerously low levels.
     A healthy person has 3 million islet cells churning out insulin in the pancreas. As a teenager, Dykes suddenly, mysteriously, had none. As a type 1 diabetic, he depended on multiple daily injections, then an insulin pump, to provide the insulin his own body no longer produced. The second whammy, the terrifying onset of hypoglycemic unawareness, eventually proved a blessing, he says. It made him eligible for a new treatment at Emory, one of only a few places in the world performing transplants of islet cells harvested from the pancreases of donors. The first type 1 diabetic treated in the clinical trial at Emory had thrown away her insulin pump after one infusion of islet cells, her lifelong diabetes gone. But she was petite. At 165 pounds, the tall, lanky Dykes required three infusions, from three separate donors, before his transplanted islet cells could produce enough insulin to achieve the same miracle.
     Dykes now must take daily toxic immunosuppressive drugs to prevent rejection of his islet cells. Filled with energy, once again in control of his body and mind, Lewis says taking the drugs is a trade-off he is delighted to make. But Christian Larsen, director of the Emory Transplant Center, and colleague Thomas Pearson, director of the kidney transplant service, are not satisfied with just one kind of miracle. Their research focuses on how to trick the body into accepting foreign tissue without having to suppress the entire immune system. Promising results—first in primates and more recently in human kidney transplant recipients—are evidence that these new strategies may one day pay off.

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In search of the holy grail
in transplantation
Every year, 23,000 organ transplant recipients get a new chance at life. However, they also get a life sentence to a regimen of immunosuppressant drugs that make them more vulnerable to infectious disease, cancer, hypertension, high cholesterol levels, and ironically, rejection of their transplanted organ. Working with colleagues at Bristol-Myers Squibb, Christian Larsen and Thomas Pearson have developed a new medication called belatacept that blocks the immune response more selectively than cyclosporine, the drug currently used, thereby avoiding some of its side effects. A study at the Yerkes National Primate Research Center at Emory found that belatacept significantly prolonged survival of transplanted kidneys in rhesus macaque monkeys. A clinical trial at Emory and 19 other transplant centers around the world found that belatacept was as effective in preventing organ rejection as cyclosporine and that patients randomly selected to get the new drug had lower blood pressure, lower cholesterol, and better-functioning kidneys. It’s another giant step toward that holy grail of transplant tolerance, and clinical trials begin soon with islet cell recipients.

Build for the future:
> AGREE TO BE AN ORGAN DONOR. Check the box on your driver’s license and tell your family your wishes. Emory’s research accomplishments in islet cell transplantation—as well as those in heart, lung, and other organs—would have been impossible without the generosity and foresight of organ donors.
> HELP SOMEONE AT THE TOP OF THEIR FIELD. Professorships created by $1 million endowments are vital in providing clinicians enough time to teach or perform research while continuing the work that made them candidates for professorships in the first place.
> ENHANCE THE IMMUNE SYSTEM. Or more precisely, enhance a new center learning how to do that. The Lowance Center for Human Immunology is developing tools to measure immune function in both healthy and sick people, and not just in traditional immune disorders such as allergy, transplant rejection, and rheumatoid arthritis but also in diseases like atherosclerosis, cancer, and Alzheimer’s.
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