LLU&MC Scope Autumn 2000-Breakthroughs in Treatment

Breakthroughs in treatment

Loma Linda forges ahead into new territory in several medical areas

Loma Linda has become well-known for its willingness to explore the frontiers of medical science through research and clinical innovation. Not all of the advances receive the widespread attention that the infant heart transplantation or proton therapy programs do, but these advances nonetheless impact the lives of individuals in very tangible ways.

Following are two such advances related to malfunctions in the bodys autoimmune response. In both instances, the advances show great promise in the effort to improve the quality of life for the individuals whose lives have been impacted by debilitating and potentially deadly diseases.

First autologous stem cell transplant for scleroderma performed at Medical Center

Before her stem cell transplant on August 15, Angela Harris was unable to raise her arms even to brush her teeth. Extreme scarring on her skin, caused by scleroderma, made it difficult for Ms. Harris to walk up stairs or make a fist. Scarring of her internal organs, which had also occurred, would eventually lead to her death if left untreated.

Since her stem cell transplant at Loma Linda University Medical Center, during which her own stem cells were reinfused into her body, Ms. Harris condition has begun to improve.

Since the experience, she says, "I no longer take little things we normally do every day for granted, like tying my shoes."

Ms. Harris, clinical research coordinator for Loma Linda University Cancer Institute, is the first patient in California to undergo a stem cell transplant for scleroderma as part of a multi-center trial funded by the National Institutes of Health and based at the Fred Hutchinson Cancer Research Center, in Seattle. Loma Linda University Medical Center is the only California hospital participating in the trial.

Although Ms. Harris progress so far is encouraging, her transplant surgeon, C. S. Chen, MD, assistant professor of medicine, hematology and oncology, wont know the full extent of the transplants success for several months. At that time, Ms. Harris is scheduled for a skin biopsy and tests of her white blood cells. These tests, explains Dr. Chen, will show whether or not the disease is responding to treatment.

It will take three to five years to determine if stem cell transplantation will be effective for all scleroderma patients, Dr. Chen adds.

In spite of Dr. Chens cautious optimism, Ms. Harris conveys that she felt sure the procedure would be successful as it was happening. Now, as her condition eases, she grants "I have to slow my pace down, because I get a little anxious to do everything right away."

The extreme scarring of scleroderma takes place when the bodys immune system attacks itself. Abnormal white blood cells target body tissue rather than foreign invaders. Scarring can form on the skin, lungs, heart, gastrointestinal tract, and kidneys. This scarring hardens the skin and, in the diffuse cutaneous disease type, can cause organ failure within five years of the first symptoms. It is a rare disease, affecting approximately one in every 2 million people-more often women than men. There is no known cure.

As part of her treatment, stem cells from Ms. Harris blood were removed from her body and frozen. She then went through two days of total body irradiation, followed by chemotherapy designed to completely kill her white blood cells. Then her stem cells were reinfused into her body.

Because blood cells and bone marrow originate from stem cells, the transplant enabled Ms. Harris body to produce new, normal white blood cells.

Not only was this a first in the treatment of scleroderma, it was also the first time that the Medical Centers radiation medicine department performed total body irradiation, attests Norman L. McBride, MBA, vice president, LLUMC.

Loma Linda University Medical Center is one of 10 active centers with the National Collaboration of Stem Cell Transplantation for Autoimmune Disease.

According to Dr. Chen, a second potential candidate for the stem cell transplant trial is currently being screened at the LLU Transplantation Institute.

Childrens Hospital breaks new ground with glucose monitoring devices

Jeanine Sharkey, CPNP, CDE, inserts a small flexible electrode under the skin of Lindsay Grace's abdomen. The electrode hooks up to a monitor the size of a pager.

For five children who prick their fingers four times a day and inject themselves with insulin once a day, a little poke in the abdomen isn't much to worry about. The children, patients at Loma Linda University Childrens Hospital Pediatric Diabetes Center, had a blood glucose sensor inserted under their abdominal skin during a press conference on September 25.

One in 400 children worldwide suffer from type I diabetes, a disease characterized by insulin deficiency. For diabetic children, controlling blood glucose is one of the most important factors in reducing the risk of life-threatening complications.

Until recently, the only way to test blood glucose was through a fingerstick test performed four times daily. The device inserted into the childrens abdomens, the MiniMed Continuous Glucose Monitoring System, takes measurements every 10 seconds and averages those results every five minutes, providing a more complete picture of overall glucose control. It takes 288 readings per day, compared to four readings with the traditional fingerstick method.

Prior to the press conference, the Pediatric Diabetes Center completed the first large-scale test of the monitor.

On September 11, 20 children came to Childrens Hospital to have the devices inserted under their skin.

During the three days they wore the devices, the children maintained a detailed diary of their activities, meals, and moods. They also continued to perform fingerstick tests and entered the scores into the monitoring system to check the accuracy of the device.

After downloading the information from the monitor into a computer, the medical staff at the Pediatric Diabetes Center learned that the children could have blood sugar highs and lows in between their fingerstick tests and never know it.

One advantage the new device provides for the children is the opportunity they now have to adjust their insulin dosage based on the information gleaned during the three-day trial.

Every opportunity to fine-tune their blood sugar control translates into less risk of complications later on. In fact, tight blood sugar control can decrease the risk of complications 30 to 60 percent, according to Eba Hathout, MD, medical director of the Center.

One child, 13-year-old Lisa Vanni, discovered that her blood sugar would rise after she had her daily bowl of Cap'n Crunch cereal for breakfast.

She has already worn the monitor, but had it reinserted to see if changes made to her insulin dosage were correct. She likes knowing more about what affects her blood sugar.

"What you can't tell can hurt you in the long term, she asserts.

The device will assist patients and medical professionals in determining the accuracy of each childs insulin level and additional factors that may be affecting the ability to control blood glucose correctly.

[Scope, Autumn 2000]