Fueling Revolutionary Discoveries
A newly developed implantable device may replace the need for insulin injections. And it all started with a single idea that took off, thanks to donor support dedicated to out-of-the-box thinking.
Since he was a young boy hanging out after school in his father’s research lab at the University of California, Berkeley, Mohamed Zayed, MD, PhD, has wanted to be a scientist. “I loved the research environment and knew I wanted to have my own research lab from a young age,” Dr. Zayed says.
While Dr. Zayed was a college student, his healthy, athletic father had an unexpected heart attack that added another dimension to Dr. Zayed’s career plans. “I spent a week in the ICU with my dad after his heart attack, and that led me to pursue a career in both medicine and science.”
Today, Dr. Zayed continues to split his time between research and treating patients with cardiovascular disease as a Washington University vascular surgeon at Barnes-Jewish Hospital. “I love it; this is the job I’ve always aspired to have,” he says.
Currently, he is leading a research lab that is making a dramatic difference in vascular disease as well as transplantation. It’s a unique intersection of disciplines that is creating revolutionary discoveries.
BELIEVING IN POSSIBILITIES
While speaking at a forum in 2019, Dr. Zayed met a scientist who was trying to figure out how to get pancreatic cells into a person with diabetes without the cells being attacked by the immune system.
Dr. Zayed’s inquisitive mind and experience as a vascular surgeon sparked an idea that may dramatically change treatment for people with diabetes. As a vascular surgeon, his role is creating attachments to an artery and vein for continuous blood supply. One common procedure he frequently performs involves inserting a graft with a hollow tube under the skin that is attached to an artery and vein for dialysis access to treat patients with kidney disease. He recognized the graft concept could be used for other purposes.
“I implant grafts all the time for different purposes, such as dialysis access,” he says. “I thought why not create a modified graft that senses glucose and make that as a platform for the pancreas.”
As a vascular surgeon, he was confident this device could work. “I kept going because I could see in real time in every surgery that this could work. The idea continued to mature in my mind, and I realized this is something doable, even if outside companies didn’t believe in it. People were telling us we were crazy—so I really thought this must be a good idea.”
BRINGING AN IDEA TO LIFE
He was right, and his colleagues and other scientists at Washington University and Barnes-Jewish Hospital also believed in his idea. As a result, Dr. Zayed and his research team received seed funding support from The Foundation for Barnes-Jewish Hospital.
With this invaluable funding, the research team set out to develop a device that could be implanted to act as an artificial pancreas—and to prove the device was feasible.
By 2021, Dr. Zayed and his research team had a prototype design they were confident would work. Through an innovative approach, they partnered with the Washington University McKelvey School of Engineering School to help.
“We constructed our own grafts in our lab,” he says. “The creation of the implanted device, called NuPanc, was the result of two disciplines colliding. To build a graft like this takes a lot of engineering insight to make sure the graft stays open, with no leaking. Creating the NuPanc would not have been possible without our collaboration with engineers.”
The simple-looking NuPanc device is implanted under the skin below the collarbone, similar to a chemotherapy port. Tubes are attached to an artery and vein. The center air-tight reservoir holds the precious donated pancreatic cells. Once NuPanc is implanted, the cells are perfused, and the pancreatic cells begin to produce the insulin needed to metabolize blood sugar.
Transplant pilot project grants brought this idea to life. “We made this device 100 percent by ourselves with no outside company,” Dr. Zayed says. “Pilot grants helped us build the graft and source the materials. We had to build multiple prototypes and pressure test them and check for quality control. We had months of testing, and there was lots on the line. Our engineers worked all night on it before the first transplant. This project would have been impossible without multidisciplinary collaboration with engineers. If we had done it by ourselves, it would have gone nowhere. It required multidisciplinary collaboration. So much goes into a project like this, and it requires critical contributions from many team members.”
On the day of the first test, Dr. Zayed placed purified pancreatic cells from a human donor into the graft device and then implanted the device into a human-size pig host.
“When we saw it work in the host, it was a real thrill,” Dr. Zayed says. “There was lots of celebration. That rush of excitement never gets old, even after we’ve implanted 20 devices so far.”
After three weeks, the insulin-producing pancreatic cells were alive and functioning and were not rejected by the immune system. Remarkably, no immunosuppression drugs were needed.
“The fact that no host has needed immunosuppression is unprecedented,” Dr. Zayed. “And the human cells are surviving and functioning in the host to make insulin. We’re excited to tell the world about this.”
The Foundation grant enabled the researchers to determine feasibility. It also triggered additional grants, including one from Mid-America Transplant, to take the study further.
“This pilot project support catalyzed further development of the graft,” Dr. Zayed says. “We’re incredibly grateful to the Foundation for the seed funding that allowed us to do what many told us was not possible. We ran with it, made a prototype, and did the necessary tests to demonstrate feasibility. Now, we’re further testing the graft to show efficacy.”
The next step is to show if NuPanc can regulate blood sugar in diabetes. If so, this NuPanc device brings hope to millions of patients with type 1 diabetes who are insulin-dependent. “This progress would not be possible without the funding and trust we received,” Dr. Zayed says.
Believing in our insights and ideas allowed us to pursue this idea and make it a reality.”
So far, the pilot grant from the Foundation has provided 16 times return on investment.
Dr. Zayed also credits Foundation support for building the bridges that led to the project’s initial success. “The incalculable components are the relationships, collaboration, and credibility we built with patients and physicians that helped progress the NuPanc idea. But we didn’t do this by ourselves. It took teams of transplant surgeons, islet specialists, immunologists, endocrinologists, and nephrologists.”
He continues: “We’ve developed a platform technology I would never have anticipated I would be working on. That’s how science works. You see where it takes you, keep an open mind, and work with incredible team members who know more than you.”
OPENING THE DOOR TO LIFE-CHANGING IMPACT
NuPanc has the potential to change the future of treatment and quality of life for the 10 million people in the United States who have type 1 diabetes. People with this disease are dependent on insulin they have to inject several times a day. They are also at risk for many complications, including deadly diabetic comas from low blood sugar. And some patients can’t afford the skyrocketing cost of insulin, or their disease is poorly managed.
“What’s revolutionary about NuPanc is that it offers a sustainable way to provide patients with insulin that can reduce the complications associated with diabetes, including long-term cardiovascular risk, vision loss, kidney disease, and death,” Dr. Zayed says. “By treating diabetes effectively, we can reduce health care costs and improve quality of life for patients. Diabetes will be even more prevalent in the next 10 years, so we need a better way to manage patients.”
In the future, he believes the device could be used in additional disease processes such as thyroid disease, or it could provide another way to slowly release other medications into the bloodstream.
More significant steps for NuPanc are on the horizon, including clinical trials. “The runway for this device to be used routinely in humans may be 10 years off, but we believe within two years we may be able to implant the device in humans in clinical trials,” Dr. Zayed says. “And Barnes-Jewish Hospital could be the first site for clinical trials. We’re still in the beginning despite progress we’ve made. It’s a long development cycle, but we have the brains and all the people who want to work on this—we just need the fuel.”