Health

The Surgeon You Should Know

Diabetes cure could be in near future, thanks to him

Within 12 months, a professor, researcher, and transplant surgeon at the University of Wisconsin will know for certain whether he can cure diabetes in a simple, safe, and affordable way.

Dr. Hans Sollinger has been experimenting with gene therapy for the past 20 years, hoping to find a way to eradicate the life-altering and potentially deadly disease.

“He’s the type of surgeon and visionary that comes along once in several generations.”

Doctors diagnose 40,000 to 50,000 new Type 1 diabetes cases each year.

If anyone can cure diabetes, say his colleagues and former students, it’s Sollinger, 69, an athletic and energetic man who recently rode his bike 179 miles across Wisconsin in one stretch.

“After three patents, we are at a point where we are ready to perform pivotal experiments in Type 1 diabetic pet dogs,” Sollinger said in a heavy German accent, a throwback to his Munich youth. “Every expert in the world would agree that curing these dogs would almost 100 percent predict success in man.”

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Sollinger is no stranger to revolutionary thought. In 1968, one of his first jobs as a medical student in Germany was to prepare an anti-rejection medication — then being made in his professor’s laboratory — for Philip Blaiberg, a dentist in South Africa who became Dr. Christiaan Barnard’s second heart transplant patient, and only the third in the world.

“I don’t think I can accurately encapsulate just how important he’s been in the field,” said Dr. Philip Wai, one of Sollinger’s former students, now associate professor in the transplant division at Loma Linda University Health. “He’s the type of surgeon and visionary that comes along once in several generations.”

Sollinger has already proven that twice. In the late 1980s, using dog models and transplanting kidneys between them, he began developing an immunosuppressant drug to prevent organ rejection. Roche Pharmaceuticals now markets it as Cellcept. Recognized as one of the five most important contributions to transplantation in the past 50 years, Cellcept is the most commercially successful drug of its kind. Current revenue: $33 billion.

“When I was pulling out of my driveway in June of 1995 to take my two kids to camp, the FedEx man stopped me to deliver a large parcel,” said Sollinger. “The sender was the CEO of Roche. The parcel contained a very expensive bottle of champagne and a note that said simply, ‘You are a father.’ The Food and Drug Administration had approved the drug.”

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By then, Sollinger already was well known internationally for performing a new technique for pancreas transplantation, one that elevated the success rate to 75 percent and lowered mortality to less than 5 percent.

It might not have happened had it not been for two things — a mandate from his boss, and Sollinger’s life-long grief for his cousin Max, who developed Type 1 diabetes at age seven. Max, who had lost both parents by the age of five, lived with the Sollinger family in Munich, and Hans became “head policeman,” watching to make sure Max didn’t eat too many sweets.

Though Max did well as a teenager, and married and had a child, he died at 33 from complications of a kidney-pancreas transplant.

“I remember we had these really big needles with the glass syringe, not the tiny little needles of today that hardly hurt. We had to boil them, and for a while it was a big deal for Max to get his insulin injection. His thighs looked awful because of the needle sticks. There was no monitoring strip, so we had to guess. And all the cooking was different, too. Max’s diabetes became the center of the family.”

Though Max did well as a teenager, and married and had a child, he died at 33 from complications of a kidney-pancreas transplant. The surgeon was Dr. Walter Land, the leading kidney-pancreas surgeon in Munich, whose lecture as a young professor had inspired Sollinger to pursue the field of transplantation as a medical student.

Land’s method, the duct injection technique, was the best for its time, but it was dangerous. It called for a latex glue-like substance to be injected in the pancreatic duct, which would control secretions. But those secretions often broke out of the back of the pancreas and formed a fluid collection, which pressed on the wound and caused infection.

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“In fact,” Sollinger said, “that happened to Max. His pancreas broke apart, and the secretions came out through his wound and formed an abscess, which eroded into his blood vessels, and he bled out. Within an hour, he was dead.”

By that time, 1980, Sollinger was in the U.S. and had just started his career as a transplant surgeon, and his 1976 marriage to Mary Lang, a woman he met on a ski lift, committed him to staying in Wisconsin. Max’s death spurred him to want to start a pancreas program at the university.

His chairman, Folkert O. Belzer, refused to allow it, arguing that the statistics showed that 40 percent of patients who underwent a pancreas transplant died within the first year, a terrible mortality rate.

“We had to do something better,” Sollinger said. “Professor Belzer laid down the law: ‘Unless you find something new, you’re not going to do a pancreas transplant in Madison.’ He more or less forced me to be creative.”

About the same time, in the early ’80s, Sollinger attended a meeting on pancreas transplantation sponsored by Dr. Land in Spitzingsee, Germany. One day Sollinger went bowling with several physicians, including Dr. David Sutherland, now professor emeritus in the department of surgery at the University of Minnesota, where the first pancreas transplants had been done. Sollinger calls Sutherland the “Pope of Pancreas Transplantation,” or the utmost authority.

“He told the whole world that my results were for real,” Sollinger said with pride, “and I was accepted. From that moment on, most centers copied my technique.”

“I will never forget,” said Sutherland, “when Hans stopped a swing of his arm in mid-stride and said, ‘I’ve got it!’ He then went back to Madison (Wisconsin) and invented bladder drainage of pancreas allograft exocrine secretions, which was much safer than the techniques being employed at the time.”

Sollinger’s new technique, which he had perfected by 1982, involved using the sterile urinary bladder for secretions, taking the pressure off the connections and lowering the incidents of serious complications. In doing so, he tested the patient’s urine for amylase, a component of the digestive juices. If it dropped significantly, it could be a marker of rejection, which had to be treated.

“Before that,” he said, “we had absolutely no way of checking the rejection of the pancreas.”

“People said, ‘As long as you do a kidney transplant, why don’t you put in a pancreas as well and cure the diabetes?’”

Still, the established surgical community was not impressed. Only in 1986, when Sutherland adopted his technique, did Sollinger earn their respect.

“He told the whole world that my results were for real,” Sollinger said with pride, “and I was accepted. From that moment on, most centers copied my technique.”

Within 10 or 15 years, the University of Wisconsin became the world’s largest center for a combined kidney-pancreas transplant. Sollinger knew that 35 percent of Type 1 diabetics develop kidney failure and go on dialysis, making their five-year survival statistics 30 to 40 percent, worse than advanced breast or colon cancer. With a kidney transplant, the chances of survival are about 50 percent better.

“People said, ‘As long as you do a kidney transplant, why don’t you put in a pancreas as well and cure the diabetes?’”

He began transplanting a kidney and a pancreas together, not only getting patients off insulin, but improving their quality of life. A patient who undergoes a combined kidney-pancreas transplant has, in Sollinger’s experience, about a 20 percent better chance of survival at 10 years, as compared to someone who receives a kidney transplant alone. A diabetic patient who does not get a transplant and has to go on dialysis has only a 30 percent chance of survival at five years and close to zero at 10 years.

While he didn’t pioneer kidney-pancreas surgery, “I did so many that within about 10 years I was the world leader, and still am.”

He went back into the lab and put three goals on the blackboard.

In 2009, he celebrated his 1,000th kidney-pancreas transplant, becoming the first surgeon to ever reach that number.

A kidney-pancreas transplant might have been the answer for the 1.5 million Type 1 diabetics, but the operation is expensive. Patients have to go on anti-rejection drugs, and most daunting of all, there aren’t enough donors. Doctors are unable to do more than about 1,300 kidney-pancreas transplants in a year, a realization that gave Sollinger serious pause.

“I said to myself, ‘Hans, this is not the way to look at the future.’”

So he went back into the lab and put three goals on the blackboard:

1. The cure has to be available for every diabetic.
2. The cure has to be affordable.
3. The cure cannot be associated with a major procedure or the need to take drugs with side effects.

Stem cells were the hot, new research focus, but Sollinger decided that gene therapy for cell transplantation ultimately would be best.

His task with gene therapy is to generate beta cells to produce insulin, thus allowing the patient to avoid surgery and immunosuppression.

“He also has to find a way to thwart autoimmunity against beta cells to make this approach succeed,” Sutherland said. “Hans has the animal models to test.”

With 40 diabetic dogs standing by (they are patients at the University of Wisconsin’s Veterinary Medical Teaching Hospital, and their owners give permission), Sollinger is more than optimistic.

“The diabetic pet dog is exactly like a diabetic child, metabolically,” he said. “If it works in our dogs, there is no reason it shouldn’t work in man.”

He added with a chuckle, “I have a little slide, and I made it myself. ‘The Dog Never Lies.’”

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