Dr. James Shapiro

Tinker, Tailor, Doctor, Researcher
Alberta Heritage Foundation for Medical Research
(University of Alberta)

Heritage Scholar Dr. James Shapiro was planning to be in Edmonton for two years—the length of time that his training in liver transplantation with the University of Alberta’s Dr. Norm Kneteman was expected to take. Then it would be back home to England. . . . That was 12 years ago.

As it turned out, Alberta was not only a good place to learn advanced surgical techniques; it was fertile ground for research in islet transplantation. Islets are the cells in the pancreas that produce insulin—a hormone that helps the body use sugar for energy. In type 1 diabetes, which is an autoimmune disease, the immune system destroys islets. Transplantation replaces the destroyed islets with healthy ones from donor pancreases.

Dr. Shapiro had done research on islet transplantation while he was at medical school in the early 1980s. “The U of A had established an islet transplantation group which was well known. I saw that, as well as doing surgical training here, I could also pick up the threads of my research.”

And pick them up he did. Dr. Shapiro decided to do a Ph.D. in addition to his surgical fellowship. His research focused on improving the anti-rejection drugs that all transplant patients must take. At that time, one of the main reasons for the failure of islet transplantation was that the drugs commonly given to transplant patients—steroids and cyclosporin—were toxic to islet cells.

At the same time, Dr. Shapiro accepted a permanent position in Edmonton. He took additional training in living-donor liver transplantation in Japan and whole-pancreas transplantation in Baltimore. “There were some lonely days and nights in Baltimore waiting for donated organs. I spent that time formulating a more islet-friendly anti-rejection recipe.”

This combination of steroid-free anti-rejection drugs coupled with a sufficient mass of islets to allow a measure of insulin independence is now known worldwide as the Edmonton Protocol. It is the most successful and most widely replicated method of islet transplantation in the world.

Since they published the first paper on the Edmonton Protocol in the New England Journal of Medicine in 2000, Dr. Shapiro and his team have taken islet transplantation from an experimental procedure to a clinical one. Forty centres in 34 countries now do islet transplantation. Globally, more than 550 people have received islet transplants.

“Down the road I think the Edmonton Protocol will be regarded as a major stepping stone toward a cure for diabetes,” says Dr. Shapiro. “It is not a cure because it falls short. But if we could find even more friendly anti-rejection drugs and ways to ensure the survival of more islets, we’d be closer to a cure. And that’s where we’re focusing most of our research. Thirty years from now, I’m confident we’ll have a better source of islets, and treatments that have few, if any, side effects. We may even reach a point where patients don’t need anti-rejection drugs.

“I feel extremely fortunate to have had the opportunities I’ve had in Alberta. The support from the Heritage Foundation is unique, and it’s why I chose to stay here.”

AHFMR supports a growing number of researchers who, like Dr. Shapiro, are also practising physicians. The Foundation expects physician-researchers to commit not less than 75% of their time to health-research activities.

“Physicians bring a clinical focus to research; we’re always asking how the knowledge that comes from basic research will help our patients,” notes Dr. Shapiro. “As a result, there are strong collaborations between physician-researchers and basic researchers. We gain from each other.”

Dr. James Shapiro is the director of the Clinical Islet Transplant Program and an assistant professor in the Department of Surgery at the University of Alberta. An AHFMR Scholar and holder of the CIHR-Wyeth-Ayerst Clinical Research Professorial Chair in Transplantation, he also receives funding from the Juvenile Diabetes Research Foundation, and the National Institutes of Health (NIH) in the United States.

For further information, please contact Dr. James Shapiro using the Email contact form or by phone at 780 407-7330