http://abc.net.au/science/news/tech/Inn ... 587896.htm

Diabetics fly far for pig cell transplants
Anna Salleh
ABC Science Online


Friday, 10 March 2006


A new type of tourism is taking off (Image: iStockphoto)

People with diabetes are flying to a clinic in Mexico for an injection of pig cells, hoping this xenotransplant will cure them.

But experts are worried about the risks involved with this so-called xenotourism or xenotravel, both to the patient and to the rest of the community.

Peta Cook, a PhD student at Queensland University of Technology's Centre for Social Change Research will present her research on xenotourism at a meeting of the Transplantation Society of Australia and New Zealand in Canberra later this month.

Xenotourism is where someone specifically goes to another country for a xenotransplant, the transplant of animal tissue or organs to treat conditions like diabetes.

Australia currently bans xenotransplantation, mainly because it could transfer infectious diseases from animals to humans.

In other countries, such as the US, clinical trials are being carried out under strict regulation.

But xenotransplants are available today to the general public for over US$35,000 (A$47,000).

The Laboratorio de Xenotransplantes in Mexico has been offering pig cell transplants to the world since 2004 to treat diabetes.

Cook says her correspondence with the clinic confirms patients from a country in the northern hemisphere were admitted in 2005.

"They confirmed with me that there were two people who had already received the therapy in January and February last year and since returned to their home country and they had two more people who were coming across to have a consultation," Cook says.

"They were looking at doing about one a month as an international patient but of course that could be stepped up."

Experts urge caution
The International Xenotransplantation Association (IXA) says xenotransplantation might introduce new infections from animals, so requires "extreme caution".

The clinic in Mexico states on its website that its pigs are raised in "pathogen free farms" and the "isolated cells are examined to establish the levels of purity, viability, functionality, sterility and then cultured before being transplanted".

The risk of infection is "extremely low", it states, adding it has been authorised by a range of Mexican government institutions.

But the international expert community is concerned there's no way of checking what Mexico is doing.

"They claim that they have approval from local and government authorities for this activity but there is no formal regulatory authority," says Professor Anthony d'Apice of St Vincent's Hospital in Melbourne, who is IXA's immediate past president.

IXA and WHO are calling for the establishment of international standards on which animals can be used for xenotransplants and which tests should be carried out to ensure infection doesn't occur.

They also say patients given xenotransplants need to be monitored closely to see if they get sick afterwards.

While the clinic in Mexico requires patients to visit their GP and endocrinologists in their home country, other experts say this is not enough.

D'Apice says infectious diseases experts should be involved in the monitoring.

Under the quarantine radar
Normally if you bring live animal material into Australia it has to go through quarantine. But when the animal material is inside someone, it's not exactly obvious.

"There is no quarantine status that says you must declare that you've had a porcine transplant," says d'Apice, whose research involves genetically modifying pigs to stop rejection of their pancreas and kidney cells when they are transplanted into non-human primates.


Pigs are considered the best source for xenotransplants (Image: USDA)
"If you go from the United States, down to Mexico, have a transplant, and fly back into the United States you don't tick on your immigration, quarantine or any other form that you've been potentially exposed to this type of risk.

"I think we place ourself at some risk from xenotourism."

While he is short on recommendations on what Australia should do about this, he says Australia should help lobby at the international level for uniform standards.

But Cook says we can't wait for international standards because xenotourism is already happening.

She says Australia should address the issue now, despite its moratorium, which d'Apice predicts will be lifted in just two or three years.

The problem is, though few people, even in the expert community, are even aware that xenotourism is happening, says Cook, least of all GPs who would be on the frontline of any fallout from xenotourism.

"If I get a xenotransplant I could walk in to my doctor and have a sore throat and just be diagnosed with a sore throat and be told to suck on some lozenges when if fact I could have something a lot more serious going on," she says.

D'Apice agrees this could be a problem.

"A GP would have absolutely no idea about this," he says.

The Royal Australian College of General Practitioners was unavailable for comment.