A world-renowned diabetes researcher has joined Wendy Novak Diabetes Institute, a part of Norton Healthcare and Norton Children’s, with the goal of curing Type 1 diabetes.

Balamurugan N. Appakalai, Ph.D., also known as Dr. Bala, is a leading researcher in islet cell transplants and is widely considered one of the most skilled islet isolation specialists in the world. Islets are types of cells in the pancreas that help produce insulin. In Type 1 diabetes, the immune system mistakenly attacks these islet cells, which causes the body not to produce insulin. Dr. Bala specializes in islet cell transplants, which can allow a patient with diabetes or who has had their pancreas removed to produce insulin on their own.

Dr. Bala joined Norton Healthcare in September and said he is excited to bring his research and team from Nationwide Children’s in Columbus, Ohio, to Louisville. Led by Dr. Bala, the Norton Islet Cell Research & Transplant Program, housed within Wendy Novak Diabetes Institute, will become a hub for diabetes research and islet cell transplants.

“I believe we have a real opportunity to find an eventual cure for Type 1 diabetes,” Dr. Bala said. “My team and I look forward to what we will accomplish in the years to come.”

Norton Healthcare and Norton Children’s currently are building more than 1,500 square feet of laboratory space, which will make it one of only 11 in the U.S., to allow the team to isolate and prepare islet cells for transplantation, pioneer new islet treatments, lead clinical studies, and support new and ongoing research efforts.

Decades dedicated to islet cell research

Dr. Bala has been an “isletologist” for more than 30 years. While his passion is in research, he specializes in performing life-changing islet transplants for patients. He has performed thousands of human pancreatic islet isolations and animal isolations. Isolated islet cells can then be transplanted back to the same patient (autotransplantation), into another patient (allotransplantation) or even into an animal of a different species (xenotransplantation), which sometimes is done for research purposes.

His fascination with diabetes research began during a project for his master’s degree, where he first tested anti-plant extracts in animal models.

Around this time, in 1993, the concept of islet cell transplantation emerged, and Dr. Bala decided to pursue a doctorate in islet cell transplant research. His entire doctoral and postdoctoral work focused on islet cell transplants, and he has worked in this field ever since.

Initially, Dr. Bala worked with monkey islet cells, then pigs for xenotransplantation, before transitioning to working with human islet cells.

He spent over five years serving as co-director of islet core research and assistant professor of surgery at the University of Pittsburgh’s Thomas E. Starzl Transplantation Institute in Pennsylvania. Dr. Bala later moved to the University of Minnesota, Minneapolis, which was a leader in pancreas and islet cell transplants, where he served as director of islet core and associate professor of surgery for more than seven years.

In Minnesota, he performed over 500 clinical islet cell transplants, including National Institutes of Health-funded clinical islet transplant (CIT) Phase 3 clinical trials and worked on research using pig islet cells for future human therapy.

With a desire to dedicate more time focusing on islet research advancements, Dr. Bala moved to Louisville, where he helped establish a clinical and research program at the University of Louisville in 2014. Through his work at Jewish Hospital, he processed human pancreas islet cells for clinical use and shipped islet cells to other hospitals. Thanks to Louisville being a UPS transportation hub, other medical facilities had the ability to ship a patient’s removed pancreas to Dr. Bala, where he could isolate islet cells in Louisville and ship them back for clinical infusions. This allowed for more patients to receive this type of transformational care.

In 2018, Dr. Bala was recruited by Cincinnati Children’s in Ohio, where he continued to perform islet cell transplants in pediatric patients, followed by Nationwide Children’s. During this time, his family never left Louisville. He always hoped for a chance to work in the city he called home.

Generous support brings islet cell research to Louisville

In 2024, Dr. Bala’s dream to return to Louisville became a reality when the new Norton Islet Cell Research & Transplant Program within Wendy Novak Diabetes Institute was created. Dr. Bala’s team and key facility development were funded with grants of more than $2 million from the Norton Children’s Hospital Foundation, thanks to generous donations from the community with lead gifts from the James and Judith K. Dimon Foundation and the Lift a Life Novak Family Foundation.

Norton Healthcare opened a research laboratory dedicated to Dr. Bala’s islet cell research activities in October 2024. A Good Manufacturing Practices islet cell transplant production lab that will produce medical products for islet cell transplants is expected to open in 2025.

Dr. Bala’s research advancements

Islet cell research has come a long way in the decades since Dr. Bala began his work.

“When I started my Ph.D. in islet cell work, the concept of transplanting islet cells to cure diabetes was emerging,” he said.

Through Dr. Bala’s research, much has been uncovered about how these clusters of cells work and how they can impact a patient with diabetes. After the islet cells are collected, their physiological behavior has been studied and better understood, including how these cells release insulin and how they can be stimulated to release insulin.

Additionally, the concept of transplanting islets has evolved from animal to human applications. Dr. Bala says this technique has been mastered through many research and animal pancreases to formulate a protocol for the best method to collect the maximum number of islet cells from every pancreas without damaging the cells or compromising their function. Different protocols and enzyme formulations have been developed and implemented through Dr. Bala’s research, including variations based on a person’s age, weight and health condition.

“Based on our research, we found we needed to provide better vascular supply to islet cells before and after we transplant,” he said. “My goal is to keep blood vessel cells alive for a longer time.”

Dr. Bala’s research work is focused around harvesting islet cells from a donor pancreas and transplanting them into the liver of a patient with diabetes, meaning the patient may be able to forgo the need for insulin injections. However, transplanted islet cells currently don’t last a patient’s lifetime, so Dr. Bala is working on research to support transplants that can last longer, including evolving stem cell research. Currently, this treatment in other countries is considered the standard of care, but in the United States it has not been approved for use by the Food and Drug Administration. The research conducted by Dr. Bala and his team could play an integral role in aiding with approval for this treatment.

Dr. Bala’s research has focused on advancing pancreatic islet cell isolation and transplantation not only in patients with Type 1 diabetes, but also for those with surgery-induced diabetes. The methods he developed have shown to improve short- and long-term outcomes in patients and have been incorporated into transplantation programs across the country.

Currently, autologous transplantation of a patient’s own islet cells harvested from their removed pancreas and transplanted back into the liver is considered the standard of care and is eligible for insurance reimbursement. Dr. Bala and his team have a group of patients who underwent successful transplantation, and some have successfully avoided the onset of diabetes for more than five years.

A happy return to Louisville

Dr. Bala chose to return to Louisville to work with Norton Healthcare, attracted by its focus on research and clinical care.

Although his work has taken him to different parts of the country, Dr. Bala has considered Louisville home for more than 10 years.

“My family has decided to stay in Louisville, no matter what,” Dr. Bala said. “That’s the reason I didn’t relocate from Louisville to another city, like Cincinnati or Columbus. When Norton provided this great opportunity, our family was very excited.”

Dr. Bala said he looks forward to remaining close to his family while contributing to health care advancements in Kentucky and Southern Indiana that will reach far beyond this region. He said he hopes groundbreaking research will continue to impact diabetes patients worldwide.

“In the future, it will be possible to treat a larger part of the population,” he said. “I also strongly believe one therapy is not the solution for all patients. For example, some patients will continue to take insulin injections, others will have native and stem cell-generated islet cell transplantation, and some patients will even be able to have a full pancreas transplant to cure their diabetes.”