Can stem cells ‘cure’ diabetes? Lessons from two trials

MANY APPROACHES TO RESTORE INSULIN SECRETION

For this, scientists tried retired pancreatic transplant, islet compartment transplant oregon stem compartment transplant. Islet cells successful the pancreas are composed of beta cells that nutrient insulin and alpha cells that nutrient glucagon. Although islet transplants tin reconstruct insulin secretion, determination aren’t capable donors and they necessitate the usage of immune-suppressing drugs to forestall the assemblage from rejecting the donor tissue.

Stem cells are a peculiar benignant of cells that tin differentiate into specialised cells. They person to beryllium programmed oregon guided to make into insulin- secreting pancreatic islet cells. Stem cells tin beryllium cultured successful the laboratory and perchance connection an endless root of pancreatic tissue.

TWO CASE STUDIES THAT OFFER HOPE

In September, scientists from Shanghai reported that a 25-year-old pistillate with Type 1 diabetes had started producing her ain insulin wrong 3 months of a transplant of reprogrammed stem cells. The researchers extracted the cells from the diligent and reverted them into a pluripotent (cells which tin differentiate into immoderate compartment type) state, and subsequently utilized them to make islet cells. About 1.5 cardinal of these cells were injected into the abdominal partition muscles. It has been implicit a twelvemonth and the pistillate is maintaining mean humor sweetener level without insulin injections.

However, she was already connected immunosuppressants due to the fact that of a anterior liver transplant, which whitethorn person helped the cells to survive. Two different patients volition besides implicit a twelvemonth successful November this year. Whether the cells tin flight rejection and autoimmunity (which already exists successful radical with Type 1 diabetes) remains to beryllium seen. Studies from Boston utilizing stem cells but with antithetic approaches — embryonic stem cells oregon donor stem cells placed successful a instrumentality to support them from immune strategy attacks — are successful precocious stages.

This study was preceded by different survey successful April, wherever scientists reported palmy transplantation of insulin-producing islets into the liver of a 59-year-old antheral with long-standing Type 2 diabetes. The islets were derived from reprogrammed stem cells taken from the man’s ain body. Instead of the pluripotent stem cells that were utilized successful the aforementioned diligent of benignant 1 diabetes, they utilized intermediate stem compartment types (endoderm stem cells, which tin differentiate into definite types of cells including pancreatic cells).Insulin was withdrawn wrong 3 months and the oral antidiabetic medications were discontinued successful astir a year.
The derivation of islet tissues from stem cells provides unprecedented caller sources for treating diabetes.

However, challenges remain. There is simply a theoretical hazard of uncontrolled proliferation/tumour formation. Whether determination is simply a request of life-long immunosuppression successful patients receiving stem compartment transplants is being studied. There is anticipation that stem cell-based approaches whitethorn trim the request for immune-suppression oregon adjacent destruct it. Both types of diabetes besides airs unsocial challenges. In Type 1 diabetes, determination tin beryllium ongoing autoimmunity, which tin perchance harm transplanted cells. In Type 2 diabetes, a transplant volition lone assistance those whose large occupation is insulin deficiency alternatively than insulin resistance.
Larger studies are needed to find semipermanent efficacy.

(Dr Mithal is chairman, endocrinology and diabetes, Max Healthcare)