Essentially the most thrilling information on the planet of diabetes this 12 months has been the profitable use of stem cells to “remedy” diabetes. Simply final month, a affected person with Kind 1 diabetes was reported to be insulin-free a 12 months after stem cell transplant. One other research earlier this 12 months confirmed comparable success in a affected person with Kind 2 diabetes, which is probably a fair larger feat. Each these experiences got here from China, though from totally different teams.
Kind 2 diabetes is brought on by a mix of resistance to insulin and insulin deficiency, happens extra generally in adults, and includes >90 per cent of all circumstances of diabetes (>10 crore are affected in India alone). Kind 1 diabetes, however has a special genesis the place autoimmunity/antibodies assault the pancreas resulting in destruction of insulin- producing beta cells.
MANY APPROACHES TO RESTORE INSULIN SECRETION
For this, scientists tried out pancreatic transplant, islet cell transplant or stem cell transplant. Islet cells within the pancreas are composed of beta cells that produce insulin and alpha cells that produce glucagon. Though islet transplants can restore insulin secretion, there aren’t sufficient donors they usually require the usage of immune-suppressing medication to forestall the physique from rejecting the donor tissue.
Stem cells are a particular sort of cells that may differentiate into specialised cells. They need to be programmed or guided to turn into insulin- secreting pancreatic islet cells. Stem cells might be cultured within the laboratory and probably supply an countless supply of pancreatic tissue.
TWO CASE STUDIES THAT OFFER HOPE
In September, scientists from Shanghai reported {that a} 25-year-old girl with Kind 1 diabetes had began producing her personal insulin inside three months of a transplant of reprogrammed stem cells. The researchers extracted the cells from the affected person and reverted them right into a pluripotent (cells which might differentiate into any cell sort) state, and subsequently used them to generate islet cells. About 1.5 million of those cells have been injected into the belly wall muscle mass. It has been over a 12 months and the girl is sustaining regular blood sugar stage with out insulin injections.
Nonetheless, she was already on immunosuppressants due to a previous liver transplant, which can have helped the cells to outlive. Two different sufferers can even full a 12 months in November this 12 months. Whether or not the cells can escape rejection and autoimmunity (which already exists in folks with Kind 1 diabetes) stays to be seen. Research from Boston utilizing stem cells however with totally different approaches — embryonic stem cells or donor stem cells positioned in a tool to guard them from immune system assaults — are in superior phases.
This report was preceded by one other research in April, the place scientists reported profitable transplantation of insulin-producing islets into the liver of a 59-year-old man with long-standing Kind 2 diabetes. The islets have been derived from reprogrammed stem cells taken from the person’s personal physique. As a substitute of the pluripotent stem cells that have been used within the aforementioned affected person of sort 1 diabetes, they used intermediate stem cell varieties (endoderm stem cells, which might differentiate into sure kinds of cells together with pancreatic cells).Insulin was withdrawn inside three months and the oral antidiabetic drugs have been discontinued in a couple of 12 months.
The derivation of islet tissues from stem cells offers unprecedented new sources for treating diabetes.
Nonetheless, challenges stay. There’s a theoretical threat of uncontrolled proliferation/tumour formation. Whether or not there’s a requirement of life-long immunosuppression in sufferers receiving stem cell transplants is being studied. There may be hope that stem cell-based approaches might cut back the necessity for immune-suppression and even remove it. Each kinds of diabetes additionally pose distinctive challenges. In Kind 1 diabetes, there might be ongoing autoimmunity, which might probably harm transplanted cells. In Kind 2 diabetes, a transplant will solely assist these whose main drawback is insulin deficiency reasonably than insulin resistance.
Bigger research are wanted to find out long-term efficacy.
(Dr Mithal is chairman, endocrinology and diabetes, Max Healthcare)
