Stem cell transplantation allows for an improvement in metabolic function in patients with type 1 diabetes

This type of diabetes develops most frequently in adolescence and results in the inability of the pancreas to produce enough insulin. It would appear that an autoimmune destruction of Stem cells underlies this dysfunction.

TYPE 1 DIABETES

A chronic disease that can take hold from an early age

This type of diabetes develops most frequently in adolescence and results in the inability of the pancreas to produce enough insulin. It would appear that an autoimmune destruction of β cells underlies this dysfunction. However, its cause, involving both genetic predisposition and environmental factors, is not yet entirely understood.

Incidence among children (between 0 and 14 years old) varies between 0.5 and 60 in 100,000 depending on the country, with the highest rates being in European countries.

Until now, the only possible treatment consists of external supply of insulin and continuous monitoring of blood glucose, several times a day and for a lifetime.

Regeneration and immunomodulation

The only way to cure this incapacitating disease would be to be able to:

  • contribute to the repair of pancreatic tissue
  • avoid destruction of β cells by the patient’s immune system

To this end, stem cell transplantation (SCT) seems to be a promising approach. Numerous pre-clinical experiments, followed by a number of clinical trials, have been conducted in order to evaluate the safety and effectiveness of resolutely innovative cell therapies.

It has emerged that the combined effect of different types of stem cells (hematopoietic and mesenchymal) from different sources (bone marrow and umbilical cord tissue) is synergetic. This is due to the complementarity of different types of stem cells: while the bone marrow stem cells induce β cell regeneration, the stem cells from the umbilical cord tissue allow for modulation of the autoimmune response.

Evaluation of safety and effectiveness

Recently, a group of researchers from the Diabetes Research Institute of Miami (FL, USA) and Xiamen University (China) conducted a pilot clinical study with the aim of evaluating safety and effectiveness in terms of endogenous insulin secretion from co-transplantation of stem cells from umbilical cord tissue (UC-MSCs) and autologous mononuclear cells from bone marrow (aBM-MNC) in patients with type 1 diabetes.

The controlled randomized study involved 42 patients

  • All 21 patients in the test group received a SCT (UC-MSCs + aBM-MNC) and the standard clinical treatment
  • All 21 patients in the control group received only the standard clinical treatment

Observations were continued up to 1 year after treatment and at intervals of 3 months.

Reduced need for external supply of insulin

C-peptide secretion, traditionally used to measure the endogenous production of insulin, increased significantly in the test group (SCT), while a tendency to decrease was parallelly observed in the control group.

The level of glycated hemoglobin (HbA1c), which allows for evaluation of the average 3-month glucose plasma concentration, dropped significantly at 3, 6, 9 and 12 months in the test group (SCT) while remaining stable in the control group.

The test group (SCT) patients did not achieve insulin independence but a reduction in need for external supply of insulin, while these same needs remained unchanged in the control group.

A measurable improvement in metabolic function

The authors of this study consider these results to be a proof of concept of the fact that stem cell transplantations (SCT) allow for a measurable improvement in metabolic function in patients with type 1 diabetes.

REFERENCES
Jinquan Cai, Zhixian Wu, Xiumin Xu, Lianming Liao, Jin Chen, Lianghu Huang, Weizhen Wu, Fang Luo, Chenguang Wu, Alberto Pugliese, Antonello Pileggi, Camillo Ricordi and Jianming Tan (2016) Umbilical Cord Mesenchymal Stromal Cell With Autologous Bone Marrow Cell Transplantation in Established Type 1 Diabetes: A Pilot Randomized Controlled Open-Label Clinical Study to Assess Safety and Impact on Insulin Secretion. Diabetes Care 39:149-157