Author: tsinghua university Dr.Hu
Expert review: Professor Li Jing, Affiliated Hospital of Jiangsu University
Recently, the internationally renowned medical journal Nature Medicine published the latest research results of Professor Deng Hongkui of the School of Life Sciences of Peking University, revealing the experimental progress and research results of stem cells in the treatment of diabetes.
The researchers established a stem cell differentiation protocol with high efficiency and good reproducibility, which solved the problem of efficiently inducing human pluripotent stem cells (IPSCs) to differentiate into functionally mature islet cells.
IPSCs are stem cells with multiple differentiation potentials that can be induced to differentiate into functionally mature islet cells in vitro, but the inefficiency of differentiation has always been an important bottleneck hindering their development. Deng Hongkui's research team greatly optimized the differentiation scheme of IPS to islet cells, focusing on how to efficiently induce differentiation from pancreatic precursor cells to islet endocrine cells, so that large-scale preparation of functionally mature islet cells in vitro isles is possible.
It is reported that this is the first long-term evaluation study of pancreatic islet cells derived from human pluripotent stem cells in diabetic primate models, and the data obtained provide strong evidence for the application of stem cell-derived islets to treat diabetes.
Cell replacement therapy: a potential means of "ending" insulin injections
Diabetes mellitus (DM) is a group of metabolic diseases characterized by hyperglycemia. Hyperglycemia is caused by a defect in insulin secretion or impaired biological action, or both. Long-standing hyperglycemia leads to chronic damage and dysfunction of various tissues, especially the eyes, kidneys, heart, blood vessels, and nerves.
Cell replacement therapy has a good outlook for treating diseases such as type 1 diabetes mellitus (T1DM), which is mainly caused by the loss of islet β cells. Human islet transplantation has been shown to reverse T1DM by effectively restoring endogenous insulin secretion in patients. However, due to the lack of easily available human islet sources, there is currently a limited number of patients who can benefit from islet transplantation. In addition, despite persistent immunosuppression, progressive loss of graft function and recurrence of β cell immune attack also hinder the widespread use of islet transplantation.
Scientists are working on a new cell-based treatment for type 1 diabetes by replacing these lost insulin-producing cells with a special kind of lab-grown cells. Over the past few years, scientists have utilized different stem cells as key components and worked to get the replacement cells to release their own immune-blocking signals. Cell replacement therapy has also become a promising means of "ending" insulin injections.
Clinical data: 30 diabetic patients benefited from mesenchymal stem cells
Human pluripotent stem cells provide a rich resource for producing functional cells, including islet β cells, thus providing a solution that avoids the need for donor-sourced tissue.
In addition to induced pluripotent stem cells, mesenchymal stem cells are also an adult pluripotent stem cell. In recent years, it has been widely used in clinical research on diabetes. In the past, we have shared a number of diabetics who have benefited from stem cells. Let's pick out another 30 of these patients and see what improvements they have received from stem cell therapy.
A study published in 2017 randomly divided 30 patients with a 5-year history of diabetes who responded to 3 times the effectiveness of oral antidiabetic drugs into three groups, two of which were treated with autologous bone marrow-derived mesenchymal stem cells and autologous bone marrow-derived monocyte transplants, respectively, while the trial set up a control group. After 12 months, the insulin needed to stabilize blood glucose decreased by more than 50 percent in six patients in the bone marrow-derived mesenchymal stem cell treatment group, while the amount of insulin used in the control group did not decrease, and this study showed that mesenchymal stem cells had a better therapeutic effect on diabetes [3].
Stem cells help restore health to patients with a 50-year history of diabetes
Let's share a more classic case. Brian Sheldon has been suffering from type 1 diabetes for 50 years, during which he has been at risk of the disease, and in June 2021, he participated in a clinical trial of stem cell treatment for diabetes, and after treatment, his glycemic index has remained stable, and he can even not take insulin for several days. This is a welcome case of stem cells treating diabetes.
brief summary:
In 2019, Time magazine included stem cell therapy for diabetes in the list of 12 innovative inventions that will change the future of top ten medical treatments. Some domestic media have also reported: "Diabetes, macular degeneration, Parkinson's disease, spinal cord injury and other diseases are not only difficult problems that plague the medical community, but also bring great pain to patients, and can bring breakthrough treatment progress, which is not stem cell therapy." From past published clinical studies, we see the potential and benefits of stem cells in treating diabetes. However, stem cell therapy also faces challenges in interfering with diabetes, for example, the quality standards for stem cell preparation have not been fully unified. In addition, more research is still needed to ensure the safety of subjects and the verification of the effect of the treatment, and more scientific evidence is expected to promote this therapy to clinical application.
bibliography:
\1. Du, Y., Liang, Z., Wang, S. et al. Human pluripotent stem-cell-derived
islets ameliorate diabetes in non-human primates. Nat Med 28, 272–282 (2022). https://doi.org/10.1038/s41591-021-01645-7
\2. Top 12 Disruptive Gene and Cell Therapy Technologies Announced Schwarcz, Erik, Le, et al. Preserved beta-Cell Function in Type 1 Diabetes by Mesenchymal Stromal Cells[J]. Diabetes: A Journal of the American Diabetes Association, 2015.
\3. Bhansali S , Dutta P , Kumar V , et al. Efficacy of Autologous Bone Marrow-Derived Mesenchymal Stem Cell and Mononuclear Cell Transplantation in Type 2 Diabetes Mellitus: A Randomized, Placebo-Controlled Comparative Study[J]. Stem Cells and Development, 2017, 26(7):471-481.