STEM CELL THERAPY AS THE EMERGING MODALITY OF TREATMENT FOR DIABETES MELLITUS

What is diabetes?


Diabetes, a leading cause of morbidity and mortality, is caused by absolute insulin deficiency due to
autoimmune destruction of insulin secreting pancreatic β-cells (type 1 diabetes) or by relative insulin
deficiency due to decreased insulin sensitivity, usually observed in overweight individuals (type 2
diabetes).

The pancreas, which helps the small intestine digest food, has hundreds of thousands of cell clusters
called islets of Langerhans where beta cells are. Beta cells produce insulin, which is released into the
bloodstream when blood sugar levels reach a certain threshold. In both types of the disease, an
inadequate mass of functional β-cells is the major determinant for the onset of hyperglycemia and
development of overt disease.

Current approach to patients with Diabetes

The increasing burden of diabetes worldwide is well-known, and the effects on health care costs and in
human suffering, morbidity, and mortality are already substantial.
New drugs are being developed at a rapid pace, and the last few years have seen several new classes of
compounds for the treatment of diabetes,
• Glucagon-like peptide (GLP-1) mimetics
• Dipeptidyl-peptidase-4 (DPP-4) inhibitors
• Sodium glucose transporter-2 (SGLT2) inhibitors
New surgical treatments have also become increasingly available and advocated as effective therapies
for diabetes,
• Gastric restriction surgery
• Gastric bypass surgery
• Simultaneous pancreas-kidney transplantation
• Pancreatic and islet transplantation

While insulin replacement represents the current therapy for type 1 diabetes, its metabolic control
remains difficult, as exogenous insulin cannot exactly mimic the physiology of insulin secretion.
Likewise, Pancreatic or islet transplantation can provide exogenous insulin independence, but is limited
by its intrinsic complications and the scarcity of organ donors.
In this context, stem cell therapy, based on the generation of insulin-producing cells (IPCs) derived
from MSCs, represents an attractive possibility.

How stem cell therapy is tackling this widespread disorder?

Primary approach is to look for ways to restore the number of functional beta cells in patients with
diabetes, pursuing both the replacement of lost beta cells and the protection of beta cells from further
damage.

The first part of this is to generate—or regenerate— cells that sense glucose and produce insulin that
might ultimately be used to replace the beta cells lost as both type 1 and 2 diabetes progresses. Several
different approaches are being used, including:
• Making beta cells from embryonic stem cells or iPS cells. Embryonic stem cells and iPS cells
can be grown in large number in the laboratory and have the potential to be coaxed into
becoming any cell type in the body, including glucose sensing, insulin-producing beta cells.
• Stimulating beta cells to make many more copies of themselves. Beta cells can do this in the
pancreas, but usually very slowly, and less and less as we get older.

Routes of Administration of stem cell:

• Intravenous Injection:- Stem cellsinfused into the body hrough the vein.
• Intra-arterial Injection:- Cells infused via catheter into the artery.

Mechanism of modifying disease pathology by stem cells:

1. Trans-differentiation of MSCs into insulin-producing cells (IPCs) has been regarded as the main
mechanism.
2. MSCs naturally produce a variety of cytokines and growth factors, promoting the survival of
surrounding cells, called as paracrine mechanisms such as angiogenic, cytoprotective, antiinflammatory,
mitogenic and anti-apoptotic effects.
Clinical applications of human embryonic stem cells are limited by ethical concerns, as well as the
potential for teratoma formation. As a consequence, alternative forms of stem cell therapies, such as
induced pluripotent stem cells, umbilical cord stem cells and bone marrow-derived mesenchymal stem
cells, have become an area of intense study.

FURTHER READINGS:

1. http://www.medicalnewstoday.com/articles/291244.php
2. https://www.statnews.com/2016/06/16/stem-cell-diabetes-treatment/
3. https://www.sciencedaily.com/releases/2016/05/160510132809.html

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