According to a 2019-published study in Diabetes Research And Clinical Practice, apart from the impact diabetes has on health, it is the top 10 causes of death in adults! There are three main types of diabetes: type 1 diabetes (T1D), type 2 diabetes mellitus (T2D), and gestational diabetes mellitus (GDM). The scientists reported that across the world, a little below half a billion people are suffering from diabetes. 463 million people or 9.3% of the people suffer from diabetes and 50.1% of them are not aware that they have the condition! 85–95% of the disease is accounted for by Type 2 diabetes mellitus (T2DM): due to affected β cell production of insulin and insulin resistance in tissues.
The treatment of T2DM involves hypoglycemic agents and lifestyle changes that can later translate into requiring insulin. While these treatment options can continue throughout life, they just address the glycaemia and not the actual cause of repairing β cells. This brings in the use of pancreatic transplantation and islet cell transplantation; while they primarily target Type 1 diabetes; there are challenges such as the requirement of surgery, donor requirements and immunosuppression.
Mesenchymal stem cells (MSCs) thus enter the scenario with their ability to overcome the ethical issues associated with embryonic stem cells. Among the various sources from which MSCs are isolated, bone marrow MSCs (BM-MSCs), foetal tissues and adipose-derived MSCs (AD-MSCs) have been and are being explored for repairing damaged pancreatic cells. The following are a few examples:
A 2014-published article in Stem Cell Research & Therapy by Liu and team showed improved metabolic control by the administration of allogeneic Wharton’s Jelly-derived mesenchymal stem cells in 22 T2Dm patients. Following one intravenous injection and one intrapancreatic injection, follow up for 12 months showed that beta cell function was improved with lowering of glucose and glycated haemoglobin as well as lowering of overall inflammation (Chinese Clinical Trial Register ChiCTR-ONC-10000985).
The administration of adipose-derived stem cells (ASC) infusion on type 2 diabetic rats lowered hyperglycaemia in 2 weeks (maintained for a total of 6 weeks) against controls. An improvement of islet β cell functions and lowering of inflammatory cytokines such as TNF-α, IL-6 and IL-1β were also observed (Hu et al, Endocrine Journal, 2015).
A team led by Bhansali reported in 2017 in Stem Cells Development the efficacy and safety of administering BM-MSCs and mononuclear cells in 30 patients with T2DM. 60% of the patients showed lowered insulin requirement by ≥50 % with an additional improvement in the insulin sensitivity index in the group that received MSCs.
Many such clinical studies have shown the safety and efficacy of MSCs in addressing the manifestations of T2DM such as regulation of metabolism, islet β cell function restoration and lowering insulin resistance. The routine practice of stem cells in treating an epidemic-like disease such as diabetes is soon expected as a clinical reality.
Qi, Y., Ma, J., Li, S. et al. Applicability of adipose-derived mesenchymal stem cells in treatment of patients with type 2 diabetes. Stem Cell Research & Therapy. 2019; 10: 274.
Pouya Saeedi , Inga Petersohn , Paraskevi Salpea. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Research And Clinical Practice. 2019; 1572: 107843.
Keane KN, Calton EK, Carlessi R, Hart PH, Newsholme P. The bioenergetics of inflammation: insights into obesity and type 2 diabetes. The European Journal of Clinical Nutrition. 2017; 71(7):904–12.
Liu X, Zheng P, Wang X, Dai G, Cheng H, Zhang Z, et al. A preliminary evaluation of efficacy and safety of Wharton’s jelly mesenchymal stem cell transplantation in patients with type 2 diabetes mellitus. Stem Cell Research & Therapy. 2014; 5(2):57.
Hu J, Fu Z, Chen Y, Tang N, Wang L, Wang F, et al. Effects of autologous adipose-derived stem cell infusion on type 2 diabetic rats. Endocrine Journal 2015; 62(4):339–52.
Bhansali S, Dutta P, Kumar V, Yadav MK, Jain A, Mudaliar S, 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. Stem Cells Development 2017; 26(7):471–81.