Stem Cell Therapy for Type 1 Diabetes Mellitus
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Type 1 diabetes mellitus (T1DM) is caused by autoimmune destruction of insulin producing β cells, and theoretically, it can be cured by replacement of the lost β cells. The limitations along with successes of pancreas transplantation opened the door for stem cell therapy for T1DM. For clinical application, regenerated β cells have to show robust glucose-responsiveness to maintain euglycemia. It is also important to protect the new β cells from autoimmune destruction as well as graft rejection. Studies using embryonic stem cells (ESCs) are encouraging, but there are ethical concerns on destroying human embryo to harvest ESCs. Researches using bone marrow stem cells (BMSCs), induced pluripotent stem cells (iPSCs), umbilical cord blood, pancreatic and hepatic cells are also promising, and they can circumvent the ethical issues on using human ESCs. BMSCs are probably the most promising because of their proven ability to promote the regeneration of β cells, and immune modulating effect that may prevent autoimmune destruction of β cells. IPSCs, reprogrammed from skin fibroblasts or spermatogonial stem cells, are also good candidates for stem cell therapy. Although there are major challenges to overcome, with rapid progress of science, stem cell therapy has the potential to realize a permanent cure for T1DM in the future.
Abstract
Type 1 diabetes mellitus (T1DM) is caused by autoimmune destruction of insulin producing β cells, and theoretically, it can be cured by replacement of the lost β cells. The limitations along with successes of pancreas transplantation opened the door for stem cell therapy for T1DM. For clinical application, regenerated β cells have to show robust glucose-responsiveness to maintain euglycemia. It is also important to protect the new β cells from autoimmune destruction as well as graft rejection. Studies using embryonic stem cells (ESCs) are encouraging, but there are ethical concerns on destroying human embryo to harvest ESCs. Researches using bone marrow stem cells (BMSCs), induced pluripotent stem cells (iPSCs), umbilical cord blood, pancreatic and hepatic cells are also promising, and they can circumvent the ethical issues on using human ESCs. BMSCs are probably the most promising because of their proven ability to promote the regeneration of β cells, and immune modulating effect that may prevent autoimmune destruction of β cells. IPSCs, reprogrammed from skin fibroblasts or spermatogonial stem cells, are also good candidates for stem cell therapy. Although there are major challenges to overcome, with rapid progress of science, stem cell therapy has the potential to realize a permanent cure for T1DM in the future.
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