Stem Cell Treatment for Diabetes: How Far Have We Reached?

September 2024 marked a historical moment in diabetes research and treatment. Scientists reversed diabetes in a 25-year-old woman with a decade-long disorder. The treatment was the transplantation of islets derived from stem cells. The significance of the breakthrough was the outcomes. The blood glucose levels remained in range, and the need for insulin injections was eliminated for over a year. The groundbreaking study delivered the promise of stem cells for diabetes made decades ago. But the research has provoked a flurry of questions- have we actually arrived at the stage of stem cell therapy for diabetes?

Diabetes

Millions of people across the globe are suffering from diabetes, and the numbers just keep on rising. The two primary classifications of this metabolic disorder:

Type I Diabetes (Juvenile Diabetes): The body’s immune system destroys the islets cells that produce insulin. The individuals are prescribed external insulin to compensate for the lack of insulin in the body.

Type II Diabetes: The body cells develop resistance to insulin. The medications aim to stimulate insulin production and reduce blood glucose levels.

The resultant rise in blood glucose has severe consequences. The increased glucose deposit on blood vessels and nerves causes damage such as retinopathy, nephropathy, neuropathy, etc.

Why do we need stem cell therapy?

The medications for diabetes focus on reducing blood glucose and increasing insulin levels. The drugs cause severe complications in long-term use. The lifelong dependency on the medications lowers the quality of life. The situation is even more grim in type I diabetes, where people have to take costly insulin injections. None of the medications can repair the damage to islet cells and restore insulin synthesis. That is where stem cells enter the picture. To regenerate, heal, and restore the islet cell function.

How Stem Cells Work?

Stem cells have two properties- self-renewal (form more stem cells) and differentiation (form different cell types). These distinguishing properties enable stem cells to restore a particular organ/tissue. For diabetes, they can form islet cells, resulting in increased insulin production, which is especially beneficial for type I diabetes. For stem cell therapy, the following outcomes are studied:

• Increase insulin levels

• Improve blood glucose levels

• Reduce dependency on external insulin and drugs

The Clinical Studies: Where are We?

Umbilical cord mesenchymal stem cell (UCMSC) transplant in diabetes patients exhibited a significant increase in insulin levels, a decline in blood glucose levels, and reduction in insulin dependency. The effects continued for months, proving the sustainable effects of therapy.

Research has suggested that UCMSCs also act by controlling immune responses. These cells increase regulatory T cells that regulate autoimmunity, thereby preventing further damage to islet cells by the immune system. It is particularly beneficial for patients recently diagnosed with diabetes. Lu et al. conducted a study with such patients and showed islet cell protection after MSCs infusion. 

Another approach employing the differentiation of MSCs into insulin-producing cells before transplant, has provided positive results in animal studies. None of the studies has reported any adverse complications arising from the stem cell treatment for juvenile diabetes.

The Challenges on the Way

Although clinical studies have proved the effectiveness and safety of stem cell treatment for juvenile diabetes, the therapy has not been translated into clinical settings. There are several reasons behind this. The clinical studies included only a limited number of people, questioning their reproducibility in the large population. Additionally, the studies vary on the stem cell dose and its administration route. Therefore, a streamlined procedure is not present.

The MSCs-Exosomes: The New Approach

MSCs synthesize and release tiny microscopic vesicles called exosomes. These exosomes contain a variety of biomolecules like RNAs, proteins, cytokines, and growth factors to communicate with other cells. They provide an alternative to cell-free therapy. The studies on MSCs-exosomes are concentrated on animal models only, and clinical trials are yet to be conducted. However, the infusion of exosomes has yielded improvements in diabetic animal models. The exosomes exhibited reduced inflammatory components of the immune system and increased regulatory immune cells. The blood glucose levels, insulin sensitivity, and even the glucose transporters on skeletal muscle. They also enhanced glycogen storage in the liver and lipid metabolism.

The Future Perspectives

Stem cells have regenerative power behind them and have shown their potential in several studies. However, the absence of large-scale studies and a standard treatment procedure has delayed their acceptance into routine treatment. MSCs-exosomes offer an attractive cell-free alternative to stem cells for diabetes, but lack the clinical trial analysis. Considering the advances in stem cell therapy, there is a high likelihood of incorporation of therapy based on MSCs or exosomes into the standard treatment, providing lasting relief to type I diabetes patients.

In India, Advancells has been a leading manufacturer of stem cells for years. It offers MSCs with consistently high quality, keeping the hope alive.