Could stem cells cure diabetes?

A stem cell treatment may reduce the need for insulin in type-1 diabetes, Sanjay Tanday reports

What is the story?
Stem cell treatment has been shown for the first time to remove the need for diabetic patients to have a daily insulin injection, according to media reports.

Stem cells were harvested from blood samples taken from 15 newly diagnosed type-1 diabetes patients.

The patients then underwent chemotherapy to destroy the white blood cells that were causing damage to the pancreas and the stem cells were transfused back into the patients to help rebuild their immune systems.

Follow-up over seven to 36 months of the study found that one patient became free from insulin injections for 35 months, four for at least 21 months, and seven for at least six months, say the papers.

Although previous studies suggested that stem cell therapies could be used to treat a variety of conditions, including Alzheimer’s disease, this study provides the first clinical evidence of the efficacy of stem cells in type-1 diabetes.

What is the research?
The reports are based on a joint US and Brazilian study of 15 patients with type-1 diabetes, aged between 14 and 31, whose condition had been diagnosed within the previous six weeks.

The researchers chose patients who had been recently diagnosed, because they wanted to intervene while a large proportion of pancreatic beta cells remain.

The researchers proposed that a technique called autologous nonmyeloablative hematopoietic stem cell transplantation (AHST) could preserve the beta cell function of the diabetic patients.

For the AHST technique, patients were treated with drugs to suppress their immune systems. This prompted the bone marrow to release stem cells into the blood.

They were then treated with high dose chemotherapy to suppress their immune system and stop the destruction of the few remaining beta cells before being given an immuno-suppressor drug to fend off infection.

The stem cells were then injected back into the body to help rejuvenate the immune system into creating insulin.

Over the course of the study, 14 out of the 15 patients became insulin-free. One patient went three years without having to use insulin. Four patients went without insulin for at least 21 months.

Two patients who initially remained on insulin use after the transplantation developed insulin independence 12 and 20 months after AHST.

Severe adverse effects noted included pneumonia in one patient and endocrine dysfunction in two others.

What the researchers say?
Lead researcher Dr Julio Voltarelli, from the University of Sao Paolo, said the team had obtained encouraging results in the patients with type-1 diabetes.

‘Ninety-three per cent of patients achieved different periods of insulin independence and treatment-related toxicity was low, with no mortality.’

Further research is required to work out how long a patient can go without insulin after the stem cell treatment, he said. The mechanism by which stem cells remove the need for injected insulin also needs to be determined.

What other researchers say?
Dr Iain Frame, research manager at Diabetes UK, said that the results could provide false hope to patients with diabetes.

‘This study had a very small number of participants and importantly did not include a comparison of people who received both immune suppression and a stem cell transplant with those who received either treatment alone,’ he said.

‘It known that there is often a short lived honeymoon period of relative remission after the onset of type-1 diabetes that complicates the interpretation of results such as the ones in this study.’

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