Abstract
BackgroundInsulin resistance and insulin deficiency are the cardinal defects in the pathogenesis of type 2 diabetes mellitus (T2DM). Despite the plethora of anti-diabetic medications, drugs specifically targeting the β-cells are still desired. Stem cell therapy has emerged as a novel therapeutics strategy to target β-cells; however, their mechanism of action has not been well defined. This study aims to examine the efficacy and safety of autologous bone marrow-derived mononuclear cells (ABM-MNCs) transplantation in T2DM, and explores the mechanistic insights into stem cells action through metabolic studies.MethodsSeven T2DM patients with the duration of disease ≥5 years, receiving triple oral anti-diabetic drugs along with insulin (≥0.4 IU per kg per day) and HbA1c ≤ 7.5% (≤58.0 mmol/mol) were enrolled for ABM-MNCs administration through a targeted approach. The primary end-point was a reduction in insulin requirement by ≥50% from baseline, while maintaining HbA1c < 7.0% (<53.0 mmol/mol) with improvement in insulin secretion, and/or insulin sensitivity after ABM-MNCs transplantation.ResultsSix out of 7 (90%) patients achieved the primary end-point. At 6 months, there was a significant reduction in insulin requirement by 51% as compared to baseline (p < 0.003). This was accompanied by a significant increase in the 2nd phase C-peptide response during hyperglycemic clamp (p = 0.018), whereas there were no significant alterations in insulin sensitivity and glucose disposal rate during hyperinsulinemic–euglycemic clamp relative to the baseline. Other measures of β-cell indices like HOMA-β, and stimulated C-peptide response to glucagon and mixed meal tolerance test were non-contributory.ConclusionABM-MNCs transplantation results in significant reduction in insulin doses and improvement in C-peptide response in patients with T2DM. Metabolic studies may be more useful than conventional indices to predict β-cell function in patients with advanced duration of T2DM.Trial registration-Clinicaltrials.gov NCT01759823
Highlights
Insulin resistance and insulin deficiency are the cardinal defects in the pathogenesis of type 2 diabetes mellitus (T2DM)
Many patients require a combination of multiple drugs and/or insulin therapy targeting different pathogenetic mechanisms. These therapies help to maintain glycemic control but do not reverse the pathophysiology of the disease, as drugs targeting β-cells are still lacking [1]. This has prompted the clinical investigators to explore the newer therapeutic strategies like cell-based therapy, such as bone marrow-derived adult stem cells, which comprises of hematopoietic stem cells (HSCs) and mesenchymal stem cells (MSCs)
The median volume of the bone marrow harvested for transplantation was 224.0 (213.0–227.0) mL, which yielded 1.2 (1.0–1.4) × 109 mononuclear cells (MNCs) (Additional file 1: Table S1) and 2.0 (0.8–2.3) × 107 of these MNCs expressed CD34+
Summary
Insulin resistance and insulin deficiency are the cardinal defects in the pathogenesis of type 2 diabetes mellitus (T2DM). Despite the plethora of anti-diabetic medications, drugs targeting the β-cells are still desired. Many patients require a combination of multiple drugs and/or insulin therapy targeting different pathogenetic mechanisms. These therapies help to maintain glycemic control but do not reverse the pathophysiology of the disease, as drugs targeting β-cells are still lacking [1]. This has prompted the clinical investigators to explore the newer therapeutic strategies like cell-based therapy, such as bone marrow-derived adult stem cells, which comprises of hematopoietic stem cells (HSCs) and mesenchymal stem cells (MSCs)
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