Chapter 21 - From Adult Pancreatic Islets to Stem Cells: Regenerative Strategies for the Treatment of Diabetes and Its Complications

Abstract

Pancreatic islet β cells synthesize the hormone insulin, which is fundamental for the control of glucose metabolism. β cells can be lost as the result of an autoimmune process, leading to type 1 diabetes (T1D), they can develop functional impairments in the context of insulin resistance (type 2 diabetes), or they can be impaired owing to genetic conditions compromising their development or function (monogenic diabetes). Cell-based therapies for beta-cell replacement are under investigation. Transplantation of cadaveric pancreas or pancreatic islets can correct diabetes, but the low numbers of organs available and the need for immunosuppression limit these strategies. β cells can be derived from embryonic stem cells, induced pluripotent stem cells, or adult stem/progenitor cells. Novel findings indicate that stem/progenitor cells exist in the adult human pancreas. Differentiation strategies are largely based on knowledge from embryology. Other regenerative strategies include reprogramming or the delivery of prodifferentiation signals. This chapter will also cover studies of mesenchymal stem cell (MSC) transplantation in diabetic patients. MSCs can modulate immunity and preserve or even stimulate the regeneration of β cells. MSCs had a good safety profile in initial clinical trials for T1D and are being tested as a therapeutic option for complications of diabetes mellitus.