Abstract
Aims. Insulin dependent diabetes mellitus (IDDM) is believed to be an autoimmune disorder with disturbed glucose/insulin metabolism, requiring life-long insulin replacement therapy (IRT), 30% of patients develop end-organ failure. We present our experience of cotransplantation of adipose tissue derived insulin-secreting mesenchymal stem cells (IS-AD-MSC) and cultured bone marrow (CBM) as IRT for these patients. Methods. This was a prospective open-labeled clinical trial to test efficacy and safety of IS-AD-MSC+CBM co-transplantation to treat IDDM, approved by the institutional review board after informed consent in 11 (males : females: 7 : 4) patients with 1–24-year disease duration, in age group: 13–43 years, on mean values of exogenous insulin requirement of 1.14 units/kg BW/day, glycosylated hemoglobin (Hb1Ac): 8.47%, and c-peptide levels: 0.1 ng/mL. Intraportal infusion of xenogeneic-free IS-AD-MSC from living donors, subjected to defined culture conditions and phenotypically differentiated to insulin-secreting cells, with mean quantum: 1.5 mL, expressing Pax-6, Isl-1, and pdx-1, cell counts: 2.1 × 103/μL, CD45−/90+/73+:40/30.1%, C-Peptide level:1.8 ng/mL, and insulin level: 339.3 IU/mL with CBM mean quantum: 96.3 mL and cell counts: 28.1 × 103/μL, CD45−/34+:0.62%, was carried out. Results. All were successfully transplanted without any untoward effect. Over mean followup of 23 months, they had a decreased mean exogenous insulin requirement to 0.63 units/kgBW/day, Hb1Ac to 7.39%, raised serum c-peptide levels to 0.38 ng/mL, and became free of diabetic ketoacidosis events with mean 2.5 Kg weight gain on normal vegetarian diet and physical activities. Conclusion. This is the first report of treating IDDM with insulin-secreting-AD-MSC+CBM safely and effectively with relatively simple techniques.
Highlights
The incidence of diabetes mellitus (DM) has been increasing in an epidemic-like fashion in the last two decades globally
Insulin dependent diabetes mellitus (IDDM) is the second most common chronic disease of childhood believed to be autoimmune in nature and characterized by irreversible destruction of insulin-secreting pancreatic β islet cells
We present our experience of insulin replacement therapy (IRT) by co-transplantation of insulin-secreting adipose tissue derived mesenchymal stem cells (IS-AD-MSC) and cultured-bone-marrow- (CBM-) derived hematopoietic stem cell transplantation (HSCT) in 11 IDDM patients
Summary
The incidence of diabetes mellitus (DM) has been increasing in an epidemic-like fashion in the last two decades globally. India is expected to become the world capital of DM by year 2030 [1,2,3]. Insulin dependent diabetes mellitus (IDDM) is the second most common chronic disease of childhood believed to be autoimmune in nature and characterized by irreversible destruction of insulin-secreting pancreatic β islet cells. Symptoms of the disease appear when insulinmaking β cell mass gets reduced by approximately 90%. Leading to severe insulin deficiency and hyperglycemia. At present the only therapeutic options for management are life-long exogenous insulin preparations. Sporadic reports of autologous hematopoietic stem cell transplantation (HSCT) have been reported with limited success [4]
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