Abstract
Advanced type 2 diabetes mellitus is associated with significant morbidity and mortality due to cardiovascular, nervous, and renal complications. Attempts to cure diabetes mellitus using islet transplantation have been successful in providing a source for insulin secreting cells. However, limited donors, graft rejection, the need for continued immune suppression, and exhaustion of the donor cell pool prompted the search for a more sustained source of insulin secreting cells. Stem cell therapy is a promising alternative for islet transplantation in type 2 diabetic patients who fail to control hyperglycemia even with insulin injection. Autologous stem cell transplantation may provide the best outcome for those patients, since autologous cells are readily available and do not entail prolonged hospital stays or sustained immunotoxic therapy. Among autologous adult stem cells, mesenchymal stem cells (MSCs) therapy has been applied with varying degrees of success in both animal models and in clinical trials. This review will focus on the advantages of MSCs over other types of stem cells and the possible mechanisms by which MSCs transplant restores normoglycemia in type 2 diabetic patients. Sources of MSCs including autologous cells from diabetic patients and the use of various differentiation protocols in relation to best transplant outcome will be discussed.
Highlights
Obesity and diabetes are the major health challenges for the twenty first century, according to a recent report by the International Diabetes Foundation
Safety studies are still ongoing for embryonic stem cells (ESCs) as well as for insulin secreting cells derived from adult induced pluripotent stem cells, both of which have achieved the highest differentiation efficacy far into insulin producing cells [9, 10]
The high differentiation potential of ESCs and induced pluripotent stem cells (iPSCs) clearly surpasses that of adult stem cells, including mesenchymal stem cells (MSCs), the latter remained a favorite for transplantation scientists because of their “benign”, nontumorigenic differentiation potential
Summary
Obesity and diabetes are the major health challenges for the twenty first century, according to a recent report by the International Diabetes Foundation. The major concerns with ESC-derived β pancreatic cells remain to be the potential to form benign cystic teratoma of the remaining high percentage of undifferentiated cells and the ethical concerns of possible destruction of embryos in the process of collecting the ESCs. Safety studies are still ongoing for ESCs as well as for insulin secreting cells derived from adult induced pluripotent stem cells (iPSCs), both of which have achieved the highest differentiation efficacy far into insulin producing cells [9, 10]. Some of the successful stem cell transplant protocols maintained that activation of endogenous progenitor cells, rather than differentiation of donor cells into insulin producing cells, provides reasonable mechanistic justification for the improved insulin secretion. Pancreatic injury seems to have stimulated the stem cells’ ability to secrete insulin and increases their number [15]
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