Abstract
Stem cells hold great promise for pancreatic beta cell replacement therapy for diabetes. In type 1 diabetes, beta cells are mostly destroyed, and in type 2 diabetes beta cell numbers are reduced by 40% to 60%. The proof-of-principle that cellular transplants of pancreatic islets, which contain insulin-secreting beta cells, can reverse the hyperglycemia of type 1 diabetes has been established, and there is now a need to find an adequate source of islet cells. Human embryonic stem cells can be directed to become fully developed beta cells and there is expectation that induced pluripotent stem (iPS) cells can be similarly directed. iPS cells can also be generated from patients with diabetes to allow studies of the genomics and pathogenesis of the disease. Some alternative approaches for replacing beta cells include finding ways to enhance the replication of existing beta cells, stimulating neogenesis (the formation of new islets in postnatal life), and reprogramming of pancreatic exocrine cells to insulin-producing cells. Stem-cell-based approaches could also be used for modulation of the immune system in type 1 diabetes, or to address the problems of obesity and insulin resistance in type 2 diabetes. Herein, we review recent advances in our understanding of diabetes and beta cell biology at the genomic level, and we discuss how stem-cell-based approaches might be used for replacing beta cells and for treating diabetes.
Highlights
Stem cells hold great promise for pancreatic beta cell replacement therapy for diabetes
E potential of stem cell approaches for diabetes is attractive because the development of both forms of diabetes is dependent upon deficiency of pancreatic beta cells, and the diabetic state can be reversed using beta cell replacement therapy
E progression of complications to the eyes, kidneys and nerves can be largely halted by prevention of hyperglycemia [5]. erefore, advances in stem cell biology have the potential to make beta cell restoration possible as an approach for both forms of diabetes
Summary
There have been extraordinary recent advances in our understanding of diabetes because of its priority as a major health problem and the remarkable development of scientific methods in genomics, genetics, cell biology and other fields. We have described some of these advances and have focused upon ways in which stem cell research might lead the way to new therapies and paths to better understand the pathophysiology of the various forms of diabetes. There has been particular emphasis upon how stem cells might allow replenishment of the beta cell deficit that is such a fundamental part of diabetes, but there are various ways in which stem cell research might help with the problems of autoimmunity, insulin resistance and the vascular complications of diabetes. Competing interests The authors declare that they have no competing interests
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