Abstract
Stem cell therapy using islet-like insulin-producing cells derived from human pluripotent stem cells has the potential to allow patients with type 1 diabetes to withdraw from insulin therapy. However, several issues exist regarding the use of stem cell therapy to treat type 1 diabetes. In this review, we will focus on the following topics: (1) autoimmune responses during the autologous transplantation of stem cell-derived islet cells, (2) a comparison of stem cell therapy with insulin injection therapy, (3) the impact of the islet microenvironment on stem cell-derived islet cells, and (4) the cost-effectiveness of stem cell-derived islet cell transplantation. Based on these various viewpoints, we will discuss what is required to perform stem cell therapy for patients with type 1 diabetes.
Highlights
The destruction of insulin-producing β-cells is the main pathophysiological feature of type 1 diabetes (T1D) [1,2]
Patients with T1D were able to withdraw from insulin therapy after undergoing islet transplantation from brain-dead donors accompanied by steroid-free immunosuppressive therapy [7]
Blood glucose monitoring using continuous glucose monitoring (CGM) or flush glucose monitoring (FGM) and insulin pumps with a Predictive Low Glucose Suspend (PLGS)
Summary
The destruction of insulin-producing β-cells is the main pathophysiological feature of type 1 diabetes (T1D) [1,2]. Sensor augmented insulin-pump therapy and transplantation therapy of whole pancreas or pancreatic islets may be useful strategies to compensate for β-cell function and control the blood glucose levels [4]. This report indicated that the abnormal gene expression during the differentiation of iPSCs could induce a T-cell-dependent immune response in autologous transplantation. The transplantation of MSC-derived insulin-producing islet-like cells improved glycaemic control in diabetic STZ-treated mice despite the infiltration of immune cells into the peritoneal cavity and left kidney capsule after local transplantation [38]. Immune response-related genes are differentially expressed in SC-islet cells from fulminant T1D donors, compared with those from control subjects, suggesting that abnormal immunoregulation in the fulminant T1D β-cells might cause rapid β-cell destruction and disease development. Immune response-related genes are differentially expressed in SC-islet cells from fulminant T1D donors, compared with those from control subjects, suggesting that abnormal. Based on thesBearseepdoornts,threesseearrecphofrotsc,urseisnegarocnhnfooct uosnilnygpoanncnroetaotinclyβ-pcealnlscrbeuattiaclβso-ctehlels and the immune cellsimofmTu1nDe pcealtliseonftsTw1Dillpbaetievnetrsywimillpboertvaenrtyfiomrpporrotmanottfionrgptrroematomtienngt tsrteraattmegeinets strategies for for diabetes udsiianbgeitPesSCussi(nFgigiPuSreC2s)(.Figure 2)
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