Developments of stem cell therapy in diabetes using latest technologies

Received: 30-Mar-2022, Manuscript No. jem-22- 63302 ;;Accepted Date: Apr 22, 2022; Editor assigned: 01-Apr-2022, Pre QC No. jem-22- 63302 (PQ); Reviewed: 15-Apr-2022, QC No. jem-22- 63302 ; Revised: 22-Apr-2022, Manuscript No. jem-22- 63302 (R); Published: 27-Apr-2022, DOI: 10.4303/jem/236058

Commentary

Insulin was one of the most significant medical breakthroughs. When this hormone was isolated in 1921, type 1 diabetes (T1D) became a treatable illness rather than a fatal one. However, there is growing optimism that insulin therapy for T1D will be obsolete in 100 years. Insulin is essential for keeping blood glucose levels stable. It is produced in the pancreas by cells that constantly detect circulating glucose concentrations and secrete insulin in response. As sugar levels rise, more hormone is released to counteract the rise. However, in T1D, the cells are destroyed by the person’s own immune system. The cause of this autoimmunity, which typically manifests in childhood, is unknown, but the effect is clear: in the absence of cells or insulin, circulating sugar levels remain toxically elevated. T1D symptoms can now be reduced with a combination of careful blood glucose monitoring and insulin administration. Despite advances in automated insulin delivery systems, most people’s lives are dominated by the need to carefully manage their own physiology. Even with people shouldering this burden, the average life expectancy for someone with T1D is 12 years lower1. The cause of this autoimmunity, which typically manifests in childhood, is incompletely understood, but the effect is clear: with neither β cells nor insulin, circulating sugar levels remain constantly, toxically elevated. This chronic hyperglycaemia damages blood vessels and nerves, leading to an accumulation of ill-health effects and, if untreated, death.Today, the effects of T1D can be mitigated through a combination of careful blood glucose monitoring and insulin administration. However, despite advances in automated insulin delivery systems, for most people this means a life dominated by the need to conscientiously manage their own physiology. And even with people taking on this burden, the life expectancy for somebody with T1D is 12 years below average1. Frederick Banting, who shared the Nobel Prize in Physiology in 1923 for discovering insulin, was well aware that his work would not provide a cure for diabetes; he concluded his Nobel lecture by saying, “insulin is not a cure for diabetes.” T1D is regarded as one of the most low-hanging fruits in regenerative medicine. It is a condition in which autoimmunity selectively kills a single cell type, so what needs to be replaced is obvious. Furthermore, only a small amount of tissue is required. Cells are one of five endocrine cell types found in the pancreas, where they reside in small pockets of hormone-producing cells known as islets of Langerhans. Although there are approximately one million islets scattered throughout the organ, they account for only 1–2% of its total mass. All cells appear to need to function is easy access to the bloodstream. Attempts to replicate this result in people with T1D in the 1980s and 1990s, using islets extracted from deceased donors’ pancreases, were rarely successful2. When surgeon James Shapiro arrived at the University of Alberta in Edmonton, Canada, in 1993, the university’s transplant programme was no longer in operation. “Nobody wanted to run this because it was such a failure,” he says. However, a review of the literature convinced Shapiro that if the cells engrafted and survived, they would be beneficial. To improve cell health, he increased the dose of cells — using tissue from two to four donors per recipient — and reduced the time between harvesting and implantation. Crucially, he realised that the drugs previously used to prevent the immune system from attacking the transplanted tissue were likely damaging the cells as well. He devised a new drug regimen to avoid this3. All seven of Shapiro’s first patients were able to go without insulin for at least a year, and one is still insulin-free more than 20 years later. “We demonstrated conceptually that islet cell transplantation can significantly improve patients’ lives,” says Shapiro. Shapiro’s method, now known as the Edmonton protocol, is still used at a few clinics to transplant cells into people with T1D who are poorly controlled by insulin. The procedure’s disadvantage is that recipients must commit to a long-term regimen of powerful immunosuppressive drugs, which exposes them to infections and other complications. Even if a large number of people with T1D were willing to make this trade, there are far too few donors to supply cells for more than a small percentage of recipients.

Acknowledgment

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Conflict of Interest

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Copyright: © 2022 Yoshihisa Yamada. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.