A Step Closer to Winning the Diabetes War: The Stem Cell Approach
Diabetes is one of the most widespread metabolic disorders in the world. According to key facts listed by the World Health Organization, the number of people with diabetes has risen dramatically from 108 million in 1980 to 422 million in 2014 with prevalence in patients 18 years old and above escalating from 4.7% to 8.5%. In 2015, an estimated 1.6 million deaths had been documented to be directly related to diabetes. By 2030, the WHO projects diabetes to hit 7th leading cause of death in the world.
Recent developments in medicine managed to keep the disease at bay with the invention of insulin shots and handheld blood sugar measurement devices. While this way of treatment has proven itself helpful, the goal of the scientific community has always been finding a way to actually cure diabetes itself.
What Happens Inside a Diabetic’s Body
Our body breaks down the carbohydrates we ingest into glucose after we eat. Insulin, a hormone secreted by the pancreas, acts as a glucose delivery system to the cells wherein the glucose is used as fuel. In a person with diabetes, insulin is either insufficient, defective, or not produced at all resulting in uncontrolled blood sugar levels that could lead to complications.
Juvenile diabetes, commonly known as diabetes mellitus type 1, is an autoimmune disease characterized by the body attacking and destroying insulin-producing cells resulting to the patient having constant and uncontrolled blood sugar elevations. To date, no medical evidence has been obtained to pinpoint its origin. Due to the complete absence of insulin, type 1 diabetes patients need lifetime insulin shots to keep their blood sugar within normal limits. According to statistical data by the 2015 International Diabetes Federation Diabetes Atlas, Seventh Edition, more than 542,000 children worldwide live with juvenile diabetes.
Type 2 diabetes mellitus, also known as adult-onset diabetes, is more common and is characterized by either insufficient insulin production or insulin malfunction. It is caused by a complex interaction between genetic and environmental factors but can be managed through lifestyle modification. According to figures provided by Diabetes UK, about 90% of diabetics have type 2 DM.
The Stem Cell: A Promising Solution
Stem cells are predecessor cells that are self-renewing and can differentiate into many diverse cell lineages. Early stem cell research focused on hematopoietic stem cells which give rise to different blood cell types. This is because tissue stem cells are more difficult to reproduce due to its precise three-dimensional arrangement and tight cell-to-cell interplay. However, because of their ability to integrate into the cellular composition of body tissues under a controlled environment and developmental cues, the tissue stem cells are perfect for cell replacement therapy.
Since they can be manipulated in vitro to transform into basically any cell type, stem cells hold a great potential for treating several malignant and non-malignant conditions.
The stem cell technique has always piqued the interest of the scientific community in the pursuit of curing various chronic diseases including diabetes. In fact, a study conducted by the Diabetes Research Institute in collaboration with Dr. Lola Reid from the University of North Carolina revealed that pancreatic stem cells may still be found in the biliary tree long after birth despite several scientific evidence suggesting otherwise. This realization opened the doors to developing a cure for diabetes by extracting these pancreatic progenitor cells, turning them into functional mature islets that can produce insulin and reintroducing them into the body.
The astounding results of this investigation paved the way for more studies exploring the world of regenerative medicine.
PEC-Direct: An Innovation in Stem Cell Therapy
A company in San Diego, California named Viacyte has recently released PEC-Direct, an implant that is designed to grow functional insulin-producing cells from stem cells to replace the ones that were destroyed in juvenile diabetes patients. Only as small as a credit card, PEC-Direct is embedded under the skin where its outer fabric will allow blood vessels to penetrate into the device and nourish the progenitor cells. In about three months, the precursor cells will mature into islet cells that are hoped to be able to monitor blood sugar levels and release insulin as a response. If proven effective, it could be a game changer in treating juvenile diabetes as it would eliminate the need for insulin shots and constant blood sugar level monitoring from patients. Two type 1 diabetes patients had just received the implants and a third one is set to get it as well.
Although not truly a cure as it doesn’t address the underlying autoimmune cause, PEC-Direct is still promising as a functional cure for juvenile diabetes according to Paul Laikind of Viacyte as it essentially restores a diabetic’s lost ability to counteract blood sugar elevation with insulin. In addition, it doesn’t require that many biological resources to mass produce as progenitor cells can be cultivated in vitro, unlike donor pancreatic cells.
An Unconventional Attempt at a Cure
Earlier this year, a team of health researchers from the University of Texas had attempted an unorthodox approach to treating diabetes. While most try to implant insulin-secreting cells into the body, the UT team “reprogrammed” existing cells in the pancreas to produce insulin.
“We’re taking a cell that is already present in the body— it’s there and it’s happy— and programming it to secrete insulin without changing it otherwise,” said Dr. Ralph DeFronzo, chief of the diabetes research at the University of Texas Health Science Center in San Antonio.
The stem cell technique has always been the conservative approach to advancing diabetes treatment. Dr. DeFronzo, together with his research partner Dr. Bruno Doiron, opted for a gene transfer technique where “the cell is not fundamentally changed but only given an additional task.” In this approach, they used mice whose biochemistry is very similar to that of humans. The gene is delivered through a virus to activate insulin production in cells already in the pancreas. According to Dr. Doiron, this will “wake up” the target cells with the purpose of producing insulin.
The study had produced very promising results as the test subjects’ immune system did not reject the new insulin-producing cells. Even more astonishing is that the insulin production in the mice had been at optimum levels— not so much as to plunge blood sugar levels and not so little as to shoot them up. According to the findings, the mice did not show signs of diabetes for more than a year after the study.
Even in its staggering success, this untraditional approach will take more rounds of animal testing, time, and money to begin human clinical trials and of course FDA approval. Dr. DeFronzo and his team are hoping to start human trials in three years.
A Renewed Hope
As of this moment, thousands of researchers all over the world are dedicating their time and energy to finding the solution all diabetes patients are praying for. In fact, hundreds of scientific journals are being published every day documenting positive results. It’s only a matter of time.
Diabetes is a lifetime sentence, but with recent advancements in stem cell research and those yet to be discovered, there is hope for a cure. In the meantime, continued care and compliance are of paramount importance.
