Regeneration Research in Diabetes: Future Application Areas
Therapies with stem cells
Stem cells are the hope of modern medicine. Into the one hand they possess a high self-renewal rate and on the other hand the ability to develop (differentiate) into any type of body cell. Therefore, approaches to replace diseased / defective tissue of the pancreas with stem cells. Stem cells are therefore also an alternative to the limited donor organs. Therapy with the body’s own stem cells (such as progenitor cells of beta cells or dopaminergic neurons for Parkinson’s therapy) thus significantly reduces the risk of a rejection reaction. Stem cell therapies can, however, other risks, in particular the formation of tumors.
Stem cells can be obtained in different ways. Pluripotent human embryonic stem cells are one possible option. They are obtained from undifferentiated cells of the embryo at an early stage of development and are then multiplied in cell cultures almost indefinitely. However, many legal and ethical hurdles still have to be overcome on the way to clinical application.
Tissues developed from stem cells could in future be an alternative to scarce donor organs such as the pancreas.
Adult stem cells
In principle, stem cell therapy could thus be possible with adult bone marrow stem cells. These progenitor cells form certain cell types as substitutes for damaged tissue. Compared to embryonic stem cells, adult bone marrow stem cells have a lower division rate and thus limited differentiation possibilities. They migrate into injured tissue and support the action of the immune system, stimulate blood vessel formation and cell growth.
Induced pluripotent stem cells (iPS cells) are another possible option. They are produced by artificial reprogramming of adult tissue-specific stem cells, in the case of diabetes from the pancreas, and are functionally similar to embryonic stem cells. Scientists are currently placing great hopes in these iPS cells: they could be used to circumvent the ethical problems of human embryonic stem cells as well as develop individual, tailor-made therapies. The 2012 Nobel Prize in Medicine has been awarded the title of “The Greatest Cells”.
Tissue regeneration through stem cells
Current stem cell research is dedicated to the key molecular mechanisms that enable stem cells to mature into tissue-specific functional cells. The aim is to artificially stimulate stem cells to undergo such maturation to produce cells as tissue replacement or to regenerate remaining cells.
Overall, however, the potential for tissue regeneration by stem cells is still poorly understood. After all, they are injected with adult bone marrow stem cells. Damage to nerves and kidneys, for example, is not as severe as it would otherwise be. The research is still at an early stage.
Regenerative therapies give opportunities for cure – for type 1 and also for type 2 diabetes. Prof. Heiko Lickert, head of the Institute of Diabetes and Regeneration Research at Helmholtz Zentrum München, explains the different strategies in a video interview. Length: 2.33 minutes
The role of the immune system
In type 1 diabetes the insulin-producing beta cells of the pancreas are destroyed by antibodies of the immune system (so-called autoantibodies). In various therapy studies, approaches are tested to stop this immune reaction.
Stem cells of the immune system
Stem cells of the immune system can be obtained from umbilical cord blood or bone marrow. The immune system from reacting incorrectly. Treatment with these cells should prevent the malfunction of the immune system.
Umbilical cord blood has not been successful for treating children with type 1 diabetes.
Umbilical cord blood for the immune system
The body’s own umbilical cord blood can be deep-frozen for years in order to serve as a stem cell source for therapy in the event of disease as an adult.
Umbilical cord blood has already been used to treat cancer and immunodeficiencies. In diabetes, the treatment approach is still new; it is intended to improve blood glucose control and regenerate the destroyed beta cells. One approach to treating type 1 diabetes what to use autologous umbilical cord blood to increase the immune system’s tolerance to beta cells.
Unfortunately, various clinical studies have shown no relevance to the metabolism and immune status of children. There was no evidence that the development of type 1 diabetes could be influenced by the therapy.
Immune stem cells from bone marrow
In other words, immune stem cells were taken from the bone marrow of patients with type 1 diabetes. They were then given strong drugs that killed the immune cells in the body. The stem cells were then administered again by infusion. In twelve of the fifteen participants, the immune destruction of beta cells was stopped, but relapses were reported. In addition, immunosuppression by the strong drugs harbors a high risk of side effects, in particular severe infections and germ cell disorders.
Immunomodulatory approaches try to intervene in the immune reaction by blocking specific cell receptors or neurotransmitters. This stops the destruction of beta cells and halts the disease. So far, however, all these methods are still the subject of research and not available for clinical treatment. One reason for this is, among other things, that the long-term effects of immunotherapeutics have not yet been studied.
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