Diabetes with insulin, syringe, vials, pills (© Sherry Young - stock.adobe.com)
Although it’s rare, some events in medicine are so monumental that they mark a new era in healthcare and society. In the 20th century, it was the advent of antibiotics. More recently, it was the synthesis of vaccines using messenger RNA (mRNA). Now, we may be witnessing another world-changing event in medicine.
A new study published in the journal Cell has documented the case of a 25-year-old woman with Type 1 diabetes. She became the first person with the disease to receive a transplant of reprogrammed stem cells from her own body. Less than three months later, researchers say she is producing her own insulin without the need for supplemental injections.
James Shapiro, a transplant surgeon and researcher from the University of Alberta in Canada, describes the results as stunning. He notes that the procedure completely reversed the patient’s diabetes, freeing her from the substantial amounts of injected insulin that she required prior to surgery.
Millions of diabetics need a solution
As of 2021, about 38.4 million people in the United States had diabetes. That’s almost 12% of the population, and the numbers are growing. About half a billion people around the globe have diabetes. Most have Type 2 diabetes, in which their bodies are less sensitive to insulin, or they don’t produce enough of it. With Type 1 diabetes, the patient’s immune system attacks their own islet cells in the pancreas.
Islet cell transplants can treat diabetes, but there aren’t enough donors to meet the need. Donor transplants also require the recipient to take immunosuppressive drugs indefinitely to avoid rejecting the foreign islets.
Stem cells can be used to produce any tissue in the body. Since they are the patient’s own cells, immunosuppressive drugs may be unnecessary.
How did scientists make this breakthrough?
For this investigation, a team of researchers led by Hongkui Deng from Peking University collected cells from three people with Type 1 diabetes. They chemically processed the cells to restore them to a pluripotent state – meaning they could be formed into any type of cell in the body. From these pluripotent cells they generated clusters of islet cells.
Clusters of cells, equivalent to about 1.5 million islets, were injected into the woman’s abdominal muscles — a new site for islet transplants. Usually, islet cells are injected into the liver. By placing them in the abdomen, the researchers could use MRI to monitor cell activity and intervene if necessary.
Less than three months later, the transplanted cells were producing enough insulin that supplemental insulin was no longer necessary. The patient’s blood sugar readings stayed in the target range 98% of the time. The scientists know that if this phenomenal response occurs in other patients as well, the treatment would be an incredible leap forward in the management of diabetes.
Although there is great excitement about his game-changing procedure, the results must be applicable to many diabetic patients, and the insulin production must be sustained for years before doctors can call it a cure for diabetes.
Deng says the results for the other two participants are also favorable. He plans to expand the next trial to include 10 to 20 individuals. It is hoped that the body will not reject the transplant because it doesn’t consider the cells to be “not self.” People with Type 1 diabetes, however, do have an autoimmune condition, so there is still a risk that the body could attack the islets. In that case, immunosuppressant drugs may be necessary.
A different group in Shanghai, China recently reported the successful transplant of insulin-producing islet cells into the liver of a 59-year-old man with Type 2 diabetes. The islets were also reprogrammed stem cells from his own body. He was able to discontinue taking insulin.
The Bottom Line
Diabetes affects every cell in an individual’s body. Even when blood sugar levels are carefully managed, diabetes triggers a cascade of complications, including kidney failure, heart attacks, strokes, eye damage leading to blindness, nervous system damage with painful symptoms and loss of function, and many others.
A cure for diabetes would have far-reaching effects, hopefully halting that cascade. The magnitude of the changes in individuals, changes in public health, and the practices of healthcare would be monumental – for the betterment of all.
