Stem cell therapy to cure T1 diabetes? The Indian perspective

Pluripotent stem cells that have the ability to transform into any cell type are pre-programmed into insulin-producing cells and transplanted into the human body: this is a potential game-changer in the treatment of Type 1 diabetes

Stem cell therapy is a cutting-edge development in regenerative medicine that holds the promise of a functional cure for Type 1 diabetes (T1D) by enabling the body to regenerate insulin-producing beta cells.

A recent report of a woman with type 1 diabetes (T1D) in China who regained her insulin production has made headlines. She received a transplantation of reprogrammed stem cells that reportedly “reversed” the disease. It marks a significant milestone in diabetes management. This is the first ever successful breakthrough in regenerating functional insulin-producing cells through stem cell therapy. There are other such trials that are still underway.

T1D is an autoimmune condition where the immune system attacks and destroys the insulin producing beta cells of the pancreas, resulting in diabetes. That means you are insulin-dependent to manage the ailment for life. For decades, managing T1D has relied on insulin therapy alone. In type 2 diabetes, the insulin that is produced by the body is either insufficient or ineffective, which is managed mostly by taking oral drugs. Insulin may be needed in some cases.

Stem cell therapy in T1DM

The concept of stem cell therapy lies in regenerative medicine. Pluripotent stem cells that have the ability to transform into any cell type are pre-programmed into insulin-producing cells and transplanted into the human body. These pre-programmed cells will then start producing insulin and help regulate glucose. This is a potential game-changer in the treatment of T1D.

Scientists have been making great strides in creating the cells that would mimic the pancreatic islets in functionality from different pluripotent stem cell sources. These include embryonic stem cells (ESC), derived from early-stage embryos, which can differentiate into beta cells; and induced pluripotent stem cells (iPSCs), adult cells that can be genetically reprogrammed to a pluripotent state and can differentiate into insulin producing cells. These offer a less controversial alternative to ESC.

The challenges

Although stem cell therapy does show positive outcomes in a controlled setting, there exist several challenges in achieving desired results in real-world practice. Firstly, the fact that it is an invasive procedure, and any invasive procedure carries risks. Also, newly-transplanted cells are prone to rejection by the body and will require long-term immune suppression that could cause infections and cancer. Even the encapsulation technology that protects the transplanted cells from immune rejection carries a risk in the long term. The requirement for periodic replenishment to sustain the durability and functional efficiency of the beta cells is also under question. In addition, regulatory approvals by the authorities need to be addressed before becoming available to the broader public.

The Indian perspective

In India, there are more than 8.6 lakh people living with T1D. The costs of healthcare for a person with T1D are far higher than for a person with the more common type 2 diabetes. The day-to-day life of a person with T1D can be challenging, considering total dependence on externally administered, multiple daily insulin injections. As it occurs in the very early years of life, there is also a likelihood of early complications. In our country, where the demand and costs are high, treatments involving stem cell transplantation are far from reality.

The availability of newer insulin therapies and improved insulin delivery devices, including more sophisticated insulin pumps that are AI-enabled, in addition to continuous glucose monitoring devices, have made management of T1D more efficient, especially in children.

Given these facts, stem cell therapy represents an exciting frontier in the treatment of T1D, offering the potential for a functional cure. While significant advances have been made in the generation of pancreatic islets from different stem cell sources, further research is needed to address its long-term efficacy.

If successful, stem cell therapy could revolutionise the management of T1D, moving beyond insulin replacement to a treatment modality that restores the body’s ability to regulate blood glucose naturally and essentially cure the disease. However, considering the cost and, more importantly, the scalability to the population at large; more time may be required to establish stem cell therapy as an accessible, standard routine treatment for T1D.

(Dr. Nanditha Arun is consultant diabetologist at Dr. A. Ramachandran’s Diabetes Hospitals. dr.nanditha.arun@gmail.com)

Published - October 04, 2024 11:14 am IST