Diabetes mellitus is the third most prevalent disease in the world after cardiovascular disorders and cancer and diabetes mellitus complications are an important cause of decreased quality of life and disability in the working age population.
The definition “diabetes” includes a group of diseases that are accompanied by an increased blood sugar level (hyperglycemia) due to decreased production of the hormone insulin, lowering blood sugar (type 1 diabetes) or insulin nonperception by cell receptors (type 2 diabetes).
Before the discovery of insulin in 1921 patients with diabetes mellitus died in a period of several weeks to several years after onset of the disease. Currently lifelong insulin replacement therapy is the main method of treatment of diabetes, which significantly increases the quality and duration of life of patients, but is not a cure for this disease.
F. Banting and John Macleod – received the Nobel Prize for the discovery of insulin.
Modern scientists hope to overcome diabetes mellitus using stem cells.
Basic approaches to the treatment of diabetes mellitus based on update cellular technologies include:
• Transplantation of donor pancreatic tissue containing insulin-producing beta cells of the Langerhans islets. Currently about 750 such operations were performed worldwide, but there are cases of transplant rejection and widespread adoption of this technique in clinical practice is hampered by the lack of donor material.
• Cultivation of insulin-producing beta cells from stem cells, particularly from induced pluripotent stem cells (iPS cells), discovered in 2012.This is an extremely complex and costly method, which clinical efficacy is still being investigated.
• The infusion of umbilical cord blood. In the last decade in Europe and in the United States of America it was reported that infusions of umbilical cord blood, rich in stem cells, allow to reduce the blood sugar level of diabetics for some period of time and have a positive effect on the course of disease and quality of life of patients.
• Transplantation of hematopoietic stem cells from bone marrow or umbilical cord blood after immunosuppressive therapy. At the moment it is the most reasonable modern approach to treatment of type 1 diabetes, with which the scientists associate the real hope for a cure for this disease. To date, about 100 multicenter clinical trials of this treatment are officially registered worldwide.
In terms of modern medicine type 1 diabetes is considered an autoimmune disease in which the insulin-producing cells in the pancreas are destroyed by autoantibodies. There is evidence that in the early stages of the disease, when not all insulin-producing cells are destroyed, immunosuppressive chemotherapy followed by stem cell transplantation may stop this process.
• Transplantation of mesenchymal stem cells.
Bone marrow, umbilical cord blood, umbilical cord tissue, placenta, adipose tissue are rich in mesenchymal stem cells. It was proved that mesenchymal stem cells are able to inhibit the formation of autoantibodies that destroy insulin-producing cells in the pancreas. Thus, the American biotechnological company Osiris Therapeutics and Research Foundation Of Juvenile Diabetes initiated a clinical study (Phase 2) to examine the effectiveness of the cell preparation PROCHYMAL® based on human bone marrow mesenchymal stem cells of a donor in the treatment of type 1 diabetes. The effectiveness of therapy by mesenchymal stem cells of other autoimmune diseases – Crohn’s disease, rheumatoid arthritis, multiple sclerosis, etc was also shown.
• Use of endothelial progenitor cells .
One of the most frequent and severe complications of diabetes mellitus are cardiovascular diseases, leading eventually to the development of lower limb ischemia, chronic ulcers, diabetic foot, kidney failure, blindness. Endothelial cell progenitors, in which umbilical cord blood is particularly rich, are precursors of blood vessels and are considered as innovative methods of treatment of vascular insufficiency and for tissue-engineering of blood vessels and heart valves.
In Ukraine, the experience of treatment of diabetes mellitus type 1 and 2 using cord blood stem cells was accumulated in the Institute of Cell Therapy (Kiev) and Research Institute of Emergency and Reconstructive Surgery n.a.VK Husak (Donetsk) .
Detailed information about the methods of treatment: