Type 1 Diabetics benefit from Stem Cell Transplantation

If you or one of your family members has diabetes, I'm pretty sure that the recent news on stem cell transplantation providing a cure for Type 1 Diabetes (Type 1 DM) has you sitting upright and your full attention. I've had a lot of positive feedback on this news which has appeared in our newspapers here, from clients asking if this would be a cure resulting in an insulin independent life.


REASON FOR OPTIMISM

I think that the news is very positive and certainly its a start to demonstrating that it may be possible to modulate diseases originating from a malfunctioned immune system through a patient's autologous (own) stem cell transplant. This concept has been tested before, systemic lupus erythmatoses for example is a case which has resulted in patients remaining SLE free after stem cell transplantation. In the case of Type 1 DM, experimental stem cell transplantation conducted previously on mice yielded results which indicated the prevention of the disease.


STEM CELL TRANSPLANTATION

It was based on these results* that the doctors Julio Voltarelli and colleagues from the Regional Blood Center, at the University of Sao Paulo in Brazil decided to initiate the study on how stem cell transplantation might assist in halting the deterioration of pancreatic beta cell function in newly diagnosed patients (patients who have had the disease for a long time may not have any pancreatic beta cells left as the immune system would have destroyed them all).


SOURCE: PATIENT'S OWN ADULT STEM CELLS

The stem cells were the patient's own stem cells, mobilized from their bone marrow to the blood stream where they were collected. Then, they were prepared for transplantation by suppressing their immune system (a form of chemotherapy) and wiping out their existing circulating immune cells. The stem cells were then administered back into their bloodstream. The patients stayed in isolation for 2 weeks, which is a typical length of time for the immune system to kick start (using stem cells from others would have taken more than 2 months to have the same result, barring no rejection issues).


SELECTION IS KEY

I have to tell you that patient selection is key in every trial, as not any one procedure will benefit everyone. Disease, timing and response varies from patient to patient and the trick is trying to find patients with similar symptoms and baseline measurements, but yet with no other organ complications. 15 patients were selected out of 100 initally screened, and took place over almost 3 years between November 2003 and July 2006, with observation up til February this year at the Bone marrow transplantation unit of the School of Medicine at Ribeirao Preto(otherwise known as Brazil's California... nice!).

The patients were monitored and gradually reduced their need for injectable insulin. The interesting and exciting results were that 14 out of 15 patients were insulin-independent for lengths from 1 to 36 months, where the insulin free period was nearly 19 months.

The doctors are wondering whether the effect was due to a reprieve of the immune system on the pancreas (hence allowing the remaining beta cells to regenerate) or whether it was truly due to the immune system modulation, which allowed the pancreas cells to work, but eventually give up (organ under stress).


WHAT IF YOU HAD TO HAVE INJECTIONS EVERY DAY?

Whilst there have been those who have pointed out the lack of a control group, it is clear that at least for a short while, these type 1 DM patients experienced a time when insulin injections weren't a mealtime affair**.



*"Autologous Nonmyeloablative Hematopoietic Stem Cell Transplantation in Newly Diagnosed Type 1 Diabetes Mellitus."
Júlio C. Voltarelli, Carlos E. B. Couri, Ana B. P. L. Stracieri, Maria C. Oliveira, Daniela A. Moraes, Fabiano Pieroni, Marina Coutinho,Kelen C. R. Malmegrim, Maria C. Foss-Freitas, Belinda P. Simões, Milton C. Foss, Elizabeth Squiers, Richard K. Burt. JAMA. 2007;297:1568-1576. Vol. 297 No. 14, April 11, 2007.

** Quite a lot of us can't bear injections once a year, so compare that to several injections per day. Transplant specialists, get ready for the phonecalls.


ps. I do apologise that I haven't posted for a while... yes it has been really busy here at StemLife (in a good way) :)