diabetes and stem cell therapy

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INTRODUCTION:

Diabetes is a metabolic complex disorder that is affecting millions of the people around the world. Diabetes is mainly caused by defects in insulin sensitivity that leads to the dysfunction and loss of B cells in pancreatic islets. There are some other factors that cause diabetes is obesity, diet, physical activity, increasing age, history of the family and ethnicity (http://www.diabetesatlas.org/content/diabetes). Physical exercise and maintaining proper diet may give relief from T2D.

Diabetes mellitus is also known as Diabetes. It is a group of metabolic diseases. There are other types of diabetes which includes congenital diabetes, it is caused due to genetic defects in insulin secretion, and cystic fibrosis connected diabetes, steroid diabetes. Due to insulin availability all types of diabetes are cured, but Type2 diabetes can be controlled with medications.

Insulin is the hormone which controls the flow of glucose in and out of the cells. Diabetes mellitus are of three types namely.

Type1 diabetes mellitus:

Type1 diabetes mellitus is an inflammatory auto-immune disease of pancreas and is caused by lack of insulin. Insulin is produced by beta cells of islets of Langerhans in the pancreas. The main source of energy is glucose. It is also known as insulin dependent diabetes mellitus or IDDM (Type1 diabetes mellitus, Johns Hopkins Medical Institution). Due to this there will be auto-immune damage to the pancreas gland. This damage can occur for so many reasons (viral infection). Type1 diabetes was traditionally known as Juvenile diabetes. Injection is the common way for administering insulin. The main symptoms for T1DM are weight loss, excessive urination and dehydration.

Diagnostic tests:

In case of high glucose level

The T1DM is treated by some common tests, Fast Plasma Glucose Test (the glucose level is measured after 12hours of fasting), Oral Glucose Tolerance Test (OGTT), Insulin and C- peptide levels are low in case of IMDM, In the very beginning of IDDM the Islet-cell and anti-insulin auto antibodies are positive.

Type2 diabetes mellitus:

Type2 diabetes is a non-insulin dependent diabetes mellitus (NIIDM), and is a metabolic disorder which is characterized by high glucose level content in blood and is insulin resistance. Unlike type1, it has little tendency towards ketoacidosis (feature of type 1 diabetes) (Brain J .et al) this also occurs in type2 diabetes. Long term complication may lead to heart attack, kidney failure, strokes.

Symptoms of diabetes are frequent urination (polyuria), increased hunger (Polyphagia), increased thirst (Polydipsia) and weight loss (type 1 mellitus paediatrics)

The main cause for T2DM is oligomers of islet amyloid polypeptide(IAPP). Amyloid is a protein that deposit in pancreas, and it triggers NLRP3 inflammanasome and thereby generates matured IL-1β (Masters SL et al).

Therapy for T2DM is Glyburide, is an in vitro suppressed IAPP which is mediated by production of IL-1β.

Gestational diabetes:

This type of diabetes is seen in pregnant women. During pregnancy, there will be a high content of blood glucose level. And it may have preliminary development of T2D .

Recent advances in cell transplantation biology, transplantation of pancreatic islet cells in to diabetic patients, giving some hopes of successful treatment of diabetes.

Diabetes Insipidus:

The main characteristic of diabetes Insipidus (DI) is mainly by excessive thirst and excretion of diluted urine. DI is of different types. Central diabetes insipidus is the common type in humans which is usually caused by arginine vasopressin (AVP) and it is also called as anti-diuretic hormone (ADH). The other type of DI is Nephrogenic diabetes insipidus, which is associated with deficient in human sensibility of kidneys to ADH. There are two complications in NDI, primary is caused by mutation in AVPR2 and AQP2 and secondary is caused from obstructive uropathy or lithium chronic therapy (D. Bockenhauer et al, 2010)

Some symptoms are quite similar to Diabetes mellitus. The typical symptoms for DI are excessive urination and thirst. DI has several types, Neurogenic DI, Nephrogenic ID, Dipsogenic DI, Gestational DI.

THERAPY:

Diabetes can be treated by maintaining of proper diet and through oral medication. It is also curable by injecting of insulin. But these will not cure the disease permanently.

Now there have been many successful studies on animal models and in humans where diabetes was successfully treated by gene therapy, immune therapy and cell transplantation. Use of stem cells in regenerative medicine may cure Type 1 diabetes. In one study, hematopoietic stem cells were isolated from bone marrow and the harvested cells were reinjected intravenously and cured successfully (Ganapathi M bhat).

In cell replacement therapy, stem cells must have the following characters. They must be able to proliferate extensively; they must be able to differentiate into desired cell type, have the capacity to survive after the transplantation, function properly during the life of transplanted person and should be harmless (status of stem cell therapy in type1 diabetics, Ganapathi M bhat).

Concluding remarks:

Even though, there have been many success stories about cell transplantation therapy of diabetes, one could need a donor to these studies and the treatment itself is very expensive. Rapid research focus on different therapies like gene therapy, immune therapy, cell therapy may give successful results.

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