Imagine a world where individuals with Type 1 diabetes no longer rely on daily insulin injections to manage their blood sugar. Stem cells, once again, have shown their incredible potential for beta cell regeneration. In a world-first, scientists have successfully reversed Type 1 diabetes in a 25-year-old woman by reprogramming stem cells to produce insulin using stem cells derived from her own cells. This revolutionary treatment offers hope for millions of people living with diabetes, marking a pivotal step forward in the search for a long-term cure.
The article titled "Stem cells reverse woman’s diabetes — a world first" published in Nature at the end of September, highlights the details of an ongoing study into using induced pluripotent stem cells of host origin for regrowing beta cells. This is encouraging for those of us with T1D, as it gives a real-life example of someone reaching the "other side" of insulin use. And while the article is generally worthy of the praise it's received, there are details and information in between the lines that need to be addressed.
Let's take a closer look at what was done to see what these results mean for you and me.
Type 1 diabetes (T1D) is currently labeled an autoimmune disease. Its hypothesized that the body’s immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. As a result, individuals with T1D cannot produce insulin, a hormone essential for regulating blood sugar levels. Without insulin, glucose builds up in the bloodstream, leading to dangerous complications. The current standard treatment involves lifelong insulin therapy through injections or pumps, but it cannot fully replicate the body’s natural insulin regulation.
There are two main factions of cure-related research: Beta cell regeneration and immune system regulation. The regeneration front has focused on alternative ways to regrow beta cells, either via allopathic transplants and stem cell therapy or homeopathic remedies. Both have shown promising, yet inconsistent results.
The immune system regulation faction has largely relied on pharmaceutical immunosuppressants to silence the T1D autoimmune attack.
Recent Breakthroughs in Stem Cell Therapy for T1D
A Brief History of Stem Cell Use for T1D
The use of stem cells in diabetes research has evolved significantly over the past few decades, with major breakthroughs emerging only recently. Here’s a look at the key milestones:
A. Early Research and Discovery (1980s-1990s)
In the 1980s and 1990s, scientists began exploring the potential of stem cells to replace damaged tissues and organs. For T1D, the hope was to develop a therapy where stem cells could be converted into insulin-producing beta cells, but the research was still in its infancy. Early studies focused on understanding the biology of stem cells and the complexities of pancreatic islet cells, laying the foundation for future research.
B. Islet Transplantation (Early 2000s)
Islet transplantation became a primary area of focus for T1D treatment. This procedure involves transferring beta cells from donor pancreases to a person with T1D to restore insulin production. While promising, the limited supply of donor pancreases and the need for long-term immunosuppression to prevent rejection made this approach impractical for widespread use. However, it confirmed that restoring beta cells could be an effective way to treat T1D, pushing scientists to look toward stem cells as a renewable source of these cells.
C. First Human Trials with Stem Cells (2010s)
The next major breakthrough came when researchers discovered how to reprogram human embryonic stem cells and later induced pluripotent stem cells (iPSCs) into insulin-producing beta cells. By the 2010s, researchers were conducting early clinical trials to test whether these stem cell-derived beta cells could be safely transplanted into humans.
In 2014, a team from the Harvard Stem Cell Institute made headlines by successfully creating large quantities of functional beta cells from human stem cells. This marked a major leap forward, as it suggested that stem cells could provide an unlimited source of beta cells for transplantation.
D. Advancements and First Successful Transplants (2020s)
The last few years have seen remarkable progress in stem cell research for T1D. In 2021, a man with severe Type 1 diabetes received a successful stem cell-derived beta cell transplant, as reported by The New York Times. This was one of the first documented cases where a T1D patient was able to regulate blood sugar levels without insulin injections after a stem cell treatment.
And this leads us to our current article.
Scientific Article Title: Transplantation of chemically induced pluripotent stem-cell-derived islets under abdominal anterior rectus sheath in a type 1 diabetes patient
At a Glimpse:
A 25-year-old woman with Type 1 diabetes successfully underwent a stem cell transplant that reversed her diabetes. Before the procedure, she relied on insulin therapy to manage her condition. Following the transplant, which involved reprogrammed beta cells, her body was able to produce insulin naturally, eliminating her need for insulin injections.
The Details:
The stem cells used were induced pluripotent stem cells (iPS), which means they were derived from her own body's cells. This builds off of a discovery 20 years ago that innate stem cells could be reprogrammed to become any number of different cell types. In theory this decreases the chances of the immune system rejecting a "foreign" cell type (which was experienced in previous embryonic stem cell cases).
The woman was described as having to use "significant amounts" of insulin prior to her stem cell therapy. What this says about her diabetic health is uncertain (HbA1c, diet, health history etc).
The woman had received a liver transplant prior to her stem cell therapy. She was using immunosuppressants for that transplant at the time of her stem cell therapy. There was not explanation as to the nature of her liver dysfunction.
The iPS were injected into the muscles of her abdominal wall. This gave researchers the opportunity to actively monitor the cells via MRIs. Previous stem cell therapies injected stem cell clusters into the liver where they could not be observed.
It took 2.5 months after the transplant for her to achieve insulin independence. The results were only reported once she reached 1 year of sustained insulin independence.
What this means for Type 1 Diabetes
THE GOOD
Scalability and Accessibility
The use of stem cells is particularly promising because they can be produced in unlimited quantities, unlike donor-derived beta cells, which are in short supply. If the therapy can be refined and made more accessible, it could dramatically expand treatment options for millions of people living with Type 1 diabetes globally.
Imagine an out-patient procedure where your own cells are taken, reprogrammed and injected into your abdomen. Within 3 months, you're able to produce your own insulin. Pretty cool, right?
No donor lists, no invasive surgery, no fear of rejected treatments. It would simply be a matter of pricing and locating professionals offering the treatment.
Indifference to Current Diabetic State
Based on how they spoke about the patients health status, it seems that her state of health was compromised. "Significant" insulin use and the need for a liver transplant all point to the possibility that her diabetes was not kept in check.
In the initial whispers of stem cell treatment, I remember endocrinologists suggesting that treatments may or may not be reserved for those with good control of their condition. It instilled in me the idea that "good" diabetics are the ones who get a cure. This may or may not have been a ploy for my obedience but it certainly worked.
Ironically the narrative later swayed in the complete opposite direction making the newest treatments only necessary for those in need of life-saving interventions.
I like the idea of no one needing to meet a specific requirement in order to qualify for the treatment.
THE BAD
Immunosuppression Requirements
As with many stem cell therapies, patients often need to take immunosuppressants to prevent rejection, which could lead to long-term complications such as increased infection risk.
This study alluded to the possibility of not having to use immunosuppressants because of the iPSs used, yet (conveniently) selected a case study where the woman was using an immunosuppressant from a previous procedure. They only went so far as to say that they could not conclude whether the immunosuppressants improved the viability of the treatment.
This seemed sneaky to me. The immunosuppressant facet of stem cell therapy is a MAJOR factor in its viability. Are we cured? Or are we trading one medication for another?
Longevity of Transplanted Cells
There is limited data on how long the transplanted beta cells will function effectively without needing repeat interventions. The study reached the 1 year milestone. That in and of itself is impressive. The question is how long is "long enough" for this treatment to made commercially available? One doctor interviewed for the article said 5 years would be the timeline needed to label it a "cure".* If this becomes a repeatable therapy, what outside factors determine the frequency of needing new stem cells?
*Note what a 5 year timeline would do for rolling out the therapy. More waiting, more trials, more funding needed etc. That suggestion seems to me like a business decision... IE Delay, delay, delay.
Cost and Accessibility
Advanced stem cell therapies can be expensive and may not be accessible to all patients, especially in lower-income settings. The cost of the treatment was not mentioned. However, that's been a common thread in every stem cell therapy ever. IE Isn't this technology amazing?! Too bad you cant afford it.
Depending on the nature of the treatment (ranging from cosmetic to chronic conditions), stem cell therapies currently range anywhere from $3,000 to $100,000.
Complexity of Autoimmunity
This has been my biggest criticism of the stem cell narrative all along. The root cause of Type 1 diabetes involves multiple layers of cellular and autoimmune dysfunction. Even with successful stem cell transplantation, the underlying autoimmune response may continue to pose risks unless addressed.
From mineral balance to pathogenic infection to genetic and epigenetic inheritance, if we aren't able to address the WHY behind the initial diagnoses, can we really prevent it from happening again?
Refusal to Elaborate on Systemic Nature of Diabetes
This particular case study involved a 25 year old in need of a new liver. That is NOT normal. The article did nothing to clarify whether her liver dysfunction was a result of poor diabetes management or a pre-existing condition.
Might the liver have a major impact (either upstream or downstream) on beta cell health? Why has it been so difficult to acknowledge this?
Conclusion
In conclusion, the advancement of stem cell therapy for Type 1 diabetes marks a significant breakthrough in the field of diabetes research. By reprogramming stem cells into insulin-producing islet cells, patients could potentially regain natural insulin production, offering a long-term solution beyond insulin injections.
This study further illustrates the potential stem cells offer from a convenience and accessibility standpoint in regrowing beta cells. I consider this study as a step in the right direction, the addition of an important "tool in the toolbox".
My focus remains on the more comprehensive approaches. It is important to remember that in order to enhance the efficacy of a stem cell treatment, we must continue to address the underlying causes of beta cell dysfunction and autoimmunity.
Improvements in food quality, targeted supplementation to rebalance mineral systems and addressing specific pathogenic cycles within the body all stand to put us in an optimal state to allow these stem cells to flourish.
Citations and References
Stem Cell Therapy for Type 1 Diabetes
Stem Cells Reverse Woman’s Diabetes — A World First. (2024). Nature.
URL: https://www.nature.com/articles/d41586-024-03129-3
Stem Cell Breakthrough for Diabetes in 2021
A Cure for Type 1 Diabetes? For One Man, It Seems to Have Worked. (2021). The New York Times.
URL: https://www.nytimes.com/2021/11/27/health/diabetes-cure-stem-cells.html
Cell Article on Stem Cell Research
Stem Cell-Based Therapy Reverses Diabetes in Mice. (2024). Cell.
URL: https://www.cell.com/cell/abstract/S0092-8674(24)01022-5
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