The prevalence of diabetes is on the rise. According to The World Health Organization, diabetes will be the 7th leading cause of death globally by 2030.
Insulin therapy has revolutionized diabetes treatment, but finding a cure for the disease has proven to be challenging. A biological cure would need to address the underlying physiology — in the case of Type 1 diabetes, restoring the pancreatic beta cells which secrete insulin; in the case of Type 2 diabetes, re-sensitizing the body to insulin. The developing field of cell therapy shows promise on both fronts, though primarily in Type 1 diabetes research.
A recent review from Cell Press describes current progress in this area. One well-studied experimental intervention in Type 1 diabetes is the transplantation of donated pancreatic islets, which contain insulin-secreting beta cells. Once the pancreatic cells become vascularized, healthy insulin levels can be restored.
Stem cell therapy, using human embryonic stem cells (hESC) or induced pluripotent stem cells, may be able to generate beta cells on a greater scale. Cambridge-based startup Semma Therapeutics is deriving beta cells from hESC, which it plans to house in a subcutaneous implant to treat Type 1 diabetes. San Diego’s ViaCyte is pursuing a very similar approach, with plans for the therapy to treat both Type 1 and Type 2 diabetes.
Additional technologies are directed toward minimizing the risk for immune rejection. One approach is to implant cells within a protective capsule made of alginate, allowing sugar and insulin to flow but preventing immune cell entry. Researchers at the Massachusetts Institute of Technology have identified several alginates that minimize immune reaction to the implanted device in rodents and monkeys.
Researchers from the U.S., China and Spain have shown promising results in diabetes patients given stem cell educator therapy, which uses umbilical cord blood cells to teach the immune system to tolerate transplanted cells. Other researchers are exploring the use of CRISPR-Cas9 to remove antigen-presenting proteins from stem cells, so that they can evade immune destruction.
Researchers from Cincinnati Children’s Hospital and Yokahama City University are tackling another challenge – revascularization of beta cells after transplant. Their research has successfully generated tissue organoids from beta cells mixed with stem cells and endothelial cells. This method, termed self-condensation cell culture, vastly improved post-transplant vascularization when the organoids were transplanted in mouse models.
As cell therapy treatments continue to make their way into the mainstream biotech space, diabetes could well become a disease area of focus. It’s hopeful news for a disease that impacts the daily lives of more than 400 million people worldwide.