In Brazil, a recent study published in the Journal of the American Medical Association (JAMA) successfully showed how transplanted stem cells kick started the pancreas into producing insulin again.
As you probably already know, Type 1 diabetes is the result of the immune system attacking the insulin producing beta cells of the pancreas. There have been many theories to why this happens, including a genetic predisposition, even an infection such as the German measles, and early immune system exposure to cow’s milk in infants who were not breast fed.
Diabetes acutally develops very slowly, remaining undetected for several years until 60 to 80 percent of the beta cells are destroyed. This is the point when you started to experience those common symptoms of weight loss, blurry vision, fatigue, thirst, etc..
Dr. Julio Voltarelli and colleagues from the Regional Blood Center at the University of Sao Paulo recruited 15 patients recently diagnosed with Type 1 diabetes. The patients' ages were between 14 and 31 years and all were on supplemental insulin before the study began.
The study involved the use of a technique called "autologous hematopoietic stem cell transplantation" or AHST for short. This type of treatment has been used to treat other autoimmune diseases successfully. Previous trials have shown that moderate suppression of the immune system in newly diagnosed Type 1 diabetes patients can stop the further loss of beta cells and reduce the need for supplemental insulin.
This study was the first to combine both the suppression of the immune system and the stem cell transplant in newly diagnosed Type 1 diabetes patients.
After receiving drugs to stimulate stem cell production, bone marrow was removed to harvest a supply of blood stem cells. The patients then received drugs to suppress their immune systems along with antibiotics and were placed in isolation to prevent infection. After two weeks, the previously extracted and conditioned stem cells were infused back into their blood stream through the jugular vein.
This treatment took place between November of 2003 and July of 2006 (the results were not published until 2009) with observations being conducted at the Bone Marrow Transplantation Unit of the School of Medicine of Ribeirão Preto, Brazil. During the trial, patients were monitored and underwent tests for insulin and other diabetes markers frequently.
As the treatment took its effect, patients reduced their need for supplemental insulin gradually and at different rates. Fourteen of the 15 patients were insulin-independent over the 7 to 36 month follow up period and the average insulin free period was close to 19 months. One patient was insulin free at 35 months, 4 others at 21 months, 7 for 6 months and 2 for 1 and 5 months. One patient’s treatment failed completely due to their beta cell count being too low at the start of the treatment.
This led to a more selective process in choosing patients for the remainder of the study. Voltarelli and colleagues conclude that: "High-dose immunosuppression and AHST were performed with acceptable toxicity in a small number of patients with newly diagnosed type 1 DM. With AHST, beta cell function was increased in all but 1 patient and induced prolonged insulin independence in the majority of the patients". They recognize that this type of study is in its infancy and was a very small study without a control group, but hope that their work will open the door to further explorations into AHST for diabetes management.
