Bose Bipasha, Katikireddy Kishore Reddy, Shenoy P Sudheer
Nanyang Technological University, School of Biological Sciences, NTU Lab Location @ Level 2 Singapore Institute for Clinical Sciences, Brenner Centre for Molecular Medicine, Singapore, Singapore.
Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts, USA.
Vitam Horm. 2014;95:223-48. doi: 10.1016/B978-0-12-800174-5.00009-0.
Diabetes is a group of metabolic diseases, rising globally at an alarming rate. Type 1 (juvenile diabetes) is the autoimmune version of diabetes where the pancreas is unable to produce insulin, whereas type 2 (adult onset diabetes) is caused due to insulin resistance of the cells. In either of the cases, elevated blood glucose levels are observed which leads to progressive comorbidity like renal failure, cardiovascular disease, retinopathy, etc. Metformin, sulphonyl urea group of drugs, as well as insulin injections are the available therapies. In advanced cases of diabetes, the drug alone or drug in combination with insulin injections are not able to maintain a steady level of blood glucose. Moreover, frequent insulin injections are rather cumbersome for the patient. So, regenerative medicine could be a permanent solution for fighting diabetes. Islet transplantation has been tried with a limited amount of success on a large population of diabetics because of the shortage of cadaveric pancreas. Therefore, the best proposed alternative is regenerative medicine involving human pluripotent stem cell (hPSC)-derived beta islet transplantation which can be obtained in large quantities. Efficient protocols for in vitro differentiation of hPSC into a large number of sustained insulin-producing beta cells for transplantation will be considered to be a giant leap to address global rise in diabetic cases. Although most of the protocols mimic in vivo pancreatic development in humans, considerable amount of lacuna persists for near-perfect differentiation strategies. Moreover, beta islets differentiated from hPSC have not yet been successfully translated under clinical scenario.
糖尿病是一组代谢性疾病,在全球范围内正以惊人的速度上升。1型糖尿病(青少年糖尿病)是糖尿病的自身免疫形式,胰腺无法产生胰岛素,而2型糖尿病(成人发病型糖尿病)是由细胞的胰岛素抵抗引起的。在任何一种情况下,都会观察到血糖水平升高,这会导致诸如肾衰竭、心血管疾病、视网膜病变等渐进性合并症。二甲双胍、磺脲类药物以及胰岛素注射是现有的治疗方法。在糖尿病的晚期病例中,单独使用药物或药物与胰岛素注射联合使用都无法维持稳定的血糖水平。此外,频繁的胰岛素注射对患者来说相当麻烦。因此,再生医学可能是对抗糖尿病的一个永久性解决方案。由于尸体胰腺的短缺,胰岛移植在大量糖尿病患者中进行了尝试,但取得的成功有限。因此,提出的最佳替代方案是涉及人多能干细胞(hPSC)衍生的β胰岛移植的再生医学,这种胰岛可以大量获得。将hPSC体外高效分化为大量用于移植的持续产生胰岛素的β细胞的方案,将被视为应对全球糖尿病病例增加的巨大飞跃。尽管大多数方案模仿了人类体内胰腺的发育,但在近乎完美的分化策略方面仍存在相当多的空白。此外,从hPSC分化而来的β胰岛尚未在临床情况下成功转化应用。