Aghazadeh Yasaman, Nostro Maria Cristina
Toronto General Hospital Research Institute and McEwen Centre for Regenerative Medicine, Toronto, Canada.
University Health Network, Toronto, Ontario, M5G 1L7, Canada.
Curr Diab Rep. 2017 Jun;17(6):37. doi: 10.1007/s11892-017-0863-6.
Type 1 diabetes (T1D) is defined by an autoimmune destruction of insulin producing β-cells located in the endocrine part of the pancreas, the islets of Langerhans. As exogenous insulin administration fails at preventing severe complications associated with this disease, cell replacement therapies are being considered as a means to treat T1D. The purpose of this manuscript is to review the challenges associated with current strategies and discuss the potential of stem cell therapy for the treatment of T1D.
The most prominent therapy offered to T1D patients is exogenous insulin administration which, despite formulations improvement, remains a suboptimal treatment, due to the frequency of injections and the issues associated with precise dosing. As immunotherapy approaches have remained unsuccessful, the only cure for T1D is transplantation of donor-derived pancreas or islets. However, donor scarcity, graft loss, and immune response to the foreign tissue are issues challenging this approach and limiting the number of patients who can benefit from such treatments. In this review, we discuss the causes of T1D and the shortcomings of the current treatments. Furthermore, we summarize the cutting edge research that aims to tackle the current challenges in reaching a quality-controlled product with long-term effects, with a focus on regenerative medicine approaches using human pluripotent stem cells.
1型糖尿病(T1D)的定义是位于胰腺内分泌部分即胰岛的胰岛素分泌β细胞发生自身免疫性破坏。由于外源性胰岛素给药无法预防与该疾病相关的严重并发症,细胞替代疗法正被视为治疗T1D的一种手段。本手稿的目的是回顾当前策略所面临的挑战,并讨论干细胞疗法治疗T1D的潜力。
提供给T1D患者的最主要治疗方法是外源性胰岛素给药,尽管制剂有所改进,但由于注射频率以及与精确给药相关的问题,它仍然是一种次优治疗方法。由于免疫疗法一直未取得成功,T1D的唯一治愈方法是移植供体来源的胰腺或胰岛。然而,供体稀缺、移植物丢失以及对外来组织的免疫反应是挑战这种方法并限制能够从此类治疗中受益的患者数量的问题。在本综述中,我们讨论了T1D的病因以及当前治疗方法的缺点。此外,我们总结了前沿研究,这些研究旨在应对在获得具有长期效果的质量可控产品方面的当前挑战,重点是使用人类多能干细胞的再生医学方法。