Zhang Yazhen, Chen Wenyi, Feng Bing, Cao Hongcui
1State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
2Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
Aging Dis. 2020 Feb 1;11(1):141-153. doi: 10.14336/AD.2019.0421. eCollection 2020 Feb.
Diabetes mellitus (DM) is a chronic metabolic disease with high morbidity and mortality. Recently, stem cell-based therapy for DM has shown considerable promise. Here, we undertook a systematic review and meta-analysis of published clinical studies to evaluate the efficacy and safety of stem cell therapy for both type 1 DM (T1DM) and type 2 DM (T2DM). The PubMed, Cochrane Central Register of Controlled Trials, EMBASE, and ClinicalTrials.gov databases were searched up to November 2018. We employed a fixed-effect model using 95% confidence intervals (CIs) when no statistically significant heterogeneity existed. Otherwise, a random-effects statistical model was used. Twenty-one studies met our inclusion criteria: ten T1DM studies including 226 patients and eleven T2DM studies including 386 patients. Stem cell therapy improved C-peptide levels (mean difference (MD), 0.41; 95% CI, 0.06 to 0.76) and glycosylated hemoglobin (HbA1c; MD, -3.46; 95% CI, -6.01 to -0.91) for T1DM patients. For T2DM patients, stem cell therapy improved C-peptide levels (MD, 0.33; 95% CI, 0.07 to 0.59), HbA1c (MD, -0.87; 95% CI, -1.37 to -0.37) and insulin requirements (MD, -35.76; 95% CI, -40.47 to -31.04). However, there was no significant change in fasting plasma glucose levels (MD, -0.52; 95% CI, -1.38 to 0.34). Subgroup analyses showed significant HbA1c and C-peptide improvements in patients with T1DM treated with bone marrow hematopoietic stem cells (BM-HSCs), while there was no significant change in the mesenchymal stem cell (MSC) group. In T2DM, HbA1c and insulin requirements decreased significantly after MSC transplantation, and insulin requirements and C-peptide levels were significantly improved after bone marrow mononuclear cell (BM-MNC) treatment. Stem cell therapy is a relatively safe and effective method for selected individuals with DM. The data showed that BM-HSCs are superior to MSCs in the treatment of T1DM. In T2DM, MSC and BM-MNC transplantation showed favorable therapeutic effects.
糖尿病（DM）是一种发病率和死亡率都很高的慢性代谢性疾病。最近，基于干细胞的糖尿病治疗方法已显示出相当大的前景。在此，我们对已发表的临床研究进行了系统评价和荟萃分析，以评估干细胞疗法对1型糖尿病（T1DM）和2型糖尿病（T2DM）的疗效和安全性。检索了截至2018年11月的PubMed、Cochrane对照试验中央注册库、EMBASE和ClinicalTrials.gov数据库。当不存在统计学上的显著异质性时，我们采用固定效应模型并使用95%置信区间（CI）。否则，使用随机效应统计模型。21项研究符合我们的纳入标准：10项T1DM研究，包括226例患者；11项T2DM研究，包括386例患者。干细胞疗法改善了T1DM患者的C肽水平（平均差（MD），0.41；95%CI，0.06至0.76）和糖化血红蛋白（HbA1c；MD，-3.46；95%CI，-6.01至-0.91）。对于T2DM患者，干细胞疗法改善了C肽水平（MD，0.33；95%CI，0.07至0.59）、HbA1c（MD，-0.87；95%CI，-1.37至-0.37）和胰岛素需求量（MD，-35.76；95%CI，-40.47至-31.04）。然而，空腹血糖水平无显著变化（MD，-0.52；95%CI，-1.38至0.34）。亚组分析显示，接受骨髓造血干细胞（BM-HSCs）治疗的T1DM患者的HbA1c和C肽有显著改善，而间充质干细胞（MSC）组则无显著变化。在T2DM中，MSC移植后HbA1c和胰岛素需求量显著降低，骨髓单个核细胞（BM-MNC）治疗后胰岛素需求量和C肽水平显著改善。对于选定的糖尿病患者，干细胞疗法是一种相对安全有效的方法。数据表明，在治疗T1DM方面，BM-HSCs优于MSCs。在T2DM中，MSC和BM-MNC移植显示出良好的治疗效果。
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