Stem cell transplant to treat diabetes

Medical science is increasingly aiming at the prevention and repair of the defect at the origin of the disease, according to a new philosophy aimed at intervening further upstream of the pathogenic process than on the final effects with devices or treatments aimed at mitigating rather than definitively curing a disease, such as diabetes. Confirmations of the effectiveness of diabetes prevention also come from American and Swedish studies which make us hope for "greater attention to the issue by governments", for a highly disabling disease with high social costs and which in 2030 will have 300 million patients. The next goal on which the large pharmaceutical companies in the sector aim is no longer research in the technological-instrumental field, but on the exploitation of engineered cells and tissues to give and/or directly stimulate the body to repair itself in order to eliminate the "problem " At the source. Speaking of cells and cellular bioengineering, stem cells cannot fail to spring to mind, considered by the scientific community as a great tool or means with which to interact positively with human tissues in an effective and totally biocompatible way. In 2007 in a small clinical trial performed in South America, which appeared in the Journal of the American Medical Association (vol 297, p 1568), a procedure similar to a bone marrow transplant was performed, but which would be able to cure diabetes type 1. The procedure developed by the team consisted in extracting haematopoietic stem cells directly from the patient's blood and destroying their immune system and then reinfusing them into the body and prompting them to develop a new immune system. ”¨”¨In the trial, the immune system appears to have been reset or re-educated, and after the procedure, the symptoms of diabetes disappeared.”¨Julio Voltarelli of the University of Sao Paulo in Brazil and his colleagues involved 15 patients, among 14 to 31 years of age, who had been newly diagnosed. Between 60% and 80% of the patients' insulin-producing cells were destroyed at the time of diagnosis, and all required exogenous insulin. ”¨”¨ The researchers took stem cells from the volunteers' bone marrow with a needle, gave them medicines such as Cytoxan to “cancel” the immune system and at the same time they were treated with antibiotics and kept in isolation to avoid the onset of infections caused precisely by the deficiency of the immune system. After two weeks of culture, the "ready" stem cells were injected through the jugular vein, re-establishing their immune system. ”¨”¨ Of the 15 patients, 12 no longer needed insulin for about three years in one case, 2 years in four cases and several months in the others.”¨One patient took insulin for a year, before becoming insulin independent, and has remained so to this day. On average, therefore, the period of insulin independence is 18 months. ”¨”¨Exactly why some patients responded to treatment and one didn't remains a mystery, but it could be due to genetic differences or the severity of the autoimmune attack, as suggested by Voltarelli himself. ”¨ The effectiveness of the procedure at the moment would be limited in time and above all it carries with it high risks linked to the silencing of the immune system. Indeed, during the trial, one patient developed pneumonia, caused by the immunosuppressants used in the procedure, two developed complications, thyroid dysfunction and early menopause, but it is not clear whether these are related to stem cell transplantation. ”¨”¨ Overall, however, the experiment reported some positive aspects: mainly it was observed that the immune system of people with type 1 diabetes can be reset or re-educated, at least for a certain period thanks to the regeneration of beta cells to reduce or even eliminate their need for exogenous insulin. A negative note comes from Jay Skyler, who directs the Diabetes Research Institute of the University of Miami in Florida (USA), calls for caution, as the trial did not include a control group. Skyler adds that many people experience remission of symptoms soon after being diagnosed, and the increase in insulin production seen among study participants could be linked to what's called a "honeymoon" (the initiation of therapy insulin in some cases gives the illusion that the disease is cured). ”¨ Research on the use of stem cells and on the "re-education" of the immune system continues with great fervor and hopes on the part of the scientific community and above all by those who experience the symptoms of diabetes on their skin every day, as the presence of a virus in the development of type 1 diabetes. The University of Siena and Pisa, in collaboration with Novartis Vaccines, have recently demonstrated the incidence of a virus, Coxsackie B4, which attacks the pancreas leading to the well-known consequences . The antigens of the Coxsackie virus B4 react with the similar antigens present on the beta cells of the Islets of Langerhans (glomerations of spherical cells located in the pancreas) inducing an autoimmune response by NK cells (“Natural Killer”, cells of the immune system “born to kill” infected cells), which thus leads to the incorrect elimination of beta cells, resulting in insulin deficiency. [via springerlink , pnas | photo University of Wisconsin-Madison]