Regenerative medicine for diabetes treatment.

Abstract

Extract: Type 1 diabetes (T1D) is an autoimmune disease in which insulin-producing beta-cells contained within the pancreatic islet of Langerhans are destroyed by autoreactive T cells. T1D patients are treated via insulin hormone replacement therapy by subcutaneous injection of recombinant insulin (produced by molecular engineering). Blood glucose levels must be monitored many times a day to determine the appropriate quantity of insulin to be injected in order to control blood glucose levels (glycemia). Under the insulin-based treatment, the large and sustained effort that a patient must make to strive for near optimal control of glycemia over many decades, frequently beginning in childhood, often make this approach impractical. As a result, T1D contributes substantially to the high rate of nephropathy, neuropathy, retinopathy, and generalized microvascular disease experienced by this population. Since insulin replacement therapy alone does not completely protect these individuals from severe complications, more appropriate treatments for curing T1D are needed. Transplantation of the whole pancreas or isolated pancreatic islets, have both been proposed in the aim of more effectively treating patients with complicated T1D. However, tempering the initial enthusiasm over transplantation has been the reported worsened survival rate for recipients of the pancreas alone, when compared with the survival of waiting-list patients receiving conventional insulin therapy, and the follow-up studies on islet recipients in which a gradual loss of islet function has been observed with time.