Thaindian News

By Dr. Vikas Ahluwalia

New Delhi, July 20 (ANI): Diabetes is a chronic disease characterized by a deficit in cell mass and a failure of glucose homeostasis. Both circumstances result in a variety of severe complications and an overall shortened life expectancy.

The current treatment of insulin does not represent a cure because insulin dosage is difficult to adjust. Exogenous insulin frequently fails to achieve optimal glucose control even when intensive regimens are used. In addition, intensive therapy, which uses multiple daily insulin injections or insulin pump infusion with frequent monitoring of blood glucose, often leads to an increased incidence and severity of hypoglycaemic episodes.

Thus, according to Dr. Vikas Ahluwalia, President of the New Delhi-based Diabetes Care Foundation of India, diabetes represents an attractive candidate for cell therapy.

Dr. Ahluwalia is of the view that reversal of diabetes along with total independence from insulin injections, can be achieved through pancreas and islet transplantation, but shortage of donor organs has prompted an intensive search for alternative sources of cells.

Stem cells are defined as cells that have clonegenic and self-renewing capabilities and differentiate into multiple cell lineages. Embryonic stem cells (ESCs) are derived from mammalian embryos in the blastocyst stage and have the ability to generate any differentiated cell in the body.

Adult stem cells are part of tissue-specific cells of the postnatal organism into which they are committed to differentiate. Another advantage is that they behave as an autologous model whereby a patient’s own cells can be used, thereby preventing an immune rejection.

The benefits of the ESCs include the possibility of propagating an unlimited number of cells that possess the ability to become fully functioning endocrine tissue.

Dwelling on the advantages and disadvantages of islet transplantation, Dr. Ahluwalia says that the main advantage includes the achievement of physiologic insulin secretion in those patients who are able to achieve insulin independence.

“Islet transplantation is a much less invasive procedure and is considered safer than whole pancreas transplantation. Isolated islets carry a lower antigenic property than the whole organ, which may thus require reduced immunosuppression with fewer side effects. Islets can also be manipulated in vitro before transplantation to reduce graft rejection,” he adds.

A major disadvantage is the commitment of a patient to lifelong immuno-suppression that is not only costly, but also has potential side effects.

According to Dr. Ahluwalia, the use of high dose calcineurin inhibitor therapy has raised concerns because of the possibility of worsening nephropathy in long-standing diabetic patients. Moreover islet transplantation requires at least two donor organs for each recipient and therefore its broad application remains limited due to lack of sufficient cadaveric donors.