DIABETES
April 16, 2007

Stem Cell Transplant and Diabetes

Stem cell transplantation can help people with type 1 diabetes mellitus get off insulin, at least temporarily, according to a new study.

Type 1 diabetes mellitus (DM) happens when the body's immune system attacks cells, called beta cells, within the pancreas. By the time most cases are diagnosed, 60 to 80 percent of the beta cells have been destroyed. Preserving the remaining beta cells is key in treating the disease and preventing its devastating long-term health effects.

The new study, conducted by Julio C. Voltarelli, M.D., Ph.D., of the University of S?o Paulo, Brazil; Richard Burt, M.D., of Chicago's Northwestern University Feinberg School of Medicine; and colleagues, examined the effect of high-dose immunosuppressant drugs followed by a stem cell transplantation procedure called AHST on beta-cell preservation in 15 people newly diagnosed with type 1 DM. AHST uses a person's own blood stem cells, which are removed, treated and then returned to the person's body by intravenous injection.

During a 7 to 36-month follow-up, 14 out of 15 subjects became insulin-free (one for 35 months, four for at least 21 months, seven for at least six months; and two with late response were insulin-free for one and five months, respectively). Among those, one resumed insulin use one year after AHST.

As reported in the April 11, 2007 issue of JAMA, the only significant bad effects were pneumonia in one case and endocrine (hormonal) problems in two others.

"This is, to our knowledge," the authors say,"the first report of high-dose immunosuppression followed by AHST stem cell transplantation for human type 1 DM. Very encouraging results were obtained in a small number of people with early-onset disease. Ninety-three percent achieved different periods of insulin independence and treatment-related toxicity was low, with no mortality. Further follow-up is necessary to confirm the duration of insulin independence and the mechanisms of action of the procedure."
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