减肥
胰岛素
内科学
干细胞
移植
糖尿病
胃肠病学
内分泌学
生物
2型糖尿病
骨髓
医学
肥胖
遗传学
作者
Anil Bhansali,Vimal Upreti,Niranjan Khandelwal,Neelam Marwaha,Vivek Gupta,Naresh Sachdeva,Ratti Ram Sharma,Karan Saluja,Pinaki Dutta,Rama Walia,Ranjana Walker Minz,Sanjay Kumar Bhadada,Sambit Das,Santosh Ramakrishnan
出处
期刊:Stem Cells and Development
[Mary Ann Liebert]
日期:2009-12-01
卷期号:18 (10): 1407-1416
被引量:106
标识
DOI:10.1089/scd.2009.0164
摘要
Progressive and inexorable β-cell dysfunction is the hallmark of type 2 diabetes mellitus (T2DM) and β-cell regeneration using stem cell therapy may prove to be an effective modality. A total of 10 patients (8 men) with T2DM for >5 years, failure of triple oral antidiabetic drugs, currently on insulin (≥0.7 U/kg/day) at least for 1 year, and glutamic acid decarboxylase antibody negative were included. Patients on stable doses of medications for past 3 months were recruited. Primary end points were reduction in insulin requirement by ≥50% and improvement in glucagon-stimulated C-peptide levels at the end of 6 months of autologous bone marrow–derived stem cell transplantation (SCT), while secondary end points were a change in weight and HbA1c and lipid levels as compared to baseline. Seven patients were responders and showed a reduction in insulin requirement by 75% as compared to baseline. Mean duration to achieve the primary objective was 48 days. Three patients were able to discontinue insulin completely, although it was short-lived in one. Mean HbA1c reduction was 1% and 3 of the 7 responders had HbA1c value <7%. A significant weight loss of 5.5 kg was noted in the responders, whereas, nonresponders gained 2.2 kg of weight. However, weight loss did not correlate with reduction in insulin requirement (r = 0.68, P = 0.06). There was a significant improvement in both fasting and glucagon-stimulated C-peptide level in the group (P = 0.03) and responders (P = 0.03). HOMA-B increased significantly in the whole group (P = 0.02) and responders (P = 0.04) whereas, HOMA-IR did not change significantly (P = 0.74). Reduction in insulin doses correlated with stimulated C-peptide response at the baseline (r = 0.83, P = 0.047) and mononuclear cell count of infused stem cells (r = 0.57, P = 0.04). No serious adverse effects were noted. Our observations indicate that SCT is a safe and effective modality of treatment to improve β-cell function in patients with T2DM. However, further large-scale studies are needed to substantiate these observations.
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