Cell therapies for type 1 diabetes mellitus

Proliferation and pluripotency of human embryonic stem cells maintained on type I collagen

Human embryonic stem cells (hESC) require a balance of growth factors and signaling molecules to proliferate and retain pluripotency. Conditioned medium (CM) from a human embryonic germ-cell-derived cell culture, SDEC, was observed to support the growth of hESC on type I collagen (COL I) and on Matrigel (MAT) biomatricies. After 1 month, the population doubling of hESC grown in SDEC CM on COL I was equivalent to that of hESC grown in mouse embryonic fibroblast (MEF) CM on MAT. hESC grown in SDEC CM on COL I expressed OCT4, NANOG, SSEA-4, alkaline phosphatase (AP), and TRA-1-60; retained a normal karyotype; and were capable of forming teratomas. DNA microarray analysis was used to compare the transcriptional profiles of SDEC and the less supportive WI38 and Detroit 551 human cell lines. The mRNA level of secreted frizzled-related protein (sFRP-1), a known antagonist of the WNT/β-catenin signaling pathway, was significantly reduced in SDEC as compared with the other 2 cell lines, whereas the mRNA levels of prostaglandin-endoperoxide synthase 2 (PTGS2 or COX-2) and prostaglandin I₂ synthase (PGIS), two prostaglandin biosynthesis genes, were significantly increased in SDEC. The level of sFRP-1 protein was significantly reduced, and levels of 2 prostaglandins that are downstream products of PTGS2 and PGIS, prostaglandin E₂ and 6-keto-prostaglandin F(1α), were significantly elevated in SDEC CM compared with WI38, Detroit 551, and MEF CM. Further, addition of purified sFRP-1 to SDEC CM reduced the proliferation of hESC grown on COL I as well as MAT in a dose-dependent manner.

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Role of histone and transcription factor acetylation in diabetes pathogenesis

Globally, diabetes (and, in particular, type 2 diabetes) represents a major challenge to world health. Currently in the United States, the costs of treating diabetes and its associated complications exceed 100 billion US dollars annually, and this figure is expected to soar in the near future. Despite decades of intense research efforts, the genetic basis of the events involved in the pathogenesis of diabetes is still poorly understood. Diabetes is a complex multigenic syndrome primarily due to beta-cell dysfunction associated with a variable degree of insulin resistance. Recent advances have led to exciting new developments with regard to our understanding of the mechanisms that regulate insulin transcription. These include data that implicate chromatin as a critical regulator of this event. The 'Histone Code' is a widely accepted hypothesis, whereby sequential modifications to the histones in chromatin lead to regulated transcription of genes. One of the modifications used in the histone code is acetylation. This is probably the best characterized modification of histones, which is carried out under the control of histone acetyltransferases (HATs) and histone deacetylases (HDACs). These enzymes also regulate the activity of a number of transcription factors through acetylation. Increasing evidence links possible dysregulation of these mechanisms in the pathogenesis of diabetes, with important therapeutic implications.

A perspective on pancreatic stem/progenitor cells

The prevalence of both type 1 and type 2 diabetes mellitus is increasing throughout the world along with the ensuant morbidity and early mortality because of premature microvascular and macrovascular disease. Current insulin and drug therapies control diabetes, but do not cure it. Cell-based therapies offer the possibilities of a permanent cure for diabetes. Recently, success in the transplantation of pancreatic islets in the livers of type 1 diabetics has afforded the opportunity for a potential cure. However, the severe shortage of donor islets for transplantation limits the usefulness of this therapy. One approach is to exploit the use of stem cells, either embryo-derived or adult tissue-derived, as substrates to create islet tissue suitable for transplantation. Cells isolated from embryo blastocysts and from adult pancreas, liver, and bone marrow can be expanded extensively in vitro and differentiated into islet-like clusters that produce insulin, and, in some instances, can achieve glycemic control when transplanted into streptozotocin-induced diabetic mice. It is, now, also possible to envision the direct systemic administration of stem cells that would home in on and regenerate injured islets, or to administer stem cell stimulators that would enhance endogenous pancreatic stem cells to expand and differentiate into functional, insulin-producing beta-cells. This perspective discusses the potential applications of cellular medicines, in the new discipline of regenerative medicine, to achieve a cure for diabetes.

Local umbilical cord blood renin?angiotensin system

Local bone marrow (BM) renin-angiotensin system (RAS) is an autocrine-paracrine system affecting normal and neoplastic hematopoiesis. Angiotensin II type 1a (AT1a) receptors are present on the CD34(+) hematopoietic stem cells (HSC). Angiotensin II stimulates the proliferation and differentiation of the HSC populations through the activation of AT1 receptors on HSC. Umbilical cord blood (UCB) is a rich source of HSC. The existence of a complete local UCB RAS has not been previously investigated. In this study, local synthesis of the major RAS components, namely, angiotensin-converting enzyme (ACE), renin, and angiotensinogen, was identified by demonstrating their corresponding mRNAs using quantitative reverse transcriptase polymerase chain reaction (RT-PCR) in human UCB. Local RAS could regulate cellular growth in a variety of tissues including the BM. Major RAS peptides can exert significant effects on primitive pluripotential HSC populations. Further studies should focus on the interactions between possible autocrine, paracrine, endocrine, and intracrine actions of the local UCB RAS and growth, engraftment, differentiation, and plasticity functions of HSC of UCB origin.

Derivation, growth and applications of human embryonic stem cells

Human embryonic stem (hES) cells are pluripotent cells derived from the inner cell mass cells of blastocysts with the potential to maintain an undifferentiated state indefinitely. Fully characterised hES cell lines express typical stem cell markers, possess high levels of telomerase activity, show normal karyotype and have the potential to differentiate into numerous cell types under in vitro and in vivo conditions. Therefore, hES cells are potentially valuable for the development of cell transplantation therapies for the treatment of various human diseases. However, there are a number of factors which may limit the medical application of hES cells: (a) continuous culture of hES cells in an undifferentiated state requires the presence of feeder layers and animal-based ingredients which incurs a risk of cross-transfer of pathogens; (b) hES cells demonstrate high genomic instability and non-predictable differentiation after long-term growth; and (c) differentiated hES cells express molecules which could cause immune rejection. In this review we summarise recent progress in the derivation and growth of undifferentiated hES cells and their differentiated progeny, and the problems associated with these techniques. We also examine the potential use of the therapeutic cloning technique to derive isogenic hES cells.

Transplantation of human umbilical cord blood cells improves glycemia and glomerular hypertrophy in type 2 diabetic mice

Recent in vitro and in vivo studies have shown that either animal- or human-derived embryonic stem cells can differentiate into insulin-secreting cells and lower blood glucose levels. However, studies utilizing human umbilical cord blood (HUCB) mononuclear cells to improve blood glucose levels in diabetic animals have received little attention. In this study, we examined the effect of transplanted HUCB mononuclear cells on blood glucose levels, survival, and renal pathology in obese mice with spontaneous development of type 2 diabetes. The results show that injection of HUCB mononuclear cells into orbital plexus of mice caused improvement not only in blood glucose levels and survival rate but also normalization of glomerular hypertrophy and tubular dilatation. Thus, transplantation of HUCB mononuclear cells appears to be another modality of stem cell therapy in diabetes mellitus.

Insulin production by insulin-producing cells induced from embryonic stem cells

AIM: To study the insulin secretion of insulin-producing cells (IPCs) induced from embryonic stem cells (ESCs).

METHODS: ESCs were allowed to grow on mouse fetal fibroblast feeder layer to keep undifferentiated state, and then transferred into serum-free DMEM supplemented with bFGF to form outgrowths in the culture. At day 21 after induction, the outgrowths were incubated in DTZ solution (final concentration, 100 mg/L) for 15 minutes before being observed microscopically. In addition, insulin production was examined immunohistochemically, and its secretion was determined using ELISA. The gene expression of endocrine pancreatic markers, including PDX-1, insulin1, insulin2 and Glut2, was also analyzed by RT-PCR, and the activity of secreted insulin was determined by glucose-reducing experiment on mice.

RESULTS: ESCs grew and formed embryoid bodies at day 4, and the addition of bFGF promoted the differentiation of ESCs into IPCs. The induced IPCs self-assembled to form three-dimentional clusters, and were stained crimson red by DTZ at day 21 after differentiation. They were found to be immunoreactive to insulin, express pancreatic-duodenal homeobox 1 (PDX1) and insulin2 mRNA. They were also able to secrete detectable amounts of active insulin, which could reduce mouse blood glucose significantly.

CONCLUSION: ES cell-induced IPCs can synthesize and secrete active insulin that is able to reduce blood glucose significantly.