Ask the doctors: Can stem cells help cure Type 1 diabetes?
Q: I have Type 1 diabetes. I try to stay healthy and keep my blood sugar under control, but it feels like a fight every day. I read there's a study using stem cells for a cure. Are there any updates? Does it seem like this might lead to a treatment?
A: Type 1 diabetes is a chronic autoimmune disease. The immune system mistakenly targets and destroys beta cells in the pancreas. These cells are mainly responsible for producing insulin, the hormone crucial to glucose metabolism. Without enough insulin, the body is unable to keep blood glucose within a healthy range. Ways to manage blood sugar in these cases include injectable insulin, a carefully curated diet and healthy lifestyle choices.
Introduced in 1922, injectable insulin revolutionized diabetes treatment. Before that, life expectancy with the disease was just a few years. Today, even with the benefit of insulin, people with diabetes are at an increased risk of developing serious complications, including cardiovascular disease, nerve damage, kidney disease and eye damage.
As you point out, the vigilance required to manage blood sugar can be both daunting and tiring. That brings us to your question.
Stem cells are what is known as undifferentiated cells. That means they have not yet developed a specific function, like muscle, bone or nerve cells. Because stem cells are like a blank slate, they can develop into other types of specialized cells. They can also self-renew. These unique qualities have made stem cells the focus of research into treatment for a wide range of diseases, including Type 1 diabetes.
In the clinical trial you asked about, participants were infused with stem cells “taught” to behave like beta cells. It was a small study with just 17 patients, but the preliminary results were encouraging. One participant's body began to produce insulin and release it in response to blood sugar fluctuations.
On the other hand, because these stem cell infusions introduce foreign tissue into the body, they require antirejection drugs. These drugs can cause side effects that can be hard to tolerate. Several participants dropped out of the study due to the adverse effects.
Many readers have asked for information about upcoming clinical trials into this line of research. Earlier this spring, the researchers announced they are moving on to the next expanded phase of research.
As with all clinical trials, the parameters for participation are quite specific. In this case, the study is recruiting people with Type 1 diabetes who also have severe episodes of hypoglycemia or have impaired awareness of hypoglycemia. Due to the antirejection drugs, it is important to remember there is also an element of risk.
The 27 locations of upcoming trials include cities in Illinois, Florida, California, Maryland, Texas, Massachusetts, Wisconsin and Pennsylvania. Trials in Canada and Europe are scheduled as well. For more details, visit clinicaltrials.gov and search for VX-880.
• Dr. Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr. Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu.
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