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October 30, 2001

Research: Cure

Question from Burlingame, California USA:

My 14 year old daughter has type 1 diabetes and an A positive blood type, her newborn twin first cousins have the same blood type, and their cord blood has been stored. Is there a clinic or doctor we may contact for information on compatibility and possible stem cell transplantation for our daughter?

Answer:

The use of stem cells in the management of autoimmune diabetes is still a very very long way from being a clinical prospect, which is why there are as yet no programs in type 1 diabetes to test out the possibilities First of all, stem cells from cord blood are already differentiated as ‘mesoderm’ cells which means that whilst they may be life saving in the treatment of some hereditary aplastic anemias, they cannot at present be made to produce insulin since islet cells are ‘endoderm’ derivatives, nor for that matter used for the treatment of ‘ectoderrmal’ tissues such as central nervous system disorders like Parkinsonism. Obviously though, this may change with time.

Insulin-producing stem cells have however been derived from the more primitive pluripotential cells from discarded fertilised ova from fertility clinics. Now whilst stem sells may solve the issue of the paucity of donor islet cells, there is still going to be the problem of the recipient’s immune reaction to a foreign protein in addition to the residual autoimmune response. There are ways around this like producing a chimera to get around the first issue and immunosuppressive drugs for the second.

My own personal hope for a ‘cure’ would still be for the use of some form of surrogate insulin producing cells, but in a program, still at the laboratory mouse stage of course, where the activation of the destructive lymphocytes is permanently halted by just a few injections of two monoclonal antibodies. The intriguing aspect of this approach is that the tolerance produced in the original mouse can be transferred to another subject, thus potentially getting around both the donor shortage and the immunity problems.

DOB