Stem Cells to Insulin Secreting Cells: Two Steps Forward and Now a Time to Pause?

摘要

Two groups recently reported the in vitro differentiation of human embryonic stem cells into insulin-secreting cells, achieving an elusive goal for regenerative medicine. Herein we provide a perspective regarding these developments, compare phenotypes of the insulin-containing cells to human beta cells, and discuss implications for type 1 diabetes research and clinical care. Type 1 diabetes (T1D) results from an autoimmune destruction of insulin-producing pancreatic beta cells (Atkinson et al., 2014). Patients require multiple daily injections of insulin that, while life-saving, are associated with significant alterations in lifestyle, the potential for hypogiycemia and hyper-glycemia, and an increased risk of life-threatening complications. Although islet transplantation could represent a definitive therapy for T1D, multiple issues have precluded its widespread use including the need for chronic immunosuppression, inadequate supply of cadaveric organ donors, and limited duration of graft function (e.g., 2-5 years). As a result, extensive research has been directed at improving technologies for regulating metabolism (such as insulin pumps and continuous glucose monitors) and developing beta cell replacement therapies, including xenoge-neic islet cells, regeneration of beta cells in vivo, and surrogate insulin-producing cells generated from stem cells.