Stem cell therapy can prevent the progression of type 1 diabetes, which can reduce the risk of complications, provide better living conditions and a longer lifespan.
Photograph: Mikael Wallerstedt
Diabetes is the fastest growing widespread disease in the world. About 465 million people across the globe are living with diabetes today. Modern medicines have led to better health and longer lifespans, but research still faces many challenges.
in medical cell biology. Photo: Cecilia Yates
Diabetes, both type 1 and type 2, are chronic diseases for which there are, as yet, no cure. Current research is dominated both by finding strategies to stop the progression of the disease for affected patients, and by finding methods for the early detection of people at risk of developing diabetes to stop its course before the disease breaks out.
'Research is now being conducted in studies with mesenchymal stem cells (MSCs) to prevent the progression of type 1 diabetes,' says Per-Ola Carlsson, senior physician and professor in medical cell biology, who is working both experimentally and clinically with diabetes research. 'Through treatment, the remaining insulin-producing cells, which are at about 25–50% at the onset of diabetes, can hopefully be preserved and the patient can thereby manage on very low insulin doses.'
Reduced risk of complications
In the long run, this will enable us to reduce the risk of complications and provide better living conditions and a longer lifespan.
'In the future,' says Carlsson, 'we can imagine identifying individuals who are starting to show signs of immune activity against insulin-producing cells and treating them to prevent the destruction of the cells before so many of them have been lost that it results in high blood sugar.'
Another research track is transplantation with stem cell-derived insulin-producing cells. This treatment is aimed at type 1 diabetes patients who have already lost their insulin-producing cells.
Increase of diabetes type 2 in the younger population
Problems such as increased weight and obesity have led to a rise in society of diabetes type 2, especially at younger ages. The main treatments are diet and exercise. Many new drugs have a good impact and reduce the risk of sequelae, but no medicine can currently stop the progressive course of the disease in type 2 diabetes.
'There is of course,' says Carlsson, 'a hope to develop drugs that focus on the disease mechanism itself, i.e., stop the course of the disease. This could include those that affect free radical stress against the insulin-productive cells. It would be extremely significant if we could intervene in the disease process.'
Influence of the immune system on diabetes
Diabetes research is also being conducted at Uppsala University to increase our understanding of the immune system and its function early in life to determine what influences the risk of developing diabetes later on.
Department of Medical Cell Biology.
Photo: Cecilia Yates
Like many of the greatest discoveries, the idea for the new study arose unexpectedly. Along with her research team, Mia Phillipson, professor in physiology at the Department of Medical Cell Biology, has had several successful research projects through the years. The team studies what the immune system's cells do in different tissues, both healthy and sick, and have discovered new functions for the immune system's cells. One discovery is that certain types of cells in the immune defence system, called macrophages, are important in wound healing, something that is being clinically tested just now in patients with diabetic foot ulcers.
'Basic research involves quite a lot of random discoveries,' explains Mia Phillipson, 'and it is important that these can be safeguarded and allowed to begin to germinate in a creative and permissive research environment. In our mouse models with stained macrophages that were used in completely different projects, we found a very high accumulation of these cells in other healthy tissues, for example in the pancreas.'
'We have found that these macrophages have completely different functions than they have later in life, and that they are important for the insulin-producing pancreatic islets to be able to mature and become functional after birth. We now want to investigate how these macrophages come to play in the risk of developing diabetes later in life.'
Infections can influence diabetes development
The research is focused on discovering new functions in immune cells, so as to then develop drugs that use these functions to heal damaged tissue, or to treat inflammatory bowel disease, diabetes or cancer.
'We now want to understand,' says Phillipson, 'if, for example, infections in a child's first year of life affect the pancreatic macrophages and thereby increase the riskof developing diabetes later in life, and how we can counteract this. More knowledge of why we have different levels of risk for diabetes will eventually enable us to customise advice and treatments for different subgroups so that we can stay healthy.'
Cecilia Yates
Two forms of diabetes
The two most common forms are type 1 and type 2 diabetes and have different disease courses.
- In type 1 diabetes, the body's own immune system attacks the insulin-producing cells in the pancreas, resulting in insulin deficiency. The body completely stops producing insulin, and the patient needs to administer it via an insulin pump or through injections for the rest of their lives.
- In type 2 diabetes, there is an insensitivity to insulin in the body tissues coupled with an inadequate ability to increase insulin production. The effect is an incomplete uptake of sugar into the body's tissues with high blood sugar as a result. Type 2 diabetes often occurs along with high blood pressure, high blood fats and obesity.
The two types of diabetes need to be treated differently.
