The incidence of diabetes is on a rapid rise worldwide, and the number of diabetic patients worldwide is expected to exceed 300 million in 2025, while the number of diagnosed diabetics in China has reached 92 million, with about 148 million patients in the early stages of diabetes. Because of its many complications and high disability rate, diabetes has become one of the major killers of people’s health in this century.
Type 2 diabetes is mainly caused by two major causes: insufficient insulin secretion and insulin resistance, while type 1 diabetes is mainly caused by insufficient insulin secretion due to the destruction of pancreatic islet beta cells. For a long time, people have been exploring the root cause of diabetes, but due to its complex pathogenesis, the treatment of diabetes is still based on symptomatic treatment such as drugs and insulin injections. With the development of organ transplantation, islet transplantation and pancreas transplantation have been attempted, but they cannot be widely used due to two major problems that are difficult to overcome, namely donor shortage and immune rejection. In recent years, a lot of research has confirmed that stem cells are a type of cells with multiple differentiation potentials, just like “seeds”, and when a certain number of stem cells are migrated to pancreatic tissue through arterial catheters, the “seeds” will differentiate and proliferate into islet-like cells under the induction of pancreatic tissue microenvironment. The “seeds” will be induced by the microenvironment of pancreatic tissue to differentiate and proliferate into islet-like cells, which will replace the damaged pancreatic β-cells to secrete insulin, thus exploring a new method of stem cell transplantation for the treatment of diabetes, which overcomes the two major problems of donor shortage and immune rejection and greatly improves safety. It provides a new hope for the majority of diabetic patients.
Diabetic foot is one of the serious complications of diabetes, with a high amputation rate, which seriously affects the survival quality of diabetic patients. It is the result of a combination of ischemia, neuropathy, infection and other factors caused by diabetic lower limb vasculopathy, with typical clinical manifestations of resting pain, foot ulceration and gangrene. Traditional treatment uses a combination of medical drugs and surgical blood flow reconstruction, but the long-term results are not satisfactory. A large number of animal experiments and clinical studies have found that stem cells can differentiate into vascular endothelial cells in ischemic lower limb tissues and can release a variety of cytokines locally to promote neovascularization in ischemic limbs and improve and restore blood flow to the limbs. Therefore, stem cell transplantation is a new method for the treatment of diabetic foot and has shown a bright future in the field of diabetic foot treatment.
Stem cell transplantation is currently at the forefront of diabetes treatment in the world, and there are still very limited hospitals in China that carry out this therapy. The Department of Endocrinology of the Second People’s Hospital of Guangdong Province has carried out the new therapy of stem cell transplantation for the treatment of diabetes and diabetic foot. If you have the conditions and willingness to carry out this therapy, you can contact us for consultation at any time, hoping that our efforts can make your dream of stem cell transplantation a reality and save you from the pain and suffering of diabetes.
I. Frequently Asked Questions about Stem Cell Transplantation for Diabetes
1. What are stem cells and how to treat diabetes?
A: Research has confirmed that stem cells are a type of cells with multiple differentiation potentials, which can differentiate into various cells under the appropriate microenvironment, and grow in various tissues and organs like “seeds”, so they can play the role of repairing tissues and organs. When a certain number of stem cells are injected into the pancreatic tissue through the arterial catheter, the “seeds” will differentiate and proliferate into islet-like cells under the induction of the microenvironment of the pancreatic tissue, replacing the damaged beta islet cells to secrete insulin and play a role in the treatment of diabetes.
2. What are the methods of stem cell transplantation for diabetes treatment?
A: Stem cell transplantation for the treatment of diabetes is divided into three methods: autologous bone marrow stem cell transplantation, autologous peripheral stem cell transplantation and umbilical cord blood stem cell transplantation. Our department is currently carrying out autologous peripheral blood stem cell transplantation and umbilical cord blood stem cell transplantation for the treatment of diabetes, which is simpler in operation, does not require bone marrow collection, is less traumatic, causes fewer adverse reactions, has a significantly shorter hospital stay and costs less.
3. Indications for stem cell transplantation for the treatment of diabetes mellitus.
① Patients with type 1 or type 2 diabetes (WHO criteria, 1999).
② Age 6 to 65 years.
③ Fair general physical condition.
④ Those with good compliance.
4. Indications for stem cell treatment of diabetic foot.
① Those with intermittent claudication, numbness of limbs or ulcers that do not heal for a long time.
② Those with poor results of conservative drug treatment.
③ Those who cannot tolerate surgical bypass surgery due to old age and frailty; or those with obstructed outflow tracts, although arteriography shows that there are good arterial outflow tracts in the distal part of the lower limbs and lower limb arterial bypass can be performed.
5. Contraindications to stem cell therapy for diabetes mellitus and diabetic foot.
① Patients with definite malignant diseases or those with significantly elevated levels of tumor markers in the blood.
② Those with serious diseases or insufficiency of important organs such as heart, liver, spleen, lung and kidney.
③ Bleeding disorders or coagulation abnormalities.
④ congenital or acquired immunodeficiency disorders.
⑤ Allergy to contrast media.
(vi) Those with severe occlusive aortic, iliac arteries.
(7) Those who have suffered from myocardial infarction or cerebral infarction within six months.
⑧ Those with systemic infection.
⑨ Hypercoagulable state with no clear etiology.
⑩Patients with poor compliance and unable to cooperate with the surgery.
6. General procedure of stem cell transplantation for diabetes.
(1) Type 1 diabetes: preoperative disease assessment → preoperative non-cleared marrow pretreatment → cord blood collection or stem cell mobilization → isolation of stem cells → stem cell implantation → postoperative observation.
(2) Type 2 diabetes or diabetic foot: preoperative assessment of disease → cord blood collection or stem cell mobilization → stem cell isolation → stem cell implantation → postoperative observation.
7. Is stem cell transplantation safe?
In a large number of animal experiments, no animal death caused by pancreatitis or liver function damage was found after stem cell transplantation, and no tumor formation was found after transplantation. The safety of stem cell transplantation for the treatment of diabetes has been clinically confirmed, and no systemic or pancreatic infections, liver and kidney function damage, cardiovascular and cerebrovascular complications or increased chance of tumors have been observed in the implemented cases. The stem cells are collected by machine in a sealed environment, using exclusively disposable imported materials, eliminating and avoiding the chance of contamination. The interventional procedure used for stem cell implantation has been clinically used for many years and the technology is very mature. It is performed by trained catheter specialists to minimize complications caused by catheters.
8. What is the efficacy of this treatment?
A: The short-term efficacy is satisfactory from the domestic and international literature and the cases we have performed. Foreign studies have shown that “more than 93% of patients treated with stem cells for type 1 diabetes are able to get rid of insulin dependence in different periods of time, and the toxicity of the treatment is very low and the mortality rate is zero. If they intervene early enough in the treatment of diabetes, they have full confidence in curing the disease. type 2 diabetes can also achieve more than 80% efficacy”. Thousands of cases have been carried out in China and it has been confirmed that stem cell transplantation has a definite efficacy in diabetes. Our hospital has already treated many patients with this treatment, and the short-term effect is positive. All patients have achieved a decrease in blood sugar or a reduction in the amount of glucose-lowering drugs, and some patients have stopped using all glucose-lowering drugs. The long-term efficacy should be very good in theory, but due to the limited time of this technology, the long-term efficacy is currently under clinical observation.
9.How to transplant stem cells into diabetic patients?
A: There are two methods commonly used for stem cell transplantation: interventional method and intravenous input method. Interventional method is to inject stem cells directly into the pancreas through the femoral artery using a catheter. The procedure is performed by puncturing the femoral artery under local anesthesia, which is less invasive, less risky and safer. The whole procedure takes about 2-3 hours. After the operation, you can go down to the ground in 2-3 days and be discharged after 1 week of observation. The intravenous input method is just like the usual infusion we give with a hangnail, and the stem cells are directly input into the patient’s blood vessels, and the method is even simpler and safer.
A: Cord blood stem cell transplantation
10.Can stem cell transplantation be repeated?
A: A lot of clinical practice has confirmed that multiple stem cell transplants can improve the clinical efficacy of stem cells, both for diabetic patients and patients with cirrhosis. Therefore, at present, we adopt 2-3 times of stem cell transplantation to treat diabetes.
11.The difference between stem cell transplantation and organ transplantation
1) The source of organ transplantation is extremely limited, and most people are not willing to donate their organs due to the conceptual barrier, so patients often wait painfully. In contrast, there are sufficient sources of stem cells, which can basically meet the needs of all people.
2) Organ transplantation is complicated and risky, and the higher the age, the riskier the surgery is, and some clinical emergencies may occur. Stem cell transplantation is mainly done by intervention or intravenous infusion, and the process is easy and fast, less traumatic, less painful, and almost risk-free.
(3) The main obstacle of organ transplantation is immune rejection, once the anti-rejection treatment fails, the organ will lose its function and the previous work will be abandoned; even if the transplantation is successful, it may still need to use immunosuppressive drugs for life, which will bring long-lasting harm to the body. Stem cell transplantation solves the rejection problem of organ transplantation, no immune rejection, no mating, no immunosuppressant, and no side effects to human body.
12.What is the difference between hematopoietic stem cell transplantation and bone marrow transplantation?
A: The principle of hematopoietic stem cell transplantation is exactly the same as that of bone marrow transplantation, only the way of collecting hematopoietic cells is different. The vast majority of hematopoietic stem cells exist in the bone marrow, and bone marrow transplantation involves extracting bone marrow from the bone marrow cavity through bone marrow puncture and then collecting hematopoietic stem cells for input into the patient’s body; stem cell transplantation, on the other hand, uses hematopoietic stem cells to be released from the bone marrow into the blood, and hematopoietic cells are collected from the peripheral blood through a blood cell separator. To perform a bone marrow transplant, the volunteer donor needs to be put under local anesthesia and hundreds of milliliters of bone marrow mixture is extracted by drilling holes in the iliac bone several times; for stem cell transplantation, only blood is collected from the volunteer’s vein and enriched by the machine, and the blood is returned to the human body with only 50 milliliters of stem cells, which is safe for the human body because the total amount of incoming and outgoing is balanced and the donor does not suffer from circulatory disorders after collection.
Before routine bone marrow transplantation, HLA-A, B and DR are required to be the same. Generally, HLA-AB typing is done on volunteers first, and after the HLA-AB of the donor and recipient match after retrieval, the HLA-DR typing test is done on the donor to see if there is a match. If the HLA of the donor and recipient are a perfect match, and the donor passes the health examination, then we can proceed to prepare for transplantation. The cancer cells in the patient’s body are first destroyed with chemical drugs and radiation therapy (pre-treatment before transplantation). At this time, the patient’s normal hematopoietic cells are also killed and the body’s immunity is reduced, making it susceptible to infection, and the transplant must be received in a sterile ward (laminar flow room).
The bone marrow transplantation process is associated with varying degrees of rejection. This is because the immune system can recognize a foreign body as “foreign” and attack it to eliminate it, a process called “rejection”. If the donor and recipient are related, the rejection reaction will be weaker, while if they are not related, the reaction will be heavier. Another type of rejection reaction is graft-versus-host reaction (GVHD for short). The immune cells in the donor tissue act on the recipient (host), and the host tissue antigen is also a foreign substance to the donor immune cells, so the donor immune cells gradually grow up to “attack” the recipient more and more, and can produce “graft-versus-host reaction “The stem cell transplantation treatment has solved the problem of diabetes.
In contrast, stem cell transplantation for diabetes solves the problem of organ transplant rejection by eliminating immune rejection, requiring no mating and no immunosuppressive drugs, and producing no side effects in the human body. It is also usually easier to pretreat type 1 diabetes before transplantation, while type 2 diabetes does not require pretreatment before transplantation.
14. Characteristics of cord blood stem cell transplantation: 1) At this stage, cord blood hematopoietic stem cells can be used to treat diseases such as hematologic diseases (re-infarction, thalassemia…) ;malignant diseases (acute gonorrhea…) congenital metabolic defects; autoimmune diseases…
2) Cord blood is abundant in source; easy to collect, no damage to the mother and fetus; unlike non-blood marrow banks, cord blood is preserved in physical form and will not be rejected by the donor; the time required to find HLA compatible cord blood is short and can be transplanted in time according to the patient’s needs; immune cells in cord blood are immature, the incidence of acute and chronic GVHD after transplantation is low and mild, and can tolerate large HLA differences The chance of various viral infections in cord blood is very small, and the incidence of viral diseases after transplantation is low.
(3) Indiana University published the results of a study showing that cord blood stem cells frozen for 15 years are still potent, confirming
cell activity and function were not impaired. Cord blood stem cells can be stored for a long time after deep cryogenic storage.