Autologous bone marrow-derived mononuclear cells transplantation in type 2 diabetes mellitus: effect on beta-cell function and insulin sensitivity

作者：Bhansali Shobhit; Dutta Pinaki; Yadav Mukesh Kumar; Jain Ashish; Mudaliar Sunder; Hawkins Meredith; Kurpad Anura V; Pahwa Deepak; Yadav Ashok Kumar; Sharma Ratti Ram; Jha Vivekanand; Marwaha Neelam; Bhansali Shipra; Bhansali Anil^*

来源：Diabetology & Metabolic Syndrome, 2017, 9(1): 50.

DOI：10.1186/s13098-017-0248-7

• T2DM
• Stem cells
• Autologous bone marrow-derived mononuclear cells

Background: Insulin resistance and insulin deficiency are the cardinal defects in the pathogenesis of type 2 diabetes mellitus (T2DM). Despite the plethora of anti-diabetic medications, drugs specifically targeting the beta-cells are still desired. Stem cell therapy has emerged as a novel therapeutics strategy to target beta-cells; however, their mechanism of action has not been well defined. This study aims to examine the efficacy and safety of autologous bone marrow-derived mononuclear cells (ABM-MNCs) transplantation in T2DM, and explores the mechanistic insights into stem cells action through metabolic studies.
Methods: Seven T2DM patients with the duration of disease >= 5 years, receiving triple oral anti-diabetic drugs along with insulin (>= 0.4 IU per kg per day) and HbA1c <= 7.5% (<= 58.0 mmol/mol) were enrolled for ABM-MNCs administration through a targeted approach. The primary end-point was a reduction in insulin requirement by >= 50% from baseline, while maintaining HbA1c < 7.0% (< 53.0 mmol/mol) with improvement in insulin secretion, and/or insulin sensitivity after ABM-MNCs transplantation.
Results: Six out of 7 (90%) patients achieved the primary end-point. At 6 months, there was a significant reduction in insulin requirement by 51% as compared to baseline (p < 0.003). This was accompanied by a significant increase in the 2nd phase C-peptide response during hyperglycemic clamp (p = 0.018), whereas there were no significant alterations in insulin sensitivity and glucose disposal rate during hyperinsulinemic-euglycemic clamp relative to the baseline. Other measures of beta-cell indices like HOMA-beta, and stimulated C-peptide response to glucagon and mixed meal tolerance test were non-contributory.
Conclusion: ABM-MNCs transplantation results in significant reduction in insulin doses and improvement in C-peptide response in patients with T2DM. Metabolic studies may be more useful than conventional indices to predict beta-cell function in patients with advanced duration of T2DM.

• 出版日期2017-7-4
• 单位河北医科大学