By Tia Ghose — published October 31, 2024
For the first time, scientists in China reprogrammed a woman’s fat cells to become insulin-producing pancreatic islet cells and reversed her type 1 diabetes.
Researchers took fat cells from the patient, chemically reverted them to pluripotent stem cells (cells that can become many different cell types), and then coaxed those stem cells to become islet cells. The new islet cells were implanted in the patient’s abdomen. The study was published Oct. 31 in the journal Cell.
Before the procedure the patient spent less than half her time in a healthy blood-glucose range. After the transplant, her time in the target range improved to over 98%. By 75 days after the transplant she no longer needed to inject insulin, and she remained off injected insulin a year after the procedure.
Study lead author Hongkui Deng of the Peking–Tsinghua Center for Life Sciences said the rapid reversal and insulin independence were surprising and suggest strong potential for this therapeutic approach. Yale immunobiologist Dr. Kevan Herold, who was not involved in the work, called the findings “very exciting.”
Transplanting islet cells is not a new idea: for decades clinicians have transplanted islets from deceased donors into patients with type 1 diabetes. Those approaches are limited by donor availability and require lifelong, strong immunosuppression to prevent rejection. The patient in this study had previously received a liver transplant and was already on immunosuppressive drugs.
Using a patient’s own cells offers two major potential advantages: an essentially unlimited supply of replacement islets from reprogrammed stem cells, and the possibility of avoiding some donor-related limitations. In this study, the islets grafted into the abdomen showed markedly improved insulin secretion compared with islets typically implanted in the liver. The abdomen is also more accessible for imaging (for example, by MRI) and for removal if problems arise.
However, challenges remain. Even if the cells are derived from a patient’s own tissue, transplanted islets could still be targeted by the autoimmune process that causes type 1 diabetes. To extend this approach to more patients, researchers must find ways to protect transplanted cells from immune attack without relying on strong, lifelong immunosuppression.
The new work adds to growing evidence that stem-cell–derived islets can reverse type 1 diabetes at least temporarily; other groups and companies (for example, Vertex Pharmaceuticals) are developing stem-cell–derived islet therapies and have reported early promising results in humans.
Reference: Cell (publication date Oct. 31, 2024).
