Authors : Bhansali S, Dutta, Yadav MK, Jain A, Mudaliar S, Hawkins M, Kurpad AV, Pahwa D, Yadav AK, Sharma RR, Jha V, Marwaha N, Bhansali S, Bhansali A
Publication Year : 2018
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 ß-cells are still desired. Stem cell therapy has emerged as a novel therapeutics strategy to target ß-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.
Seven T2DM patients with the duration of disease greater than or equal to 5 years, receiving triple oral anti-diabetic drugs along with insulin (greater than or equal to 0.4 IU per kg per day) and HbA1c less than or equal to 7.5% (less than or equal to 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 greater than or equal to 50% from baseline, while maintaining HbA1c less than 7.0% (less than 53.0 mmol/mol) with improvement in insulin secretion, and/or insulin sensitivity after ABM-MNCs transplantation.
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 less than 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 ß-cell indices like HOMA-ß, and stimulated C-peptide response to glucagon and mixed meal tolerance test were non-contributory.
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 ß-cell function in patients with advanced duration of T2DM.