Immunomodulatory and Regenerative Potential of Mesenchymal Stem Cells in Type 1 Diabetes: A Systematic Review

Abstract

Introduction: Type 1 diabetes (T1D) is an autoimmune disease resulting in the destruction of pancreatic beta cells. Stem cell medicine aims to either replace lost cells or preserve remaining beta-cell function by modulating the autoimmune attack. This review focuses on the use of mesenchymal stem cells (MSCs) for this purpose.

Methods: A systematic search of MEDLINE, Embase, and clinical trial registries was conducted for studies investigating MSC infusions in patients with new-onset T1D. Primary endpoints were C-peptide levels (a measure of endogenous insulin production) and insulin requirements.

Results: Eighteen clinical trials were included. The majority of studies showed that a single infusion of MSCs was safe and well-tolerated. Patients receiving MSCs demonstrated a slower decline in C-peptide levels compared to control groups and had significantly lower insulin requirements at 1-year follow-up.

Discussion: MSC therapy appears to preserve beta-cell function in new-onset T1D, likely through potent immunomodulatory and anti-inflammatory effects that quell the autoimmune assault. The therapy does not appear to directly generate new beta cells but rather creates a supportive microenvironment for surviving cells.

Conclusion: MSC infusion is a safe and potentially effective intervention to prolong the "honeymoon period" in new-onset Type 1 Diabetes. Larger, multi-center trials are needed to confirm these findings and determine the optimal timing and dosage.