Wharton's Jelly Mesenchymal stem cells for the treatment of type 1 diabetes

Abstract

Type 1 diabetes is an autoimmune disease caused by the destruction of endocrine pancreas β cells by T lymphocytes, for which genetic and environmental risk factors have been proposed. Patients require daily infusions of recombinant insulin to overcome the reduced production by their own cells, but there is an increasing demand for a permanent and efficient supplementation which could better modulate the need for the hormone during the normal activities. For this reason, transplant-based therapeutic models have been proposed such as whole organ transplantation and Langerhans islets transplantation. These techniques are limited by many factors such as the lack of donors, the risks linked to the surgical practice, and the rejection reactions of the transplanted organ. Further opportunities may come from the research on stem cells. Multiple studies showed that multiple populations of stem cells may be differentiated toward pancreatic endocrine-like ones, which may express insulin in vitro and in vivo and often respond to glucose challenge. Another developing field in stem cells research is that on the immunomodulatory ability of some stem populations, in particular those defined as perinatal, derived from fetus-associated tissues usually discarded at birth. Wharton's jelly mesenchymal stem cells (WJ-MSCs), which derive from the mature mucous tissue constituting the bulk of the umbilical cord, can also differentiate toward beta cells. Moreover, these cells feature important immunomodulatory activities, which seem to be maintained also in differentiated populations, which should render these cells even more promising for cell therapy applications in type 1 diabetes. This chapter analyzes the literature regarding the features and potential of WJ-MSCs for the therapy of type 1 diabetes, in the light of multiple possible therapeutic approaches, in which cells should be used both undifferentiated and differentiated, and in cotransplantation with islets. We propose that WJ-MSCs transplantation may be useful both to regenerate β cells and also prevent the autoimmune destruction of remnant and neogenetic β cells in patients.