13 Brazilian's Suffering from Type I Diabetes Insulin Free After Stem Cell Treatment

By Lindey Tanner, Times Leader, April 18, 2007

Thanks to a promising treatment using their own stem cells, insulin shots and medication are a thing of the past for thirteen young diabetics in Brazil. This is thought to be the first time that such a dramatic benefit has been observed in diabetic patients.

All the patients suffered from Type I diabetes, and some have lived normal lives as long as three years without insulin. Using stem cells extracted from the patients’ own blood, the treatment uses non-controversial adult stem cells. However, it is still a bit too early to call the treatment a cure for diabetes.

“It’s the first time in the history of Type 1 diabetes where people have gone with no treatment whatsoever ... no medications at all, with normal blood sugars,” said study co-author Dr. Richard Burt of Northwestern University’s medical school in Chicago.

The treatment did not work for two of the patients that were involved in the study, but the treatment was successful in the other 13. The procedure does carry some risk, but none of the patients suffered any lingering side-effects.

To establish if the stem cell procedure can become a standard treatment for Type I Diabetes, more studies will be necessary. Unlike Type II Diabetes, Type I (also called juvenile diabetes) is not linked with obesity and is less common.

The study results were an important step in the right direction said Dr. Burt.

“It’s the threshold of a very promising time for the field,” said Dr. Jay Skyler of the Diabetes Research Institute at the University of Miami.

The results of the study will likely influence other researchers to explore more methods to prevent or reverse Type I diabetes wrote Dr. Skyler in an editorial for the Journal of the American Medical Association.

“These are exciting results. They look impressive,” said Dr. Gordon Weir of Joslin Diabetes Center in Boston.

But in order to be certain the treatment is safe and effective, Dr. Weir agreed that more studies are necessary.

“It’s really too early to suggest to people that this is a cure,” he said.

The patients in the study were all diagnosed with Type I diabetes early in the course of the illness, and their ages ranged between 14 to 31. This autoimmune disease is usually diagnosed in young adults and children. One to two million individuals in the United States are afflicted with this illness; worldwide, the numbers are between 12 and 24 million people.

The condition occurs when the body attacks the insulin-producing cells in the pancreas. Consequently, the body cannot produce insulin. Nerve problem, blindness, kidney damage, and heart disease can all occur without insulin which is needed to regulate blood sugar levels and keep them low.

The goal of the treatment was to stop the body’s immune attack on the pancreas, so the stem cell treatment was designed to do just that.

Enabling a few people to give up insulin shots, a study published last year described a different kind of experiment where the stem cells were donated from the pancreas of cadavers. However, since the stem cells came from donor tissue, the patients involved had to use anti-rejection medication for the rest of their lives. In the case of the Brazilian subjects, the medication was unnecessary since the possibility of rejection was negated by using the patient’s own stem cells.

The treatments were conducted at the University of Sao Paulo in the bone marrow center.

It should be noted that the patients were treated before all their insulin producing cells were destroyed by their immune systems. All 15 patients were recently diagnosed.

That timing is key, Burt said. “If you wait too long,” he said, “you’ve exceeded the body’s ability to repair itself.”

The procedure involves harvesting stem cells from the patient’s blood after stimulating the body to produce new cells. In order to save the few remaining insulin-producing cells in the pancreas, the attack of the immune system needs to be shut down. This requires high-dose chemotherapy for the next several days to stop the patient’s immune response. Strong drugs and hospitalization are needed during this time to prevent illness since the body becomes defenseless without an immune system. A new immune system that does not attack the insulin-producing cells is then rebuilt by injecting the harvested stem cells back into the patient’s body.

Patients experienced some short term side-effects during their three week long hospital stays. These included hair loss, nausea, and vomiting. The only severe complication was pneumonia which only affected one patient. The side-effects can be contributed to the chemotherapy and medication; not the stem cells.

One of the patients relapsed, and another ended up needing more insulin that before the study began after the treatment failed, and his drug treatment was modified to correct this result.

The remaining 13 “live a normal life without taking insulin,” said study co-author Dr. Julio Voltarelli of the University of Sao Paulo. “They all went back to their lives.”