Transplantation of umbilical cord blood stem cells to treat type 1 diabetes

The patient: Huang Hong(alias), male, six years old, Haian County, Jiangsu Province.
1. Main Complaints: Half a year ago, the patient showed up the symptoms of dryness of the mouth, polydipsia
and polyuria, so he was hospitalized in a local hospital with the test result of fasting blood sugar 19.3mmol/l, urine glucose 4+ and urine acetone bodies 3+. He was diagnosed as Type 1 Diabetes. Before long, he was transferred into our Hospital with the further test report as postprandial blood sugar 27.63mmol/L, urine acetone bodies 3+, and also diagnosed as Type 1 Diabetes together with Diabetic Ketoacidosis. After giving him the static point insulin therapy, the urine acetone bodies turned to negative. In the later, the therapy was adjusted to insulin aspart injection treatment with 6U in the morning, 4U the afternoon and 3U the evening. And the LANTUS insulin glargine subcutaneous injection was conducted 2U per evening. The blood sugar was controlled between 9—26mmol/l.
2. Inspection in Hospital: The blood pressure is 90/60mmHg; the blood sugar control is not steady and its fluctuation is relatively great with fasting blood sugar 7mmol/l and postprandial blood sugar 26mmol/L or so. The function of liver and kidney is normal and the urokinase protein shows the negative character and also, the hematopoiesis function is normal with no serious infection recently.
3. Treatment in Hospital: According to the discussion result of experts and the consent from his parents, the patient was given cord stem cell transplant. Three months after operation, the blood sugar was controlled stably and the insulin decreased with fasting 4mmol/l and postprandial 10mmol/l or so; the renal function is normal and the urokinase protein shows the negative character. The pancreas islet function is better than before and the blood sugar is stably controlled with fasting 5mmol/l and postprandial 12mmol/l or so. And the glycosylated hemoglobin is 7%.
4. Expert Comments: Type 1 diabetes relies upon insulin in the treatment, so that is to say, the patients need to use insulin from the start of the attacking of the disease and have to use it for a lifelong time. The patients not only have to suffer the inconvenience and pain resulted by insulin injection, but also cannot control the glycemic stability completely, and also cannot prevent the occurrence of later complications. So the ideal therapy is to make the pancreas cell proliferated by exogenous or endogenous transplantation. Stem cell is a kind of that cell which has the strong capacity to self-renew and have the ability to generate differentiated cells. After its injection into the organism, pancreatic cells regeneration mechanism could have the following changes:
1. After the implantation of stem cells, bone marrow cell return homing first, then it is mobilized to the damaged pancreas tissues, and then it boosts the regeneration of the islet cells.
2. After the transplant of stem cells, the previous immune network would be broken and organism would rebuilds the new network, and then develop into the new tolerance and meantime repair the damaged pancreas. The main manifestations for Immune Reconstitution Therapy (IRT) are the change of T cell, the proportion inversion of CD4/CD8 lymphocyte and the increase of the natural inhabitation cells. During the process of IRT after the clearance of immune, autoantigen can produce tolerance again and restore the normal immunologic balance.
3. Stem cells could differentiate into the endothelial cells after its entering into the pancreas islet, and these differentiated endothelial cells could stimulate the pancreas somatic cells and make them proliferation, which would make the precursors eventually differentiated into pancreatic endocrine cells, insulin, glucagon, Islet-like Cell Clusters(ICCs) of somatostatin, etc. All those factors could make the endogenous pancreatic cells regeneration. The graft in pancreas could also make the pancreatic cells proliferation rapidly, and produce the new-born insulin positive cells, so the blood sugar could be reduced.
4. Improve the organic immunity, adjust the internal environment, reduce the resistance to insulin, and increase the sensibility to insulin, promote the paracrine of insulin and promote the repair to insulin. We think that stem cells could promote the regeneration of pancreas endogenous islet cell as well as the insulin secretion cell; increase the insulin secretions, and at the same time, increase the sensitivity of the glycoprotein in cells and promote the combination of islet receptor and insulin, and reduce the resistance of insulin and promote the paracrine of insulin, so as to achieve the purpose of treating Diabetes.