Efficacy and safety of stem cells transplantation in patients with type 1 diabetes mellitus—a systematic review and meta-analysis

Abstract

Stem cells (SCs) therapy is a new promising therapeutic modality for type 1 diabetes (T1DM). We performed a systematic review and meta-analysis to evaluate the efficacy and safety of stem cells transplantation (SCT) in patients with T1DM. We searched five literature databases (MEDLINE, EMBASE, Web of Science, WanFang and CENTRAL) up to 31 October 2019. 29 studies (487 patients with T1DM) were included in our meta-analysis. There was no substantial publication bias. Meta-analysis showed the SCT had significant effect to decrease HbA1c (SMD, 1.40; 95% CI, 0.93 to 1.86; p < 0.00001; I 2 = 89%) and to improve C-peptide levels (SMD,-0.62; 95% CI,-1.22 to-0.02; p = 0.04; I 2 = 92%) at 1 year follow-up. Subgroup analyses showed the heterogeneity level of the results was high. Significant improvement of metabolic outcomes was observed in the subgroups of mesenchymal stem cells (MSCs) combined with hematopoietic stem cells (HSCs) and HSCs. The older age showed significant association with the efficacy in HSCs subgroup. The higher GADA positive rate before treatment also significantly associated with the decrease of daily insulin requirement. The transient insulin independence rate at last follow-up was 9.6 per 100 person-years (95% CI: 5.8-13.5%). The mean length of insulin independence was 15.6 months (95% CI: 12.3-18.9). The mortality of SCT was 3.4% (95% CI: 2.1-5.5%). Therefore, SCT is an efficacious and safe method for treating patients with T1DM especially in the subgroups of MSCs + HSCs and HSCs. Well designed, double blind and randomized controlled trails with large sample size and long-term follow-up are needed for further evaluation.

Efficacy of mesenchymal stromal cells in the treatment of type 1 diabetes: a systematic review

“…Despite heterogeneity among the studies reviewed, our findings support an association between MSCs therapy and better glycemic control for T1D patients. This aligns with a recently published meta-analysis (Wu et al 2020 ), which reported a significant effect on reducing HbA1c levels and improving C-peptide levels among T1D patients after one year follow-up of SCT.…”

Distinctive Clinical and Pathologic Features of Immature Teratomas Arising from Induced Pluripotent Stem Cell Injection in a Patient with type 2 Diabetes: A Case Report

“…It is di cult to clarify the validity and safety of iPSC treatment based on the limited number of clinical trials (i.e., NCT03403699) [7]. In in vitro and in vivo iPSC experimental models, wide genomic instability has been detected, including chromosomal aberrations, copy number variations, and single nucleotide variations [8,9].…”