Efficacy of mesenchymal stem cell transplantation therapy for type 1 and type 2 diabetes mellitus: a meta-analysis

Abstract

Background This meta-analysis was first conducted to evaluate the efficacy and safety of transplantation of mesenchymal stem cells in the treatment of type 1 and type 2 diabetes mellitus (T1DM and T2DM). Methods We systematically searched PubMed, ScienceDirect, Google Scholar, CNKI, EMBASE, Web of Science, MEDLINE, and the Cochrane Library for studies published from the establishment of the databases to November 2020. Two researchers independently screened the identified studies, based on inclusion and exclusion criteria. The combined standard mean difference (SMD) and 95% confidence interval (CI) of data from the included studies were calculated using fixed- or random-effects models. Results We included 10 studies in our meta-analysis (4 studies on T1DM and 6 on T2DM, with 239 participants) to examine the efficacy of mesenchymal stem cells (MSCs) therapy in the treatment of diabetes mellitus. According to the pooled estimates, the glycated hemoglobin (HbA1c) level of the MSC-treated group was significantly lower than it was at baseline (mean difference (MD) = −1.51, 95% CI −2.42 to −0.60, P = 0.001). The fasting C-peptide level of the MSC-treated group with T1DM was higher than that of the control group (SMD = 0.89, 95% CI 0.36 to 1.42, P = 0.001), and their insulin requirement was significantly lower than it was at baseline (SMD = −1.14, 95% CI −1.52 to −0.77, P < 0.00001). Conclusion Transplantation of mesenchymal stem cells has beneficial effects on diabetes mellitus, especially T1DM, and no obvious adverse reactions.

Comparison of therapeutic effects of mesenchymal stem cells from umbilical cord and bone marrow in the treatment of type 1 diabetes

“…Over 15 trials are currently registered on clinicaltrials.gov to evaluate the safety and efficacy of MSCs in treating T1D. Although MSCs have shown tolerable safety, their ability to enhance islet function and reduce insulin dependence has not met expectations and has varied among published data [17][18][19]. In one randomized controlled trial (RCT), a single transplantation of autologous BM-MSCs showed obvious but limited improvement in β-cell function at the 1-year follow-up, with an approximately 5% increase in peak C-peptide levels in the MSC recipients compared to an approximately 15% decrease in those who received insulin alone.…”

Bone marrow mesenchymal stromal cells for diabetes therapy: touch, fuse, and fix?

“…Over 50 clinical trials for MSC applications, reaching from tackling diabetes-related vascular damage and impaired wound healing to treating new-onset type 1 diabetes (T1D) and type 2 diabetes (T2D), have been registered in the last decade [ 30 , 38 ]. The first trial of autologous BM-MSCs transplantation for T1D has started in 2010 at Uppsala University Hospital (NCT01068951); 20 adult patients with newly diagnosed T1D received combined BM-MSCs/insulin or insulin only, which resulted in a preserved or even increased C-peptide response in BM-MSC-treated patients without any discernible side effects during the 1-year study period.…”

“…In T2D, several studies show improved C-peptide and lowered insulin requirements by BM-MSCs therapy [ 39 , 40 ]. A recent meta-analysis which included bone marrow-, umbilical cord-, adipose-, and Wharton’s jelly-derived MSC therapy in patients with T1D and T2D confirmed improved C-peptide levels, lower HbA1c and blood glucose levels, and lesser insulin requirement without serious or chronic adverse responses [ 38 ] and concludes a more beneficial effect of MSCs in the treatment of T1D than in T2D. In contrast, another recent meta-analysis [ 41 ] presented no difference in C-peptide levels in T1D but improvement in T2D and comes to the conclusion of MSC therapy being more effective in improving β-cell function in T2D.…”

“…Inclusion of several underpowered studies, different study designs, trial durations, heterogenous patient groups (e.g., age and time of diagnosis), non-transparent data reports from several trials and the use of MSCs of various origins raise some doubts on reproducibility of various studies and their conclusions. Therefore, well-designed standardized randomized studies with larger numbers of patients and longer observation periods are needed to finally prove a long-term effective MSC therapy for patients with T1D and T2D [ 30 , 38 ].…”

An Overview of the Safety, Efficiency, and Signal Pathways of Stem Cell Therapy for Systemic Lupus Erythematosus

“…The safety of MSC clinical applications is still the most concerning issue. In the past years, MSCs were used for the treatment of liver diseases [ 33 ], diabetes mellitus [ 34 ], and idiopathic Parkinson's disease [ 35 ], with no significant adverse effects reported in most clinical trials. Stem cell therapy for SLE has less adverse effects compared with conventional treatment (steroid and/or and immunosuppressive drugs).…”