Diabetes and Stem Cells
Pp. 120-139 (20)
Juan Domínguez-Bendala and Camillo Ricordi
The existence of clinically successful cell therapies (islet transplantation) for type 1 diabetes has
stoked a keen interest in developing alternative, inexhaustible sources of insulin-producing cells. In this chapter
we will broadly cover the state of the art regenerative therapies for the endocrine component of the pancreas,
from stem cells to transdifferentiation. In particular, we will review the basics of pancreatic development,
whose recapitulation remains the subject of a plethora of in vitro differentiation strategies using both
embryonic and adult stem cells. Then we will examine the leading theories about the cellular and molecular
mechanisms behind the in vivo regeneration of the organ that is observed under specific circumstances, as well
as the purported ability of some tissues to turn into pancreatic endocrine cells when subjected to specific
interventions (transdifferentiation). Finally, we will conclude with a general overview of the remaining
challenges and clinical perspectives of all the above strategies, with a special emphasis on the immunological
hurdles to be overcome for these approaches to find their way to standard clinical practice.
Diabetes Research Institute, University of Miami Leonard M. Miller School of Medicine, 1450 NW 10th Avenue, Miami, FL 33136, USA.