Umbilical cord mesenchymal stem cells in diabetes mellitus

Diabetes mellitus (type 1 diabetes mellitus and type 2 diabetes mellitus) results from a failure of pancreatic β cells at different velocities and time frames resulting insulin deficiency. Currently, management of type 1 diabetes mellitus relies on replacing insulin, without changing the natural course of progressive β cell loss. Stem cell therapy can prevent autoimmune destruction as well replenish pancreatic β cells. Among various sources, human umbilical cord mesenchymal stem cells (hUC-MSCs) have the advantage of generating progenitor cells, greater immunosuppression, cell proliferation and clonality. Further they are less immunogenic. Practical advantages for their use include painless extraction and potential of long term storage. In this review we provide a brief of interventions available to prevent and slow down immune destruction of pancreatic β cell cells, and discuss evidence obtained from cell and animal studies, combined use with adjuvants, their potential on microvascular complications, human clinical trials, meta-analysis and umbrella reviews. We then discuss the limitations and challenges, and offer future perspectives. Currently, hUC-MSC is a treatment with promise. Further large randomized clinical trials with diverse populations, proper trial protocol with inclusion criteria, treatment methods and pre-defined outcome measures in the long term are necessary to bring hUC-MSC therapy into mainstream clinical use.