|
|
 |
Diabetes and Liver
Both the liver and the pancreas derive from a common region of the gut endoderm during development, and extensive investigation has begun to clarify the developmental program necessary for the differentiation of mature hepatocytes and islet cells from gut endoderm. These studies suggest that both cell types can now indeed be produced from stem cells. Much of this pioneering work has been conducted by Mike German and Matthias Hebrok (Diabetes Center, UCSF). Thus, important groundwork has been laid to cure these common conditions through transplantation of a single differentiated cell type.
Further challenges will be to optimize differentiation of mature liver and islet cells from stem cells in vitro, and determine if these differentiated cells behave in every respect like native cells. Most importantly, we will need to determine that liver cells can perform the metabolic functions of normal hepatocytes, and that insulin secretion from islet cells is normally regulated at levels adequate to normalize metabolic control. Furthermore, diabetes poses additional immunological hurdles—in addition to issues with tissue rejection, the cells will be transplanted back into an autoimmune milieu. Thus, we will need to determine how to modulate the immune response to effect a long-lasting cure without risk of rejection. Ongoing clinical trials in transplantation tolerance, diabetes prevention and new onset diabetes will synergize with the stem cell initiative, and enable us to offer stem cell-based therapy without the need for life-long chronic immunosuppression. Thus, definitive cures may indeed become possible in the future.
|
|
|
