Autologous umbilical cord blood infusion for type 1 diabetes

Abstract

Objective: The physical, emotional, and economic costs of type 1 diabetes (T1D) mandate continued efforts to develop effective strategies to prevent or reverse the disease. Herein, we describe the scientific and therapeutic rationale underlying efforts utilizing umbilical cord blood (UCB) as a therapy for ameliorating the progression of this autoimmune disease.

Materials and methods: We recently embarked on a pilot study to document the safety and potential efficacy of autologous UCB infusion in subjects with T1D. Under this protocol, patients recently diagnosed with the disease and for whom autologous cord blood is stored, undergo infusion. Studies are performed before infusion and every 3 to 6 months postinfusion for immunologic and metabolic assessment. To date, 15 autologous infusions have been performed.

Results: Preliminary observations suggest that autologous cord blood transfusion is safe and provides some slowing of the loss of endogenous insulin production in children with T1D. Mechanistic studies demonstrate that umbilical cord blood contains highly functional populations of regulatory T cells (Treg) and that increased Treg populations may be found in the peripheral blood of subjects more than 6 months after cord blood infusion. We provide the rationale for cord blood-based therapies, a summary of our initial protocol, and plans for future studies designed to explore the potential of cord blood-derived regulatory T cells to treat T1D.

Conclusions: Prolonged follow-up and additional mechanistic efforts are urgently needed to determine if umbilical cord blood-derived stem cells can be used as part of safe and effective therapies for T1D.

Figures

FIGURE 1. Cord Blood Mediated Restoration of Immune Tolerance In T1D

This theoretical model of the basic imbalance between Treg number or function seen in autoimmune disease demonstrates the simple concept that a rich source of Treg such as cord blood may have the potential to tip the scales back in favor or immune tolerance. If true, this concept could be applied the treatment of many autoimmune diseases. (Figure produced, with permission, using software from www.servier.com).

FIGURE 2. Cord Blood in T1D Study Timeline

Our study was designed to be a 2 year observational study of the effects of autologous cord blood infusion in children with T1D. We follow each child every 3 months during the first year post infusion and every 6 months during the second year post infusion. Blood is obtained for metabolic and immunologic studies at each visit.