Evaluation of type 1 diabetes' partial clinical remission after three years of heterologous adipose tissue derived stromal/stem cells transplantation associated with vitamin D supplementation.

Autor: Leão IS; Department of Internal Medicine, Nutrology Section, Universidade Federal do Rio de Janeiro (UFRJ), Av Professor Rodolpho Paulo Rocco 255, 22440035, Rio de Janeiro, RJ, Brazil. isabellaleao1@gmail.com., Dantas JR; Department of Internal Medicine, Nutrology Section, Universidade Federal do Rio de Janeiro (UFRJ), Av Professor Rodolpho Paulo Rocco 255, 22440035, Rio de Janeiro, RJ, Brazil., Araújo DB; Department of Internal Medicine, Nutrology Section, Universidade Federal do Rio de Janeiro (UFRJ), Av Professor Rodolpho Paulo Rocco 255, 22440035, Rio de Janeiro, RJ, Brazil., Ramos MEN; Department of Internal Medicine, Nutrology Section, Universidade Federal do Rio de Janeiro (UFRJ), Av Professor Rodolpho Paulo Rocco 255, 22440035, Rio de Janeiro, RJ, Brazil., Silva KR; Laboratory of Tissue Bioengineering, Instituto Nacional de Metrologia Qualidade e Tecnologia Campus de Xerem, Duque de Caxias, Brazil.; Histology and Embryology Departament, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, Brazil., Batista LS; Laboratory of Tissue Bioengineering, Instituto Nacional de Metrologia Qualidade e Tecnologia Campus de Xerem, Duque de Caxias, Brazil.; Center for Biological Research (Numpex-Bio), Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil., Pereira MFC; Department of Internal Medicine, Nutrology Section, Universidade Federal do Rio de Janeiro (UFRJ), Av Professor Rodolpho Paulo Rocco 255, 22440035, Rio de Janeiro, RJ, Brazil., Luiz RR; Institute of Public Health Studies, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil., da Silva CC; Plastic Surgery, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil., Maiolino A; Hematology Department, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil., Rebelatto CLK; Core Cell Technology, Pontifical Catholic University of Parana, Curitiba, Brazil., Daga DR; Core Cell Technology, Pontifical Catholic University of Parana, Curitiba, Brazil., Senegaglia AC; Core Cell Technology, Pontifical Catholic University of Parana, Curitiba, Brazil., Brofman PRS; Core Cell Technology, Pontifical Catholic University of Parana, Curitiba, Brazil., de Oliveira JEP; Department of Internal Medicine, Nutrology Section, Universidade Federal do Rio de Janeiro (UFRJ), Av Professor Rodolpho Paulo Rocco 255, 22440035, Rio de Janeiro, RJ, Brazil., Zajdenverg L; Department of Internal Medicine, Nutrology Section, Universidade Federal do Rio de Janeiro (UFRJ), Av Professor Rodolpho Paulo Rocco 255, 22440035, Rio de Janeiro, RJ, Brazil., Rodacki M; Department of Internal Medicine, Nutrology Section, Universidade Federal do Rio de Janeiro (UFRJ), Av Professor Rodolpho Paulo Rocco 255, 22440035, Rio de Janeiro, RJ, Brazil.
Jazyk: angličtina
Zdroj: Diabetology & metabolic syndrome [Diabetol Metab Syndr] 2024 May 24; Vol. 16 (1), pp. 114. Date of Electronic Publication: 2024 May 24.
DOI: 10.1186/s13098-024-01302-2
Abstrakt: Background: Mesenchymal stem cell infusion and vitamin D supplementation may have immunomodulatory actions that could prolong the preservation of residual insulin secretion in patients with type 1 diabetes (T1D). Intervention with these agents after onset of T1D could favor the development of a remission phase, with potential clinical impact. We aimed to compare the presence of clinical remission (CR), glycemic control and daily insulin requirement at 6, 12, 18, 24 and 36 months after the diagnosis of T1D using IDAA1c in patients who received therapy with adipose tissue-derived mesenchymal stem cell (ASC) infusion and vitamin D supplementation and a control group.
Methods: This retrospective cohort study analyzed data from the medical records of patients with T1D diagnosed between 15 and 40 years. Partial CR was defined as an IDAA1c index < 9. Patients in the intervention group received an infusion of adipose tissued-derived mesenchymal stem cells (ASCs) within 3 months after diagnosis and supplementation with 2000 IU of cholecalciferol for 1 year, started on the day following the infusion. Partial CR was also determined using the ISPAD criteria, to assess its agreement with IDAA1c.
Results: A total of 28 patients were evaluated: 7 in the intervention group (group 1) and 21 in the control group (group 2). All patients in group 1 evolved with partial CR while only 46.7% of patients in group 2 had this outcome. Group 1 had a higher frequency of CR when evaluated with IDAA1c and ISPAD criteria. The mean duration of CR varied between the two criteria. Although HbA1c was similar between groups during follow-up, group 1 had a lower total daily insulin requirement (p < 0.005) at all time points. At 36 months, group 1 used 49% of the total daily insulin dose used by group 2 with similar glycemic control.
Conclusion: The intervention with infusion of ASC + vitamin D supplementation was associated with partial CR at 6 months. Although there were no differences in CR established by the IDAA1c and ISPAD criteria after three years of follow-up, patients who underwent intervention had nearly the half insulin requirement of controls with conventional treatment, with similar glycemic control.
Trial Registration: 37001514.0.0000.5257.
(© 2024. The Author(s).)
Databáze: MEDLINE
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