[Stem cell therapy for diabetes mellitus: progress, prospects and challenges]

Curative therapy for diabetes mellitus mainly implies replacement of missing insulin-producing pancreatic beta cells, with pancreas or islet-cell transplants. The limited supply currently available from cadaveric donor islets for transplantation, however, determines that researchers must explore alternative sources of graft material. Stem cells represent a promising solution to this problem, and current research is being aimed at the creation of islet-endocrine tissue from these undifferentiated cells. Both embryonic stem cells (derived from the inner cell mass of a blastocyst) and adult tissue stem cells (found in the postnatal organism) have been used to generate surrogate beta cells or otherwise restore beta cell functioning. Nevertheless, cell replacement therapies that are stem cell based will remain fiction rather than fact until we can efficiently and reproducibly ensure that stable, fully functional cells can be generated in vitro. It is also critical to ensure that any surrogate or regenerated beta cells have perfectly regulated insulin production, which is essential for physiological glucose homeostasis. As in every emerging field in biology, early reports seem confusing and conflicting. Therefore, discrepancies between different results need to be reconciled. In addition, encouraging studies in rodent models may ultimately set the stage for large-animal studies. In this review, the authors provide insight into research efforts to overcome existing hurdles for this promising therapy.