Mesenchymal stem cell therapy for diabetes: clinical evidence, emerging strategies, and future perspectives

Area of Science:

• Endocrinology and Metabolic Diseases
• Regenerative Medicine
• Immunology

Background:

• Diabetes mellitus (DM) involves complex hyperglycemia, adipose dysfunction, and multiorgan damage.
• Current therapies targeting single pathways are insufficient as DM progresses.
• Multimodal therapies acting on interconnected disease nodes are conceptually attractive.

Purpose of the Study:

• To analyze registered interventional trials evaluating mesenchymal stem cell (MSC) therapies for diabetes and its complications.
• To assess the evolution of MSC sources and therapeutic approaches in diabetes research.
• To evaluate the efficacy and safety of MSC-based treatments across different diabetic conditions.

Main Methods:

• Systematic review and analysis of 107 registered interventional trials from 124 screened records.
• Categorization of trials based on diabetes type (type 1, type 2) and complications.
• Examination of MSC sources (BMMSC, AdMSC, UCMSC) and cell-free derivatives.

Main Results:

• MSC therapy has been evaluated across type 1 diabetes, type 2 diabetes, and various diabetic complications.
• Early trials utilized autologous BMMSCs and AdMSCs; later trials shifted to allogeneic UCMSCs and cell-free derivatives.
• Most consistent benefits observed in ischemic and wound-healing complications (e.g., diabetic foot ulcers); metabolic outcomes were variable.

Conclusions:

• MSC therapy is a safe adjunct for diabetes, showing potential for disease modification, especially in wound healing.
• Evidence suggests MSCs engage immune, vascular, and metabolic pathways simultaneously.
• Larger, randomized trials with standardized endpoints are necessary to confirm MSC therapy's efficacy for metabolic control in diabetes.