lecture 21: stem cells and diabetes Flashcards
What are the main characteristics of stem cells?
- stem cells can renew themselves
- can differentiate to make mature cell types
- needed for organs to repair after injury
What are the two main types of stem cells?
- pluripotent stem cells (PSCs)
- can be cultured for extended periods in the laboratory and retain stem cell characteristics
- actually very difficult to grow a cell in culture for a long time, but relatively well done in PSCs
- can turn into any cell type
- embryonic stem cells made from early embryos
- induced pluripotent stem cells made by reprogramming adult cells
- adult stem cells (ASCs)
- difficult to grow in the laboratory and remain as stem cells
- purified from adult tissues and tend to make a restricted range of cell types
- haematopoietic stem cells make blood cells
- mesenchymal stem cells make bone, fat, and cartilage
- currently used clinically (bone marrow transplants)
What is diabetes?
- diabetes is a chronic condition in which the body deals with glucose ineffectively
- rather than being taken up and used by the tissues, glucose remains in the blood
- high blood glucose is called hyperglycemia
- symptoms of hyperglycemia
- feeling excessively thirsty
- frequently passing large volumes of urine
- feeling tired
- blurred vision
- infections (e.g. thrush, cystitis, wound infections)
- weight loss
- symptoms of hyperglycemia
What are the two main types of diabetes?
- type 1: specific immune mediated destruction of beta cells
- type one unlucky person
- unable to produce insulin and therefore respond to blood glucose levels
- type 2: chronic energy overload associated with diet and lifestyle
- type too much food
What is type 2 diabetes?
- usually caused by prolonged excess energy intake
- characterised by:
- sustained elevated blood glucose
- insulin resistance in peripheral tissues
- diminished function of beta cells
- treatment involves dietary modification and sometimes insulin injection
- epidemic transmitted by “Do you want diabetes with that”?
What is type 1 diabetes?
- cause unknown
- characterised by autoimmune attack on insulin producing beta cells in the pancreas (current best hypothesis)
- usually occurs during childhood/adolescence
- traditional treatment involves regular insulin injections (many times a day)/monitoring blood glucose – this is particularly hard for young children and their parents
- thought to be an autoimmune disorder resulting in destruction of insulin-secreting beta-cells
- ~122,000 people in australia (~0.6%)
- complications from type 1 diabetes
- retinopathy
- neuropathy
- depression or anxiety
- end-stage kidney disease
What are some fun facts about diabetes?
- 4% of australians have diabetes
- 10% of all diabetes is type 1
- vast majority have type 2
- gestational diabetes → prone to type 2 later in life
- type 2 has other factors associated - CVD and so on
Compare type 1 and 2 diabetes
type 1 vs type 2
- onset
- sudden vs gradual
- cause
- unknown vs lifestyle
- age at onset
- mostly in children vs mostly in adults
- appearance
- thin or normal vs often obese
- ketoacidosis
- common vs rare
- autoantibodies
- usually present vs absent
- endogenous insulin
- low or absent vs normal, decreased
- prevalence
- ~10% vs ~90%
What does the pancreas do?
- controls food digestion and distribution
- located under the stomach adjacent to the duodenum

What are the islets of the pancreas?
- only small part of the pancreas
- acinar/exocrine cells secrete digestive enzymes into ducts leading to duodenum/intestines
- islets/endocrine cells secrete hormones into the blood stream
- beta cells
- endocrine cells sit in close proximity to blood vessels

What are the hormones produces by the islets?
- hormones produced in the islets are secreted into the blood
- there are five different types of cells
- alpha cells producing glucagon (~15%)
- beta cells producing insulin (~75%)
- delta cells producing somatostatin (~5%)
- PP cells producing pancreatic polypeptide (~3%)
- epsilon cells producing ghrelin (less than 1%)
What are current treatments for type 1 diabetes?
- insulin injection (many times a day), or infused through catheter (a small needle) attached to an insulin pump
- frequent monitoring of bloodsugar levels by finger prick glucose testing
- can be long term complications even if tight blood sugar control is maintained
- many live in constant fear of ‘hypos’ - severe hypoglycaemia (low blood sugar) which can result in loss of consciousness and sometimes death
- there is a need for new forms of treatments
What are problems with current treatment options?
- injection of insulin
- onerous
- imperfect control of blood glucose
- does not prevent complications
- islet transplantation
- high rate of graft failure
- requires immunosuppression
- lack of donor material
- very tight window to collect after someone has died
What are potential stem cell alternatives to insulin injections?
- would a new blood system help?
- if type 1 diabetes is caused by errant lymphocytes then why can’t we just replace these by getting rid of the old blood system and putting in a new one?
- bone marrow transplantation?
- has too many adverse affects to be a viable option
- if type 1 diabetes is caused by errant lymphocytes then why can’t we just replace these by getting rid of the old blood system and putting in a new one?
- would bew beta cells help?
- if we can tame the immune system then we might be able to replace the lost insulin producing cells with new ones
- islet transplantation?
- if we can tame the immune system then we might be able to replace the lost insulin producing cells with new ones
What are transplant options?
- pancreas transplant
- most often performed when a patient also needs a kidney transplant
- the success rate (long-term insulin independence) is increasing
- after one year about 85% of pancreas transplant recipients are insulin independent
- a few thousand pancreas transplants a year worldwide, mostly in the U.S.
- islet transplantation and other experimental treatment options
- does not require a major operation and the procedure has a small complication rate
- results generally not as good as pancreas transplantation
- individuals receiving a pancreas or islet transplant must take immuno suppressive medications to prevent graft rejection
What is islet transplantation?
- increasingly successful but limited by lack of donors
- donor (usually dead)
- pancreas removed
- islets isolated and injected into portal vein of liver
- lodge in there and find a place to live and start working

What are isolated islets?
- isolated islets stained with a dye that reacts with zinc
- insulin is stored in granules which are high in zinc

How could we replace beta cells with cells made from pluripotent stem cells?
- given we know islet transplantation works a little bit then the aim is alleciate the shortage of donor material by generating the appropriate cells in teh laboratory using stem cells
- the pancreas has its own stem cells but these are difficult to grow in the laboratory and, at the moment, coaxing these cells to become large numbers of endocrine cells is very difficult
- pluripotent stem cells represent an attractive starting point because they can grow in large quantities – large numbers of cells will be needed to treat a person
What are human embryonic stem cells?
- normal diploid cells grown from a 6 day embryo called a blastocyst
- can differentiate into any cell found in adults
What are induce pluripotent stem cells?
- adult cells
- add reprogramming genes or chemicals
- colony of iPS cells
- similar to ES cells called iPSCs can be made in the lab by adding extra genes or chemicals to adult cells in a process called reprogramming
- iPS cells behave like ES cells and are a genetic match to the person whose cells were reprogrammed → however in diabetes immune system has already rejected own cell, so benefits of using iPS cells over hESCs are not immediately apparent
What are important considerations of using stem cells?
- need to be able to make enough cells to be effective
- cells need to be safe – left over undifferentiated hESCs could give rise to teratomas (a form of tumour)
- cells will still be subject to immune surveillance
- cells actually have to work
- so how do we go about making beta cells from hESCs?
How do beta-cells arise?
- an orderly developmental process during embryogenesis
- embryonic stem cell differentiation recapitulates aspects of this process
- morala
- ICM
- epiblast
- definitive endoderm
- foregut
- pancreas
- endocrine
- pancreas
- foregut
- definitive endoderm
- epiblast
- ICM
- if each step is only 10% efficient, by the time you get to beta cells you have almost nothing left
- even if each step is 90% efficient, far fewer at the end than the begining
- people working on these kinds of protocols

What is PSC differentiation to pancreatic endoderm?
- incorporates growth factors implicated in development
- people have looked at which growth factors are present at particular times along the development of embryo nd tried to add these in at correct times during the growth of PSCs
- ES cell → activin, Wnt3a → definitive endoderm → RA, Cyc, FGF → posterior foregut → DAPT → pancreatic endoderm → Ex4, IGF1 → endocrine cell

What are growth factors controlling the differentiation of hESCs toward pancreatic endoderm?
- developed a very influential protocol
- developmental biologists
- each cell type along the path of differentiation needs a specific set of genes expressed



