Essay: Exploring the Importance of Stem Cells in Diabetes Treatments

Introduction
Medicine is vital in today’s world as it improves the quality of people’s lives. Stem cells play a fundamental role in the scientific world as they have the potential ability to cure a variety of diseases. The rapid increase of stem cell research can evidently be shown in the recent articles, news scientific journals. This area of research brings something new to the table year after year. In the human body, there are approximately 78 organs and 13 of which are major organ systems in the body (B Yozgat, 2011). These organs are made out of tissues and carry a specific function. However, what make these tissues are relatively small undifferentiated cells called stem cells. They can be specialised to become a variety of different cells to cure or at least help the treatment of diseases such as diabetes. The use of stem cell research is intended to cure diseases such as Alzheimer’s, Parkinson’s, diabetes and also cancer (A Belth, 2009.) The research of stem cells continues to advance knowledge about how organisms develop single cells and how healthy cells can be replaced (Pike, R 2002). A fascinating area of contemporary biology.
Diabetes Mellitus is a condition in which the patient is unable to control blood glucose concentrations ( B Soria, 2000). It ‘s common life-long health condition. There are 3.2 people diagnosed with diabetes in the UK and an estimated 630, 000 people who have this condition but don’t have any idea (House M, 20014.) There are two types of diabetes, type I and type II. Many people have a false misconception that one of the types of diabetes requires an insulin injection whilst the other does not. However, it has been proven that this is not right. Depending on how extreme the case is an insulin injection can be given to help bring blood glucose concentration levels back to normal. In both types of diabetes, it is vital that one’s diet is under control.
Stem cells have potential to develop into many different cells. This is during the early life and growth of cells such as embryos or adult stem cells. In addition, in many tissues they are able to act as an internal repair system. This happens by division of cells whilst the person or animal is alive. When stem cells divide, every new cell has the potential to either remain undifferentiated or to become a specialised cell that carries a specific function around the body. Examples area muscle cells, red blood cells or brain cells (Pike R, 2002.). There are many different types of cells such as embryonic and adult stem cells, however throughout this report; the main focus will be embryonic stem cells.
The aims of this report it to explore the importance of stem cells and how they help with the treatments of diabetes. In addition to this, the report will be able to identify the variety of effects of diabetes. This will to help to gain a clear understanding of how treatments such as embryonic stem cell treatments can differentiate into cells that will help maintain blood sugar levels in the human body.
Chapter 1 – The importance of stem cells and diabetes
Diabetes Mellitus which is also known as diabetes has a huge impact on the body’s metabolic reactions. It is a life -long condition that causes a person’s blood glucose levels to become high. The organ which is the responsibility of diabetes is the pancreas (Diabetes Research Institute, 2014). Diabetes is caused when the pancreas does not produce enough insulin or any insulin at all. There are two types of diabetes. Type I diabetes is where the pancreas does not produce any insulin. However, type II diabetes is where the pancreas does not produce enough insulin meaning that the pancreas does produce insulin but not enough to bring the blood glucose concentrations under control (NHS, 2014).
According to research carried out by Doug Melton, it has been found that pluripotent stem cells have been useful in the treatment of diabetes. Hebrew University Stem Cell Unit Director Nissim Benvenisty told Bioscience that ‘the generation of pancreatic beta cells was an elusive target in the past decade. The new study demonstrates an efficient methology for generating the cells, and shows many of the characteristics of authentic beta cells both in vitro and in vivo’ (Fox, C 2014).This suggests that the development of the treatment of diabetes with the use of stem cells is increasing becoming successful. With this piece of evidence, it is obvious that embryonic stem cell treatment can be used to help treat diabetes both type I and II.
There are two types of stem cells which are adult and embryonic stem cells. Both stem cells are unspecialised cells that can specialise into specific cells to carry a particular function. Adult stem cells have the ability to differentiate into many different boy cells that are specific. On the other hand, embryonic stem cells can specialise into all types of stem cells to carry out many specific functions (BBC, 2007).
The term cell potency determines its ability to differentiate into a variety of cells. Potency is a term which means ‘having power’ in Latin. Within the context of stem cells it means ‘having the power’ to change and differentiated into a type or types of cells. The more types of cells in which stem cells can differentiate into, the greater its potency is. In addition, potency is described as the gene activation potential in which a stem cell can become a specific cell with a specific function. This leads on to the variety of stem cells that all have different potential abilities to change into particular cells.
Totipotent stem cells are one of the most vital stem cells as they have the potential to develop into any cell found in the human body. Whilst humans develop, the egg cell in a female and the sperm cell in a male fuse together to form a single cell organism which is called a zygote. The zygote then divides numerous times which are precursors to the trillions of cells that will constitute the human body. Totipotent cells are the most versatile cells of the stem cell types. Totipotent means ‘entirely’ therefore the cells have the total potential to develop into specific cells (Murnaghan I, 2014.) There are special qualities of totipotent cells. Some of which include having the ability to become any cell type in a fully developed human. They also have the potential to replicate in unlimited numbers and this is without losing their total potency. A human totipotent stem cell can develop into any cell in the body and this could include placental cells.
IPS cells are also known induced pluripotent stem cells and that are often named as ‘true’ stem cells. This is because they have the potential to into almost every cell in the body. According to research carried out by Ian Murnaghan it has been stated that ‘under the right circumstances, a stem cell that is isolated from an embryo can produce almost all of the cells in the body (Murnaghan I, 2014.) However, after this embryonic development, it is important to understand that stem cells no longer have unlimited potential to develop into all cell types. This is what makes them ‘almost’ able to differentiate into any body cell due to the fact that whilst the embryonic development, their pluripotency loses meaning that they can only become certain types of cells. They are several types of pluripotent stem cells. One of which are embryonic stem cells. These cells are isolated from the inner cell mass of the blastocyst. In addition to this, embryonic germ cells are taken from the aborted foetuses. These early cells can become sperm or egg cells. A few benefits of pluripotent cells include their ability to provide a chance to obtain a renewable source of healthy cells and tissues to treat a variety of diseases which could involve diabetes. They also have the ability to specialise into cells that can ultimately replace diseased cells and drugs. Moving onto the case of diabetes, it is possible for pluripotent cells to develop into pancreatic cells and help with the treatment of diabetes.
In addition, another type of stem cell is omnipotent stem cells. Omnipotent stem cells can differentiate into any kind of cell in the human body. Embryonic cells can isolate in inner cells or blastocysts and adult cells. Through mitosis, specialised cells can divide and produce more stem cells where these can be used to treat diseases and conditions such as diabetes.
Taking into consideration the research carried out by Diabetes Institute Foundation, it has been conveyed that ‘stem cells hold tremendous potential as a source of insulin-producing cells that could be placed in a BioHub. This is because stem cells have the potential to become virtually any kind of cell (Reid, L 2012).’ The challenge of this organisation is to be able to push stem cells and emerge them to become cells that sense glucose and secrete insulin.
According to research carried out by scientists it has been found out that biliary cells mature into islets. These islet structures then produce insulin and c-peptide in response to glucose. These structures were transplanted into diabetic mice which showed an improvement in blood sugar levels (Diabetes Research Institute, 2014).
Stem cells have been used in medicine for many years and during these years the word ethics has causes many people to have controversial opinions. It forces people to choose between two moral principles. One of which is the duty to prevent or alleviate pain and suffering. On the other hand, it is the idea of maintain a duty to respect the value of human life. It is impossible in order to respect both principles during the same time (H, Kristina 2011.)
Religion plays a huge part in the ethical issues surrounding the topic stem cells. The Roman Catholic, Orthodox and conservative Protestant Churches believe the embryo has the status of a human from the time of conception; therefore no embryo research should be permitted. In addition, Christians believe in something called the ‘sanctity of life’ (H, Kristina 2011).This means that an embryo should have the same rights as a human being resulting into them having the right to live and not being used for other purposes. Judaism and Islam however emphasise the importance of helping others and argue that the embryo does not have full human status before 40 days. This means that both these religions allow and give permission for some research on embryos. On the other hand, other religions have a different approach to the research of stem cells (H Kristina 2011).
Chapter 2 – The causes and symptoms of diabetes
Diabetes is a common disease affecting the blood glucose levels of one’s body. The disease affects around 370 million adults worldwide. The global diabetes rate is expected to grow to 552 million by 2030 or 9.9% of the adult population. Diabetes is rapidly increasing in low-middle income countries. Worldwide, China has the largest diabetes population, with 90 million diabetes sufferers followed by India (63.1m) and the USA (23.7m). However in the UK, more than 3 million people are diagnosed with diabetes and approximately out of this 3 million, 270,000 have type 2 diabetes and around 300,000 have type 1. Approximately 850,000 people in the UK have undiagnosed type 2 diabetes. In the UK, most diabetic patients receive treatment from the National Health Services (The global diabetes community, 2015).
There are a wide range of symptoms which can lead up to diseases such as type 1 and type 2 diabetes. One of the most common symptoms of diabetes is feeling very thirsty and tired. In addition to this, other symptoms are urinating more frequently, especially in the night, and weight loss. If diabetes is not treated, it could cause many complications to one’s body. Minor complications could include diabetic ketoacidosis and non-ketotic hyperosmolar coma. Diabetic ketoacidosis is a dangerous complication of diabetes caused by a lack of insulin in the body. Non-ketotic hyperosmolar coma is a metabolic derangement in which there is an abnormally high serum glucose level without ketoacidosis (NHS, 2014). However, the major complications could be kidney failure, foot ulcers, stroke, heart disease and a very common effect is damage to eyesight (Jerrold M. Olefsky 2004).
The main question which arises from all of these symptoms is what is the main cause of diabetes? According to the research carried out by the NHS, it is evident that when thinking about diabetes, the main link is glucose (NHS, 2014). The raised glucose levels that characterise diabetes are caused by a shortage of insulin or by the body failing to respond to the body normally. Insulin is a hormone which is released from the pancreas and causes blood glucose concentration to decrease. The concentration of blood glucose concentration is carefully regulated. The Islets of Langerhans which are small patches of tissue in the pancreas that have an endocrine function monitor the concentration of glucose in the blood (Hocking S, 2008.) Alpha cells and beta cells are the cells which are found in the islets of Langerhans. Alpha cells secrete the hormone glucagon whereas beta cells secrete the hormone insulin. If there is a rise in blood glucose concentration, this is first detected by the beta cells. The beta cells then secrete insulin into the blood. In addition, insulin is detected by the receptors on the liver and muscle cells. The liver and muscle cells remove glucose from the blood and convert glucose to glycogen. This finally causes a fall in glucose concentration levels.
Furthermore, the most important thing to extract from the process of the blood glucose concentration decreasing is the islets of Langerhans. Islets of Langerhans are commonly referred as ‘islets.’ Islets are clusters of cells and a single ‘islet’ contains more than 3,000 to 4,000 cells (Diabetes Research Institute Foundation, 2014.) A piece of research has been carried out which shows that scientists have found out that there are one million islets in a healthy, adult pancreas and they only make up one to two percent of the entire organ (Diabetes Research Institute, 2014).
Within each islet there are several types of cells, which work together to regulate blood sugar concentration. A beta cell is one and this type of cell senses sugar in the blood and releases the necessary amount of insulin to maintain normal blood sugar levels. The immune system however potentially notices them as dangerous and destroys them. These are one of the effects of type 1 diabetes. The loss of these cells means that the body can no longer produce insulin. This is the hormone required to convert insulin into energy for the body’s cells.
The pancreas is vital as it carries two very important roles, one of which involves making pancreatic juices which helps the body to digest proteins, carbohydrates and fats. It also makes a hormone called insulin which enables the body to use sugars and store fats. The structure of the pancreas has a huge impact on the way and reasons to how it functions. The pancreas is in the upper half of the abdomen which is level with the V-shape where the ribs meet at the front. This lies behind the stomach and is just in front of the backbone. It is about 15cm (6in) long and is shaped like a tadpole. Pancreatic juices travel through the small tubes called ducts in the pancreas and into a larger duct called the pancreatic duct which join with the bile duct, which carries bile from the liver to the gall bladder. This is before opening into the duodenum. The pancreatic juices flow along the pancreatic duct into the duodenum where they then help to digest the food (Macmillian, 2013).
It is evident that pancreatic cells are cells that are within the pancreas that are able to produce the levels of glucose in the blood. Glucose is found in starchy foods such as pasta, rice, bread and potatoes, and also within fruit and sweet foods. When we eat food that contains glucose, insulin helps to remove insulin from our blood into our cells where it is broken down and converted to energy. Statistics show that in England in 2010, the number of adults diagnosed was 3.1 million accounting for around 1 in 14 of the population. If trends continue as they are this figure is expected to rise to 4.6 million in the year 2030. This represents nearly 1 in 10 of the population (NHS, 2014).
A pancreas transplant allows patients with only type I diabetes to get a new source of insulin from a pancreas that has been donated by another person. Hypoglycaemic attacks are a serious complication of diabetes caused by low levels of glucose in the blood. An estimation of about one in 10 pancreas transplants is carried out for this particular reason (Guys and St Thomas’ NHS Foundation Transplant, 2014). Statistics show that pancreas transplantation is less common than kidney or liver transplantation, and only 200 such transplants are carried out in the UK each year with more than 300 people on the waiting list. In addition, waiting time for a pancreas transplant is between one and two years because there is a shortage of suitable donor organs (NHS, 2014).
Most people with type 1 diabetes are able to control the condition with the help of regular injections of insulin. On the other hand, a small number of people go on to develop a range of serious complications despite being given the best available treatment. These complications could include kidney failure. This is where the kidneys are no longer able to filter waste products from the blood. Also, diabetic retinopathy and this is where there are high levels of glucose in the blood and damages the eyes which could also result into a loss of vision. Another serious complication consists of arterial disease which affects the arteries to the heart, legs and brain. In addition to this, diabetic neuropathy is also another problem. This is where high sugar levels have damaged the nerves in hands and feet meaning that the sensation is lost and ulcers can occur (NHS, 2014).
Furthermore, the real question arises which is what actually happens during a pancreas transplant. The pancreas transplant can be carried out in three different ways. One of which is the simultaneous kidney pancreas transplant. This is where both the pancreas and kidney is transplanted at the same time. It is the most common pancreas transplant and it is used normally in people who have kidney disease as a result of diabetes therefore one transplant can take care of both problems (Guy’s and St Thomas’ NHS Foundation Trust, 2014).
Another type of a pancreas transplant is a pancreas after kidney (PAK) transplant. This is where the patient has a living donor kidney transplant and at least four months after this, a pancreas transplant is arranged. These transplants need to be carried out under certain conditions and it is also possible to transplant just a pancreas into a human body. Transplantation of the islets (specialised cells that produce insulin) alone is needed and trials are underway. However, it does not involve an open injection. This is where cells are injected into the liver through a long needle which then crosses into the skin. A small number of patients many benefit from this procedure but it is still a procedure that carries many risks and under evaluation it has no long term follow up results (Guy’s and St Thomas’ NHS Foundation Trust, 2014).
Taking all information into consideration, it is evidently seen that it is vital to keep the blood glucose insulin levels under control as Diabetes is a disorder where the blood glucose levels remain high. Professor Melton who is the co-director of the Harvard Stem Cell Institute said ‘a device being tested so far protected beta cells implanted in mice from immune attack for many months.’ In addition, he also quotes that ‘there have been previous reports of other labs deriving beta cell types from stem cells where no other group has produced mature beta cells as suitable for use in patients’ (The Guardian, 2014).This shows that there have been many experiments taken place to suggest whether the use of stem cells is ideal in the treatment of diabetes.
Chapter 3 – Embryonic Treatments
Whether you believe in stem cell treatment or not, a numerous amounts of people have heard about the word embryos which caused controversy almost everywhere. This is where embryonic stem cells are grown from cells and are found in the embryo which is just a few days old. In living organisms such as, humans and mice, the embryo is a ball of approximately 100 cells at this stage. Scientists have also made embryonic stem cells from the inner cell masses of human embryos by employing the same technique used to isolate mouse embryonic stem cells (Blair, K. Nicholls, J. Smith A, 2008.)
Scientists at the Harvard Stem Cell Institute and the University of Massachusetts Medical School published new research to show that large numbers of insulin-producing cells has been grown from stem cells in the lab. Research carried out by Dr Dough Melton, identified a protocol which is able to turn embryonic stem cells into function pancreatic beta cells. These cells are ones that are destroyed by the body’s own immune system in Type I diabetes. The cells that were produced by the researchers respond to glucose and are called induced pluripotent stem cells which have been mentioned earlier in this dissertation. Also, the group studied the signals that guide through pancreas development which then applies what they and others have found to develop a method that turns stem cells into mature beta cells (Diabetes UK, 2014).
Statistics portray that stem cells are grown in flasks and require five different growth media and 11 molecular factors, from proteins to sugars and are added in precise combinations for over 35 days to turn them into beta cells. Melton says that the technique can produce 200 million Beta cells in a single 500 ml flask and this is enough within theory to treat a patient (Diabetes UK, 2014).
For decades, diabetes researchers have been searching for many years to replace the insulin-producing cells of the pancreas that are destroyed by a patient’s own immune system. It appears that this may be possible. Figures show that each year, diabetes affects more people and causes more deaths than breast cancer and AIDS combined. Diabetes is the seventh leading cause of death in the U.S today. Statistics convey that there are nearly 200,000 deaths that are reported each year. The American Diabetes Association estimates that nearly 16 million people, or 5.9 percent of the United States population who currently suffer from diabetes Zulewski, H., Abraham, E.J., Gerlach, M.J., Daniel, P.B., Moritz, W., Muller, B., Vallejo, M., Thomas, M.K., and Habener, J.F, 2001).
It is possible to make human embryonic stem cells into all pancreatic cell lineages (Guo T, M Hebrok, 2009). Beta-like cells are produced during a complex differentiation process and are not efficient insulin producers and are not as completely responsive to cell signalling as native beta cells. Embryonic cells can be differentiated in vitro into a wide range of cell types (Jones, E. A. Tosh, D Wilson, D. I., Lindsay, S. and Forrester. L.M, 2002).
‘Human cloning has been used to produce early embryos, marking a significant step for medicine, say US scientists.’ A quote conveyed from the BBC to show the development of stem cells and how it improves the health of those who suffer from life-long diseases. Stem cells are one of the great hopes for medicine. Therefore, being able to create new tissue might be able to heal the damage caused by a heart attack or repair a severed spinal cord (Gallagher J, 2013).
Embryonic stem cells are found in a blastocyst which is a very early embryo. They can make all cells that are required in the body which means they are pluripotent. The advantages involve the potency of the stem cells and also the idea of the cell easily being able to be grown in culture. Disadvantages however include the stem cells being difficult to control differentiation, ethical issues and immune reactions which could take place. On the other hand, tissue stem cells are found in some tissues in the body therefore they are known to be multi-potent. The advantages include the cells already being partially specialised so it is easier to control the differentiation process. Also, the cells could act as disease models for research. The disadvantages involve the cells being difficult to grow in culture. The immune reactions could take place if the patients cells are not being used (ABPI, 2011).
Chapter 4 – Management of diabetic patients
Diabetes is a disease that affect numerous amounts of people not only in the UK but worldwide. However, many diabetic sufferers do not have the knowledge of how to control their diabetes in order to have the correct blood glucose levels. There are a variety of ways in controlling diabetes. Some of which include eating the right foods therefore having a balanced diet and avoiding fast food, having regular insulin injections and exercising (NHS, 2014).
Blood glucose testing is a main way in checking that your sugar levels are under control. A blood glucose monitor is an excellent way for managing diabetes. Testing before and after meals can be a useful technique for measuring how different meals affect sugar levels and help to improve diet and dosage decisions (D, Michael 2012).
In the year 1996, Dolly the sheep was cloned in the UK. This caused controversial issues worldwide as opponents say it is unethical to experiment on human embryos and have asked for a ban. Many experiments have been carried out to notice the different effects of stem cell transplants. A team of Oregon Health and Science University have developed an embryo to the blastocyst stage where 150 cells provide a source of embryonic stem cells (Gallagher J, 2013).
Research carried out by Chris Mason who is a professor of regenerative medicine at University College London said, ‘they’ve done the same as the Wright brothers really and they’ve looked around at where are all the best bits of how to do this from different groups all over the place and basically amalgamated,’ (The Guardian, 2014).
There are many laws which have been put in place due to an incident which took place. William Burke and William Hare murdered sixteen people in Edinburgh in the year 1828. They sold their bodies of their victims to a doctor to use as anatomy species. Killing someone to provide a body to carry out research on was wrong, the same way in which killing a person for spare body parts or cells is wrong. Therefore the question arises is there a moral (and legal) difference between killing a person for research purposes, and destroying an embryo to obtain stem cells? Therefore, the UK law states that any scientific establishment using human embryos to create stem cells much hold a license from the HFEA. Any establishment storing and using human tissue must hold a license from the HTA. The establishment testing the effects of stem cells in animals must hold a license from the Home Office. Finally, any establishment altering genetic material of a stem cell must inform the Health and Safety Executive of what they are doing. All these government bodies ensure that the research carried out using stem cells and safe and within the law (ADPI, 2011).
Conclusion
It is evident that stem cell research is potentially a new way to treat many diseases including diabetes. Although controversy takes its toll on if stem cells are the ‘right’ way to treat people, it potentially is becoming one of the favoured ways to treat diabetes. The ethical considerations of stem cell research have certainly caused controversy but many people are beginning to understand that in order to save lives, it is almost required to use other living organisms.
Albert Einstein one quoted ‘Ethical axioms are found and tested not very differently from the axioms of science. Truth is what stands the test of experience.’ Therefore, it is portrayed that people need to think about the well-being of others and not the consequences in which it will encounter. It is clear that the future of the use of stem cells will not always be positive but as people begin to understand the importance of it and exactly how stem cells can help people live a few more years, hopefully positive impacts will be made.
The symptoms of diabetes show that it is definitely a disease that affects daily lives. Statistics show that in year 2010, the number of adults who were diagnosed was 3.1 million. This is taking into consideration for around 1 of 14 people in the population. It has been said that if the trends continue, this figure is expected to rise to 4.6 million people in the year 2030. This shockingly shows an estimation of almost 1 of 10 people in the population (NHS, 2014).Stem cell research has positive impacts of people’s lives therefore many people are able to understand the real impact and progression of medicine.
Therefore, this is known to be a disease which is rapid affecting many people worldwide. It must still be remembered that having an early diagnosis of diabetes can have a profound effect on the life of a patient. Even though many physical aspects need to be taken into consideration of the consideration, the medical professionals need to focus on the care of the patients. It is also necessary to examine the health of the patients as stem cells could be rejected by the body leading to fatal comas or death which could occur suddenly. This is why it is necessary to support patients from every single aspect during their treatment, after treatment and diagnosis.