1

1 REVIEW ARTICLE

2 Stem Cell Therapy: A beacon of hope for diabetes patients in

3 Nigeria.
4 Suliyat Aremu*

5 1
Department of Physiology, Ladoke Akintola University of Technology, Ogbomoso; suliyatabiodun@mail.com
6 * Correspondence: suliyatabiodun@mail.com; Tel.: (+2348134276260, +2347010612448)

7 Abstract: Diabetes mellitus is a group of metabolic diseases characterized by insufficient or

8 resistant insulin production caused by dysfunctional pancreatic β-cells. Pancreas or Islet cell
9 transplantation have been suggested as alternatives for β-cell repair. However, shortage of donors,
10 graft rejections and immunosuppressive medications have been a hindrance. To overcome this,
11 embryonic stem cells, mesenchymal stem cells and induced pluripotent stem cells have been
12 considered and used for cell replacement. In this chapter, stem cell has considered to be the future
13 in the treatment of diabetes. In Nigeria, where many patients resort to traditional treatments
14 method as the cure for diabetes, introduction of stem cell therapy as well as public awareness will
15 reduce the burden of the disease and improve quality of life.

16 Keywords: stem cells, stem cell therapy, diabetes mellitus, embryonic stem cells
17

18

19 1. Introduction
20 The World Health Organization (WHO) reported that about 177 million people are
21 Citation: To be added by editorial affected by diabetes globally, but this figure is expected to rise to over 300 million by
22 staff during production. 2025 .1 Diabetes mellitus (DM) constitutes one of the greatest menaces to modern global
23 Academic Editor: Firstname
health with its morbidity rising rapidly. However, diabetes care in Nigeria is poorly
24 Lastname
organized especially at the primary and secondary levels of the public health sector
25 leading to reduced life expectancy and quality of life.2
Received: date
26 DM puts extra burden on affected individuals and their families especially majority
Revised: date
27 of patients unable to access quality health care. DM is a group of metabolic diseases
Accepted: date
28 characterized by inadequate or resistant insulin production. Type 1 diabetes mellitus
Published: date
29 (T1DM) or insulin-dependent DM is caused by total insulin deficiency as a result of
30 autoimmune destruction of pancreatic β-cells. Type 2 DM (T2DM) or non-insulin

Copyright: © 2024 by the authors.

Submitted for possible open access
publication under the terms and
conditions of the Creative Commons
Attribution (CC BY) license
(https://creativecommons.org/license
s/by/4.0/).

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31 dependent DM is as a result of insulin resistance and insufficient insulin release

32 response.3
33 Stem cells are unspecialized cells of the human body that can be differentiated into
34 any cells such as lymphocytes, hepatocytes, leukocytes, erythrocytes, myocytes, nerve
35 cells.4 They have the ability to self-renew and exists in both embryos and adult cells.
36 STCs are of two types namely the pluripotent stem cells (PSCs) and multipotent stem
37 cells. Pluripotent STCS can differentiate into any cell types in the body and multipotent
38 STCs can only differentiate into a specific cell type.5 Stem cells therapy hold great
39 prospects for the treatment of diabetic patients. For T1DM patients, pancreas or islet cell
40 transplantation (ICT) have been suggested as a feasible alternative. Studies have shown
41 that T1DM patients who undergo pancreas transplantation were able to stop taking
42 insulin.6 However, scarcity of pancreas donor, immunosuppressive medication and graft
43 rejection issues have been an obstacle to clinical islet transplantation. 7 Human
44 pluripotent stem cells such as embryonic stem cells (ESCs) and induced pluripotent stem
45 cells (iPSCs) are important source to deal with shortage of donor β-cells.
46 STCs have the potential to be a real cure for T1DM and possibly T2DM. ICT has
47 been connected to repair of pancreatic β-cells, reduced progression of microvascular
48 complications such as diabetic neuropathy, diabetic nephropathy, diabetic retinopathy
49 and other complications.8 STCs seems to be the future in the treatment of diabetes.
50 However, further research is needed to overcome the various clinical challenges such as
51 donor shortages and to determine its feasibility.

52 2. Stem cells vs Diabetes

53 Stem cells are classified into ESCs and adult stem cells (ASCs). ASCs are uncommon
54 STC found in almost all major body organs and are known as multipotent due to their
55 limited ability to differentiate, ESCs also known as PSCs can be differentiate from the
56 embryo cell mass and have the ability to differentiate. 9 Examples of ASCs includes
57 hematopoietic stem cells (needed for treatment of leukemia, hematological tumors, bone
58 transplantation) and mesenchymal stem cells (MSCs) (promotes the formation of fat,
59 bone and cartilage).10,11
60 Embryonic stem cells are viable source of cell replacement in diabetes. ESCS are
61 great source for the production of islet cells capable of producing insulin. 12 Ethical and
62 immunological challenges made investigation of regenerating insulin secreting cells
63 difficult. To overcome this, scientists have suggested induced pluripotent STCs be used
64 to replace ESCs, to prevent ethical and immunological concerns connected to ESCs
65 transplantation.13-22
66 3. Stem cell in treatment of type 2 DM
67 It has been suggested that T2DM can be treated using stem cells therapy. Hyperbaric
68 oxygen and intrapancreatic bone marrow infusion have been shown to improve blood
69 glucose , glycemic control and C-peptide level thereby reducing the need for insulin in
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70 T2DM patients.23 MSCs derive in human placenta have been shown to improve islet cells
71 functions thereby reducing blood glucose.21,24 Also, VEGF has been implicated in
72 vascular damage in diabetic neuropathy (DN). Blocking VEGF is important in managing
73 the condition. MSCs injection reduce VEGF production thereby mitigating the effects of
74 diabetic neuropathy. 25-31
75 T1DM and T2DM are at risk of developing foot ulcers which require amputations as a
76 result of diabetic neuropathy. Increasing hyperglycemia worsens DN 32,33 which is
77 connected to dysregulation of glucose levels, oxidative stress, elevated glycolysis
78 hemoglobin levels and reduced blood velocity as a result of ROS production.33,34
79 Hyperglycemia also promotes the generation of advanced glycated end products (AGEs)
80 which starts an inflammatory reaction and promotes oxidative stresss which futher
81 causes deterioration of the cells.35-40 MSC injection have been shown to improve cells
82 functions and control the levels of AGEs and glucose in the blood.
83 4. Stem cell as a beacon of hope
84 In Nigeria, diabetes is regarded as the disease of the rich. However, due to lifestyle,
85 diets and poor economic situation of the country, many people including the masses
86 suffer from this disease. Due to poor and disorganized health care sector in Nigeria,
87 many Nigerian population are undiagnosed because a lot of people resort to self
88 medication until it deteriorates into a bigger problem. The increasing burden of diabetes
89 as well as the effects on the health care costs, morbidity and mortality are felt by the
90 patients and their families.
91 Treatment of T1DM and T2DM in Nigeria is limited as both causes are treated as the
92 same thing. In a country where patients resort to tradomedical care, introduction of stem
93 cell therapy will change the course in the treatment of diabetes.
94
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95 3. Conclusions
96 STC therapy have been considered as a safe type of transplantation therapy in
97 diabetes compared to whole organ and Islet cell transplantation. Although ICT has been
98 tested by researchers as an alternate therapy, the scarcity of donors and organ rejection
99 still poses problems in clinical practice. Furthermore, the first stem cells used in the
100 treatment of diabetes were ESCs. Yet, iPSCs have emerged as an alternative due to issues
101 including tumor risk as well as ethical questions.
102 Diabetes and its accompanying complication continue to affect human lives. Stem
103 cell therapy, if introduced in Nigeria will help to improve disease outcomes and reduce
104 the burden on the patients.
105 Conflicts of Interest: Author declares no conflict of interests.
106 Funding: This research received no external funding.

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