Annicchiarico A, Barile B, Buccoliero C, Nicchia GP, Brunetti G. Alternative therapeutic strategies in diabetes management. World J Diabetes 2024; 15(6): 1142-1161 [PMID: 38983831 DOI: 10.4239/wjd.v15.i6.1142]
Corresponding Author of This Article
Giacomina Brunetti, PhD, Associate Professor of Histology, Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari Aldo Moro, 4 Via Orabona, Bari 70125, Italy. giacomina.brunetti@uniba.it
Research Domain of This Article
Management
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Alessia Annicchiarico, Barbara Barile, Cinzia Buccoliero, Grazia Paola Nicchia, Giacomina Brunetti, Department of Biosciences, Biotechnologies and Environment, University of Bari Aldo Moro, Bari 70125, Italy
Author contributions: Annicchiarico A wrote the introduction and mesenchymal stem cell content and edited the manuscript; Barile B contributed the wound healing content; Buccoliero C deepened the discussion on the role of exosomes; Nicchia GP critically revised the manuscript for overall intellectual content; Brunetti G contributed to the transplantation content; and all authors read and approved the final manuscript.
Conflict-of-interest statement: The authors declare having no conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Corresponding author: Giacomina Brunetti, PhD, Associate Professor of Histology, Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari Aldo Moro, 4 Via Orabona, Bari 70125, Italy. giacomina.brunetti@uniba.it
Received: January 29, 2024 Revised: February 17, 2024 Accepted: April 12, 2024 Published online: June 15, 2024 Processing time: 133 Days and 22.2 Hours
Abstract
Diabetes is a heterogeneous metabolic disease characterized by elevated blood glucose levels resulting from the destruction or malfunction of pancreatic β cells, insulin resistance in peripheral tissues, or both, and results in a non-sufficient production of insulin. To adjust blood glucose levels, diabetic patients need exogenous insulin administration together with medical nutrition therapy and physical activity. With the aim of improving insulin availability in diabetic patients as well as ameliorating diabetes comorbidities, different strategies have been investigated. The first approaches included enhancing endogenous β cell activity or transplanting new islets. The protocol for this kind of intervention has recently been optimized, leading to standardized procedures. It is indicated for diabetic patients with severe hypoglycemia, complicated by impaired hypoglycemia awareness or exacerbated glycemic lability. Transplantation has been associated with improvement in all comorbidities associated with diabetes, quality of life, and survival. However, different trials are ongoing to further improve the beneficial effects of transplantation. Furthermore, to overcome some limitations associated with the availability of islets/pancreas, alternative therapeutic strategies are under evaluation, such as the use of mesenchymal stem cells (MSCs) or induced pluripotent stem cells for transplantation. The cotransplantation of MSCs with islets has been successful, thus providing protection against proinflammatory cytokines and hypoxia through different mechanisms, including exosome release. The use of induced pluripotent stem cells is recent and requires further investigation. The advantages of MSC implantation have also included the improvement of diabetes-related comorbidities, such as wound healing. Despite the number of advantages of the direct injection of MSCs, new strategies involving biomaterials and scaffolds have been developed to improve the efficacy of mesenchymal cell delivery with promising results. In conclusion, this paper offered an overview of new alternative strategies for diabetes management while highlighting some limitations that will need to be overcome by future approaches.
Core Tip: Common management issues are associated with insulin administration for the treatment of diabetes, a heterogeneous metabolic disease characterized by elevated blood glucose levels resulting from the destruction or malfunction of pancreatic β cells. This review focused on alternative therapeutic strategies, such as islet/pancreas implantation and islet/mesenchymal stem cell and induced pluripotent stem cell transplantation. The use of these different approaches is also associated with amelioration of diabetes-related comorbidities.
