Impact of autologous bone marrow-derived stem cells to markers of renal deterioration in type 1 diabetes mellitus with nephropathy

Introduction and Aims: Diabetic nephropathy is one of the leading causes of ESRD worldwide. Recent pre-clinical studies have been showed promising tool to treatment of type 1 diabetes mellitus via regeneration of pancreatic beta-cells. Some experimental studies reported direct renoprotective action of mesenchymal stem cells without normalisation of hyperglycaemia.We aimed to study influence of autologous bone marrow-derived stem cells (BMDSCs) therapy in amelioration of kidney function type 1 diabetic nephropathy patients. Methods: This is a preliminary data of prospective cohort study which included 5 patients (2 male and 3 female) with type 1 diabetic nephropathy, who had completed 2 visits during 6 months. Autologous BMDSCs were prepared from each patient (from the posterior iliac crest of patients under local anaesthesia) and cultivated in DMEM medium and incubated at 37c for three days according to cell preparation protocol. All of the patients received autologous BMDSCs (up to 140x106 cells) via IV infusion according to study protocol every 6 months. Routine physical and laboratory data were obtained at each visit. Markers providing renal deterioration such as microalbuminuria, urinary type IV collagen, urinary neutrophil gelatinase-associated lipocalin (NGAL) and urinary transforming growth factor (TGF)-beta1 were also determined at each visit. Results: Descriptive analysis showed that mean age of patients were 23,2+/-4,08 years, duration of diabetes 117,6+/-63,7 months, maximal glucose level 12,6+/-1,69 mmol/L during one year follow-up time. Baseline (I visit) and control (II visit) laboratory data after autologous BMDSCs therapy is presented in Table 1. All of the parameters providing pancreatic endocrine function showed trend to improvement, but non significant except fasting glucose (p=0,035). In some cases, patients reduced dose of insulin and oral antidiabetic medications. Markers indicating renal deterioration also improved after single dose autologous BMDSCs therapy but not significantly except microalbuminuria (p=0,026). Conclusions: Autologous bone marrow-derived stem cells transplantation is a safe and may be beneficial in type 1 diabetes mellitus with nephropathy. Further studies with a large number of patients are needed to substantiate these observations. (Table Presented).