Stem cells and regenerative medicine for the treatment of type 1 diabetes: the challenges lying ahead.

The differentiation of insulin-producing cells in vitro from embryonic or adult stem cells offers potential new treatment options for type 1 diabetes. Progress toward this goal has been made in the recent years, but substantial obstacles still remain. In order to be advantageous over the current standard regimens with exogenous insulin, any stem cell-based therapy would have to restore normal or near normal metabolic control. To achieve this, many of the complex regulatory mechanisms that control physiologic insulin secretion would have to be recreated with in vitro-generated tissue. An alternative approach would be to use the insights gained through stem cell research to develop pharmacologic agents that can induce regeneration of endogenous pancreatic islets in patients with type 1 diabetes. Such a therapy also requires extensive further research, but it could have principal advantages over tissue transplantation.