review of literature on clinical pancreatology - The Pancreapedia

hormones. The roles <strong>of</strong> the incretin hormones in the regulation <strong>of</strong> glucose metabolism andother related physiologic processes such as gut motility and food intake are disturbed in type2 diabetes. These disturbances – defects in the incretin system – contribute to thepathophysiology <strong>of</strong> type 2 diabetes in manifold ways. Consequently, therapies designed toaddress impairments to the effects <strong>of</strong> the incretin hormones have the potential to improveglucose regulation and other abnormalities (e.g. weight gain, loss <strong>of</strong> beta-cell function)associated with type 2 diabetes [139].Impaired insulin secretion plays a major role in the pathogenesis <strong>of</strong> type 2 diabetes mellitus,and progressive loss <strong>of</strong> beta-cell function is a pathophysiologic hallmark <strong>of</strong> type 2 diabetes.Recent science has elaborated on the role <strong>of</strong> the incretin hormones on beta-cell function andinsulin secretion, as well as the role that incretin-based pharmacotherapies may have onglycemic control and beta-cell function, possibly altering the progressive loss <strong>of</strong> beta-cellfunction and possibly reversing/halting disease progression. However, incretin-basedtherapies may also have benefits extending beyond glycemic control and insulin secretion. Inone <strong>review</strong> it wasd examine some <strong>of</strong> those "beyond-glycemic" benefits, includingpresentation <strong>of</strong> data on weight reduction, blood pressure lowering, beneficial changes in thelipid pr<strong>of</strong>ile, and improvements in myocardial and endothelial function [140].Stem cell therapyWith the already heightened demand placed on organ donation, stem cell therapy hasbecome a tantalizing idea to provide glucose-responsive insulin-producing cells to Type 1diabetic patients as an alternative to islet transplantation. Multiple groups have developedvaried approaches to create a population <strong>of</strong> cells with the appropriate characteristics. Bothadult and embryonic stem cells have received an enormous amount <strong>of</strong> attention as possiblesources <strong>of</strong> insulin-producing cells. Although adult stem cells lack the pluripotent nature <strong>of</strong>their embryonic counterparts, they appear to avoid the ethical debate that has centredaround the latter. This may limit the eventual application <strong>of</strong> embryonic stem cells, which havealready shown promise in early mouse models. One must also consider the potential <strong>of</strong> stemcells to form teratomas, a complication which would prove devastating in an immunologicallycompromised transplant recipient. One <strong>review</strong> looked at the progress to date in both theadult and embryonic stem cells fields as potential treatments for diabetes. It was alsoconsider some <strong>of</strong> the limitations <strong>of</strong> stem cell therapy and the potential complications that maydevelop with their use [141].