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Autologous Umbilical Cord Blood Transfusion in Very Young Children With Type 1 Diabetes

Author:
Haller, Michael J., Wasserfall, Clive H., McGrail, Kieran M., Cintron, Miriam, Brusko, Todd M., Wingard, John R., Kelly, Susan S., Shuster, Jonathan J., Atkinson, Mark A., Schatz, Desmond A.
Source:
Diabetes care 2009 v.32 no.11 pp. 2041-2046
ISSN:
0149-5992
Subject:
blood, blood transfusion, c-peptide, children, glycemic control, insulin-dependent diabetes mellitus, intravenous injection, patients, phenotype, umbilical cord
Abstract:
OBJECTIVE: Interest continues to grow regarding the therapeutic potential for umbilical cord blood therapies to modulate autoimmune disease. We conducted an open-label phase I study using autologous umbilical cord blood infusion to ameliorate type 1 diabetes. RESEARCH DESIGN AND METHODS: Fifteen patients diagnosed with type 1 diabetes and for whom autologous umbilical cord blood was stored underwent a single intravenous infusion of autologous cells and completed 1 year of postinfusion follow-up. Intensive insulin regimens were used to optimize glycemic control. Metabolic and immunologic assessments were performed before infusion and at established time periods thereafter. RESULTS: Median (interquartile range [IQR]) age at infusion was 5.25 (3.1-7.3) years, with a median postdiagnosis time to infusion of 17.7 (10.9-26.5) weeks. No infusion-related adverse events were observed. Metabolic indexes 1 year postinfusion were peak C-peptide median 0.50 ng/ml (IQR 0.26-1.30), P = 0.002; A1C 7.0% (IQR 6.5-7.7), P = 0.97; and insulin dose 0.67 units · kg⁻¹ · day⁻¹ (IQR 0.55-0.77), P = 0.009. One year postinfusion, no changes were observed in autoantibody titers, regulatory T-cell numbers, CD4-to-CD8 ratio, or other T-cell phenotypes. CONCLUSIONS: Autologous umbilical cord blood transfusion in children with type 1 diabetes is safe but has yet to demonstrate efficacy in preserving C-peptide. Larger randomized studies as well as 2-year postinfusion follow-up of this cohort are needed to determine whether autologous cord blood-based approaches can be used to slow the decline of endogenous insulin production in children with type 1 diabetes.
Agid:
282002