Title : Omental pouch and intrapancreatic stem cell therapy for type 1 diabetes
Abstract:
Background: Type 1 diabetes mellitus (T1DM) is a chronic autoimmune disorder characterized by destruction of pancreatic β-cells, resulting in lifelong dependence on exogenous insulin. Although insulin therapy and islet cell transplantation remain the standard treatment options, both have important limitations related to lifelong treatment, cost, donor availability, and limited long-term efficacy. This presentation describes two novel autologous stem cell–based therapeutic approaches developed for T1DM: the Omental Pouch Stem Cell Operation for children below 10 years of age and Intrapancreatic Stem Cell Transplantation for patients above 10 years of age.
Methods: Adult autologous stem cells were obtained either from omental adipose tissue through enzymatic collagenase digestion or from bone marrow using density-gradient centrifugation. In the omental pouch technique, stem cells were distributed into a surgically created omental pouch, the peritoneal cavity, and intravenously. Twenty-one insulin-dependent children aged 2.5–10 years underwent this procedure and were compared with 26 conventionally treated controls. In the intrapancreatic technique, performed in 23 insulin-dependent patients aged 10–56 years, stem cells were infused directly into the pancreatic artery and distal splenic artery using interventional radiology to maximize pancreatic stem cell delivery. Patients were evaluated at three-month intervals using fasting and postprandial blood glucose, HbA1c, Anti-GAD antibody titres, C-peptide levels, and insulin requirements.
Results: In the omental pouch group, improvement became evident after approximately three months. At one-year follow-up, 14.3% of patients became insulin independent, while the remaining patients experienced an approximately 50% reduction in insulin requirement together with substantial improvement in blood glucose control. Anti-GAD antibody titres decreased by 50–75%, suggesting partial reversal of autoimmunity, while C-peptide levels increased by approximately 50%, indicating improved endogenous insulin secretion. No therapy-related mortality was reported. Among patients undergoing intrapancreatic stem cell transplantation, 30.4% achieved insulin independence after one year, whereas the remaining patients demonstrated approximately 50% reduction in insulin requirement with improved glycaemic control. Similar reductions in Anti-GAD antibody titres and increases in C-peptide levels were observed. Direct arterial delivery was proposed to increase pancreatic stem cell concentration substantially compared with conventional intravenous administration. In both studies, control groups showed no patients achieving insulin independence and demonstrated comparatively poorer metabolic outcomes during follow-up.
Discussion: These approaches are based on the regenerative and immunomodulatory properties of adult stem cells. The omentum provides a vascularized, relatively immune-privileged environment that may support stem cell survival and differentiation, while direct arterial infusion increases stem cell delivery to pancreatic tissue. The proposed mechanisms include regeneration of β-cells, stimulation of endogenous repair through growth factors and cytokines, and partial reversal of autoimmune activity. The reported procedures were designed as cost-effective alternatives, with treatment costs substantially lower than conventional cell-based therapies.
Conclusion: The presented clinical experience suggests that autologous stem cell therapy delivered through either an omental pouch or direct intrapancreatic infusion may improve glycaemic control, reduce insulin dependence, and partially reverse autoimmune markers in selected patients with Type 1 diabetes. The author concludes that these techniques appear affordable, safe, and promising; however, larger controlled clinical studies with longer follow-up are required to establish their efficacy, long-term safety, reproducibility, and role in routine clinical practice.
