Derivation of insulin producing cells (IPCs) from embryonic stem (ES) cells provides a potentially innovative form of treatment for type 1 diabetes. Here, we discuss the current state of the art, unique challenges, and future directions on generating IPCs. J. Cell. Physiol. 218: 256-263, 2009. Published 2008 Type 1 diabetes is caused by the autoimmune destruction of insulin producing b cells within the pancreatic islets. Islet transplantation is now well established and has allowed weaning some patients off of insulin treatment. However, two major problems have prevented a widespread use of this promising treatment modality. First, each patient requires more than 600 islet equivalents/kg body weight per transplantation, thereby necessitating at least two deceased organ donors. However, at present the chronic shortage of the organ donors is the major limiting factor. Second, islet transplants require lifelong immunosuppressive regimens to control rejection. These regimens are not only expensive but generally reduce the patient's quality of life due to drug-induced side effects. Hence, there is an urgent and compelling need to develop novel alternative therapies for the treatment of type 1 diabetes. An additional problem is the re-emerging autoreactive T cells capable of destroying not only the patient's remaining islets and blocking b-cell regeneration, but also the newly transplanted donor islets thereby ultimately leading to chronic graft rejection. If additional renewable sources of insulin producing cells (IPCs) can be generated, islet transplantation could significantly be improved. In this regard, embryonic stem (ES) cells and induced pluripotent stem (iPS) cells offer a potentially novel approach for their lineage commitment into IPCs (Raikwar et al., 2006;Takahashi and Yamanaka, 2006;Chan et al., 2007;Hanna et al., 2007;Okita et al., 2007;Wernig et al., 2007;Yu et al., 2007;Nakagawa et al., 2008;Park et al., 2008). ES cells that are derived from the inner cell mass of the early developing embryo are pluripotent and are capable of undergoing multilineage differentiation into highly specialized cells representing all three germinal layers (Evans and Kaufman, 1981;Martin, 1981;Thomson et al., 1998). Due to their unlimited proliferation and differentiation potential, ES cells and iPS cells represent an alternate novel source for targeted therapies and regenerative medicine especially for type 1 diabetes. However, earlier studies (Lumelsky et al., 2001) have shown inherent difficulties in establishing a consistent protocol for b-cell derivation from ES cells. The development of the pancreas and especially pancreatic b cells is governed by major transcription factors and signaling pathways (Fig. 1). The protocols for the efficient differentiation of ES cells into IPCs are expected to recapitulate the in vivo development of pancreatic b cells.
ES Cell Differentiation Into IPCsCurrently, there are two main strategies for the differentiation of ES cells into IPCs: (i) embryoid body (EB) formation and (ii) definit...