Type 1 diabetes mellitus (T1DM) is a chronic autoimmune disease characterised by the destruction of beta cells in the islets of Langerhans in the pancreas, leading to an absolute insulin deficiency. Despite advances in insulin therapy and glycaemic control, T1DM remains an incurable disease associated with numerous complications. An alternative treatment approach involves cell therapies based on cellular reprogramming, which offer advantages such as the absence of ethical concerns and the need for immunosuppressive therapy. Through reprogramming, adult somatic cells can be transformed into induced pluripotent stem cells (iPSCs), which can then be further differentiated into functional pancreatic beta cells. In addition to the generation and differentiation of iPSC lines, direct reprogramming or transdifferentiation can also be carried out, in which somatic cells (e.g. alpha cells) are converted directly into beta cells without passing through a pluripotent state. There are several methods for reprogramming cells. The most commonly used methods are the introduction of specific transcription factors using viral vectors or the use of small molecules that mimic the action of these factors. In clinical trials for the treatment of T1DM, allogeneic hESC, autologous iPSC and transplantation of pancreatic islets in combination with encapsulation or genetic manipulation are being tested.
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