The review by Dziadosz et al brings a very relevant immunological discussion to the forefront of obstetrics. The authors describe the limitless clinical advantages of amniotic fluid’s versatile stem cell population.

With this in mind, we would like to further the discussion by providing an update on amniotic stem cell use in therapy for individuals affected by type 1 diabetes therapy. Numerous in vitro studies are exploring the possibility of differentiating amniotic epithelial cells into insulin-producing cells in vivo. The use of a stem cell source that is virtually unlimited would be groundbreaking for a disease that has long been considered incurable.

A recent study by Okere et al has shown that 3-dimensional spheroids formed by human amniotic epithelial cells can be differentiated into insulin-producing cells in vitro. Moreover, this study determined that the immunogenicity of human amniotic epithelial cells was not altered during differentiation. This is especially important when considering the relevance of a cell’s immunogenic profile during transplantation. Although this cell-based therapy is in its early stages of development, conducted research on modifiable transcription factors is quite promising.

The transcription factor at the forefront of this in vitro pancreatic induction is pancreatic duodenal homeobox-1 (PDX1), which is essential for the differentiation of human amniotic stem cells into endocrine pancreatic cells. Amniotic stem cells are known to express large amounts of PDX1, which makes them an ideal target for cell-based therapy. The importance of targeting PDX1 is its connection to both pancreatic islet cell and ductal cell development as well as its ability to direct cells into differentiation rather than proliferation.

We congratulate this completed in vitro research, which will undoubtedly serve as a template for future studies, and anticipate amniotic PDX1 expression will be an important component of advances in diabetic therapy.