Overcoming the Challenges Now Limiting Islet Transplantation

A Sequential, Integrated Approach

Authors

  • ANTONELLO PILEGGI,

    1. Cell Transplant Center, Diabetes Research Institute, University of Miami Leonard M. Miller School of Medicine, Miami, Florida 33136, USA
    2. Dewitt Family Department of Surgery, Division of Cellular Transplantation, University of Miami Leonard M. Miller School of Medicine, Miami, Florida 33136, USA
    Search for more papers by this author
  • LORENZO COBIANCHI,

    1. Cell Transplant Center, Diabetes Research Institute, University of Miami Leonard M. Miller School of Medicine, Miami, Florida 33136, USA
    2. Istituto di Chirurgia Generale Epatopancreatica, Dipartimento di Scienze Chirurgiche, Universita' degli Studi di Pavia, IRCCS Policlinico ‘San Matteo,’ 27100 Pavia, Italy
    Search for more papers by this author
  • LUCA INVERARDI,

    1. Cell Transplant Center, Diabetes Research Institute, University of Miami Leonard M. Miller School of Medicine, Miami, Florida 33136, USA
    2. Department of Microbiology and Immunology, University of Miami Leonard M. Miller School of Medicine, Miami, Florida 33136, USA
    Search for more papers by this author
  • CAMILLO RICORDI

    1. Cell Transplant Center, Diabetes Research Institute, University of Miami Leonard M. Miller School of Medicine, Miami, Florida 33136, USA
    2. Dewitt Family Department of Surgery, Division of Cellular Transplantation, University of Miami Leonard M. Miller School of Medicine, Miami, Florida 33136, USA
    Search for more papers by this author

Address for correspondence: Camillo Ricordi, M.D., Diabetes Research Institute, Miller School of Medicine, University of Miami, 1450 NW 10th Avenue (R-134), Miami, FL 33136. Voice: 305-243-5275; fax: 305-243-4404. e-mail: ricordi@miami.edu

Abstract

Abstract: Steady improvements in islet cell processing technology and immunosuppressive protocols have made pancreatic islet transplantation a clinical reality for the treatment of patients with Type 1 diabetes mellitus (T1DM). Recent trials are showing that improved glycemic metabolic control, prevention of severe hypoglycemia, and better quality of life can be reproducibly achieved after transplantation of allogeneic islets in patients with unstable T1DM. Despite these encouraging results, challenges ahead comprise obtaining adequate islet cells for transplant, enhancing islets engraftment, sustaining β cell mass and function over time, and defining effective immune interventions, among others. In order to overcome the current hurdles to the widespread application of islet transplantation there is a need for implementation of integrated, sequential therapeutic approaches.

Ancillary