Islet cell transplantation for the treatment of type 1 diabetes: recent advances and future challenges

Abstract

Islet transplantation is a well-established therapeutic treatment for a subset of patients with complicated type I diabetes mellitus. Prior to the Edmonton Protocol, only 9% of the 267 islet transplant recipients since 1999 were insulin independent for >1 year. In 2000, the Edmonton group reported the achievement of insulin independence in seven consecutive patients, which in a collaborative team effort propagated expansion of clinical islet transplantation centers worldwide in an effort to ameliorate the consequences of this disease. To date, clinical islet transplantation has established improved success with insulin independence rates up to 5 years post-transplant with minimal complications. In spite of marked clinical success, donor availability and selection, engraftment, and side effects of immunosuppression remain as existing obstacles to be addressed to further improve this therapy. Clinical trials to improve engraftment, the availability of insulin-producing cell sources, as well as alternative transplant sites are currently under investigation to expand treatment. With ongoing experimental and clinical studies, islet transplantation continues to be an exciting and attractive therapy to treat type I diabetes mellitus with the prospect of shifting from a treatment for some to a cure for all.

Keywords: Edmonton Protocol; engraftment; immunosuppression; islet transplantation; type I diabetes mellitus.

Figure 1

Number of islet transplant recipients from 1999–2013 in Edmonton, North America and International Islet Transplant Centers. Notes: This data is kindly reproduced with express permission from the CITR Coordinating Center and Investigators. The Collaborative Islet Transplant Registry 2011 Seventh Annual Report. Reported data is unavailable from 2010–2013 for North America and International Islet Transplant Centers. Abbreviation: CITR, Collaborative Islet Transplant Registry.