From insulin injections to islet transplantation: An overview of the journey

When, in 1869, Paul Langerhans detected the islands of tissue in the pancreas, he took the first step on a journey towards islet transplantation as a treatment for type 1 diabetes. The route has embraced developments across biosciences, surgery, gene therapy and clinical research. This review highlights major milestones along that journey involving whole pancreas transplantation, islet transplantation, the creation of surrogate insulin-secreting cells and novel islet-like structures using genetic and bio-engineering technologies. To obviate the paucity of human tissue, pluripotent stem cells and non-beta-cells within the pancreas have been modified to create physiologically responsive insulin-secreting cells. Before implantation, these can be co-cultured with endothelial cells to promote vascularisation and with immune defence cells such as placental amnion cells to reduce immune rejection. Scaffolds to contain grafts and facilitate surgical placement provide further opportunities to achieve physiological insulin delivery. Alternatively, xenotransplants such as porcine islets might be reconsidered as opportunities exist to circumvent safety concerns and immune rejection. Thus, despite a long and arduous journey, the prospects for increased use of tissue transplantation to provide physiological insulin replacement are drawing ever closer.

Automated summary

The journey towards islet transplantation as a treatment for type 1 diabetes began with Paul Langerhans' discovery of tissue islands in the pancreas in 1869. Advances in biosciences, surgery, gene therapy, and clinical research have led to the development of surrogate insulin-secreting cells from pluripotent stem cells and non-beta cells within the pancreas. Additionally, xenotransplants such as porcine islets are being reconsidered as potential alternatives to overcome safety concerns and immune rejection.