Berney Thierry, Thaunat Olivier, Berishvili Ekaterine
Department of Transplantation, Nephrology and Clinical Immunology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
Faculty Diabetes Center, University of Geneva Medical Center, University of Geneva, Geneva, Switzerland.
Transpl Int. 2025 Apr 1;38:14598. doi: 10.3389/ti.2025.14598. eCollection 2025.
Innovative solutions have entered the routine management of patients with type 1 diabetes or are making the headlines and this is shaking the world of beta cell replacement therapies. Above all, allogeneic islet transplantation is enthusiastically doomed to extinction by the aficionados of "closed loop" artificial insulin delivery systems or those convinced of the imminent large scale availability of stem-cell derived insulin-producing tissues. This opinion paper will propose that neither will be a universal solution in the very near future and will argue that xenogeneic islet transplantation may be a serious outsider in the race for new therapies. In the meantime, the odds are in favor of allogeneic islet (and pancreas) transplantation remaining first line options in the treatment of complicated type 1 diabetes. There is no question that "closed loop" systems have already greatly improved the management of type 1 diabetes, but, while "unlimited" sources of insulin-producing cells are jockeying for approval as standard-of-care, these improvements are more likely to drive a shift of indications -from islet transplant alone to simultaneous islet-kidney transplantation- than to herald the demise of islet transplantation.
创新解决方案已进入1型糖尿病患者的常规管理领域，或者成为新闻头条，这正在撼动β细胞替代疗法的世界。最重要的是，同种异体胰岛移植被“闭环”人工胰岛素输送系统的狂热支持者或坚信干细胞衍生的胰岛素产生组织即将大规模可用的人热情地判定为注定要灭绝。这篇观点文章将提出，在不久的将来，这两者都不会成为通用解决方案，并将论证异种胰岛移植可能在新疗法的竞争中成为一个严重的局外人。与此同时，同种异体胰岛（和胰腺）移植仍有可能成为治疗复杂1型糖尿病的一线选择。毫无疑问，“闭环”系统已经极大地改善了1型糖尿病的管理，但是，当“无限”的胰岛素产生细胞来源正在争取被批准作为标准治疗方法时，这些改进更有可能推动适应症的转变——从单纯的胰岛移植到胰岛-肾脏联合移植——而不是预示着胰岛移植的消亡。
