Diabetes mellitus: rational basis, clinical approach and future therapy

Clinical islet transplantation has recently received a strong impulse from the results obtained with the introduction of the Edomonton group. However, islet transplantation is at present a minimally invasive procedure and offers for the future the unique possibility of being performed under donor-specific tolerant conditions because islets may potentially be engineered in vitro. In addition, various approaches such as in vitro islet expansion, or xenogenic islets could make the availability of donor tissues unlimited. Recent advances in tissue engineering (technology) and cell biology may allow for the development of novel strategies for the treatment and cure of type I diabetes. In particular, it is now possible to envisage restoration of insulin secretion by cell-replacement therapy. And it will be necessary to ensure that implanted β-cells are protected in some way from recognition by the immune system (a bio-artificial endocrine pancreas).