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Journal Article
Advances in islet encapsulation technologies
2017
Overview
Key Points
The autoimmune response in type 1 diabetes combined with the response to allogeneic cell transplantation remains a formidable barrier to transplant success that currently requires the use of powerful immunosuppressive drugs.
Encapsulation strategies have the potential to ameliorate these responses to promote survival post-transplantation, with modifications to the biomaterial chemistry, the incorporation of biologics or cell co-transplantation being used to avoid lifelong immunosuppression.
Allogeneic islets are the current standard for clinical use; however, the supply of these islets is insufficient to meet the need for patients. Alternative sources such as human embryonic stem cell-derived β-cells and porcine islets have the potential to satisfy demand, although efficacy, safety and regulatory issues remain to be addressed.
Vascularization of the transplant site is being developed to enhance islet function post-transplantation by providing the nutrients necessary for survival, while also allowing the sensing of glucose and the distribution of insulin. Oxygen is frequently the limiting factor and oxygen delivery systems are also being developed to complement the vascularization process.
A small number of islet encapsulation systems have been applied clinically, all of which have demonstrated good safety profiles, although it is too early to evaluate functional outcomes.
Islet transplantation can be an effective therapy for patients with type 1 diabetes, but its widespread use is limited by the need for lifelong immunosuppression. Here, Desai and Shea discuss the emerging potential of islet cell encapsulation including new strategies, assess key challenges facing the human translation of this technology and highlight encapsulation devices that have entered the clinic.
Type 1 diabetes is an autoimmune disorder in which the immune system attacks and destroys insulin-producing islet cells of the pancreas. Although islet transplantation has proved to be successful for some patients with type 1 diabetes, its widespread use is limited by islet donor shortage and the requirement for lifelong immunosuppression. An encapsulation strategy that can prevent the rejection of xenogeneic islets or of stem cell-derived allogeneic islets can potentially eliminate both of these barriers. Although encapsulation technology has met several challenges, the convergence of expertise in materials, nanotechnology, stem cell biology and immunology is allowing us to get closer to the goal of encapsulated islet cell therapy for humans.
Publisher
Nature Publishing Group UK,Nature Publishing Group
