Molecular development of the pancreatic beta cell: implications for cell replacement therapy

Conventional insulin therapy is an imperfect treatment for diabetes mellitus, often failing to match insulin with prevailing blood glucose concentration. Accordingly, there is a drive for approaches such as beta-cell replacement therapy, which is a permanent replacement for the lack of endogenous insulin production. The lack of cadaveric islets for transplantation determines that researchers must explore alternative sources of graft material. Cell engineering of non-beta cells and selective expansion of stem cells are key potential sources. The past decade has witnessed an increase in our understanding of the molecular basis of pancreas and beta-cell development. Our understanding of the molecular blueprint of how a beta cell is made and maintained is crucial to realizing the potential of cell engineering and stem cell technologies in this area. This review outlines progress in this exciting field and highlights the key role of development in guiding our appraisal of these new technologies.