Stem Cell-Derived Islet Transplantation in Patients With Type 2 Diabetes: Can Diabetes Subtypes Guide Implementation?

Area of Science:

• Endocrinology and Transplantation Immunology
• Regenerative Medicine
• Diabetes Subtyping

Background:

• Islet transplantation (ITx) has historically been reserved for patients with brittle diabetes or severe hypoglycemia.
• This selection aimed to balance the risks of immunosuppression and organ scarcity against potential benefits.
• The traditional view of diabetes is evolving with new classification systems like the All New Diabetics in Scania (ANDIS) system.

Approach:

• This review evaluates the potential for expanding ITx eligibility to broader patient populations based on novel diabetes subtypes.
• It examines the limitations and unique transplant considerations for these "unconventional" cohorts.
• The analysis incorporates evidence from whole pancreas transplantation and extensive ITx experience.

Key Points:

• Stem cell (SC)-derived ITx and potential for immunosuppression-free protocols may broaden ITx candidacy.
• The ANDIS classification identifies 5 distinct diabetes subtypes, each with unique etiologies and prognoses.
• Revisiting ITx criteria is necessary to align with current diabetes understanding and emerging technologies.

Conclusions:

• SC-derived ITx offers a promising avenue for treating a wider range of diabetes patients.
• Further research and tailored transplant strategies are needed to implement ITx in diverse diabetes subtypes.
• This approach could significantly improve outcomes for patients previously excluded from ITx consideration.