[Cell therapy of diabetes in France: from islet transplantation to future perspectives]

Pancreatic islet transplantation (PIT) became a clinical reality in France in 2021, providing a groundbreaking alternative for patients with type 1 diabetes (T1D) suffering from lability or severe hypoglycemic unawareness. This cellular therapy involves implanting insulin-producing islets from brain-deceased donors (allograft) or after pancreatectomy (autograft), significantly improving glucose control and reducing diabetes-related complications. However, PIT faces major challenges, including limited donor availability, lifelong immunosuppression, and progressive islet loss. Researchers are now exploring alternative approaches, such as stem cell-derived islets and xenografts, to overcome these obstacles and expand access to this promising therapy. The future of PIT may hinge on the success of hypoimmune stem cell-derived insulin secreting islets or autologous grafts that would avoid rejection and autoimmune recurrence in the absence of immunosuppressive drug treatment, paving the way for a long-term solution for millions of diabetic patients worldwide.