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Biologic Agents in Islet Transplantation

  • Transplantation (A Pileggi, Section Editor)
  • Published:
Current Diabetes Reports Aims and scope Submit manuscript

Abstract

Islet transplantation is today an accepted modality for treating selected patients with frequent hypoglycemic events or severe glycemic lability. Despite tremendous progress in islet isolation, culture, and preservation, clinical use is still restricted to a limited subset, and lifelong immunosuppression is required. Issues surrounding limited islet revascularization and immune destruction remain. One of the major challenges is to prevent alloreactivity and recurrence of autoimmunity against β-cells. These two hurdles can be effectively reduced by immunosuppressive therapy combining induction and maintenance treatments. The introduction of highly potent and selective biologic agents has significantly reduced the frequency of acute rejection and has prolonged graft survival, while minimizing the complications of this therapeutic scheme. This review will address the most important biological agents used in islet transplantation. We provide a historical perspective of their introduction into clinical practice and their role in current clinical protocols, aiming at improved engraftment efficiency, increased long-term survival, and better overall results of clinical islet transplantation.

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Abbreviations

IT:

Islet transplant

IS:

Immunosuppression

ICAM-1:

Intercellular Adhesion Molecule-1

IL:

Interleukin

T1DM:

Type 1 diabetes mellitus

CNI:

Calcineurin inhibitor

MMF:

mycophenolate mofetil

mTOR:

mammalian target of rapamycin

ATG:

Anti-thymocyte globulin

IgG1:

Immunoglobulin G1

CTLA-4:

Cytotoxic T-lymphocyte antigen 4

LFA:

Leukocyte Function Antigen

mAb:

Monoclonal antibody

TCR:

T-cell receptor

BAFF-R:

BAAF receptor

GLP-1:

Glucagon-like peptide 1

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Boris Gala-Lopez, Andrew R. Pepper, and A. M. James Shapiro declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Correspondence to A. M. James Shapiro.

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Gala-Lopez, B., Pepper, A.R. & Shapiro, A.M.J. Biologic Agents in Islet Transplantation. Curr Diab Rep 13, 713–722 (2013). https://doi.org/10.1007/s11892-013-0414-8

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  • DOI: https://doi.org/10.1007/s11892-013-0414-8

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