Current Diabetes Reports

, Volume 13, Issue 5, pp 713–722

Biologic Agents in Islet Transplantation

  • Boris Gala-Lopez
  • Andrew R. Pepper
  • A. M. James Shapiro
Transplantation (A Pileggi, Section Editor)

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.

Keywords

Islet transplantation Immunosuppression Biologic agents Antibodies Induction strategies Maintenance schemes Immune response Acute rejection Graft survival 

Abbreviation list

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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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Boris Gala-Lopez
    • 1
  • Andrew R. Pepper
    • 1
  • A. M. James Shapiro
    • 1
    • 2
  1. 1.Clinical Islet Transplant Program and Department of SurgeryUniversity of AlbertaEdmontonCanada
  2. 2.Medicine and Surgical OncologyUniversity of AlbertaEdmontonCanada

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