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Immunological Monitoring in Beta Cell Replacement: Towards a Pathophysiology-Guided Implementation of Biomarkers

  • Immunology, Transplantation, and Regenerative Medicine (L Piemonti and V Sordi, Section Editors)
  • Published:
Current Diabetes Reports Aims and scope Submit manuscript

Abstract

Purpose of review

Grafted beta cells are lost because of recurrence of T1D and/or allograft rejection, two conditions diagnosed with pancreas graft biopsy, which is invasive and impossible in case of islet transplantation. This review synthetizes the current pathophysiological knowledge and discusses the interest of available immune biomarkers.

Recent findings

Despite the central role of auto-(recurrence of T1D) and allo-(T-cell mediated rejection) immune cellular responses, the latter are not directly monitored in routine. In striking contrast, there have been undisputable progresses in monitoring of auto and alloantibodies.

Summary

Except for pancreas recipients in whom anti-donor HLA antibodies can be directly responsible for antibody-mediated rejection, autoantibodies (and alloantibodies in islet recipients) have no direct pathogenic effect. However, their fluctuation offers a surrogate marker for the activation status of T cells (because antibody generation depends on T cells). This illustrates the necessity to understand the pathophysiology when interpreting a biomarker and selecting the appropriate treatment.

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Acknowledgements

The authors wish to thank Clemence Thaunat for her help in the design of the figure. OT has received funding from the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation programme (SC1-BHC-07-2019 - VANGUARD).

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Authors and Affiliations

  1. Department of Transplantation, Nephrology and Clinical Immunology, Edouard Herriot Hospital, Hospices Civils de Lyon, 5 Place d’Arsonval, 69003, Lyon, France

    Fanny Buron, Emmanuel Morelon & Olivier Thaunat

  2. Department of Endocrinology and Diabetes, Lyon-Sud Hospital, Hospices Civils de Lyon, 69310, Pierre-Bénite, France

    Sophie Reffet

  3. Department of Urology and Transplantation surgery, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France

    Lionel Badet

  4. French National Institute of Health and Medical Research (Inserm) Unit 1111, Lyon, France

    Emmanuel Morelon & Olivier Thaunat

  5. Lyon-Est Medical Faculty, Claude Bernard University (Lyon 1), Lyon, France

    Emmanuel Morelon & Olivier Thaunat

  6. Service de Transplantation, Néphrologie et Immunologie Clinique, Hôpital Edouard Herriot, 5 Place d’Arsonval, 69003, Lyon, France

    Olivier Thaunat

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  1. Fanny Buron
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Correspondence to Olivier Thaunat.

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Buron, F., Reffet, S., Badet, L. et al. Immunological Monitoring in Beta Cell Replacement: Towards a Pathophysiology-Guided Implementation of Biomarkers. Curr Diab Rep 21, 19 (2021). https://doi.org/10.1007/s11892-021-01386-4

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