Inserm U859, Thérapie Cellulaire du Diabète, pôle recherche, faculté de médecine, 3
e étage Est, université Lille-II, 1, place de Verdun, 59045 Lille cedex, France
Allogeneic transplantation of islets of Langerhans, based on the selective graft of endocrine islets of Langerhans, several mililiters of tissue isolated from nondiabetic subjects and infused in the portal vein, allows in the most experienced centers achievement of short-term results identical to pancreas transplantation (80% of insulin-independence at one year). Development of cell therapy of diabetes is crucial and is currently confronted with three major obstacles: immune rejection, the poor initial implantation of islets and the limited duration of their function in the recipient. The forseeable progress will lead to an extension of the indications in years to come to patients suffering from the most severe forms of type 1 diabetes. The structural shortage of organ donors limits however the development of primary islet allografts. Involvement in the production of insulin-secreting cells destined for transplantation in man represents an considerable stake for the treatment of diabetes by cell therapy and, in particular, by the proliferation of adult human islets, the exploitation of living and non-heart beating donors, the acquisition of xenogeneic islets, the proliferation and differentiation of stem cells and precursor/progenitor cells, and transdifferentiation.