Investigators who have doggedly worked to improve islet transplantation have made tremendous strides. They have improved isolation methods, decreased
diabetogenic (arising from diabetes) immunosuppression, and designed minimally invasive implantation techniques. Nevertheless, several hurdles including a
replenishable cellular insulin source and finding safer and more effective treatments to prevent recurrent autoimmunity and/or allograft rejection need to be
overcome before this procedure can be considered a viable T1D therapy.
Though the ultimate breakthrough still eludes us, diabetes treatments are increasingly safe and effective. While islet transplantation may not be ready for widespread
clinical application, talented and committed clinicianscientists continue to study the possibility of islet regeneration, βcell replacement, and ways to prevent the
immunemediated killing of those insulinproducing cells. For the 3rd edition of his Treatment of Diabetes Mellitus, Elliott Joslin wrote, “Imagine the feelings of a
doctor with a background of 1,000 fatal cases, who has lived to see what the ages have longed for with the discovery of insulin… Who wants a vacation when he can
watch mere ghosts of children start to grow, play and make noise and see their mothers smile again?” The enthusiasm and optimism so eloquently expressed by Dr.
Joslin over 50 years ago is alive today.