Favorable outcome of experimental islet xenotransplantation without immunosuppression in a nonhuman primate model of diabetes

Significance
Diabetes mellitus type 1 is an autoimmune disease that results in irreversible destruction of insulin-producing beta cells. Substantial advances have been made in beta cell replacement therapies during the last decades. However, lack of eligible donor organs and the need for chronic immunosuppression to prevent rejection critically limit widespread application of these strategies. In this manuscript, we present an experimental study using a bioartificial pancreas device for the transplantation of xenogeneic islet without affecting the immune system in nonhuman primates. We could demonstrate stable graft function and adequate glucose-regulated insulin secretion without the need for immunosuppressive medication. This strategy opens up new avenues for more widespread and safe application of various cell-based therapies.

Transplantation of pancreatic islets for treating type 1 diabetes is restricted to patients with critical metabolic lability resulting from the need for immunosuppression and the shortage of donor organs. To overcome these barriers, we developed a strategy to macroencapsulate islets from different sources that allow their survival and function without immunosuppression. Here we report successful and safe transplantation of porcine islets with a bioartificial pancreas device in diabetic primates without any immune suppression. This strategy should lead to pioneering clinical trials with xenotransplantation for treatment of diabetes and, thereby, represents a previously unidentified approach to efficient cell replacement for a broad spectrum of endocrine disorders and other organ dysfunctions.