Immunosuppression in islet transplantation

J Clin Invest. 2008 May;118(5):1625-8. doi: 10.1172/JCI35639.

Abstract

Islet transplantation can temporarily cure type 1 diabetes mellitus (T1DM) but requires simultaneous immunosuppression to avoid allograft rejection. In this issue of the JCI, Monti et al. report that immune conditioning via use of the Edmonton protocol - a treatment approach in which T1DM patients infused with pancreatic islets from multiple cadaveric donors simultaneously receive immunosuppressive drugs - results in lymphopenia that is associated with elevated serum levels of the homeostatic cytokines IL-7 and IL-15, which causes in vivo expansion of the autoreactive CD8(+) T cell population (see the related article beginning on page 1806). Reemergence of autoreactivity is likely the main culprit underlying long-term islet graft failure, and new strategies will need to be tested to circumvent this homeostatic expansion and recurrent autoreactivity.

Publication types

  • Comment
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Autoimmunity / physiology
  • Diabetes Mellitus, Type 1 / therapy
  • Graft Rejection / prevention & control
  • Homeostasis
  • Humans
  • Immunosuppression / methods*
  • Immunosuppressive Agents / adverse effects
  • Immunosuppressive Agents / therapeutic use
  • Islets of Langerhans Transplantation / immunology*
  • Mice
  • T-Lymphocytes, Regulatory / immunology

Substances

  • Immunosuppressive Agents