Strategies for durable β cell replacement in type 1 diabetes

Science. 2021 Jul 30;373(6554):516-522. doi: 10.1126/science.abh1657.


Technological advancements in blood glucose monitoring and therapeutic insulin administration have improved the quality of life for people with type 1 diabetes. However, these efforts fall short of replicating the exquisite metabolic control provided by native islets. We examine the integrated advancements in islet cell replacement and immunomodulatory therapies that are coalescing to enable the restoration of endogenous glucose regulation. We highlight advances in stem cell biology and graft site design, which offer innovative sources of cellular material and improved engraftment. We also cover cutting-edge approaches for preventing allograft rejection and recurrent autoimmunity. These insights reflect a growing understanding of type 1 diabetes etiology, β cell biology, and biomaterial design, together highlighting therapeutic opportunities to durably replace the β cells destroyed in type 1 diabetes.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Autoimmunity
  • Blood Glucose / metabolism
  • Cell Differentiation
  • Cell Engineering
  • Cellular Microenvironment
  • Diabetes Mellitus, Type 1 / metabolism
  • Diabetes Mellitus, Type 1 / therapy*
  • Graft Rejection / prevention & control
  • Graft Survival
  • Humans
  • Immune Tolerance
  • Immunomodulation*
  • Insulin-Secreting Cells / cytology
  • Insulin-Secreting Cells / physiology
  • Insulin-Secreting Cells / transplantation*
  • Islets of Langerhans / physiology
  • Islets of Langerhans Transplantation*
  • Pluripotent Stem Cells / transplantation
  • Stem Cell Transplantation


  • Blood Glucose