PROBLEM: Islet or whole-pancreas transplantation is limited by the shortage of donors and need for chronic immune suppression. Novel strategies are needed to prevent β-cell loss and to rescue production of endogenous insulin
NOVEL APPROACH: This review covers the latest advances in cell-based therapies for the treatment and prevention of T1D. Topics include adoptive transfer of cells with increased immunoregulatory potential for β-cell protection, and β-cell replacement strategies such as generation of insulin-producing β-like cells from unlimited sources
FINDINGS: Cell therapy provides an opportunity to prevent or reverse T1D. Adoptive transfer of autologous cells having enhanced immunomodulatory properties can suppress autoimmunity and preserve β-cells. Such therapies have been made possible by a combination of genome-editing techniques and transplantation of tolerogenic cells. In-vitro modified autologous hematopoietic stem cells and tolerogenic dendritic cells may protect endogenous and newly generated β-cells from a patient’s autoimmune response without hampering immune surveillance for infectious agents and malignant cellular transformations. However, methods to generate cells that meet quality and safety standards for clinical applications require further refinement
Dr. Fiorina is interested in three major areas: (1) the treatment of autoimmune diabetes; (2) the replacement of beta cells through islet transplantation; (3) the treatment of diabetic nephropathy. Dr. Fiorina has made significant and innovative contributions in understanding the mechanism underlying the beneficial effects of life expectancy obtained after islet transplantation, even when patients only have partial islet function.