Moving Islet Cell Xenotransplantation to the Clinic

The ultimate goal to provide a cure for all patients suffering from type-1-diabetes has remained out of the patients reach despite major advances in technologies. There has however, for a number of decades been a concerted effort to use various forms of porcine β-cells as a replacement transplant alternative to cadaveric human donors. This has seen major advances in the last decade with significant development of multi-transgenic donor pigs that now can potentially be used for xenotransplantation. This has been achieved with cellular transplants leading the way using porcine islet cell transplants as a form of β cell replacement in pre-clinical studies to treat diabetic non-human primates in various guises. These uniquely modified islet cells have the potential to offer an unlimited source of insulin-producing cells once we have solved all of the issues required to prevent loss of the xenotransplant. This chapter provides an in depth overview as to how the most recent advances have been achieved in regards to the genetic modification of donor pigs to provide protection from hyperacute rejection, instant blood mediated inflammatory reaction, xenoantibody and cellular responses to provide long-term functional islet cell xenotransplants to be able to move islet cell xenotransplantation to the clinic