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World J Transplant. Jun 18, 2023; 13(4): 107-121
Published online Jun 18, 2023. doi: 10.5500/wjt.v13.i4.107
Islet transplantation-immunological challenges and current perspectives
Plamena Kabakchieva, Yavor Assyov, Stavros Gerasoudis, Georgi Vasilev, Monika Peshevska-Sekulovska, Metodija Sekulovski, Snezhina Lazova, Dimitrina Georgieva Miteva, Milena Gulinac, Latchezar Tomov, Tsvetelina Velikova
Plamena Kabakchieva, Clinic of Internal Diseases, Naval Hospital-Varna, Military Medical Academy, Varna 9010, Bulgaria
Yavor Assyov, Clinic of Endocrinology, Department of Internal Diseases, University Hospital "Alexandrovska", Medical University-Sofia, Sofia 1434, Bulgaria
Stavros Gerasoudis, Faculty of Medicine, Trakia University, Stara Zagora 6000, Bulgaria
Georgi Vasilev, Department of Neurology, Faculty of Medicine, Medical University of Plovdiv, Plovdiv 4000, Bulgaria
Monika Peshevska-Sekulovska, Department of Gastroenterology, University Hospital Lozenetz, Sofia 1407, Bulgaria
Monika Peshevska-Sekulovska, Metodija Sekulovski, Tsvetelina Velikova, Medical Faculty, Sofia University St. Kliment Ohridski, Sofia 1407, Bulgaria
Metodija Sekulovski, Department of Anesthesiology and Intensive Care, University hospital Lozenetz, Sofia 1407, Bulgaria
Snezhina Lazova, Department of Pediatric, University Hospital "N. I. Pirogov", Sofia 1606, Bulgaria
Snezhina Lazova, Department of Healthcare, Faculty of Public Health "Prof. Tsekomir Vodenicharov, MD, DSc", Medical University of Sofia, Sofia 1527, Bulgaria
Dimitrina Georgieva Miteva, Department of Genetics, Sofia University "St. Kliment Ohridski", Sofia 1164, Bulgaria
Milena Gulinac, Department of General and Clinical Pathology, Medical University of Plovdiv, Plovdiv 4000, Bulgaria
Latchezar Tomov, Department of Informatics, New Bulgarian University, Sofia 1618, Bulgaria
Author contributions: Kabakchieva P and Velikova T performed the conceptualization; Kabakchieva P, Gerasoudis S, Assyov Y, Vasilev G, Peshevska-Sekulovska M, Sekulovski M and Velikova T contributed to the resources; Lazova S, Miteva D, Gulinac M, Tomov L, Visualization, Peshevska-Sekulovska M, Sekulovski M and Velikova T contributed to the data curation; Kabakchieva P, Gerasoudis S, Assyov Y, Vasilev G, Peshevska-Sekulovska M, Sekulovski M and Velikova T wrote the original draft; Kabakchieva P, and Velikova T wrote the review and edited; Velikova T performed the supervision; All authors revised and approved the final version of the manuscript, they were approved the final version of the paper prior to submission.
Supported by European Union-NextGenerationEU, through The National Recovery and Resilience Plan of the Republic of Bulgaria, No. BG-RRP-2.004-0008-C01.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Plamena Kabakchieva, MD, PhD, Academic Research, Assistant Professor, Clinic of Internal Diseases, Naval Hospital-Varna, Military Medical Academy, No. 3 Hristo Smirnenski Blvd, Varna 9010, Bulgaria. plamenakabakchieva@yahoo.com
Received: March 22, 2023
Peer-review started: March 22, 2023
First decision: April 11, 2023
Revised: May 16, 2023
Accepted: June 6, 2023
Article in press: June 6, 2023
Published online: June 18, 2023
Processing time: 86 Days and 0.6 Hours
Core Tip

Core Tip: Type 1 diabetes (T1D) is associated with loss of beta-cell mass and insulin secretion. Regardless of its nature, autoimmune or idiopathic, the loss of own insulin secretion is a hallmark dysfunction in T1D mellitus; thus, therapeutic options are aimed at either replacing the missing insulin or restoring physiological insulin secretion to achieve normoglycemia and postponing micro- and macrovascular complications. Nevertheless, the need to completely replace the depleted pancreatic secretion also leads to the emergence of new therapeutic horizons, including pancreas and islet cell transplantation. However, this approach also meets several immunological challenges-cellular and antibody-mediated rejection and loss of function. To improve the outcomes, several approaches are performed: Immunosuppression, apoptotic donor lymphocytes, anti-TIM-1 antibodies, mixed chimerism-based tolerance induction, induction of antigen-specific tolerance utilizing ethylene carbodiimide-fixed splenocytes, infusion of donor apoptotic cells before transplantation, combined with anti-CD40L antibodies and rapamycin, preconditioning of isolated islets, inducing local immunotolerance, cell encapsulation and immunoisolation, using of biomaterials, immunomodulatory cells, etc. mesenchymal stem cells, as an adjunct therapy to islet transplantation, can promote long-term graft survival, possibly by reducing inflammation and enhancing immune tolerance.