A UK key opinion leader perspective: Navigating the immunological and logistical transformation brought by stem cell-derived islets for the treatment of type 1 diabetes.

AIMS: To explore UK key-opinion leader perspectives on the future role of stem cell-derived islets (sc-islets) in islet transplantation for people with type 1 diabetes (T1D).

METHODS

Four UK-based key-opinion leaders evaluated current limitations of donor islet transplantation and reviewed emerging evidence, clinical pathways and logistical considerations for sc-islet transplantation, including alternative delivery sites and implications for kidney transplantation strategies.

RESULTS

Conventional islet transplantation is constrained by donor scarcity, variable graft quality and lifelong immunosuppression, with associated risks of infection, malignancy and calcineurin inhibitor (CNI) nephrotoxicity. Stem cell-derived islets, generated from human embryonic and induced pluripotent stem cells, provide a scalable and standardised alternative. Early investigational products, including Zimislecel (VX-880), demonstrate potential for insulin independence and may offer an alternative to simultaneous pancreas-kidney (SPK) transplantation. Strategies to reduce or eliminate systemic immunosuppression particularly CNI immunosuppression through local immunomodulation, gene editing and encapsulation technologies may further broaden access. Ethics, infrastructural and economic considerations remain central to equitable implementation.

CONCLUSION

Stem cell-derived islets may redefine islet transplantation for T1D by enabling more scalable, less invasive and sustainable therapeutic pathways while maintaining access to technological diabetes management options.