When, in 1869, Paul Langerhans detected the “islands of tissue” in the pancreas, he took the first step on a journey towards islet transplantation as a treatment for type 1 diabetes. The route has embraced developments across biosciences, surgery, gene therapy and clinical research. This review highlights major milestones along that journey involving whole pancreas transplantation, islet transplantation, the creation of surrogate insulin-secreting cells and novel islet-like structures using genetic and bio-engineering technologies. To obviate the paucity of human tissue, pluripotent stem cells and non-β-cells within the pancreas have been modified to create physiologically responsive insulin-secreting cells. Before implantation, these can be co-cultured with endothelial cells to promote vascularisation and with immune defence cells such as placental amnion cells to reduce immune rejection. Scaffolds to contain grafts and facilitate surgical placement provide further opportunities to achieve physiological insulin delivery. Alternatively, xenotransplants such as porcine islets might be reconsidered as opportunities exist to circumvent safety concerns and immune rejection. Thus, despite a long and arduous journey, the prospects for increased use of tissue transplantation to provide physiological insulin replacement are drawing ever closer.

中文翻译：

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从胰岛素注射到胰岛移植：旅程概述

1869 年，当 Paul Langerhans 在胰腺中检测到“组织岛”时，他迈出了将胰岛移植作为 1 型糖尿病治疗的第一步。该路线涵盖了生物科学、外科、基因治疗和临床研究的发展。这篇综述重点介绍了整个胰腺移植、胰岛移植、使用基因和生物工程技术创建替代胰岛素分泌细胞和新型胰岛样结构的过程中的主要里程碑。为了避免人体组织的缺乏，胰腺内的多能干细胞和非β细胞已被修饰，以产生生理反应性的胰岛素分泌细胞。植入前，这些可以与内皮细胞共培养以促进血管形成，并与免疫防御细胞如胎盘羊膜细胞共培养以减少免疫排斥。包含移植物和便于手术放置的支架为实现生理胰岛素输送提供了进一步的机会。或者，可能会重新考虑猪胰岛等异种移植物，因为存在规避安全问题和免疫排斥的机会。因此，尽管经历了漫长而艰巨的旅程，但更多地使用组织移植来提供生理胰岛素替代的前景越来越近。猪胰岛等异种移植物可能会被重新考虑，因为存在规避安全问题和免疫排斥的机会。因此，尽管经历了漫长而艰巨的旅程，但更多地使用组织移植来提供生理胰岛素替代的前景越来越近。猪胰岛等异种移植物可能会被重新考虑，因为存在规避安全问题和免疫排斥的机会。因此，尽管经历了漫长而艰巨的旅程，但更多地使用组织移植来提供生理胰岛素替代的前景越来越近。