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CHAPTER 13. Engineering an Endocrine Neo-Pancreas

The severe short- and long-term unwanted effects and the huge economic burden of diabetes mellitus have led to immense research efforts regarding possible therapeutic modalities. Subcutaneous insulin injection and external insulin pumps, the so-called open-loop methods, albeit already established in clinical practice, are unable to maintain long-term normoglycemia. The most novel therapeutic options, summarized under the term closed-loop models, comprise pancreas transplantation, islet cell transplantation and artificial endocrine pancreas devices. Even though very promising, various obstacles hinder the translation of these concepts to the bedside. The fact that the disease only affects the endocrine pancreas and the already assembled insights into extracellular matrix and the effects its components exert on cell growth, proliferation and functionality encouraged abundant research on bioengineering an endocrine extracellular matrix-based implantable organ. Indeed, whole-organ decellularization and the subsequent perfusion recellularization of the scaffold with endothelial and islet cells has generated a new treatment alternative capable of eliminating many downsides of the exiting options. Nevertheless, further research is needed to widen our understanding of the extracellular matrix, its immunogenicity and the fundamental components on which cellular livelihood and proliferation depends, in order to achieve long-term in vitro and in vivo results.