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Islet transplantation: a brave new world.

It has indeed been a distinct honor to be the recipient of the 2002 Outstanding Scientific Achievement Award, and I was happy to accept it, on behalf of the entire islet transplant field, as there have been many surgeons, physicians, and scientists who have worked as a team, moving this field forward. I was born the year the Lilly Lecture was established, 1957, and since then, this is the first time that the award goes to islet transplantation, representing indeed a very important recognition to all of us in the field. Therefore, I’d like to outline the major steps in the development of islet transplantation, from a hypothesis, to its clinical application, through what we call translational research, bench to bedside. At the end, some of the challenges ahead, including novel immunomodulatory strategies, tolerance induction, and the development of alternative sources of insulin-producing tissue, are discussed.

The challenge, as you may predict, is diabetes. A syndrome well known since over 3,500 years ago, even if the term “diabetes” was coined in the first century by Arataeus from the Greek “siphon” or “pipe-like.” Arataeus described diabetes as “a melting down of flesh and limbs into urine.” It took over 3,500 years to link diabetes to the pancreas, and until insulin was discovered, diabetes remained a devastating, deadly disease, often treated by starvation. The discovery of insulin, by Banting and Best in 1922, changed the course of history in the treatment of the disease, and suddenly children with diabetes could be offered a new chance at life. While definitely a life-saving breakthrough, insulin treatment still cannot fully prevent chronic complications, and intensive insulin treatment to improve metabolic control has paralleled an increased risk of severe hypoglycemia (1). The hypothesis that replacement of the endocrine pancreas by transplantation of insulin-producing tissue could represent …