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International Journal of Endocrinology
Volume 2012 (2012), Article ID 396524, 13 pages
Review Article

Tolerance-Inducing Strategies in Islet Transplantation

1Department of Immunology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
2Department of General Surgery, Transplant Center, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, USA

Received 15 December 2011; Accepted 8 March 2012

Academic Editor: A. N. Balamurugan

Copyright © 2012 Sumantha Bhatt et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Allogeneic islet transplantation is a promising approach for restoring normoglycemia in type 1 diabetic patients. Current use of immunosuppressive therapies for management of islet transplant recipients can be counterintuitive to islet function and can lead to complications in the long term. The induction of donor-specific tolerance eliminates the dependency on immunosuppression and allows recipients to retain responses to foreign antigens. The mechanisms by which tolerance is achieved involve the deletion of donor-reactive T cells, induction of T-cell anergy, immune deviation, and generation of regulatory T cells. This review will outline the various methods used for inducing donor-specific tolerance in islet transplantation and will highlight the previously unforeseen potential of tissue stromal cells in promoting islet engraftment.