# 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

## TL;DR

Experts in the UK discuss how stem cell-derived islets could transform diabetes treatment by overcoming donor shortages and reducing risks.

## Contribution

The paper presents UK key opinion leaders' views on the potential of stem cell-derived islets to revolutionize type 1 diabetes treatment.

## Key findings

- Stem cell-derived islets offer a scalable alternative to donor islets, addressing scarcity and quality issues.
- Early investigational products like Zimislecel show potential for insulin independence in type 1 diabetes.
- Technologies like encapsulation and gene editing may reduce the need for harmful immunosuppression.

## Abstract

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).

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.

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.

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.