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Comment by Trasmatta | Hacker News Reader

> To prevent islet rejection, immune-suppressing drugs are given over the long term.

This makes it a non starter. Immunosuppressants are generally considered a worse quality of life than insulin treatment. That's why pancreas transplants are generally only done for type 1 diabetics if they are already on immunosuppressants.

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Lots of biotech companies are working on immunosuppressant-free islet-equivalent transplantation.

Two examples off the top of my head: Sana recently announced islet cell transplantation without immunosuppression (press release: https://ir.sana.com/news-releases/news-release-details/sana-... ) and Vertex (ongoing trial: https://www.breakthrought1d.org/news-and-updates/vertex-laun... ).

I'm hopeful that someday we'll have a good system for "caging" cells to prevent an immune response (in either direction) while also permitting the visitors to sustain themselves with blood nutrients and regulate hormones or clean waste.

Sort of like the role of the blood-brain barrier, or maybe a placenta.

What'd be interesting would being able to shut down specific auto-immune responses. Currently most of what we have are hammers of one sort or another.

I am of the glum opinion that the hideously interwoven nature of our immune system is at least partly a security feature rather than an engineering flaw.

That said, we might still learn from the success of its contemporary attackers, who haven't been slacking over the past millions of years either.

Yes! I think there was some work being done with a islet transplant like that. I'm not sure of the details though - it's probably a long way off, if it works.

As a T1D: can confirm. Taking insulin is a hassle, but definitely not "I'd rather take immunosuppressants". I'm having a hard time even contextualizing how much worse that is.

Yep. The hard, if not kear impossible part will be just resetting the one part of the immune system attacking the islets without turning off or resetting the immune system.

The promising part here is that someday it will be possible to take stem cells from a patient and specialize them to islet cells. Similar to what they’re doing here with vascular cells. It’s far too expensive at the moment, but ultimately the process will be improved and refined, and the costs will come down. At least that’s my hope for a cure.

Easiest method may be to nuke the immune system and put a new one in place. As the immune system consists of several parts it may be sufficient to just replace one of them.

Sounds like 22nd century tech at least. Good to dream of, not practical even for very young here to think it would help them

not really? this is basically already deployed as a cure for AIDS (with an N in the single digits iirc). the issue is not technical, it's that it's such an extreme solution that without more safety data it's ethically a hard sell for a condition like diabetes.

Note this is for the current common approach, not the new approach.

This makes the vascular implants produced by Humacyte more interesting. They’re made of cells which aren’t recognized by the immune system. Humacyte is in the beginning stages of seeing if they can fit beta cells into the produced vascular implants, while remaining undetected by the immune system.

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