Abstract
Autoimmune destruction of insulin producing pancreatic cells results in type 1 diabetes, a condition for which there is presently no cure. Clinical trials indicate that, in some instances, control of blood glucose can be restored by transplantation of cadaveric derived islets 1, raising hopes that such cell-based therapies may eventually form part of a curative treatment. However, even if the outcome of islet transplantation can be significantly improved, the availability of this treatment option will always be limited by the dearth of cadaveric islet donors. It is in this context that the derivation of cells from human embryonic stem cells (hESCs) represents an important step toward the creation of an inexhaustible source of therapeutic replacement cells for the treatment of type 1 diabetes. Notwithstanding this promise, before in vitro derived cells can be used clinically, a number of conceptual and actual impediments will need to be surmounted. These relate to the cost and efficiency of cell generation from hESC differentiation cultures and the perennial hoary chestnut of immunity, tolerance and graft rejection.
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