Islet Identity in Transplantation Procedures: The Intersection of Cellular Maturity and Function

Pancreatic islet transplantation holds promise for patients with insulin-dependent diabetes, but is severely limited by a shortage of cadaveric donor islets, and more so because of stringent inclusion criteria for organ donation including donor metabolic function, age, and comorbidities. The impact of these diverse factors on islet health has led to a broad investigation of global influences on islet biology, not least of all, characterization of mature, functional cellular identity and maintenance of appropriate endocrine lineage. This review will present the current knowledge on β-cell heterogeneity and inherent plasticity, and the role of cellular dedifferentiation of islets and β-cells in the normal and pathophysiological states, including aging, diabetes subtypes, and islet transplantation. Examination of potential strategies for reduction of metabolic stress by endogenous and exogenous modes is further discussed.