Here’s a wild idea: what if, someday, people diagnosed with type 1 diabetes were given a menu of treatment options aimed at eliminating insulin dependence? Not one therapy. Not one shot at a cure. A menu based on the time since your diagnosis, your genetics, and much more.

It sounds outrageous — especially for those of us who’ve lived with this condition for decades. But if you zoom out and look at what’s happening in biotech right now, it’s hard not to feel a flicker of something we haven’t felt in a long time: hope and possibility.

Now, let’s be clear. Many of these therapies are early-stage. Some are proof-of-concept. Some may never make it to market in their current form. But they represent real progress — and real people in clinical trials are experiencing real results.

Here’s a snapshot of who’s building what.

---

JOIN THE DIABETES NERD NETWORK —> RIGHT HERE

---

Eledon Pharmaceuticals

Eledon is pairing donor (cadaver) islet cells with its targeted immune-modulating therapy, tegoprubart.

Instead of broadly suppressing the immune system, tegoprubart aims to more precisely block the immune attack that destroys insulin-producing cells. And so far? Several participants in their trial are reportedly nearly insulin independent — while receiving monthly infusions and living full, active lives.

That’s not nothing.

It’s important to remember: this approach still uses donor cells, which limits scalability. But it’s proving something incredibly important — that targeted immune modulation can protect transplanted insulin-producing cells effectively.

Watch my interview with trial participant Katie Beth Hand.

Otsuka Pharmaceutical

Yes. Pig islet cells. Otsuka is transplanting islet cells from pigs into humans — without any immunosuppression.

Let that sink in.

No anti-rejection drugs. No chronic immune suppression. And early data suggests it’s working. Now, it’s not instant insulin independence. This therapy appears to work more gradually than some lab-manufactured cell therapies. But the concept is extraordinary: pig neonatal islet cells seem capable of evading the immune system in ways we didn’t fully appreciate before.

If scalable, this could solve one of the biggest bottlenecks in cell therapy — cell supply. Watch my interview with Michael Revland to understand how this is even possible.

Sana Biotechnology

Sana is working toward what many consider the “holy grail” approach.

They’re developing hypo-immune, lab-made insulin-producing cells. “Hypo-immune” means the cells are engineered to hide from the immune system — both the autoimmune attack that causes type 1 diabetes and the broader rejection response.

The goal? Transplant manufactured insulin-producing cells without immunosuppression. No donor shortages. No lifelong anti-rejection drugs. They’re not there yet. But the science is bold — and if it works at scale, it could change everything. Learn more here.

SAB Biotherapeutics

SAB Bio is taking a different angle: protect the insulin-producing cells — whether they’re your own or transplanted — with a highly targeted immune therapy.

There is an older version of this concept. Historically, anti-thymocyte globulin (ATG) was derived from rabbits, and while it could suppress immune activity, it came with significant toxicity and safety limitations.

SAB’s approach uses a fully human-derived therapy designed to be more targeted and potentially safer — allowing it to be administered as needed without the severe risks of older formulations.

Instead of replacing cells, this strategy focuses on protecting them. And that matters, especially for people newly diagnosed who still have functioning beta cells. Learn more in my videos #1 and #2.

Sernova Corp.

Sernova is combining multiple innovations. They’re using donor islet cells housed inside their proprietary Cell Pouch — a device implanted under the skin that creates a vascularized, protected environment for transplanted cells. And they’re pairing it with Eledon’s immune-modulator, tegoprubart.

It’s a layered approach:

• Protective device

• Donor cells

• Targeted immune modulation

Each piece solves a different problem in the transplant equation. Combination strategies like this may ultimately prove essential. Learn more in my video about Sernova.

Vertex Pharmaceuticals

Vertex made massive waves with its VX-880 trial.

Last publicly shared data showed 11 out of 12 participants labeled “insulin independent” using their lab-manufactured islet cell therapy (zimislecel) alongside targeted immunosuppression.

That’s remarkable.

However, immunosuppression is still required — and their encapsulated version (VX-264), designed to eliminate that need, was discontinued last year. Vertex has been quiet recently, but its data helped legitimize the entire field of stem-cell–derived islet replacement therapy.

And that changed the tone of the conversation globally. Learn more from past updates here.

Yup. We’re Still Waiting.

Here’s the hard truth: It’s one thing to functionally cure a handful of people in a clinical trial. It’s another thing entirely to:

• Manufacture cells at scale

• Ensure long-term safety

• Eliminate immunosuppression drugs

• Make it accessible and affordable

• Offer it to millions of people

That’s the mountain. And yes, it means more waiting. But here’s what feels different from 20 years ago: We’re not waiting on a single idea anymore. And the therapies are working in humans, not just mice. We’re watching multiple parallel strategies evolve:

• Replace the lost cells in people with longstanding T1D

• Protect the remaining cells in people newly diagnosed with T1D

• Disguise or hide the cells from the immune system

• Retrain the immune system to behave differently with target therapies

• Use islet cells from pigs without any immune suppression

• Use lab-made cells that can be produced in unlimited quantities

• Use devices to protect and nurture transplanted cells

That’s not hype. That’s a diversified pipeline.

And for the first time in my life with type 1 diabetes, I can genuinely imagine a future where managing this disease looks wildly different from what it did when I was diagnosed — and wildly different from what it looks like today.

We’re not there yet. But we’re not where we used to be either.