OBJECTIVE-Expansion of insulin-producing -cells from adult human islets could alleviate donor shortage for cellreplacement therapy of diabetes. A major obstacle to development of effective expansion protocols is the rapid loss of -cell markers in the cultured cells. Here, we report a genetic celllineage tracing approach for following the fate of cultured -cells.RESEARCH DESIGN AND METHODS-Cells dissociated from isolated human islets were infected with two lentiviruses, one expressing Cre recombinase under control of the insulin promoter and the other, a reporter cassette with the structure cytomegalovirus promoter-loxP-DsRed2-loxP-eGFP.RESULTS--Cells were efficiently and specifically labeled by the dual virus system. Label ϩ , insulin Ϫ cells derived from -cells were shown to proliferate for a maximum of 16 population doublings, with an approximate doubling time of 7 days. Isolated labeled cells could be expanded in the absence of other pancreas cell types if provided with medium conditioned by pancreatic non--cells. Analysis of mouse islet cells by the same method revealed a much lower proliferation of labeled cells under similar culture conditions. CONCLUSIONS-Our findings provide direct evidence for survival and dedifferentiation of cultured adult human -cells and demonstrate that the dedifferentiated cells significantly proliferate in vitro. The findings confirm the difference between mouse and human -cell proliferation under our culture conditions. These findings demonstrate the feasibility of cell-specific labeling of cultured primary human cells using a genetic recombination approach that was previously restricted to transgenic animals. Diabetes 57:1575-1583, 2008 R estoration of an adequate -cell mass is the central therapeutic goal in patients with type 1 diabetes. However, pancreatic islet transplantation is severely limited by the number of organ donors. Studies of adult islet renewal in vivo suggest that differentiated -cells maintain a replication capacity (1). However, success in expansion of functional insulinproducing -cells in vitro has been limited. Culture of adult human islets resulted in a small number of cell population doublings and loss of insulin expression (2-5). Insulin Ϫ cells derived from such cultures could be induced to re-express insulin; however, insulin levels were low and varied considerably among cells from different donors (6 -8). In the absence of stable markers for cultured -cells, it was not possible to determine whether the loss of -cell phenotype in the expanded cells reflected -cell dedifferentiation or -cell death accompanied by expansion of islet cells from a non--cell origin. Efficient expansion of dedifferentiated human -cells in vitro could be of therapeutic significance because these cells may retain enough of their specific open chromatin structure to facilitate their redifferentiation. Genetic cell-lineage tracing provided evidence for dedifferentiation of cultured mouse -cells (9); however, it could not detect a significant proliferation of th...