Transplantation therapy for human diabetes is limited by the toxicity of immunosuppressive drugs.However, even if toxicity can be minimalized, there will still be a shortage of human donor organs. Xenotransplantation of porcine islets may be a strategy to overcome these supply problems. Xenotransplantation in mesentery of pig pancreatic primordia obtained very early during organogenesis [embryonic day 28 (E28)] can obviate the need for immune suppression in rats or rhesus macaques. Here, in rats transplanted previously with E28 pig pancreatic primordia in the mesentery, we show normalization of glucose tolerance in nonimmune-suppressed streptozotocin-diabetic LEW rats and insulin and porcine proinsulin mRNA-expressing cell engraftment in the kidney following implantation of porcine islets beneath the renal capsule. Donor cell engraftment was confirmed using fluorescent in situ hybridization for the porcine X chromosome and electron microscopy. In contrast, cells from islets did not engraft in the kidney without prior transplantation of E28 pig pancreatic primordia in the mesentery. This is the first report of prolonged engraftment and sustained normalization of glucose tolerance following transplantation of porcine islets in nonimmune-suppressed, immunecompetent rodents. The data are consistent with tolerance induction to a cell component of porcine islets induced by previous transplantation of E28 pig pancreatic primordia. In that pigs are plentiful and because porcine insulin works well in humans, the pig has been suggested to be a pancreas organ donor for humans with diabetes. The severity of humoral rejection due to pre-existing natural antibodies effectively precludes their use as whole pancreas donors in nonhuman primates or humans.1-4 However, isolated islets of Langerhans (islets) can be transplanted into nonhuman primates 2,3 or humans with diabetes 1 without initiating humoral rejection. Unfortunately, recent experience with pig to primate islet 2 or neonatal islet 3 transplantation shows that sustained insulin independence can be achieved, but only through the use of immune suppressive agents that are not approved for human use or would result in an unacceptable level of morbidity in humans.
2,3We have shown that glucose tolerance can be normalized in streptozotocin (STZ)-diabetic (type 1) LEW rats or ZDF (type 2) diabetic rats within 4 weeks following transplantation in mesentery of pig pancreatic primordia obtained very early during embryogenesis [on embryonic day 28 (E28)-just after the organ differentiates and before the time dorsal and ventral anlagen fuse] without host immune suppression. [5][6][7][8] No rat insulin can be detected in STZ-treated rats. Porcine insulin circulates posttransplantation of E28 pig pancreatic primordia (embryonic pancreas) and levels increase after a glucose load.6,7 Cells expressing insulin and porcine proinsulin mRNA with  cell morphology engraft in host mesentery, mesenteric lymph nodes, liver, and pancreas posttransplantation.5-8 Cells originating from E28 pig pa...