Background.: In previous studies, we showed that beta cell-specific overexpression of high-affinity variant of human CTLA-4 (LEA29Y), a high-affinity variant of cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4)-immunoglobulin, prevented porcine islet rejection in humanized mouse models. We here investigate whether long-term xenograft function and survival is maintained after neutralization of LEA29Y-mediated co-stimulation blockade. Methods.: Diabetic humanized NOD-SCID IL2rγ ^–/– mice were transplanted with transgenic neonatal porcine islet-like clusters expressing LEA29Y under control of the porcine insulin promoter. After development of normal glucose tolerance, mice were treated with blocking anti-CTLA-4 antibody (Ab) or isotype control Ab. Reoccurrence of diabetes, plasma cytokines/chemokines and graft histology were analyzed. Results.: Systemic treatment with an inhibitory anti-humanized CTLA-4 Ab led to a significant increase of pro-inflammatory plasma cytokine production (interferon gamma, monokine induced by interferon gamma; P < 0.05) at day 14 and reoccurrence of diabetes in 100% of the animals within 40 d after Ab application ( P = 0.01). Strong infiltration with human CD45 ⁺ cells consisting mainly of CD4 ⁺ and CD8 ⁺ T cells and some B lymphocytes and few destructed remaining beta cells were observed in the treatment group indicating rapid and severe graft rejection. Conclusions.: The present data demonstrate that long-lasting acceptance of LEA29Y transgenic porcine islet grafts is dependent on CTLA-4/LEA29Y signaling even several months after transplantation. This finding has important implications on safety of pig islet xenotransplantation in patients with type 1 diabetes because it provides a potent tool for graft elimination in case of medical indication.

The engraftment of transplanted islets depends on the rapid establishment of a novel vascular network. The present study evaluated the effects of cord blood-derived blood outgrowth endothelial cells (BOECs) on the viability of neonatal porcine islets (NPIs) and the post-transplant outcome of grafted NPIs. Dispersed NPIs and human BOECs were reaggregated on microwell cell culture plates and tested for their anti-apoptotic and pro-angiogenic capacity by qRT-PCR and immunohistochemistry. The in vivo functionality was analyzed after transplantation into diabetic NOD-SCID IL2rγ^−/− (NSG) mice. The spheroids, which contained reaggregated neonatal porcine islet cells (REPIs) and BOECs, exhibited enhanced viability and a significantly elevated gene expression of VEGFA, angiopoetin-1, heme oxygenase-1, and TNFAIP3 (A20) in vitro. The development of normoglycemia was significantly faster in animals transplanted with spheroids in comparison to the only REPI group (median 51.5 days versus 60 days) (p < 0.05). Furthermore, intragraft vascular density was substantially increased (p < 0.01). The co-transplantation of prevascularized REPI-BOEC spheroids resulted in superior angiogenesis and accelerated in vivo function. These findings may provide a novel tool to enhance the efficacy of porcine islet xenotransplantation.