This manuscript was supported by a clinical innovation grant from the Mid-America Transplant Foundation.

All procedures involving animals are approved by the Institutional Animal Care and Use Committee (IACUC) at the Washington University School of Medicine Division of Comparative Medicine. Adult Yorkshire pigs ranging from 35 to 35 kg are ideal for this procedure; however, the protocol can be adapted for pigs of different sizes depending on the experimental context. The entire procedure should be performed in a sterile fashion in an operating room setup.
1. Preoperative preparation and ane...

Purification of Porcine Islets by Surgical Perfusion of Pig Pancreas

<ol>
	<li>Gillespie, K. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Type+1+diabetes:+pathogenesis+and+prevention.">Type 1 diabetes: pathogenesis and prevention.</a> CMAJ. 175 (2), 165-170 (2006).</li><li>Shapiro, A. M., Pokrywczynska, M., Ricordi, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+pancreatic+islet+transplantation.">Clinical pancreatic islet transplantation.</a> Nat Rev Endocrinol. 13 (5), 268-277 (2017).</li><li>Shapiro, A. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Islet+transplantation+in+seven+patients+with+type+1+diabetes+mellitus+using+a+glucocorticoid-free+immunosuppressive+regimen.">Islet transplantation in seven patients with type 1 diabetes mellitus using a glucocorticoid-free immunosuppressive regimen.</a> N Engl J Med. 343 (4), 230-238 (2000).</li><li>Anazawa, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Improved+method+of+porcine+pancreas+procurement+with+arterial+flush+and+ductal+injection+enhances+islet+isolation+outcome.">Improved method of porcine pancreas procurement with arterial flush and ductal injection enhances islet isolation outcome.</a> Transplant Proc. 42 (6), 2032-2035 (2010).</li><li>Dufrane, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Parameters+favouring+successful+adult+pig+islet+isolations+for+xenotransplantation+in+pig-to-primate+models.">Parameters favouring successful adult pig islet isolations for xenotransplantation in pig-to-primate models.</a> Xenotransplantation. 13 (3), 204-214 (2006).</li><li>Hilling, D. E., Rijkelijkhuizen, J. K., Tons, H. A., Terpstra, O. T., Bouwman, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Porcine+islet+isolation+outcome+is+not+affected+by+the+amount+and+distribution+of+collagen+in+the+pancreas.">Porcine islet isolation outcome is not affected by the amount and distribution of collagen in the pancreas.</a> Xenotransplantation. 17 (3), 250-255 (2010).</li><li>Lamb, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=In+vitro+maturation+of+viable+islets+from+partially+digested+young+pig+pancreas.">In vitro maturation of viable islets from partially digested young pig pancreas.</a> Cell Transplant. 23 (3), 263-272 (2014).</li><li>Otsuka, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pancreas+preservation+with+a+neutrophil+elastase+inhibitor,+alvelestat,+contributes+to+improvement+of+porcine+islet+isolation+and+transplantation.">Pancreas preservation with a neutrophil elastase inhibitor, alvelestat, contributes to improvement of porcine islet isolation and transplantation.</a> J Clin Med. 11 (15), 4290 (2022).</li><li>Vanderschelden, R., Sathialingam, M., Alexander, M., Lakey, J. R. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cost+and+scalability+analysis+of+porcine+islet+isolation+for+islet+transplantation:+comparison+of+juvenile,+neonatal+and+adult+pigs.">Cost and scalability analysis of porcine islet isolation for islet transplantation: comparison of juvenile, neonatal and adult pigs.</a> Cell Transplant. 28 (7), 967-972 (2019).</li><li>Weegman, B. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Temperature+profiles+of+different+cooling+methods+in+porcine+pancreas+procurement.">Temperature profiles of different cooling methods in porcine pancreas procurement.</a> Xenotransplantation. 21 (6), 574-581 (2014).</li><li>Hart, N. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Determination+of+an+adequate+perfusion+pressure+for+continuous+dual+vessel+hypothermic+machine+perfusion+of+the+rat+liver.">Determination of an adequate perfusion pressure for continuous dual vessel hypothermic machine perfusion of the rat liver.</a> Transpl Int. 20 (4), 343-352 (2007).</li><li>Tullius, S. G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Accumulation+of+crystal+deposits+in+abdominal+organs+following+perfusion+with+defrosted+University+of+Wisconsin+solutions.">Accumulation of crystal deposits in abdominal organs following perfusion with defrosted University of Wisconsin solutions.</a> Am J Transplant. 2 (7), 627-630 (2002).</li><li>Ching, C. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+reliable+method+for+isolation+of+viable+porcine+islet+cells.">A reliable method for isolation of viable porcine islet cells.</a> Arch Surg. 136 (3), 276-279 (2001).</li><li>Lu, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Adult+pig+islet+isolation.">Adult pig islet isolation.</a> J Vis Exp. (176), (2021).</li><li>Taylor, M. J., Baicu, S., Greene, E., Vazquez, A., Brassil, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Islet+isolation+from+juvenile+porcine+pancreas+after+24-h+hypothermic+machine+perfusion+preservation.">Islet isolation from juvenile porcine pancreas after 24-h hypothermic machine perfusion preservation.</a> Cell Transplant. 19 (5), 613-628 (2010).</li><li>Iwanaga, Y., Sutherland, D. E., Harmon, J. V., Papas, K. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pancreas+preservation+for+pancreas+and+islet+transplantation.">Pancreas preservation for pancreas and islet transplantation.</a> Curr Opin Organ Transplant. 13 (4), 445-451 (2008).</li><li>Pratschke, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Brain+death+and+its+influence+on+donor+organ+quality+and+outcome+after+transplantation.">Brain death and its influence on donor organ quality and outcome after transplantation.</a> Transplantation. 67 (3), 343-348 (1999).</li><li>vander Windt, D. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Early+islet+damage+after+direct+exposure+of+pig+islets+to+blood:+has+humoral+immunity+been+underestimated.">Early islet damage after direct exposure of pig islets to blood: has humoral immunity been underestimated.</a> Cell Transplant. 21 (8), 1791-1802 (2012).</li><li>Wright, M. J., Cavanagh, T. J., Fetterhoff, T. J., Wile, K. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+blood+content+on+porcine+pancreatic+dissociation+and+islet+yield.">Effect of blood content on porcine pancreatic dissociation and islet yield.</a> Transplant Proc. 26 (6), 3442 (1994).</li><li>Toso, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Isolation+of+adult+porcine+islets+of+Langerhans.">Isolation of adult porcine islets of Langerhans.</a> Cell Transplant. 9 (3), 297-305 (2000).</li></ol>

Pancreatic islet xenotransplantation using porcine donors is a promising strategy for the treatment of Type I diabetes. Islet isolation is challenging, and final islet viability and yield are highly susceptible to hypotension and tissue ischemia encountered during organ procurement16,17. To optimize pancreas procurement and preservation, this protocol presents a new method for aortic cannulation, visceral isolation, and perfusion during the procurement of the por...

Type 1 diabetes is caused by the autoimmune destruction of pancreatic beta cells1.&#160;Consequently, patients are dependent on exogenous insulin, placing them at high-risk glycemic fluctuations with episodes of hyper- and hypoglycemia2. Islet allotransplantation is a potential cure for type I diabetes; however, the limited availability of pancreatic organ donors remains a major barrier to widespread adoption of the procedure2,3. Islet xenotransplantation from porcine donors is a promising alternative as these animals are readily available. Optimization and scaling of porcine pancreatic islet isolation will be critical for progressing islet xenotransplantation.
Although several porcine pancreas procurement techniques have been previously published, many of these procedures describe pancreatectomy after induction of cardiac death or exsanguination4,5,6,7,8,9,10. One major disadvantage of these techniques is the variable warm ischemic time (WIT) occurring between the time of cardiac death and the initiation of intraarterial and/or intraductal infusion of preservation solution. Even 10 min of WIT will negatively impact islet yield and viability5. Minimizing WIT requires prompt perfusion of the pancreas with a preservation solution. During abdominal organ procurement, aortic cannulation followed by intracorporeal perfusion with University of Wisconsin (UW) solution is crucial for removing blood, preventing intravascular thrombosis, protecting against ischemic damage, and minimizing cellular injury11,12.
Previous studies have demonstrated that during porcine pancreas procurement, low-pressure flushing of the celiac trunk and superior mesenteric artery with UW solution improves islet yield and purity4. However, previously published methods for porcine pancreas procurement include open aortic cannulation, which can be technically challenging, particularly for smaller pigs13,14,15. In this manuscript, we present a detailed, step-by-step protocol with accompanying visual aids for the surgical perfusion and procurement of the porcine pancreas, followed by islet isolation and purification. This new technique of aortic cannulation during pancreatic isolation was developed specifically to minimize WIT and allow the pancreatic procurement to be performed in a bloodless field as a means of maximizing islet isolation yield and viability.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>1 M NaOH, 100 mL</td>
			<td>Millipore Sigma</td>
			<td>1310-73-2</td>
			<td></td>
		</tr>
		<tr>
			<td>10x HBSS, 500 mL (15 to 30 &#176;C)</td>
			<td>Thermo Fisher</td>
			<td>14065056</td>
			<td></td>
		</tr>
		<tr>
			<td>1x D-PBS, 500 mL</td>
			<td>Thermo Fisher</td>
			<td>14200075</td>
			<td></td>
		</tr>
		<tr>
			<td>1x HBSS, 1 L</td>
			<td>Thermo Fisher</td>
			<td>14025076</td>
			<td></td>
		</tr>
		<tr>
			<td>250 mL Conical Tubes</td>
			<td>Millipore Sigma</td>
			<td>CLS430236-6EA</td>
			<td></td>
		</tr>
		<tr>
			<td>Amphotericin B [50 mg]</td>
			<td>Millipore Sigma</td>
			<td>PHR1662</td>
			<td></td>
		</tr>
		<tr>
			<td>Antiseptic Povidone Iodine 10%</td>
			<td>Millipore Sigma</td>
			<td>25655-41-8</td>
			<td></td>
		</tr>
		<tr>
			<td>BioRad Gradient Former</td>
			<td>BioRad</td>
			<td>395</td>
			<td></td>
		</tr>
		<tr>
			<td>Calcium Chloride dihydrate</td>
			<td>Thermo Fisher</td>
			<td>10035-04-8</td>
			<td></td>
		</tr>
		<tr>
			<td>COBE Cell Processor</td>
			<td>Ebay</td>
			<td>317690&#160;</td>
			<td></td>
		</tr>
		<tr>
			<td>Digestion circuit reservoir, Gibco bottle, 1 L</td>
			<td>Thermo Fisher</td>
			<td>10341001</td>
			<td></td>
		</tr>
		<tr>
			<td>Dimethylsulfoxide (DMSO)</td>
			<td>Thermo Fisher</td>
			<td>85190</td>
			<td></td>
		</tr>
		<tr>
			<td>Dithizone</td>
			<td>Thermo Fisher</td>
			<td>60-10-6</td>
			<td></td>
		</tr>
		<tr>
			<td>Gradient Former Connection Kit</td>
			<td>BioRad</td>
			<td>1652008</td>
			<td></td>
		</tr>
		<tr>
			<td>Heparin [1000 U/mL]</td>
			<td>Emergency Medical Products</td>
			<td>0409-2720-01</td>
			<td></td>
		</tr>
		<tr>
			<td>HEPES Buffer (1 M), 100 mL</td>
			<td>Thermo Fisher</td>
			<td>15630080</td>
			<td></td>
		</tr>
		<tr>
			<td>Human Serum Albumin 25%, 100 mL</td>
			<td>Celprogen</td>
			<td>HSA2001-25-1</td>
			<td></td>
		</tr>
		<tr>
			<td>Isoflurane</td>
			<td>Covetrus</td>
			<td>Item#:11695067772</td>
			<td></td>
		</tr>
		<tr>
			<td>Ketamine</td>
			<td>Patterson</td>
			<td>Item #:07-894-8462</td>
			<td></td>
		</tr>
		<tr>
			<td>Liberase (100 mg)</td>
			<td>Millipore Sigma</td>
			<td>5401020001</td>
			<td></td>
		</tr>
		<tr>
			<td>LIVE/DEAD Viability/Cytotoxicity Kit</td>
			<td>Thermo Fisher</td>
			<td>L3224</td>
			<td></td>
		</tr>
		<tr>
			<td>Lympholyte 1.1 Media 500 mL</td>
			<td>Cedarlane Labs</td>
			<td>CL5020</td>
			<td></td>
		</tr>
		<tr>
			<td>Masterflex LS 16 Tubing</td>
			<td>Masterfle</td>
			<td>96419-16</td>
			<td></td>
		</tr>
		<tr>
			<td>Masterflex Peristaltic Pump</td>
			<td>Masterflex</td>
			<td>07522-30</td>
			<td></td>
		</tr>
		<tr>
			<td>PenStrep (2 mg/mL)</td>
			<td>Celprogen</td>
			<td>PS-30-002</td>
			<td></td>
		</tr>
		<tr>
			<td>Pulmozyme (1 mg/mL, 2.5 mL/vial)</td>
			<td>Dornase Alfa</td>
			<td>8931278</td>
			<td></td>
		</tr>
		<tr>
			<td>Recovery Medium, PIM(R)</td>
			<td>Prodo Laboratories, Inc.</td>
			<td>PIM-R001GMP</td>
			<td></td>
		</tr>
		<tr>
			<td>RPMI 1640</td>
			<td>Millipore Sigma</td>
			<td>R8758-1L</td>
			<td></td>
		</tr>
		<tr>
			<td>Standard Culture Medium, PIM(S)</td>
			<td>Prodo Laboratories, Inc.</td>
			<td>PIM-S001GMP</td>
			<td></td>
		</tr>
		<tr>
			<td>Tzed&#8482; (tiletamine and zolazepam) Injection C</td>
			<td>Patterson</td>
			<td>Item #:07-894-6240</td>
			<td></td>
		</tr>
		<tr>
			<td>University of Wisconsin (UW) Solution, 3 L</td>
			<td>Global Transplant Solutions</td>
			<td>1000-0046-06</td>
			<td></td>
		</tr>
		<tr>
			<td>Waterbath</td>
			<td>Sigma Alderich</td>
			<td>CLS6783-1EA</td>
			<td></td>
		</tr>
		<tr>
			<td>Xylazine</td>
			<td>Patterson</td>
			<td>Item #:07-891-6165</td>
			<td></td>
		</tr>
	</tbody>
</table>

surgical perfusion and isolation of the porcine pancreas for islet isolation

Pancreatic islet transplantation is an emerging treatment for type I diabetes; however, it is limited by donor matching and availability. Porcine islet xenotransplantation offers a promising alternative to allotransplantation, with the potential for large-scale production of on-demand, functional islets. The yield and viability of isolated islets is highly susceptible to the quality of the donor pancreas and the method of procurement, particularly the duration of warm-ischemia time. To improve organ preservation and subsequent islet yield and viability, we have developed a protocol for surgical perfusion and resection of the porcine pancreas. This protocol employs direct infrarenal aortic cannulation and organ perfusion to both minimize warm-ischemia time and simplify the procedure for operators who do not have extensive surgical expertise. Subsequent arterial perfusion of the pancreas via the aorta flushes stagnant blood from the microvasculature, thereby reducing thrombosis and oxidative damage to the tissue. This manuscript provides a detailed protocol for surgical perfusion and resection of the porcine pancreas, followed by islet isolation and purification.

Author Spotlight: Techniques and Challenges in Islet Purification for Xenotransplantation

Surgical Perfusion and Isolation of the Porcine Pancreas for Islet Isolation

Our lab focuses on microencapsulation for pancreatic islet xenotransplantation. This requires reliable islet isolation and purification. We tackle this challenge by isolating the pancreas without damaging it from warm ischemia or mechanical injury.And this offers strategies for effective digestion and a high islet yield. Isolating pancreatic islets is very challenging. Both the yield and purity depend on every phase of the process being executed effectively and efficiently from the organ procurement and digestion to the islet purification.Furthermore, ethical and humane considerations are important when planning animal procedures that will facilitate optimal outcomes while reducing any animal suffering. So here we demonstrate that we can percutaneously cannulate the aorta to selectively perfuse the pancreas. This technique allows us to efficiently preserve the pancreas and then isolate the islets.So a major advantage of our protocol is the use of Seldinger technique for aortic cannulation. This helps maintain a bloodless operative field and preserves the dissection planes. This technique can also be easily adapted for smaller pigs simply by using a smaller sheath.Our lab is currently investigating methods for creating an on-demand supply of pancreatic islets. Specifically, we're interested in seeing if encapsulating islets in a hydrogel can prolong their lifespan and improve their function in vitro and in culture. The ultimate goal is to reliably isolate porcine islets to use it in transplantation research, or even for xenotransplantation.

The operative setup and midline laparotomy is shown in Figure 1. The laparotomy incision should be curved to avoid the urogenital opening (Figure 1B). When setting up the retractor, attach the post for the Omni or Bookwalter retractor to the left, inferior corner of the table. Ideal retraction includes two retractor blades for the right abdominal wall, two for the left abdominal wall, and 1-2 for the right colon and small bowel wrapped in a sterile towel (<stron...

This protocol provides a step-by-step guide for the procurement of a porcine pancreas for islet isolation and purification.

Pancreatic islet transplantation is an emerging treatment for type I diabetes; however, it is limited by donor matching and availability. Porcine islet ...

surgical-perfusion-isolation-porcine-pancreas-for-islet