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Porcine endogenous retrovirus – advances, issues and solutions

Pancreatic islet xenotransplantation (XTx) has been proposed as one of the initial types of xenotransplant to undergo clinical trials. It is not as technically demanding as vascularized organ XTx, it may be possible to protect the islets from the strong innate immune response that is directed against other forms of xenotransplants, and there are many patients who could potentially benefit from the procedure. Most importantly, we already know that there are no physiological incompatibilities between pig islets and humans, as porcine insulin has been used clinically for years. Despite this optimism the level of investment and development in pancreatic islet XTx has lagged behind that of its solid organ counterparts. There have been only a few studies in nonhuman primates, a necessary precursor to clinical trials, and the opportunity to use genetically manipulated donor tissue has not been pursued vigorously. These issues are now being addressed, and the problems that are preventing islet XTx from progressing to clinical trials have been identified. These can be divided into five main areas: