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Cotransplantation of islets with mesenchymal stromal cells (MSCs) has been shown to improve islet transplantation outcome. Improved glycemia in graft recipients have been attributed to superior islet revascularization,maintenance of islet organization and morphology, and a multitude of immunomodulatory mechanisms. These effects are mediated by a vast array of soluble trophic MSC-derived factors and extracellular matrix production, and/or direct cell-cell contact mechanisms. Most of these studies have used experimental transplantation sites, such as the kidney, to facilitate the colocalization of large numbers ofMSCswith the islet graft. However, there are notable disparities with the clinically preferred intraportal route which have implications for colocalization of the islets and MSCs. Thus, because of the differences in their size, islets lodge in small vessels of the hepatic microcirculation, whereas the smaller MSCs will

Composite Mesenchymal Stromal Cell Islets: Implications for Transplantation via the Clinically Preferred Intraportal Route