Juang J, Peng S, Kuo C, Tang S. Three-dimensional islet graft histology: panoramic imaging of neural plasticity in sympathetic reinnervation of transplanted islets under the kidney capsule. Am J Physiol Endocrinol Metab 306: E559 -E570, 2014. First published January 14, 2014; doi:10.1152/ajpendo.00515.2013.-Microscopic examination of transplanted islets in an ectopic environment provides information to evaluate islet engraftment, including revascularization and reinnervation. However, because of the dispersed nature of blood vessels and nerves, global visualization of the graft neurovascular network has been difficult. In this research we revealed the neurovascular network by preparing transparent mouse islet grafts under the kidney capsule with optical clearing to investigate the sympathetic reinnervation via three-dimensional confocal microscopy. Normoglycemic and streptozotocin-induced diabetic mice were used in syngeneic islet transplantation, with both groups maintaining euglycemia after transplantation. Triple staining of insulin/glucagon, blood vessels, and tyrosine hydroxylase (sympathetic marker) was used to reveal the graft microstructure, vasculature, and sympathetic innervation. Three weeks after transplantation, we observed perigraft sympathetic innervation similar to the peri-islet sympathetic innervation in the pancreas. Six weeks after transplantation, prominent intragraft, perivascular sympathetic innervation was achieved, resembling the pancreatic intraislet, perivascular sympathetic innervation in situ. Meanwhile, in diabetic recipients, a higher graft sympathetic nerve density was found compared with grafts in normoglycemic recipients, indicating the graft neural plasticity in response to the physiological difference of the recipients and the resolving power of this imaging approach. Overall, this new graft imaging method provides a useful tool to identify the islet neurovascular complex in an ectopic environment to study islet engraftment. islet transplantation; graft innervation; neural plasticity; sympathetic nerves; three dimensional ISLET TRANSPLANTATION HAS BEEN PROPOSED as an effective cure for patients with unstable type 1 diabetes in whom the diabetes care alone is inadequate to avoid serious complications (2,8,15,25). To achieve long-term graft survival, revascularization and reinnervation of islets in the new microenvironment are essential for islet engraftment (5,16,27,30,34,38). The neurovascular integration is particularly important for grafts to receive signals from the circulation and nerves in response to physiological cues to maintain glucose homeostasis and avoid hypoglycemia. However, because of the dispersed nature of blood vessels and nerves, global and integrated visualization of the graft microstructure, vasculature, and innervation has been difficult, even in animals. The difficulty of examining the neurovascular complex in a three-dimensional (3D) continuum has limited our understanding of islet engraftment after transplantation to help evaluate and improve the proce...