1
|
Garcia LR, Brito FDS, Felicio ML, Garzesi AM, Tardivo MT, Polegato BF, Minicucci MF, Zornoff LAM. Clinical trials in cardiac xenotransplantation: Are we ready to overcome barriers? J Card Surg 2021; 36:3796-3801. [PMID: 34137071 DOI: 10.1111/jocs.15747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/25/2021] [Accepted: 06/10/2021] [Indexed: 11/28/2022]
Abstract
Heart allotransplantation has become one of the methods of choice in the treatment of severe heart failure. In the face of its difficulties, such as the unmet balance between organ supply and demand, the use of xenotransplantation (XTx) might be an attractive option shortly, even more with the ongoing progress achieved regarding the avoidance of hyperacute rejection and primary organ disfunction, maintenance of xenograft function and control of xenograft growth. To make possible this translational challenge, some points must be taken into account indeed, and they are the equipoise of human benefit and animal suffering, the risk of unknown infections, a well prepared informed consent, ethical and religious beliefs, and the role of cardiac XTx in a ventricular assistance device era.
Collapse
Affiliation(s)
- Leonardo Rufino Garcia
- Department of Surgery, Universidade Estadual Paulista-UNESP, SP, São Paulo, São Paulo, Brazil
| | - Flavio de Souza Brito
- Department of Surgery, Universidade Estadual Paulista-UNESP, SP, São Paulo, São Paulo, Brazil
| | - Marcello Laneza Felicio
- Department of Surgery, Universidade Estadual Paulista-UNESP, SP, São Paulo, São Paulo, Brazil
| | - André Monti Garzesi
- Department of Surgery, Universidade Estadual Paulista-UNESP, SP, São Paulo, São Paulo, Brazil
| | - Márcia Terezinha Tardivo
- Department of Internal Medicine, Universidade Estadual Paulista-UNESP, SP, São Paulo, São Paulo, Brazil
| | - Bertha Furlan Polegato
- Department of Internal Medicine, Universidade Estadual Paulista-UNESP, SP, São Paulo, São Paulo, Brazil
| | - Marcos Ferreira Minicucci
- Department of Internal Medicine, Universidade Estadual Paulista-UNESP, SP, São Paulo, São Paulo, Brazil
| | | |
Collapse
|
2
|
Martínez-Alarcón L, Ríos A, Ramis G, Quereda J, Herrero J, Mendonça L, Muñoz A, Hernández A, Ramírez P, Parrilla P. Impact of 2009 Pandemic H1N1 Influenza A Virus on Veterinary Students' Perception of Xenotransplantation. Transplant Proc 2018; 50:2291-2295. [DOI: 10.1016/j.transproceed.2018.02.178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 02/26/2018] [Indexed: 12/24/2022]
|
3
|
Li C, Qi F, Liu T, Wang H, Wang PZ. Improved Cuff Technique for Establishing a Mouse-Rat Heterotopic Cardiac Xenotransplantation Model. Transplant Proc 2015; 47:2026-31. [PMID: 26293092 DOI: 10.1016/j.transproceed.2015.02.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 01/23/2015] [Accepted: 02/09/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND The small animal model of cardiac transplantation is the most common model in organ transplantation studies. The cervical heterotopic transplantation is widely performed because this allows for direct observation of the graft heartbeat and contributes to early prediction of graft rejection. OBJECTIVE A mouse-rat cervical heterotopic cardiac xenotransplantation model was modified with respect to the anesthesia method, cardiac graft harvesting method, and perioperative treatment. These improvements ensure the stability and reliability of xenotransplantation models for in vivo studies of immune-mediated graft rejection. METHODS After establishing isoflurane inhalation anesthesia, the donors' hearts were harvested. The experimental method involved separate ligation of the left and right superior venae cavae; the other blood vessels were ligated in a cluster. Both the donor and recipient animals were placed on a heating pad intraoperatively to maintain a body temperature of 37-40 °C. The model establishment was divided into 3 stages: practice, stabilization, and stereotyping. The surgical success rate and operation time were recorded. Specimens were harvested at different time points for histopathological examination. RESULTS The anesthetic effect of isoflurane was well maintained, and no animals died of adverse anesthetic events. Body temperature was maintained at 37-40 °C which effectively shortened the time to restoration. The modification of the cardiac graft harvesting method is conducive to rebeating of the donor heart. The success rates in the stabilization and stereotyping stages were significantly higher than that in the practice stage (P < .05). The operation time in the stabilization and stereotyping stages were significantly shorter than those in the practice stage (P < .05). Histopathological examination revealed thrombosis formation, interstitial hemorrhage, and inflammatory cell infiltration in the donor hearts. CONCLUSION Our findings suggest that the mouse-rat cervical heterotopic cardiac xenotransplantation model is the ideal animal model for studying xenograft rejection.
Collapse
Affiliation(s)
- C Li
- Department of General Surgery, General Hospital of Tianjin Medical University, Tianjin 300052, China
| | - F Qi
- Department of General Surgery, General Hospital of Tianjin Medical University, Tianjin 300052, China.
| | - T Liu
- Department of General Surgery, General Hospital of Tianjin Medical University, Tianjin 300052, China
| | - H Wang
- Department of General Surgery, General Hospital of Tianjin Medical University, Tianjin 300052, China
| | - P-Z Wang
- Department of General Surgery, General Hospital of Tianjin Medical University, Tianjin 300052, China
| |
Collapse
|
4
|
Abstract
There is an increasing worldwide shortage of organs and cells for transplantation in patients with end-stage organ failure or cellular dysfunction. This shortage could be resolved by the transplantation of organs or cells from pigs into humans. What competing approaches might provide support for the patient with end-stage organ or cell failure? Four main approaches are receiving increasing attention - (i) implantable mechanical devices, although these are currently limited almost entirely to devices aimed at supporting or replacing the heart, (ii) stem cell technology, at present directed mainly to replace absent or failing cells, but which is also fundamental to progress in (iii) tissue engineering and regenerative medicine, in which the ultimate aim is to replace an entire organ. A final novel potential approach is (iv) blastocyst complementation. These potential alternative approaches are briefly reviewed, and comments added on their current status and whether they are now (or will soon become) realistic alternative therapies to xenotransplantation.
Collapse
|
5
|
Ekser B, Cooper DKC, Tector AJ. The need for xenotransplantation as a source of organs and cells for clinical transplantation. Int J Surg 2015; 23:199-204. [PMID: 26188183 DOI: 10.1016/j.ijsu.2015.06.066] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 06/18/2015] [Indexed: 10/23/2022]
Abstract
The limited availability of deceased human organs and cells for the purposes of clinical transplantation remains critical worldwide. Despite the increasing utilization of 'high-risk', 'marginal', or 'extended criteria' deceased donors, in the U.S. each day 30 patients either die or are removed from the waiting list because they become too sick to undergo organ transplantation. In certain other countries, where there is cultural resistance to deceased donation, e.g., Japan, the increased utilization of living donors, e.g., of a single kidney or partial liver, only very partially addresses the organ shortage. For transplants of tissues and cells, e.g., pancreatic islet transplantation for patients with diabetes, and corneal transplantation for patients with corneal blindness (whose numbers worldwide are potentially in the millions), allotransplantation will never prove a sufficient source. There is an urgent need for an alternative source of organs and cells. The pig could prove to be a satisfactory source, and clinical xenotransplantation using pig organs or cells, particularly with the advantages provided by genetic engineering to provide resistance to the human immune response, may resolve the organ shortage. The physiologic compatibilities and incompatibilities of the pig and the human are briefly reviewed.
Collapse
Affiliation(s)
- Burcin Ekser
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - David K C Cooper
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - A Joseph Tector
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| |
Collapse
|
6
|
Affiliation(s)
- David K C Cooper
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA, USA.
| |
Collapse
|
7
|
Li W, Zhang H, Li J, Dong R, Yao B, He X, Wang H, Song J. Comparison of Biomechanical Properties of Bile Duct Between Pigs and Humans for Liver Xenotransplant. Transplant Proc 2013; 45:741-7. [DOI: 10.1016/j.transproceed.2012.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 11/08/2012] [Indexed: 10/27/2022]
|
8
|
Lampert BC, Teuteberg JJ. Mechanical circulatory support in 2012 - raising the bar or closing the door, for xenotransplantation? Xenotransplantation 2012. [DOI: 10.1111/xen.12006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
9
|
Li J, Li WC, Song J, Zhang HM, Yu MH, He XJ, Wang MH, Wang HQ, Huang TZ. Effect of Sex on Biomechanical Properties of the Proper Hepatic Artery in Pigs and Humans for Liver Xenotransplant. EXP CLIN TRANSPLANT 2012; 10:356-62. [DOI: 10.6002/ect.2011.0136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
10
|
Dons EM, Montoya C, Long CE, Hara H, Echeverri GJ, Ekser B, Ezzelarab C, Medellin DR, van der Windt DJ, Murase N, Rigatti LH, Wagner R, Wolf RF, Ezzelarab M, West LJ, Ijzermans JNM, Cooper DKC. T-cell-based immunosuppressive therapy inhibits the development of natural antibodies in infant baboons. Transplantation 2012; 93:769-76. [PMID: 22441321 PMCID: PMC3776575 DOI: 10.1097/tp.0b013e3182481168] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND We set out to determine whether B-cell tolerance to A/B-incompatible alloantigens and pig xenoantigens could be achieved in infant baboons. METHODS Artery patch grafts were implanted in the abdominal aorta in 3-month-old baboons using A/B-incompatible (AB-I) allografts or wild-type pig xenografts (pig). Group 1 (Gp1) (controls, n=6) received no immunosuppressive therapy (IS) and no graft. Gp2 (n=2) received an AB-I or pig graft but no IS. Gp3 received AB-I grafts+IS (Gp3A: n=2) or pig grafts+IS (Gp3B: n=2). IS consisted of ATG, anti-CD154mAb, and mycophenolate mofetil until age 8 to 12 months. Gp4 (n=2) received IS only but no graft. RESULTS In Gp1, anti-A/B and cytotoxic anti-pig immunoglobulin-M increased steadily during the first year. Gp2 became sensitized to donor-specific AB-I or pig antigens within 2 weeks. Gp3 and Gp4 infants that received anti-CD154mAb made no or minimal anti-A/B and anti-pig antibodies while receiving IS. DISCUSSION The production of natural anti-A/B and anti-pig antibodies was inhibited by IS with anti-CD154mAb, even in the absence of an allograft or xenograft, suggesting that natural antibodies may not be entirely T-cell independent. These data are in contrast to clinical experience with AB-I allotransplantation in infants, who cease producing only donor-specific antibodies.
Collapse
Affiliation(s)
- Eefje M. Dons
- Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA
- Department of Surgery, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Claudia Montoya
- Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA
| | - Cassandra E. Long
- Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA
| | - Hidetaka Hara
- Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA
| | - Gabriel J. Echeverri
- Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA
| | - Burcin Ekser
- Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA
| | - Corin Ezzelarab
- Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA
| | - Dasha Roa Medellin
- Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA
| | - Dirk J. van der Windt
- Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA
- Department of Surgery, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Noriko Murase
- Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA
| | - Lora H. Rigatti
- Division of Laboratory Animal Resources, University of Pittsburgh, Pittsburgh, PA
| | - Robert Wagner
- Division of Laboratory Animal Resources, University of Pittsburgh, Pittsburgh, PA
| | - Roman F. Wolf
- Comparative Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Mohamed Ezzelarab
- Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA
| | - Lori J. West
- Department of Pediatrics, Cardiac Transplant Research, University of Alberta, Edmonton, AL, Canada
| | - Jan N. M. Ijzermans
- Department of Surgery, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - David K. C. Cooper
- Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|
11
|
Ekser B, Ezzelarab M, Hara H, van der Windt DJ, Wijkstrom M, Bottino R, Trucco M, Cooper DKC. Clinical xenotransplantation: the next medical revolution? Lancet 2012; 379:672-83. [PMID: 22019026 DOI: 10.1016/s0140-6736(11)61091-x] [Citation(s) in RCA: 245] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The shortage of organs and cells from deceased individuals continues to restrict allotransplantation. Pigs could provide an alternative source of tissue and cells but the immunological challenges and other barriers associated with xenotransplantation need to be overcome. Transplantation of organs from genetically modified pigs into non-human primates is now not substantially limited by hyperacute, acute antibody-mediated, or cellular rejection, but other issues have become more prominent, such as development of thrombotic microangiopathy in the graft or systemic consumptive coagulopathy in the recipient. To address these problems, pigs that express one or more human thromboregulatory or anti-inflammatory genes are being developed. The results of preclinical transplantation of pig cells--eg, islets, neuronal cells, hepatocytes, or corneas--are much more encouraging than they are for organ transplantation, with survival times greater than 1 year in all cases. Risk of transfer of an infectious microorganism to the recipient is small.
Collapse
Affiliation(s)
- Burcin Ekser
- Thomas E Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
| | | | | | | | | | | | | | | |
Collapse
|
12
|
van der Windt DJ, Dons EM, Montoya CL, Ezzelarab M, Long C, Wolf RF, Ijzermans JNM, Lakkis FG, Cooper DKC. T-lymphocyte homeostasis and function in infant baboons: implications for transplantation. Transpl Int 2012; 25:218-28. [PMID: 22093092 DOI: 10.1111/j.1432-2277.2011.01384.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Laboratory mice are born lymphopenic and demonstrate lymphopenia-induced proliferation that generates memory T cells, yet they are prone to immunologic tolerance. Here we tested whether these fundamental immunologic observations apply to higher animals by studying the immune system of infant baboons. Using flow cytometry of the peripheral blood cells, it was found that baboons are born relatively lymphopenic and subsequently expand their initially naïve T cell pool with increasing numbers of memory T cells. After transplantation of an artery patch allograft or xenograft, non-immunosuppressed recipients readily mounted an immune response against donor-type antigens, as evidenced by mixed lymphocyte reaction. Immunosuppression with anti-thymocyte globulin (ATG), anti-CD154 mAb, and mycophenolate mofetil prevented T cell-mediated rejection. After lymphocyte depletion with ATG, homeostatic T cell proliferation was observed. In conclusion, the baboon proved a suitable model to investigate the infant immune system. In this study, neonatal lymphopenia and expansion of the memory T cell population were observed but, unlike mice, there were no indications that infant baboons are prone to T cell tolerance. The expansion of memory T cells during the neonatal period or after induction therapy may actually form an obstacle to tapering immunosuppressive therapy, or ultimately achieving immunologic tolerance.
Collapse
Affiliation(s)
- Dirk J van der Windt
- Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | | | | | | | | | | | | |
Collapse
|