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Rother T, Horgby C, Schmalkuche K, Burgmann JM, Nocke F, Jägers J, Schmitz J, Bräsen JH, Cantore M, Zal F, Ferenz KB, Blasczyk R, Figueiredo C. Oxygen carriers affect kidney immunogenicity during ex-vivo machine perfusion. FRONTIERS IN TRANSPLANTATION 2023; 2:1183908. [PMID: 38993849 PMCID: PMC11235266 DOI: 10.3389/frtra.2023.1183908] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/29/2023] [Indexed: 07/13/2024]
Abstract
Normothermic ex-vivo machine perfusion provides a powerful tool to improve donor kidney preservation and a route for the delivery of pharmacological or gene therapeutic interventions prior to transplantation. However, perfusion at normothermic temperatures requires adequate tissue oxygenation to meet the physiological metabolic demand. For this purpose, the addition of appropriate oxygen carriers (OCs) to the perfusion solution is essential to ensure a sufficient oxygen supply and reduce the risk for tissue injury due to hypoxia. It is crucial that the selected OCs preserve the integrity and low immunogenicity of the graft. In this study, the effect of two OCs on the organ's integrity and immunogenicity was evaluated. Porcine kidneys were perfused ex-vivo for four hours using perfusion solutions supplemented with red blood cells (RBCs) as conventional OC, perfluorocarbon (PFC)-based OC, or Hemarina-M101 (M101), a lugworm hemoglobin-based OC named HEMO2life®, recently approved in Europe (i.e., CE obtained in October 2022). Perfusions with all OCs led to decreased lactate levels. Additionally, none of the OCs negatively affected renal morphology as determined by histological analyses. Remarkably, all OCs improved the perfusion solution by reducing the expression of pro-inflammatory mediators (IL-6, IL-8, TNFα) and adhesion molecules (ICAM-1) on both transcript and protein level, suggesting a beneficial effect of the OCs in maintaining the low immunogenicity of the graft. Thus, PFC-based OCs and M101 may constitute a promising alternative to RBCs during normothermic ex-vivo kidney perfusion.
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Affiliation(s)
- Tamina Rother
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Hannover, Germany
| | - Carina Horgby
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Hannover, Germany
| | - Katharina Schmalkuche
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Hannover, Germany
| | - Jonathan M. Burgmann
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Hannover, Germany
| | - Fabian Nocke
- Institute of Physiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Johannes Jägers
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Jessica Schmitz
- Nephropathology Unit, Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Jan Hinrich Bräsen
- Nephropathology Unit, Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Miriam Cantore
- Institute of Physiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Franck Zal
- Hemarina SA, Aéropôle Centre, Morlaix, France
| | - Katja B. Ferenz
- Institute of Physiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- CeNIDE (Center for Nanointegration Duisburg-Essen), University of Duisburg-Essen, Duisburg, Germany
| | - Rainer Blasczyk
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Hannover, Germany
| | - Constanca Figueiredo
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Hannover, Germany
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Smood B, Hara H, Schoel LJ, Cooper DKC. Genetically-engineered pigs as sources for clinical red blood cell transfusion: What pathobiological barriers need to be overcome? Blood Rev 2019; 35:7-17. [PMID: 30711308 DOI: 10.1016/j.blre.2019.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 01/02/2019] [Accepted: 01/25/2019] [Indexed: 12/27/2022]
Abstract
An alternative to human red blood cells (RBCs) for clinical transfusion would be advantageous, particularly in situations of massive acute blood loss (where availability and compatibility are limited) or chronic hematologic diseases requiring frequent transfusions (resulting in alloimmunization). Ideally, any alternative must be neither immunogenic nor pathogenic, but readily available, inexpensive, and physiologically effective. Pig RBCs (pRBCs) provide a promising alternative due to their several similarities with human RBCs, and our increasing ability to genetically-modify pigs to reduce cellular immunogenicity. We briefly summarize the history of xenotransfusion, the progress that has been made in recent years, and the remaining barriers. These barriers include prevention of (i) human natural antibody binding to pRBCs, (ii) their phagocytosis by macrophages, and (iii) the T cell adaptive immune response (in the absence of exogenous immunosuppressive therapy). Although techniques of genetic engineering have advanced in recent years, novel methods to introduce human transgenes into pRBCs (which do not have nuclei) will need to be developed before clinical trials can be initiated.
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Affiliation(s)
- Benjamin Smood
- Xenotransplantation Program, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hidetaka Hara
- Xenotransplantation Program, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Leah J Schoel
- Xenotransplantation Program, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David K C Cooper
- Xenotransplantation Program, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
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Cortázar TM, Wilson IBH, Hykollari A, Reyes EA, Vega NA. Differential recognition of natural and remodeled glycotopes by three Diocleae lectins. Glycoconj J 2018; 35:205-216. [PMID: 29374812 DOI: 10.1007/s10719-018-9812-0] [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: 09/12/2017] [Revised: 01/05/2018] [Accepted: 01/10/2018] [Indexed: 10/18/2022]
Abstract
The carbohydrate specificities of Dioclea grandiflora lectins DGL-I1 and DGL-II, and Galactia lindenii lectin II (GLL-II) were explored by use of remodeled glycoproteins as well as by the lectin hemagglutinating activity against erythrocytes from various species with different glycomic profiles. The three lectins exhibited differences in glycan binding specificity but also showed overlapping recognition of some glycotopes (i.e. Tα glycotope for the three lectins; IIβ glycotope for DGL-II and GLL-II lectins); in many cases the interaction with distinct glycotopes was influenced by the structural context, i.e., by the neighbouring sugar residues. Our data complement and expand the existing knowledge about the binding specificity of these three Diocleae lectins, and taken together with results of previous studies, allow us to suggest a functional map of the carbohydrate recognition which illustrate the impact of modification of basic glycotopes enhancing, permiting, or inhibiting their recognition by each lectin.
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Affiliation(s)
- Tania M Cortázar
- Protein Research Group, Department of Chemistry, Universidad Nacional, Calle 45 # 30-03, Building 451. Lab. 201-1, Bogotá, Colombia.
| | - Iain B H Wilson
- Molecular Glycobiology Research Group, Department für Chemie, Universität für Bodenkultur (BOKU), Muthgasse 18, A-1190, Wien, Austria
| | - Alba Hykollari
- Molecular Glycobiology Research Group, Department für Chemie, Universität für Bodenkultur (BOKU), Muthgasse 18, A-1190, Wien, Austria
| | - Edgar A Reyes
- Protein Research Group, Department of Chemistry, Universidad Nacional, Calle 45 # 30-03, Building 451. Lab. 201-1, Bogotá, Colombia
| | - Nohora A Vega
- Protein Research Group, Department of Chemistry, Universidad Nacional, Calle 45 # 30-03, Building 451. Lab. 201-1, Bogotá, Colombia
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Bukara K, Drvenica I, Ilić V, Stančić A, Mišić D, Vasić B, Gajić R, Vučetić D, Kiekens F, Bugarski B. Comparative studies on osmosis based encapsulation of sodium diclofenac in porcine and outdated human erythrocyte ghosts. J Biotechnol 2016; 240:14-22. [PMID: 27773756 DOI: 10.1016/j.jbiotec.2016.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 10/16/2016] [Accepted: 10/19/2016] [Indexed: 10/20/2022]
Abstract
The objective of our study was to develop controlled drug delivery system based on erythrocyte ghosts for amphiphilic compound sodium diclofenac considering the differences between erythrocytes derived from two readily available materials - porcine slaughterhouse and outdated transfusion human blood. Starting erythrocytes, empty erythrocyte ghosts and diclofenac loaded ghosts were compared in terms of the encapsulation efficiency, drug releasing profiles, size distribution, surface charge, conductivity, surface roughness and morphology. The encapsulation of sodium diclofenac was performed by an osmosis based process - gradual hemolysis. During this process sodium diclofenac exerted mild and delayed antihemolytic effect and increased potassium efflux in porcine but not in outdated human erythrocytes. FTIR spectra revealed lack of any membrane lipid disorder and chemical reaction with sodium diclofenac in encapsulated ghosts. Outdated human erythrocyte ghosts with detected nanoscale damages and reduced ability to shrink had encapsulation efficiency of only 8%. On the other hand, porcine erythrocyte ghosts had encapsulation efficiency of 37% and relatively slow drug release rate. More preserved structure and functional properties of porcine erythrocytes related to their superior encapsulation and release performances, define them as more appropriate for the usage in sodium diclofenac encapsulation process.
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Affiliation(s)
- Katarina Bukara
- Department Pharmaceutics, Campus Drie Eiken, University of Antwerp, Antwerp, Belgium; Department of Chemical Engineering, Faculty of Technology and Metallurgy, University of Belgrade, Belgrade, Serbia.
| | - Ivana Drvenica
- Department of Chemical Engineering, Faculty of Technology and Metallurgy, University of Belgrade, Belgrade, Serbia
| | - Vesna Ilić
- Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | - Ana Stančić
- Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | - Danijela Mišić
- Institute for Biological Research "Siniša Stanković", University of Belgrade, Bulevar Despota Stefana 142, 11060 Belgrade, Serbia
| | - Borislav Vasić
- Institute of Physics, University of Belgrade, Pregrevica 118, 11080 Zemun, Belgrade, Serbia
| | - Radoš Gajić
- Institute of Physics, University of Belgrade, Pregrevica 118, 11080 Zemun, Belgrade, Serbia
| | - Dušan Vučetić
- Institute for Tranfusiology and Haemobiology of Military Medical Academy, Belgrade, Serbia
| | - Filip Kiekens
- Department Pharmaceutics, Campus Drie Eiken, University of Antwerp, Antwerp, Belgium
| | - Branko Bugarski
- Department of Chemical Engineering, Faculty of Technology and Metallurgy, University of Belgrade, Belgrade, Serbia
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Cooper DK, Hara H, Yazer M. Genetically Engineered Pigs as a Source for Clinical Red Blood Cell Transfusion. Clin Lab Med 2010; 30:365-80. [DOI: 10.1016/j.cll.2010.02.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bassuni WY, Blajchman MA, Al-Moshary MA. Why implement universal leukoreduction? Hematol Oncol Stem Cell Ther 2010; 1:106-23. [PMID: 20063539 DOI: 10.1016/s1658-3876(08)50042-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The improvement of transfusion medicine technology is an ongoing process primarily directed at increasing the safety of allogeneic blood component transfusions for recipients. Over the years, relatively little attention had been paid to the leukocytes present in the various blood components. The availability of leukocyte removal (leukoreduction) techniques for blood components is associated with a considerable improvement in various clinical outcomes. These include a reduction in the frequency and severity of febrile transfusion reactions, reduced cytomegalovirus transfusion-transmission risk, the reduced incidence of alloimmune platelet refractoriness, a possible reduction in the risk of transfusion-associated variant Creutzfeldt-Jakob disease transmission, as well as reducing the overall risk of both recipient mortality and organ dysfunction, particularly in cardiac surgery patients and possibly in other categories of patients. Internationally, 19 countries have implemented universal leukocyte reduction (ULR) as part of their blood safety policy. The main reason for not implementing ULR in those countries that have not appears to be primarily concerns over costs. Nonetheless, the available international experience supports the concept that ULR is a process that results in improved safety of allogeneic blood components.
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Affiliation(s)
- Wafaa Y Bassuni
- Central Laboratory and Transfusion Services, King Fahad Medical City, Riyadh, Saudi Arabia.
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Irregular Xenoantibodies Against Human Red Blood Cells in Papio anubis, P ursinus, P hamadryas, P papio, Saimiri sciureus, and Macaca mulatta: Possible Effect on Xenotransplantation Results. Transplant Proc 2010; 42:387-9. [DOI: 10.1016/j.transproceed.2009.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Long C, Hara H, Pawlikowski Z, Koike N, d'Arville T, Yeh P, Ezzelarab M, Ayares D, Yazer M, Cooper DKC. Genetically engineered pig red blood cells for clinical transfusion: initial in vitro studies. Transfusion 2009; 49:2418-29. [PMID: 19624491 DOI: 10.1111/j.1537-2995.2009.02306.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pigs are a potential source of red blood cells (RBCs) and could resolve the shortage of human blood for transfusion. This study investigated in vitro the compatibility of genetically engineered pig RBCs (pRBCs) with the human innate immune response. STUDY DESIGN AND METHODS Human volunteers of all ABO blood types were sources of sera and those of O blood type were sources of circulating monocytes/macrophages. RBCs from ABO-compatible (ABO-C) and ABO-incompatible (ABO-I) humans and wild-type (WT) and alpha-1,3-galactosyltransferase gene-knockout (GTKO) pigs were tested for hemagglutination, immunoglobulin (Ig)M/IgG antibody binding, and complement-dependent cytotoxicity (CDC) using human sera. Phagocytosis of RBCs by human monocyte-derived macrophages was measured by coculture in the absence or presence of pooled human O serum. RESULTS RBCs showed significant differences (p < 0.01) with regard to hemagglutination, IgM and IgG binding, and CDC (ABO-C < GTKO < ABO-I < WT). In the absence of pooled human O serum (antibodies), there was no phagocytosis of any RBCs; in the presence of serum (antibodies), phagocytosis of ABO-I RBCs was greater than of WT (p < 0.01), which in turn was greater than of GTKO RBCs (p < 0.05). CONCLUSIONS GTKO RBCs were significantly more compatible than ABO-I and WT RBCs, but were not comparable to ABO-C combinations. In the presence of antibody, human monocyte-derived macrophages phagocytosed ABO-I RBC/sera combinations more efficiently than pRBCs. These observations contribute to our ultimate goal of using genetically engineered pRBCs for clinical blood transfusion. However, pigs will require other modifications or manipulations if they are to become suitable for human transfusion.
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Affiliation(s)
- Cassandra Long
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Starzl Biomedical Science Tower, W1540, 200 Lothrop Street, Pittsburgh, PA 15261, USA
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Abstract
BACKGROUND The use of porcine red blood cells has recently been proposed as a possible solution to the shortage of blood for human transfusion. OBJECTIVES The purpose of this paper is to compare some ethical issues regarding xenotransfusion (XTF) with those relating to xenotransplantation (XT) of organs, tissues and cells. MATERIALS AND METHODS Various ethical concerns and viewpoints relating to XTF are discussed. RESULTS The main ethical obstacles to XT do not apply to XTF. It is much more ethically acceptable to raise pigs for regular blood collection as it doesn't damage the health of the animal. Porcine endogenous retrovirus infection, the major concern associated with XT, does not apply to XTF, since red blood cells have no DNA and have a very short lifespan. Clinical trials will be possible in humans once XTF has been demonstrated to be effective and harmless in non-human primates. Transgenesis is acceptable for pig blood donors because only a limited number of genes are involved, and these animals will never enter into the livestock gene pool or the food chain. CONCLUSION Because the need for blood is less pressing than that for organs, tissues or cells, the use of animal blood for human transfusion is not an absolute necessity. However, it represents a real opportunity. The ability to gain access to an unlimited quantity of blood is a reasonable justification for XTF. Because its technical and ethical hurdles are less stringent, XTF could be the first large-scale clinical application of XT.
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Affiliation(s)
- Françoise A Roux
- Department of Cellular and Molecular Immuno-Endocrinology, INRA, Nantes School of Veterinary Medicine, Atlanpole, La Chantrerie, Nantes, France
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Abstract
The first blood transfusions in humans were xenotransfusions, carried out by Jean-Baptiste Denis beginning in 1667. Richard Lower, Matthäus Purmann and Georges Mercklin also experimented with the use of animal blood for transfusion until this practice was forbidden in 1670, after the death of one of Denis's patients. In the middle of the 19th century, xenotransfusion was rescued from oblivion by the work of Pierre Cyprien Oré. Franz Gesellius and Oscar Hasse fervently defended xenotransfusion, but Emil Ponfick and Leonard Landois stressed the potentially harmful effects of inter-species transfusion from 1874 onward. Xenotransfusion was abandoned completely following the discovery of blood groups by Karl Landsteiner in 1900. From 2000, because of progress in xenotransplantation and the need of blood supply, xenotransfusion is again being considered. Pigs are the best potential donors. The development of alpha-1,3-galactosyltransferase gene-knockout pigs has overcome the first hurdle to xenotransfusion. The main obstacle to porcine red blood cell transfusion is now the cellular response involving macrophages or natural killer cells.
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Affiliation(s)
- Françoise A Roux
- Department of Cellular and Molecular Immuno-Endocrinology, INRA, Nantes School of Veterinary Medicine, Nantes Cedex, France
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Zhu M, Wang SS, Xia ZX, Cao RH, Chen D, Huang YB, Liu B, Chen ZK, Chen S. Inhibition of xenogeneic response in porcine endothelium using RNA interference. Transplantation 2005; 79:289-96. [PMID: 15699758 DOI: 10.1097/01.tp.0000148733.57977.fd] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Rejection mediated by antibody recognition of the alpha-Gal epitope (Galalpha1-3Galbeta1-4GlcNAc-R) is a major barrier in porcine-to-human xenotransplantation. Because the synthesis of alpha-Gal is dependent on alpha1,3 galactosyltransferase (alpha1,3GT), methods of blocking this enzyme are needed. RNA interference induced by small interfering RNA (siRNA) is a powerful technique for allowing the silencing of mammalian genes with great specificity and potency. In this study, we use siRNA for silencing of alpha1,3GT with the purpose of reducing expression of the alpha-Gal epitope and subsequently decreasing immunogenicity of porcine endothelial cells. METHODS alpha1,3GT-specific and control siRNAs were transfected into the porcine aortic endothelial cell line, PED. alpha-Gal expression was assessed by Western blotting, flow cytometry, and immunofluorescence. Protection from human-complement and natural killer (NK)-cell-mediated cytotoxicity was evaluated by Cr-release assays after incubation of PED with normal human serum (NHS) and NK92 cell, respectively. RESULTS RNA interference was successfully achieved in PED as witnessed by the specific knock-down of alpha1,3GT mRNA levels. Flow cytometric analysis using the Griffonia simplicifolia isolectin B4 lectin confirmed the suppression of alpha1,3GT activity as evidenced by decreased alpha-Gal. Functional relevance of the knock-down phenotype was illustrated by the finding that silenced PED were protected from cytotoxicity of NHS. Protection from NK-mediated cytotoxicity was not observed. CONCLUSIONS Our data are the first to demonstrate that RNA interference is a potent tool to down modulate alpha-Gal expression and to protect endothelial cells from complement-mediated cytotoxicity. Gene silencing by siRNA may represent a new approach for overcoming hyperacute and acute vascular rejection.
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Affiliation(s)
- Min Zhu
- Key Laboratory of Organ Transplantation, Ministry of Education Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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