1
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Yang S, Zhang M, Wei H, Zhang B, Peng J, Shang P, Sun S. Research prospects for kidney xenotransplantation: a bibliometric analysis. Ren Fail 2024; 46:2301681. [PMID: 38391160 PMCID: PMC10916899 DOI: 10.1080/0886022x.2023.2301681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/30/2023] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Xenograft kidney transplantation has been receiving increasing attention. The purpose of this study is to use bibliometric analysis to identify papers in this research field and explore their current status and development trends. METHODS Using the data in the Web of Science core database from Clarivate Analytics as the object of study, we used 'TS = Kidney OR Renal AND xenotransplantation' as the search term to find all literature from 1980 to 2 November 2022. RESULTS In total, 1005 articles were included. The United States has the highest number of publications and has made significant contributions in this field. Harvard University was at the forefront of this study. Professor Cooper has published 114 articles in this field. Xenotransplantation has the largest number of relevant articles. Transplantation was the most cited journal. High-frequency keywords illustrated the current state of development and future trends in xenotransplantation. The use of transgenic pigs and the development of coordinated co-stimulatory blockers have greatly facilitated progress in xenotransplantation research. We found that 'co-stimulation blockade', 'xenograft survival', 'pluripotent stem cell', 'translational research', and 'genetic engineering' were likely to be the focus of attention in the coming years. CONCLUSIONS This study screened global publications related to xenogeneic kidney transplantation; analyzed their literature metrology characteristics; identified the most cited articles in the research field; understood the current situation, hot spots, and trends of global research; and provided future development directions for researchers and practitioners.
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Affiliation(s)
- Shujun Yang
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Mingtao Zhang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, China
| | - Hao Wei
- Department of Urology, Qingdao University Hospital, Qingdao, China
| | - Bin Zhang
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Jiang Peng
- Department of Orthopaedics, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
| | - Panfeng Shang
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Shengkun Sun
- Department of Urology, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
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2
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Abe T, Endo K, Hanazono Y, Kobayashi E. In Vivo Luciferin-Luciferase Reaction in Micro-Mini Pigs Using Xenogeneic Rat Bone Marrow Transplantation. Int J Mol Sci 2024; 25:8609. [PMID: 39201296 PMCID: PMC11354750 DOI: 10.3390/ijms25168609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 07/27/2024] [Accepted: 08/06/2024] [Indexed: 09/02/2024] Open
Abstract
Luminescent technology based on the luciferin-luciferase reaction has been extensively employed across various disciplines as a quantitative imaging modality. Owing to its non-invasive imaging capacity, it has evolved as a valuable in vivo bioimaging tool, particularly in small animal models in fields such as gene and cell therapies. We have previously successfully generated rats with a systemic expression of the luciferase gene at the Rosa26 locus. In this study, we transplanted bone marrow from these rats into micro-mini pigs and used in vivo imaging to non-invasively analyze the dynamics of the transplanted cells. In addition, we established that the rat-to-pig transplantation system is a discordant system, similar to the pig-to-human transplantation system. Thus, rat-to-pig transplantation may provide a clinically appropriate large animal model for pig-to-human xenotransplantation.
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Affiliation(s)
- Tomoyuki Abe
- Center for Development of Advanced Medical Technology, Jichi Medical University, Tochigi 329-0498, Japan
- Division of Regenerative Medicine, Center for Molecular Medicine, Jichi Medical University, Tochigi 329-0498, Japan
| | - Kazuhiro Endo
- Center for Development of Advanced Medical Technology, Jichi Medical University, Tochigi 329-0498, Japan
| | - Yutaka Hanazono
- Center for Development of Advanced Medical Technology, Jichi Medical University, Tochigi 329-0498, Japan
- Division of Regenerative Medicine, Center for Molecular Medicine, Jichi Medical University, Tochigi 329-0498, Japan
| | - Eiji Kobayashi
- Center for Development of Advanced Medical Technology, Jichi Medical University, Tochigi 329-0498, Japan
- Department of Kidney Regenerative Medicine, The Jikei University School of Medicine, Tokyo 105-8461, Japan
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3
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Peterson L, Yacoub MH, Ayares D, Yamada K, Eisenson D, Griffith BP, Mohiuddin MM, Eyestone W, Venter JC, Smolenski RT, Rothblatt M. Physiological basis for xenotransplantation from genetically modified pigs to humans. Physiol Rev 2024; 104:1409-1459. [PMID: 38517040 PMCID: PMC11390123 DOI: 10.1152/physrev.00041.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 03/06/2024] [Accepted: 03/14/2024] [Indexed: 03/23/2024] Open
Abstract
The collective efforts of scientists over multiple decades have led to advancements in molecular and cellular biology-based technologies including genetic engineering and animal cloning that are now being harnessed to enhance the suitability of pig organs for xenotransplantation into humans. Using organs sourced from pigs with multiple gene deletions and human transgene insertions, investigators have overcome formidable immunological and physiological barriers in pig-to-nonhuman primate (NHP) xenotransplantation and achieved prolonged pig xenograft survival. These studies informed the design of Revivicor's (Revivicor Inc, Blacksburg, VA) genetically engineered pigs with 10 genetic modifications (10 GE) (including the inactivation of 4 endogenous porcine genes and insertion of 6 human transgenes), whose hearts and kidneys have now been studied in preclinical human xenotransplantation models with brain-dead recipients. Additionally, the first two clinical cases of pig-to-human heart xenotransplantation were recently performed with hearts from this 10 GE pig at the University of Maryland. Although this review focuses on xenotransplantation of hearts and kidneys, multiple organs, tissues, and cell types from genetically engineered pigs will provide much-needed therapeutic interventions in the future.
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Affiliation(s)
- Leigh Peterson
- United Therapeutics Corporation, Silver Spring, Maryland, United States
| | | | - David Ayares
- United Therapeutics Corporation, Silver Spring, Maryland, United States
| | - Kazuhiko Yamada
- Department of Surgery, Division of Transplantation, Johns Hopkins Medicine, Baltimore, Maryland, United States
| | - Daniel Eisenson
- Department of Surgery, Division of Transplantation, Johns Hopkins Medicine, Baltimore, Maryland, United States
| | - Bartley P Griffith
- University of Maryland Medical Center, Baltimore, Maryland, United States
| | | | - Willard Eyestone
- United Therapeutics Corporation, Silver Spring, Maryland, United States
| | - J Craig Venter
- J. Craig Venter Institute, Rockville, Maryland, United States
| | | | - Martine Rothblatt
- United Therapeutics Corporation, Silver Spring, Maryland, United States
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4
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Byrne GW, McGregor CGA. Anti-pig antibodies in swine veterinarian serum: Implications for clinical xenotransplantation. Xenotransplantation 2024; 31:e12865. [PMID: 38853364 DOI: 10.1111/xen.12865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/06/2024] [Accepted: 05/14/2024] [Indexed: 06/11/2024]
Abstract
Recent clinical xenotransplantation and human decedent studies demonstrate that clinical hyperacute rejection of genetically engineered porcine organs can be reliably avoided but that antibody mediated rejection (AMR) continues to limit graft survival. We previously identified porcine glycans and proteins which are immunogenic after cardiac xenotransplantation in non-human primates, but the clinical immune response to antigens present in glycan depleted triple knockout (TKO) donor pigs is poorly understood. In this study we use fluorescence barcoded human embryonic kidney cells (HEK) and HEK cell lines expressing porcine glycans (Gal and SDa) or proteins (tetraspanin-29 [CD9], membrane cofactor protein [CD46], protectin, membrane attack complex inhibition factor [CD59], endothelial cell protein C receptor, and Annexin A2) to screen antibody reactivity in human serum from 160 swine veterinarians, a serum source with potential occupational immune challenge from porcine tissues and pathogens. High levels of anti-Gal IgM were present in all samples and lower levels of anti-SDa IgM were present in 41% of samples. IgM binding to porcine proteins, primarily CD9 and CD46, previously identified as immunogenic in pig to non-human primate cardiac xenograft recipients, was detected in 28 of the 160 swine veterinarian samples. These results suggest that barcoded HEK cell lines expressing porcine protein antigens can be useful for screening human patient serum. A comprehensive analysis of sera from clinical xenotransplant recipients to define a panel of commonly immunogenic porcine antigens will likely be necessary to establish an array of porcine non-Gal antigens for effective monitoring of patient immune responses and allow earlier therapies to reverse AMR.
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Affiliation(s)
- Guerard W Byrne
- Twin Cities, Department of Surgery, Experimental Surgical Services, University of Minnesota, Minneapolis, Minnesota, USA
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Christopher G A McGregor
- Twin Cities, Department of Surgery, Experimental Surgical Services, University of Minnesota, Minneapolis, Minnesota, USA
- Institute of Cardiovascular Sciences, University College London, London, UK
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5
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Sachs DH. Xenotransplantation at 30 years - A personal reminiscence and some thoughts for the future. Xenotransplantation 2024; 31:e12846. [PMID: 38465797 DOI: 10.1111/xen.12846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 03/12/2024]
Affiliation(s)
- David H Sachs
- Departments of Surgery and Medicine, Columbia University Irving Medical Center, New York, USA
- Department of Surgery, Massachusetts General Hospital, Boston, USA
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6
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Xu H, He X. Developments in kidney xenotransplantation. Front Immunol 2024; 14:1242478. [PMID: 38274798 PMCID: PMC10808336 DOI: 10.3389/fimmu.2023.1242478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 12/13/2023] [Indexed: 01/27/2024] Open
Abstract
The search for kidney xenografts that are appropriate for patients with end-stage renal disease has been ongoing since the beginning of the last century. The major cause of xenograft loss is hyperacute and acute rejection, and this has almost been overcome via scientific progress. The success of two pre-clinical trials of α1,3-galactosyltransferase gene-knockout porcine kidneys in brain-dead patients in 2021 triggered research enthusiasm for kidney xenotransplantation. This minireview summarizes key issues from an immunological perspective: the discovery of key xenoantigens, investigations into key co-stimulatory signal inhibition, gene-editing technology, and immune tolerance induction. Further developments in immunology, particularly immunometabolism, might help promote the long-term outcomes of kidney xenografts.
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Affiliation(s)
| | - Xiaozhou He
- Urology Department, Third Affiliated Hospital of Soochow University, Changzhou, China
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7
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Loupy A, Goutaudier V, Giarraputo A, Mezine F, Morgand E, Robin B, Khalil K, Mehta S, Keating B, Dandro A, Certain A, Tharaux PL, Narula N, Tissier R, Giraud S, Hauet T, Pass HI, Sannier A, Wu M, Griesemer A, Ayares D, Tatapudi V, Stern J, Lefaucheur C, Bruneval P, Mangiola M, Montgomery RA. Immune response after pig-to-human kidney xenotransplantation: a multimodal phenotyping study. Lancet 2023; 402:1158-1169. [PMID: 37598688 DOI: 10.1016/s0140-6736(23)01349-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/16/2023] [Accepted: 06/26/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Cross-species immunological incompatibilities have hampered pig-to-human xenotransplantation, but porcine genome engineering recently enabled the first successful experiments. However, little is known about the immune response after the transplantation of pig kidneys to human recipients. We aimed to precisely characterise the early immune responses to the xenotransplantation using a multimodal deep phenotyping approach. METHODS We did a complete phenotyping of two pig kidney xenografts transplanted to decedent humans. We used a multimodal strategy combining morphological evaluation, immunophenotyping (IgM, IgG, C4d, CD68, CD15, NKp46, CD3, CD20, and von Willebrand factor), gene expression profiling, and whole-transcriptome digital spatial profiling and cell deconvolution. Xenografts before implantation, wild-type pig kidney autografts, as well as wild-type, non-transplanted pig kidneys with and without ischaemia-reperfusion were used as controls. FINDINGS The data collected from xenografts suggested early signs of antibody-mediated rejection, characterised by microvascular inflammation with immune deposits, endothelial cell activation, and positive xenoreactive crossmatches. Capillary inflammation was mainly composed of intravascular CD68+ and CD15+ innate immune cells, as well as NKp46+ cells. Both xenografts showed increased expression of genes biologically related to a humoral response, including monocyte and macrophage activation, natural killer cell burden, endothelial activation, complement activation, and T-cell development. Whole-transcriptome digital spatial profiling showed that antibody-mediated injury was mainly located in the glomeruli of the xenografts, with significant enrichment of transcripts associated with monocytes, macrophages, neutrophils, and natural killer cells. This phenotype was not observed in control pig kidney autografts or in ischaemia-reperfusion models. INTERPRETATION Despite favourable short-term outcomes and absence of hyperacute injuries, our findings suggest that antibody-mediated rejection in pig-to-human kidney xenografts might be occurring. Our results suggest specific therapeutic targets towards the humoral arm of rejection to improve xenotransplantation results. FUNDING OrganX and MSD Avenir.
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Affiliation(s)
- Alexandre Loupy
- Université Paris Cité, INSERM U970 PARCC, Paris Institute for Transplantation and Organ Regeneration, Paris, France; Department of Kidney Transplantation, Necker Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.
| | - Valentin Goutaudier
- Université Paris Cité, INSERM U970 PARCC, Paris Institute for Transplantation and Organ Regeneration, Paris, France; Department of Kidney Transplantation, Necker Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Alessia Giarraputo
- Université Paris Cité, INSERM U970 PARCC, Paris Institute for Transplantation and Organ Regeneration, Paris, France; Cardiovascular Pathology and Pathological Anatomy, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Fariza Mezine
- Université Paris Cité, INSERM U970 PARCC, Paris Institute for Transplantation and Organ Regeneration, Paris, France
| | - Erwan Morgand
- Université Paris Cité, INSERM U970 PARCC, Paris Institute for Transplantation and Organ Regeneration, Paris, France
| | - Blaise Robin
- Université Paris Cité, INSERM U970 PARCC, Paris Institute for Transplantation and Organ Regeneration, Paris, France
| | - Karen Khalil
- NYU Langone Transplant Institute, NYU Langone Health, New York, NY, USA; Department of Pharmacy, NYU Langone Health, New York, NY, USA
| | - Sapna Mehta
- NYU Langone Transplant Institute, NYU Langone Health, New York, NY, USA; Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Brendan Keating
- Division of Transplantation, Department of Surgery, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
| | | | - Anaïs Certain
- Université Paris Cité, INSERM U970 PARCC, Paris Institute for Transplantation and Organ Regeneration, Paris, France
| | - Pierre-Louis Tharaux
- Paris Cardiovascular Research Center, PARCC, INSERM U970, Université Paris Cité, Paris, France
| | - Navneet Narula
- NYU Langone Transplant Institute, NYU Langone Health, New York, NY, USA; Department of Pathology, NYU Grossman School of Medicine, New York, NY, USA
| | - Renaud Tissier
- Ecole Nationale Vétérinaire d'Alfort, IMRB, After ROSC Network, Maisons-Alfort, France
| | - Sébastien Giraud
- INSERM U1313, IRMETIST, Université de Poitiers et CHU de Poitiers, Poitiers, France
| | - Thierry Hauet
- INSERM U1313, IRMETIST, Université de Poitiers et CHU de Poitiers, Poitiers, France
| | - Harvey I Pass
- NYU Langone Transplant Institute, NYU Langone Health, New York, NY, USA; Department of Cardiothoracic Surgery, NYU Grossman School of Medicine, New York, NY, USA; Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Aurélie Sannier
- Université Paris Cité, INSERM U970 PARCC, Paris Institute for Transplantation and Organ Regeneration, Paris, France; Department of Pathology, Bichat Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Ming Wu
- NYU Langone Transplant Institute, NYU Langone Health, New York, NY, USA; Department of Pathology, NYU Grossman School of Medicine, New York, NY, USA
| | - Adam Griesemer
- NYU Langone Transplant Institute, NYU Langone Health, New York, NY, USA; Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | | | - Vasishta Tatapudi
- NYU Langone Transplant Institute, NYU Langone Health, New York, NY, USA; Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Jeffrey Stern
- NYU Langone Transplant Institute, NYU Langone Health, New York, NY, USA; Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Carmen Lefaucheur
- Université Paris Cité, INSERM U970 PARCC, Paris Institute for Transplantation and Organ Regeneration, Paris, France; Kidney Transplant Department, Saint-Louis Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Patrick Bruneval
- Université Paris Cité, INSERM U970 PARCC, Paris Institute for Transplantation and Organ Regeneration, Paris, France; Department of Pathology, Georges Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Massimo Mangiola
- NYU Langone Transplant Institute, NYU Langone Health, New York, NY, USA; Department of Pathology, NYU Grossman School of Medicine, New York, NY, USA
| | - Robert A Montgomery
- NYU Langone Transplant Institute, NYU Langone Health, New York, NY, USA; Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA
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8
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Chornenkyy Y, Yamamoto T, Hara H, Stowell SR, Ghiran I, Robson SC, Cooper DKC. Future prospects for the clinical transfusion of pig red blood cells. Blood Rev 2023; 61:101113. [PMID: 37474379 PMCID: PMC10968389 DOI: 10.1016/j.blre.2023.101113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/23/2023] [Accepted: 07/09/2023] [Indexed: 07/22/2023]
Abstract
Transfusion of allogeneic human red blood cell (hRBCs) is limited by supply and compatibility between individual donors and recipients. In situations where the blood supply is constrained or when no compatible RBCs are available, patients suffer. As a result, alternatives to hRBCs that complement existing RBC transfusion strategies are needed. Pig RBCs (pRBCs) could provide an alternative because of their abundant supply, and functional similarities to hRBCs. The ability to genetically modify pigs to limit pRBC immunogenicity and augment expression of human 'protective' proteins has provided major boosts to this research and opens up new therapeutic avenues. Although deletion of expression of xenoantigens has been achieved in genetically-engineered pigs, novel genetic methods are needed to introduce human 'protective' transgenes into pRBCs at the high levels required to prevent hemolysis and extend RBC survival in vivo. This review addresses recent progress and examines future prospects for clinical xenogeneic pRBC transfusion.
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Affiliation(s)
- Yevgen Chornenkyy
- Department of Pathology, McGaw Medical Center of Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Takayuki Yamamoto
- Center for Transplantation Science, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA; Division of Transplantation, Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.
| | - Hidetaka Hara
- College of Veterinary Medicine, Yunnan Agricultural University, Kunming, Yunnan, China
| | - Sean R Stowell
- Joint Program in Transfusion Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ionita Ghiran
- Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Simon C Robson
- Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - David K C Cooper
- Center for Transplantation Science, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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9
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Hess NR, Kaczorowski DJ. The history of cardiac xenotransplantation: early attempts, major advances, and current progress. FRONTIERS IN TRANSPLANTATION 2023; 2:1125047. [PMID: 38993853 PMCID: PMC11235224 DOI: 10.3389/frtra.2023.1125047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/16/2023] [Indexed: 07/13/2024]
Abstract
In light of ongoing shortage of donor organs for transplantation, alternative sources for donor organ sources have been examined to address this supply-demand mismatch. Of these, xenotransplantation, or the transplantation of organs across species, has been considered, with early applications dating back to the 1600s. The purpose of this review is to summarize the early experiences of xenotransplantation, with special focus on heart xenotransplantation. It aims to highlight the important ethical concerns of animal-to-human heart xenotransplantation, identify the key immunological barriers to successful long-term xenograft survival, as well as summarize the progress made in terms of development of pharmacological and genetic engineering strategies to address these barriers. Lastly, we discuss more recent attempts of porcine-to-human heart xenotransplantation, as well as provide some commentary on the current concerns and possible applications for future clinical heart xenotransplantation.
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Affiliation(s)
- Nicholas R. Hess
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - David J. Kaczorowski
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- University of Pittsburgh Medical Center Heart and Vascular Institute, Pittsburgh, PA, United States
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10
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Alhejailan RS, Garoffolo G, Raveendran VV, Pesce M. Cells and Materials for Cardiac Repair and Regeneration. J Clin Med 2023; 12:jcm12103398. [PMID: 37240504 DOI: 10.3390/jcm12103398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
After more than 20 years following the introduction of regenerative medicine to address the problem of cardiac diseases, still questions arise as to the best cell types and materials to use to obtain effective clinical translation. Now that it is definitively clear that the heart does not have a consistent reservoir of stem cells that could give rise to new myocytes, and that there are cells that could contribute, at most, with their pro-angiogenic or immunomodulatory potential, there is fierce debate on what will emerge as the winning strategy. In this regard, new developments in somatic cells' reprogramming, material science and cell biophysics may be of help, not only for protecting the heart from the deleterious consequences of aging, ischemia and metabolic disorders, but also to boost an endogenous regeneration potential that seems to be lost in the adulthood of the human heart.
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Affiliation(s)
- Reem Saud Alhejailan
- Cell Biology Department, King's Faisal Specialist Hospital & Research Center, Riyadh 11564, Saudi Arabia
| | - Gloria Garoffolo
- Unità di Ingegneria Tissutale Cardiovascolare, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy
| | - Vineesh Vimala Raveendran
- Cell Biology Department, King's Faisal Specialist Hospital & Research Center, Riyadh 11564, Saudi Arabia
| | - Maurizio Pesce
- Unità di Ingegneria Tissutale Cardiovascolare, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy
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11
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Cooper DKC, Pierson RN. Milestones on the path to clinical pig organ xenotransplantation. Am J Transplant 2023; 23:326-335. [PMID: 36775767 PMCID: PMC10127379 DOI: 10.1016/j.ajt.2022.12.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/20/2022] [Accepted: 12/28/2022] [Indexed: 01/19/2023]
Abstract
Progress in pig organ xenotransplantation has been made largely through (1) genetic engineering of the organ-source pig to protect its tissues from the human innate immune response, and (2) development of an immunosuppressive regimen based on blockade of the CD40/CD154 costimulation pathway to prevent the adaptive immune response. In the 1980s, after transplantation into nonhuman primates (NHPs), wild-type (genetically unmodified) pig organs were rejected within minutes or hours. In the 1990s, organs from pigs expressing a human complement-regulatory protein (CD55) transplanted into NHPs receiving intensive conventional immunosuppressive therapy functioned for days or weeks. When costimulation blockade was introduced in 2000, the adaptive immune response was suppressed more readily. The identification of galactose-α1,3-galactose as the major antigen target for human and NHP anti-pig antibodies in 1991 allowed for deletion of expression of galactose-α1,3-galactose in 2003, extending pig graft survival for up to 6 months. Subsequent gene editing to overcome molecular incompatibilities between the pig and primate coagulation systems proved additionally beneficial. The identification of 2 further pig carbohydrate xenoantigens allowed the production of 'triple-knockout' pigs that are preferred for clinical organ transplantation. These combined advances enabled the first clinical pig heart transplant to be performed and opened the door to formal clinical trials.
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Affiliation(s)
- David K C Cooper
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA.
| | - Richard N Pierson
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
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12
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Cooper DKC, Habibabady Z, Kinoshita K, Hara H, Pierson RN. The respective relevance of sensitization to alloantigens and xenoantigens in pig organ xenotransplantation. Hum Immunol 2023; 84:18-26. [PMID: 35817653 PMCID: PMC10154072 DOI: 10.1016/j.humimm.2022.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/14/2022] [Accepted: 06/20/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Antibody-mediated rejection is a major cause of graft injury and contributes to failure of pig xenografts in nonhuman primates (NHPs). Most 'natural' or elicited antibodies found in humans and NHPs are directed against pig glycan antigens, but antibodies binding to swine leukocyte antigens (SLA) have also been detected. Of clinical importance is (i) whether the presence of high levels of antibodies directed towards human leukocyte antigens (HLA) (i.e., high panel-reactive antibodies) would be detrimental to the outcome of a pig organ xenograft; and (ii) whether, in the event of sensitization to pig antigens, a subsequent allotransplant would be at increased risk of graft failure due to elicited anti-pig antibodies that cross-react with human HLA or other antigens. SUMMARY A literature review of pig-to-primate studies indicates that relatively few highly-HLA-sensitized humans have antibodies that cross-react with pigs, predicting that most would not be at increased risk of rejecting an organ xenograft. Furthermore, the existing evidence indicates that sensitization to pig antigens will probably not elicit increased alloantibody titers; if so, 'bridging' with a pig organ could be carried out without increased risk of subsequent antibody-mediated allograft failure. KEY MESSAGE These issues have important implications for the design and conduct of clinical xenotransplantation trials.
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Affiliation(s)
- D K C Cooper
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.
| | - Z Habibabady
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - K Kinoshita
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - H Hara
- Yunnan Xenotransplantation Engineering Research Center, Yunnan Agricultural University, Kunming, Yunnan, China
| | - R N Pierson
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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13
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Choe YH, Sorensen J, Garry DJ, Garry MG. Blastocyst complementation and interspecies chimeras in gene edited pigs. Front Cell Dev Biol 2022; 10:1065536. [PMID: 36568986 PMCID: PMC9773398 DOI: 10.3389/fcell.2022.1065536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 11/17/2022] [Indexed: 12/13/2022] Open
Abstract
The only curative therapy for many endstage diseases is allograft organ transplantation. Due to the limited supply of donor organs, relatively few patients are recipients of a transplanted organ. Therefore, new strategies are warranted to address this unmet need. Using gene editing technologies, somatic cell nuclear transfer and human induced pluripotent stem cell technologies, interspecies chimeric organs have been pursued with promising results. In this review, we highlight the overall technical strategy, the successful early results and the hurdles that need to be addressed in order for these approaches to produce a successful organ that could be transplanted in patients with endstage diseases.
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Affiliation(s)
- Yong-ho Choe
- Lillehei Heart Institute, University of Minnesota, Minneapolis, MN, United States
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Jacob Sorensen
- Lillehei Heart Institute, University of Minnesota, Minneapolis, MN, United States
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Daniel J. Garry
- Lillehei Heart Institute, University of Minnesota, Minneapolis, MN, United States
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
- Stem Cell Institute, University of Minnesota, Minneapolis, MN, United States
- Paul and Sheila Wellstone Muscular Dystrophy Center, University of Minnesota, Minneapolis, MN, United States
| | - Mary G. Garry
- Lillehei Heart Institute, University of Minnesota, Minneapolis, MN, United States
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
- Stem Cell Institute, University of Minnesota, Minneapolis, MN, United States
- Paul and Sheila Wellstone Muscular Dystrophy Center, University of Minnesota, Minneapolis, MN, United States
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14
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Delgado-Coello B, Navarro-Alvarez N, Mas-Oliva J. The Influence of Interdisciplinary Work towards Advancing Knowledge on Human Liver Physiology. Cells 2022; 11:cells11223696. [PMID: 36429123 PMCID: PMC9688355 DOI: 10.3390/cells11223696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/11/2022] [Accepted: 11/13/2022] [Indexed: 11/23/2022] Open
Abstract
The knowledge accumulated throughout the years about liver regeneration has allowed a better understanding of normal liver physiology, by reconstructing the sequence of steps that this organ follows when it must rebuild itself after being injured. The scientific community has used several interdisciplinary approaches searching to improve liver regeneration and, therefore, human health. Here, we provide a brief history of the milestones that have advanced liver surgery, and review some of the new insights offered by the interdisciplinary work using animals, in vitro models, tissue engineering, or mathematical models to help advance the knowledge on liver regeneration. We also present several of the main approaches currently available aiming at providing liver support and overcoming organ shortage and we conclude with some of the challenges found in clinical practice and the ethical issues that have concomitantly emerged with the use of those approaches.
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Affiliation(s)
- Blanca Delgado-Coello
- Department of Structural Biology and Biochemistry, Instituto de Fisiología Celular, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
- Correspondence:
| | - Nalu Navarro-Alvarez
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
- Departament of Molecular Biology, Universidad Panamericana School of Medicine, Mexico City 03920, Mexico
- Department of Surgery, University of Colorado Anschutz Medical Campus, Denver, CO 80045, USA
| | - Jaime Mas-Oliva
- Department of Structural Biology and Biochemistry, Instituto de Fisiología Celular, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
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15
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Eisenson DL, Hisadome Y, Santillan MR, Yamada K. Progress in islet xenotransplantation: Immunologic barriers, advances in gene editing, and tolerance induction strategies for xenogeneic islets in pig-to-primate transplantation. FRONTIERS IN TRANSPLANTATION 2022; 1:989811. [PMID: 38390384 PMCID: PMC10883655 DOI: 10.3389/frtra.2022.989811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Islet transplantation has emerged as a curative therapy for diabetes in select patients but remains rare due to shortage of suitable donor pancreases. Islet transplantation using porcine islets has long been proposed as a solution to this organ shortage. There have already been several small clinical trials using porcine islets in humans, but results have been mixed and further trials limited by calls for more rigorous pre-clinical data. Recent progress in heart and kidney xenograft transplant, including three studies of pig-to-human xenograft transplant, have recaptured popular imagination and renewed interest in clinical islet xenotransplantation. This review outlines immunologic barriers to islet transplantation, summarizes current strategies to overcome these barriers with a particular focus on approaches to induce tolerance, and describes an innovative strategy for treatment of diabetic nephropathy with composite islet-kidney transplantation.
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Affiliation(s)
- Daniel L Eisenson
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, United States
| | - Yu Hisadome
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, United States
| | | | - Kazuhiko Yamada
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, United States
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16
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Sykes M, Sachs DH. Progress in xenotransplantation: overcoming immune barriers. Nat Rev Nephrol 2022; 18:745-761. [PMID: 36198911 DOI: 10.1038/s41581-022-00624-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2022] [Indexed: 11/09/2022]
Abstract
A major limitation of organ allotransplantation is the insufficient supply of donor organs. Consequently, thousands of patients die every year while waiting for a transplant. Progress in xenotransplantation that has permitted pig organ graft survivals of years in non-human primates has led to renewed excitement about the potential of this approach to alleviate the organ shortage. In 2022, the first pig-to-human heart transplant was performed on a compassionate use basis, and xenotransplantation experiments using pig kidneys in deceased human recipients provided encouraging data. Many advances in xenotransplantation have resulted from improvements in the ability to genetically modify pigs using CRISPR-Cas9 and other methodologies. Gene editing has the capacity to generate pig organs that more closely resemble those of humans and are hence more physiologically compatible and less prone to rejection. Despite such modifications, immune responses to xenografts remain powerful and multi-faceted, involving innate immune components that do not attack allografts. Thus, the induction of innate and adaptive immune tolerance to prevent rejection while preserving the capacity of the immune system to protect the recipient and the graft from infection is desirable to enable clinical xenotransplantation.
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Affiliation(s)
- Megan Sykes
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA. .,Department of Surgery, Columbia University, New York, NY, USA. .,Department of Microbiology and Immunology, Columbia University, New York, NY, USA.
| | - David H Sachs
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA. .,Department of Surgery, Columbia University, New York, NY, USA.
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17
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Leonova EI, Reshetnikov VV, Sopova JV. CRISPR/Cas-edited pigs for personalized medicine: more than preclinical test-system. RESEARCH RESULTS IN PHARMACOLOGY 2022. [DOI: 10.3897/rrpharmacology.8.83872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Novel CRISPR-Cas-based genome editing tools made it feasible to introduce a variety of precise genomic modifications in the pig genome, including introducing multiple edits simultaneously, inserting long DNA sequences into specifically targeted loci, and performing nucleotide transitions and transversions. Pigs serve as a vital agricultural resource and animal model in biomedical studies, given their advantages over the other models. Pigs share high similarities to humans regarding body/organ size, anatomy, physiology, and a metabolic profile. The pig genome can be modified to carry the same genetic mutations found in humans to replicate inherited diseases to provide preclinical trials of drugs. Moreover, CRISPR-based modification of pigs antigen profile makes it possible to offer porcine organs for xenotransplantation with minimal transplant rejection responses. This review summarizes recent advances in endonuclease-mediated genome editing tools and research progress of genome-edited pigs as personalized test-systems for preclinical trials and as donors of organs with human-fit antigen profile.
Graphical abstract:
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18
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Montgomery RA, Mehta SA, Parent B, Griesemer A. Next steps for the xenotransplantation of pig organs into humans. Nat Med 2022; 28:1533-1536. [PMID: 35941375 DOI: 10.1038/s41591-022-01896-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Sapna A Mehta
- NYU Langone Transplant Institute, NYU Langone Health, New York, NY, USA
| | - Brendan Parent
- Department of Population Health, NYU Langone Health, New York, NY, USA
| | - Adam Griesemer
- NYU Langone Transplant Institute, NYU Langone Health, New York, NY, USA
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19
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Huang B, Zeng Z, Zhang CC, Schreiber ME, Li Z. Approaches to kidney replacement therapies—opportunities and challenges. Front Cell Dev Biol 2022; 10:953408. [PMID: 35982852 PMCID: PMC9380013 DOI: 10.3389/fcell.2022.953408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/01/2022] [Indexed: 11/29/2022] Open
Abstract
One out of seven people develop chronic kidney disease (CKD). When kidney function continues to decline, CKD patients may develop end-stage renal disease (ESRD, or kidney failure). More than 2 out of 1,000 adults develop ESRD and these patients must live on dialysis or get a kidney transplant to survive. Each year, more than $51 billion is spent to treat patients with ESRD in the United States. In addition, ESRD greatly reduces longevity and quality of life for patients. Compared to dialysis, kidney transplant offers the best chance of survival, but few donor organs are available. Thus, there is an urgent need for innovative solutions that address the shortage of kidneys available for transplantation. Here we summarize the status of current approaches that are being developed to solve the shortage of donor kidneys. These include the bioartificial kidney approach which aims to make a portable dialysis device, the recellularization approach which utilizes native kidney scaffold to make an engineered kidney, the stem cell-based approach which aims to generate a kidney de novo by recapitulating normal kidney organogenesis, the xenotransplantation approach which has the goal to make immunocompatible pig kidneys for transplantation, and the interspecies chimera approach which has potential to generate a human kidney in a host animal. We also discuss the interconnections among the different approaches, and the remaining challenges of translating these approaches into novel therapies.
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Affiliation(s)
- Biao Huang
- USC/UKRO Kidney Research Center, Division of Nephrology and Hypertension, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Deptartment of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Zipeng Zeng
- USC/UKRO Kidney Research Center, Division of Nephrology and Hypertension, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Deptartment of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Chennan C. Zhang
- USC/UKRO Kidney Research Center, Division of Nephrology and Hypertension, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Deptartment of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Megan E. Schreiber
- USC/UKRO Kidney Research Center, Division of Nephrology and Hypertension, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Deptartment of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Zhongwei Li
- USC/UKRO Kidney Research Center, Division of Nephrology and Hypertension, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Deptartment of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- *Correspondence: Zhongwei Li,
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20
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Kavarana S, Kwon JH, Zilinskas K, Kang L, Turek JW, Mohiuddin MM, Rajab TK. Recent advances in porcine cardiac xenotransplantation: from aortic valve replacement to heart transplantation. Expert Rev Cardiovasc Ther 2022; 20:597-608. [PMID: 35818712 DOI: 10.1080/14779072.2022.2100760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Cardiac xenotransplantation presents significant potential to the field of heart failure by addressing the high demand for donor organs. The availability of xenograft hearts would substantially augment the number of life-saving organs available to patients and may ultimately liberalize eligibility criteria for transplantation. AREAS COVERED In this review, we will discuss the need for cardiac xenotransplantation and the history of research and clinical practice in this field. Specifically, we address immunologic concepts and clinical lessons learned from heart valve replacement using xenogeneic tissues, the advancement of xenotransplantation using organs from genetically modified animals, and the progression of this research to the first-in-man pig-to-human heart transplantation. EXPERT OPINION Cardiac xenotransplantation holds tremendous promise, but the indications for this new treatment will need to be clearly defined because mechanical support with ventricular assist devices and total artificial hearts are increasingly successful alternatives for adults in heart failure. Cardiac xenotransplantation will also serve as temporary bridge to allotransplantation in babies with complex congenital heart disease who are too small for the currently available mechanical assist devices. Moreover, xenotransplantation of the part of the heart containing a heart valve could deliver growing heart valve implants for babies with severe heart valve dysfunction.
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21
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Whitworth KM, Green JA, Redel BK, Geisert RD, Lee K, Telugu BP, Wells KD, Prather RS. Improvements in pig agriculture through gene editing. CABI AGRICULTURE AND BIOSCIENCE 2022; 3:41. [PMID: 35755158 PMCID: PMC9209828 DOI: 10.1186/s43170-022-00111-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/12/2022] [Indexed: 05/06/2023]
Abstract
Genetic modification of animals via selective breeding is the basis for modern agriculture. The current breeding paradigm however has limitations, chief among them is the requirement for the beneficial trait to exist within the population. Desirable alleles in geographically isolated breeds, or breeds selected for a different conformation and commercial application, and more importantly animals from different genera or species cannot be introgressed into the population via selective breeding. Additionally, linkage disequilibrium results in low heritability and necessitates breeding over successive generations to fix a beneficial trait within a population. Given the need to sustainably improve animal production to feed an anticipated 9 billion global population by 2030 against a backdrop of infectious diseases and a looming threat from climate change, there is a pressing need for responsive, precise, and agile breeding strategies. The availability of genome editing tools that allow for the introduction of precise genetic modification at a single nucleotide resolution, while also facilitating large transgene integration in the target population, offers a solution. Concordant with the developments in genomic sequencing approaches, progress among germline editing efforts is expected to reach feverish pace. The current manuscript reviews past and current developments in germline engineering in pigs, and the many advantages they confer for advancing animal agriculture.
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Affiliation(s)
- Kristin M. Whitworth
- Division of Animal Science, College of Agriculture Food and Natural Resources, University of Missouri, 920 East Campus Drive, Columbia, MO 65211 USA
| | - Jonathan A. Green
- Division of Animal Science, College of Agriculture Food and Natural Resources, University of Missouri, 920 East Campus Drive, Columbia, MO 65211 USA
| | - Bethany K. Redel
- United States Department of Agriculture – Agriculture Research Service, Plant Genetics Research Unit, Columbia, MO 65211 USA
| | - Rodney D. Geisert
- Division of Animal Science, College of Agriculture Food and Natural Resources, University of Missouri, 920 East Campus Drive, Columbia, MO 65211 USA
| | - Kiho Lee
- Division of Animal Science, College of Agriculture Food and Natural Resources, University of Missouri, 920 East Campus Drive, Columbia, MO 65211 USA
| | - Bhanu P. Telugu
- Division of Animal Science, College of Agriculture Food and Natural Resources, University of Missouri, 920 East Campus Drive, Columbia, MO 65211 USA
| | - Kevin D. Wells
- Division of Animal Science, College of Agriculture Food and Natural Resources, University of Missouri, 920 East Campus Drive, Columbia, MO 65211 USA
| | - Randall S. Prather
- Division of Animal Science, College of Agriculture Food and Natural Resources, University of Missouri, 920 East Campus Drive, Columbia, MO 65211 USA
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22
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Eisenson DL, Hisadome Y, Yamada K. Progress in Xenotransplantation: Immunologic Barriers, Advances in Gene Editing, and Successful Tolerance Induction Strategies in Pig-To-Primate Transplantation. Front Immunol 2022; 13:899657. [PMID: 35663933 PMCID: PMC9157571 DOI: 10.3389/fimmu.2022.899657] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 04/20/2022] [Indexed: 02/05/2023] Open
Abstract
Organ transplantation is the most effective treatment for end stage organ failure, but there are not enough organs to meet burgeoning demand. One potential solution to this organ shortage is xenotransplantation using pig tissues. Decades of progress in xenotransplantation, accelerated by the development of rapid genome editing tools, particularly the advent of CRISPR-Cas9 gene editing technologies, have enabled remarkable advances in kidney and heart xenotransplantation in pig-to-nonhuman primates. These breakthroughs in large animal preclinical models laid the foundation for three recent pig-to-human transplants by three different groups: two kidney xenografts in brain dead recipients deemed ineligible for transplant, and one heart xenograft in the first clinical grade study of pig-to-human transplantation. However, despite tremendous progress, recent data including the first clinical case suggest that gene-modification alone will not overcome all xenogeneic immunologic barriers, and thus an active and innovative immunologic strategy is required for successful xenotransplantation. This review highlights xenogeneic immunologic barriers, advances in gene editing, and tolerance-inducing strategies in pig-to-human xenotransplantation.
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Affiliation(s)
- Daniel L Eisenson
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States.,Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, United States
| | - Yu Hisadome
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - Kazuhiko Yamada
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States.,Department of Surgery, Columbia University Irving Medical Center, New York, NY, United States
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23
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Montgomery RA, Stern JM, Lonze BE, Tatapudi VS, Mangiola M, Wu M, Weldon E, Lawson N, Deterville C, Dieter RA, Sullivan B, Boulton G, Parent B, Piper G, Sommer P, Cawthon S, Duggan E, Ayares D, Dandro A, Fazio-Kroll A, Kokkinaki M, Burdorf L, Lorber M, Boeke JD, Pass H, Keating B, Griesemer A, Ali NM, Mehta SA, Stewart ZA. Results of Two Cases of Pig-to-Human Kidney Xenotransplantation. N Engl J Med 2022; 386:1889-1898. [PMID: 35584156 DOI: 10.1056/nejmoa2120238] [Citation(s) in RCA: 172] [Impact Index Per Article: 86.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Xenografts from genetically modified pigs have become one of the most promising solutions to the dearth of human organs available for transplantation. The challenge in this model has been hyperacute rejection. To avoid this, pigs have been bred with a knockout of the alpha-1,3-galactosyltransferase gene and with subcapsular autologous thymic tissue. METHODS We transplanted kidneys from these genetically modified pigs into two brain-dead human recipients whose circulatory and respiratory activity was maintained on ventilators for the duration of the study. We performed serial biopsies and monitored the urine output and kinetic estimated glomerular filtration rate (eGFR) to assess renal function and xenograft rejection. RESULTS The xenograft in both recipients began to make urine within moments after reperfusion. Over the 54-hour study, the kinetic eGFR increased from 23 ml per minute per 1.73 m2 of body-surface area before transplantation to 62 ml per minute per 1.73 m2 after transplantation in Recipient 1 and from 55 to 109 ml per minute per 1.73 m2 in Recipient 2. In both recipients, the creatinine level, which had been at a steady state, decreased after implantation of the xenograft, from 1.97 to 0.82 mg per deciliter in Recipient 1 and from 1.10 to 0.57 mg per deciliter in Recipient 2. The transplanted kidneys remained pink and well-perfused, continuing to make urine throughout the study. Biopsies that were performed at 6, 24, 48, and 54 hours revealed no signs of hyperacute or antibody-mediated rejection. Hourly urine output with the xenograft was more than double the output with the native kidneys. CONCLUSIONS Genetically modified kidney xenografts from pigs remained viable and functioning in brain-dead human recipients for 54 hours, without signs of hyperacute rejection. (Funded by Lung Biotechnology.).
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Affiliation(s)
- Robert A Montgomery
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Jeffrey M Stern
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Bonnie E Lonze
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Vasishta S Tatapudi
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Massimo Mangiola
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Ming Wu
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Elaina Weldon
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Nikki Lawson
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Cecilia Deterville
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Rebecca A Dieter
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Brigitte Sullivan
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Gabriella Boulton
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Brendan Parent
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Greta Piper
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Philip Sommer
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Samantha Cawthon
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Erin Duggan
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - David Ayares
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Amy Dandro
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Ana Fazio-Kroll
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Maria Kokkinaki
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Lars Burdorf
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Marc Lorber
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Jef D Boeke
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Harvey Pass
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Brendan Keating
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Adam Griesemer
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Nicole M Ali
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Sapna A Mehta
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Zoe A Stewart
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
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Signaling cascades in the failing heart and emerging therapeutic strategies. Signal Transduct Target Ther 2022; 7:134. [PMID: 35461308 PMCID: PMC9035186 DOI: 10.1038/s41392-022-00972-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/13/2022] [Accepted: 03/20/2022] [Indexed: 12/11/2022] Open
Abstract
Chronic heart failure is the end stage of cardiac diseases. With a high prevalence and a high mortality rate worldwide, chronic heart failure is one of the heaviest health-related burdens. In addition to the standard neurohormonal blockade therapy, several medications have been developed for chronic heart failure treatment, but the population-wide improvement in chronic heart failure prognosis over time has been modest, and novel therapies are still needed. Mechanistic discovery and technical innovation are powerful driving forces for therapeutic development. On the one hand, the past decades have witnessed great progress in understanding the mechanism of chronic heart failure. It is now known that chronic heart failure is not only a matter involving cardiomyocytes. Instead, chronic heart failure involves numerous signaling pathways in noncardiomyocytes, including fibroblasts, immune cells, vascular cells, and lymphatic endothelial cells, and crosstalk among these cells. The complex regulatory network includes protein-protein, protein-RNA, and RNA-RNA interactions. These achievements in mechanistic studies provide novel insights for future therapeutic targets. On the other hand, with the development of modern biological techniques, targeting a protein pharmacologically is no longer the sole option for treating chronic heart failure. Gene therapy can directly manipulate the expression level of genes; gene editing techniques provide hope for curing hereditary cardiomyopathy; cell therapy aims to replace dysfunctional cardiomyocytes; and xenotransplantation may solve the problem of donor heart shortages. In this paper, we reviewed these two aspects in the field of failing heart signaling cascades and emerging therapeutic strategies based on modern biological techniques.
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Cross-Najafi AA, Lopez K, Isidan A, Park Y, Zhang W, Li P, Yilmaz S, Akbulut S, Ekser B. Current Barriers to Clinical Liver Xenotransplantation. Front Immunol 2022; 13:827535. [PMID: 35281047 PMCID: PMC8904558 DOI: 10.3389/fimmu.2022.827535] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/02/2022] [Indexed: 02/05/2023] Open
Abstract
Preclinical trials of pig-to-nonhuman primate liver xenotransplantation have recently achieved longer survival times. However, life-threatening thrombocytopenia and coagulation dysregulation continue to limit preclinical liver xenograft survival times to less than one month despite various genetic modifications in pigs and intensive pharmacological support. Transfusion of human coagulation factors and complex immunosuppressive regimens have resulted in substantial improvements in recipient survival. The fundamental biological mechanisms of thrombocytopenia and coagulation dysregulation remain incompletely understood. Current studies demonstrate that porcine von Willebrand Factor binds more tightly to human platelet GPIb receptors due to increased O-linked glycosylation, resulting in increased human platelet activation. Porcine liver sinusoidal endothelial cells and Kupffer cells phagocytose human platelets in an asialoglycoprotein receptor 1-dependent and CD40/CD154-dependent manner, respectively. Porcine Kupffer cells phagocytose human platelets via a species-incompatible SIRPα/CD47 axis. Key drivers of coagulation dysregulation include constitutive activation of the extrinsic clotting cascade due to failure of porcine tissue factor pathway inhibitor to repress recipient tissue factor. Additionally, porcine thrombomodulin fails to activate human protein C when bound by human thrombin, leading to a hypercoagulable state. Combined genetic modification of these key genes may mitigate liver xenotransplantation-induced thrombocytopenia and coagulation dysregulation, leading to greater recipient survival in pig-to-nonhuman primate liver xenotransplantation and, potentially, the first pig-to-human clinical trial.
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Affiliation(s)
- Arthur A. Cross-Najafi
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Kevin Lopez
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Abdulkadir Isidan
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Yujin Park
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Wenjun Zhang
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Ping Li
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Sezai Yilmaz
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Sami Akbulut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Burcin Ekser
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, United States
- *Correspondence: Burcin Ekser,
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26
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Kano M, Mizutani E, Homma S, Masaki H, Nakauchi H. Xenotransplantation and interspecies organogenesis: current status and issues. Front Endocrinol (Lausanne) 2022; 13:963282. [PMID: 35992127 PMCID: PMC9388829 DOI: 10.3389/fendo.2022.963282] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/06/2022] [Indexed: 12/04/2022] Open
Abstract
Pancreas (and islet) transplantation is the only curative treatment for type 1 diabetes patients whose β-cell functions have been abolished. However, the lack of donor organs has been the major hurdle to save a large number of patients. Therefore, transplantation of animal organs is expected to be an alternative method to solve the serious shortage of donor organs. More recently, a method to generate organs from pluripotent stem cells inside the body of other species has been developed. This interspecies organ generation using blastocyst complementation (BC) is expected to be the next-generation regenerative medicine. Here, we describe the recent advances and future prospects for these two approaches.
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Affiliation(s)
- Mayuko Kano
- Stem Cell Therapy Laboratory, Advanced Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Eiji Mizutani
- Stem Cell Therapy Laboratory, Advanced Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
- Laboratory of Stem Cell Therapy, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Shota Homma
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Hideki Masaki
- Stem Cell Therapy Laboratory, Advanced Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
- *Correspondence: Hiromitsu Nakauchi, ; Hideki Masaki,
| | - Hiromitsu Nakauchi
- Stem Cell Therapy Laboratory, Advanced Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, United States
- *Correspondence: Hiromitsu Nakauchi, ; Hideki Masaki,
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27
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The MHC-characterized Miniature Swine: Lessons Learned From a 40-Year Experience in Transplantation. Transplantation 2021; 106:928-937. [PMID: 34720103 DOI: 10.1097/tp.0000000000003977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Over the last 40 y, a specialized herd of miniature swine has been intentionally bred to develop lines of animals homozygous for the swine major histocompatibility complex (MHC), which have facilitated transplantation studies across reproducible MHC and minor antigen mismatch barriers. These MHC-characterized miniature swine (Mc-MS) have been used for the study of novel surgical techniques, various approaches to tolerance induction of solid organ and vascularized composite allografts, as well as studies of the immunobiology of allografts and xenografts. Mc-MS possess characteristics that are highly advantageous to these studies, and their continued use will likely continue to play an important role in bridging "bench-to-cage-to bedside" therapies in the field of transplantation. In this review, we highlight the seminal contributions of the Mc-MS model to the field and analyze their role in the broader context of large animal models in transplantation research.
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28
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Waffarn EE, Khosravi-Maharlooei M, Vecchione A, Shao S, Vishwasrao P, HÖlzl MA, Frangaj K, Sykes M, Li HW. Mixed xenogeneic porcine chimerism tolerizes human anti-pig natural antibody-producing cells in a humanized mouse model. Xenotransplantation 2021; 28:e12691. [PMID: 33904221 DOI: 10.1111/xen.12691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/11/2021] [Accepted: 04/09/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND A major obstacle to the success of organ transplantation from pigs to humans, necessitated by the shortage of human organs, is robust humoral immune rejection by pig-reactive human antibodies. Mixed xenogeneic hematopoietic chimerism induces xenoreactive B cell tolerance in rodents, but whether mixed pig/human chimerism could induce tolerance of human B cells to pig xenoantigens is unknown. METHODS We investigated this question using a humanized mouse model in which durable mixed (pig-human) xenogeneic chimerism can be established. RESULTS Human natural anti-pig cytotoxic antibodies, predominantly IgM, are detectable in non-chimeric humanized mouse serum, and pig-reactive antibodies were reduced in mixed chimeric versus non-chimeric humanized mice. This difference required persistent mixed chimerism and was not due to the adsorption of antibodies on pig cells in vivo. Furthermore, human B cells from spleens of mixed chimeric mice produced lower levels of anti-pig antibodies when stimulated in vitro compared with those from non-chimeric mice. CONCLUSIONS Our findings demonstrate that mixed chimerism reduces human natural antibodies to pig xenoantigens, providing the first in vivo evidence of human B cell tolerance induction by mixed xenogeneic chimerism and supporting further evaluation of this approach for inducing human B cell tolerance to xenografts.
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Affiliation(s)
- Elizabeth E Waffarn
- Department of Medicine, Columbia Center for Translational Immunology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Mohsen Khosravi-Maharlooei
- Department of Medicine, Columbia Center for Translational Immunology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Andrea Vecchione
- Department of Medicine, Columbia Center for Translational Immunology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Steven Shao
- Department of Medicine, Columbia Center for Translational Immunology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Paresh Vishwasrao
- Department of Medicine, Columbia Center for Translational Immunology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.,Department of Hematology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Markus A HÖlzl
- Department of Medicine, Columbia Center for Translational Immunology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Kristjana Frangaj
- Department of Medicine, Columbia Center for Translational Immunology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Megan Sykes
- Department of Medicine, Columbia Center for Translational Immunology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Hao Wei Li
- Department of Medicine, Columbia Center for Translational Immunology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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29
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Nguyen VK, Somfai T, Salamone D, Thu Huong VT, Le Thi Nguyen H, Huu QX, Hoang AT, Phan HT, Thi Pham YK, Pham LD. Optimization of donor cell cycle synchrony, maturation media and embryo culture system for somatic cell nuclear transfer in the critically endangered Vietnamese Ỉ pig. Theriogenology 2021; 166:21-28. [PMID: 33667861 DOI: 10.1016/j.theriogenology.2021.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/05/2021] [Accepted: 02/07/2021] [Indexed: 10/22/2022]
Abstract
Our aim was to establish an efficient culture system to produce embryos by SCNT of the endangered Vietnamese Ỉ pig. Reducing the serum concentration from 10.0% to 0.2% during culture efficiently synchronized Ỉ pig fibroblasts used as donor cells at the G0/G1 stage. Oocyte maturation in a defined porcine oocyte medium (POM) supplemented with EGF and gonadotrophins resulted in higher cleavage and blastocyst rates compared with a non-defined POM containing pig follicular fluid (but without EGF) and both the defined and non-defined variants of NCSU-37. For embryo culture PZM3 and PZM5 media were superior to NCSU-37, in terms of the percentage of cleaved embryos. Addition of serum to PZM3 medium on Day 5 of culture (Day 0 = SCNT) improved blastocyst development. When SCNT embryos were transferred at the blastocyst stage, 7 of 11 recipients became pregnant. However, live offspring were not obtained. In conclusion, we established a system for the production of Ỉ pig embryos by SCNT and achieved blastocyst production rate at 26.4% by improving culture systems for donor cells, oocytes and embryos culture. Transfer of embryos resulted in pregnancies; however, live offspring were not obtained.
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Affiliation(s)
- Van Khanh Nguyen
- Key Lab of Animal Cell Biotechnology, National Institute of Animal Science, Hanoi, Viet Nam
| | - Tamas Somfai
- Animal Breeding and Reproduction Research Division, Institute of Livestock and Grassland Science, NARO, Tsukuba, Ibaraki, 305-0901, Japan
| | - Daniel Salamone
- Facultad de Agronomía, Universidad de Buenos Aires, CONICET, Buenos Aires, Argentina
| | - Vu Thi Thu Huong
- Key Lab of Animal Cell Biotechnology, National Institute of Animal Science, Hanoi, Viet Nam
| | - Huong Le Thi Nguyen
- Key Lab of Animal Cell Biotechnology, National Institute of Animal Science, Hanoi, Viet Nam
| | - Quan Xuan Huu
- Key Lab of Animal Cell Biotechnology, National Institute of Animal Science, Hanoi, Viet Nam
| | - Au Thi Hoang
- Key Lab of Animal Cell Biotechnology, National Institute of Animal Science, Hanoi, Viet Nam
| | - Hieu Trung Phan
- Key Lab of Animal Cell Biotechnology, National Institute of Animal Science, Hanoi, Viet Nam
| | - Yen Kim Thi Pham
- Key Lab of Animal Cell Biotechnology, National Institute of Animal Science, Hanoi, Viet Nam
| | - Lan Doan Pham
- Key Lab of Animal Cell Biotechnology, National Institute of Animal Science, Hanoi, Viet Nam.
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30
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Niu D, Ma X, Yuan T, Niu Y, Xu Y, Sun Z, Ping Y, Li W, Zhang J, Wang T, Church GM. Porcine genome engineering for xenotransplantation. Adv Drug Deliv Rev 2021; 168:229-245. [PMID: 32275950 DOI: 10.1016/j.addr.2020.04.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/28/2020] [Accepted: 04/06/2020] [Indexed: 02/06/2023]
Abstract
The extreme shortage of human donor organs for treatment of patients with end-stage organ failures is well known. Xenotransplantation, which might provide unlimited organ supply, is a most promising strategy to solve this problem. Domestic pigs are regarded as ideal organ-source animals owing to similarity in anatomy, physiology and organ size to humans as well as high reproductive capacity and low maintenance cost. However, several barriers, which include immune rejection, inflammation and coagulative dysfunctions, as well as the cross-species transmission risk of porcine endogenous retrovirus, blocked the pig-to-human xenotransplantation. With the rapid development of genome engineering technologies and the potent immunosuppressive medications in recent years, these barriers could be eliminated through genetic modification of pig genome together with the administration of effective immunosuppressants. A number of candidate genes involved in the regulation of immune response, inflammation and coagulation have been explored to optimize porcine xenograft survival in non-human primate recipients. PERV inactivation in pigs has also been accomplished to firmly address the safety issue in pig-to-human xenotransplantation. Many encouraging preclinical milestones have been achieved with some organs surviving for years. Therefore, the clinical trials of some promising organs, such as islet, kidney and heart, are aimed to be launched in the near future.
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Affiliation(s)
- Dong Niu
- Key Laboratory of Applied Technology on Green-Eco-Healthy Animal Husbandry of Zhejiang Province, China-Australian Joint Laboratory for Animal Health Big Data Analytics, Zhejiang Provincial Engineering Laboratory for Animal Health Inspection & Internet Technology, College of Animal Science and Technology & College of Veterinary Medicine of Zhejiang A&F University, Hangzhou, P.R. China
| | - Xiang Ma
- Key Laboratory of Applied Technology on Green-Eco-Healthy Animal Husbandry of Zhejiang Province, China-Australian Joint Laboratory for Animal Health Big Data Analytics, Zhejiang Provincial Engineering Laboratory for Animal Health Inspection & Internet Technology, College of Animal Science and Technology & College of Veterinary Medicine of Zhejiang A&F University, Hangzhou, P.R. China
| | - Taoyan Yuan
- Institute of Animal Husbandry and Veterinary Science, Zhejiang Academy of Agricultural Sciences, Hangzhou, Zhejiang 310021, China
| | - Yifan Niu
- Nanjing Kgene Genetic Engineering Co., Ltd, Nanjing, Jiangsu 211300, China
| | - Yibin Xu
- College of Animal Sciences, Zhejiang University, Hangzhou, Zhejiang 310058, China
| | - Zhongxin Sun
- Cosmetic & Plastic Surgery Department, Hangzhou First People's Hospital, Hangzhou, Zhejiang 310006, China
| | - Yuan Ping
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, Zhejiang 310058, China
| | - Weifen Li
- College of Animal Sciences, Zhejiang University, Hangzhou, Zhejiang 310058, China
| | - Jufang Zhang
- Cosmetic & Plastic Surgery Department, Hangzhou First People's Hospital, Hangzhou, Zhejiang 310006, China.
| | - Tao Wang
- Nanjing Kgene Genetic Engineering Co., Ltd, Nanjing, Jiangsu 211300, China.
| | - George M Church
- Department of Genetics, Harvard Medical School, Boston, MA 02115, USA; Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA 02138, USA.
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31
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Galow AM, Goldammer T, Hoeflich A. Xenogeneic and Stem Cell-Based Therapy for Cardiovascular Diseases: Genetic Engineering of Porcine Cells and Their Applications in Heart Regeneration. Int J Mol Sci 2020; 21:ijms21249686. [PMID: 33353186 PMCID: PMC7766969 DOI: 10.3390/ijms21249686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 12/25/2022] Open
Abstract
Cardiovascular diseases represent a major health concern worldwide with few therapy options for ischemic injuries due to the limited regeneration potential of affected cardiomyocytes. Innovative cell replacement approaches could facilitate efficient regenerative therapy. However, despite extensive attempts to expand primary human cells in vitro, present technological limitations and the lack of human donors have so far prevented their broad clinical use. Cell xenotransplantation might provide an ethically acceptable unlimited source for cell replacement therapies and bridge the gap between waiting recipients and available donors. Pigs are considered the most suitable candidates as a source for xenogeneic cells and tissues due to their anatomical and physiological similarities with humans. The potential of porcine cells in the field of stem cell-based therapy and regenerative medicine is under intensive investigation. This review outlines the current progress and highlights the most promising approaches in xenogeneic cell therapy with a focus on the cardiovascular system.
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Affiliation(s)
- Anne-Marie Galow
- Institute of Genome Biology, Leibniz Institute for Farm Animal Biology, 18196 Dummerstorf, Germany; (T.G.); (A.H.)
- Correspondence: ; Tel.: +49-38208-68-723
| | - Tom Goldammer
- Institute of Genome Biology, Leibniz Institute for Farm Animal Biology, 18196 Dummerstorf, Germany; (T.G.); (A.H.)
- Molecular Biology and Fish Genetics Unit, Faculty of Agriculture and Environmental Sciences, University of Rostock, 18059 Rostock, Germany
| | - Andreas Hoeflich
- Institute of Genome Biology, Leibniz Institute for Farm Animal Biology, 18196 Dummerstorf, Germany; (T.G.); (A.H.)
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32
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Yilmaz S, Sahin T, Saglam K. What Are the Immune Obstacles to Liver Xenotransplantation Which Is Promising for Patients with Hepatocellular Carcinoma? J Gastrointest Cancer 2020; 51:1209-1214. [PMID: 32833222 DOI: 10.1007/s12029-020-00495-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE Liver transplantation is the most important achievement in the twentieth and twenty-first century. It is the gold standard treatment for hepatocellular carcinoma. However, it provides the best results when performed under strict selection criteria. Nevertheless, organ supply is overwhelmed by the number of patients on the waiting list. There are certain strategies to expand the donor pool such as split liver transplantation, use of extended criteria donors, and living donor liver transplantation. Xenotransplantation can also be a strategy in decreasing the organ shortage. We reviewed the current status of xenotransplantation. METHODS We evaluated the historical attempts of xenotransplantation to humans and also made a summary of the preclinical studies in the field. RESULTS Molecular biology and genetic engineering are developing with an incredible speed. There are great achievements made in cell therapy, 3D bioprinting of the organs, and ultimately xenotransplantation. There is a vast amount of problems to be handled before evaluating the efficacy of xenotransplantation in the treatment of hepatocellular carcinoma. Major problems include antibody-mediated rejection to antigens such as galactose ⍺1-3 galactose, N- glycolylneuraminic acid, β1,4-N-acetylgalactosaminyltransferase, lethal thrombocytopenia, and erythrocyte sequestration. Antibody mediated rejection to these specific antigens are addressed using gene editing technology including CRISPR Cas9, TALEN and other recombination methods. Although hyperacute rejection is reduced, long-term survival could not be achieved in experimental models. CONCLUSION The future is yet to come, there are developments made in the field of genetic editing, immunosuppressive medication, and pretransplant desensitization techniques. Therefore, we believe that xenotransplantation will be in clinical practice, at least for treatment of critically ill patients.
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Affiliation(s)
- Sezai Yilmaz
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, 244280, Malatya, Turkey.
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Elazig Yolu 10. Km, 44280, Malatya, Turkey.
| | - Tolga Sahin
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, 244280, Malatya, Turkey
| | - Kutay Saglam
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, 244280, Malatya, Turkey
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33
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Pierson RN, Fishman JA, Lewis GD, D'Alessandro DA, Connolly MR, Burdorf L, Madsen JC, Azimzadeh AM. Progress Toward Cardiac Xenotransplantation. Circulation 2020; 142:1389-1398. [PMID: 33017208 DOI: 10.1161/circulationaha.120.048186] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Consistent survival of life-supporting pig heart xenograft recipients beyond 90 days was recently reported using genetically modified pigs and a clinically applicable drug treatment regimen. If this remarkable achievement proves reproducible, published benchmarks for clinical translation of cardiac xenografts appear to be within reach. Key mechanistic insights are summarized here that informed recent pig design and therapeutic choices, which together appear likely to enable early clinical translation.
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Affiliation(s)
- Richard N Pierson
- Division of Cardiac Surgery, Department of Surgery (R.N.P., D.A.D., M.R.C., L.B., J.C.M., A.M.A.), Massachusetts General Hospital and Harvard University, Boston.,Center for Transplantation Sciences (R.N.P., J.A.F., M.R.C., L.B., J.C.M., A.M.A.), Massachusetts General Hospital and Harvard University, Boston
| | - Jay A Fishman
- Center for Transplantation Sciences (R.N.P., J.A.F., M.R.C., L.B., J.C.M., A.M.A.), Massachusetts General Hospital and Harvard University, Boston
| | - Gregory D Lewis
- Division of Cardiology, Department of Medicine (G.D.L.), Massachusetts General Hospital and Harvard University, Boston
| | - David A D'Alessandro
- Division of Cardiac Surgery, Department of Surgery (R.N.P., D.A.D., M.R.C., L.B., J.C.M., A.M.A.), Massachusetts General Hospital and Harvard University, Boston
| | - Margaret R Connolly
- Division of Cardiac Surgery, Department of Surgery (R.N.P., D.A.D., M.R.C., L.B., J.C.M., A.M.A.), Massachusetts General Hospital and Harvard University, Boston.,Center for Transplantation Sciences (R.N.P., J.A.F., M.R.C., L.B., J.C.M., A.M.A.), Massachusetts General Hospital and Harvard University, Boston
| | - Lars Burdorf
- Division of Cardiac Surgery, Department of Surgery (R.N.P., D.A.D., M.R.C., L.B., J.C.M., A.M.A.), Massachusetts General Hospital and Harvard University, Boston.,Center for Transplantation Sciences (R.N.P., J.A.F., M.R.C., L.B., J.C.M., A.M.A.), Massachusetts General Hospital and Harvard University, Boston
| | - Joren C Madsen
- Division of Cardiac Surgery, Department of Surgery (R.N.P., D.A.D., M.R.C., L.B., J.C.M., A.M.A.), Massachusetts General Hospital and Harvard University, Boston.,Center for Transplantation Sciences (R.N.P., J.A.F., M.R.C., L.B., J.C.M., A.M.A.), Massachusetts General Hospital and Harvard University, Boston
| | - Agnes M Azimzadeh
- Division of Cardiac Surgery, Department of Surgery (R.N.P., D.A.D., M.R.C., L.B., J.C.M., A.M.A.), Massachusetts General Hospital and Harvard University, Boston.,Center for Transplantation Sciences (R.N.P., J.A.F., M.R.C., L.B., J.C.M., A.M.A.), Massachusetts General Hospital and Harvard University, Boston
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34
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Ariyoshi Y, Takeuchi K, Pomposelli T, Ekanayake-Alper DK, Shimizu A, Boyd L, Estime E, Ohta M, Asfour A, Scott Arn J, Ayares D, Lorber M, Sykes M, Sachs D, Yamada K. Antibody reactivity with new antigens revealed in multi-transgenic triple knockout pigs may cause early loss of pig kidneys in baboons. Xenotransplantation 2020; 28:e12642. [PMID: 32909301 DOI: 10.1111/xen.12642] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 07/30/2020] [Accepted: 08/17/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Recent advances in gene editing technology have enabled the production of multi-knockout (KO) and transgenic pigs in order to overcome immunologic barriers in xenotransplantation (XTx). However, the genetic manipulations required to produce these changes may have the unintended consequence of producing or revealing neoantigens reactive with natural antibodies present in baboons. In this study, we examined whether the neoantigens that develop in multi-transgenic (mTg) GalT, Cytidine monophospho-N-acetylneuraminic acid hydroxylase (CMAH), β-1,4-N-acetyl-galactosaminyl transferase 2 (B4) KO pigs can cause rejection of xenografts in baboons. METHODS Five baboons that had <35% cytotoxicity against GalT-KO peripheral blood mononuclear cells (PBMCs) in a pre-screening assay received pig kidneys and vascularized thymic grafts (VT + K) from multi-transgenic hCD47, human thrombomodulin (hTBM), human endothelial protein C receptor (EPCR) with/without hCD46 and hCD55 with GalT-KO/NeuGC-KO/B4-KO (mTg Tri-KO) swine. In order to further examine the effects of anti-donor non-Gal natural antibody (nAb), anti-pig preformed IgM and IgG nAb binding against the GalT-KO PBMCs was compared with the donor-type PBMCs using donor pretransplant sera as well as 5 additional naïve baboon sera by flow cytometric analysis. RESULTS Five baboons that received VT + K grafts had stable renal function in the first 11 days (serum creatinine < 1.5 mg/dL). Two of the five baboons had higher binding of preformed IgG to mTg Tri-KO PBMCs than to GalT-KO PBMCs (mTg Tri-KO > GalT-KO), and they rejected their grafts at POD 20. In contrast, the other three baboons demonstrated either mTg Tri-KO = GalT-KO or mTg Tri-KO < GalT-KO, and they maintained renal function 43, 52, and 154 days without rejection. Among 10 baboon sera, two had less antibody binding against PBMCs that were syngeneic to the mTg Tri-KO than against GalT-KO PBMCs (mTg Tri-KO < GalT-KO); three had similar binding to mTg Tri-KO and GalT-KO PBMCs (mTg Tri-KO = GalT-KO); and five had higher binding to m Tg Tri-KO than to GalT-KO PBMCs (mTg Tri-KO > GalT-KO). CONCLUSIONS These data suggest that neoantigens associated with mTg Tri-KO promote acute xenograft rejection in a pig-to-baboon VT + K XTx model. The screening assays may be useful to select "safe" recipients to receive mTg Tri-KO kidneys.
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Affiliation(s)
- Yuichi Ariyoshi
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA
| | - Kazuhiro Takeuchi
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA
| | - Thomas Pomposelli
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA
| | - Dilrukshi K Ekanayake-Alper
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA
| | - Akira Shimizu
- Department of Pathology, Nippon Medical School, Bunkyo-ku, Japan
| | - Lennan Boyd
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA
| | - Ermance Estime
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA
| | - Mayu Ohta
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA
| | - Arsenoi Asfour
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA
| | - J Scott Arn
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA
| | | | - Marc Lorber
- Lung BioTechnology PBC, Silver Spring, MD, USA
| | - Megan Sykes
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA.,Department of Surgery, Columbia University Medical Center, New York, NY, USA.,Department of Microbiology and Immunology, Columbia University, New York, NY, USA
| | - David Sachs
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA.,Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Kazuhiko Yamada
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA.,Department of Surgery, Columbia University Medical Center, New York, NY, USA
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35
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Holzer PW, Chang E, Wicks J, Scobie L, Crossan C, Monroy R. Immunological response in cynomolgus macaques to porcine α-1,3 galactosyltransferase knockout viable skin xenotransplants-A pre-clinical study. Xenotransplantation 2020; 27:e12632. [PMID: 32781479 DOI: 10.1111/xen.12632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 07/02/2020] [Accepted: 07/10/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Allogeneic skin recovered from human deceased donors (HDD) has been a mainstay interim treatment for severe burns, but unfortunately risk of infectious disease and availability limitations exist. Genetically engineered ɑ-1,3 galactosyltransferase knockout (GalT-KO) porcine source animals for viable skin xenotransplants may provide a promising clinical alternative. METHODS Four cynomolgus macaque recipients received full-thickness surgical wounds to model the defects arising from excision of full-thickness burn injury and were treated with biologically active skin xenotransplants derived from GalT-KO, Designated Pathogen Free (DPF) miniature swine. Evaluations were conducted for safety, tolerability, and recipient immunological response. RESULTS All skin xenotransplants demonstrated prolonged survival, vascularity, and persistent dermal adhesion until the study endpoint at post-operative day 30. No adverse outcomes were observed during the study. Varying levels of epidermolysis coincided with histologic detection of CD4+ and CD8+ T cells, and other cellular infiltrates in the epidermis. Recipient sera IgM and IgG demonstrated significant antibody immune response to non-α-1,3-galactose porcine xenoantigens. Separately, specific wound healing mediators were quantified. Neither porcine cell migration nor PERV were detected in circulation or any visceral organs. CONCLUSIONS These results provide a detailed analysis of vital skin xenotransplants utilizing a non-human primate model to predict the anticipated immunological response of human patients. The lack of adverse rejection even in the presence of elevated Ig indicates this is a prospective therapeutic option. The findings reported here directly supported regulatory clearance for a first-in-man, Phase I xenotransplantation clinical trial.
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36
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Sykes M, Sachs DH. Transplanting organs from pigs to humans. Sci Immunol 2020; 4:4/41/eaau6298. [PMID: 31676497 DOI: 10.1126/sciimmunol.aau6298] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 10/02/2019] [Indexed: 12/20/2022]
Abstract
The success of organ transplantation is limited by the complications of immunosuppression, by chronic rejection, and by the insufficient organ supply, and thousands of patients die every year while waiting for a transplant. With recent progress in xenotransplantation permitting porcine organ graft survival of months or even years in nonhuman primates, there is renewed interest in its potential to alleviate the organ shortage. Many of these advances are the result of our heightened capacity to modify pigs genetically, particularly with the development of CRISPR-Cas9-based gene editing methodologies. Although this approach allows the engineering of pig organs that are less prone to rejection, the clinical application of xenotransplantation will require the ability to avoid the ravages of a multifaceted attack on the immune system while preserving the capacity to protect both the recipient and the graft from infectious microorganisms. In this review, we will discuss the potential and limitations of these modifications and how the engineering of the graft can be leveraged to alter the host immune response so that all types of immune attack are avoided.
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Affiliation(s)
- Megan Sykes
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Medical Center, NY, USA. .,Department of Microbiology and Immunology, Columbia University Medical Center, NY, USA.,Department of Surgery, Columbia University Medical Center, NY, USA
| | - David H Sachs
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Medical Center, NY, USA.,Department of Surgery, Columbia University Medical Center, NY, USA
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Hein R, Sake HJ, Pokoyski C, Hundrieser J, Brinkmann A, Baars W, Nowak-Imialek M, Lucas-Hahn A, Figueiredo C, Schuberth HJ, Niemann H, Petersen B, Schwinzer R. Triple (GGTA1, CMAH, B2M) modified pigs expressing an SLA class I low phenotype-Effects on immune status and susceptibility to human immune responses. Am J Transplant 2020; 20:988-998. [PMID: 31733031 DOI: 10.1111/ajt.15710] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/07/2019] [Accepted: 11/01/2019] [Indexed: 02/06/2023]
Abstract
Porcine xenografts lacking swine leukocyte antigen (SLA) class I are thought to be protected from human T cell responses. We have previously shown that SLA class I deficiency can be achieved in pigs by CRISPR/Cas9-mediated deletion of β2 -microglobulin (B2M). Here, we characterized another line of genetically modified pigs in which targeting of the B2M locus did not result in complete absence of B2M and SLA class I but rather in significantly reduced expression levels of both molecules. Residual SLA class I was functionally inert, because no proper differentiation of the CD8+ T cell subset was observed in B2Mlow pigs. Cells from B2Mlow pigs were less capable in triggering proliferation of human peripheral blood mononuclear cells in vitro, which was mainly due to the nonresponsiveness of CD8+ T cells. Nevertheless, cytotoxic effector cells developing from unaffected cell populations (eg, CD4+ T cells, natural killer cells) lysed targets from both SLA class I+ wildtype and SLA class Ilow pigs with similar efficiency. These data indicate that the absence of SLA class I is an effective approach to prevent the activation of human CD8+ T cells during the induction phase of an anti-xenograft response. However, cytotoxic activity of cells during the effector phase cannot be controlled by this approach.
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Affiliation(s)
- Rabea Hein
- Transplant Laboratory, Department of General-, Visceral-, and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Hendrik J Sake
- Department of Biotechnology, Institute of Farm Animal Genetics, Friedrich-Loeffler-Institute, Mariensee, Neustadt, Germany
| | - Claudia Pokoyski
- Transplant Laboratory, Department of General-, Visceral-, and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Joachim Hundrieser
- Transplant Laboratory, Department of General-, Visceral-, and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Antje Brinkmann
- Transplant Laboratory, Department of General-, Visceral-, and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Wiebke Baars
- Transplant Laboratory, Department of General-, Visceral-, and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Monika Nowak-Imialek
- Department of Biotechnology, Institute of Farm Animal Genetics, Friedrich-Loeffler-Institute, Mariensee, Neustadt, Germany
| | - Andrea Lucas-Hahn
- Department of Biotechnology, Institute of Farm Animal Genetics, Friedrich-Loeffler-Institute, Mariensee, Neustadt, Germany
| | | | | | - Heiner Niemann
- Department of Biotechnology, Institute of Farm Animal Genetics, Friedrich-Loeffler-Institute, Mariensee, Neustadt, Germany
| | - Björn Petersen
- Department of Biotechnology, Institute of Farm Animal Genetics, Friedrich-Loeffler-Institute, Mariensee, Neustadt, Germany
| | - Reinhard Schwinzer
- Transplant Laboratory, Department of General-, Visceral-, and Transplantation Surgery, Hannover Medical School, Hannover, Germany
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Suzuki N. Glycan diversity in the course of vertebrate evolution. Glycobiology 2020; 29:625-644. [PMID: 31287538 DOI: 10.1093/glycob/cwz038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/29/2019] [Accepted: 05/15/2019] [Indexed: 11/12/2022] Open
Abstract
Vertebrates are estimated to have arisen over 500 million years ago in the Cambrian Period. Species that survived the Big Five extinction events at a global scale underwent repeated adaptive radiations along with habitat expansions from the sea to the land and sky. The development of the endoskeleton and neural tube enabled more complex body shapes. At the same time, vertebrates became suitable for the invasion and proliferation of foreign organisms. Adaptive immune systems were acquired for responses to a wide variety of pathogens, and more sophisticated systems developed during the evolution of mammals and birds. Vertebrate glycans consist of common core structures and various elongated structures, such as Neu5Gc, Galα1-3Gal, Galα1-4Gal, and Galβ1-4Gal epitopes, depending on the species. During species diversification, complex glycan structures were generated, maintained or lost. Whole-genome sequencing has revealed that vertebrates harbor numerous and even redundant glycosyltransferase genes. The production of various glycan structures is controlled at the genetic level in a species-specific manner. Because cell surface glycans are often targets of bacterial and viral infections, glycan structural diversity is presumed to be protective against infections. However, the maintenance of apparently redundant glycosyltransferase genes and investment in species-specific glycan structures, even in higher vertebrates with highly developed immune systems, are not well explained. This fact suggests that glycans play important roles in unknown biological processes.
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Affiliation(s)
- Noriko Suzuki
- Graduate School of Science and Technology, Niigata University, Niigata, Japan
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Lu T, Yang B, Wang R, Qin C. Xenotransplantation: Current Status in Preclinical Research. Front Immunol 2020; 10:3060. [PMID: 32038617 PMCID: PMC6989439 DOI: 10.3389/fimmu.2019.03060] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 12/16/2019] [Indexed: 12/13/2022] Open
Abstract
The increasing life expectancy of humans has led to a growing numbers of patients with chronic diseases and end-stage organ failure. Transplantation is an effective approach for the treatment of end-stage organ failure; however, the imbalance between organ supply and the demand for human organs is a bottleneck for clinical transplantation. Therefore, xenotransplantation might be a promising alternative approach to bridge the gap between the supply and demand of organs, tissues, and cells; however, immunological barriers are limiting factors in clinical xenotransplantation. Thanks to advances in gene-editing tools and immunosuppressive therapy as well as the prolonged xenograft survival time in pig-to-non-human primate models, clinical xenotransplantation has become more viable. In this review, we focus on the evolution and current status of xenotransplantation research, including our current understanding of the immunological mechanisms involved in xenograft rejection, genetically modified pigs used for xenotransplantation, and progress that has been made in developing pig-to-pig-to-non-human primate models. Three main types of rejection can occur after xenotransplantation, which we discuss in detail: (1) hyperacute xenograft rejection, (2) acute humoral xenograft rejection, and (3) acute cellular rejection. Furthermore, in studies on immunological rejection, genetically modified pigs have been generated to bridge cross-species molecular incompatibilities; in the last decade, most advances made in the field of xenotransplantation have resulted from the production of genetically engineered pigs; accordingly, we summarize the genetically modified pigs that are currently available for xenotransplantation. Next, we summarize the longest survival time of solid organs in preclinical models in recent years, including heart, liver, kidney, and lung xenotransplantation. Overall, we conclude that recent achievements and the accumulation of experience in xenotransplantation mean that the first-in-human clinical trial could be possible in the near future. Furthermore, we hope that xenotransplantation and various approaches will be able to collectively solve the problem of human organ shortage.
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Affiliation(s)
- Tianyu Lu
- Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences and Comparative Medicine Center, Peking Union Medical College, Beijing, China.,NHC Key Laboratory of Human Disease Comparative Medicine, The Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.,Beijing Engineering Research Center for Experimental Animal Models of Human Critical Diseases, Beijing, China
| | - Bochao Yang
- Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences and Comparative Medicine Center, Peking Union Medical College, Beijing, China.,NHC Key Laboratory of Human Disease Comparative Medicine, The Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.,Beijing Engineering Research Center for Experimental Animal Models of Human Critical Diseases, Beijing, China
| | - Ruolin Wang
- Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences and Comparative Medicine Center, Peking Union Medical College, Beijing, China.,NHC Key Laboratory of Human Disease Comparative Medicine, The Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.,Beijing Engineering Research Center for Experimental Animal Models of Human Critical Diseases, Beijing, China
| | - Chuan Qin
- Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences and Comparative Medicine Center, Peking Union Medical College, Beijing, China.,NHC Key Laboratory of Human Disease Comparative Medicine, The Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.,Beijing Engineering Research Center for Experimental Animal Models of Human Critical Diseases, Beijing, China
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Holzer P, Adkins J, Moulton K, Zhu L, Monroy R, Cetrulo CL. Vital, Porcine, Gal-Knockout Skin Transplants Provide Efficacious Temporary Closure of Full-Thickness Wounds: Good Laboratory Practice-Compliant Studies in Nonhuman Primates. J Burn Care Res 2020; 41:229-240. [DOI: 10.1093/jbcr/irz124] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AbstractVital, genetically engineered porcine skin transplants have long been regarded as a promising treatment option for severe burn wounds. The objective of this two-part, preclinical study was to evaluate the ability of vital, split-thickness skin xenotransplants derived from designated pathogen-free, alpha 1,3 galactosyltransferase knockout miniature swine to provide temporary wound closure of full-thickness wound defects intended to model severe and extensive, deep partial- and full-thickness burn wounds. In part 1 of the study, four full-thickness wound defects were introduced in four cynomolgus macaques recipients and, then engrafted with two xenografts and two allografts to achieve temporary wound closure. On POD-15, autografts were used to achieve definitive wound closure and were observed until POD-22. In part 2 of the study, four additional subjects each received two full-thickness wound defects, followed by two xenografts to achieve temporary wound closure, and were observed postoperatively for 30 days without further intervention. All grafts were assessed for signs of adherence to the wound bed, vascularity, and signs of immune rejection via gross clinical and histological methods. Xenograft and allograft comparators were equivalent in part 1, and later autografts were otherwise indistinguishable. In part 2, all xenotransplants demonstrated adherence, vascularity, and survival until POD-30. These were unexpected results that exceed previously published findings in similar models. Furthermore, the ensuing GLP-study report directly supported regulatory clearance, permitting a phase I clinical trial. This solution holds great promise as an alternative to human cadaver allograft, the current standard of care for the treatment of severe burns.
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Affiliation(s)
| | - Jon Adkins
- XenoTherapeutics, Grantham, New Hampshire
| | | | | | - Rod Monroy
- XenoTherapeutics, Grantham, New Hampshire
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41
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Yamada K, Ariyoshi Y, Pomposelli T, Sekijima M. Co-transplantation of Vascularized Thymic Graft with Kidney in Pig-to-Nonhuman Primates for the Induction of Tolerance Across Xenogeneic Barriers. Methods Mol Biol 2020; 2110:151-171. [PMID: 32002908 DOI: 10.1007/978-1-0716-0255-3_11] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Using advanced gene editing technologies, xenotransplantation from multi-transgenic alpha-1,3-galactosyltransferase knockout pigs has demonstrated marked prolongation of renal xenograft survival, ranging from days to greater than several months for life-supporting kidneys and >2 years in a heterotopic non-life-supporting cardiac xenograft model. However, continuous administration of multiple immunosuppressive drugs continues to be required, and attempts to taper immunosuppression have been unsuccessful. These data are consistent with previous reports indicating that the human-anti-porcine T cell response is similar or stronger than that across allogeneic barriers. Due to the strength of both the innate and adaptive immune responses in xenotransplantation, the level of continuous immunosuppression needed to control these responses and prolong xenograft survival has been associated with prohibitive morbidity and mortality. These facts provide compelling rationale to pursue a clinically applicable strategy for the induction of tolerance.Mixed chimerism and thymic tissue transplantation have both achieved xenogeneic tolerance in pig-to-mouse models, and both have recently been extended to pig-to-baboon models. Although these strategies are promising in small animal models, neither direct intravenous injection of porcine bone marrow cells nor direct fetal thymic tissue transplantation into recipients was able to achieve >2 days chimerism following BM Tx or the engraftment of thymic tissues across xenogeneic barriers in pig-to-nonhuman primate models. Several innovative procedures have been largely developed by Kazuhiko Yamada to overcome these failures. These include vascularized thymic transplantation, combined with either thymokidney (TK) or vascularized thymic lobe (VTL) transplantation. Utilizing the strategy of transplanting vascularized thymic grafts with kidney from the same GalT-KO donor without further gene modification, we have achieved longer than 6 months survival of life-supporting kidneys in a baboon. Notably, the recipient became donor specific unresponsive and developed new thymic emigrants. In this chapter, we introduce a brief summary of our achievements to date toward the successful induction of tolerance by utilizing our novel strategy of vascularized thymic transplantation (including thymokidney transplantation), as well as describe the step-by-step methodology of surgical and in vitro procedures which are required for this experiment.
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Affiliation(s)
- Kazuhiko Yamada
- Yamada Laboratory, Department of Surgery, Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY, USA.
| | - Yuichi Ariyoshi
- Yamada Laboratory, Department of Surgery, Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY, USA
| | - Thomas Pomposelli
- Yamada Laboratory, Department of Surgery, Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY, USA
| | - Mitsuhiro Sekijima
- Yamada Laboratory, Department of Surgery, Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY, USA
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Abstract
There is a well-known worldwide shortage of deceased human donor organs for clinical transplantation. The transplantation of organs from genetically engineered pigs may prove an alternative solution. In the past 5 years, there have been sequential advances that have significantly increased pig graft survival in nonhuman primates. This progress has been associated with (1) the availability of increasingly sophisticated genetically engineered pigs; (2) the introduction of novel immunosuppressive agents, particularly those that block the second T-cell signal (costimulation blockade); (3) a better understanding of the inflammatory response to pig xenografts; and (4) increasing experience in the management of nonhuman primates with pig organ or cell grafts. The range of investigations required in experimental studies has increased. The standard immunologic assays are still carried out, but increasingly investigations aimed toward other pathobiologic barriers (e.g., coagulation dysregulation and inflammation) have become more important in determining injury to the graft.Now that prolonged graft survival, extending to months or even years, is increasingly being obtained, the function of the grafts can be more reliably assessed. If the source pigs are bred and housed under biosecure isolation conditions, and weaned early from the sow, most microorganisms can be eradicated from the herd. The potential risk of porcine endogenous retrovirus (PERV) infection remains unknown, but is probably small. Attention is being directed toward the selection of patients for the first clinical trials of xenotransplantation.
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Affiliation(s)
- David K C Cooper
- Xenotransplantation Program, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
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Cooper DKC, Hara H, Iwase H, Yamamoto T, Jagdale A, Kumar V, Mannon RB, Hanaway MJ, Anderson DJ, Eckhoff DE. Clinical Pig Kidney Xenotransplantation: How Close Are We? J Am Soc Nephrol 2019; 31:12-21. [PMID: 31792154 DOI: 10.1681/asn.2019070651] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Patients with ESKD who would benefit from a kidney transplant face a critical and continuing shortage of kidneys from deceased human donors. As a result, such patients wait a median of 3.9 years to receive a donor kidney, by which time approximately 35% of transplant candidates have died while waiting or have been removed from the waiting list. Those of blood group B or O may experience a significantly longer waiting period. This problem could be resolved if kidneys from genetically engineered pigs offered an alternative with an acceptable clinical outcome. Attempts to accomplish this have followed two major paths: deletion of pig xenoantigens, as well as insertion of "protective" human transgenes to counter the human immune response. Pigs with up to nine genetic manipulations are now available. In nonhuman primates, administering novel agents that block the CD40/CD154 costimulation pathway, such as an anti-CD40 mAb, suppresses the adaptive immune response, leading to pig kidney graft survival of many months without features of rejection (experiments were terminated for infectious complications). In the absence of innate and adaptive immune responses, the transplanted pig kidneys have generally displayed excellent function. A clinical trial is anticipated within 2 years. We suggest that it would be ethical to offer a pig kidney transplant to selected patients who have a life expectancy shorter than the time it would take for them to obtain a kidney from a deceased human donor. In the future, the pigs will also be genetically engineered to control the adaptive immune response, thus enabling exogenous immunosuppressive therapy to be significantly reduced or eliminated.
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Affiliation(s)
| | - Hidetaka Hara
- Division of Transplantation, Department of Surgery and
| | - Hayato Iwase
- Division of Transplantation, Department of Surgery and
| | | | | | - Vineeta Kumar
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Roslyn Bernstein Mannon
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Tatapudi VS, Montgomery RA. Therapeutic Modulation of the Complement System in Kidney Transplantation: Clinical Indications and Emerging Drug Leads. Front Immunol 2019; 10:2306. [PMID: 31632397 PMCID: PMC6779821 DOI: 10.3389/fimmu.2019.02306] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 09/12/2019] [Indexed: 12/20/2022] Open
Abstract
The complement system is integral to innate immunity, and it is an essential deterrent against infections. The complement apparatus comprises of >30 fluid-phase and surface-bound elements that also engage with the adaptive immune system, clear harmful immune complexes, and orchestrates several salutary physiological processes. An imbalance in the complement system's tightly regulated machinery and the consequent unrestrained complement activation underpins the pathogenesis of a wide array of inflammatory, autoimmune, neoplastic and degenerative disorders. Antibody-mediated rejection is a leading cause of graft failure in kidney transplantation. Complement-induced inflammation and endothelial injury have emerged as the primary mechanisms in the pathogenesis of this form of rejection. Researchers in the field of transplantation are now trying to define the role and efficacy of complement targeting agents in the prevention and treatment of rejection and other complement related conditions that lead to graft injury. Here, we detail the current clinical indications for complement therapeutics and the scope of existing and emerging therapies that target the complement system, focusing on kidney transplantation.
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45
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Nomura S, Ariyoshi Y, Watanabe H, Pomposelli T, Takeuchi K, Garcia G, Tasaki M, Ayares D, Sykes M, Sachs D, Johnson R, Yamada K. Transgenic expression of human CD47 reduces phagocytosis of porcine endothelial cells and podocytes by baboon and human macrophages. Xenotransplantation 2019; 27:e12549. [PMID: 31495971 DOI: 10.1111/xen.12549] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/12/2019] [Accepted: 07/24/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Our initial studies utilizing a galactosyl-α1-3-galactosyltransferase gene knockout (GalTKO) pig-to-baboon renal transplant model demonstrated that the early development of nephrotic syndrome has been a significant obstacle to the long-term survival of baboon recipients. We have recently documented that sphingomyelin phosphodiesterase-3 (SMPDL3b) and CD80 expressed on podocytes in porcine kidney grafts contribute to this complication. We have hypothesized that one regulator of immune function is CD47 and that incompatibilities in CD47 between pig and baboon could potentially affect macrophage function, increasing the susceptibility of the kidney grafts to immunologically induced injury. METHODS In order to address this hypothesis in vitro, we isolated and cultured porcine podocytes and ECs from GalTKO alone, human CD47 (hCD47)/hCD55 expressing transgenic (Tg) GalTKO swine, and GalTKO hCD46/hCD55 Tg swine along with baboon or human macrophages. RESULTS We found that baboon macrophages phagocytosed porcine ECs in a similar manner to human macrophages, and this response was significantly reduced when porcine ECs and podocytes expressed hCD47/hCD55 but not hCD46/hCD55 without hCD47. Furthermore, masking hCD47 by anti-hCD47 antibody on hCD47/hCD55Tg ECs restored phagocytosis. These results are consistent with the hypothesis that CD47 incompatibility plays an important role in promoting macrophage phagocytosis of endogenous cells from the transplanted kidney. CONCLUSIONS The similar levels of phagocytosis of porcine cells by baboon and human macrophages suggest that the expression of hCD47Tg on glomerular cells in donor porcine kidneys may prove to be a key strategy for preventing proteinuria following kidney xenotransplantation in a pig-to-human as well as a pig-to-baboon model.
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Affiliation(s)
- Shunichiro Nomura
- Columbia Center for Translational Immunology (CCTI)/Surgery, Columbia University Medical Center, New York, NY, USA
| | - Yuichi Ariyoshi
- Columbia Center for Translational Immunology (CCTI)/Surgery, Columbia University Medical Center, New York, NY, USA
| | - Hironosuke Watanabe
- Columbia Center for Translational Immunology (CCTI)/Surgery, Columbia University Medical Center, New York, NY, USA
| | - Thomas Pomposelli
- Columbia Center for Translational Immunology (CCTI)/Surgery, Columbia University Medical Center, New York, NY, USA
| | - Kazuhiro Takeuchi
- Columbia Center for Translational Immunology (CCTI)/Surgery, Columbia University Medical Center, New York, NY, USA
| | - Gabriela Garcia
- Department of Medicine, University of Colorado Hospital- Renal Clinic/Nephrology, Aurora, CO, USA
| | - Masayuki Tasaki
- Department of Urology, Graduate School of Medicine, Niigata University, Niigata, Japan
| | | | - Megan Sykes
- Columbia Center for Translational Immunology (CCTI)/Surgery, Columbia University Medical Center, New York, NY, USA
| | - David Sachs
- Columbia Center for Translational Immunology (CCTI)/Surgery, Columbia University Medical Center, New York, NY, USA
| | - Richard Johnson
- Department of Medicine, University of Colorado Hospital- Renal Clinic/Nephrology, Aurora, CO, USA
| | - Kazuhiko Yamada
- Columbia Center for Translational Immunology (CCTI)/Surgery, Columbia University Medical Center, New York, NY, USA
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Abstract
PURPOSE OF REVIEW Xenotransplantation offers the opportunity to alleviate the imbalance between the demand of patients with end stage organ failure and the supply of organs available for transplantation but remains aspirational. This review highlights how collaboration between academia and industry are essential for success. RECENT FINDINGS The science of xenotransplantation has accelerated in recent years with key discoveries in genetic engineering, enabling disruption of genes facilitating rejection, and transgenic expression of desired human genes. Combined with similar progress directed toward induction of transplant tolerance, the stage has been set for meaningful progress. These advances are reviewed in detail elsewhere in this volume and argue that the breakthroughs needed to deliver substantial cross-species organ survival have largely been achieved, heralding a liminal stage of human xenotransplantation. However, xenotransplantation as a meaningful therapy for medically refractory end organ failure will not be realized through scientific innovation alone. The advent of broadly available, therapeutic xenogeneic tissues requires extensive development and regulatory expertise; the biotechnology/pharmaceutical industry can provide extensive resources and expertise in those essential areas. SUMMARY Successful delivery of xenotransplantation as an available therapy for curing end stage organ failure is best accomplished through partnership and collaboration between academia and industry.
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Wu G, Bazer FW. Application of new biotechnologies for improvements in swine nutrition and pork production. J Anim Sci Biotechnol 2019; 10:28. [PMID: 31019685 PMCID: PMC6474057 DOI: 10.1186/s40104-019-0337-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 02/17/2019] [Indexed: 12/18/2022] Open
Abstract
Meeting the increasing demands for high-quality pork protein requires not only improved diets but also biotechnology-based breeding to generate swine with desired production traits. Biotechnology can be classified as the cloning of animals with identical genetic composition or genetic engineering (via recombinant DNA technology and gene editing) to produce genetically modified animals or microorganisms. Cloning helps to conserve species and breeds, particularly those with excellent biological and economical traits. Recombinant DNA technology combines genetic materials from multiple sources into single cells to generate proteins. Gene (genome) editing involves the deletion, insertion or silencing of genes to produce: (a) genetically modified pigs with important production traits; or (b) microorganisms without an ability to resist antimicrobial substances. Current gene-editing tools include the use of zinc finger nuclease (ZFN), transcription activator-like effector nuclease (TALEN), or clustered regularly interspaced short palindromic repeats-associated nuclease-9 (CRISPR/Cas9) as editors. ZFN, TALEN, or CRISPR/Cas9 components are delivered into target cells through transfection (lipid-based agents, electroporation, nucleofection, or microinjection) or bacteriophages, depending on cell type and plasmid. Compared to the ZFN and TALEN, CRISPR/Cas9 offers greater ease of design and greater flexibility in genetic engineering, but has a higher frequency of off-target effects. To date, genetically modified pigs have been generated to express bovine growth hormone, bacterial phytase, fungal carbohydrases, plant and C. elagan fatty acid desaturases, and uncoupling protein-1; and to lack myostatin, α-1,3-galactosyltransferase, or CD163 (a cellular receptor for the "blue ear disease" virus). Biotechnology holds promise in improving the efficiency of swine production and developing alternatives to antibiotics in the future.
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Affiliation(s)
- Guoyao Wu
- Department of Animal Science and Center for Animal Biotechnology and Genomics, Texas A&M University, College Station, TX 77843-2471 USA
| | - Fuller W Bazer
- Department of Animal Science and Center for Animal Biotechnology and Genomics, Texas A&M University, College Station, TX 77843-2471 USA
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Cooper DKC, Hara H, Iwase H, Yamamoto T, Li Q, Ezzelarab M, Federzoni E, Dandro A, Ayares D. Justification of specific genetic modifications in pigs for clinical organ xenotransplantation. Xenotransplantation 2019; 26:e12516. [PMID: 30989742 PMCID: PMC10154075 DOI: 10.1111/xen.12516] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 03/11/2019] [Accepted: 03/22/2019] [Indexed: 12/17/2022]
Abstract
Xenotransplantation research has made considerable progress in recent years, largely through the increasing availability of pigs with multiple genetic modifications. We suggest that a pig with nine genetic modifications (ie, currently available) will provide organs (initially kidneys and hearts) that would function for a clinically valuable period of time, for example, >12 months, after transplantation into patients with end-stage organ failure. The national regulatory authorities, however, will likely require evidence, based on in vitro and/or in vivo experimental data, to justify the inclusion of each individual genetic modification in the pig. We provide data both from our own experience and that of others on the advantages of pigs in which (a) all three known carbohydrate xenoantigens have been deleted (triple-knockout pigs), (b) two human complement-regulatory proteins (CD46, CD55) and two human coagulation-regulatory proteins (thrombomodulin, endothelial cell protein C receptor) are expressed, (c) the anti-apoptotic and "anti-inflammatory" molecule, human hemeoxygenase-1 is expressed, and (d) human CD47 is expressed to suppress elements of the macrophage and T-cell responses. Although many alternative genetic modifications could be made to an organ-source pig, we suggest that the genetic manipulations we identify above will all contribute to the success of the initial clinical pig kidney or heart transplants, and that the beneficial contribution of each individual manipulation is supported by considerable experimental evidence.
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Affiliation(s)
- David K C Cooper
- Xenotransplantation Program, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Hidetaka Hara
- Xenotransplantation Program, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Hayato Iwase
- Xenotransplantation Program, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Takayuki Yamamoto
- Xenotransplantation Program, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Qi Li
- Xenotransplantation Program, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.,Second Affiliated Hospital, University of South China, Hengyang City, China
| | - Mohamed Ezzelarab
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elena Federzoni
- Exponential Biotherapeutic Engineering, United Therapeutics, LaJolla, California
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Ladowski J, Martens G, Estrada J, Tector M, Tector J. The desirable donor pig to eliminate all xenoreactive antigens. Xenotransplantation 2019; 26:e12504. [PMID: 30825348 DOI: 10.1111/xen.12504] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 12/17/2018] [Accepted: 01/29/2019] [Indexed: 02/05/2023]
Abstract
The humoral barrier has been the limiting factor in moving xenotransplantation towards the clinic. Improvements in somatic cell nuclear transfer and genome editing, particularly CRISPR-Cas9, have made it possible to create pigs with multiple glycan xenoantigen deletions for the purposes of reducing xenoreactive antibody binding to the xenografted organ. Recent studies have also considered the aetiology and existence of antibodies directed at the swine leucocyte antigen (SLA) complex, and potential genetic engineering strategies to avoid these antibodies. Evaluation of xenoreactive antibody binding is very important for the advancement of xenotransplantation, because if patients do not have any detectable xenoreactive antibody, then it is reasonable to expect that cellular rejection and not antibody-mediated rejection (AMR) will be the next hurdle to clinical application.
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Affiliation(s)
- Joseph Ladowski
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Greg Martens
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jose Estrada
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Matthew Tector
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Joseph Tector
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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Dong Z, Coates D, Liu Q, Sun H, Li C. Quantitative proteomic analysis of deer antler stem cells as a model of mammalian organ regeneration. J Proteomics 2019; 195:98-113. [DOI: 10.1016/j.jprot.2019.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 12/25/2018] [Accepted: 01/07/2019] [Indexed: 12/18/2022]
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