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Hu X, Geng Z, Gonelle C, Hawthrone WJ, Deng S, Buhler L. International Human Xenotransplantation Inventory: A 10-y Follow-up. Transplantation 2022; 106:1713-1716. [PMID: 34982756 DOI: 10.1097/tp.0000000000004016] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Following the recommendations by a panel of experts gathered by the World Health Organization in 2005, an inventory was established to collect practices of human xenotransplantation worldwide (www.humanxenotransplant.org). The website was activated in October 2006, in collaboration with the International Xenotransplantation Association, the University Hospital Geneva, and the World Health Organization. A first report on the collected xenotransplantation activities was published in 2010 in the journal Transplantation. In 2020, the website was redesigned, and its hosting and management were transferred to the Sichuan Provincial People's Hospital. METHODS We collected information from publications in scientific journals, presentations at international congresses, the internet, and declarations of International Xenotransplantation Association members on xenotransplantation procedures in humans performed over the past 10 y. RESULTS A total of 5 new applications of human xenotransplantation were identified, with pig as source animal in all applications. The procedures involved transplantation of islets of Langerhans, skin, cornea, and choroid plexus cells. The treatments were performed in China, United States, New Zealand, and Argentina. No major complications or deaths were reported. CONCLUSIONS Several clinical applications of cell or tissue xenotransplantation are ongoing around the world. Compared with the previous reported period (1995-2010, with 29 activities, mostly without governmental regulation), the recent number of clinical activities was reduced, and all were officially approved. This information should be used to inform healthcare officials, staff, and the public with the objective of encouraging good practices based on internationally harmonized guidelines driven by initiatives such as the Changsha Communiqué.
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Affiliation(s)
- Xiaowei Hu
- Faculty of Medicine, University of Geneva, Geneva, Switzerland. Sichuan Provincial People's Hospital, Chengdu, People's Republic of China. Cantonal Hospital Fribourg, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland. Department of Surgery, Western Clinical School, University of Sydney, Sydney, NSW, Australia
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Yoon CH, Choi HJ, Kim MK. Corneal xenotransplantation: Where are we standing? Prog Retin Eye Res 2021; 80:100876. [PMID: 32755676 PMCID: PMC7396149 DOI: 10.1016/j.preteyeres.2020.100876] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/23/2020] [Accepted: 06/04/2020] [Indexed: 02/08/2023]
Abstract
The search for alternatives to allotransplants is driven by the shortage of corneal donors and is demanding because of the limitations of the alternatives. Indeed, current progress in genetically engineered (GE) pigs, the introduction of gene-editing technology by clustered regularly interspaced short palindromic repeats (CRISPR)-Cas9, and advanced immunosuppressants have made xenotransplantation a possible option for a human trial. Porcine corneal xenotransplantation is considered applicable because the eye is regarded as an immune-privileged site. Furthermore, recent non-human primate studies have shown long-term survival of porcine xenotransplants in keratoplasty. Herein, corneal immune privilege is briefly introduced, and xenogeneic reactions are compared with allogeneic reactions in corneal transplantation. This review describes the current knowledge on special issues of xenotransplantation, xenogeneic rejection mechanisms, current immunosuppressive regimens of corneal xenotransplantation, preclinical efficacy and safety data of corneal xenotransplantation, and updates of the regulatory framework to conduct a clinical trial on corneal xenotransplantation. We also discuss barriers that might prevent xenotransplantation from becoming common practice, such as ethical dilemmas, public concerns on xenotransplantation, and the possible risk of xenozoonosis. Given that the legal definition of decellularized porcine cornea (DPC) lies somewhere between a medical device and a xenotransplant, the preclinical efficacy and clinical trial data using DPC are included. The review finally provides perspectives on the current standpoint of corneal xenotransplantation in the fields of regenerative medicine.
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Affiliation(s)
- Chang Ho Yoon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea; Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Hyuk Jin Choi
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea; Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Ophthalmology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
| | - Mee Kum Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea; Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
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3
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Scobie L, Schuurman HJ. Introduction to the theme issue on regulatory aspects of xenotransplantation. Xenotransplantation 2020; 27:e12620. [PMID: 32537837 DOI: 10.1111/xen.12620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 01/03/2023]
Affiliation(s)
- Linda Scobie
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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4
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Cooper DKC. Clinical trials of xenotransplantation: The need for a worldwide registry. Xenotransplantation 2020; 27:e12598. [DOI: 10.1111/xen.12598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 03/21/2020] [Accepted: 04/08/2020] [Indexed: 11/29/2022]
Affiliation(s)
- David K. C. Cooper
- Xenotransplantation Program Department of Surgery University of Alabama at Birmingham Birmingham AL USA
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5
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Stem cells and genome editing: approaches to tissue regeneration and regenerative medicine. J Hum Genet 2017; 63:165-178. [PMID: 29192237 DOI: 10.1038/s10038-017-0348-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/20/2017] [Accepted: 08/21/2017] [Indexed: 12/20/2022]
Abstract
Understanding the basis of regeneration of each tissue and organ, and incorporating this knowledge into clinical treatments for degenerative tissues and organs in patients, are major goals for researchers in regenerative biology. Here we provide an overview of current work, from high-regeneration animal models, to stem cell-based culture models, transplantation technologies, large-animal chimeric models, and programmable nuclease-based genome-editing technologies. Three-dimensional culture generating organoids, which represents intact tissue/organ identity including cell fate and morphology are getting more general approaches in the fields by taking advantage of embryonic stem cells, induced pluripotent stem cells and adult stem cells. The organoid culture system potentially has profound impact on the field of regenerative medicine. We also emphasize that the large animal model, in particular pig model would be a hope to manufacture humanized organs in in vivo empty (vacant) niche, which now potentially allows not only appropriate cell fate identity but nearly the same property as human organs in size. Therefore, integrative and collaborative researches across different fields might be critical to the aims needed in clinical trial.
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Cooper DK, Bottino R, Gianello P, Graham M, Hawthorne WJ, Kirk AD, Korsgren O, Park CG, Weber C. First update of the International Xenotransplantation Association consensus statement on conditions for undertaking clinical trials of porcine islet products in type 1 diabetes-Chapter 4: pre-clinical efficacy and complication data required to justify a c. Xenotransplantation 2016; 23:46-52. [DOI: 10.1111/xen.12226] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 02/08/2016] [Indexed: 12/23/2022]
Affiliation(s)
| | - Rita Bottino
- Institute for Cellular Therapeutics; Allegheny-Singer Research Institute; Pittsburgh PA USA
| | - Pierre Gianello
- Faculté de Medecine; Laboratory of Experimental Surgery; Université Catholique de Louvain; Brussels Belgium
| | - Melanie Graham
- Department of Surgery; Preclinical Research Center; University of Minnesota; St. Paul MN USA
| | - Wayne J. Hawthorne
- Department of Surgery; University of Sydney at Westmead Hospital; Westmead NSW Australia
| | - Allan D. Kirk
- Department of Surgery; Duke University Medical School; Durham NC USA
| | - Olle Korsgren
- Department of Immunology, Genetics, and Pathology; Uppsala University; Uppsala Sweden
| | - Chung-Gyu Park
- Department of Microbiology and Immunology; Department of Biomedical Sciences; Xenotransplantation Research Center; College of Medicine; Seoul National University; Seoul South Korea
| | - Collin Weber
- Department of Surgery; Emory University School of Medicine; Atlanta GA USA
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7
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Regulatory aspects of clinical xenotransplantation. Int J Surg 2015; 23:312-321. [DOI: 10.1016/j.ijsu.2015.09.051] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 08/29/2015] [Accepted: 09/03/2015] [Indexed: 01/08/2023]
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8
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Robyn MP, Newman AP, Amato M, Walawander M, Kothe C, Nerone JD, Pomerantz C, Behravesh CB, Biggs HM, Dahlgren FS, Pieracci EG, Whitfield Y, Sider D, Ozaldin O, Berger L, Buck PA, Downing M, Blog D. Q Fever Outbreak Among Travelers to Germany Who Received Live Cell Therapy — United States and Canada, 2014. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2015; 64:1071-3. [DOI: 10.15585/mmwr.mm6438a3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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9
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Robyn MP, Newman AP, Amato M, Walawander M, Kothe C, Nerone JD, Pomerantz C, Behravesh CB, Biggs HM, Dahlgren FS, Pieracci EG, Whitfield Y, Sider D, Ozaldin O, Berger L, Buck PA, Downing M, Blog D. Q fever outbreak among travelers to Germany associated with live cell therapy - United States and Canada, 2014: a co-publication. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2015; 41:223-226. [PMID: 29769916 PMCID: PMC5864281 DOI: 10.14745/ccdr.v41i10a01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
WHAT IS ALREADY KNOWN ON THIS TOPIC? Q fever is a zoonotic disease caused by Coxiella burnetii and is usually transmitted through inhalation of air contaminated with animal excreta. The disease is considered to be underdiagnosed because symptoms are nonspecific and can vary from patient to patient, making diagnosis difficult. WHAT IS ADDED BY THIS REPORT? During September-October 2014, the New York State Department of Health identified Q fever in five patients with exposure to a treatment known as live cell therapy, an alternative medicine practice involving injections of fetal sheep cells, which is a type of xenotransplantation. Investigation revealed that a group of U.S. residents traveled to Germany twice a year to receive this treatment. WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICE? Clinicians should consider zoonotic diseases, such as Q fever, in patients whose history includes receipt of a treatment known as live cell therapy. International travel for xenotransplantation procedures can facilitate transmission of zoonotic disease.
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Affiliation(s)
- MP Robyn
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA
- New York State Department of Health, Albany, NY
| | - AP Newman
- New York State Department of Health, Albany, NY
| | - M Amato
- Erie County Department of Health, Buffalo, NY
| | | | - C Kothe
- Ulster County Department of Health and Mental Health, Ellenville, NY
| | - JD Nerone
- Ulster County Department of Health and Mental Health, Ellenville, NY
| | - C Pomerantz
- Ulster County Department of Health and Mental Health, Ellenville, NY
| | - CB Behravesh
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - HM Biggs
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - FS Dahlgren
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - EG Pieracci
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - D Sider
- Public Health Ontario, Toronto, ON
| | | | - L Berger
- Toronto Public Health, Toronto, ON
| | - PA Buck
- Centre for Food-borne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
| | - M Downing
- Saint Joseph’s Health Centre, Toronto, ON
- Department of Medicine, University of Toronto, Toronto, ON
| | - D Blog
- New York State Department of Health, Albany, NY
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Xenozoonoses. LABORATORY ANIMAL MEDICINE 2015. [PMCID: PMC7150069 DOI: 10.1016/b978-0-12-409527-4.00029-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Immunological and technical advances have led to tremendous increases in the number of people potentially able to benefit from allotransplantation. Ironically, it is the success of the field that has led to a renewed interest in xenotransplantation during the past several decades. To a large part, this has occurred because of the great scarcity of human organ and tissue donors. However, it has expanded to include the use of cells from animals into humans such as porcine islet cells for diabetes or extracorporeal perfusion of human blood through animal organs or cells. Similar to allotransplantation, issues regarding transmission of infections from the graft to the human recipient were brought up for consideration with these procedures in the 1990s (Michaels and Simmons, 1994; Chapman et al., 1995; Hammel et al., 1998; Fishman et al., 1998). A risk for infection exists with the use of any biologic agent regardless of whether it is from a human or an animal source. Accordingly, transmission of infections from human organs, tissues, or cells is a well-recognized cause of disease after allotransplantation (Ison and Grossi, 2013; Green and Michaels, 2012). As the human graft shortage continues, newer cellular therapies are explored. Thus, attention continues to be given to the potential use of xenogeneic organs, tissues, or cells for human maladies through xenotransplantation. The potential for novel zoonotic infections to emerge because of xenotransplantation (xenozoonoses or xenosis) led to a debate on whether the field should be permitted to progress. This chapter reviews the issues of xenotransplantation related to infections from animals to humans. Lessons learned from infections with prior nonhuman primate xenotransplantation and human allotransplantation are used to help inform about risks with newer xenogeneic procedures. In addition, information on known zoonoses is reviewed to better develop constructs to decrease the hazard of infection with these novel procedures.
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Michel SG, Madariaga MLL, Villani V, Shanmugarajah K. Current progress in xenotransplantation and organ bioengineering. Int J Surg 2014; 13:239-244. [PMID: 25496853 DOI: 10.1016/j.ijsu.2014.12.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 11/30/2014] [Accepted: 12/07/2014] [Indexed: 12/25/2022]
Abstract
Organ transplantation represents a unique method of treatment to cure people with end-stage organ failure. Since the first successful organ transplant in 1954, the field of transplantation has made great strides forward. However, despite the ability to transform and save lives, transplant surgery is still faced with a fundamental problem the number of people requiring organ transplants is simply higher than the number of organs available. To put this in stark perspective, because of this critical organ shortage 18 people every day in the United States alone die on a transplant waiting list (U.S. Department of Health & Human Services, http://organdonor.gov/about/data.html). To address this problem, attempts have been made to increase the organ supply through xenotransplantation and more recently, bioengineering. Here we trace the development of both fields, discuss their current status and highlight limitations going forward. Ultimately, lessons learned in each field may prove widely applicable and lead to the successful development of xenografts, bioengineered constructs, and bioengineered xeno-organs, thereby increasing the supply of organs for transplantation.
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Affiliation(s)
- Sebastian G Michel
- Transplantation Biology Research Center, Massachusetts General Hospital, Building 149, 13th Street, Charlestown, Boston, MA 02114, USA; Department of Cardiac Surgery, Ludwig-Maximilians-Universität München, Munich D-81377, Germany.
| | - Maria Lucia L Madariaga
- Transplantation Biology Research Center, Massachusetts General Hospital, Building 149, 13th Street, Charlestown, Boston, MA 02114, USA; Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02129, USA
| | - Vincenzo Villani
- Transplantation Biology Research Center, Massachusetts General Hospital, Building 149, 13th Street, Charlestown, Boston, MA 02114, USA
| | - Kumaran Shanmugarajah
- Transplantation Biology Research Center, Massachusetts General Hospital, Building 149, 13th Street, Charlestown, Boston, MA 02114, USA; Division of Surgery, Imperial College London, Exhibition Road, London SW7 2AZ, United Kingdom.
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Schuurman HJ. Commentary on “Characterization of acid and non-acid glycosphingolipids of porcine heart valve cusps as potential immune targets in biological heart valve grafts” (by Barone et al.): bioprosthetic products from animal origin are xenotransplantation produc. Xenotransplantation 2014; 21:507-9. [DOI: 10.1111/xen.12146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Cooper DKC, Satyananda V, Ekser B, van der Windt DJ, Hara H, Ezzelarab MB, Schuurman HJ. Progress in pig-to-non-human primate transplantation models (1998-2013): a comprehensive review of the literature. Xenotransplantation 2014; 21:397-419. [PMID: 25176336 DOI: 10.1111/xen.12127] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 06/03/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND The pig-to-non-human primate model is the standard choice for in vivo studies of organ and cell xenotransplantation. In 1998, Lambrigts and his colleagues surveyed the entire world literature and reported all experimental studies in this model. With the increasing number of genetically engineered pigs that have become available during the past few years, this model is being utilized ever more frequently. METHODS We have now reviewed the literature again and have compiled the data we have been able to find for the period January 1, 1998 to December 31, 2013, a period of 16 yr. RESULTS The data are presented for transplants of the heart (heterotopic and orthotopic), kidney, liver, lung, islets, neuronal cells, hepatocytes, corneas, artery patches, and skin. Heart, kidney, and, particularly, islet xenograft survival have increased significantly since 1998. DISCUSSION The reasons for this are briefly discussed. A comment on the limitations of the model has been made, particularly with regard to those that will affect progression of xenotransplantation toward the clinic.
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Affiliation(s)
- David K C Cooper
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA, USA
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Harris DG, Quinn KJ, Dahi S, Burdorf L, Azimzadeh AM, Pierson RN. Lung xenotransplantation: recent progress and current status. Xenotransplantation 2014; 21:496-506. [PMID: 25040467 DOI: 10.1111/xen.12116] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 05/05/2014] [Indexed: 12/22/2022]
Abstract
Xenotransplantation has undergone important progress in controlling initial hyperacute rejection in many preclinical models, with some cell, tissue, and organ xenografts advancing toward clinical trials. However, acute injury, driven primarily by innate immune and inflammatory responses, continues to limit results in lung xenograft models. The purpose of this article is to review the current status of lung xenotransplantation--including the seemingly unique challenges posed by this organ-and summarize proven and emerging means of overcoming acute lung xenograft injury.
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Affiliation(s)
- Donald G Harris
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA; Center for Vascular and Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, MD, USA
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Scobie L, Padler-Karavani V, Le Bas-Bernardet S, Crossan C, Blaha J, Matouskova M, Hector RD, Cozzi E, Vanhove B, Charreau B, Blancho G, Bourdais L, Tallacchini M, Ribes JM, Yu H, Chen X, Kracikova J, Broz L, Hejnar J, Vesely P, Takeuchi Y, Varki A, Soulillou JP. Long-term IgG response to porcine Neu5Gc antigens without transmission of PERV in burn patients treated with porcine skin xenografts. THE JOURNAL OF IMMUNOLOGY 2013; 191:2907-15. [PMID: 23945141 DOI: 10.4049/jimmunol.1301195] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Acellular materials of xenogenic origin are used worldwide as xenografts, and phase I trials of viable pig pancreatic islets are currently being performed. However, limited information is available on transmission of porcine endogenous retrovirus (PERV) after xenotransplantation and on the long-term immune response of recipients to xenoantigens. We analyzed the blood of burn patients who had received living pig-skin dressings for up to 8 wk for the presence of PERV as well as for the level and nature of their long term (maximum, 34 y) immune response against pig Ags. Although no evidence of PERV genomic material or anti-PERV Ab response was found, we observed a moderate increase in anti-αGal Abs and a high and sustained anti-non-αGal IgG response in those patients. Abs against the nonhuman sialic acid Neu5Gc constituted the anti-non-αGal response with the recognition pattern on a sialoglycan array differing from that of burn patients treated without pig skin. These data suggest that anti-Neu5Gc Abs represent a barrier for long-term acceptance of porcine xenografts. Because anti-Neu5Gc Abs can promote chronic inflammation, the long-term safety of living and acellular pig tissue implants in recipients warrants further evaluation.
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Affiliation(s)
- Linda Scobie
- Department of Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, United Kingdom
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Cooper DK, Bottino R, Satyananda V, Wijkstrom M, Trucco M. Toward clinical islet xenotransplantation - are revisions to the IXA guidelines warranted? Xenotransplantation 2013; 20:68-74. [DOI: 10.1111/xen.12015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- David K.C. Cooper
- Department of Surgery; Thomas E. Starzl Transplantation Institute; Pittsburgh; PA; USA
| | | | - Vikas Satyananda
- Department of Surgery; Thomas E. Starzl Transplantation Institute; Pittsburgh; PA; USA
| | - Martin Wijkstrom
- Department of Surgery; Thomas E. Starzl Transplantation Institute; Pittsburgh; PA; USA
| | - Massimo Trucco
- Division of Immunogenetics; Department of Pediatrics; Children's Hospital of Pittsburgh; University of Pittsburgh Medical Center; Pittsburgh; PA; USA
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Golriz M, Fonouni H, Nickkholgh A, Hafezi M, Garoussi C, Mehrabi A. Pig kidney transplantation: an up-to-date guideline. ACTA ACUST UNITED AC 2012; 49:121-9. [PMID: 23172014 DOI: 10.1159/000343132] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 09/04/2012] [Indexed: 12/19/2022]
Abstract
BACKGROUND Swine and human beings have many aspects in common that make swine a well-characterized large animal model for kidney transplantation (KTx). However, pigs have some peculiar anatomical characteristics that standardized techniques must adapt to. The aim of this study was to prepare an up-to-date guideline for porcine KTx. METHODS To achieve this goal, we performed a Medline search using the terminology 'kidney' or 'renal' and 'transplantation' and 'pig' or 'swine' or 'porcine'. We found over 1,300 published articles since 1963. Only 13 studies focused on the surgical aspect. Furthermore, we reviewed related books and articles about swine anatomical characteristics and surgery. Finally, our experimental experiences of KTx during the last few decades were added to this collection. RESULTS Proper hosting, fasting, anesthesia, medical therapy and monitoring can prevent postoperative complications. Explantation with a Carrel patch of the aorta facilitates the implantation and prevents future stenosis. Native nephrectomy makes the follow-up of the implanted organ more precise. KTx in the infrarenal fossa via end-to-side anastomosis to the aorta and inferior vena cava followed by ureteroureterostomy are the recommended options for KTx in pigs compared to other possible methods. CONCLUSION Pigs, with respect to their characterizations, constitute one of the best large animal models for KTx. Preoperative preparations are as important as the intra- and postoperative management. Using the most adaptable methods of surgery with respect to the specific anatomical characteristics of pigs can prevent undermining the studies and avoid preventable complications and pitfalls.
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Affiliation(s)
- M Golriz
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
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Schneider MKJ, Seebach JD. Xenotransplantation literature update, January-February 2012. Xenotransplantation 2012; 19:133-6. [PMID: 22497515 DOI: 10.1111/j.1399-3089.2012.00698.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Mårten K J Schneider
- Laboratory of Vascular Immunology, Division of Internal Medicine, University Hospital Zurich, Zurich, Switzerland.
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Ekser B, Ezzelarab M, Hara H, van der Windt DJ, Wijkstrom M, Bottino R, Trucco M, Cooper DKC. Clinical xenotransplantation: the next medical revolution? Lancet 2012; 379:672-83. [PMID: 22019026 DOI: 10.1016/s0140-6736(11)61091-x] [Citation(s) in RCA: 245] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The shortage of organs and cells from deceased individuals continues to restrict allotransplantation. Pigs could provide an alternative source of tissue and cells but the immunological challenges and other barriers associated with xenotransplantation need to be overcome. Transplantation of organs from genetically modified pigs into non-human primates is now not substantially limited by hyperacute, acute antibody-mediated, or cellular rejection, but other issues have become more prominent, such as development of thrombotic microangiopathy in the graft or systemic consumptive coagulopathy in the recipient. To address these problems, pigs that express one or more human thromboregulatory or anti-inflammatory genes are being developed. The results of preclinical transplantation of pig cells--eg, islets, neuronal cells, hepatocytes, or corneas--are much more encouraging than they are for organ transplantation, with survival times greater than 1 year in all cases. Risk of transfer of an infectious microorganism to the recipient is small.
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Affiliation(s)
- Burcin Ekser
- Thomas E Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
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Abstract
Xenotransplantation, the transplantation of cells, tissues, or organs between different species, has the potential to overcome the current shortage of human organs and tissues for transplantation. In the last decade, the progress made in the field is remarkable, suggesting that clinical xenotransplantation procedures, particularly those involving cells, may become a reality in the not-too-distant future. However, several hurdles remain, mainly immunological barriers, physiological discrepancies, and safety issues, making xenotransplantion a complex and multidisciplinary discipline.
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Abstract
Cross-species transplantation (xenotransplantation) offers the prospect of an unlimited supply of organs and cells for clinical transplantation, thus resolving the critical shortage of human tissues that currently prohibits a majority of patients on the waiting list from receiving transplants. Between the 17th and 20th centuries, blood was transfused from various animal species into patients with a variety of pathological conditions. Skin grafts were carried out in the 19th century from a variety of animals, with frogs being the most popular. In the 1920s, Voronoff advocated the transplantation of slices of chimpanzee testis into aged men whose "zest for life" was deteriorating, believing that the hormones produced by the testis would rejuvenate his patients. Following the pioneering surgical work of Carrel, who developed the technique of blood vessel anastomosis, numerous attempts at nonhuman primate organ transplantation in patients were carried out in the 20th century. In 1963-1964, when human organs were not available and chronic dialysis was not yet in use, Reemtsma transplanted chimpanzee kidneys into 13 patients, one of whom returned to work for almost 9 months before suddenly dying from what was believed to be an electrolyte disturbance. The first heart transplant in a human ever performed was by Hardy in 1964, using a chimpanzee heart, but the patient died within 2 hours. Starzl carried out the first chimpanzee-to-human liver transplantation in 1966; in 1992, he obtained patient survival for 70 days following a baboon liver transplant. With the advent of genetic engineering and cloning technologies, pigs are currently available with a number of different manipulations that protect their tissues from the human immune response, resulting in increasing pig graft survival in nonhuman primate models. Genetically modified pigs offer hope of a limitless supply of organs and cells for those in need of a transplant.
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Affiliation(s)
- David K C Cooper
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh Medical Center. Pittsburgh, Pennsylvania
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22
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Schneider MKJ, Seebach JD. Xenotransplantation literature update June-October 2010. Xenotransplantation 2011; 17:481-8. [PMID: 21158949 DOI: 10.1111/j.1399-3089.2010.00615.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Mårten K J Schneider
- Laboratory of Vascular Immunology, Division of Internal Medicine, University Hospital Zurich, Zurich, Switzerland.
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