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Fishman JA, Mueller NJ. Infectious Diseases and Clinical Xenotransplantation. Emerg Infect Dis 2024; 30:1311-1318. [PMID: 38916550 PMCID: PMC11210669 DOI: 10.3201/eid3007.240273] [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] [Indexed: 06/26/2024] Open
Abstract
Xenotransplantation, transplantation into humans of vascularized organs or viable cells from nonhuman species, is a potential solution to shortages of transplantable human organs. Among challenges to application of clinical xenotransplantation are unknown risks of transmission of animal microbes to immunosuppressed recipients or the community. Experience in allotransplantation and in preclinical models suggests that viral infections are the greatest concern. Worldwide, the distribution of swine pathogens is heterogeneous and cannot be fully controlled by international agricultural regulations. It is possible to screen source animals for potential human pathogens before procuring organs in a manner not possible within the time available for surveillance testing in allotransplantation. Infection control measures require microbiological assays for surveillance of source animals and xenograft recipients and research into zoonotic potential of porcine organisms. Available data suggest that infectious risks of xenotransplantation are manageable and that clinical trials can advance with appropriate protocols for microbiological monitoring of source animals and recipients.
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Adams A, Cendales LC, Cooper DKC, Cozzi E, Gill J, Judd E, Katz E, Kirk AD, Fishman JA, Reese PP, Wall A, Markmann JF. American Society of Transplant Surgeons-American Society of Transplantation report of FDA meeting on regulatory expectations for xenotransplantation products. Am J Transplant 2023; 23:1290-1299. [PMID: 37217005 DOI: 10.1016/j.ajt.2023.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/02/2023] [Accepted: 05/17/2023] [Indexed: 05/24/2023]
Abstract
In June 2022, the US Food and Drug Administration Center for Biologics Evaluation and Research held the 73rd meeting of the Cellular, Tissue, and Gene Therapies Advisory Committee for public discussion of regulatory expectations for xenotransplantation products. The members of a joint American Society of Transplant Surgeons/American Society of Transplantation committee on xenotransplantation compiled a meeting summary focusing on 7 topics believed to be key by the committee: (1) preclinical evidence supporting progression to a clinical trial, (2) porcine kidney function, (3) ethical aspects, (4) design of initial clinical trials, (5) infectious disease issues, (6) industry perspectives, and (7) regulatory oversight.
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Affiliation(s)
- Andrew Adams
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Linda C Cendales
- Department of Surgery, Duke University, Durham, North Carolina, USA
| | - David K C Cooper
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Emanuele Cozzi
- Department of Cardiothoracic and Vascular Surgery, University of Padua, Padua, Italy
| | - John Gill
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric Judd
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Allan D Kirk
- Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Jay A Fishman
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, Massachusetts, USA; Transplant Infectious Disease and Compromised Host Program and MGH Transplant Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter P Reese
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Anji Wall
- Division of Abdominal Transplantation, Baylor University Medical Center, Dallas, Texas, USA
| | - James F Markmann
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, Massachusetts, USA.
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Mehta SA, Saharia KK, Nellore A, Blumberg EA, Fishman JA. Infection and clinical xenotransplantation: Guidance from the Infectious Disease Community of Practice of the American Society of Transplantation. Am J Transplant 2023; 23:309-315. [PMID: 36695690 DOI: 10.1016/j.ajt.2022.12.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/20/2022] [Accepted: 12/10/2022] [Indexed: 01/04/2023]
Abstract
This guidance was developed to summarize current approaches to the potential transmission of swine-derived organisms to xenograft recipients, health care providers, or the public in clinical xenotransplantation. Limited specific data are available on the zoonotic potential of pig pathogens. It is anticipated that the risk of zoonotic infection in xenograft recipients will be determined by organisms present in source animals and relate to the nature and intensity of the immunosuppression used to maintain xenograft function. Based on experience in allotransplantation and with preclinical models, viral infections are of greatest concern, including porcine cytomegalovirus, porcine lymphotropic herpesvirus, and porcine endogenous retroviruses. Sensitive and specific microbiological assays are required for routine microbiological surveillance of source animals and xenograft recipients. Archiving of blood samples from recipients, contacts, and hospital staff may provide a basis for microbiological investigations if infectious syndromes develop. Carefully implemented infection control practices are required to prevent zoonotic pathogen exposures by clinical care providers. Informed consent practices for recipients and their close contacts must convey the lack of specific data for infectious risk assessment. Available data suggest that infectious risks of xenotransplantation are manageable and that clinical trials can advance with carefully developed protocols for pretransplant assessment, syndrome evaluation, and microbiological monitoring.
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Affiliation(s)
- Sapna A Mehta
- Transplant Infectious Diseases, NYU Langone Transplant Institute and NYU Grossman School of Medicine, New York, New York, USA
| | - Kapil K Saharia
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Anoma Nellore
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Emily A Blumberg
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jay A Fishman
- Transplant and Compromised Host Infectious Disease Program and MGH Transplant Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
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Affiliation(s)
- Jay A Fishman
- From the Transplant and Immunocompromised Host Program, Infectious Disease Division and Transplant Center, Massachusetts General Hospital and Harvard Medical School, Boston
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Nellore A, Walker J, Kahn MJ, Fishman JA. Moving xenotransplantation from bench to bedside: Managing infectious risk. Transpl Infect Dis 2022; 24:e13909. [PMID: 35870125 DOI: 10.1111/tid.13909] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/26/2022] [Accepted: 07/01/2022] [Indexed: 12/24/2022]
Abstract
Xenotransplantation of organs from swine in immunosuppressed human recipients poses many of the same challenges of allotransplantation relative to the risk for infection, malignancy, or graft rejection in proportion to the degree of immunosuppression and epidemiologic exposures. The unique features of xenotransplantation from pigs relative to infectious risk center on the potential for unusual organisms derived from swine causing productive infection, "xenosis" or "xenozoonosis," in the host. Based on experience in allotransplantation, the greatest hazard is due to viruses, due to the relative lack of information regarding the behavior of these potential pathogens in humans, the absence of validated serologic and molecular assays for swine-derived pathogens, and uncertainty regarding the efficacy of therapeutic agents for these organisms. Other known, potential pathogens (i.e., bacteria, fungi, parasites) tend to be comparable to those of humans. Concerns remain for unknown organisms in swine that may replicate in immunosuppressed humans. Clinical trials of genetically modified organs sourced from swine in immunosuppressed humans with organ failure are under development. Such trials require informed consent regarding potential infectious risks to the recipient, determination of breeding characteristics of swine, assessments of potential risks to the public and healthcare providers, consideration of ethical issues posed by this novel therapy, and defined strategies to monitor and address infectious episodes that may be encountered by healthcare teams. Clinical trials in xenotransplantation will allow improved definition of potential infectious risks.
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Affiliation(s)
- Anoma Nellore
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jeremey Walker
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mauricio J Kahn
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jay A Fishman
- Division of Infectious Diseases and Transplant Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Fishman JA. Prevention of infection in xenotransplantation: Designated pathogen‐free swine in the safety equation. Xenotransplantation 2020; 27:e12595. [DOI: 10.1111/xen.12595] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/06/2020] [Accepted: 02/18/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Jay A. Fishman
- MGH Transplant Center Transplantation Infectious Disease and Compromised Host Program Infectious Disease Division Massachusetts General Hospital Boston MA USA
- Harvard Medical School Boston MA USA
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Li X, Hawthorne WJ, Burlak C. Xenotransplantation literature update, September/October 2019. Xenotransplantation 2019; 26:e12573. [PMID: 31762126 DOI: 10.1111/xen.12573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 11/10/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Xiaohang Li
- Department of Surgery, Schulze Diabetes Institute, University of Minnesota Medical School, Minneapolis, Minnesota.,Department of Hepatobiliary Surgery and Transplantation Unit, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Wayne J Hawthorne
- The Department of Surgery, Westmead Hospital, Westmead, NSW, Australia.,The Centre for Transplant & Renal Research, The Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Christopher Burlak
- Department of Surgery, Schulze Diabetes Institute, University of Minnesota Medical School, Minneapolis, Minnesota
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Abstract
PURPOSE OF REVIEW Posttransplantation infections are common. It is anticipated that infection will be no less common in xenotransplantation recipients. Prolonged xenograft survivals have resulted from advances in immunosuppressive strategies and development of swine that decrease host immune responses via genetic manipulation, notably CRISPR/cas9 manipulation. As prospects for clinical trials improve, consideration of the unique infectious risks posed by xenotransplantation reemerge. RECENT FINDINGS Organisms likely to cause infection in human recipients of porcine xenografts are unknown in advance of clinical trials. Microbiological screening of swine intended as xenograft donors can be more intensive than is currently feasible for human allograft donors. Monitoring infection in recipients will also be more intensive. Key opportunities in infectious diseases of xenotransplantation include major technological advances in evaluation of the microbiome by unbiased metagenomic sequencing, assessments of some risks posed by porcine endogenous retroviruses (PERVs) including antiretroviral susceptibilities, availability of swine with deletion of genomic PERVs, and recognition of the rapidly changing epidemiology of infection in swine worldwide. SUMMARY Unknown infectious risks in xenotransplantation requires application of advanced microbiological techniques to discern and prevent infection in graft recipients. Clinical trials will provide an opportunity to advance the safety of all of organ transplantation.
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Affiliation(s)
- Jay A Fishman
- Transplantation Infectious Disease and Compromised Host Program, Infectious Disease Division and MGH Transplant Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Noordergraaf J, Schucker A, Martin M, Schuurman HJ, Ordway B, Cooley K, Sheffler M, Theis K, Armstrong C, Klein L, Hansen D, Olson M, Schlechter L, Spizzo T. Pathogen elimination and prevention within a regulated, Designated Pathogen Free, closed pig herd for long-term breeding and production of xenotransplantation materials. Xenotransplantation 2019; 25:e12428. [PMID: 30264879 PMCID: PMC7169735 DOI: 10.1111/xen.12428] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/21/2018] [Accepted: 05/25/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND We established a Source Animal (barrier) Facility (SAF) for generating designated pathogen-free (DPF) pigs to serve as donors of viable organs, tissues, or cells for xenotransplantation into clinical patients. This facility was populated with caesarian derived, colostrum deprived (CDCD) piglets, from sows of conventional-specific (or specified) pathogen-free (SPF) health status in six cohorts over a 10-month period. In all cases, CDCD piglets fulfilled DPF status including negativity for porcine circovirus (PCV), a particularly environmentally robust and difficult to inactivate virus which at the time of SAF population was epidemic in the US commercial swine production industry. Two outbreaks of PCV infection were subsequently detected during sentinel testing. The first occurred several weeks after PCV-negative animals were moved under quarantine from the nursery into an animal holding room. The apparent origin of PCV was newly installed stainless steel penning, which was not sufficiently degreased thereby protecting viral particles from disinfection. The second outbreak was apparently transmitted via employee activities in the Caesarian-section suite adjacent to the barrier facility. In both cases, PCV was contained in the animal holding room where it was diagnosed making a complete facility depopulation-repopulation unnecessary. METHOD Infectious PCV was eliminated during both outbreaks by the following: euthanizing infected animals, disposing of all removable items from the affected animal holding room, extensive cleaning with detergents and degreasing agents, sterilization of equipment and rooms with chlorine dioxide, vaporized hydrogen peroxide, and potassium peroxymonosulfate, and for the second outbreak also glutaraldehyde/quaternary ammonium. Impact on other barrier animals throughout the process was monitored by frequent PCV diagnostic testing. RESULT After close monitoring for 6 months indicating PCV absence from all rooms and animals, herd animals were removed from quarantine status. CONCLUSION Ten years after PCV clearance following the second outbreak, due to strict adherence to biosecurity protocols and based on ongoing sentinel diagnostic monitoring (currently monthly), the herd remains DPF including PCV negative.
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Affiliation(s)
| | | | | | | | | | | | | | - Kara Theis
- Spring Point Project, Minneapolis, MN, USA
| | | | | | | | | | | | - Tom Spizzo
- Spring Point Project, Minneapolis, MN, USA
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10
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Nellore A, Fishman JA. Donor-derived infections and infectious risk in xenotransplantation and allotransplantation. Xenotransplantation 2019; 25:e12423. [PMID: 30264880 DOI: 10.1111/xen.12423] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/03/2018] [Accepted: 05/14/2018] [Indexed: 01/06/2023]
Abstract
Post-transplantation infections are common in allograft recipients and should be expected in all immunocompromised hosts. Based on the need for immunosuppression in xenotransplantation, procedures developed to enhance safety in allotransplantation can be applied in future xenotransplantation clinical trials. Standardized approaches can be developed to guide the evaluation of common infectious syndromes in xenograft recipients. The opportunity created by screening of swine intended as xenograft donors has equal applicability to allotransplantation-notably broader screening strategies for allograft donors such as use of advanced sequencing modalities including broad-range molecular probes, microarrays, and high-throughput pyrosequencing. Considerations in management of allotransplant- and xenotransplant-associated infections are largely the same. Experience in xenotransplantation will continue to inform thinking regarding donor-derived infections in allotransplantation. We expect that experience in managing complex allotransplant recipients will similarly inform clinical trials in xenotransplantation.
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Affiliation(s)
- Anoma Nellore
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jay A Fishman
- Transplant and Compromised Host Infectious Disease Program and MGH Transplant Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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11
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Fishman JA. Infectious disease risks in xenotransplantation. Am J Transplant 2018; 18:1857-1864. [PMID: 29513380 DOI: 10.1111/ajt.14725] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/01/2018] [Accepted: 03/02/2018] [Indexed: 01/25/2023]
Abstract
Hurdles exist to clinical xenotransplantation including potential infectious transmission from nonhuman species to xenograft recipients. In anticipation of clinical trials of xenotransplantation, the associated infectious risks have been investigated. Swine and immunocompromised humans share some potential pathogens. Swine herpesviruses including porcine cytomegalovirus (PCMV) and porcine lymphotropic herpesvirus (PLHV) are largely species-specific and do not, generally, infect human cells. Human cellular receptors exist for porcine endogenous retrovirus (PERV), which infects certain human-derived cell lines in vitro. PERV-inactivated pigs have been produced recently. Human infection due to PERV has not been described. A screening paradigm can be applied to exclude potential human pathogens from "designated pathogen free" breeding colonies. Various microbiological assays have been developed for screening and diagnosis including antibody-based tests and qualitative and quantitative molecular assays for viruses. Additional assays may be required to diagnose pig-specific organisms in human xenograft recipients. Significant progress has been made in the evaluation of the potential infectious risks of clinical xenotransplantation. Infectious risk would be amplified by intensive immunosuppression. The available data suggest that risks of xenotransplant-associated recipient infection are manageable and that clinical trials can be performed safely. Possible infectious risks of xenotransplantation to the community at large are undefined but merit consideration.
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Affiliation(s)
- Jay A Fishman
- Infectious Disease Division and MGH Transplant Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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12
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Cooper DKC, Cowan P, Fishman JA, Hering BJ, Mohiuddin MM, Pierson RN, Sachs DH, Schuurman HJ, Dennis JU, Tönjes RR. Joint FDA‐IXA Symposium, September 20, 2017. Xenotransplantation 2017; 24. [PMID: 29193342 DOI: 10.1111/xen.12365] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- David K C Cooper
- Xenotransplantation Program, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Peter Cowan
- Immunology Research Centre, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Jay A Fishman
- Infectious Disease Division and MGH Transplant Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Bernhard J Hering
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Muhammad M Mohiuddin
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Richard N Pierson
- Department of Surgery, University of Maryland School of Medicine, Baltimore VA Medical Center, Baltimore, MD, USA
| | - David H Sachs
- Columbia University Medical Center, New York City, NY, USA.,Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
| | | | - John U Dennis
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ralf R Tönjes
- Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines, Division of Medical Biotechnology, Langen, Germany
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13
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Porcine to Human Heart Transplantation: Is Clinical Application Now Appropriate? J Immunol Res 2017; 2017:2534653. [PMID: 29238731 PMCID: PMC5697125 DOI: 10.1155/2017/2534653] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 10/08/2017] [Indexed: 11/24/2022] Open
Abstract
Cardiac xenotransplantation (CXTx) is a promising solution to the chronic shortage of donor hearts. Recent advancements in immune suppression have greatly improved the survival of heterotopic CXTx, now extended beyond 2 years, and life-supporting kidney XTx. Advances in donor genetic modification (B4GALNT2 and CMAH mutations) with proven Gal-deficient donors expressing human complement regulatory protein(s) have also accelerated, reducing donor pig organ antigenicity. These advances can now be combined and tested in life-supporting orthotopic preclinical studies in nonhuman primates and immunologically appropriate models confirming their efficacy and safety for a clinical CXTx program. Preclinical studies should also allow for organ rejection to develop xenospecific assays and therapies to reverse rejection. The complexity of future clinical CXTx presents a substantial and unique set of regulatory challenges which must be addressed to avoid delay; however, dependent on these prospective life-supporting preclinical studies in NHPs, it appears that the scientific path forward is well defined and the era of clinical CXTx is approaching.
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Abalovich A, Matsumoto S, Wechsler CJ, Carulla ME, Siciliano ME, Sznaider D, Denner J, Elliott RB. Level of acceptance of islet cell and kidney xenotransplants by personnel of hospitals with and without experience in clinical xenotransplantation. Xenotransplantation 2017. [PMID: 28623861 DOI: 10.1111/xen.12315] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Recently, significant progress in both safety and efficacy has been achieved in the field of xenotransplantation, as exemplified by results from the first clinical trials of porcine islet transplantation. It would be of interest to learn whether the attitude of the clinical staff involved in such trials changes as the trials are carried out in their own hospital. METHODS One hundred and four clinical staff members from the Eva Peron Hospital of San Martin (Buenos Aires, Argentina) where clinical trials of islet xenotransplantation have been performed and 92 similar staff members from the Diego Thompson Hospital (Buenos Aires, Argentina) where no such xenotransplantation has been carried out participated in the study. Data were collected anonymously using questionnaires. RESULTS Statistically significant differences between the acceptance of xenotransplantation by clinical personnel in a hospital that had carried out clinical xenotransplantation trials were observed when compared with the acceptance of a similar staff from the hospital that had not carried out such trials. CONCLUSION This study shows that involvement in clinical xenotransplantation trials significantly changes the attitude of the clinical staff towards this technology and suggests that better information given to the society may increase acceptance of the xenotransplantation.
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Affiliation(s)
- Adrian Abalovich
- Hospital Interzonal General de Agudos Eva Perón de San Martin, Buenos Aires, Argentina.,Universidad Nacional de San Martín (UNSAM), Buenos Aires, Argentina
| | | | - Carlos J Wechsler
- Hospital Interzonal General de Agudos Eva Perón de San Martin, Buenos Aires, Argentina
| | - Mariana E Carulla
- Hospital Interzonal General de Agudos Eva Perón de San Martin, Buenos Aires, Argentina
| | | | - Daniel Sznaider
- Hospital Municipal Dr. Diego Thompson, Buenos Aires, Argentina
| | - Joachim Denner
- Robert Koch Institute, HIV and other Retroviruses, Berlin, Germany
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Schuurman HJ. Microbiological safety of clinical xenotransplantation products: monitoring strategies and regulatory aspects. A commentary. Xenotransplantation 2016; 23:440-443. [PMID: 27859642 DOI: 10.1111/xen.12280] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 10/07/2016] [Indexed: 01/17/2023]
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Morozov VA, Plotzki E, Rotem A, Barkai U, Denner J. Extended microbiological characterization of Göttingen minipigs: porcine cytomegalovirus and other viruses. Xenotransplantation 2016; 23:490-496. [DOI: 10.1111/xen.12265] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 06/28/2016] [Accepted: 08/16/2016] [Indexed: 01/27/2023]
Affiliation(s)
| | - Elena Plotzki
- HIV and other Retroviruses; Robert Koch Institute; Berlin Germany
| | - Avi Rotem
- Beta-O 2 Technologies Ltd.; Rosh-Haain Israel
| | | | - Joachim Denner
- HIV and other Retroviruses; Robert Koch Institute; Berlin Germany
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Morozov VA, Ludwig S, Ludwig B, Rotem A, Barkai U, Bornstein SR, Denner J. Islet cell transplantation from Göttingen minipigs to cynomolgus monkeys: analysis of virus safety. Xenotransplantation 2016; 23:320-7. [PMID: 27440468 DOI: 10.1111/xen.12252] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 06/28/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Xenotransplantation using pig cells, tissues or organs may be associated with the transmission of porcine zoonotic micro-organisms. Hepatitis E virus (HEV), porcine cytomegalovirus (PCMV) and porcine endogenous retroviruses (PERVs) are potentially zoonotic micro-organisms which do not show clinical symptoms in pigs and which are due to the low expression level difficult to detect. Göttingen Minipigs (GöMP) are often used for biomedical investigations and they are well characterized concerning the presence of numerous bacteria, fungi, viruses and parasites and therefore may be used for islet cell transplantation. METHODS Islet cells derived from three GöMP were transplanted into four healthy, non-diabetic cynomolgus monkeys using a macroencapsulation device. PCR, nested PCR, real-time PCR, real-time RT-PCR and Western blot analyses were used to estimate the presence of PERV, PCMV and HEV in the donors and recipients. RESULTS Using sensitive detection methods, no HEV was found in the donor pigs and in the pig islet cell preparations. Antibodies against PERV, PCMV and HEV were not found in all cynomolgus monkeys with exception of one monkey showing an immune response against HEV. Using real-time PCR, no PCMV and HEV were found in the sera of all monkeys. CONCLUSION Although the donor islet cells and the recipients were negative for HEV using PCR and Western blot analysis, in one recipient, antibodies against HEV were found, indicating infection in a single case. All recipients were negative for antibodies against PERV, and all were negative for PCMV, indicating absence of infection. As HEV was not detected in the donor pig before transplantation, a more complex and regular screening of the animals using highly sensitive methods is required to avoid virus transmission.
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Affiliation(s)
| | - Stefan Ludwig
- Department of Visceral- Thorax- and Vascular Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Barbara Ludwig
- Department of Medicine III, University Hospital Carl Gustav Carus, Dresden, Germany.,Paul Langerhans Institute Dresden of Helmholtz Centre Munich at University Clinic Carl Gustav Carus of TU Dresden and DZD- German Centre for Diabetes Research, Dresden, Germany.,Centre for Regenerative Therapies Dresden, Technische Universität Dresden, Dresden, Germany
| | - Avi Rotem
- Beta-O2 Technologies Ltd., Rosh-Haain, Israel
| | | | - Stefan R Bornstein
- Department of Medicine III, University Hospital Carl Gustav Carus, Dresden, Germany.,Paul Langerhans Institute Dresden of Helmholtz Centre Munich at University Clinic Carl Gustav Carus of TU Dresden and DZD- German Centre for Diabetes Research, Dresden, Germany.,Centre for Regenerative Therapies Dresden, Technische Universität Dresden, Dresden, Germany.,Department of Endocrinology and Diabetes, King's College, London, UK
| | - Joachim Denner
- HIV and other Retroviruses, Robert Koch Institute, Berlin, Germany
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18
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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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Morozov VA, Morozov AV, Rotem A, Barkai U, Bornstein S, Denner J. Extended Microbiological Characterization of Göttingen Minipigs in the Context of Xenotransplantation: Detection and Vertical Transmission of Hepatitis E Virus. PLoS One 2015; 10:e0139893. [PMID: 26466154 PMCID: PMC4605773 DOI: 10.1371/journal.pone.0139893] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 08/08/2015] [Indexed: 12/28/2022] Open
Abstract
Xenotransplantation has been proposed as a solution to the shortage of suitable human donors. Pigs are currently favoured as donor animals for xenotransplantation of cells, including islet cells, or organs. To reduce the xenotransplantation-associated risk of infection of the recipient the pig donor should be carefully characterised. Göttingen minipigs from Ellegaard are often used for biomedical research and are regularly tested by their vendor for the presence of numerous bacteria, fungi, viruses and parasites. However, screening for some pathogens transmittable to humans had not been performed.The presence of microorganisms was examined in Göttingen Minipigs by PCR methods. Since zoonotic transmission of porcine hepatitis E virus HEV to humans has been demonstrated, extended search for HEV was considered as a priority. RNA from sera, islet and other cells from 40 minipigs were examined for HEV using different real-time reverse transcription (RT)-PCRs, among them two newly established. In addition, sera were examined by Western blot analysis using two recombinant capsid proteins of HEV as antigens. HEV RNA was not detected in pigs older than one year including gilts, but it was detected in the sera of three of ten animals younger than 1 year. Furthermore, HEV was also detected in the sera of three sows six days after delivery and their offspring, indicating vertical transmission of the virus. PCR amplicons were cloned, sequenced and the viruses were found to belong to the HEV genotype (gt) 3/4. Anti-HEV immunoglobulins G were detected in one sow and maternal antibodies in her six day old piglet. Since Göttingen minipigs were negative for many xenotransplantation-relevant microorganisms, they can now be classified as safe. HEV may be eliminated from the Ellegaard herd by selection of negative animals and/or by treatment of the animals.
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Affiliation(s)
| | | | - Avi Rotem
- Beta-O2 Technologies Ltd., Rosh Haain, Israel
| | | | - Stefan Bornstein
- Center Internal Medicine, University Clinics Carl Gustav Carus, Technical University, Dresden, Germany
| | - Joachim Denner
- Robert Koch Institute, Berlin, Germany
- * E-mail: (VAM); (JD)
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Kim MK, Choi HJ, Kwon I, Pierson RN, Cooper DKC, Soulillou JP, O'Connell PJ, Vabres B, Maeda N, Hara H, Scobie L, Gianello P, Takeuchi Y, Yamada K, Hwang ES, Kim SJ, Park CG. The International Xenotransplantation Association consensus statement on conditions for undertaking clinical trials of xenocorneal transplantation. Xenotransplantation 2014; 21:420-30. [PMID: 25176471 DOI: 10.1111/xen.12129] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 06/20/2014] [Indexed: 11/27/2022]
Abstract
To develop an international consensus regarding the appropriate conditions for undertaking clinical trials in xenocorneal transplantation, here we review specific ethical, logistical, scientific, and regulatory issues regarding xenocorneal transplantation, and propose guidelines for conduct of clinical xenocorneal transplantation trials. These proposed guidelines are modeled on the published consensus statement of the International Xenotransplantation Association regarding recommended guidelines for conduct of clinical islet xenotransplantation. It is expected that this initial consensus statement will be revised over time in response to scientific advances in the field, and changes in the regulatory framework based on accumulating clinical experience.
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Affiliation(s)
- Mee Kum Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea; Xenotransplantation Research Center, Seoul National University College Of Medicine and Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
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Porcine endogenous retroviruses in xenotransplantation--molecular aspects. Viruses 2014; 6:2062-83. [PMID: 24828841 PMCID: PMC4036542 DOI: 10.3390/v6052062] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 04/15/2014] [Accepted: 04/26/2014] [Indexed: 02/06/2023] Open
Abstract
In the context of the shortage of organs and other tissues for use in human transplantation, xenotransplantation procedures with material taken from pigs have come under increased consideration. However, there are unclear consequences of the potential transmission of porcine pathogens to humans. Of particular concern are porcine endogenous retroviruses (PERVs). Three subtypes of PERV have been identified, of which PERV-A and PERV-B have the ability to infect human cells in vitro. The PERV-C subtype does not show this ability but recombinant PERV-A/C forms have demonstrated infectivity in human cells. In view of the risk presented by these observations, the International Xenotransplantation Association recently indicated the existence of four strategies to prevent transmission of PERVs. This article focuses on the molecular aspects of PERV infection in xenotransplantation and reviews the techniques available for the detection of PERV DNA, RNA, reverse transcriptase activity and proteins, and anti-PERV antibodies to enable carrying out these recommendations. These methods could be used to evaluate the risk of PERV transmission in human recipients, enhance the effectiveness and reliability of monitoring procedures, and stimulate discussion on the development of improved, more sensitive methods for the detection of PERVs in the future.
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Kim MK, Lee JJ, Choi HJ, Kwon I, Lee H, Song JS, Kim MJ, Chung ES, Wee WR, Park CG, Kim SJ. Ethical and regulatory guidelines in clinical trials of xenocorneal transplantation in Korea; the Korean xenocorneal transplantation consensus statement. Xenotransplantation 2013; 20:209-18. [DOI: 10.1111/xen.12036] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 04/09/2013] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Sang Joon Kim
- Xenotransplantation Research Center and Clinical Research Institute; Seoul National University Hospital; Seoul; Korea
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Semaan M, Rotem A, Barkai U, Bornstein S, Denner J. Screening pigs for xenotransplantation: prevalence and expression of porcine endogenous retroviruses in Göttingen minipigs. Xenotransplantation 2013; 20:148-56. [DOI: 10.1111/xen.12032] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 03/12/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Marwan Semaan
- Robert Koch Institute; HIV and Other Retroviruses; Berlin Germany
| | - Avi Rotem
- Beta-O 2 Technologies Ltd; Petach-Tikva Israel
| | | | - Stefan Bornstein
- Center Internal Medicine; University Clinics Carl Gustav Carus; Technical University; Dresden Germany
| | - Joachim Denner
- Robert Koch Institute; HIV and Other Retroviruses; Berlin Germany
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Van Leeuwen AC, Van Kooten TG, Grijpma DW, Bos RRM. In vivo behaviour of a biodegradable poly(trimethylene carbonate) barrier membrane: a histological study in rats. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2012; 23:1951-1959. [PMID: 22569734 PMCID: PMC3400755 DOI: 10.1007/s10856-012-4663-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 04/24/2012] [Indexed: 05/31/2023]
Abstract
The aim of the present study was to evaluate the response of surrounding tissues to newly developed poly(trimethylene carbonate) (PTMC) membranes. Furthermore, the tissue formation beneath and the space maintaining properties of the PTMC membrane were evaluated. Results were compared with a collagen membrane (Geistlich BioGide), which served as control. Single-sided standardized 5.0 mm circular bicortical defects were created in the mandibular angle of rats. Defects were covered with either the PTMC membrane or a collagen membrane. After 2, 4 and 12 weeks rats were sacrificed and histology was performed. The PTMC membranes induced a mild tissue reaction corresponding to a normal foreign body reaction. The PTMC membranes showed minimal cellular capsule formation and showed signs of a surface erosion process. Bone tissue formed beneath the PTMC membranes comparable to that beneath the collagen membranes. The space maintaining properties of the PTMC membranes were superior to those of the collagen membrane. Newly developed PTMC membranes can be used with success as barrier membranes in critical size rat mandibular defects.
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Affiliation(s)
- A C Van Leeuwen
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, The Netherlands.
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van Leeuwen AC, Huddleston Slater JJR, Gielkens PFM, de Jong JR, Grijpma DW, Bos RRM. Guided bone regeneration in rat mandibular defects using resorbable poly(trimethylene carbonate) barrier membranes. Acta Biomater 2012; 8:1422-9. [PMID: 22186161 DOI: 10.1016/j.actbio.2011.12.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2011] [Revised: 11/16/2011] [Accepted: 12/05/2011] [Indexed: 11/15/2022]
Abstract
The present study evaluates a new synthetic degradable barrier membrane based on poly(trimethylene carbonate) (PTMC) for use in guided bone regeneration. A collagen membrane and an expanded polytetrafluoroethylene (e-PTFE) membrane served as reference materials. In 192 male Sprague-Dawley rats, a standardized 5.0mm circular defect was created in the left mandibular angle. New bone formation was demonstrated by post mortem micro-radiography, micro-computed tomography imaging and histological analysis. Four groups (control, PTMC, collagen, e-PTFE) were evaluated at three time intervals (2, 4 and 12 weeks). In the membrane groups the defects were covered; in the control group the defects were left uncovered. Data were analysed using a multiple regression model. In contrast to uncovered mandibular defects, substantial bone healing was observed in defects covered with a barrier membrane. In the latter case, the formation of bone was progressive over 12 weeks. No statistically significant differences between the amount of new bone formed under the PTMC membranes and the amount of bone formed under the collagen and e-PTFE membranes were observed. Therefore, it can be concluded that PTMC membranes are well suited for use in guided bone regeneration.
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Affiliation(s)
- A C van Leeuwen
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, P.O. Box 30.001, 9700 RB, The Netherlands.
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Denner J, Tönjes RR. Infection barriers to successful xenotransplantation focusing on porcine endogenous retroviruses. Clin Microbiol Rev 2012; 25:318-43. [PMID: 22491774 PMCID: PMC3346299 DOI: 10.1128/cmr.05011-11] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Xenotransplantation may be a solution to overcome the shortage of organs for the treatment of patients with organ failure, but it may be associated with the transmission of porcine microorganisms and the development of xenozoonoses. Whereas most microorganisms may be eliminated by pathogen-free breeding of the donor animals, porcine endogenous retroviruses (PERVs) cannot be eliminated, since these are integrated into the genomes of all pigs. Human-tropic PERV-A and -B are present in all pigs and are able to infect human cells. Infection of ecotropic PERV-C is limited to pig cells. PERVs may adapt to host cells by varying the number of LTR-binding transcription factor binding sites. Like all retroviruses, they may induce tumors and/or immunodeficiencies. To date, all experimental, preclinical, and clinical xenotransplantations using pig cells, tissues, and organs have not shown transmission of PERV. Highly sensitive and specific methods have been developed to analyze the PERV status of donor pigs and to monitor recipients for PERV infection. Strategies have been developed to prevent PERV transmission, including selection of PERV-C-negative, low-producer pigs, generation of an effective vaccine, selection of effective antiretrovirals, and generation of animals transgenic for a PERV-specific short hairpin RNA inhibiting PERV expression by RNA interference.
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27
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Abrahante JE, Martins K, Papas KK, Hering BJ, Schuurman HJ, Murtaugh MP. Microbiological safety of porcine islets: comparison with source pig. Xenotransplantation 2011; 18:88-93. [PMID: 21496116 DOI: 10.1111/j.1399-3089.2011.00632.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pig islet donors intended for clinical xenotransplantation for the treatment of diabetes must meet stringent conditions. Among others, viruses with the potential to cross the species barrier should be excluded from the herd: this list includes encephalomyocarditis virus (EMCV), hepatitis E virus (HEV), porcine cytomegalovirus (PCMV) and porcine γ-lymphotropic herpesvirus (PLHV). As an islet product is isolated from the pancreas and then subjected to culture before implantation, the question is raised whether islets could be negative even if the animal itself is positive for a distinct pathogen. METHODS To answer this question, sensitive quantitative real-time PCR assays were established for EMCV, HEV, PCMV and PLHV. Twelve adult animals from a high-hygienic herd were then evaluated; testing tissues, where the virus is expected to reside in latent infection, testing islets immediately after isolation, and then isolated islets after a 7-day culture. RESULTS None of the tissues tested positive for EMCV, HEV or PLHV. PCMV was observed in spleen tissue from six animals: three of these six animals were positive for isolated islets, and two of these three cases were also positive for islets after culture. Older animals in particular showed positivity, and within a given litter not all animals were PCMV positive. CONCLUSIONS These data fit with spread through the herd by horizontal transmission, not in utero infection. PCMV has to be excluded from the herd to ensure that islets for transplantation are negative for PCMV.
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Affiliation(s)
- Juan E Abrahante
- Department of Veterinary & Biomedical Sciences, University of Minnesota, St. Paul, MN 55108, USA
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Park CG, Kim JS, Kim YH. Current Status and Future Perspectives of Xenotransplantation and Stem Cell Research in Transplantation Field. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2008. [DOI: 10.5124/jkma.2008.51.8.732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Chung-Gyu Park
- Department of Microbiology and Immunology, Seoul National University College of Medicine, Korea.
| | - Jung-Sik Kim
- Department of Microbiology and Immunology, Seoul National University College of Medicine, Korea.
| | - Yong-Hee Kim
- Department of Microbiology and Immunology, Seoul National University College of Medicine, Korea.
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Sakudo A, Tsenkova R, Tei K, Morita H, Ikuta K, Onodera T. Ex vivo tissue discrimination by visible and near-infrared spectra with chemometrics. J Vet Med Sci 2007; 68:1375-8. [PMID: 17213714 DOI: 10.1292/jvms.68.1375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The risk of infections from zoonotic pathogens of tissues and/or tissue-derived products has been increasing. One preventive approach in reducing infection risk is tissue decontamination, where selection and screening of highly infectious tissues are strictly followed. Therefore, the development of reliable analytical methods for rapid tissue discrimination is essentially important. In the present study, a procedure has been developed for intact tissue discrimination on the basis of multivariate analysis of visible and near-infrared (Vis-NIR) spectra of certain tissues such as brain, liver, kidney and testis of mice without any pretreatment. Transmittance spectra in the 600- to 1000-nm regions were subjected to a principal component analysis (PCA), and leave-out cross-validation was employed to develop multivariate models for tissue discrimination. The plot of PCA scores against Vis-NIR spectra of brains, kidneys, livers and testes from 11 mice portrayed reliable tissue discrimination. This result suggests that Vis-NIR spectroscopy combined with chemometrics analysis may provide a potentially useful approach for rapid non-destructive discrimination of tissues.
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Affiliation(s)
- Akikazu Sakudo
- Department of Molecular Immunology, School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
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Pauli G. Tissue Safety in View of CJD and Variant CJD. Cell Tissue Bank 2005; 6:191-200. [PMID: 16151959 DOI: 10.1007/s10561-005-0336-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2005] [Accepted: 06/23/2005] [Indexed: 11/30/2022]
Abstract
Epidemiological studies on human transmissible spongiform encephalopathies (Creutzfeldt-Jakob Disease, CJD) have shown that the agent could be transmitted by highly infectious tissues like brain, spinal cord or retina and medicinal products derived from these tissues (i.e. human growth hormone, dura mater). A few cases of transmission of CJD by neurosurgical instruments have been reported. The transmission of the agent of variant CJD, which is suspected to be transmitted by BSE-contaminated food, by blood transfusion implies that in contrast to the agent of classical CJD this agent can also be transmitted by organs and tissues other than nerve tissues. Health authorities have implemented guidelines to reduce the risk of transmission of human and animal TSE by human and veterinary medicinal products. The high resistance of TSE agents against physical or chemical treatment hamper the development of highly efficient inactivation steps in the production of medicinal products. Donor selection is considered as an efficient measure to reduce the risk of TSE transmission. However, the development of rapid, sensitive and specific diagnostic test systems is urgently required to test blood, organs and tissue of donors.
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Affiliation(s)
- Georg Pauli
- Center for Biological Safety, Robert Koch-Institut, Nordufer 20, 13353 Berlin, Germany.
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Teotia SS, Walker RC, Schirmer JM, Tazelaar HD, Michaels MG, Risdahl JM, Byrne GW, Logan JS, McGregor CGA. Prevention, detection, and management of early bacterial and fungal infections in a preclinical cardiac xenotransplantation model that achieves prolonged survival. Xenotransplantation 2005; 12:127-33. [PMID: 15693843 DOI: 10.1111/j.1399-3089.2005.00205.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND We analyzed bacterial and fungal infectious complications in a cohort of 16 consecutive experiments with the longest surviving cardiac xenografts to date. METHODS Transgenic, porcine-to-baboon, heterotopic (abdomen) cardiac xenotransplantation was performed in 16 consecutive experiments, using rapamycin, tacrolimus, corticosteroids, anti-CD20 monoclonal antibody, and an alpha-Gal-PEG polymer, as immunosuppression. Prophylactic anti-microbials included i.v. trimethoprim/sulfamethoxazole, oral ganciclovir/valganciclovir, and oral itraconazole. An episode of bacterial infection was defined as a positive blood and/or wound culture with: leukocytosis, fever >101.5 degrees F, and/or clinical deterioration. RESULTS Mean graft survival was 71 +/- 29 days; the longest was 113 days. There were 23 episodes of bacterial infection; 14 resolved with treatment. The mean time to the first episode of infection was 44 +/- 21 days (n=12). Eight of 16 deaths were due to infection: two bacterial-only, two cytomegalovirus (CMV) only, four both bacterial and CMV, and none fungal. The frequency of infection was 1, 2.8, and 1.8 episodes/100 survival days, respectively, for animals whose grafts survived for 30 to 59, 60 to 89, and >90 days. CMV infection (reviewed in detail in a separate communications) was due to baboon CMV, and was associated with low serum levels of ganciclovir. CONCLUSION In a cardiac xenograft model that achieved prolonged (>3 months) survival, bacteremia was common, but usually reversible, and fungal infection was prevented with prophylaxis. The level of immunosuppression required to achieve clinically meaningful xenograft survival is associated with a level of bacterial and fungal infectious complications that is manageable and similar to the early clinical experiences in human transplantation. Further research will determine if the viral infectious complications observed in these experiments can be reduced by optimizing blood levels of anti-viral prophylaxis and monitoring viral polymerase chain reaction levels.
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Affiliation(s)
- Sumeet S Teotia
- William J von Liebig Transplant Center, Mayo Clinic College of Medicine, Rochester, MN 55902, USA
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Tucker AW, McNeilly F, Meehan B, Galbraith D, McArdle PD, Allan G, Patience C. Methods for the exclusion of circoviruses and gammaherpesviruses from pigs. Xenotransplantation 2003; 10:343-8. [PMID: 12795683 DOI: 10.1034/j.1399-3089.2003.02048.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The use of porcine tissues is being developed as a means to alleviate the shortage of allogeneic tissues and organs available for transplantation. To reduce the possibility of a microorganism of pigs being inadvertently transferred to the recipient of the xenograft, recommendations have been published on the microbiological specifications for organ source pigs. The porcine circoviruses (PCV1 and PCV2) and porcine lymphotropic herpesviruses (PLHV1 and PLHV2) are two infectious agents of pigs which are considered to be of significance for the microbiological safety of xenotransplantation. To ensure the exclusion of these microorganisms from animals destined for use under clinical conditions, reliable breeding methodologies are required. We investigated the efficiency of established derivation procedures for the removal of PCV and PLHV. In comparison with conventionally reared pigs, caesarian and barrier derived animals showed a markedly reduced prevalence of PCVs and PLHVs. Our results indicate that the derivation of animals free of both of these microorganisms is achievable and will enhance the microbiological safety of xenotransplantation.
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Affiliation(s)
- A W Tucker
- Imutran Ltd. (A Novartis Pharma AG Co.), Cambridge, UK
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