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Hisadome Y, Eisenson DL, Santillan MR, Iwase H, Yamada K. Pretransplant Screening for Prevention of Hyperacute Graft Loss in Pig-to-primate Kidney Xenotransplantation. Transplantation 2024; 108:1749-1759. [PMID: 39042769 DOI: 10.1097/tp.0000000000004958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
BACKGROUND Xenotransplantation using pig organs is now a clinical reality. However, the process for xenograft recipient screening lacks clarity and scientific rigor: no established thresholds exist to determine which levels of preformed antipig natural antibodies (Nabs) will be safe for clinical xenograft transplantation, and hyperacute rejection (HAR) or acute humoral xenograft rejection (AHXR), which still impacts pig-to-primate kidney xenograft survivals, may impede broader application of pig-to-human clinical xenograft transplantation. METHODS We retrospectively examined 28 cases of pig-to-baboon kidney xenotransplantation using GalTKO±human complement regulatory protein (hCRP)-transgenic (Tg) pig donors, as well as 6 cases of triple-KO multi-Tg (10GE) pig donors, and developed screening algorithms to predict risk of HAR/AHXR based on recipient antipig Nab levels. Preformed Nabs were evaluated using both complement-dependent cytotoxicity and antibody (IgM and IgG) binding flow-cytometry assays. RESULTS High complement-dependent cytotoxicity was associated with HAR/AHXR as expected. However, we also found that high levels of IgG were independently associated with HAR/AHXR, and we developed 2 indices to interpret and predict the risk of IgG-mediated HAR/AHXR. CONCLUSIONS Based on the data in this study, we have established a new 2-step screening, which will be used for future clinical kidney xenotransplantation trials.
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Affiliation(s)
- Yu Hisadome
- Department of Surgery, Division of Transplantation, The Johns Hopkins School of Medicine, Baltimore, MD
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2
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Peterson L, Yacoub MH, Ayares D, Yamada K, Eisenson D, Griffith BP, Mohiuddin MM, Eyestone W, Venter JC, Smolenski RT, Rothblatt M. Physiological basis for xenotransplantation from genetically modified pigs to humans. Physiol Rev 2024; 104:1409-1459. [PMID: 38517040 DOI: 10.1152/physrev.00041.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 03/06/2024] [Accepted: 03/14/2024] [Indexed: 03/23/2024] Open
Abstract
The collective efforts of scientists over multiple decades have led to advancements in molecular and cellular biology-based technologies including genetic engineering and animal cloning that are now being harnessed to enhance the suitability of pig organs for xenotransplantation into humans. Using organs sourced from pigs with multiple gene deletions and human transgene insertions, investigators have overcome formidable immunological and physiological barriers in pig-to-nonhuman primate (NHP) xenotransplantation and achieved prolonged pig xenograft survival. These studies informed the design of Revivicor's (Revivicor Inc, Blacksburg, VA) genetically engineered pigs with 10 genetic modifications (10 GE) (including the inactivation of 4 endogenous porcine genes and insertion of 6 human transgenes), whose hearts and kidneys have now been studied in preclinical human xenotransplantation models with brain-dead recipients. Additionally, the first two clinical cases of pig-to-human heart xenotransplantation were recently performed with hearts from this 10 GE pig at the University of Maryland. Although this review focuses on xenotransplantation of hearts and kidneys, multiple organs, tissues, and cell types from genetically engineered pigs will provide much-needed therapeutic interventions in the future.
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Affiliation(s)
- Leigh Peterson
- United Therapeutics Corporation, Silver Spring, Maryland, United States
| | | | - David Ayares
- United Therapeutics Corporation, Silver Spring, Maryland, United States
| | - Kazuhiko Yamada
- Department of Surgery, Division of Transplantation, Johns Hopkins Medicine, Baltimore, Maryland, United States
| | - Daniel Eisenson
- Department of Surgery, Division of Transplantation, Johns Hopkins Medicine, Baltimore, Maryland, United States
| | - Bartley P Griffith
- University of Maryland Medical Center, Baltimore, Maryland, United States
| | | | - Willard Eyestone
- United Therapeutics Corporation, Silver Spring, Maryland, United States
| | - J Craig Venter
- J. Craig Venter Institute, Rockville, Maryland, United States
| | | | - Martine Rothblatt
- United Therapeutics Corporation, Silver Spring, Maryland, United States
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3
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Eisenson DL, Iwase H, Chen W, Hisadome Y, Cui W, Santillan MR, Schulick AC, Gu D, Maxwell A, Koenig K, Sun Z, Warren D, Yamada K. Combined islet and kidney xenotransplantation for diabetic nephropathy: an update in ongoing research for a clinically relevant application of porcine islet transplantation. Front Immunol 2024; 15:1351717. [PMID: 38476227 PMCID: PMC10927755 DOI: 10.3389/fimmu.2024.1351717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/08/2024] [Indexed: 03/14/2024] Open
Abstract
Combined islet and kidney xenotransplantation for the treatment of diabetic nephropathy represents a compelling and increasingly relevant therapeutic possibility for an ever-growing number of patients who would benefit from both durable renal replacement and cure of the underlying cause of their renal insufficiency: diabetes. Here we briefly review immune barriers to islet transplantation, highlight preclinical progress in the field, and summarize our experience with combined islet and kidney xenotransplantation, including both challenges with islet-kidney composite grafts as well as our recent success with sequential kidney followed by islet xenotransplantation in a pig-to-baboon model.
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Affiliation(s)
- Daniel L. Eisenson
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Hayato Iwase
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Weili Chen
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Yu Hisadome
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Wanxing Cui
- Cell Therapy and Manufacturing, Medstar Georgetown University Hospital, Washington DC, United States
| | - Michelle R. Santillan
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Alexander C. Schulick
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Du Gu
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Amanda Maxwell
- Research Animal Resources, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kristy Koenig
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Zhaoli Sun
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Daniel Warren
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kazuhiko Yamada
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
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4
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Blake MJ, Steer CJ. Chimeric Livers: Interspecies Blastocyst Complementation and Xenotransplantation for End-Stage Liver Disease. Hepat Med 2024; 16:11-29. [PMID: 38379783 PMCID: PMC10878318 DOI: 10.2147/hmer.s440697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 02/10/2024] [Indexed: 02/22/2024] Open
Abstract
Orthotopic liver transplantation (OLT) currently serves as the sole definitive treatment for thousands of patients suffering from end-stage liver disease; and the existing supply of donor livers for OLT is drastically outpaced by the increasing demand. To alleviate this significant gap in treatment, several experimental approaches have been devised with the aim of either offering interim support to patients waiting on the transplant list or bioengineering complete livers for OLT by infusing them with fresh hepatic cells. Recently, interspecies blastocyst complementation has emerged as a promising method for generating complete organs in utero over a short timeframe. When coupled with gene editing technology, it has brought about a potentially revolutionary transformation in regenerative medicine. Blastocyst complementation harbors notable potential for generating complete human livers in large animals, which could be used for xenotransplantation in humans, addressing the scarcity of livers for OLT. Nevertheless, substantial experimental and ethical challenges still need to be overcome to produce human livers in larger domestic animals like pigs. This review compiles the current understanding of interspecies blastocyst complementation and outlines future possibilities for liver xenotransplantation in humans.
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Affiliation(s)
- Madelyn J Blake
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Clifford J Steer
- Departments of Medicine, and Genetics, Cell Biology and Development, University of Minnesota Medical School, Minneapolis, MN, USA
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5
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Rosales IA, Kinoshita K, Maenaka A, How IDAL, Selig MK, Laguerre CM, Collins AB, Ayares D, Cooper DKC, Colvin RB. De novo membranous nephropathy in a pig-to-baboon kidney xenograft: A new xenograft glomerulopathy. Am J Transplant 2024; 24:30-36. [PMID: 37633449 PMCID: PMC11059234 DOI: 10.1016/j.ajt.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/02/2023] [Accepted: 08/17/2023] [Indexed: 08/28/2023]
Abstract
De novo membranous nephropathy (dnMN) is an uncommon immune complex-mediated late complication of human kidney allografts that causes proteinuria. We report here the first case of dnMN in a pig-to-baboon kidney xenograft. The donor was a double knockout (GGTA1 and β4GalNT1) genetically engineered pig with a knockout of the growth hormone receptor and addition of 6 human transgenes (hCD46, hCD55, hTBM, hEPCR, hHO1, and hCD47). The recipient developed proteinuria at 42 days posttransplant, which progressively rose to the nephrotic-range at 106 days, associated with an increase in serum antidonor IgG. Kidney biopsies showed antibody-mediated rejection (AMR) with C4d and thrombotic microangiopathy that eventually led to graft failure at 120 days. In addition to AMR, the xenograft had diffuse, global granular deposition of C4d and IgG along the glomerular basement membrane on days 111 and 120. Electron microscopy showed extensive amorphous subepithelial electron-dense deposits with intervening spikes along the glomerular basement membrane. These findings, in analogy to human renal allografts, are interpreted as dnMN in the xenograft superimposed on AMR. The target was not identified but is hypothesized to be a pig xenoantigen expressed on podocytes. Whether dnMN will be a significant problem in other longer-term xenokidneys remains to be determined.
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Affiliation(s)
- Ivy A Rosales
- Department of Pathology, Immunopathology Research Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
| | - Kohei Kinoshita
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Akihiro Maenaka
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ira Doressa Anne L How
- Department of Pathology, Immunopathology Research Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Martin K Selig
- Department of Pathology, Immunopathology Research Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Christina M Laguerre
- Department of Pathology, Immunopathology Research Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - A Bernard Collins
- Department of Pathology, Immunopathology Research Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - David K C Cooper
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Robert B Colvin
- Department of Pathology, Immunopathology Research Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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6
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Burke GW, Mitrofanova A, Fontanella A, Ciancio G, Roth D, Ruiz P, Abitbol C, Chandar J, Merscher S, Fornoni A. The podocyte: glomerular sentinel at the crossroads of innate and adaptive immunity. Front Immunol 2023; 14:1201619. [PMID: 37564655 PMCID: PMC10410139 DOI: 10.3389/fimmu.2023.1201619] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/26/2023] [Indexed: 08/12/2023] Open
Abstract
Focal segmental glomerulosclerosis (FSGS) is a common glomerular disorder that manifests clinically with the nephrotic syndrome and has a propensity to recur following kidney transplantation. The pathophysiology and therapies available to treat FSGS currently remain elusive. Since the podocyte appears to be the target of apparent circulating factor(s) that lead to recurrence of proteinuria following kidney transplantation, this article is focused on the podocyte. In the context of kidney transplantation, the performance of pre- and post-reperfusion biopsies, and the establishment of in vitro podocyte liquid biopsies/assays allow for the development of clinically relevant studies of podocyte biology. This has given insight into new pathways, involving novel targets in innate and adaptive immunity, such as SMPDL3b, cGAS-STING, and B7-1. Elegant experimental studies suggest that the successful clinical use of rituximab and abatacept, two immunomodulating agents, in our case series, may be due to direct effects on the podocyte, in addition to, or perhaps distinct from their immunosuppressive functions. Thus, tissue biomarker-directed therapy may provide a rational approach to validate the mechanism of disease and allow for the development of new therapeutics for FSGS. This report highlights recent progress in the field and emphasizes the importance of kidney transplantation and recurrent FSGS (rFSGS) as a platform for the study of primary FSGS.
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Affiliation(s)
- George W. Burke
- Division of Kidney−Pancreas Transplantation, Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Alla Mitrofanova
- Research, Katz Family Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Antonio Fontanella
- Research, Katz Family Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Gaetano Ciancio
- Division of Kidney−Pancreas Transplantation, Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - David Roth
- Katz Family Division of Nephrology and Hypertension, Department of Medicine, and the Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Phil Ruiz
- Transplant Pathology, Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Carolyn Abitbol
- Division of Pediatric Nephrology, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Jayanthi Chandar
- Division of Pediatric Kidney Transplantation, Department of Pediatrics, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Sandra Merscher
- Katz Family Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Alessia Fornoni
- Katz Family Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
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7
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Sarmah H, Sawada A, Hwang Y, Miura A, Shimamura Y, Tanaka J, Yamada K, Mori M. Towards human organ generation using interspecies blastocyst complementation: Challenges and perspectives for therapy. Front Cell Dev Biol 2023; 11:1070560. [PMID: 36743411 PMCID: PMC9893295 DOI: 10.3389/fcell.2023.1070560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 01/05/2023] [Indexed: 01/20/2023] Open
Abstract
Millions of people suffer from end-stage refractory diseases. The ideal treatment option for terminally ill patients is organ transplantation. However, donor organs are in absolute shortage, and sadly, most patients die while waiting for a donor organ. To date, no technology has achieved long-term sustainable patient-derived organ generation. In this regard, emerging technologies of chimeric human organ production via blastocyst complementation (BC) holds great promise. To take human organ generation via BC and transplantation to the next step, we reviewed current emerging organ generation technologies and the associated efficiency of chimera formation in human cells from the standpoint of developmental biology.
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Affiliation(s)
- Hemanta Sarmah
- Department of Medicine, Columbia Center for Human Development, Columbia University Medical Center, New York, NY, United States
| | - Anri Sawada
- Department of Medicine, Columbia Center for Human Development, Columbia University Medical Center, New York, NY, United States
| | - Youngmin Hwang
- Department of Medicine, Columbia Center for Human Development, Columbia University Medical Center, New York, NY, United States
| | - Akihiro Miura
- Department of Medicine, Columbia Center for Human Development, Columbia University Medical Center, New York, NY, United States
| | - Yuko Shimamura
- Department of Medicine, Columbia Center for Human Development, Columbia University Medical Center, New York, NY, United States
| | - Junichi Tanaka
- Department of Medicine, Columbia Center for Human Development, Columbia University Medical Center, New York, NY, United States
| | - Kazuhiko Yamada
- Department of Surgery, Johns Hopkins University, Baltimore, MD, United States
| | - Munemasa Mori
- Department of Medicine, Columbia Center for Human Development, Columbia University Medical Center, New York, NY, United States
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8
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Yamada K, Bottino R. Editorial: Xenotransplantation for the therapy of diabetes: A new look. Front Endocrinol (Lausanne) 2023; 14:1190442. [PMID: 37065758 PMCID: PMC10103645 DOI: 10.3389/fendo.2023.1190442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 04/03/2023] Open
Affiliation(s)
- Kazuhiko Yamada
- Johns Hopkins Medicine, Division of Transplant Surgery, Department of Surgery, Johns Hopkins University, Baltimore, MD, United States
| | - Rita Bottino
- Imagine Islet Center - Imagine Pharma, Pittsburgh, PA, United States
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9
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Yamada K, Eisenson DL, Chen X, Ji L, Santillan MR, Moore A. Vascularized Islet Transplantation as Composite Islet-Kidney Grafts with Nanoparticle-Labeled Islets in Large Animal Preclinical Transplant Models. Methods Mol Biol 2023; 2592:233-249. [PMID: 36507998 DOI: 10.1007/978-1-0716-2807-2_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Although there are many patients with diabetes and end-stage renal failure (DM/ESRD) who would benefit from a transplantation strategy that addresses both their ESRD and its underlying cause, current methods of islet and kidney transplantation using live donors have had only limited success. The first major obstacle is that the number of islets obtained from a live donor partial pancreatectomy is generally insufficient to cure diabetes in recipients, as large numbers of intraportally administered islets are lost due to ischemia before they are engrafted and vascularized in the recipient liver. To overcome this hurdle, we have developed a strategy to transplant islets as a vascularized graft. Autologous prevascularization of donor islets under the donor's own renal capsule prior to transplantation preserves islets and thus achieves normal glycemic control in diabetic recipients in our preclinical transplant models with a limited donor pancreas resection. In addition, from an immunological perspective, the innate tolerogenic qualities of the kidney provide immunoprotection for the engrafted, vascularized islets when they are transplanted as part of the composite islet-kidney (I-K) grafts. This "Trojan Horse" approach of transplanting a composite I-K eliminates the lengthy time which is otherwise required for vascularization of intraportally administered free islets, minimizing loss of islets to ischemic damage and facilitating the induction of tolerance. We have also recently developed a strategy to further minimize the required size of resected donor pancreas to prepare composite I-K graft using a novel, synthesized, small interfering RNA (siRNA)-nanoparticle probe. In this chapter, we introduce our living donor transplantation strategy to cure diabetic nephropathy using composite I-K graft.
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Affiliation(s)
- Kazuhiko Yamada
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Daniel L Eisenson
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Xiaojuan Chen
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Lei Ji
- Center for Transplantation Science, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michelle R Santillan
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anna Moore
- Precision Health Program, Michigan State University, East Lansing, MI, USA
- Department of Radiology, College of Human Medicine, Michigan State University, East Lansing, MI, USA
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10
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Eisenson DL, Hisadome Y, Santillan MR, Yamada K. Progress in islet xenotransplantation: Immunologic barriers, advances in gene editing, and tolerance induction strategies for xenogeneic islets in pig-to-primate transplantation. FRONTIERS IN TRANSPLANTATION 2022; 1:989811. [PMID: 38390384 PMCID: PMC10883655 DOI: 10.3389/frtra.2022.989811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Islet transplantation has emerged as a curative therapy for diabetes in select patients but remains rare due to shortage of suitable donor pancreases. Islet transplantation using porcine islets has long been proposed as a solution to this organ shortage. There have already been several small clinical trials using porcine islets in humans, but results have been mixed and further trials limited by calls for more rigorous pre-clinical data. Recent progress in heart and kidney xenograft transplant, including three studies of pig-to-human xenograft transplant, have recaptured popular imagination and renewed interest in clinical islet xenotransplantation. This review outlines immunologic barriers to islet transplantation, summarizes current strategies to overcome these barriers with a particular focus on approaches to induce tolerance, and describes an innovative strategy for treatment of diabetic nephropathy with composite islet-kidney transplantation.
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Affiliation(s)
- Daniel L Eisenson
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, United States
| | - Yu Hisadome
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, United States
| | | | - Kazuhiko Yamada
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, United States
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11
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Eisenson DL, Hisadome Y, Yamada K. Progress in Xenotransplantation: Immunologic Barriers, Advances in Gene Editing, and Successful Tolerance Induction Strategies in Pig-To-Primate Transplantation. Front Immunol 2022; 13:899657. [PMID: 35663933 PMCID: PMC9157571 DOI: 10.3389/fimmu.2022.899657] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 04/20/2022] [Indexed: 02/05/2023] Open
Abstract
Organ transplantation is the most effective treatment for end stage organ failure, but there are not enough organs to meet burgeoning demand. One potential solution to this organ shortage is xenotransplantation using pig tissues. Decades of progress in xenotransplantation, accelerated by the development of rapid genome editing tools, particularly the advent of CRISPR-Cas9 gene editing technologies, have enabled remarkable advances in kidney and heart xenotransplantation in pig-to-nonhuman primates. These breakthroughs in large animal preclinical models laid the foundation for three recent pig-to-human transplants by three different groups: two kidney xenografts in brain dead recipients deemed ineligible for transplant, and one heart xenograft in the first clinical grade study of pig-to-human transplantation. However, despite tremendous progress, recent data including the first clinical case suggest that gene-modification alone will not overcome all xenogeneic immunologic barriers, and thus an active and innovative immunologic strategy is required for successful xenotransplantation. This review highlights xenogeneic immunologic barriers, advances in gene editing, and tolerance-inducing strategies in pig-to-human xenotransplantation.
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Affiliation(s)
- Daniel L Eisenson
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States.,Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, United States
| | - Yu Hisadome
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - Kazuhiko Yamada
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States.,Department of Surgery, Columbia University Irving Medical Center, New York, NY, United States
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12
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Montgomery RA, Stern JM, Lonze BE, Tatapudi VS, Mangiola M, Wu M, Weldon E, Lawson N, Deterville C, Dieter RA, Sullivan B, Boulton G, Parent B, Piper G, Sommer P, Cawthon S, Duggan E, Ayares D, Dandro A, Fazio-Kroll A, Kokkinaki M, Burdorf L, Lorber M, Boeke JD, Pass H, Keating B, Griesemer A, Ali NM, Mehta SA, Stewart ZA. Results of Two Cases of Pig-to-Human Kidney Xenotransplantation. N Engl J Med 2022; 386:1889-1898. [PMID: 35584156 DOI: 10.1056/nejmoa2120238] [Citation(s) in RCA: 157] [Impact Index Per Article: 78.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Xenografts from genetically modified pigs have become one of the most promising solutions to the dearth of human organs available for transplantation. The challenge in this model has been hyperacute rejection. To avoid this, pigs have been bred with a knockout of the alpha-1,3-galactosyltransferase gene and with subcapsular autologous thymic tissue. METHODS We transplanted kidneys from these genetically modified pigs into two brain-dead human recipients whose circulatory and respiratory activity was maintained on ventilators for the duration of the study. We performed serial biopsies and monitored the urine output and kinetic estimated glomerular filtration rate (eGFR) to assess renal function and xenograft rejection. RESULTS The xenograft in both recipients began to make urine within moments after reperfusion. Over the 54-hour study, the kinetic eGFR increased from 23 ml per minute per 1.73 m2 of body-surface area before transplantation to 62 ml per minute per 1.73 m2 after transplantation in Recipient 1 and from 55 to 109 ml per minute per 1.73 m2 in Recipient 2. In both recipients, the creatinine level, which had been at a steady state, decreased after implantation of the xenograft, from 1.97 to 0.82 mg per deciliter in Recipient 1 and from 1.10 to 0.57 mg per deciliter in Recipient 2. The transplanted kidneys remained pink and well-perfused, continuing to make urine throughout the study. Biopsies that were performed at 6, 24, 48, and 54 hours revealed no signs of hyperacute or antibody-mediated rejection. Hourly urine output with the xenograft was more than double the output with the native kidneys. CONCLUSIONS Genetically modified kidney xenografts from pigs remained viable and functioning in brain-dead human recipients for 54 hours, without signs of hyperacute rejection. (Funded by Lung Biotechnology.).
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Affiliation(s)
- Robert A Montgomery
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Jeffrey M Stern
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Bonnie E Lonze
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Vasishta S Tatapudi
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Massimo Mangiola
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Ming Wu
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Elaina Weldon
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Nikki Lawson
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Cecilia Deterville
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Rebecca A Dieter
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Brigitte Sullivan
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Gabriella Boulton
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Brendan Parent
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Greta Piper
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Philip Sommer
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Samantha Cawthon
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Erin Duggan
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - David Ayares
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Amy Dandro
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Ana Fazio-Kroll
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Maria Kokkinaki
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Lars Burdorf
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Marc Lorber
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Jef D Boeke
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Harvey Pass
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Brendan Keating
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Adam Griesemer
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Nicole M Ali
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Sapna A Mehta
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
| | - Zoe A Stewart
- From the New York University (NYU) Langone Transplant Institute (R.A.M., J.M.S., B.E.L., V.S.T., M.M., E.W., N.L., C.D., R.A.D., B.S., G.B., G.P., N.M.A., S.A.M., Z.A.S.), the Departments of Pathology (M.W.), Anesthesia (P.S.), Biochemistry and Molecular Pharmacology (J.D.B.), and Cardiothoracic Surgery (H.P.), and the Institute for Systems Genetics (J.D.B.), NYU Langone Health, the Department of Population Health, Division of Medical Ethics (B.P.), NYU Grossman School of Medicine (S.C.), and the Columbia Center for Translational Immunology and the Department of Surgery, Columbia University (E.D., A.G.) - all in New York; Revivicor, Blacksburg, VA (D.A., A.D., A.F.-K., M.K., L.B.); United Therapeutics, Silver Spring, MD (M.L.); and the Department of Surgery, University of Pennsylvania, Philadelphia (B.K.)
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13
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Graham ML, Ramachandran S, Singh A, Moore MEG, Flanagan EB, Azimzadeh A, Burlak C, Mueller KR, Martins K, Anazawa T, Balamurugan AN, Bansal-Pakala P, Murtaugh MP, O’Brien TD, Papas KK, Spizzo T, Schuurman HJ, Hancock WW, Hering BJ. Clinically available immunosuppression averts rejection but not systemic inflammation after porcine islet xenotransplant in cynomolgus macaques. Am J Transplant 2022; 22:745-760. [PMID: 34704345 PMCID: PMC9832996 DOI: 10.1111/ajt.16876] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/30/2021] [Accepted: 10/19/2021] [Indexed: 01/25/2023]
Abstract
A safe, efficacious, and clinically applicable immunosuppressive regimen is necessary for islet xenotransplantation to become a viable treatment option for diabetes. We performed intraportal transplants of wild-type adult porcine islets in 25 streptozotocin-diabetic cynomolgus monkeys. Islet engraftment was good in 21, partial in 3, and poor in 1 recipient. Median xenograft survival was 25 days with rapamycin and CTLA4Ig immunosuppression. Adding basiliximab induction and maintenance tacrolimus to the base regimen significantly extended median graft survival to 147 days (p < .0001), with three animals maintaining insulin-free xenograft survival for 265, 282, and 288 days. We demonstrate that this regimen suppresses non-Gal anti-pig antibody responses, circulating effector memory T cell expansion, effector function, and infiltration of the graft. However, a chronic systemic inflammatory state manifested in the majority of recipients with long-term graft survival indicated by increased neutrophil to lymphocyte ratio, IL-6, MCP-1, CD40, and CRP expression. This suggests that this immunosuppression regimen fails to regulate innate immunity and resulting inflammation is significantly associated with increased incidence and severity of adverse events making this regimen unacceptable for translation. Additional studies are needed to optimize a maintenance regimen for regulating the innate inflammatory response.
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Affiliation(s)
- Melanie L. Graham
- Schulze Diabetes Institute, Department of Surgery, University of Minnesota, Minneapolis, MN
| | | | - Amar Singh
- Schulze Diabetes Institute, Department of Surgery, University of Minnesota, Minneapolis, MN
| | - Meghan E. G. Moore
- Department of Veterinary Population Medicine, University of Minnesota, St. Paul, MN
| | - E. Brian Flanagan
- Schulze Diabetes Institute, Department of Surgery, University of Minnesota, Minneapolis, MN
| | - Agnes Azimzadeh
- Department of Surgery, University of Maryland, Baltimore, MD
| | - Christopher Burlak
- Schulze Diabetes Institute, Department of Surgery, University of Minnesota, Minneapolis, MN
| | - Kate R. Mueller
- Schulze Diabetes Institute, Department of Surgery, University of Minnesota, Minneapolis, MN
| | - Kyra Martins
- Department of Veterinary and Biomedical Sciences, University of Minnesota, St. Paul, MN
| | - Takayuki Anazawa
- Schulze Diabetes Institute, Department of Surgery, University of Minnesota, Minneapolis, MN
| | | | - Pratima Bansal-Pakala
- Schulze Diabetes Institute, Department of Surgery, University of Minnesota, Minneapolis, MN
| | - Michael P. Murtaugh
- Department of Veterinary and Biomedical Sciences, University of Minnesota, St. Paul, MN
| | - Timothy D. O’Brien
- Department of Veterinary Population Medicine, University of Minnesota, St. Paul, MN
| | - Klearchos K. Papas
- Schulze Diabetes Institute, Department of Surgery, University of Minnesota, Minneapolis, MN
| | | | - Henk-J. Schuurman
- Schulze Diabetes Institute, Department of Surgery, University of Minnesota, Minneapolis, MN,Spring Point Project, Minneapolis, MN
| | - Wayne W. Hancock
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA
| | - Bernhard. J. Hering
- Schulze Diabetes Institute, Department of Surgery, University of Minnesota, Minneapolis, MN
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14
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The MHC-characterized Miniature Swine: Lessons Learned From a 40-Year Experience in Transplantation. Transplantation 2021; 106:928-937. [PMID: 34720103 DOI: 10.1097/tp.0000000000003977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Over the last 40 y, a specialized herd of miniature swine has been intentionally bred to develop lines of animals homozygous for the swine major histocompatibility complex (MHC), which have facilitated transplantation studies across reproducible MHC and minor antigen mismatch barriers. These MHC-characterized miniature swine (Mc-MS) have been used for the study of novel surgical techniques, various approaches to tolerance induction of solid organ and vascularized composite allografts, as well as studies of the immunobiology of allografts and xenografts. Mc-MS possess characteristics that are highly advantageous to these studies, and their continued use will likely continue to play an important role in bridging "bench-to-cage-to bedside" therapies in the field of transplantation. In this review, we highlight the seminal contributions of the Mc-MS model to the field and analyze their role in the broader context of large animal models in transplantation research.
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15
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Takeuchi K, Ariyoshi Y, Shimizu A, Okumura Y, Cara-Fuentes G, Garcia GE, Pomposelli T, Watanabe H, Boyd L, Ekanayake-Alper DK, Amarnath D, Sykes M, Sachs DH, Johnson RJ, Yamada K. Expression of human CD47 in pig glomeruli prevents proteinuria and prolongs graft survival following pig-to-baboon xenotransplantation. Xenotransplantation 2021; 28:e12708. [PMID: 34418164 DOI: 10.1111/xen.12708] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/29/2021] [Accepted: 08/01/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Nephrotic syndrome is a common complication of pig-to-baboon kidney xenotransplantation (KXTx) that adversely affects outcomes. We have reported that upregulation of CD80 and down-regulation of SMPDL-3b in glomeruli have an important role in the development of proteinuria following pig-to-baboon KXTx. Recently we found induced expression of human CD47 (hCD47) on endothelial cells and podocytes isolated from hCD47 transgenic (Tg) swine markedly reduced phagocytosis by baboon and human macrophages. These observations led us to hypothesize that transplanting hCD47 Tg porcine kidneys could overcome the incompatibility of the porcine CD47-baboon SIRPα interspecies ligand-receptor interaction and prevent the development of proteinuria following KXTx. METHODS Ten baboons received pig kidneys with vascularized thymic grafts (n = 8) or intra-bone bone marrow transplants (n = 2). Baboons were divided into three groups (A, B, and C) based on the transgenic expression of hCD47 in GalT-KO pigs. Baboons in Group A received kidney grafts with expression of hCD47 restricted to glomerular cells (n = 2). Baboons in Group B received kidney grafts with high expression of hCD47 on both glomerular and tubular cells of the kidneys (n = 4). Baboons in Group C received kidney grafts with low/no glomerular expression of hCD47, and high expression of hCD47 on renal tubular cells (n = 4). RESULTS Consistent with this hypothesis, GalT-KO/hCD47 kidney grafts with high expression of hCD47 on glomerular cells developed minimal proteinuria. However, high hCD47 expression in all renal cells including renal tubular cells induced an apparent destructive inflammatory response associated with upregulated thrombospondin-1. This response could be avoided by a short course of weekly anti-IL6R antibody administration, resulting in prolonged survival without proteinuria (mean 170.5 days from 47.8 days). CONCLUSION Data showed that transgenic expression of hCD47 on glomerular cells in the GalT-KO donor kidneys can prevent xenograft nephropathy, a significant barrier for therapeutic applications of xenotransplantation. The ability to prevent nephrotic syndrome following KXTx overcomes a critical barrier for future clinical applications of KXTx.
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Affiliation(s)
- Kazuhiro Takeuchi
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University, New York, New York, USA
| | - Yuichi Ariyoshi
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University, New York, New York, USA
| | - Akira Shimizu
- Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan
| | - Yuichiro Okumura
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University, New York, New York, USA
| | - Gabriel Cara-Fuentes
- Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, Colorado, USA
| | - Gabriela E Garcia
- Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, Colorado, USA
| | - Thomas Pomposelli
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University, New York, New York, USA
| | - Hironosuke Watanabe
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University, New York, New York, USA
| | - Lennan Boyd
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University, New York, New York, USA
| | - Dilrukshi K Ekanayake-Alper
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University, New York, New York, USA
| | - Dasari Amarnath
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University, New York, New York, USA
| | - Megan Sykes
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University, New York, New York, USA.,Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - David H Sachs
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University, New York, New York, USA.,Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Richard J Johnson
- Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, Colorado, USA
| | - Kazuhiko Yamada
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University, New York, New York, USA.,Department of Surgery, Columbia University Medical Center, New York, New York, USA
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16
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Carvalho-Oliveira M, Valdivia E, Blasczyk R, Figueiredo C. Immunogenetics of xenotransplantation. Int J Immunogenet 2021; 48:120-134. [PMID: 33410582 DOI: 10.1111/iji.12526] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/06/2020] [Accepted: 12/21/2020] [Indexed: 02/07/2023]
Abstract
Xenotransplantation may become the highly desired solution to close the gap between the availability of donated organs and number of patients on the waiting list. In recent years, enormous progress has been made in the development of genetically engineered donor pigs. The introduced genetic modifications showed to be efficient in prolonging xenograft survival. In this review, we focus on the type of immune responses that may target xeno-organs after transplantation and promising immunogenetic modifications that show a beneficial effect in ameliorating or eliminating harmful xenogeneic immune responses. Increasing histocompatibility of xenografts by eliminating genetic discrepancies between species will pave their way into clinical application.
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Affiliation(s)
- Marco Carvalho-Oliveira
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Hannover, Germany.,TRR127 - Biology of Xenogeneic Cell and Organ Transplantation - from bench to bedside, Hannover, Germany
| | - Emilio Valdivia
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Hannover, Germany
| | - Rainer Blasczyk
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Hannover, Germany
| | - Constanca Figueiredo
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Hannover, Germany.,TRR127 - Biology of Xenogeneic Cell and Organ Transplantation - from bench to bedside, Hannover, Germany
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17
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CD80 Insights as Therapeutic Target in the Current and Future Treatment Options of Frequent-Relapse Minimal Change Disease. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6671552. [PMID: 33506028 PMCID: PMC7806396 DOI: 10.1155/2021/6671552] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/26/2020] [Indexed: 12/14/2022]
Abstract
Minimal change disease (MCD) is the most common cause of idiopathic nephrotic syndrome in children, and it is well known for its multifactorial causes which are the manifestation of the disease. Proteinuria is an early consequence of podocyte injury and a typical sign of kidney disease. Steroid-sensitive patients react well with glucocorticoids, but there is a high chance of multiple relapses. CD80, also known as B7-1, is generally expressed on antigen-presenting cells (APCs) in steroid-sensitive MCD patients. Various glomerular disease models associated with proteinuria demonstrated that the detection of CD80 with the increase of urinary CD80 was strongly associated closely with frequent-relapse MCD patients. The role of CD80 in MCD became controversial because one contradicts finding. This review covers the treatment alternatives for MCD with the insight of CD80 as a potential therapeutic target. The promising effectiveness of CD20 (rituximab) antibody and CD80 inhibitor (abatacept) encourages further investigation of CD80 as a therapeutic target in frequent-relapse MCD patients. Therapeutic-based antibody towards CD80 (galiximab) had never been investigated in MCD or any kidney-related disease; hence, the role of CD80 is still undetermined. A new therapeutic approach towards MCD is essential to provide broader effective treatment options besides the general immunosuppressive agents with gruesome adverse effects.
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18
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Pomposelli T, Schuetz C, Wang P, Yamada K. A Strategy to Simultaneously Cure Type 1 Diabetes and Diabetic Nephropathy by Transplant of Composite Islet-Kidney Grafts. Front Endocrinol (Lausanne) 2021; 12:632605. [PMID: 34054721 PMCID: PMC8153710 DOI: 10.3389/fendo.2021.632605] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/16/2021] [Indexed: 11/13/2022] Open
Abstract
In recent years islet cell transplant has proven itself to be a viable clinical option for a select group of diabetic patients. Graft loss after transplant however continues to hinder the long-term success of the procedure. Transplanting the islets as a pre-vascularized composite islet-kidney graft has emerged as a relevant solution. Much groundbreaking research has been done utilizing this model in conjunction with strategies aimed towards islet cell survival and prolongation of function in the host. Transplanting the islet cells as a prevascularized graft under the capsule of the donor kidney as a composite islet-kidney graft has been shown to provide long term durable blood glucose control in large animal studies by limiting graft apoptosis as well as providing a physical barrier against the host immune response. While promising, this technique is limited by long term immunosuppression requirements of the host with its well-known adverse sequelae. Research into tolerance inducing strategies of the host to the allogeneic and xenogeneic islet-kidney graft has shown much promise in the avoidance of long-term immunosuppression. In addition, utilizing xenogeneic tissue grafts could provide a near-limitless supply of organs. The islet-kidney model could provide a durable and long-term cure for diabetes. Here we summarize the most recent data, as well as groundbreaking strategies to avoid long term immunosuppression and promote graft acceptance.
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Affiliation(s)
- Thomas Pomposelli
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, United States
| | - Christian Schuetz
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - Ping Wang
- Precision Health Program, Michigan State University, East Lansing, MI, United States
- Department of Radiology, College of Human Medicine, Michigan State University, East Lansing, MI, United States
| | - Kazuhiko Yamada
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, United States
- *Correspondence: Kazuhiko Yamada,
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19
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Abstract
PURPOSE OF REVIEW To describe the most recent progress towards tolerance in xenotransplantation. RECENT FINDINGS Mixed chimerism and thymic transplantation have been used to promote tolerance in xenotransplantation models. Intra-bone bone marrow transplantation is a recent advance for mixed chimerism, which promotes longer lasting chimerism and early graft function of subsequent organ transplantation. The hybrid thymus, an advancement to the vascularized thymokidney and vascularized thymic lobe, is being developed to allow for both donor and recipient T-cell selection in the chimeric thymus, encouraging tolerance to self and donor while maintaining appropriate immune function. Regulatory T cells show promise to promote tolerance by suppressing effector T cells and by supporting mixed chimerism. Monoclonal antibodies such as anti-CD2 may promote tolerance through suppression of CD2+ effector and memory T cells whereas Tregs, which express lower numbers of CD2, are relatively spared and might be used to promote tolerance. SUMMARY These findings contribute major advances to tolerance in xenotransplantation. A combination of many of these mechanisms will likely be needed to have long-term tolerance maintained without the use of immunosuppression.
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Affiliation(s)
- Erin M. Duggan
- Columbia Center for Translational Immunology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
- Department of Surgery, Columbia University, New York, NY
| | - Adam Griesemer
- Columbia Center for Translational Immunology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
- Department of Surgery, Columbia University, New York, NY
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20
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Cara-Fuentes G, Venkatareddy M, Verma R, Segarra A, Cleuren AC, Martínez-Ramos A, Johnson RJ, Garg P. Glomerular endothelial cells and podocytes can express CD80 in patients with minimal change disease during relapse. Pediatr Nephrol 2020; 35:1887-1896. [PMID: 32399663 PMCID: PMC8528162 DOI: 10.1007/s00467-020-04541-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/05/2020] [Accepted: 03/18/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Urinary CD80 has emerged as potential biomarker in idiopathic nephrotic syndrome (INS). However, its cellular source remains controversial. The aim of the study was to assess whether CD80 is truly expressed by glomerular cells in INS patients during relapse and in the LPS mouse model of podocyte injury. METHODS The presence of CD80 in glomeruli was evaluated by combining immunostaining, immunogold labeling, and in situ hybridization techniques. RESULTS CD80 was present along the surface of glomerular endothelial cells (GEC) and rarely in podocytes in six of nine minimal change disease (MCD) patients in relapse, two of eleven patients with focal segmental glomerulosclerosis in relapse, and absent in controls. In mice, CD80 was upregulated at mRNA and protein level in GEC and podocytes, in a similar pattern to that seen in MCD patients. CONCLUSIONS Glomerular endothelial cells and podocytes can express CD80 in patients with MCD during relapse. A better understanding of the role of CD80 in glomerular cells may provide further insights into the mechanisms of proteinuria in INS.
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Affiliation(s)
- Gabriel Cara-Fuentes
- Division of Pediatric Nephrology, Department of Pediatrics, University of Michigan, MSRB-2, Room 1574, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.
| | - Madhusudan Venkatareddy
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, USA
| | - Rakesh Verma
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, USA
| | - Alfons Segarra
- Division of Nephrology, Hospital Vall d’Hebron, Barcelona, Spain
| | | | | | - Richard J Johnson
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado, Denver, USA
| | - Puneet Garg
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, USA
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21
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Ariyoshi Y, Takeuchi K, Pomposelli T, Ekanayake-Alper DK, Shimizu A, Boyd L, Estime E, Ohta M, Asfour A, Scott Arn J, Ayares D, Lorber M, Sykes M, Sachs D, Yamada K. Antibody reactivity with new antigens revealed in multi-transgenic triple knockout pigs may cause early loss of pig kidneys in baboons. Xenotransplantation 2020; 28:e12642. [PMID: 32909301 DOI: 10.1111/xen.12642] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 07/30/2020] [Accepted: 08/17/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Recent advances in gene editing technology have enabled the production of multi-knockout (KO) and transgenic pigs in order to overcome immunologic barriers in xenotransplantation (XTx). However, the genetic manipulations required to produce these changes may have the unintended consequence of producing or revealing neoantigens reactive with natural antibodies present in baboons. In this study, we examined whether the neoantigens that develop in multi-transgenic (mTg) GalT, Cytidine monophospho-N-acetylneuraminic acid hydroxylase (CMAH), β-1,4-N-acetyl-galactosaminyl transferase 2 (B4) KO pigs can cause rejection of xenografts in baboons. METHODS Five baboons that had <35% cytotoxicity against GalT-KO peripheral blood mononuclear cells (PBMCs) in a pre-screening assay received pig kidneys and vascularized thymic grafts (VT + K) from multi-transgenic hCD47, human thrombomodulin (hTBM), human endothelial protein C receptor (EPCR) with/without hCD46 and hCD55 with GalT-KO/NeuGC-KO/B4-KO (mTg Tri-KO) swine. In order to further examine the effects of anti-donor non-Gal natural antibody (nAb), anti-pig preformed IgM and IgG nAb binding against the GalT-KO PBMCs was compared with the donor-type PBMCs using donor pretransplant sera as well as 5 additional naïve baboon sera by flow cytometric analysis. RESULTS Five baboons that received VT + K grafts had stable renal function in the first 11 days (serum creatinine < 1.5 mg/dL). Two of the five baboons had higher binding of preformed IgG to mTg Tri-KO PBMCs than to GalT-KO PBMCs (mTg Tri-KO > GalT-KO), and they rejected their grafts at POD 20. In contrast, the other three baboons demonstrated either mTg Tri-KO = GalT-KO or mTg Tri-KO < GalT-KO, and they maintained renal function 43, 52, and 154 days without rejection. Among 10 baboon sera, two had less antibody binding against PBMCs that were syngeneic to the mTg Tri-KO than against GalT-KO PBMCs (mTg Tri-KO < GalT-KO); three had similar binding to mTg Tri-KO and GalT-KO PBMCs (mTg Tri-KO = GalT-KO); and five had higher binding to m Tg Tri-KO than to GalT-KO PBMCs (mTg Tri-KO > GalT-KO). CONCLUSIONS These data suggest that neoantigens associated with mTg Tri-KO promote acute xenograft rejection in a pig-to-baboon VT + K XTx model. The screening assays may be useful to select "safe" recipients to receive mTg Tri-KO kidneys.
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Affiliation(s)
- Yuichi Ariyoshi
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA
| | - Kazuhiro Takeuchi
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA
| | - Thomas Pomposelli
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA
| | - Dilrukshi K Ekanayake-Alper
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA
| | - Akira Shimizu
- Department of Pathology, Nippon Medical School, Bunkyo-ku, Japan
| | - Lennan Boyd
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA
| | - Ermance Estime
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA
| | - Mayu Ohta
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA
| | - Arsenoi Asfour
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA
| | - J Scott Arn
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA
| | | | - Marc Lorber
- Lung BioTechnology PBC, Silver Spring, MD, USA
| | - Megan Sykes
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA.,Department of Surgery, Columbia University Medical Center, New York, NY, USA.,Department of Microbiology and Immunology, Columbia University, New York, NY, USA
| | - David Sachs
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA.,Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Kazuhiko Yamada
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA.,Department of Surgery, Columbia University Medical Center, New York, NY, USA
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22
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Thomas A, Hawthorne WJ, Burlak C. Xenotransplantation literature update, November/December 2019. Xenotransplantation 2020; 27:e12582. [PMID: 31984549 DOI: 10.1111/xen.12582] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 01/14/2020] [Indexed: 12/13/2022]
Abstract
The ever-increasing disparity between the lack of organ donors and patients on the transplant waiting list is increasing worldwide. For the past several decades xenotransplantation has led the way to correct this deficit and remains clearly the only feasible option to provide a means to meet the demand for patients in need of an organ transplant. Xenotransplantation's ability to provide a specifically designed unlimited supply of organs, suited to treat the various needs for transplant organs and cells, has recently been championed by successful pre-clinical trials that have run long-term in non-human primate studies. In this review we show how these improvements have come about due to long-term dedicated research and recent advances in biomedical engineering technology, such as genome editing tools including zinc finger nucleases, TALEN, and CRISPER/Cas9 which have paved the way for significant breakthroughs in improving xenograft outcomes through genetic modifications to the donor source pig. Other novel approaches include the development of decellularized porcine tissue, such as corneas which can now be transplanted into patients with the minimal need for immunosuppression or other side effects. Further genetic variants of the porcine genome are also now being optimized to abrogate rejection. The emergence of new modalities such as; mesenchymal stem cells, donor thymic vascularization, in vivo bioreactors, chemokine and cytokine therapies have come to show improvements in xenograft outcomes. Furthermore, new studies confirm the safety status of using porcine xenografts, verifying that with current technologies and approaches, the issue of PERV transmission is a moot point. These breakthroughs and technological advancements push the reality of xenotransplantation one step closer to the clinic.
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Affiliation(s)
- Adwin Thomas
- The Centre for Transplant & Renal Research, The Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Wayne J Hawthorne
- The Centre for Transplant & Renal Research, The Westmead Institute for Medical Research, Westmead, NSW, Australia.,The Department of Surgery, University of Sydney, Westmead Hospital, Westmead, NSW, Australia
| | - Christopher Burlak
- Department of Surgery, Schulze Diabetes Institute, University of Minnesota Medical School, Minneapolis, Minnesota
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Peired AJ, Mazzinghi B, De Chiara L, Guzzi F, Lasagni L, Romagnani P, Lazzeri E. Bioengineering strategies for nephrologists: kidney was not built in a day. Expert Opin Biol Ther 2020; 20:467-480. [DOI: 10.1080/14712598.2020.1709439] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Anna Julie Peired
- Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (DENOTHE), University of Florence, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy
| | - Benedetta Mazzinghi
- Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (DENOTHE), University of Florence, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy
- Nephrology and Dialysis Unit, Meyer Children’s University Hospital, Florence, Italy
| | - Letizia De Chiara
- Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (DENOTHE), University of Florence, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy
| | - Francesco Guzzi
- Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (DENOTHE), University of Florence, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy
- Nephrology and Dialysis Unit, Meyer Children’s University Hospital, Florence, Italy
| | - Laura Lasagni
- Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (DENOTHE), University of Florence, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy
| | - Paola Romagnani
- Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (DENOTHE), University of Florence, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy
- Nephrology and Dialysis Unit, Meyer Children’s University Hospital, Florence, Italy
| | - Elena Lazzeri
- Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (DENOTHE), University of Florence, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy
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Yamada K, Ariyoshi Y, Pomposelli T, Sekijima M. Co-transplantation of Vascularized Thymic Graft with Kidney in Pig-to-Nonhuman Primates for the Induction of Tolerance Across Xenogeneic Barriers. Methods Mol Biol 2020; 2110:151-171. [PMID: 32002908 DOI: 10.1007/978-1-0716-0255-3_11] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Using advanced gene editing technologies, xenotransplantation from multi-transgenic alpha-1,3-galactosyltransferase knockout pigs has demonstrated marked prolongation of renal xenograft survival, ranging from days to greater than several months for life-supporting kidneys and >2 years in a heterotopic non-life-supporting cardiac xenograft model. However, continuous administration of multiple immunosuppressive drugs continues to be required, and attempts to taper immunosuppression have been unsuccessful. These data are consistent with previous reports indicating that the human-anti-porcine T cell response is similar or stronger than that across allogeneic barriers. Due to the strength of both the innate and adaptive immune responses in xenotransplantation, the level of continuous immunosuppression needed to control these responses and prolong xenograft survival has been associated with prohibitive morbidity and mortality. These facts provide compelling rationale to pursue a clinically applicable strategy for the induction of tolerance.Mixed chimerism and thymic tissue transplantation have both achieved xenogeneic tolerance in pig-to-mouse models, and both have recently been extended to pig-to-baboon models. Although these strategies are promising in small animal models, neither direct intravenous injection of porcine bone marrow cells nor direct fetal thymic tissue transplantation into recipients was able to achieve >2 days chimerism following BM Tx or the engraftment of thymic tissues across xenogeneic barriers in pig-to-nonhuman primate models. Several innovative procedures have been largely developed by Kazuhiko Yamada to overcome these failures. These include vascularized thymic transplantation, combined with either thymokidney (TK) or vascularized thymic lobe (VTL) transplantation. Utilizing the strategy of transplanting vascularized thymic grafts with kidney from the same GalT-KO donor without further gene modification, we have achieved longer than 6 months survival of life-supporting kidneys in a baboon. Notably, the recipient became donor specific unresponsive and developed new thymic emigrants. In this chapter, we introduce a brief summary of our achievements to date toward the successful induction of tolerance by utilizing our novel strategy of vascularized thymic transplantation (including thymokidney transplantation), as well as describe the step-by-step methodology of surgical and in vitro procedures which are required for this experiment.
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Affiliation(s)
- Kazuhiko Yamada
- Yamada Laboratory, Department of Surgery, Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY, USA.
| | - Yuichi Ariyoshi
- Yamada Laboratory, Department of Surgery, Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY, USA
| | - Thomas Pomposelli
- Yamada Laboratory, Department of Surgery, Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY, USA
| | - Mitsuhiro Sekijima
- Yamada Laboratory, Department of Surgery, Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY, USA
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Intra-bone Bone Marrow Transplantation in Pig-to-Nonhuman Primates for the Induction of Tolerance Across Xenogeneic Barriers. Methods Mol Biol 2020; 2110:213-225. [PMID: 32002911 DOI: 10.1007/978-1-0716-0255-3_14] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Mixed chimerism and thymic tissue transplantation strategies have achieved xenogeneic tolerance in pig-to-mouse models, and both have been extended to pig-to-baboon models. A mixed chimerism strategy has shown promise toward inducing tolerance in allogeneic models in mice, pigs, nonhuman primates (NHP), humans, and a rat-to-mouse small animal xeno-model. However, even though α-1,3-galactosyltransferase gene knockout (GalTKO) pigs have been used as bone marrow (BM) donors, direct intravenous injection of porcine BM cells was detected for only up to 4 days (peripheral macro-chimerism) in one case, and the rest lost chimerism within 2 days.Recent data in allogeneic models demonstrated that direct injection of donor BM cells into recipient BM spaces (intra-bone bone marrow transplantation: IBBMTx) produces rapid reconstitution and a higher survival rate compared to i.v. injection. In order to minimize the loss of injected porcine BM peripherally before reaching the BM space, Yamada developed a xeno-specific regimen including IBBMTx coated with a collagen gel matrix in a preclinical pig-to-baboon model (Yamada IBBMTx). This strategy aims to achieve improved, persistent macro-chimerism as well as engraftment of BM across a xenogeneic barrier. The initial study published in 2015 demonstrated that this IBBMTx strategy leads to markedly prolonged peripheral macro-chimerism detectable for up to 23 days. Furthermore, a more recent study using human CD47-transgenic (Tg) GalTKO pigs as xeno-donors achieved long-lasting macro-chimerism >60 days with evidence of reduction of anti-pig natural antibodies (nAb). This is the longest macro-chimerism that has ever been achieved in a preclinical large animal xenotransplant model to date. In this chapter, we introduce a brief summary of our achievements in regard to successful tolerance induction by utilizing our novel strategy of IBBMTx as well as describe the step-by-step methodology of surgical and in vitro procedures that are required for this project.
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Watanabe H, Ariyoshi Y, Pomposelli T, Takeuchi K, Ekanayake-Alper DK, Boyd L, Arn S, Sahara H, Shimizu A, Ayares D, Lorber MI, Sykes M, Sachs DH, Yamada K. Intra-bone bone marrow transplantation from hCD47 transgenic pigs to baboons prolongs chimerism to >60 days and promotes increased porcine lung transplant survival. Xenotransplantation 2020; 27:e12552. [PMID: 31544995 PMCID: PMC7007336 DOI: 10.1111/xen.12552] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/17/2019] [Accepted: 08/02/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND We have recently demonstrated that human-CD47 (hCD47) expressed on endothelial cells of porcine lung xenografts extended median graft survival from 3.5 days to 8.7 days in baboons. Intra-bone bone marrow transplantation (IBBMTx) in a pig-to-baboon model was previously shown to markedly prolong the duration of macrochimerism up to 21 days from 1 to 4 days by intravenous BMTx. We now examined whether the use of hCD47 transgenic (Tg) BM further prolonged the duration of chimerism following IBBMTx. We then tested if lung xenograft survival was prolonged following IBBMTx. METHODS Baboons received GalTKO-hCD47/hCD55Tg (n = 5) or -hCD55Tg (n = 1) or -hCD46/HLA-E Tg (n = 1) pig IBBMTx. Macrochimerism, anti-pig T cells and antibody responses were assessed. Animals received lung xenografts from either hCD47+ or hCD47- porcine lungs 1-3 months later. RESULTS All baboons that received hCD47Tg porcine IBBM maintained durable macrochimerism >30 days, and two maintained chimerism for >8 weeks. Notably, anti-pig antibody levels decreased over time and anti-pig cellular unresponsiveness developed following IBBMTx. Lungs from hCD47Tg IBBMTx matched pigs were transplanted at day 33 or day 49 after IBBMTx. These animals showed extended survival up to 13 and 14 days, while animals that received lungs from hCD47 negative pigs displayed no prolonged survival (1-4 days). CONCLUSION This is the first report demonstrating durable macrochimerism beyond 8 weeks, as well as evidence for B cell tolerance in large animal xenotransplantation. Using hCD47Tg pigs as both IBBMTx and lung donors prolongs lung xenograft survival. However, additional strategies are required to control the acute loss of lung xenografts.
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Affiliation(s)
- Hironosuke Watanabe
- Columbia Center for Translational Immunology, Columbia
University Medical Center, New York, NY
| | - Yuichi Ariyoshi
- Columbia Center for Translational Immunology, Columbia
University Medical Center, New York, NY
| | - Thomas Pomposelli
- Columbia Center for Translational Immunology, Columbia
University Medical Center, New York, NY
| | - Kazuhiro Takeuchi
- Columbia Center for Translational Immunology, Columbia
University Medical Center, New York, NY
| | | | - Lennan Boyd
- Columbia Center for Translational Immunology, Columbia
University Medical Center, New York, NY
| | - Scott Arn
- Columbia Center for Translational Immunology, Columbia
University Medical Center, New York, NY
| | - Hisashi Sahara
- Columbia Center for Translational Immunology, Columbia
University Medical Center, New York, NY
- Division of Organ Replacement and Xenotransplantation
Surgery, Center for Advanced Biomedical Science and Swine Research, Kagoshima
University, Japan
| | - Akira Shimizu
- Department of Analytic Human Pathology, Graduate School of
Medicine, Nippon Medical School, Tokyo, Japan
| | | | | | - Megan Sykes
- Columbia Center for Translational Immunology, Columbia
University Medical Center, New York, NY
| | - David H Sachs
- Columbia Center for Translational Immunology, Columbia
University Medical Center, New York, NY
| | - Kazuhiko Yamada
- Columbia Center for Translational Immunology, Columbia
University Medical Center, New York, NY
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Sekijima M, Sahara H, Shimizu A, Iwanaga T, Murokawa T, Ariyoshi Y, Pomposelli T, Maharlooei MK, Sykes M, Yamada K. Preparation of hybrid porcine thymus containing non-human primate thymic epithelial cells in miniature swine. Xenotransplantation 2019; 26:e12543. [PMID: 31293016 PMCID: PMC6908759 DOI: 10.1111/xen.12543] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/26/2019] [Accepted: 06/04/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND We have achieved greater than a 6-month survival of a life-supporting kidney co-transplanted with a vascularized thymic graft into non-human primates (NHPs). Although we have achieved pig-specific unresponsiveness in vitro, immunosuppression was not able to be fully weaned. Studies in mice and humanized mice suggest that a hybrid pig thymus (Hyb-thy)-containing host thymic epithelial cells (TECs) can optimize intra-thymic selection, achieving xenograft tolerance with improved reconstitution of T-cell function. METHODS We have tested the feasibility of the preparation of a Hyb-thy that contains NHP TECs in the donor thymic grafts. We first prepared the Hyb-thy in the donor pigs 2-3 weeks before xeno-Tx. We performed six cases of Hyb-thy preparation in six juvenile miniature swine. Two pigs received non-manipulated cynomolgus monkey thymic cells that were isolated from an excised atrophic thymus via injection into their thymic lobes (Group 1). The remaining four received thymic cells that were isolated from non-atrophic thymic glands (Groups 2 and 3). Pigs in Group 2 received unmanipulated thymic cells in one thymic lobe, as well as CD2-positive cell-depleted TEC-enriched cells in the contralateral lobe. Pigs in Group 3 received TEC-enriched cells alone. RESULTS All thymus-injected pigs received tacrolimus and rapamycin until endpoint (POD16). We detected cynomolgus monkey TEC networks in pig thymus from Groups 1 and 3, while pigs in Group 2 rejected the thymic cells. We demonstrated the preparation of Hyb-thy in pigs using tacrolimus plus rapamycin therapy. CONCLUSIONS Our results suggest that the enrichment of TEC from the excised NHP thymus facilitated NHP TEC engraftment in pig thymus.
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Affiliation(s)
- Mitsuhiro Sekijima
- Division of Organ Replacement and Xenotransplantation
Surgery, Center for Advanced Biomedical Science and Swine Research, Kagoshima
University, Japan
| | - Hisashi Sahara
- Division of Organ Replacement and Xenotransplantation
Surgery, Center for Advanced Biomedical Science and Swine Research, Kagoshima
University, Japan
- Columbia University Center for Translational Immunology,
Department of Surgery, Columbia University, New York, NY
| | - Akira Shimizu
- Department of Analytic Human Pathology, Nippon Medical
School, Tokyo, Japan
| | - Takehiro Iwanaga
- Division of Organ Replacement and Xenotransplantation
Surgery, Center for Advanced Biomedical Science and Swine Research, Kagoshima
University, Japan
| | - Takahiro Murokawa
- Division of Organ Replacement and Xenotransplantation
Surgery, Center for Advanced Biomedical Science and Swine Research, Kagoshima
University, Japan
| | - Yuichi Ariyoshi
- Division of Organ Replacement and Xenotransplantation
Surgery, Center for Advanced Biomedical Science and Swine Research, Kagoshima
University, Japan
| | - Thomas Pomposelli
- Columbia University Center for Translational Immunology,
Department of Surgery, Columbia University, New York, NY
| | - Mohsen Khosravi Maharlooei
- Columbia University Center for Translational Immunology,
Department of Surgery, Columbia University, New York, NY
| | - Megan Sykes
- Columbia University Center for Translational Immunology,
Department of Surgery, Columbia University, New York, NY
| | - Kazuhiko Yamada
- Columbia University Center for Translational Immunology,
Department of Surgery, Columbia University, New York, NY
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Nomura S, Ariyoshi Y, Watanabe H, Pomposelli T, Takeuchi K, Garcia G, Tasaki M, Ayares D, Sykes M, Sachs D, Johnson R, Yamada K. Transgenic expression of human CD47 reduces phagocytosis of porcine endothelial cells and podocytes by baboon and human macrophages. Xenotransplantation 2019; 27:e12549. [PMID: 31495971 DOI: 10.1111/xen.12549] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/12/2019] [Accepted: 07/24/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Our initial studies utilizing a galactosyl-α1-3-galactosyltransferase gene knockout (GalTKO) pig-to-baboon renal transplant model demonstrated that the early development of nephrotic syndrome has been a significant obstacle to the long-term survival of baboon recipients. We have recently documented that sphingomyelin phosphodiesterase-3 (SMPDL3b) and CD80 expressed on podocytes in porcine kidney grafts contribute to this complication. We have hypothesized that one regulator of immune function is CD47 and that incompatibilities in CD47 between pig and baboon could potentially affect macrophage function, increasing the susceptibility of the kidney grafts to immunologically induced injury. METHODS In order to address this hypothesis in vitro, we isolated and cultured porcine podocytes and ECs from GalTKO alone, human CD47 (hCD47)/hCD55 expressing transgenic (Tg) GalTKO swine, and GalTKO hCD46/hCD55 Tg swine along with baboon or human macrophages. RESULTS We found that baboon macrophages phagocytosed porcine ECs in a similar manner to human macrophages, and this response was significantly reduced when porcine ECs and podocytes expressed hCD47/hCD55 but not hCD46/hCD55 without hCD47. Furthermore, masking hCD47 by anti-hCD47 antibody on hCD47/hCD55Tg ECs restored phagocytosis. These results are consistent with the hypothesis that CD47 incompatibility plays an important role in promoting macrophage phagocytosis of endogenous cells from the transplanted kidney. CONCLUSIONS The similar levels of phagocytosis of porcine cells by baboon and human macrophages suggest that the expression of hCD47Tg on glomerular cells in donor porcine kidneys may prove to be a key strategy for preventing proteinuria following kidney xenotransplantation in a pig-to-human as well as a pig-to-baboon model.
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Affiliation(s)
- Shunichiro Nomura
- Columbia Center for Translational Immunology (CCTI)/Surgery, Columbia University Medical Center, New York, NY, USA
| | - Yuichi Ariyoshi
- Columbia Center for Translational Immunology (CCTI)/Surgery, Columbia University Medical Center, New York, NY, USA
| | - Hironosuke Watanabe
- Columbia Center for Translational Immunology (CCTI)/Surgery, Columbia University Medical Center, New York, NY, USA
| | - Thomas Pomposelli
- Columbia Center for Translational Immunology (CCTI)/Surgery, Columbia University Medical Center, New York, NY, USA
| | - Kazuhiro Takeuchi
- Columbia Center for Translational Immunology (CCTI)/Surgery, Columbia University Medical Center, New York, NY, USA
| | - Gabriela Garcia
- Department of Medicine, University of Colorado Hospital- Renal Clinic/Nephrology, Aurora, CO, USA
| | - Masayuki Tasaki
- Department of Urology, Graduate School of Medicine, Niigata University, Niigata, Japan
| | | | - Megan Sykes
- Columbia Center for Translational Immunology (CCTI)/Surgery, Columbia University Medical Center, New York, NY, USA
| | - David Sachs
- Columbia Center for Translational Immunology (CCTI)/Surgery, Columbia University Medical Center, New York, NY, USA
| | - Richard Johnson
- Department of Medicine, University of Colorado Hospital- Renal Clinic/Nephrology, Aurora, CO, USA
| | - Kazuhiko Yamada
- Columbia Center for Translational Immunology (CCTI)/Surgery, Columbia University Medical Center, New York, NY, USA
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