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Roh J, Hwang JH, Park S, Lee H, Park EM, Lee HW, Lee JY, Shim J, Choi K, Kang HJ. Investigation of the efficacy and safety of wild- type and triple-gene knockout pig RBC transfusions in nonhuman primates. Front Immunol 2024; 15:1418249. [PMID: 38994362 PMCID: PMC11236543 DOI: 10.3389/fimmu.2024.1418249] [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: 04/16/2024] [Accepted: 06/13/2024] [Indexed: 07/13/2024] Open
Abstract
Introduction Decreasing rates of blood donation and close margins between blood supply and demand pose challenges in healthcare. Genetically engineered pig red blood cells (pRBCs) have been explored as alternatives to human RBCs for transfusion, and triple-gene knockout (TKO) modification improves the compatibility of pRBCs with human blood in vitro. In this study, we assessed the efficacy and risks of transfusing wild-type (WT)- and TKO-pRBCs into nonhuman primates (NHPs). Methods Blood from O-type WT and TKO pigs was processed to produce pRBCs for transfusion, which were transfused or not into NHPs (n=4 per group: WT, TKO, and control) after 25% total blood volume withdrawal: their biological responses were compared. Hematological, biochemical, and immunological parameters were measured before, immediately after, and at intervals following transfusion. Two months later, a second transfusion was performed in three NHPs of the transfusion group. Results Transfusion of both WT- and TKO-pRBCs significantly improved RBC counts, hematocrit, and hemoglobin levels up to the first day post-transfusion, compared to the controls. The transfusion groups showed instant complement activation and rapid elicitation of anti-pig antibodies, as well as elevated liver enzyme and bilirubin levels post-transfusion. Despite the higher agglutination titers with WT-pRBCs in the pre-transfusion crossmatch, the differences between the WT and TKO groups were not remarkable except for less impairment of liver function in the TKO group. After the second transfusion, more pronounced adverse responses without any hematological gain were observed. Conclusions WT- and TKO-pRBC transfusions effectively increased hematologic parameters on the first day, with rapid clearance from circulation thereafter. However, pRBC transfusion triggers strong antibody responses, limiting the benefits of the pRBC transfusion and increasing the risk of adverse reactions.
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Affiliation(s)
- Juhye Roh
- Department of Laboratory Medicine, Hallym University College of Medicine and Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Jeong Ho Hwang
- Animal Model Research Group, Jeonbuk Branch Institute, Korea Institute of Toxicology, Jeongeup, Republic of Korea
| | - Sangkeun Park
- Department of Laboratory Medicine, Hallym University College of Medicine and Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Haneulnari Lee
- Department of Laboratory Medicine, Hallym University College of Medicine and Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Eun Mi Park
- Department of Laboratory Medicine, Hallym University College of Medicine and Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Hye Won Lee
- Department of Laboratory Medicine, Hallym University College of Medicine and Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Ju Young Lee
- Animal Model Research Group, Jeonbuk Branch Institute, Korea Institute of Toxicology, Jeongeup, Republic of Korea
| | - Joohyun Shim
- Department of Transgenic Animal Research, Optipharm Inc., Cheongju, Republic of Korea
| | - Kimyung Choi
- Department of Transgenic Animal Research, Optipharm Inc., Cheongju, Republic of Korea
| | - Hee Jung Kang
- Department of Laboratory Medicine, Hallym University College of Medicine and Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
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Suh HN, Lee JY, Kang HJ, Park EM, Yun IJ, Kim WS, Choi K, Hwang JH. A Comparison Between GalT-/-; hCD39;hCD55 and GalT-/-; hCD39;hCD46;hCD55;TBM Pig Kidneys Transplanted in Nonhuman Primates. Cell Transplant 2024; 33:9636897231217382. [PMID: 38229498 PMCID: PMC10798062 DOI: 10.1177/09636897231217382] [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: 06/07/2023] [Revised: 11/09/2023] [Accepted: 11/14/2023] [Indexed: 01/18/2024] Open
Abstract
Because there is a shortage of donor kidneys, researchers are exploring the possibility of using genetically modified pig kidneys for transplantation. Approaches involving knockout of carbohydrate genes or knockin of protective proteins have been attempted to determine the best gene modifications. In this study, we utilized GalT-/-;hCD39;hCD55 and GalT-/-;hCD39;hCD46;hCD55;thrombomodulin (TBM) pigs for transplantation in nonhuman primates (NHPs). The NHPs survived for 4 weeks after kidney transplantation (4 WAT) from the GalT-/-;hCD39;hCD55 pig and for 6 WAT from the GalT-/-;hCD39;hCD46;hCD55;TBM pig. However, messenger RNA (mRNA) sequencing and immunohistochemistry analysis revealed that the 6 WAT kidney exhibited more severe apoptosis, inflammation, loss of renal function, and renal fibrosis than the 4 WAT kidney. These results indicate that additional knockin of complement regulator (hCD46) and coagulation regulator (TBM) is not enough to prevent renal damage, suggesting that improved immune suppression is needed for more prolonged survival.
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Affiliation(s)
- Han Na Suh
- Animal Model Research Group, Korea Institute of Toxicology, Jeongeup, Republic of Korea
- Center for Companion Animal New Drug Development, Korea Institute of Toxicology, Jeongeup, Republic of Korea
| | - Ju Young Lee
- Animal Model Research Group, Korea Institute of Toxicology, Jeongeup, Republic of Korea
| | - Hee Jung Kang
- Department of Laboratory Medicine, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Chuncheon-si, Republic of Korea
| | - Eun Mi Park
- Department of Laboratory Medicine, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Chuncheon-si, Republic of Korea
| | - Ik Jin Yun
- Department of Surgery, School of Medicine, Konkuk University, Seoul, Korea
| | - Wan Seop Kim
- Department of Pathology, School of Medicine, Konkuk University, Seoul, Korea
| | - Kimyung Choi
- Department of Transgenic Animal Research, Optipharm Inc, Cheongju-si, Republic of Korea
| | - Jeong Ho Hwang
- Animal Model Research Group, Korea Institute of Toxicology, Jeongeup, Republic of Korea
- Center for Companion Animal New Drug Development, Korea Institute of Toxicology, Jeongeup, Republic of Korea
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Lee EJ, Lee H, Park EM, Kang HJ, Kim SJ, Park CG. Immunoglobulin M and Immunoglobulin G Subclass Distribution of Anti-galactose-Alpha-1,3-Galactose and Anti-N-Glycolylneuraminic Acid Antibodies in Healthy Korean Adults. Transplant Proc 2021; 53:1762-1770. [PMID: 33581850 DOI: 10.1016/j.transproceed.2021.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/19/2020] [Accepted: 01/08/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Human preformed antibodies (Abs), anti-galactose-alpha-1,3-galactose (Gal) and anti-N-glycolylneuraminic acid (Neu5Gc), can react with porcine antigens of wild-type pigs. To provide basic population data of the Abs for potential application in clinical xenotransplantation, we developed enzyme-linked immunosorbent assay methods and investigated the serum titers of anti-Gal and anti-Neu5Gc Abs, including immunoglobulin (Ig) M and IgG along with its subclasses, in humans. METHODS Anti-Gal and anti-Neu5Gc Abs serum titers were measured in 380 healthy Korean adults using the in-house enzyme-linked immunosorbent assays. The frequency and median values of anti-Gal and anti-Neu5Gc were measured, and their class and subclass distribution were evaluated. RESULTS The detection frequencies of anti-Gal were 99.2%, 95.0%, 23.2%, 94.5%, 12.4%, and 3.4% for IgM, IgG, IgG1, IgG2, IgG3, and IgG4, respectively. The detection frequencies of anti-Neu5Gc Abs were 87.4%, 96.6%, 1.6%, 46.3%, 0.0%, and 0.0% for IgM, IgG, IgG1, IgG2, IgG3, and IgG4, respectively. The median values of anti-Gal IgM (1001.6 ng/mL) and IgG (1198.3 ng/mL) were significantly higher than those of anti-Neu5Gc Abs (IgM, 328.4 ng/mL; IgG, 194.7 ng/mL; P < .001). IgG2 titers of both anti-Gal and anti-Neu5Gc Abs correlated better with the IgG class than the titers of other IgG subclasses. CONCLUSIONS The titers of anti-Gal Abs were higher than those of anti-Neu5Gc Abs. IgG2 was the main IgG subclass in both anti-Gal and anti-Neu5Gc Abs. Variation in the titers of anti-Gal or anti-Neu5Gc Abs may partly explain the biological and immunologic changes that occur in recipients of xenotransplants.
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Affiliation(s)
- Eun Jin Lee
- Department of Laboratory Medicine, Hallym University College of Medicine, Dongtan Sacred Heart Hospital, Hwaseong-si, Republic of Korea
| | - Haneulnari Lee
- Department of Laboratory Medicine, Hallym University College of Medicine, Hallym, University Sacred Heart Hospital, Anyang-si, Republic of Korea
| | - Eun Mi Park
- Department of Laboratory Medicine, Hallym University College of Medicine, Hallym, University Sacred Heart Hospital, Anyang-si, Republic of Korea
| | - Hee Jung Kang
- Department of Laboratory Medicine, Hallym University College of Medicine, Hallym, University Sacred Heart Hospital, Anyang-si, Republic of Korea.
| | - Sang Joon Kim
- Department of Surgery, Myongji Hospital, Goyang-si, Republic of Korea
| | - Chung-Gyu Park
- Xenotransplantation Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Microbiology and Immunology, Department of Biomedical Sciences, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Endemic Diseases, Seoul National University College of Medicine, Seoul, Republic of Korea
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Hong SH, Kim HJ, Kang SJ, Park CG. Novel Immunomodulatory Approaches for Porcine Islet Xenotransplantation. Curr Diab Rep 2021; 21:3. [PMID: 33433735 DOI: 10.1007/s11892-020-01368-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW Porcine islet xenotransplantation is a promising alternative to overcome the shortage of organ donors. For the successful application of islet xenotransplantation, robust immune/inflammatory responses against porcine islets should be thoroughly controlled. Over the last few decades, there have been numerous attempts to surmount xenogeneic immune barriers. In this review, we summarize the current progress in immunomodulatory therapy for the clinical application of porcine islet xenotransplantation. RECENT FINDINGS Long-term graft survival of porcine islets was achieved by using anti-CD154 Ab-based regimens in a preclinical non-human primate (NHP) model. However, owing to a serious complication of thromboembolism in clinical trials, the development of an anti-CD154 Ab-sparing immunosuppressant procedure is required. The efficacy of new immunosuppressive practices that employ anti-CD40 Abs or other immunosuppressive reagents has been tested in a NHP model to realize their utility in porcine islet xenotransplantation. The recent progress in the development of immunomodulatory approaches, including the immunosuppressive regimen, which enables long-term graft survival in a pig-to-non-human primate islet xenotransplantation model, with their potential clinical applicability was reviewed.
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Affiliation(s)
- So-Hee Hong
- Xenotransplantation Research Center, Seoul National University, College of Medicine, Seoul, South Korea
- Department of Microbiology and Immunology, Seoul National University, College of Medicine, Seoul, South Korea
- Institute of Endemic Diseases, Seoul National University, College of Medicine, Seoul, South Korea
- Cancer Research Institute, Seoul National University, College of Medicine, Seoul, South Korea
- Department of Biomedical Sciences, Seoul National University, College of Medicine, Seoul, South Korea
| | - Hyun-Je Kim
- Xenotransplantation Research Center, Seoul National University, College of Medicine, Seoul, South Korea
- Department of Microbiology and Immunology, Seoul National University, College of Medicine, Seoul, South Korea
- Institute of Endemic Diseases, Seoul National University, College of Medicine, Seoul, South Korea
| | - Seong-Jun Kang
- Xenotransplantation Research Center, Seoul National University, College of Medicine, Seoul, South Korea
- Department of Microbiology and Immunology, Seoul National University, College of Medicine, Seoul, South Korea
- Department of Biomedical Sciences, Seoul National University, College of Medicine, Seoul, South Korea
| | - Chung-Gyu Park
- Xenotransplantation Research Center, Seoul National University, College of Medicine, Seoul, South Korea.
- Department of Microbiology and Immunology, Seoul National University, College of Medicine, Seoul, South Korea.
- Institute of Endemic Diseases, Seoul National University, College of Medicine, Seoul, South Korea.
- Cancer Research Institute, Seoul National University, College of Medicine, Seoul, South Korea.
- Department of Biomedical Sciences, Seoul National University, College of Medicine, Seoul, South Korea.
- Xenotransplantation Research Center, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
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Yoon CH, Choi SH, Choi HJ, Lee HJ, Kang HJ, Kim JM, Park CG, Choi K, Kim H, Ahn C, Kim MK. Long-term survival of full-thickness corneal xenografts from α1,3-galactosyltransferase gene-knockout miniature pigs in non-human primates. Xenotransplantation 2019; 27:e12559. [PMID: 31566261 DOI: 10.1111/xen.12559] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/22/2019] [Accepted: 09/13/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND We aimed to investigate (a) the long-term survival of corneal grafts from α1,3-galactosyltransferase gene-knockout miniature (GTKOm) pigs in non-human primates as a primary outcome and (b) the effect of anti-CD20 antibody on the survival of corneal grafts from GTKOm pigs as a secondary outcome. METHODS Nine rhesus macaques undergoing full-thickness corneal xenotransplantation using GTKOm pigs were systemically administered steroid, basiliximab, intravenous immunoglobulin, and tacrolimus with (CD20 group) or without (control group) anti-CD20 antibody. RESULTS Graft survival was significantly longer (P = .008) in the CD20 group (>375, >187, >187, >83 days) than control group (165, 91, 72, 55, 37 days). When we compared the graft survival time between older (>7- month-old) and younger (≤7-month-old) aged donor recipients, there was no significant difference. Activated B cells were lower in the CD20 group than control group (P = .026). Aqueous humor complement C3a was increased in the control group at last examination (P = .043) and was higher than that in the CD20 group (P = .014). Anti-αGal IgG/M levels were unchanged in both groups. At last examination, anti-non-Gal IgG was increased in the control group alone (P = .013). CONCLUSIONS The GTKOm pig corneal graft achieved long-term survival when combined with anti-CD20 antibody treatment. Inhibition of activated B cells and complement is imperative even when using GTKO pig corneas.
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Affiliation(s)
- Chang Ho Yoon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Xenotransplantation Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Se Hyun Choi
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Xenotransplantation Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hyuk Jin Choi
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Xenotransplantation Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Ju Lee
- Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Hee Jung Kang
- Department of Laboratory Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Jong Min Kim
- Xenotransplantation Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Chung-Gyu Park
- Xenotransplantation Research Center, Seoul National University College of Medicine, Seoul, Korea.,Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, Korea
| | | | | | - Curie Ahn
- Department of Internal medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Mee Kum Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Xenotransplantation Research Center, Seoul National University College of Medicine, Seoul, Korea
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Kang HJ, Lee H, Park EM, Kim JM, Shin JS, Park CG. The value of glycated albumin for the prediction of graft outcome in the non-human primate porcine islet transplantation model. Xenotransplantation 2018; 25:e12384. [PMID: 29359356 DOI: 10.1111/xen.12384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 12/07/2017] [Accepted: 01/02/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The development of a precise and easy-to-use tool for monitoring islet graft function is important in clarifying the causes of graft loss, identifying appropriate therapy, and ensuring graft survival in the nonhuman primate (NHP) model of porcine islet transplantation (PITx). Glycated albumin (GA) is an indicator of intermediate-term changes in blood glucose control and is useful in clinical diabetes management. The validity of GA for monitoring graft function in NHP recipients of PITx was evaluated using a retrospective analysis of cohort samples. METHODS Data from a total of 23 PITxs performed in 20 recipients (3 were retransplanted) were included in this study. Islet clusters purified from adult wild-type pigs were transplanted via the intraportal route into streptozotocin-induced diabetic rhesus monkeys with immune suppression. Blood samples were obtained once per week from the recipients until they lost insulin-independence. Blood samples were also obtained from 69 non-diabetic monkeys that served as a control group. The levels of GA and albumin in stored plasma aliquots were measured using each enzymatic method, and the GA result was expressed as the percentage of GA level to the total albumin level. RESULTS The median level of GA in the recipients on the day of PITx (median 18.6%, 95% confidence interval [CI] 16.7%-20.4%) was significantly higher than that of healthy controls (median 9.14%, 95% CI 9.0%-9.3%, P < .0001). However, the level decreased after PITx and remained low or increased depending on the extent of residual graft function. The GA level at a nadir (median 11.6%, 95% CI 10.8%-13.0%) and the time to reach a nadir (median 43 days, 95% CI 21.7-69.3 days) both correlated with the duration of insulin-independence (rho [ρ] = -.605, P = .0028 and ρ = .662, P = .0008, respectively). The GA level strongly correlated with KG , the glucose disappearance rate during intravenous glucose tolerance testing (ρ = -.76, P < .0001). At post-transplant week (PTW) 3 and at PTW 4, the GA levels in recipients with long-term insulin-independence (>90 days) were significantly lower than those with short-term insulin-independence, which revealed the excellent performance for the prediction of long-term insulin-independence that is comparable to that of porcine C-peptide (historic data). CONCLUSIONS As a surrogate indicator for graft function, serial measurement of GA may provide Supporting Information to that obtained from conventional monitoring techniques of graft function for assessing porcine islet grafts in NHP models.
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Affiliation(s)
- Hee Jung Kang
- Department of Laboratory Medicine, Hallym University College of Medicine, Anyang-si, Korea
| | - Haneulnari Lee
- Department of Laboratory Medicine, Hallym University College of Medicine, Anyang-si, Korea
| | - Eun Mi Park
- Department of Laboratory Medicine, Hallym University College of Medicine, Anyang-si, Korea
| | - Jong-Min Kim
- Xenotransplantation Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jun-Seop Shin
- Xenotransplantation Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Chung-Gyu Park
- Xenotransplantation Research Center, Seoul National University College of Medicine, Seoul, Korea.,Department of Microbiology and Immunology, Department of Biomedical Sciences, Cancer Research Institute, Institute of Endemic Diseases, Seoul National University College of Medicine, Seoul, Korea
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Zhang Z, Gao B, Zhao C, Long C, Qi H, Ezzelarab M, Cooper DK, Hara H. The impact of serum incubation time on IgM/IgG binding to porcine aortic endothelial cells. Xenotransplantation 2017; 24. [PMID: 28547819 DOI: 10.1111/xen.12312] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 04/05/2017] [Accepted: 04/06/2017] [Indexed: 12/25/2022]
Abstract
The results of the assay for measuring anti-non-Gal antibodies (which affect pig xenograft survival) in recipients are important. Serum incubation time and concentration may be important factors in the extent of antibody binding to the graft. The aim of this in vitro study was to determine the optimal incubation time and serum concentration for measuring anti-non-Gal antibody binding to porcine aortic endothelial cells (pAECs). Pooled human, naive, and sensitized baboon sera were incubated with wild-type, α1,3-galactosyltransferase gene-knockout (GTKO), and GTKO/human CD55 pAECs. IgM/IgG binding to pAECs after varying serum incubation times (0.5, 1, 2, and 3 hour) and concentrations (5, 10, 20, and 40 μL) was determined by flow cytometry. An increase in incubation time from 30 minutes to 2 hour was associated with increases in anti-non-Gal IgM/IgG binding to GTKO and GTKO/hCD55 pAECs of pooled human, naive and sensitized baboon sera (P<.05). Pooled human serum showed a significant increase in anti-non-Gal IgM (1.5 times) and a minimal increase in anti-non-Gal IgG antibody binding. IgM/IgG binding of sensitized baboon serum to GTKO pAECs after 2-hour incubation was 1.5 times and 2 times greater than after 30-minutes incubation, respectively, whereas naïve baboon sera showed minimal (non-significant) increase in anti-non-Gal IgM/IgG antibody binding. With 2-hour incubation, increasing the serum concentration from 5 μL to 20 μL significantly increased antibody binding to non-Gal antigens in pooled human and sensitized baboon serum. With naïve baboon serum, only IgG was significantly increased. Increasing the serum incubation time contributed to improve the sensitivity of detecting anti-non-Gal antibodies, without affecting cell viability in vitro.
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Affiliation(s)
- Zhongqiang Zhang
- Department of Organ Transplantation and General Surgery, Second Xiangya Hospital of the Central South University, Hunan, Changsha, China.,Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, USA
| | - Bingsi Gao
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, USA
| | - Chengjiang Zhao
- Shenzhen Xenotransplantation Medical Engineering Research and Development Center, Shenzhen Second People's Hospital, First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Cassandra Long
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, USA
| | - Haizhi Qi
- Department of Organ Transplantation and General Surgery, Second Xiangya Hospital of the Central South University, Hunan, Changsha, China
| | - Mohamed Ezzelarab
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, USA
| | - David Kc Cooper
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, USA
| | - Hidetaka Hara
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, USA
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Kim J, Kim DH, Choi HJ, Lee HJ, Kang HJ, Park CG, Hwang ES, Kim MK, Wee WR. Anti-CD40 antibody-mediated costimulation blockade promotes long-term survival of deep-lamellar porcine corneal grafts in non-human primates. Xenotransplantation 2017; 24:10.1111/xen.12298. [PMID: 28393447 PMCID: PMC5464973 DOI: 10.1111/xen.12298] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 12/26/2016] [Accepted: 03/01/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Corneal xenotransplantation is an effective solution for the shortage of human donor corneas, and the porcine cornea may be a suitable candidate for the donor cornea because of its optical similarity with humans. However, it is necessary to administer additional immunosuppressants to overcome antigenic differences. We aimed to investigate the feasibility of porcine corneas with anti-CD40 antibody-mediated costimulation blockade in a clinically applicable pig-to-non-human primate corneal xenotransplantation model. METHODS Five Chinese rhesus macaques underwent deep-lamellar corneal transplantation using clinically acceptable sized (7.5 mm diameter) porcine corneal grafts. The anti-CD40 antibody was intravenously administered on a programmed schedule. Graft survival, central corneal thickness, and intraocular pressure were evaluated. Changes in effector and memory T and B cell subsets and anti-αGal and donor-specific antibodies were investigated in the blood, and the changes in complement levels in the aqueous humor and blood were evaluated. Memory cell profiles in the anti-CD40 antibody-treated group were compared with those from the anti-CD154 antibody-treated group or rejected controls presented in our previous report. The changes in anti-αGal, non-αGal, and donor-specific antibodies after 6 months were compared with baseline values. RESULTS Anti-CD40 antibody-mediated costimulation blockade resulted in the successful survival of xenocorneal grafts (>389, >382, >236, >201, and >61 days), with 80% reaching 6 months of survival. Injection of anti-CD40 antibody considerably reduced the infiltration of inflammatory cells into the grafts and significantly blocked the complement response in the aqueous humor (P=.0159, Mann-Whitney U test). Systemic expansion of central or effector memory T cells was abrogated in the anti-CD40 antibody-treated primates compared with those in the rejected controls (P<.05, Mann-Whitney U test) or those in the anti-CD154 antibody-treated primates (P>.05, Mann-Whitney U test). The levels of anti-αGal, non-αGal, and donor-specific antibodies at 6 months were not significantly increased compared with baseline levels (P>.05, Wilcoxon signed rank test). CONCLUSIONS An anti-CD40 antibody-mediated blockade appears to be effective immunosuppressive approach for porcine corneal deep-lamellar xenotransplantation in primates.
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Affiliation(s)
- Jaeyoung Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
- Translational Xenotransplantation Research Center, Seoul National University College of Medicine and Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Dong Hyun Kim
- Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
- Translational Xenotransplantation Research Center, Seoul National University College of Medicine and Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
- Department of Ophthalmology, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Hyuk Jin Choi
- Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
- Translational Xenotransplantation Research Center, Seoul National University College of Medicine and Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
- Department of Ophthalmology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
| | - Hyun Ju Lee
- Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Hee Jung Kang
- Department of Laboratory Medicine, Hallym University College of Medicine, Anyang, Gyeonggi-do, Republic of Korea
| | - Chung-Gyu Park
- Translational Xenotransplantation Research Center, Seoul National University College of Medicine and Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
- Department of Microbiology and Immunology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eung-Soo Hwang
- Department of Microbiology and Immunology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Mee Kum Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
- Translational Xenotransplantation Research Center, Seoul National University College of Medicine and Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Won Ryang Wee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
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Kang HJ, Lee H, Park EM, Kim JM, Min BH, Park CG. D-dimer level, in association with humoral responses, negatively correlates with survival of porcine islet grafts in non-human primates with immunosuppression. Xenotransplantation 2017; 24. [DOI: 10.1111/xen.12299] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 02/15/2017] [Accepted: 03/01/2017] [Indexed: 01/09/2023]
Affiliation(s)
- Hee Jung Kang
- Department of Laboratory Medicine; Hallym University College of Medicine; Anyang-si Korea
| | - Haneulnari Lee
- Department of Laboratory Medicine; Hallym University College of Medicine; Anyang-si Korea
| | - Eun Mi Park
- Department of Laboratory Medicine; Hallym University College of Medicine; Anyang-si Korea
| | - Jong-Min Kim
- Xenotransplantation Research Center; Seoul National University College of Medicine; Seoul Korea
| | - Byoung-Hoon Min
- Xenotransplantation Research Center; Seoul National University College of Medicine; Seoul Korea
| | - Chung-Gyu Park
- Xenotransplantation Research Center; Seoul National University College of Medicine; Seoul Korea
- Department of Microbiology and Immunology; Department of Biomedical Sciences; Cancer Research Institute; Institute of Endemic Diseases; Seoul National University College of Medicine; Seoul Korea
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Böer U, Buettner FFR, Schridde A, Klingenberg M, Sarikouch S, Haverich A, Wilhelmi M. Antibody formation towards porcine tissue in patients implanted with crosslinked heart valves is directed to antigenic tissue proteins and αGal epitopes and is reduced in healthy vegetarian subjects. Xenotransplantation 2017; 24. [DOI: 10.1111/xen.12288] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 12/14/2016] [Accepted: 12/27/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Ulrike Böer
- Lower Saxony Centre of Biotechnology Implant Research and Development (NIFE); Hannover Medical School; Hannover Germany
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery; Hannover Medical School; Hannover Germany
| | | | - Ariane Schridde
- Lower Saxony Centre of Biotechnology Implant Research and Development (NIFE); Hannover Medical School; Hannover Germany
| | - Melanie Klingenberg
- Lower Saxony Centre of Biotechnology Implant Research and Development (NIFE); Hannover Medical School; Hannover Germany
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery; Hannover Medical School; Hannover Germany
| | - Samir Sarikouch
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery; Hannover Medical School; Hannover Germany
| | - Axel Haverich
- Lower Saxony Centre of Biotechnology Implant Research and Development (NIFE); Hannover Medical School; Hannover Germany
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery; Hannover Medical School; Hannover Germany
| | - Mathias Wilhelmi
- Lower Saxony Centre of Biotechnology Implant Research and Development (NIFE); Hannover Medical School; Hannover Germany
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery; Hannover Medical School; Hannover Germany
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Kang HJ, Lee H, Park EM, Kim JM, Shin JS, Kim JS, Park CG, Kim SJ. Increase in anti-Gal IgM level is associated with early graft failure in intraportal porcine islet xenotransplantation. Ann Lab Med 2016; 35:611-7. [PMID: 26354349 PMCID: PMC4579105 DOI: 10.3343/alm.2015.35.6.611] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 05/04/2015] [Accepted: 08/08/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Anti-Gal is a major antibody induced in non-human primates (NHPs) after xenotransplantation. To understand the mechanism of graft rejection, we investigated the association between anti-Gal responses and graft failure in NHP recipients of porcine islet transplantation (PITx). METHODS Intraportal PITx was performed in 35 diabetic NHPs, and graft function was monitored. Early graft failure (EGF) was defined as loss of graft function within a month after PITx. Seven, 19, nine NHPs received immunosuppression (IS) without CD40 pathway blockade (Group I), with anti-CD154 (Group II), and with anti-CD40 (Group III), respectively. The anti-Gal levels on day 0 and day 7 of PITx were measured by ELISA. RESULTS The frequency of EGF was significantly lower in Group II (26.3%) than in Group I (100%, P=0.0012) and Group III (77.8%, P=0.0166). While levels of anti-Gal IgG in Group I and anti-Gal IgM in Group III increased on day 7 compared with day 0 (P=0.0156 and 0.0273), there was no increase in either on day 7 in Group II. The ratio of anti-Gal IgM or IgG level on day 7 to that on day 0 (Ratio7/0) was significantly higher in recipients with EGF than without EGF (P=0.0009 and 0.0027). ROC curve analysis of anti-Gal IgM Ratio7/0 revealed an area under the curve of 0.789 (P=0.0003). CONCLUSIONS IS with anti-CD154 suppressed anti-Gal responses and prevented EGF in PITx. Anti-Gal IgM Ratio7/0, being associated with EGF, is a predictive marker for EGF.
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Affiliation(s)
- Hee Jung Kang
- Department of Laboratory Medicine, Hallym University College of Medicine, Anyang, Korea.
| | - Haneulnari Lee
- Department of Laboratory Medicine, Hallym University College of Medicine, Anyang, Korea
| | - Eun Mi Park
- Department of Laboratory Medicine, Hallym University College of Medicine, Anyang, Korea
| | - Jong Min Kim
- Xenotransplantation Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jun Seop Shin
- Xenotransplantation Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Sik Kim
- Xenotransplantation Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Chung Gyu Park
- Xenotransplantation Research Center, Seoul National University College of Medicine, Seoul, Korea.,Department of Microbiology and Immunology, Cancer Research Institute, Seoul National University College of Medicine, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Sang Joon Kim
- Xenotransplantation Research Center, Seoul National University College of Medicine, Seoul, Korea
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13
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Park CG, Bottino R, Hawthorne WJ. Current status of islet xenotransplantation. Int J Surg 2015; 23:261-266. [PMID: 26253846 DOI: 10.1016/j.ijsu.2015.07.703] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 07/15/2015] [Indexed: 11/27/2022]
Abstract
Cell therapy for Type 1 diabetes (T1D) utilizing islet cell transplantation can successfully restore endogenous insulin production in affected patients. Islet cell engraftment and survival are conditional on the use of efficacious anti-rejection therapies and on the availability of healthy donor cells. The scarcity of healthy human donor pancreata is a limiting factor in providing sufficient tissue to meet the demand for islet transplantation worldwide. A potential alternative to the use of cadaveric human donor pancreases is the use of animal sourced islets. Pancreatic islets obtained from pigs have emerged as an alternative to human tissues due to their great availability, physiological similarities to human islets, including the time-tested use of porcine insulin in diabetic patients and the ability to genetically modify the donor source. The evolution of refined, efficacious immunosuppressive therapies with reduced toxicity, improvements in donor management and genetic manipulation of the donor have all contributed to facilitate long-term function in pre-clinical models of pig islet grafts in non-human primates. As clinical consideration for this option is growing, and trials involving the use of porcine islets have begun, more compelling experimental data suggest that the use of pig islets may soon become a viable, safe, effective and readily available treatment for insulin deficiency in T1D patients.
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Affiliation(s)
- Chung-Gyu Park
- Department of Microbiology and Immunology, Xenotransplantation Research Center, Institute of Endemic Diseases, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea; Department of Biomedical Sciences, Seoul National University, Seoul, South Korea.
| | - Rita Bottino
- Institute of Cellular Therapeutics, Allegheny Health Network, Pittsburgh, PA 15212, USA.
| | - Wayne J Hawthorne
- The Centre for Transplant & Renal Research, Westmead Research Institute, Westmead, NSW, Australia; Department of Surgery, University of Sydney at Westmead Hospital, Westmead, NSW, Australia.
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14
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Burlak C, Kerns K, Taylor RT. Xenotransplantation literature update, March-April 2015. Xenotransplantation 2015; 22:236-8. [PMID: 25988427 DOI: 10.1111/xen.12171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 05/07/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Christopher Burlak
- Schulze Diabetes Institute, Department of Surgery, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Karl Kerns
- Division of Animal Sciences, University of Missouri-Columbia, Columbia, MO, USA
| | - R Travis Taylor
- Department of Medical Microbiology and Immunology, University of Toledo Medical Center, Toledo, OH, USA
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