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Tarabeih M, Amiel A, Na'amnih W. The view of the three monotheistic religions toward xenotransplantation. Clin Transplant 2024; 38:e15192. [PMID: 37975531 DOI: 10.1111/ctr.15192] [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: 10/08/2023] [Revised: 10/28/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
Xenotransplantation, transplanting animal organs into humans, may offer a solution to the shortage of organs for transplantation. This would increase the chances for scheduled, elective transplantation, even for patients currently ineligible for receiving a human organ. However, xenotransplantation raises specific ethical and philosophical issues, that is, a personal identification of the body parts with the soul and spirit, the relationships between humans and animals, and challenges related to issues of medical and social ethics. The three monotheistic religions have laws and perspectives pertaining to xenotransplantation. This scholarly review examines the theology and viewpoints of the three monotheistic religions and their concerns regarding xenotransplantation (interspecies) in terms of religious-legal rulings, the ethical considerations related to the procedure, through religious scriptures and rulings of scholars of the three faith communities. This review should be viewed as a continuation of an extensive investigation of these issues, as the field of transplantation advances toward clinical trials. It was found that there are no fundamental religious reasons presented by any of the three religions to prohibit the use of animal organs as a means of treating severe and life-threatening conditions. However, there are certain limitations prescribed by each religion relating to the treatment of the animals and the choice of organs to be transplanted.
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Affiliation(s)
- Mahdi Tarabeih
- School of Nursing Science, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
| | - Aliza Amiel
- School of Nursing Science, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
| | - Wasef Na'amnih
- School of Nursing Science, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Cherukuru N, Athanasiadi A, LeMalefant R, Mancini D, Forrester A, Glovinsky D, Miski P, Harrison-Restelli C, Robinson C. Lessons learned from the first cardiac xenotransplant in a consciously consenting human: Psychiatric considerations and the impact of media exposure. Xenotransplantation 2023; 30:e12830. [PMID: 37864487 DOI: 10.1111/xen.12830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 09/18/2023] [Accepted: 10/05/2023] [Indexed: 10/23/2023]
Affiliation(s)
- Nithya Cherukuru
- Department of Psychiatry, Division of Consultation-Liaison Psychiatry, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Argyro Athanasiadi
- Department of Psychiatry, Division of Consultation-Liaison Psychiatry, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Rachel LeMalefant
- Department of Psychiatry, Division of Consultation-Liaison Psychiatry, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - David Mancini
- Department of Psychiatry, Division of Consultation-Liaison Psychiatry, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Anique Forrester
- Department of Psychiatry, Division of Consultation-Liaison Psychiatry, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - David Glovinsky
- Department of Psychiatry, Division of Consultation-Liaison Psychiatry, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Pinar Miski
- Ascension Saint Agnes Hospital, Baltimore, Maryland, USA
| | - Catherine Harrison-Restelli
- Department of Psychiatry, Division of Consultation-Liaison Psychiatry, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Charles Robinson
- Department of Psychiatry, Division of Consultation-Liaison Psychiatry, University of Maryland Medical Center, Baltimore, Maryland, USA
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Ethics and Theoretical Issues in Kidney Xenotransplantation. Semin Nephrol 2022; 42:151288. [PMID: 36587995 DOI: 10.1016/j.semnephrol.2022.151288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Xenotransplantation has seen recent global interest peak as a result of several clinical xenotransplants being performed in decedents and a live cardiac recipient. However, underpinning these latest transplants have been decades of invested scientific research programs that have been developing the ideal donor source animals to avoid the overwhelming hyperacute xenograft rejection seen using nongenetically modified animal organs, tissues, and cells. However, this also needs to be undertaken along with the development of safe and efficacious xenotransplantation technologies, immunosuppression, monitoring, disease screening, patient selection, societal education, and acceptance. Paralleling the advent of such extraordinary transplants have been several decades of establishment of world xenotransplantation authorities such as the International Xenotransplantation Association, and the development of guidance documents and regulations for the assessment of these cutting-edge technologies. Similar to all new technologies there remain outdated concerns and fears of the theoretical potential for transmission of xenozoonosis, ethical concerns, and outdated or appropriately educated societal concerns and religious views of the benefits or risks and issues for xenotransplantation use of organs, tissues, or cells from animals to human beings. Here, we discuss the development of xenotransplantation and the intricate balance in managing the various challenges with which we are faced: in the absolute benefits of xenotransplantation and the dichotomy in balancing the pros and cons of xenotransplantation with social, religious, ethical, scientific, and medical opinions. Ultimately, the benefits are to those patients suffering from the many and various diseases that drive the need for xenotransplantation. The hope is that it will be implemented as soon as possible to help the many millions of patients who can truly benefit.
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Hurst DJ, Padilla LA, Cooper DKC, Paris W. Scientific and psychosocial ethical considerations for initial clinical trials of kidney xenotransplantation. Xenotransplantation 2021; 29:e12722. [PMID: 34800313 DOI: 10.1111/xen.12722] [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: 04/15/2021] [Revised: 09/23/2021] [Accepted: 10/21/2021] [Indexed: 12/28/2022]
Abstract
The initial clinical trials of pig solid organ xenotransplantation (XTx) are drawing closer and could begin in the coming years. The first clinical trials may aim to transplant genetically-modified pig kidneys into adult humans. The impetus for beginning these first-in-human trials is the severe lack of deceased donor kidneys for transplantation and the number of patients with end-stage renal disease currently on transplant waitlists, which in the USA approaches 100 000. The majority of patients on the kidney transplant waitlist receive continuous renal replacement therapy. In the United States, for patients on the kidney waitlist, the median wait-time to receive a deceased human donor organ is approximately 4.5 years for patients aged 45-74, with a 5-year mortality (or removal from the waitlist because of deteriorating health) of approximately 40%. XTx has the potential to reduce the kidney waitlist morbidity and mortality while improving quality of life. By focusing on scientific and psychosocial criteria, we present ethical considerations of certain inclusion and exclusion criteria for these first-in-human clinical trials that we suggest have not yet been fully explored.
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Affiliation(s)
- Daniel J Hurst
- Department of Family Medicine, Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - Luz A Padilla
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David K C Cooper
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Wayne Paris
- School of Social Work, Abilene Christian University, Abilene, Texas, USA
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5
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Lipps AJ, Jang K. Social Work Research and Evidence-Based Practice in Experimental Medicine Exploring Issues in the Xenotransplantation Context. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2021; 18:475-491. [PMID: 32985375 DOI: 10.1080/26408066.2020.1819927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Purpose: The purpose of this paper was to discuss challenges to interdisciplinary evidence-based social work practice (EBP) within a context of xenotransplantation (XTx) using genetically modified animal organs, and the broader context of experimental medicine.Method This paper reviewed EBP terminology and discussed the meaning and function of evidence-based social work practice within an IDT in a XTx setting. Meta-analytic systematic reviews, and psychosocial surveys, were discussed to glean insights into ways in which IDTs can incorporate those research methodologies into EBP within an experimental medical (i.e., XTx) context. Several issues that arise while conducting psychosocial research in preparation for clinical trials were also discussed.Conclusions Social workers can assume leadership roles on IDT's within experimental medicine by using their group facilitation skills and training in EBP. An evidence-based pathway model for interdisciplinary care was proposed and briefly illustrated as a framework for collaboration among IDT members using EBP in XTx practice.
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Affiliation(s)
- Alan J Lipps
- School of Social Work, Abilene Christian University, Abilene, TX, USA
| | - Kyeonghee Jang
- School of Social Work, Abilene Christian University, Abilene, TX, USA
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Garcia LR, Brito FDS, Felicio ML, Garzesi AM, Tardivo MT, Polegato BF, Minicucci MF, Zornoff LAM. Clinical trials in cardiac xenotransplantation: Are we ready to overcome barriers? J Card Surg 2021; 36:3796-3801. [PMID: 34137071 DOI: 10.1111/jocs.15747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/25/2021] [Accepted: 06/10/2021] [Indexed: 11/28/2022]
Abstract
Heart allotransplantation has become one of the methods of choice in the treatment of severe heart failure. In the face of its difficulties, such as the unmet balance between organ supply and demand, the use of xenotransplantation (XTx) might be an attractive option shortly, even more with the ongoing progress achieved regarding the avoidance of hyperacute rejection and primary organ disfunction, maintenance of xenograft function and control of xenograft growth. To make possible this translational challenge, some points must be taken into account indeed, and they are the equipoise of human benefit and animal suffering, the risk of unknown infections, a well prepared informed consent, ethical and religious beliefs, and the role of cardiac XTx in a ventricular assistance device era.
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Affiliation(s)
- Leonardo Rufino Garcia
- Department of Surgery, Universidade Estadual Paulista-UNESP, SP, São Paulo, São Paulo, Brazil
| | - Flavio de Souza Brito
- Department of Surgery, Universidade Estadual Paulista-UNESP, SP, São Paulo, São Paulo, Brazil
| | - Marcello Laneza Felicio
- Department of Surgery, Universidade Estadual Paulista-UNESP, SP, São Paulo, São Paulo, Brazil
| | - André Monti Garzesi
- Department of Surgery, Universidade Estadual Paulista-UNESP, SP, São Paulo, São Paulo, Brazil
| | - Márcia Terezinha Tardivo
- Department of Internal Medicine, Universidade Estadual Paulista-UNESP, SP, São Paulo, São Paulo, Brazil
| | - Bertha Furlan Polegato
- Department of Internal Medicine, Universidade Estadual Paulista-UNESP, SP, São Paulo, São Paulo, Brazil
| | - Marcos Ferreira Minicucci
- Department of Internal Medicine, Universidade Estadual Paulista-UNESP, SP, São Paulo, São Paulo, Brazil
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Javier MFDM, Javier Delmo EM, Hetzer R. Heart transplantation: the Berlin experience and perspectives. Cardiovasc Diagn Ther 2021; 11:243-253. [PMID: 33708496 DOI: 10.21037/cdt-20-290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In patients with end-stage heart failure, heart transplants are now an ingrained practice, as they provide satisfying long-term results with good predictability and quality of life. The successful outcome has evolved from the development of effective immunosuppression, recognition of allograft rejection through diagnostic modalities and improvement in donor organ perfusion. Unfortunately, transplant availability is constrained by the shortage of donor organs and is therefore considered a casuistic therapy. The outcome is defined by unwanted effects of immunosuppressants, increased tumor occurrence and chronic transplant angiopathies. In the long term, patients fear primarily the occurrence of renal insufficiency and secondly osteoporosis with its skeletal complications and corresponding pain. Nevertheless, the overall quality of life is not very limited; on the contrary, patients demonstrate a surprisingly meaningful lives 10-20 years after the transplant. Their physical presentation is similar to those with varying co-morbidities. Most of the 20-year surviving patients are physically active and happy with their daily lives. Medical ambition has seen heart transplantation become reality and develop into an influential force regarding heart surgery, immunology, pharmacology, organ logistics and medical ethics. Its development has also molded our definitions of death and has driven public and health care approval of medical advances. It has provided a strong solidarity among politicians, sociologists, physicians and citizens. Problems regarding ethics continue to endure, and will forecast heart transplants as a defining, but temporary era in human medicine. The donor organ shortage has stimulated the use of resuscitated donor hearts and encouraged exploration and advancement of mechanical circulatory support systems and xenotransplantation as alternatives in the management of end-stage heart failure.
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Ebner K, Ostheimer J, Sautermeister J. The role of religious beliefs for the acceptance of xenotransplantation. Exploring dimensions of xenotransplantation in the field of hospital chaplaincy. Xenotransplantation 2020; 27:e12579. [DOI: 10.1111/xen.12579] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/28/2019] [Accepted: 12/25/2019] [Indexed: 02/04/2023]
Affiliation(s)
- Katharina Ebner
- Ludwig Maximilians University Munich Munich Germany
- Julius Maximilians University Würzburg Würzburg Germany
| | - Jochen Ostheimer
- Ludwig Maximilians University Munich Munich Germany
- University of Graz Graz Austria
| | - Jochen Sautermeister
- Ludwig Maximilians University Munich Munich Germany
- Rheinische Friedrich‐Wilhelms‐Universität Bonn Bonn Germany
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Martínez-Alarcón L, Ríos A, Santainés-Borredá E, Agras-Suarez MC, Cañadas-De la Fuente GA, Hurtado-Pardos B, Bárcena-Calvo C, Alorda-Terrasa C, Morillo-Velázquez JM, Martí-García C, Redin-Areta MD, Alconero-Camarero AR, Jiménez-Navascues ML, Gutierrez-Izquierdo MI, Chamorro-Rebollo E, de Las Nieves Merchán-Felipe M, Barandiaran-Lasa M, Martín-Espinosa N, Gala-León FJ, Oter-Quintana C, Benbunan-Bentata B, Tirado-Altamirano F, Fernández-Vallhonrat MB, Ramírez-Rodrigo J, Maciá-Soler L, Saez A, Sánchez Á, López-Navas A, Ramírez P, Parrilla P. Student nurses at Spanish universities and their attitude toward xenotransplantation. Xenotransplantation 2019; 26:e12507. [PMID: 30963648 DOI: 10.1111/xen.12507] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 02/27/2019] [Accepted: 03/07/2019] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Recent immunological and transgenic advances are a promising alternative using limited materials of human origin for transplantation. However, it is essential to achieve social acceptance of this therapy. OBJECTIVE To analyze the attitude of nursing students from Spanish universities toward organ xenotransplantation (XTx) and to determine the factors affecting their attitude. MATERIALS AND METHODS Type of study: A sociological, multicentre, and observational study. STUDY POPULATION Nursing students enrolled in Spain (n = 28,000). SAMPLE SIZE A sample of 10 566 students estimating a proportion of 76% (99% confidence and precision of ±1%), stratified by geographical area and year of study. Instrument of measurement: A validated questionnaire (PCID-XenoTx-RIOS) was handed out to every student in a compulsory session. This survey was self-administered and self-completed voluntarily and anonymously by each student in a period of 5-10 min. STATISTICAL ANALYSIS descriptive analysis, Student's t test, the chi-square test, and a logistic regression analysis. RESULTS A completion rate: 84% (n = 8913) was obtained. If the results of XTx were as good as in human donation, 74% (n = 6564) would be in favor and 22% (n = 1946) would have doubts. The following variables affected this attitude: age (P < 0.001); sex (P < 0.001); geographical location (P < 0.001); academic year of study (P < 0.001); attitude toward organ donation (P < 0.001); belief in the possibility of needing a transplant (P < 0.001); discussion of transplantation with one's family (P < 0.001) and friends (P < 0.001); and the opinion of one's partner (P < 0.001). The following variables persisted in the multivariate analysis: being a male (OR = 1.436; P < 0.001); geographical location (OR = 1.937; P < 0.001); an attitude in favor of donation (OR = 1.519; P < 0.001); belief in the possibility of needing a transplant (OR = 1.497; P = 0.036); and having spoken about the issue with family (OR = 1.351; P < 0.001) or friends (OR = 1.240; P = 0.001). CONCLUSIONS The attitude of nursing students toward organ XTx is favorable and is associated with factors of general knowledge about organ donation and transplantation and social interaction.
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Affiliation(s)
- Laura Martínez-Alarcón
- Department of Surgery, Transplant Unit, Virgen de la Arrixaca Univeristy Hospital, El Palmar, Spain.,Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), El Palmar, Spain.,"International Collaborative Donor Project", El Palmar, Spain
| | - Antonio Ríos
- Department of Surgery, Transplant Unit, Virgen de la Arrixaca Univeristy Hospital, El Palmar, Spain.,Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), El Palmar, Spain.,"International Collaborative Donor Project", El Palmar, Spain
| | - Elena Santainés-Borredá
- Departamento de Enfermería, Facultad de Enfermeria, Universidad de Valencia, Valencia, Spain
| | | | | | | | - Carmen Bárcena-Calvo
- Departamento de Enfermería y Fisioterapia-Área de Enfermería, Facultad de Ciencias de la Salud, Universidad de León, León, Spain
| | - Carme Alorda-Terrasa
- Departamento de Enfermeria y Fisioterapia, Universidad de las Islas Baleares, Baleares, Spain
| | - Juan Manuel Morillo-Velázquez
- Departamento de Ciencias de la Salud, Escuela Universitaria de Enfermería y Fisioterapia "San Juan de Dios", Universidad Pontificia Comillas, Madrid, Spain
| | - Celia Martí-García
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Málaga, Málaga, Spain
| | | | | | | | | | - Elena Chamorro-Rebollo
- Facultad de Enfermería y Fisioterapia Salus Infirmorum, Universidad Pontificia de Salamanca, Madrid, Spain
| | | | - Maite Barandiaran-Lasa
- Facultad de Medicina y Enfermería, Departamento de Enfermería II Donostia, Sección Donostia UPV/EHU, Gipuzkoa, Spain
| | - Noelia Martín-Espinosa
- Escuela Universitaria de Enfermería y Fisioterapia de Toledo, Universidad de Castilla la Mancha, Toledo, Spain
| | | | | | - Bibinha Benbunan-Bentata
- Departamento de Personalidad, evaluación y tratamiento psicológico, Universalidad de Granada, Melilla, Spain
| | | | | | - Jesús Ramírez-Rodrigo
- Departamento de Enfermería, Facultad de Ciencias de la Salud de Ceuta, Universidad de Granada, Ceuta, Spain
| | - Loreto Maciá-Soler
- Departamento de Enfermería, Facultad de Ciencias de la salud, Universidad de Alicante, Alicante, Spain
| | - Aida Saez
- Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), El Palmar, Spain
| | - Álvaro Sánchez
- "International Collaborative Donor Project", El Palmar, Spain
| | - Ana López-Navas
- Departmento de Psicología, Universidad Católica San Antonio Murcia, Murcia, Spain
| | - Pablo Ramírez
- Department of Surgery, Transplant Unit, Virgen de la Arrixaca Univeristy Hospital, El Palmar, Spain.,Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), El Palmar, Spain.,"International Collaborative Donor Project", El Palmar, Spain
| | - Pascual Parrilla
- Department of Surgery, Transplant Unit, Virgen de la Arrixaca Univeristy Hospital, El Palmar, Spain.,Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), El Palmar, Spain
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Paris W, Seidler RJH, FitzGerald K, Padela AI, Cozzi E, Cooper DKC. Jewish, Christian and Muslim theological perspectives about xenotransplantation. Xenotransplantation 2018; 25:e12400. [PMID: 29687920 DOI: 10.1111/xen.12400] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/23/2018] [Accepted: 03/29/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND This paper is based on a theological symposium presented at the International Xenotransplantation Association's 14th Congress held in Baltimore, MD, September, 2017. METHODS The information explores the Jewish, Christian and Muslim theological perceptions and perspectives about cross-species (ie pig-to-human) organ transplantation, the genetic alterations required in the organ-source pig, and their potential to influence individual acceptance of the procedure. RESULTS/CONCLUSIONS This work should not be considered as the ultimate word about individual theological views, but rather as part of an ongoing conversation that will hopefully lead to wider consideration and exploration of these issues as xenotransplantation science advances towards clinical trials.
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Affiliation(s)
- Wayne Paris
- School of Social Work, Abilene Christian University, Abilene, TX, USA
| | | | - Kevin FitzGerald
- Dr David Lauler Chair of Catholic Care Ethics in the Center for Clinical Bioethics, Georgetown University, Washington, DC, USA.,Department of Oncology, Georgetown University, Washington, DC, USA
| | - Aasim I Padela
- Initiative on Islam and Medicine, Section of Emergency Medicine, Faculty, MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL, USA
| | - Emanuele Cozzi
- Transplantation Immunology Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua Hospital, Padua, Italy
| | - David K C Cooper
- Department of Surgery, Xenotransplantation Program, University of Alabama Birmingham, Birmingham, AL, USA
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Abstract
PURPOSE OF REVIEW To review the progress in the field of xenotransplantation with special attention to most recent encouraging findings which will eventually bring xenotransplantation to the clinic in the near future. RECENT FINDINGS Starting from early 2000, with the introduction of galactose-α1,3-galactose (Gal)-knockout pigs, prolonged survival especially in heart and kidney xenotransplantation was recorded. However, remaining antibody barriers to non-Gal antigens continue to be the hurdle to overcome. The production of genetically engineered pigs was difficult requiring prolonged time. However, advances in gene editing, such as zinc finger nucleases, transcription activator-like effector nucleases, and most recently clustered regularly interspaced short palindromic repeats (CRISPR) technology made the production of genetically engineered pigs easier and available to more researchers. Today, the survival of pig-to-nonhuman primate heterotopic heart, kidney, and islet xenotransplantation reached more than 900, more than 400, and more than 600 days, respectively. The availability of multiple-gene pigs (five or six genetic modifications) and/or newer costimulation blockade agents significantly contributed to this success. Now, the field is getting ready for clinical trials with an international consensus. SUMMARY Clinical trials in cellular or solid organ xenotransplantation are getting closer with convincing preclinical data from many centers. The next decade will show us new achievements and additional barriers in clinical xenotransplantation.
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12
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Renal xenotransplantation: experimental progress and clinical prospects. Kidney Int 2016; 91:790-796. [PMID: 27914702 DOI: 10.1016/j.kint.2016.08.035] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/09/2016] [Accepted: 08/18/2016] [Indexed: 12/17/2022]
Abstract
There are >100,000 patients waiting for kidney transplants in the United States and a vast need worldwide. Xenotransplantation, in the form of the transplantation of kidneys from genetically engineered pigs, offers the possibility of overcoming the chronic shortage of deceased and living human donors. These genetic manipulations can take the form of (i) knockout of pig genes that are responsible for the expression of antigens against which the primate (human or nonhuman primate) has natural "preformed" antibodies that bind and initiate complement-mediated destruction or (ii) the insertion of human transgenes that provide protection against the human complement, coagulation, or inflammatory responses. Between 1989 and 2015, pig kidney graft survival in nonhuman primates increased from 23 days to almost 10 months. There appear to be no clinically significant physiological incompatibilities in renal function between pigs and primates. The organ-source pigs will be housed in a biosecure environment, and thus the risk of transferring an exogenous potentially pathogenic microorganism will be less than that after allotransplantation. Although the risk associated with porcine endogenous retroviruses is considered small, techniques are now available whereby they could potentially be excluded from the pig. The US Food and Drug Administration suggests that xenotransplantation should be restricted to "patients with serious or life-threatening diseases for whom adequately safe and effective alternative therapies are not available." These might include those with (i) a high degree of allosensitization to human leukocyte antigens or (ii) rapid recurrence of primary disease in previous allografts. The potential psychosocial, regulatory, and legal aspects of clinical xenotransplantation are briefly discussed.
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