1
|
Yang S, Zhang M, Wei H, Zhang B, Peng J, Shang P, Sun S. Research prospects for kidney xenotransplantation: a bibliometric analysis. Ren Fail 2024; 46:2301681. [PMID: 38391160 PMCID: PMC10916899 DOI: 10.1080/0886022x.2023.2301681] [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: 10/12/2023] [Accepted: 12/30/2023] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Xenograft kidney transplantation has been receiving increasing attention. The purpose of this study is to use bibliometric analysis to identify papers in this research field and explore their current status and development trends. METHODS Using the data in the Web of Science core database from Clarivate Analytics as the object of study, we used 'TS = Kidney OR Renal AND xenotransplantation' as the search term to find all literature from 1980 to 2 November 2022. RESULTS In total, 1005 articles were included. The United States has the highest number of publications and has made significant contributions in this field. Harvard University was at the forefront of this study. Professor Cooper has published 114 articles in this field. Xenotransplantation has the largest number of relevant articles. Transplantation was the most cited journal. High-frequency keywords illustrated the current state of development and future trends in xenotransplantation. The use of transgenic pigs and the development of coordinated co-stimulatory blockers have greatly facilitated progress in xenotransplantation research. We found that 'co-stimulation blockade', 'xenograft survival', 'pluripotent stem cell', 'translational research', and 'genetic engineering' were likely to be the focus of attention in the coming years. CONCLUSIONS This study screened global publications related to xenogeneic kidney transplantation; analyzed their literature metrology characteristics; identified the most cited articles in the research field; understood the current situation, hot spots, and trends of global research; and provided future development directions for researchers and practitioners.
Collapse
Affiliation(s)
- Shujun Yang
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Mingtao Zhang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, China
| | - Hao Wei
- Department of Urology, Qingdao University Hospital, Qingdao, China
| | - Bin Zhang
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Jiang Peng
- Department of Orthopaedics, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
| | - Panfeng Shang
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Shengkun Sun
- Department of Urology, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Vadori M, Cozzi E. Current challenges in xenotransplantation. Curr Opin Organ Transplant 2024; 29:205-211. [PMID: 38529696 PMCID: PMC11064916 DOI: 10.1097/mot.0000000000001146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
PURPOSE OF REVIEW In recent years, the xenotransplantation science has advanced tremendously, with significant strides in both preclinical and clinical research. This review intends to describe the latest cutting-edge progress in knowledge and methodologies developed to overcome potential obstacles that may preclude the translation and successful application of clinical xenotransplantation. RECENT FINDINGS Preclinical studies have demonstrated that it is now possible to extend beyond two years survival of primate recipients of life saving xenografts. This has been accomplished thanks to the utilization of genetic engineering methodologies that have allowed the generation of specifically designed gene-edited pigs, a careful donor and recipient selection, and appropriate immunosuppressive strategies.In this light, the compassionate use of genetically modified pig hearts has been authorized in two human recipients and xenotransplants have also been achieved in human decedents. Although encouraging the preliminary results suggest that several challenges have yet to be fully addressed for a successful clinical translation of xenotransplantation. These challenges include immunologic, physiologic and biosafety aspects. SUMMARY Recent progress has paved the way for the initial compassionate use of pig organs in humans and sets the scene for a wider application of clinical xenotransplantation.
Collapse
Affiliation(s)
- Marta Vadori
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua
| | - Emanuele Cozzi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua
- Transplant Immunology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health Padua University Hospital, Padua, Italy
| |
Collapse
|
4
|
Knechtle SJ, Ladowski JM, Kwun J. A pig kidney supporting human physiology. Kidney Int 2024; 105:921-922. [PMID: 38642988 DOI: 10.1016/j.kint.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 02/20/2024] [Indexed: 04/22/2024]
Abstract
Because of the global shortage of donor kidneys, xenotransplantation emerges as a potential solution for individuals with kidney failure who face challenges in securing a suitable donor kidney. A study featured in this month's issue of Kidney International assesses the kidney physiology of a porcine kidney transplanted into a brain-dead human with kidney failure, demonstrating life-sustaining physiological function for 7 days. Together with preclinical nonhuman primate studies, decedent models provide complementary data for development of clinical kidney xenotransplantation.
Collapse
Affiliation(s)
- Stuart J Knechtle
- Department of Surgery, Duke University, School of Medicine, Durham, North Carolina, USA.
| | - Joseph M Ladowski
- Department of Surgery, Duke University, School of Medicine, Durham, North Carolina, USA
| | - Jean Kwun
- Department of Surgery, Duke University, School of Medicine, Durham, North Carolina, USA
| |
Collapse
|
5
|
Judd E, Kumar V, Porrett PM, Hyndman KA, Anderson DJ, Jones-Carr ME, Shunk A, Epstein DR, Fatima H, Katsurada A, Satou R, Navar LG, Locke JE. Physiologic homeostasis after pig-to-human kidney xenotransplantation. Kidney Int 2024; 105:971-979. [PMID: 38290599 DOI: 10.1016/j.kint.2024.01.016] [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: 10/31/2023] [Revised: 12/15/2023] [Accepted: 01/09/2024] [Indexed: 02/01/2024]
Abstract
Demand for kidney grafts outpaces supply, limiting kidney transplantation as a treatment for kidney failure. Xenotransplantation has the potential to make kidney transplantation available to many more patients with kidney failure, but the ability of xenografts to support human physiologic homeostasis has not been established. A brain-dead adult decedent underwent bilateral native nephrectomies followed by 10 gene-edited (four gene knockouts, six human transgenes) pig-to-human xenotransplantation. Physiologic parameters and laboratory values were measured for seven days in a critical care setting. Data collection aimed to assess homeostasis by measuring components of the renin-angiotensin-aldosterone system, parathyroid hormone signaling, glomerular filtration rate, and markers of salt and water balance. Mean arterial blood pressure was maintained above 60 mmHg throughout. Pig kidneys secreted renin (post-operative day three to seven mean and standard deviation: 47.3 ± 9 pg/mL). Aldosterone and angiotensin II levels were present (post-operative day three to seven, 57.0 ± 8 pg/mL and 5.4 ± 4.3 pg/mL, respectively) despite plasma renin activity under 0.6 ng/mL/hr. Parathyroid hormone levels followed ionized calcium. Urine output down trended from 37 L to 6 L per day with 4.5 L of electrolyte free water loss on post-operative day six. Aquaporin 2 channels were detected in the apical surface of principal cells, supporting pig kidney response to human vasopressin. Serum creatinine down trended to 0.9 mg/dL by day seven. Glomerular filtration rate ranged 90-240 mL/min by creatinine clearance and single-dose inulin clearance. Thus, in a human decedent model, xenotransplantation of 10 gene-edited pig kidneys provided physiologic balance for seven days. Hence, our in-human study paves the way for future clinical study of pig-to-human kidney xenotransplantation in living persons.
Collapse
Affiliation(s)
- Eric Judd
- Department of Medicine, Division of Nephrology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Vineeta Kumar
- Department of Medicine, Division of Nephrology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Paige M Porrett
- Department of Surgery, Division of Transplantation, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Kelly A Hyndman
- Department of Medicine, Division of Nephrology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Douglas J Anderson
- Department of Surgery, Division of Transplantation, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Maggie E Jones-Carr
- Department of Surgery, Division of Transplantation, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | | | - Daniel R Epstein
- Department of Surgery, Division of Transplantation, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Huma Fatima
- Department of Pathology, Division of Anatomic Pathology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Akemi Katsurada
- Department of Physiology and Hypertension and Renal Center, Tulane University, New Orleans, Louisianna, USA
| | - Ryousuke Satou
- Department of Physiology and Hypertension and Renal Center, Tulane University, New Orleans, Louisianna, USA
| | - L Gabriel Navar
- Department of Physiology and Hypertension and Renal Center, Tulane University, New Orleans, Louisianna, USA
| | - Jayme E Locke
- Department of Surgery, Division of Transplantation, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA.
| |
Collapse
|
6
|
Raza SS, Hara H, Eyestone W, Ayares D, Cleveland DC, Cooper DKC. Pigs in Transplantation Research and Their Potential as Sources of Organs in Clinical Xenotransplantation. Comp Med 2024; 74:33-48. [PMID: 38359908 PMCID: PMC11078278 DOI: 10.30802/aalas-cm-23-000030] [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: 05/03/2023] [Revised: 06/20/2023] [Accepted: 10/29/2023] [Indexed: 02/17/2024]
Abstract
The pig has long been used as a research animal and has now gained importance as a potential source of organs for clinical xenotransplantation. When an organ from a wild-type (i. e., genetically unmodified) pig is transplanted into an immunosuppressed nonhuman primate, a vigorous host immune response causes hyperacute rejection (within minutes or hours). This response has been largely overcome by 1) extensive gene editing of the organ-source pig and 2) the administration to the recipient of novel immunosuppressive therapy based on blockade of the CD40/CD154 T cell costimulation pathway. Gene editing has consisted of 1) deletion of expression of the 3 known carbohydrate xenoantigens against which humans have natural (preformed) antibodies and 2) the introduction of human 'protective' genes. The combination of gene editing and novel immunosuppressive therapy has extended life-supporting pig kidney graft survival to greater than 1 y and of pig heart survival to up to 9 mo. This review briefly describes the techniques of gene editing, the potential risks of transfer of porcine endogenous retroviruses with the organ, and the need for breeding and housing of donor pigs under biosecure conditions.
Collapse
Key Words
- crp, complement-regulatory protein
- epcr, endothelial protein c receptor
- gal, galactose-α1,3-galactose
- gtko, α1,3-galactosyltransferase gene-knockout
- herv, human endogenous retrovirus
- neu5gc, n-glycolylneuraminic acid
- nhp, nonhuman primates
- perv, porcine endogenous retrovirus
- tko, triple knockout
- wt, wild-type
Collapse
Affiliation(s)
- S Sikandar Raza
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Hidetaka Hara
- College of Veterinary Medicine, Yunnan Agricultural University, Kunming, Yunnan, China
| | | | | | - David C Cleveland
- Department of Cardiothoracic Surgery, Children's Hospital of Los Angeles, Los Angeles, California
| | - David K C Cooper
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts;,
| |
Collapse
|
7
|
Cooper DKC, Kobayashi T. Xenotransplantation experiments in brain-dead human subjects-A critical appraisal. Am J Transplant 2024; 24:520-525. [PMID: 38158188 DOI: 10.1016/j.ajt.2023.12.020] [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: 09/30/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Abstract
Brain-dead human subjects (decedents) were recently introduced as a potential preclinical experimental model in xenotransplantation. Brain death is associated with major pathophysiological changes, eg, structural injury and cell infiltration in vital organs, and major hormonal, metabolic, inflammatory, and hemodynamic changes. In 2 of the 3 initial experiments, the design of the experiments resulted in little or no new information becoming available. In the third, the experiment was unfortunately unsuccessful as neither of the 2 pig kidneys transplanted into the decedent functioned adequately. Failure may well have been associated with the effects of brain death, but an immune/inflammatory response to the xenograft could not be excluded. Subsequently, 2 further pig kidney transplants and 2 pig heart transplants have been carried out in human decedents, but again the data obtained do not add much to what is already known. In view of the profound changes that take place during and after brain death, it may prove difficult to determine whether graft failure or dysfunction results from the effects of brain death or from an immune/inflammatory response to the xenograft. A major concern is that, if the results are confusing, they may impact decisions relating to the introduction of clinical xenotransplantation.
Collapse
Affiliation(s)
- David K C Cooper
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA.
| | - Takaaki Kobayashi
- Department of Renal Transplant Surgery, Aichi University School of Medicine, Nagakute, Japan
| |
Collapse
|
8
|
Zhang X, Wang H, Xie Q, Zhang Y, Yang Y, Yuan M, Cui Y, Song SY, Lv J, Wang Y. Advancing kidney xenotransplantation with anesthesia and surgery - bridging preclinical and clinical frontiers challenges and prospects. Front Immunol 2024; 15:1386382. [PMID: 38585270 PMCID: PMC10998442 DOI: 10.3389/fimmu.2024.1386382] [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: 02/15/2024] [Accepted: 03/13/2024] [Indexed: 04/09/2024] Open
Abstract
Xenotransplantation is emerging as a vital solution to the critical shortage of organs available for transplantation, significantly propelled by advancements in genetic engineering and the development of sophisticated immunosuppressive treatments. Specifically, the transplantation of kidneys from genetically engineered pigs into human patients has made significant progress, offering a potential clinical solution to the shortage of human kidney supply. Recent trials involving the transplantation of these modified porcine kidneys into deceased human bodies have underscored the practicality of this approach, advancing the field towards potential clinical applications. However, numerous challenges remain, especially in the domains of identifying suitable donor-recipient matches and formulating effective immunosuppressive protocols crucial for transplant success. Critical to advancing xenotransplantation into clinical settings are the nuanced considerations of anesthesia and surgical practices required for these complex procedures. The precise genetic modification of porcine kidneys marks a significant leap in addressing the biological and immunological hurdles that have traditionally challenged xenotransplantation. Yet, the success of these transplants hinges on the process of meticulously matching these organs with human recipients, which demands thorough understanding of immunological compatibility, the risk of organ rejection, and the prevention of zoonotic disease transmission. In parallel, the development and optimization of immunosuppressive protocols are imperative to mitigate rejection risks while minimizing side effects, necessitating innovative approaches in both pharmacology and clinical practices. Furthermore, the post-operative care of recipients, encompassing vigilant monitoring for signs of organ rejection, infectious disease surveillance, and psychological support, is crucial for ensuring post-transplant life quality. This comprehensive care highlights the importance of a multidisciplinary approach involving transplant surgeons, anesthesiologists, immunologists, infectiologists and psychiatrists. The integration of anesthesia and surgical expertise is particularly vital, ensuring the best possible outcomes of those patients undergoing these novel transplants, through safe procedural practices. As xenotransplantation moving closer to clinical reality, establishing consensus guidelines on various aspects, including donor-recipient selection, immunosuppression, as well as surgical and anesthetic management of these transplants, is essential. Addressing these challenges through rigorous research and collective collaboration will be the key, not only to navigate the ethical, medical, and logistical complexities of introducing kidney xenotransplantation into mainstream clinical practice, but also itself marks a new era in organ transplantation.
Collapse
Affiliation(s)
- Xiaojian Zhang
- Central of Reproductive Medicine, Department of Obstetrics and Gynecology, Sichuan Academy of Medical Science and Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Hailian Wang
- Clinical Immunology Translational Medicine Key Laboratory of Sichuan Province, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Qin Xie
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yang Zhang
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Standford, CA, United States
| | - Yixin Yang
- The First Clinical Medical College of Norman Bethune University of Medical Sciences, Jilin, China
| | - Man Yuan
- Eye Center, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, Hubei, China
| | - Yuqi Cui
- Department of Geriatrics, Donald W. Reynolds Institute on Aging, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Si-Yuan Song
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, United States
| | - Jianzhen Lv
- School of Pharmacy, Guangxi University of Chinese Medicine, Nanning, China
| | - Yi Wang
- Clinical Immunology Translational Medicine Key Laboratory of Sichuan Province, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| |
Collapse
|
9
|
Zheng H, Choi H, Oh D, Kim M, Cai L, Jawad A, Kim S, Lee J, Hyun SH. Supplementation with fibroblast growth factor 7 during in vitro maturation of porcine cumulus-oocyte complexes improves oocyte maturation and early embryonic development. Front Vet Sci 2023; 10:1250551. [PMID: 38026656 PMCID: PMC10662523 DOI: 10.3389/fvets.2023.1250551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
In vitro generation of porcine embryos is an indispensable method in the realms of both agriculture and biomedicine. Nonetheless, the extant procedures encounter substantial obstacles pertaining to both the caliber and efficacy of the produced embryos, necessitating extensive research to in vitro maturation (IVM), the seminal commencement phase. One potentially fruitful approach may lie in refining the media and supplements composition utilized for oocyte maturation. Fibroblast growth factor-7 (FGF7), alternatively termed keratinocyte growth factor, is a theca-derived cytokine integral to folliculogenesis. This study aimed to examine the ramifications of supplementing FGF7 during the IVM phase. To determine the FGF7 location and its receptor in porcine ovaries, immunohistochemistry was executed based on follicle size categories (1-2, 3-6, and 7-9 mm). Regardless of follicle size, it was determined that FGF7 was expressed in theca and granulosa cells (GCs), whereas the FGF7 receptor was only expressed in the GCs of the larger follicles. During the IVM process, the maturation medium was supplied with various concentrations of FGF7, aiming to mature porcine cumulus-oocyte complexes (COCs). The data indicated a significant augmentation in the nuclear maturation rate only within the group treated with 10 ng/mL of FGF7 (p < 0.05). Post-IVM, the oocytes diameter exhibited a significant expansion in all groups that received FGF7 supplementation (p < 0.05). Additionally, all FGF7-supplemented groups exhibited a substantial elevation in intracellular glutathione levels, coupled with a noticeable reduction in reactive oxygen species levels (p < 0.05). With respect to gene expressions related to apoptosis, FGF7 treatment elicited a downregulation of pro-apoptotic genes and an upregulation of anti-apoptotic genes. The expression of genes associated with antioxidants underwent a significant enhancement (p < 0.05). In terms of the FGF7 signaling pathway-associated genes, there was a significant elevation in the mRNA expression of ERK1, ERK2, c-kit, and KITLG (p < 0.05). Remarkably, the group of 10 ng/mL of FGF7 demonstrated an appreciable uptick in the blastocyst formation rate during embryonic development post-parthenogenetic activation (p < 0.05). In conclusion, the FGF7 supplementation during IVM substantially augments the quality of matured oocytes and facilitates the subsequent development of parthenogenetically activated embryos. These results offer fresh perspectives on improved maturation and following in vitro evolution of porcine oocytes.
Collapse
Affiliation(s)
- Haomiao Zheng
- Laboratory of Veterinary Embryology and Biotechnology (VETEMBIO), Veterinary Medical Center and College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
- Institute of Stem Cell and Regenerative Medicine (ISCRM), Research Institute for Natural Science, Chungbuk National University, Cheongju, Republic of Korea
| | - Hyerin Choi
- Laboratory of Veterinary Embryology and Biotechnology (VETEMBIO), Veterinary Medical Center and College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
- Institute of Stem Cell and Regenerative Medicine (ISCRM), Research Institute for Natural Science, Chungbuk National University, Cheongju, Republic of Korea
| | - Dongjin Oh
- Laboratory of Veterinary Embryology and Biotechnology (VETEMBIO), Veterinary Medical Center and College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
- Institute of Stem Cell and Regenerative Medicine (ISCRM), Research Institute for Natural Science, Chungbuk National University, Cheongju, Republic of Korea
| | - Mirae Kim
- Laboratory of Veterinary Embryology and Biotechnology (VETEMBIO), Veterinary Medical Center and College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
- Institute of Stem Cell and Regenerative Medicine (ISCRM), Research Institute for Natural Science, Chungbuk National University, Cheongju, Republic of Korea
| | - Lian Cai
- Department of Biological Sciences, College of Arts and Sciences, University at Buffalo, The State University of New York (SUNY), Buffalo, NY, United States
| | - Ali Jawad
- Laboratory of Veterinary Embryology and Biotechnology (VETEMBIO), Veterinary Medical Center and College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
- Institute of Stem Cell and Regenerative Medicine (ISCRM), Research Institute for Natural Science, Chungbuk National University, Cheongju, Republic of Korea
| | - Sohee Kim
- Laboratory of Veterinary Embryology and Biotechnology (VETEMBIO), Veterinary Medical Center and College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
- Institute of Stem Cell and Regenerative Medicine (ISCRM), Research Institute for Natural Science, Chungbuk National University, Cheongju, Republic of Korea
| | - Joohyeong Lee
- Laboratory of Veterinary Embryology and Biotechnology (VETEMBIO), Veterinary Medical Center and College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
- Institute of Stem Cell and Regenerative Medicine (ISCRM), Research Institute for Natural Science, Chungbuk National University, Cheongju, Republic of Korea
| | - Sang-Hwan Hyun
- Laboratory of Veterinary Embryology and Biotechnology (VETEMBIO), Veterinary Medical Center and College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
- Institute of Stem Cell and Regenerative Medicine (ISCRM), Research Institute for Natural Science, Chungbuk National University, Cheongju, Republic of Korea
- Graduate School of Veterinary Biosecurity and Protection, Chungbuk National University, Cheongju, Republic of Korea
| |
Collapse
|
10
|
Adams A, Cendales LC, Cooper DKC, Cozzi E, Gill J, Judd E, Katz E, Kirk AD, Fishman JA, Reese PP, Wall A, Markmann JF. American Society of Transplant Surgeons-American Society of Transplantation report of FDA meeting on regulatory expectations for xenotransplantation products. Am J Transplant 2023; 23:1290-1299. [PMID: 37217005 DOI: 10.1016/j.ajt.2023.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/02/2023] [Accepted: 05/17/2023] [Indexed: 05/24/2023]
Abstract
In June 2022, the US Food and Drug Administration Center for Biologics Evaluation and Research held the 73rd meeting of the Cellular, Tissue, and Gene Therapies Advisory Committee for public discussion of regulatory expectations for xenotransplantation products. The members of a joint American Society of Transplant Surgeons/American Society of Transplantation committee on xenotransplantation compiled a meeting summary focusing on 7 topics believed to be key by the committee: (1) preclinical evidence supporting progression to a clinical trial, (2) porcine kidney function, (3) ethical aspects, (4) design of initial clinical trials, (5) infectious disease issues, (6) industry perspectives, and (7) regulatory oversight.
Collapse
Affiliation(s)
- Andrew Adams
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Linda C Cendales
- Department of Surgery, Duke University, Durham, North Carolina, USA
| | - David K C Cooper
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Emanuele Cozzi
- Department of Cardiothoracic and Vascular Surgery, University of Padua, Padua, Italy
| | - John Gill
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric Judd
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Allan D Kirk
- Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Jay A Fishman
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, Massachusetts, USA; Transplant Infectious Disease and Compromised Host Program and MGH Transplant Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter P Reese
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Anji Wall
- Division of Abdominal Transplantation, Baylor University Medical Center, Dallas, Texas, USA
| | - James F Markmann
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, Massachusetts, USA.
| |
Collapse
|
11
|
Cooper DK, Hara H. Xenotransplantation-A Basic Science Perspective. KIDNEY360 2023; 4:1147-1149. [PMID: 37265370 PMCID: PMC10476676 DOI: 10.34067/kid.0000000000000173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 05/03/2023] [Indexed: 06/03/2023]
Affiliation(s)
- David K.C. Cooper
- Center for Transplantation Sciences, Department of Surgery, General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Hidetaka Hara
- College of Veterinary Medicine, Yunnan Agricultural University, Kunming, Yunnan, China
| |
Collapse
|
12
|
Firl DJ, Lassiter G, Hirose T, Policastro R, D'Attilio A, Markmann JF, Kawai T, Hall KC. Clinical and molecular correlation defines activity of physiological pathways in life-sustaining kidney xenotransplantation. Nat Commun 2023; 14:3022. [PMID: 37311769 PMCID: PMC10264453 DOI: 10.1038/s41467-023-38465-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/04/2023] [Indexed: 06/15/2023] Open
Abstract
Porcine kidney xenotransplantation is accelerating towards clinical translation. However, despite the demonstrated ability of porcine kidneys to remove metabolic waste products, questions remain about their ability to faithfully recapitulate renal endocrine functions after transplantation. Here we analyze xenograft growth and function of two kidney dependent endocrine pathways in seventeen cynomolgus macaques after kidney xenotransplantation from gene edited Yucatan minipigs. Xenograft growth, the renin-angiotensinogen aldosterone-system, and the calcium-vitamin D-parathyroid hormone axis are assessed using clinical chemistries data, renin activity and beta-C-terminal-telopeptide assays, kidney graft RNA-sequencing and serial ultrasonography. We demonstrate that xenografts transplanted from minipigs show only modest growth and do not substantially contribute to recipient RAAS pathway activity. However, parathyroid hormone-independent hypercalcemia and hypophosphatemia are observed, suggesting a need for close monitoring and timely intervention during human testing. Further study of these phenotypes is warranted in designing prospective clinical trials.
Collapse
Affiliation(s)
- Daniel J Firl
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA, USA
- eGenesis Inc, Cambridge, MA, USA
| | - Grace Lassiter
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA, USA
| | - Takayuki Hirose
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA, USA
| | | | - Ashley D'Attilio
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA, USA
| | - James F Markmann
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA, USA
| | - Tatsuo Kawai
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA, USA
| | | |
Collapse
|
13
|
Hansen-Estruch C, Bikhet MH, Shaik IH, Vasudevan V, Zhao W, Javed M, Collins DE, Ayares D, Judd E, Cooper DKC, Venkataramanan R. Assessment of glomerular filtration and tubular secretion in baboons with life-supporting pig kidney grafts. Xenotransplantation 2023; 30:e12795. [PMID: 36820525 PMCID: PMC10354795 DOI: 10.1111/xen.12795] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/22/2022] [Accepted: 01/26/2023] [Indexed: 02/24/2023]
Abstract
With pig kidney xenotransplantation nearing clinical reality, it is imperative to measure pig kidney function in the graft recipients. Our aims were (i) to compare inulin clearance after a short intravenous (IV) bolus with steady-state inulin IV infusion, (ii) to use this method to measure the glomerular filtration rate (GFR), and (iii) to determine the tubular secretory function using cefoxitin in a pig-to-baboon renal transplant model. A short IV infusion of inulin and cefoxitin were followed by a maintenance IV infusion of inulin over 5 h in seven healthy baboons, three healthy pigs, and five baboons after bilateral native nephrectomy and intra-abdominal pig renal transplantation. Blood and urine samples were collected. Serum and urinary inulin and serum cefoxitin concentrations measured by validated assays were used to calculate GFR and renal secretion. GFR calculated were similar by both methods. The body weight normalized total body clearance of inulin was similar in pigs and baboons despite differences in absolute clearances. Pig kidney transplanted into baboons provided similar clearance in baboons when normalized to baboon body weight and sustained filtration and secretory functions. The study documented that pig kidneys support the physiologic needs of baboons and are likely to support human recipients as well.
Collapse
Affiliation(s)
- Christophe Hansen-Estruch
- Xenotransplantation Program, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mohamed H. Bikhet
- Xenotransplantation Program, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Imam H. Shaik
- Clinical Pharmacokinetics Laboratory, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania, USA
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania, USA
| | - Vignesh Vasudevan
- Clinical Pharmacokinetics Laboratory, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania, USA
| | - Wenchen Zhao
- Clinical Pharmacokinetics Laboratory, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania, USA
| | - Mariyam Javed
- Xenotransplantation Program, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Dalis E. Collins
- Animal Resources Program, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Eric Judd
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David K. C. Cooper
- Xenotransplantation Program, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Raman Venkataramanan
- Clinical Pharmacokinetics Laboratory, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania, USA
- Starzl Transplantation Institute, and Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
14
|
Rodger D, Cooper DKC. Kidney xenotransplantation: Future clinical reality or science fiction? Nurs Health Sci 2023; 25:161-170. [PMID: 36335558 PMCID: PMC10124775 DOI: 10.1111/nhs.12994] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/10/2022] [Accepted: 11/02/2022] [Indexed: 11/07/2022]
Abstract
There is a global shortage of organs for transplantation and despite many governments making significant changes to their organ donation systems, there are not enough kidneys available to meet the demand. This has led scientists and clinicians to explore alternative means of meeting this organ shortfall. One of the alternatives to human organ transplantation is xenotransplantation, which is the transplantation of organs, tissues, or cells between different species. The resurgence of interest in xenotransplantation and recent scientific breakthroughs suggest that genetically engineered pigs may soon present a realistic alternative as sources of kidneys for clinical transplantation. It is therefore important for healthcare professionals to understand what is involved in xenotransplantation and its future implications for their clinical practices. First, we explore the insufficiency of different organ donation systems to meet the kidney shortage. Second, we provide a background and a summary of the progress made so far in xenotransplantation research. Third, we discuss some of the scientific, technological, ethical, and public health issues associated with xenotransplantation. Finally, we summarize the literature on the attitudes of healthcare professionals toward xenotransplantation.
Collapse
Affiliation(s)
- Daniel Rodger
- Institute of Health and Social Care, School of Allied and Community Health, London South Bank University, London, UK
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - David K. C. Cooper
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
15
|
Tatapudi VS, Griesemer AD. Physiologic considerations of pig-to-human kidney xenotransplantation. Curr Opin Nephrol Hypertens 2023; 32:193-198. [PMID: 36683545 DOI: 10.1097/mnh.0000000000000858] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE OF REVIEW The greatest challenge facing end-stage kidney disease (ESKD) patients is the scarcity of transplantable organs. Advances in genetic engineering that mitigate xenogeneic immune responses have made transplantation across species a potentially viable solution to this unmet need. Preclinical studies and recent reports of pig-to-human decedent renal xenotransplantation signify that clinical trials are on the horizon. Here, we review the physiologic differences between porcine and human kidneys that could impede xenograft survival. Topics addressed include porcine renin and sodium handling, xenograft water handling, calcium, phosphate and acid-base balance, responses to porcine erythropoietin and xenograft growth. RECENT FINDINGS Studies in nonhuman primates (NHPs) have demonstrated that genetically modified pig kidneys can survive for an extended period when transplanted into baboons. In recent studies conducted by our group and others, hyperacute rejection did not occur in pig kidneys lacking the α1,3Gal epitope transplanted into brain-dead human recipients. These experimental trials did not study potential clinical abnormalities arising from idiosyncratic xenograft responses to human physiologic stimuli due to the brief duration of observation this model entails. SUMMARY Progress in biotechnology is heralding an era of xenotransplantation. We highlight the physiologic considerations for xenogeneic grafts to succeed.
Collapse
Affiliation(s)
- Vasishta S Tatapudi
- NYU Langone Transplant Institute, NYU Langone Health, New York, New York, USA
| | | |
Collapse
|
16
|
Hansen-Estruch C, Bikhet MH, Javed M, Katsurada A, Satou R, Shao W, Ayares D, Venkataramanan R, Cooper DKC, Judd E, Navar LG. Renin-angiotensin-aldosterone system function in the pig-to-baboon kidney xenotransplantation model. Am J Transplant 2023; 23:353-365. [PMID: 36695679 PMCID: PMC10124771 DOI: 10.1016/j.ajt.2022.11.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 10/31/2022] [Accepted: 11/22/2022] [Indexed: 01/07/2023]
Abstract
After pig-to-baboon kidney transplantation, episodes of hypovolemia and hypotension from an unexplained mechanism have been reported. This study evaluated the renin-angiotensin-aldosterone system post-kidney xenotransplantation. Kidneys from genetically-engineered pigs were transplanted into 5 immunosuppressed baboons after the excision of the native kidneys. Immunosuppressive therapy was based on the blockade of the CD40/CD154 costimulation pathway. Plasma renin, angiotensinogen (AGT), angiotensin II (Ang II), aldosterone levels, and urine osmolality and electrolytes were measured in healthy pigs, healthy nonimmunosuppressed baboons, and immunosuppressed baboons with life-supporting pig kidney grafts. After pig kidney transplantation, plasma renin and Ang II levels were not significantly different, although Ang II trended lower, even though plasma AGT and potassium were increased. Plasma aldosterone levels were unchanged. Urine osmolality and sodium concentration were decreased. Even in the presence of increasing AGT and potassium levels, lower plasma Ang II concentrations may be because of reduced, albeit not absent, the reactivity of pig renin to cleave baboon AGT, suggesting an impaired response of the renin-angiotensin-aldosterone system to hypovolemic and hypotensive episodes. The maintenance of aldosterone may be protective. The reduced urine osmolality and sodium concentration reflect the decreased ability of the pig kidney to concentrate urine. These considerations should not prohibit successful clinical pig kidney xenotransplantation.
Collapse
Affiliation(s)
- Christophe Hansen-Estruch
- Department of Surgery, Xenotransplantation Program, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mohamed H Bikhet
- Department of Surgery, Xenotransplantation Program, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mariyam Javed
- Department of Surgery, Xenotransplantation Program, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Akemi Katsurada
- Department of Physiology and Hypertension and Renal Center, Tulane University, New Orleans, Louisiana, USA
| | - Ryousuke Satou
- Department of Physiology and Hypertension and Renal Center, Tulane University, New Orleans, Louisiana, USA
| | - Weijian Shao
- Department of Physiology and Hypertension and Renal Center, Tulane University, New Orleans, Louisiana, USA
| | | | - Raman Venkataramanan
- Clinical Pharmacokinetics Laboratory, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania, USA
| | - David K C Cooper
- Department of Surgery, Xenotransplantation Program, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Eric Judd
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
| | - Luis Gabriel Navar
- Department of Physiology and Hypertension and Renal Center, Tulane University, New Orleans, Louisiana, USA
| |
Collapse
|
17
|
Bayliss G. Practical ethical concerns in allocation of pig kidneys to humans. Clin Kidney J 2022; 15:2161-2168. [PMID: 36381360 PMCID: PMC9664566 DOI: 10.1093/ckj/sfac125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Indexed: 01/04/2024] Open
Abstract
The fundamental ethical question of whether pig organs should be transplanted into humans has been settled, as recent surgeries demonstrating proof of concept demonstrate. Other issues need to be considered and reconciled before xenotransplantation of pig kidneys becomes a solution to the organ shortage for people waiting for a kidney transplant or as a viable alternative to the deceased donor or living donor human kidneys. Human trials will be needed beyond brain-dead individuals to show that xenotransplantation is safe from immunologic and infectious standpoints. Transplant centers will need to show that xenotransplantation provides a long-term benefit to recipients and is financially viable. If trials are successful and receive regulatory approval, pig xenotransplants may become another option for people waiting for a kidney. Before patients are discharged with a functioning xenograft, practical issues with ethical implications remain.
Collapse
Affiliation(s)
- George Bayliss
- Alpert Medical School, Brown University, Providence, RI, USA
- Rhode Island Hospital Division Organ Transplantation, Providence, RI, USA
| |
Collapse
|
18
|
Lucander ACK, Judd E, Cooper DKC. What is the clinical relevance of deviant serum calcium and phosphate levels after pig-to-primate kidney xenotransplantation? Xenotransplantation 2022; 29:e12785. [PMID: 36300760 PMCID: PMC10154070 DOI: 10.1111/xen.12785] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/06/2022] [Indexed: 01/15/2023]
Abstract
Experience from human renal allotransplantation informs us that disturbances in serum calcium and phosphate levels are relatively common. Post-transplant hypercalcemia is associated with an increased risk of recipient mortality, but not of graft loss or nephropathy, and post-transplant hyperphosphatemia with an increased risk of both recipient mortality and death-censored graft failure, but neither post-transplant hypocalcemia nor hypophosphatemia is associated with adverse outcome. Studies after pig-to-nonhuman primate kidney xenotransplantation have demonstrated consistent supranormal serum calcium and subnormal serum phosphate levels. If these trends in serum electrolyte levels were to occur following pig-to-human kidney xenotransplantation, the data from allotransplant studies would indicate an increased risk of recipient mortality (associated with hypercalcemia) but not of graft loss or nephropathy, and no adverse outcome from hypophosphatemia. Furthermore, some nonhuman primates are now surviving in a healthy state for longer than a year after life-supporting pig kidney transplantation, suggesting that chronic hypercalcemia and/or hypophosphatemia are not detrimental to long-term survival, and should not prevent clinical trials of pig kidney transplantation from being undertaken.
Collapse
Affiliation(s)
- Aaron C K Lucander
- Medical Scientist Training Program, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Eric Judd
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - David K C Cooper
- Center for Transplantation Sciences, Massachusetts General Hospital/Harvard Medical School, Charlestown, Massachusetts, USA
| |
Collapse
|
19
|
Zhang X, Cooper DKC, Dou K. Genetically-engineered pig-to-human organ transplantation: a new beginning. Sci Bull (Beijing) 2022; 67:1827-1829. [PMID: 36546291 PMCID: PMC10159615 DOI: 10.1016/j.scib.2022.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Xuan Zhang
- Department of Hepatobiliary Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - David K C Cooper
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston 02114, USA
| | - Kefeng Dou
- Department of Hepatobiliary Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China.
| |
Collapse
|