Potential benefits and risks of clinical xenotransplantation

David KC Cooper,1 David Ayares21Thomas E Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; 2Revivicor, Blacksburg, VA, USAAbstract: The transplantation of organs and cells from pigs into humans could overcome the critical and continuing problem of the la...

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Main Authors: Cooper DKC, Ayares D
Format: Article
Language:English
Published: Dove Medical Press 2012-07-01
Series:Transplant Research and Risk Management
Online Access:http://www.dovepress.com/potential-benefits-and-risks-of-clinical-xenotransplantation-a10294
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spelling doaj-62370dcc57da4d41adf6a3df0cb93df52020-11-25T00:53:06ZengDove Medical PressTransplant Research and Risk Management1179-16162012-07-012012default717Potential benefits and risks of clinical xenotransplantationCooper DKCAyares DDavid KC Cooper,1 David Ayares21Thomas E Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; 2Revivicor, Blacksburg, VA, USAAbstract: The transplantation of organs and cells from pigs into humans could overcome the critical and continuing problem of the lack of availability of deceased human organs and cells for clinical transplantation. Developments in the genetic engineering of pigs have enabled considerable progress to be made in the experimental laboratory in overcoming the immune barriers to successful xenotransplantation. With regard to pig organ xenotransplantation, antibody- and cell-mediated rejection have largely been overcome, and the current major barrier is the development of coagulation dysregulation. This is believed to be due to a combination of immune activation of the vascular endothelial cells of the graft and molecular incompatibilities between the pig and primate coagulation–anticoagulation systems. Pigs with new genetic modifications specifically directed to this problem are now becoming available. With regard to less complex tissues, such as islets (for the treatment of diabetes), neuronal cells (for the treatment of Parkinson's disease), and corneas, the remaining barriers are less problematic, and graft survival in nonhuman primate models extends for >1 year in all three cases. In planning the initial clinical trials, consideration will be concentrated on the risk–benefit ratio, based to a large extent on the results of preclinical studies in nonhuman primates. If the benefit to the patient is anticipated to be high, eg, insulin-independent control of glycemia, and the potential risks low, eg, minimal risk of transfer of a porcine infectious agent, then a clinical trial would be justified.Keywords: infection, pigs, genetically-engineered, xenotransplantation, islets, xenotransplantation, organshttp://www.dovepress.com/potential-benefits-and-risks-of-clinical-xenotransplantation-a10294
collection DOAJ
language English
format Article
sources DOAJ
author Cooper DKC
Ayares D
spellingShingle Cooper DKC
Ayares D
Potential benefits and risks of clinical xenotransplantation
Transplant Research and Risk Management
author_facet Cooper DKC
Ayares D
author_sort Cooper DKC
title Potential benefits and risks of clinical xenotransplantation
title_short Potential benefits and risks of clinical xenotransplantation
title_full Potential benefits and risks of clinical xenotransplantation
title_fullStr Potential benefits and risks of clinical xenotransplantation
title_full_unstemmed Potential benefits and risks of clinical xenotransplantation
title_sort potential benefits and risks of clinical xenotransplantation
publisher Dove Medical Press
series Transplant Research and Risk Management
issn 1179-1616
publishDate 2012-07-01
description David KC Cooper,1 David Ayares21Thomas E Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; 2Revivicor, Blacksburg, VA, USAAbstract: The transplantation of organs and cells from pigs into humans could overcome the critical and continuing problem of the lack of availability of deceased human organs and cells for clinical transplantation. Developments in the genetic engineering of pigs have enabled considerable progress to be made in the experimental laboratory in overcoming the immune barriers to successful xenotransplantation. With regard to pig organ xenotransplantation, antibody- and cell-mediated rejection have largely been overcome, and the current major barrier is the development of coagulation dysregulation. This is believed to be due to a combination of immune activation of the vascular endothelial cells of the graft and molecular incompatibilities between the pig and primate coagulation–anticoagulation systems. Pigs with new genetic modifications specifically directed to this problem are now becoming available. With regard to less complex tissues, such as islets (for the treatment of diabetes), neuronal cells (for the treatment of Parkinson's disease), and corneas, the remaining barriers are less problematic, and graft survival in nonhuman primate models extends for >1 year in all three cases. In planning the initial clinical trials, consideration will be concentrated on the risk–benefit ratio, based to a large extent on the results of preclinical studies in nonhuman primates. If the benefit to the patient is anticipated to be high, eg, insulin-independent control of glycemia, and the potential risks low, eg, minimal risk of transfer of a porcine infectious agent, then a clinical trial would be justified.Keywords: infection, pigs, genetically-engineered, xenotransplantation, islets, xenotransplantation, organs
url http://www.dovepress.com/potential-benefits-and-risks-of-clinical-xenotransplantation-a10294
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