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Shin JS, Kim JM, Kim JS, Min BH, Kim YH, Kim HJ, Jang JY, Yoon IH, Kang HJ, Kim J, Hwang ES, Lim DG, Lee WW, Ha J, Jung KC, Park SH, Kim SJ, Park CG. Long-term control of diabetes in immunosuppressed nonhuman primates (NHP) by the transplantation of adult porcine islets. Am J Transplant 2015; 15:2837-50. [PMID: 26096041 DOI: 10.1111/ajt.13345] [Citation(s) in RCA: 148] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 04/02/2015] [Accepted: 04/04/2015] [Indexed: 01/25/2023]
Abstract
Pig islets are an alternative source for islet transplantation to treat type 1 diabetes (T1D), but reproducible curative potential in the pig-to-nonhuman primate (NHP) model has not been demonstrated. Here, we report that pig islet grafts survived and maintained normoglycemia for >6 months in four of five consecutive immunosuppressed NHPs. Pig islets were isolated from designated pathogen-free (DPF) miniature pigs and infused intraportally into streptozotocin-induced diabetic rhesus monkeys under pretreatment with cobra venom factor (CVF), anti-thymocyte globulin (ATG) induction and maintenance with anti-CD154 monoclonal antibody and low-dose sirolimus. Ex vivo expanded autologous regulatory T cells were adoptively transferred in three recipients. Blood glucose levels were promptly normalized in all five monkeys and normoglycemia (90-110 mg/dL) was maintained for >6 months in four cases, the longest currently up to 603 days. Intravenous glucose tolerance tests during the follow-up period showed excellent glucose disposal capacity and porcine C-peptide responses. Adoptive transfer of autologous regulatory T cells was likely to be associated with more stable and durable normoglycemia. Importantly, the recipients showed no serious adverse effects. Taken together, our results confirm the clinical feasibility of pig islet transplantation to treat T1D patients without the need for excessive immunosuppressive therapy.
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Affiliation(s)
- J S Shin
- Xenotransplantation Research Center, Seoul National University College of Medicine, Seoul, Korea.,Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Endemic Diseases, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - J M Kim
- Xenotransplantation Research Center, Seoul National University College of Medicine, Seoul, Korea.,Institute of Endemic Diseases, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - J S Kim
- Xenotransplantation Research Center, Seoul National University College of Medicine, Seoul, Korea.,Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Endemic Diseases, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - B H Min
- Xenotransplantation Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Y H Kim
- Xenotransplantation Research Center, Seoul National University College of Medicine, Seoul, Korea.,Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, Korea
| | - H J Kim
- Xenotransplantation Research Center, Seoul National University College of Medicine, Seoul, Korea.,Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
| | - J Y Jang
- Xenotransplantation Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - I H Yoon
- Xenotransplantation Research Center, Seoul National University College of Medicine, Seoul, Korea.,Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, Korea
| | - H J Kang
- Department of Laboratory Medicine, Hallym University College of Medicine, Anyang, Korea
| | - J Kim
- Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, Korea
| | - E S Hwang
- Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, Korea
| | - D G Lim
- National Medical Centre, Seoul, Korea
| | - W W Lee
- Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, Korea.,Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
| | - J Ha
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - K C Jung
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - S H Park
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - S J Kim
- Xenotransplantation Research Center, Seoul National University College of Medicine, Seoul, Korea.,Myong-Ji Hospital, Koyang-si, Kyeonggi-do, Korea
| | - C G 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.,Institute of Endemic Diseases, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea.,Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Le BBS, Tillou X, Branchereau J, Dilek N, Poirier N, Châtelais M, Charreau B, Minault D, Hervouet J, Renaudin K, Crossan C, Scobie L, Takeuchi Y, Diswall M, Breimer M, Klar N, Daha M, Simioni P, Robson S, Nottle M, Salvaris E, Cowan P, d’Apice A, Sachs D, Yamada K, Lagutina I, Duchi R, Perota A, Lazzari G, Galli C, Cozzi E, Soulillou JP, B. V, Blancho G. Bortezomib, C1-inhibitor and plasma exchange do not prolong the survival of multi-transgenic GalT-KO pig kidney xenografts in baboons. Am J Transplant 2015; 15:358-70. [PMID: 25612490 PMCID: PMC4306235 DOI: 10.1111/ajt.12988] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 07/23/2014] [Accepted: 08/12/2014] [Indexed: 01/25/2023]
Abstract
Galactosyl-transferase KO (GalT-KO) pigs represent a potential solution to xenograft rejection, particularly in the context of additional genetic modifications. We have performed life supporting kidney xenotransplantation into baboons utilizing GalT-KO pigs transgenic for human CD55/CD59/CD39/HT. Baboons received tacrolimus, mycophenolate mofetil, corticosteroids and recombinant human C1 inhibitor combined with cyclophosphamide or bortezomib with or without 2-3 plasma exchanges. One baboon received a control GalT-KO xenograft with the latter immunosuppression. All immunosuppressed baboons rejected the xenografts between days 9 and 15 with signs of acute humoral rejection, in contrast to untreated controls (n = 2) that lost their grafts on days 3 and 4. Immunofluorescence analyses showed deposition of IgM, C3, C5b-9 in rejected grafts, without C4d staining, indicating classical complement pathway blockade but alternate pathway activation. Moreover, rejected organs exhibited predominantly monocyte/macrophage infiltration with minimal lymphocyte representation. None of the recipients showed any signs of porcine endogenous retrovirus transmission but some showed evidence of porcine cytomegalovirus (PCMV) replication within the xenografts. Our work indicates that the addition of bortezomib and plasma exchange to the immunosuppressive regimen did not significantly prolong the survival of multi-transgenic GalT-KO renal xenografts. Non-Gal antibodies, the alternative complement pathway, innate mechanisms with monocyte activation and PCMV replication may have contributed to rejection.
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Affiliation(s)
- Bas-Bernardet S. Le
- Institut de Transplantation- Urologie- Néphrologie (ITUN), Institut National de la Santé et de la Recherche Médicale (INSERM) UMR-S 1064, Centre Hospitalier Universitaire (CHU) de Nantes, Université de Nantes, Nantes, France,Transplant Immunology Unit, Padua General Hospital, Padua, Italy and Consortium for Research in Organ Transplantation (CORIT), Padua, Italy
| | - X. Tillou
- Institut de Transplantation- Urologie- Néphrologie (ITUN), Institut National de la Santé et de la Recherche Médicale (INSERM) UMR-S 1064, Centre Hospitalier Universitaire (CHU) de Nantes, Université de Nantes, Nantes, France
| | - J. Branchereau
- Institut de Transplantation- Urologie- Néphrologie (ITUN), Institut National de la Santé et de la Recherche Médicale (INSERM) UMR-S 1064, Centre Hospitalier Universitaire (CHU) de Nantes, Université de Nantes, Nantes, France
| | - N. Dilek
- Institut de Transplantation- Urologie- Néphrologie (ITUN), Institut National de la Santé et de la Recherche Médicale (INSERM) UMR-S 1064, Centre Hospitalier Universitaire (CHU) de Nantes, Université de Nantes, Nantes, France,Effimune, Nantes, France
| | - N. Poirier
- Institut de Transplantation- Urologie- Néphrologie (ITUN), Institut National de la Santé et de la Recherche Médicale (INSERM) UMR-S 1064, Centre Hospitalier Universitaire (CHU) de Nantes, Université de Nantes, Nantes, France,Effimune, Nantes, France
| | - M. Châtelais
- Institut de Transplantation- Urologie- Néphrologie (ITUN), Institut National de la Santé et de la Recherche Médicale (INSERM) UMR-S 1064, Centre Hospitalier Universitaire (CHU) de Nantes, Université de Nantes, Nantes, France,Transplant Immunology Unit, Padua General Hospital, Padua, Italy and Consortium for Research in Organ Transplantation (CORIT), Padua, Italy
| | - B. Charreau
- Institut de Transplantation- Urologie- Néphrologie (ITUN), Institut National de la Santé et de la Recherche Médicale (INSERM) UMR-S 1064, Centre Hospitalier Universitaire (CHU) de Nantes, Université de Nantes, Nantes, France,Transplant Immunology Unit, Padua General Hospital, Padua, Italy and Consortium for Research in Organ Transplantation (CORIT), Padua, Italy
| | - D. Minault
- Institut de Transplantation- Urologie- Néphrologie (ITUN), Institut National de la Santé et de la Recherche Médicale (INSERM) UMR-S 1064, Centre Hospitalier Universitaire (CHU) de Nantes, Université de Nantes, Nantes, France
| | - J. Hervouet
- Institut de Transplantation- Urologie- Néphrologie (ITUN), Institut National de la Santé et de la Recherche Médicale (INSERM) UMR-S 1064, Centre Hospitalier Universitaire (CHU) de Nantes, Université de Nantes, Nantes, France
| | - K. Renaudin
- Pathology Laboratory, CHU- Hôtel Dieu, Nantes, France
| | - C. Crossan
- Department of Biological and Biomedical Sciences, Glasgow Caledonian University, Glasgow, United Kingdom,Transplant Immunology Unit, Padua General Hospital, Padua, Italy and Consortium for Research in Organ Transplantation (CORIT), Padua, Italy
| | - L. Scobie
- Department of Biological and Biomedical Sciences, Glasgow Caledonian University, Glasgow, United Kingdom,Transplant Immunology Unit, Padua General Hospital, Padua, Italy and Consortium for Research in Organ Transplantation (CORIT), Padua, Italy
| | - Y. Takeuchi
- University College London, London, United Kingdom,Transplant Immunology Unit, Padua General Hospital, Padua, Italy and Consortium for Research in Organ Transplantation (CORIT), Padua, Italy
| | - M. Diswall
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - M.E. Breimer
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - N. Klar
- Department of Nephrology, University Medical Center, Leiden, The Netherlands,Transplant Immunology Unit, Padua General Hospital, Padua, Italy and Consortium for Research in Organ Transplantation (CORIT), Padua, Italy
| | - M.R. Daha
- Department of Nephrology, University Medical Center, Leiden, The Netherlands,Transplant Immunology Unit, Padua General Hospital, Padua, Italy and Consortium for Research in Organ Transplantation (CORIT), Padua, Italy
| | - P. Simioni
- Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padua, Italy,European Xenotransplantation Network Xenome (LSHB- CT- 2006- 037377)
| | - S.C. Robson
- Gastroenterology and Transplant Institute, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - M.B. Nottle
- Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia
| | - E.J. Salvaris
- Immunology Research Centre, St Vincent’s Hospital Melbourne, Victoria, Australia
| | - P.J. Cowan
- Immunology Research Centre, St Vincent’s Hospital Melbourne, Victoria, Australia
| | - A.J.F. d’Apice
- Immunology Research Centre, St Vincent’s Hospital Melbourne, Victoria, Australia
| | - D.H. Sachs
- Transplantation Biology Research Center (TBRC), Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA
| | - K. Yamada
- Transplantation Biology Research Center (TBRC), Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA
| | - I. Lagutina
- Avantea, Cremona, Italy,European Xenotransplantation Network Xenome (LSHB- CT- 2006- 037377)
| | - R. Duchi
- Avantea, Cremona, Italy,European Xenotransplantation Network Xenome (LSHB- CT- 2006- 037377)
| | - A. Perota
- Avantea, Cremona, Italy,European Xenotransplantation Network Xenome (LSHB- CT- 2006- 037377)
| | - G. Lazzari
- Avantea, Cremona, Italy,European Xenotransplantation Network Xenome (LSHB- CT- 2006- 037377)
| | - C. Galli
- Avantea, Cremona, Italy,Dept. of Veterinary Medical Science, University of Bologna, Ozzano Emilia, Italy,European Xenotransplantation Network Xenome (LSHB- CT- 2006- 037377)
| | - E. Cozzi
- Transplant Immunology Unit, Padua General Hospital, Padua, Italy and Consortium for Research in Organ Transplantation (CORIT), Padua, Italy,European Xenotransplantation Network Xenome (LSHB- CT- 2006- 037377)
| | - J.-P. Soulillou
- Institut de Transplantation- Urologie- Néphrologie (ITUN), Institut National de la Santé et de la Recherche Médicale (INSERM) UMR-S 1064, Centre Hospitalier Universitaire (CHU) de Nantes, Université de Nantes, Nantes, France,European Xenotransplantation Network Xenome (LSHB- CT- 2006- 037377)
| | - Vanhove B.
- Institut de Transplantation- Urologie- Néphrologie (ITUN), Institut National de la Santé et de la Recherche Médicale (INSERM) UMR-S 1064, Centre Hospitalier Universitaire (CHU) de Nantes, Université de Nantes, Nantes, France,Effimune, Nantes, France
| | - G. Blancho
- Institut de Transplantation- Urologie- Néphrologie (ITUN), Institut National de la Santé et de la Recherche Médicale (INSERM) UMR-S 1064, Centre Hospitalier Universitaire (CHU) de Nantes, Université de Nantes, Nantes, France,European Xenotransplantation Network Xenome (LSHB- CT- 2006- 037377)
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Tena A, Kurtz J, Leonard DA, Dobrinsky JR, Terlouw SL, Mtango N, Verstegen J, Germana S, Mallard C, Arn JS, Sachs DH, Hawley RJ. Transgenic expression of human CD47 markedly increases engraftment in a murine model of pig-to-human hematopoietic cell transplantation. Am J Transplant 2014; 14:2713-22. [PMID: 25278264 PMCID: PMC4236244 DOI: 10.1111/ajt.12918] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 06/16/2014] [Accepted: 07/06/2014] [Indexed: 01/25/2023]
Abstract
Mixed chimerism approaches for induction of tolerance of solid organ transplants have been applied successfully in animal models and in the clinic. However, in xenogeneic models (pig-to-primate), host macrophages participate in the rapid clearance of porcine hematopoietic progenitor cells, hindering the ability to achieve mixed chimerism. CD47 is a cell-surface molecule that interacts in a species-specific manner with SIRPα receptors on macrophages to inhibit phagocytosis and expression of human CD47 (hCD47) on porcine cells has been shown to inhibit phagocytosis by primate macrophages. We report here the generation of hCD47 transgenic GalT-KO miniature swine that express hCD47 in all blood cell lineages. The effect of hCD47 expression on xenogeneic hematopoietic engraftment was tested in an in vivo mouse model of human hematopoietic cell engraftment. High-level porcine chimerism was observed in the bone marrow of hCD47 progenitor cell recipients and smaller but readily measurable chimerism levels were observed in the peripheral blood of these recipients. In contrast, transplantation of WT progenitor cells resulted in little or no bone marrow engraftment and no detectable peripheral chimerism. These results demonstrate a substantial protective effect of hCD47 expression on engraftment and persistence of porcine cells in this model, presumably by modulation of macrophage phagocytosis.
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Affiliation(s)
- Aseda Tena
- Transplantation Biology Research Center, Massachusetts General Hospital, Boston, MA
| | - Josef Kurtz
- Transplantation Biology Research Center, Massachusetts General Hospital, Boston, MA,Department of Biology, Emmanuel College, Boston, MA
| | - David A. Leonard
- Transplantation Biology Research Center, Massachusetts General Hospital, Boston, MA
| | | | | | | | | | - Sharon Germana
- Transplantation Biology Research Center, Massachusetts General Hospital, Boston, MA
| | - Christopher Mallard
- Transplantation Biology Research Center, Massachusetts General Hospital, Boston, MA
| | - J. Scott Arn
- Transplantation Biology Research Center, Massachusetts General Hospital, Boston, MA
| | - David H. Sachs
- Transplantation Biology Research Center, Massachusetts General Hospital, Boston, MA
| | - Robert J. Hawley
- Transplantation Biology Research Center, Massachusetts General Hospital, Boston, MA
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