A review of pig liver xenotransplantation: Current problems and recent progress

被引:34
作者
Zhang, Xuan [1 ]
Li, Xiao [1 ]
Yang, Zhaoxu [1 ]
Tao, Kaishan [1 ]
Wang, Quancheng [1 ]
Dai, Bin [1 ]
Qu, Shibin [1 ]
Peng, Wei [1 ]
Zhang, Hong [1 ]
Cooper, David K. C. [2 ]
Dou, Kefeng [1 ]
机构
[1] Fourth Mil Med Univ, Xijing Hosp, Dept Hepatobiliary Surg, Xian, Shaanxi, Peoples R China
[2] Univ Alabama Birmingham, Dept Surg, Xenotransplantat Program, Birmingham, AL 35294 USA
基金
中国国家自然科学基金;
关键词
coagulation dysregulation; genetically engineered; liver; pig; xenotransplantation; TRANSGENIC EXPRESSION; NONHUMAN PRIMATE; ENDOTHELIAL-CELLS; HUMAN PLATELETS; LUNG XENOTRANSPLANTATION; ORGAN-TRANSPLANTATION; HYPERACUTE REJECTION; XENOGRAFT REJECTION; PULMONARY XENOGRAFT; COAGULATION-FACTORS;
D O I
10.1111/xen.12497
中图分类号
R-3 [医学研究方法]; R3 [基础医学];
学科分类号
1001 ;
摘要
Pig liver xenotransplantation appears to be more perplexing when compared to heart or kidney xenotransplantation, even though great progress has been achieved. The relevant molecular mechanisms involved in xenogeneic rejection, including coagulopathy, and particularly thrombocytopenia, are complex, and need to be systematically investigated. The deletion of expression of Gal antigens in the liver graft highlights the injurious impact of nonGal antigens, which continue to induce humoral rejection. Innate immunity, particularly mediated by macrophages and natural killer cells, interplays with inflammation and coagulation disorders. Kupffer cells and liver sinusoidal endothelial cells (LSECs) together mediate leukocyte, erythrocyte, and platelet sequestration and phagocytosis, which can be exacerbated by increased cytokine production, cell desialylation, and interspecies incompatibilities. The coagulation cascade is activated by release of tissue factor which can be dependent or independent of the xenoreactive immune response. Depletion of endothelial anticoagulants and anti-platelet capacity amplify coagulation activation, and interspecies incompatibilities of coagulation-regulatory proteins facilitate dysregulation. LSECs involved in platelet phagocytosis and transcytosis, coupled with hepatocyte-mediated degradation, are responsible for thrombocytopenia. Adaptive immunity could also be problematic in long-term liver graft survival. Currently, relevant evidence and study results of various genetic modifications to the pig donor need to be fully determined, with the aim of identifying the ideal transgene combination for pig liver xenotransplantation. We believe that clinical trials of pig liver xenotransplantation should initially be considered as a bridge to allotransplantation.
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页数:11
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