title: Acute vascular rejection is associated with systemic complement activation in a pig-to-primate kidney xenograft model.
abstract: The introduction of h-DAF transgenic porcine organs into pre-clinical pig-to-primate discordant xenotransplantation has led to complete and reliable abrogation of hyperacute xenograft rejection (HAR). Despite additional heavy immunosuppression however, most xenografts are still lost due to acute vascular rejection (AVR), with current treatment protocols being of only limited value. In a life-supporting model of pig-to-primate kidney transplantation, unmodified (n=8) or h-DAF-transgenic (n=9) porcine kidneys were transplanted into cynomolgus monkeys under cyclophosphamide (CyP), cyclosporine and low-dose steroid immunosuppression. Longest recipient survival was 11 days in the control group and 68 days in the h-DAF transgenic group. Stable initial graft function with recipient survival >4 days was generated in eight animals (two controls and six transgenics). In these animals, plasma complement levels were analyzed during ongoing AVR. Compared with baseline levels, a two-fold increase in C3a levels and a four-fold increase in sC5b-9 levels were measured. In parallel to systemic complement activation, increased deposition of C3 and C5b-9 along with massive staining for recipient IgM immunoglobulins was detected in the xenografts on immunohistochemistry. We conclude that acute vascular xenograft rejection of porcine kidneys in cynomolgus monkeys is associated with classical pathway complement activation following binding of induced recipient anti-porcine antibodies. This complement activation can be observed despite membrane bound expression of human complement regulators in the porcine xenografts. Therefore, additional short-term fluid phase complement inhibition seems necessary for the future development of protocols designed for treatment of AVR in the pig-to-primate combination.
authors.affiliation: Klinik für Viszeral-und Transplantationschirurgie, Medizinische Hochschule Hannover, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Loss
authors.forename: B
authors.initials: B
authors.lastname: Vangerow
authors.forename: J
authors.initials: J
authors.lastname: Schmidtko
authors.forename: R
authors.initials: R
authors.lastname: Kunz
authors.forename: A
authors.initials: A
authors.lastname: Jalali
authors.forename: H
authors.initials: H
authors.lastname: Arends
authors.forename: M
authors.initials: M
authors.lastname: Przemeck
authors.forename: H
authors.initials: H
authors.lastname: Rückholt
authors.forename: M
authors.initials: M
authors.lastname: Leuwer
authors.forename: F J
authors.initials: FJ
authors.lastname: Kaup
authors.forename: S
authors.initials: S
authors.lastname: Rensing
authors.forename: E
authors.initials: E
authors.lastname: Cozzi
authors.forename: D J
authors.initials: DJ
authors.lastname: White
authors.forename: J
authors.initials: J
authors.lastname: Klempnauer
authors.forename: M
authors.initials: M
authors.lastname: Winkler
mesh_terms: D000208:Acute Disease; D000818:Animals; D030801:Animals, Genetically Modified; D000910:Antibodies, Heterophile / Q000032:analysis; D003167:Complement Activation; D015926:Complement C3a / Q000378:metabolism; D015938:Complement Membrane Attack Complex / Q000378:metabolism; D003520:Cyclophosphamide / Q000494:pharmacology; D006084:Graft Rejection / Q000276:immunology*; D006085:Graft Survival; D006801:Humans; D007075:Immunoglobulin M / Q000032:analysis; D007166:Immunosuppressive Agents / Q000494:pharmacology; D016030:Kidney Transplantation / Q000276:immunology* / Q000473:pathology / Q000502:physiology; D008252:Macaca fascicularis; D013552:Swine; D013997:Time Factors
chemical_list: D000910:Antibodies, Heterophile; D015938:Complement Membrane Attack Complex; D007075:Immunoglobulin M; D007166:Immunosuppressive Agents; D015926:Complement C3a; D003520:Cyclophosphamide