title: Potential of an injectable polymer to prevent hyperacute rejection of ex vivo perfused porcine lungs.
abstract: BACKGROUND
  Removal of xenoreactive antibodies in pig-to-human lung transplantation by columns or organ perfusions proofed to be unsatisfactory and associated with adverse effects. In an ex-vivo lung perfusion model, we evaluated the potential of a soluble trisaccharide polymer (GAS914) to bind alpha-Gal antibodies and to protect a pulmonary xenograft from hyperacute rejection (HAR) and pulmonary xenograft dysfunction.
  
  
  METHODS
  Porcine lungs were perfused with fresh human blood for 240 min. In the GAS914 treated group (n=6) the polymer was applied in three different concentrations. The control group (n=6) received no GAS914. Survival and function of perfused xenografts were monitored, and alpha-Gal antibodies as well as cytolytic anti-porcine antibodies analyzed.
  
  
  RESULTS
  In the GAS-treated group survival of lungs was significantly prolonged, pulmonary vascular resistance reduced, pulmonary edema prevented, and oxygenation improved. On histopathological evaluation application of GAS resulted in minimal graft injury and significantly less deposition of the terminal complement complex C5b-9. Following application of GAS914, up to 89.8% of IgG alpha-Gal, 79.5% of IgM and 73.6% of anti-porcine antibodies in the human blood were bound by the polymer. Subsequent perfusion of porcine lungs resulted in absorption of only 3% of the baseline IgG alpha-Gal antibodies in the GAS914 group, compared to 87% in the controls.
  
  
  CONCLUSIONS
  In this ex-vivo lung perfusion model, a trisaccharide polymer prevented immediate HAR, due to effective removal of alpha-Gal antibodies. In combination with additional strategies GAS914 may be a valuable tool in overcoming HAR and dysfunction of pulmonary xenografts.
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany. karstenwiebe@t-online.de
authors.forename: Karsten
authors.initials: K
authors.lastname: Wiebe
authors.forename: Mehmet
authors.initials: M
authors.lastname: Oezkur
authors.forename: Jochen
authors.initials: J
authors.lastname: Pöling
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
mesh_terms: D000208:Acute Disease; D000818:Animals; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control*; D006085:Graft Survival; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D016040:Lung Transplantation / Q000276:immunology / Q000502:physiology*; D023421:Models, Animal; D010100:Oxygen / Q000097:blood; D011652:Pulmonary Circulation; D013552:Swine; D014312:Trisaccharides / Q000627:therapeutic use*; D014655:Vascular Resistance
chemical_list: D007074:Immunoglobulin G; D007075:Immunoglobulin M; D014312:Trisaccharides; C076569:alpha-galactosyl epitope; D010100:Oxygen