Potential value of human thrombomodulin and DAF expression for coagulation control in pig-to-human xenotransplantation.
BACKGROUND
Problems of coagulation disorder remain to be resolved in pig-to-primate xenotransplantation. Molecular incompatibilities in the coagulation systems between pigs and humans, such as the thrombomodulin (TM)-protein C system or direct prothrombinase activity, have been suggested as possible causes. Coagulation and complement activation are closely related to each other. The purpose of this study was to elucidate the protective effects on the coagulation system of the expression of human TM and decay accelerating factor (hDAF) (for inhibition of complement activation) in pig endothelial cells.


METHODS
Human aortic endothelial cells (HAEC), porcine aortic endothelial cells (PAEC), hDAF-expressing PAEC (hDAF-PAEC), hDAF/Endo-beta-galactosidase C-expressing PAEC (hDAF/EndoGalC-PAEC), hTM-expressing PAEC (hTM-PAEC), hDAF/hTM expressing-PAEC (hDAF/hTM-PAEC), and hDAF/EndoGalC/hTM-expressing PAEC (hDAF/EndoGalC/hTM-PAEC) were used in this study. Coagulation activity was examined by clotting, activated protein C (APC), and thrombin generation assay.


RESULTS
A large difference was observed in clotting time of human plasma when exposed to PAEC (170 s) and HAEC (1020 s). hTM expression on PAEC was proven to produce a comparable level of APC to that produced by HAEC, which prolonged the clotting time, though not to the level of HAEC. Pretreatment with human sera considerably shortened the clotting time in PAEC (80 s). hDAF-PAEC significantly inhibited such a shortening of clotting time by reductions in tissue factor expression and thrombin generation. Thrombin generation through direct prothrombinase activity, which was detected only in PAEC, could be suppressed by hTM expression. Suppression of antibody binding and complement activation improved clotting time not in PAEC, but in PAEC expressing hTM.


CONCLUSIONS
In addition to effective suppression of antibody-induced complement activation, hTM expression in PAEC may be essential for regulating procoagulant activity in xenotransplantation.
Miwa
Yuko
Y
Department of Applied Immunology, Nagoya University School of Medicine, Nagoya, Japan.
Yamamoto
Koji
K
Onishi
Akira
A
Iwamoto
Masaki
M
Yazaki
Satoko
S
Haneda
Masataka
M
Iwasaki
Kenta
K
Liu
DaGe
D
Ogawa
Haruko
H
Nagasaka
Takaharu
T
Uchida
Kazuharu
K
Nakao
Akimasa
A
Kadomatsu
Kenji
K
Kobayashi
Takaaki
T
D000818:Animals; D001011:Aorta / Q000033:anatomy & histology; D001777:Blood Coagulation / Q000276:immunology*; D018958:CD55 Antigens / Q000276:immunology*; D002478:Cells, Cultured; D003167:Complement Activation / Q000276:immunology; D003165:Complement System Proteins / Q000276:immunology; D042783:Endothelial Cells / Q000166:cytology / Q000276:immunology; D004730:Endothelium, Vascular / Q000166:cytology; D006801:Humans; D034421:Sus scrofa; D013917:Thrombin / Q000378:metabolism; D018180:Thrombomodulin / Q000235:genetics / Q000276:immunology*; D013925:Thromboplastin / Q000378:metabolism; D014183:Transplantation, Heterologous / Q000276:immunology*; D014914:Whole Blood Coagulation Time
D018958:CD55 Antigens; D018180:Thrombomodulin; D003165:Complement System Proteins; D013925:Thromboplastin; D013917:Thrombin