title: Overcoming the barriers to xenotransplantation: prospects for the future.
abstract: Cross-species transplantation (xenotransplantation) has immense potential to solve the critical need for organs, tissues and cells for clinical transplantation. The increasing availability of genetically engineered pigs is enabling progress to be made in pig-to-nonhuman primate experimental models. Potent pharmacologic immunosuppressive regimens have largely prevented T-cell rejection and a T-cell-dependent elicited antibody response. However, coagulation dysfunction between the pig and primate is proving to be a major problem, and this can result in life-threatening consumptive coagulopathy. This complication is unlikely to be overcome until pigs expressing a human 'antithrombotic' or 'anticoagulant' gene, such as thrombomodulin, tissue factor pathway inhibitor or CD39, become available. Progress in islet xenotransplantation has been more encouraging, and diabetes has been controlled in nonhuman primates for periods in excess of 6 months, although this has usually been achieved using immunosuppressive protocols that might not be clinically applicable. Further advances are required to overcome the remaining barriers.
authors.affiliation: Thomas E Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA.
authors.forename: Burcin
authors.initials: B
authors.lastname: Ekser
authors.forename: David K C
authors.initials: DK
authors.lastname: Cooper
mesh_terms: D000818:Animals; D030801:Animals, Genetically Modified; D001778:Blood Coagulation Disorders / Q000235:genetics / Q000276:immunology* / Q000628:therapy*; D003920:Diabetes Mellitus / Q000628:therapy; D004195:Disease Models, Animal; D015316:Genetic Therapy; D006084:Graft Rejection / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016381:Islets of Langerhans Transplantation; D008074:Lipoproteins / Q000235:genetics / Q000276:immunology; D011323:Primates; D013552:Swine; D018180:Thrombomodulin / Q000235:genetics / Q000276:immunology; D014183:Transplantation, Heterologous / Q000639:trends*
chemical_list: D007166:Immunosuppressive Agents; D008074:Lipoproteins; C546931:THBD protein, human; D018180:Thrombomodulin; C051928:lipoprotein-associated coagulation inhibitor
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