CRISPR/Cas Technology in Pig-to-Human Xenotransplantation Research

CRISPR/Cas (clustered regularly interspaced short palindromic repeats linked to Cas nuclease) technology has revolutionized many aspects of genetic engineering research. Thanks to it, it became possible to study the functions and mechanisms of biology with greater precision, as well as to obtain genetically modified organisms, both prokaryotic and eukaryotic. The changes introduced by the CRISPR/Cas system are based on the repair paths of the single or double strand DNA breaks that cause insertions, deletions, or precise integrations of donor DNA. These changes are crucial for many fields of science, one of which is the use of animals (pigs) as a reservoir of tissues and organs for xenotransplantation into humans. Non-genetically modified animals cannot be used to save human life and health due to acute immunological reactions resulting from the phylogenetic distance of these two species. This review is intended to collect and summarize the advantages as well as achievements of the CRISPR/Cas system in pig-to-human xenotransplantation research. In addition, it demonstrates barriers and limitations that require careful evaluation before attempting to experiment with this technology.

Virological aspects of non-human primates or swine-to human xenotransplantation

There are a number of human diseases, which can lead to organ failure. The consequence is often the need for a transplant. The number of performed operations is very low due to the shortage of organs for transplantation. As a consequence, the number of people waiting for transplant is still growing. The solution to this situation may be xenotransplantation. Xenotransplantation word comes from the Greek xenos meaning stranger, the other. It is defined as any procedure that involves the transplantation, implantation or infusion of tissues or zoonotic organs into a human recipient, but also human body fluids, cells, tissues, organs (or fragments) that have ex vivo contact with zoonotic cells, tissues or organs. One of the obstacles of the xenograft transplantation is the risk of animal pathogens transmission to the humans. Viruses that pose risk in the non-human primates-to-human xenotransplantation includes: the human immunodeficiency virus - HIV and the Marburg virus described in this paper. In addition viruses, which is a problem in pig-to-human xenotransplantation have also been described, including: porcine endogenous retrovirus - PERV, porcine cytomegalovirus - PCMV, porcine lymphotropic herpesvirus - PLHV and hepatitis E virus - E - HEV. This review of literature is the latest knowledge of the microbiological safety of xenotransplantation.

The Role of Costimulation Blockade in Solid Organ and Islet Xenotransplantation

Pig-to-human xenotransplantation offers a potential bridge to the growing disparity between patients with end-stage organ failure and graft availability. Early studies attempting to overcome cross-species barriers demonstrated robust humoral immune responses to discordant xenoantigens. Recent advances have led to highly efficient and targeted genomic editing, drastically altering the playing field towards rapid production of less immunogenic porcine tissues and even the discussion of human xenotransplantation trials. However, as these humoral immune barriers to cross-species transplantation are overcome with advanced transgenics, cellular immunity to these novel xenografts remains an outstanding issue. Therefore, understanding and optimizing immunomodulation will be paramount for successful clinical xenotransplantation. Costimulation blockade agents have been introduced in xenotransplantation research in 2000 with anti-CD154mAb. Most recently, prolonged survival has been achieved in solid organ (kidney xenograft survival > 400 days with anti-CD154mAb, heart xenograft survival > 900 days, and liver xenograft survival 29 days with anti-CD40mAb) and islet xenotransplantation (>600 days with anti-CD154mAb) with the use of these potent experimental agents. As the development of novel genetic modifications and costimulation blocking agents converges, we review their impact thus far on preclinical xenotransplantation and the potential for future application.