Anti-pig IgM Research Articles

Characterization of human xenoreactive antibodies in liver failure patients exposed to pig hepatocytes after bioartificial liver treatment: an ex vivo model of pig to human xenotransplantation.

There are limited experimental data on the nature of the humoral response elicited in humans against pig antigens. In this study, we have examined the xenoantibody (XAb) response in eight patients with acute liver failure exposed to pig hepatocytes after treatment with the bioartificial liver (BAL). Patients' plasma samples obtained before and after BAL treatment were tested for IgM and IgG XAbs, IgG subclasses, and XAb cytotoxicity, using enzyme-linked immunosorbent assay and flow-cytometric assays. The characterization of pig aortic endothelial cell (PAEC) surface xenoantigens was analyzed by immunoprecipitation. We observed by day 10, a strong anti-pig IgG and IgM XAb response in patients undergoing two or more BAL treatments, with a significant increase in all the IgG subclasses; in contrast, XAb titers did not change if the patients received only one BAL treatment. The majority of the XAbs produced to porcine antigens were primarily specific for the alphaGal epitope. Both IgG and IgM XAbs were cytotoxic to PAECs, and the cytotoxic activity of IgG was associated with high levels of IgG1 and IgG3 subclasses, known to be efficient on complement activation. The characterization of porcine surface antigens demonstrated that IgM human XAbs, before and after BAL exposure, recognized xenoantigens on PAECs with similar molecular weights, suggesting that the same population of XAbs were present in the patients before and after exposure to pig antigens. Repetitive exposure of humans to porcine antigens after BAL treatment, results in a strong IgG and IgM XAb responses that are primarily directed against the alphaGal epitope. These XAbs are cytotoxic to PAECs and the IgG toxicity correlates with high IgG1 and IgG3 levels. Our data also suggest that no new XAb specificity emerges after porcine exposure.

IN BABOON, A COMPLETE ELIMINATION OF THE CIRCULATING IgM BY ANTI-?? MONOCLONAL ANTIBODY ALLOWS A PIG KIDNEY XENOGRAFT TO SURVIVE UP TO SIX DAYS WITHOUT ADDITIONAL IMMUNOSUPPRESSION

106 Background: In the pig to baboon xenograft model, the performed IgM xenoantibodies are presumed to be one of the most important factor involved in hyperacute vascular rejection (HAVR). Methods: We therefore developed a rat monoclonal antibody which recognizes human as well as baboon IgM (LO-BM2) in order to deplete "in vivo" the total seric IgM. As assessed by ELISA, two to four consecutive iv injections of LO-BM2 at 15-20 mg/kg totally eliminated the baboon circulating IgM. Results: As control, we transplanted a pig renal xenograft to three baboons without any immunosuppressive therapy and a fourth baboon underwent a splenectomy three days prior to the renal xenograft. All the four animals hyperacutely rejected their xenograft between the first hour after unclamping and the first postoperative day (POD). At histology, signs of HAVR were evidenced. An experimental group of five baboons was then designed to assess the effect of a selective depletion of circulating IgM on the renal xenograft survival. During the preoperative LO-BM2 treatment, the total concentration of seric IgM was assessed daily by ELISA in order to perform the renal xenograft in absence of circulating anti-pig IgM. The first baboon was splenectomized on day -3 and received four injections of LO-BM2 (20 mg/kg/day) prior to grafting. During the following 4 POD, the xenokidney functioned well (creatinine 0.8; 1.0; 1.2 and 2.0mg/dl) and the renal function eventually acutely deteriorated on POD 6 (creatinine 6.4 mg/kg). At this time, the kidney was completely rejected, cyanotic and swollen and the pathology mainly showed signs of vascular rejection. The second animal also underwent a splenectomy on day -3 and a depletion of the circulating IgM by LO-BM2. During three days, the creatinine remained normal and the kidney was acutely rejected on POD4. A third animal was similarly treated by three LO-BM2 injections but without splenectomy. This baboon maintained a normal renal function during 3 days (0.9; 0.8; 0.9mg/kg) and eventually acutely rejected the xenograft on POD4. In these three animals, the circulating seric IgM were undetectable by ELISA up to the rejection time. By Flow Cytometry on porcine aortic endothelial cells specific anti-pig xenoantibodies were detected concomitantly or just after the renal function deterioration. Two additional animals were similarly treated by LO-BM2 prior to transplant but in addition received, in the first case, five injections of DSG at 9mg/kg (from day-2) and, in the second case, 6 days of RS at 250 mg/kg (from day 0). After elimination of the circulating IgM, both animals maintained a normal renal function for 3 and 4 POD but eventually rejected acutely the graft on POD4 and 6, respectively. The lack of prolonged effect of LO-BM2 over five or six days is related to a baboon anti-rat sensitization. Conclusions: These experiments show for the first time in a pig to baboon model that a pig kidney xenograft can survive up to six days without immunosuppression besides the complete elimination of the circulating IgM. The rejection occurred simultaneously to the reappearance of a low level of circulating IgM and was of the vascular type. These results also suggest that neither the alternate pathway of the complement nor the preformed IgG are able in this model to produce alone a HAVR.

A murine model of antibody-mediated hyperacute rejection by galactose-alpha(1,3)galactose antibodies in Gal o/o mice.

In pig-to-primate/human xenografts, hyperacute rejection of primarily vascularized organs usually occurs in 10-60 min and is due to the reaction of the recipients' natural antibodies with antigens expressed on the donor endothelium, the fixation of complement, and ultimately vascular stasis and hemorrhage. Surprisingly, the major target of the natural antibodies is the disaccharide galactose-alpha(1,3)galactose (Gal alpha(1,3)Gal), which is found on many different molecules in pig tissues and reacts with naturally occurring human anti-pig IgM and IgG antibodies. There are a number of strategies to remove/block/alter Gal alpha(1,3)Gal expression in pig tissues, all of which involve the expression of transgenes in pigs. To overcome the difficulty of preclinical studies using primates, we describe a model of hyperacute rejection of heart transplants to Gal o/o mice, which are similar to humans in that they have anti-Gal alpha(1,3)Gal antibodies. Gal o/o mice received skin or heart grafts from Gal+ mice or rats, and additional antibody and complement were provided; hyperacute rejection was monitored by observation and histology. Gal alpha(1,3)Gal+ mouse tissues (skin or heart) are not rejected by Gal o/o mice. This was not unexpected, as mice do not utilize alloantibody/complement systems satisfactorily in experimental transplantation studies. However, with the addition of anti-Gal alpha(1,3)Gal antibody and complement, hyperacute rejection of hearts can occur in 10-20 min; it is mediated by IgM, not IgG, antibodies and leads predominantly to tissue hemorrhage. Gal alpha(1,3)Gal antigen modification by expression of the H transferase cDNA leads to "indefinite" survival (>120 min) and no hyperacute rejection, which shows that this model is suitable for the study of antibody-mediated rejection of relevance to pig-to-human xenografts.

Role of anti-donor antibody in the rejection of pig proislet xenografts in mice.

CBA/H mice produced serum anti-pig IgG1, IgG2a, and IgG2b following xenotransplantation of pig proislets beneath the kidney capsule; anti-pig IgM was present as pre-existing antibody in the serum of normal CBA/H mice and was also produced in response to pig proislet xenografts. Serum anti-pig IgG3 was not detected post-xenotransplantation. Rejection of pig proislet xenografts and the production of anti-pig IgG1, IgG2a, and IgG2b isotypes were CD4 T cell-dependent. The capacity for adoptively transferred hyperimmune CBA/H mouse anti-pig PBL serum to induce the rejection of intact pig proislet xenografts in CD4 T cell-depleted mice was dose dependent and correlated with markedly elevated levels of serum anti-pig IgG3. Levels of anti-pig IgG1, IgG2a, IgG2b, and IgM comparable to control mice acutely rejecting pig proislet xenografts and achieved following adoptive transfer of hyperimmune serum did not correlate with induced xenograft rejection. These findings suggest that anti-pig Ig isotypes produced during the conventional process of acute proislet xenograft rejection do not play a major role in mediating graft damage. The acute rejection of pig proislet xenografts in the absence of serum anti-pig Ig in microMT-/- hosts confirmed that anti-pig antibody is not essential for proislet xenograft destruction.

Removal of anti-porcine natural antibodies from human and nonhuman primate plasma in vitro and in vivo by a Galalpha1-3Galbeta1-4betaGlc-X immunoaffinity column.

Natural antibodies (NAbs) against a terminal alpha1-3 galactosyl (alphaGal) epitope have been identified as the major human anti-pig NAbs. We used two synthetic alphaGal trisaccharides--type 6 (alphaGal6) and type 2(alphaGal2)--linked to an inert matrix to remove NAbs from human plasma in vitro. Flow cytometry indicated that an average of 85% of the NAb binding activity was depleted by adsorption with alphaGal6. By measuring the binding of NAbs to pig peripheral blood mononuclear cells and bone marrow cells, we demonstrated that alphaGal6 was more effective than alphaGal2 in removing NAbs, and the combination of alphaGal6 + alphaGal2 did not further increase removal of NAbs. The specificity of the removal of NAbs (IgM and IgG) reactive with the alphaGal epitope by alphaGal6 matrix was shown by enzyme-linked immunosorbent assay. In vivo studies in nonhuman primates compared plasma perfusion through a alphaGal6 immunoaffinity column with hemoperfusion through a pig liver for changes in blood pressure, hematocrit, platelets, and NAb adsorption. Both methods reduced the level of anti-pig IgM and IgG xenoreactive antibodies to nearly background, but column perfusion caused less hypotension and reduction in platelets than liver perfusion. Four pig kidneys transplanted into monkeys after column perfusion did not undergo hyperacute rejection, remaining functional for 2-10 days, with a mean functional period of 7 days, demonstrating that a pig kidney can support renal function in a primate.

Immature host for xenotransplantation.

The overall shortage of appropriate donor organs has prompted transplant physicians and surgeons to consider using organs from other nonhuman species. The shortage of appropriate human donor hearts for newborn recipients is especially severe. Presently, the pig appears to be the most appropriate source for organs. Humans and baboons uniformly develop high titers of complement-fixing (IgM) anti-pig xenoantibodies, resulting in complement-mediated hyperacute rejection (HAR) of pig organs transplanted into mature baboons within minutes to hours. In contrast, newborn humans and baboons do not have high titers of anti-pig IgM xenoantibody, and consequently pig cardiac xenografts transplanted into newborn baboons do not undergo HAR. Rather, these organs are rejected at days 3 to 4 by a distinctive immunologic process that involves natural killer cells and macrophages. With the addition of cyclosporine-based triple immunosuppression, this process is reduced and graft life is prolonged to 6 to 7 days. This therapy, however, is not sufficient to prevent the induced humoral response to the graft, and the organs are rejected by antibody- and complement-dependent mechanisms. Future treatment strategies to reduce this humoral response must incorporate immunodepletion columns, soluble complement-inhibiting agents, and additional anti-B lymphocyte agents. These strategies, in conjunction with the use of transgenic pig organs that express human membrane-bound complement regulatory proteins or reduced xenoantigenic epitopes could further prolong graft life. Clinical trials are being formulated that would utilize pig organs as a "bridge," sustaining a newborn human in need of a heart transplant until an appropriate donor is located.

In vivo and in vitro optimization of depletion of IgM and IgG xenoantibodies by immunoadsorption using cell membrane proteins.

A system of immunoadsorption was developed for in vitro depletion of xenoreactive natural antibodies of classes IgG and IgM from monkey and human plasma. Porcine endothelial cell membrane proteins, platelet membrane proteins, and endothelial cells were used as affinity ligands, and cyanogen bromide-activated Sepharose 6 Fast Flow and Sepharose CL-4B gels were used for chromatography. Adsorption capacity was evaluated by means of ELISA, immunonephelometry, and cytotoxicity testing. Several consecutive adsorption-desorption cycles were performed. Different parameters influencing immunoadsorption were examined: ligand density on the column gel, adsorbent-plasma contact time, ratio of plasma volume to immunoadsorbent volume, desorption conditions, and temperature. After 2 adsorption-desorption cycles, 99% and 82 to 85% of IgG and IgM antipig antibodies were adsorbed, respectively. Furthermore, there was a 74 to 77% decrease in cytotoxicity. In vivo, we observed that after one adsorption-desorption cycle, 97% of antipig IgG antibodies and 96% of antipig IgM antibodies were adsorbed, and there was an 85% decrease in cytotoxicity. The immunoadsorption method studied and optimized in vitro and in vivo therefore efficiently depleted xenoantibodies and reduced the cytotoxicity. Thus, it can be used in xenotransplantation experiments without eliminating non-specific antibodies.

In vivo immunoadsorption of antipig antibodies in baboons using a specific Gal(alpha)1-3Gal column.

The major role of anti-alphaGal antibodies in the hyperacute rejection of pig organs by humans and baboons has been clearly demonstrated. Spacered alpha-galactose disaccharide (Gal(alpha1)-3Gal) hapten was produced by chemical synthesis and covalently attached to a flexible, hydrophilic polymer (PAA), which in turn was covalently coupled to macroporous glass beads, forming an immunoadsorbent that is mechanically and chemically stable and can be sterilized. The extracorporeal immunoadsorption (EIA) of anti-alphaGal antibodies using this column has been investigated in vivo in 3 baboons. In Baboon 1 (which had hyperacutely rejected a pig heart transplant 4 months previously, was not splenectomized, and did not receive any pharmacologic immunosuppression) the levels of anti-alphaGal antibody and antipig IgM and IgG, as well as serum cytotoxicity, fell significantly after each of 3 EIAs but were not eliminated. Serum cytotoxicity, antipig immunoglobulin and anti-alphaGal antibody rose steeply within 24 hr of the final EIA, suggesting that the return of cytotoxicity was associated with anti-alphaGa1 antibody. In Baboons 2 and 3 (which were immunologically naive and splenectomized, and received triple drug immunosuppressive therapy) serum cytotoxicity was totally eliminated and anti-alphaGal antibody and antipig IgM and IgG levels were greatly reduced by courses of EIA. In Baboon 2, cytotoxicity and all antibody levels remained negligible for approximately one week after the final (fourth) daily EIA. In Baboon 3, cytotoxicity and antibody levels were maintained low by intermittent EIA (over a period of 13 days) for almost 3 weeks, although antipig IgM began to rebound 4 days after the final EIA. We conclude that, in an immunosuppressed, splenectomized baboon, repeated EIA using a specific alphaGal disaccharide column will reduce antipig and anti-alphaGal antibody levels and serum cytotoxicity significantly for several days. This reduction in cytotoxicity will almost certainly be sufficient to delay the hyperacute rejection of a transplanted pig organ, but further studies are required to investigate whether it will be sufficient to allow accommodation to develop.

Removal Of Baboon And Human Antiporcine Igg And Igm Natural Antibodies By Immunoadsorption

The safe and effective removal of xenoreactive antibodies in the peritransplant period is likely to be critical for the clinical application of xenotransplantation involving disparate donor species, such as the pig. In an effort to develop an improved method for antibody removal in xenotransplantation, we have studied reusable antihuman antibody (Ig) columns in vitro and in vivo. Two types of columns were tested: (1) an antihuman Ig column containing polyclonal sheep antihuman IgG (heavy- and light-chain-specific) conjugated to sepharose CL-4B (Ig-Therasorb), and (2) an antihuman Ig column using polyclonal antihuman IgM (mu-chain-specific) conjugated to sepharose. Passage of human or baboon plasma through the Ig-Therasorb column resulted in 97.5% and 78.4% mean reductions in total IgG and IgM, respectively. Reductions in total IgG and IgM correlated with lowering of antipig IgG (54-486 fold) and IgM (9-54 fold) antibody titers as assessed by pig endothelial cell ELISA. The ability of the Ig-Therasorb to significantly reduce IgM may be attributed to the light chain specificity of this column. With the anti-IgM column, marked reductions in total (82.6-83.9%) and antipig (27-54 fold) IgM in human and baboon plasma occurred, while levels of total and xenoreactive IgG were slightly affected. Other than a dilutional effect, neither column resulted in significant reduction in albumin, fibrinogen, factor 5, and factor 8. Repeated in vivo use of either column in baboons achieved reductions in IgG and IgM that closely followed the results of our in vitro studies. No subject morbidity or mortality occurred. Use of the Ig-Therasorb column with immunosuppression in two baboons receiving pig renal xenografts achieved sustained reductions in antipig antibodies and prevented hyperacute rejection. Subjects were sacrificed at 11 and 13 days posttransplant with functioning xenografts and were found to have no evidence of vascular xenograft rejection. We conclude that anti-Ig columns represent a safe and effective method for antibody removal, without several of the limitations of other antibody removal techniques. Also, columns appear to be safe for repeated antibody removal in the posttransplant period.

Anti-pig IgM antibodies in human serum react predominantly with Gal(alpha 1-3)Gal epitopes.

A major problem with pig-to-human-tissue xenograft studies is that humans have natural antibodies to pig cells; these antibodies would cause hyperacute rejection if pig tissues were xenografted to humans. Here we show that most of human IgM antibodies present in the serum of healthy donors and reactive with pig cells react with galactose in an (alpha 1-3) linkage with galactose--i.e., Gal(alpha 1-3)Gal. Absorption studies demonstrated that the antibodies detected the same or similar epitopes on the surface of pig erythrocytes, blood and splenic lymphocytes, and aortic endothelial cells (EC). The antibodies were sensitive to 2-mercaptoethanol (2ME) treatment, did not bind to protein A or G, and were present in the high molecular weight fraction of serum; they are clearly IgM antibodies. Further, the antibodies did not react with human ABO blood group substances and are not related to human blood group A or B, which carry a terminal galactose. The reaction of human serum with pig erythrocytes was specifically inhibited by mono- and disaccharides: D-galactose, melibiose, stachyose, methyl-alpha-D-galactopyranoside, and D-galactosamine but not by D-glucose or methyl-beta-D-galactopyranoside; demonstrating that the reaction is with galactose in an alpha and not a beta linkage. A cDNA clone encoding the murine alpha-1,3-galactosyltransferase (which transfers a terminal galactose residue with an (alpha 1-3) linkage to a subterminal galactose) was isolated by polymerase chain reaction (PCR), cloned, and transfected into COS cells, which are of Old World monkey origin and, like humans, do not express Gal(alpha 1-3)Gal. After transfection, COS cells became strongly reactive with human serum and with IB4 lectin [which reacts only with Gal(alpha 1-3)Gal]; this reactivity could be removed by absorption with pig erythrocytes. As most of the antibody reacting with pig cells can be removed by absorption with either melibiose or Gal(alpha 1-3)Gal+ COS cells, most of these react with Gal(alpha 1-3)Gal. These findings provide the basis for genetic manipulation of the pig alpha-1,3-galactosyltransferase for future transplantation studies.

CYCLOSPORIN A

The in vitro action of the immunosuppressive agent Cyclospirin A has been investigated using porcine cells. Lymphocyte proliferation induced in response to transplantation antigens and phytohaemagglutinin (PHA), was inhibited by this agent at doses that failed to inhibit mitogenisis in response to sheep anti-pig IgM, growth of kidney cell monolayers, and leukocyte migration.

Immunoglobulins in blood serum of foetal pigs.

A total of 1,147 samples of blood serum, collected from porcine foetuses, were examined for the presence of immunoglobulin. The foetuses, from 182 sows, were sampled at abattoirs in Queensland during 1975. For detection and measurement of immunoglobulins, rabbit anti-pig serum and monospecific anti-pig IgG, anti-pig IgM and anti-pig IgA were employed in immunoelectrophoresis, double diffusion and single radial immuno-diffusion assays. Twenty-four foetuses (from 7 litters) had detectable IgG or IgM. None of the samples were positive for IgA. Two of the serums (from siblings) had high antibody titres to porcine parvovirus but in the remainder of the immunoglobulin-positive serums no antibody activity was detected.