Advances in overcoming immunological and physiological barriers in xenotransplantation
https://doi.org/10.15825/1995-1191-2025-4-133-137
Abstract
The growing number of patients with severe organ diseases, along with the increasing demand for retransplantations, has intensified the global shortage of donor organs – the primary limitation to expanding transplant programs. Advances in genetic engineering and cell therapy technologies are opening new opportunities for the use of animal organs in human transplantation. Enhancing the effi cacy and safety of this approach requires overcoming signifi cant immunological and physiological barriers inherent in xenotransplantation. This review summarizes recent progress in genetic modification of donor animals, use of cell-based therapy in xenotransplantation, and prospects for clinical application.
About the Authors
D. A. VelikiyRussian Federation
Dmitriy Velikiy
Address: 1, Shchukinskaya str., Moscow, 123182
Yu. B. Basok
Russian Federation
Moscow
N. V. Grudinin
Russian Federation
Moscow
O. E. Gichkun
Russian Federation
Moscow
A. P. Trashkov
Russian Federation
Moscow
A. V. Varlachev
Russian Federation
Moscow
O. P. Shevchenko
Russian Federation
Moscow
References
1. Transplantology: results and prospects. Vol. XV. 2023 /Ed. by S.V. Gautier. M.–Tver: Triada, 2024; 320.
2. Shilov EM, Shilova MM, Rumyantseva EI, Batyushin MM, Bevzenko AYu, Belskikh AN et al. Nephrological service of the Russian Federation 2023: Part I. Renal replacement therapy. Clinical Nephrology. 2024; 16 (1): 5–14. https://dx.doi.org/10.18565/nephrology.2024.1.5-14.
3. Orlova OV. Xenotransplantation of organs and tissues (the First Global consultation on regulatory requirements for xenotransplantation clinical trials). Russian Journal of Transplantology and Artificial Organs. 2008; 6: 6–11.
4. Damas J, Corbo M, Kim J, Turner-Maier J, Farré M, Larkin DM et al. Evolution of the ancestral mammalian karyotype and syntenic regions. Proc Natl Acad Sci USA. 2022 Oct 4; 119 (40): e2209139119. doi: 10.1073/pnas.2209139119.
5. Cooper DK. Xenotransplantation – state of the art. Front Biosci (Landmark Ed). 1996 Sep 1; 1 (4): 248–265. doi: 10.2741/a130.
6. Mudur G. Indian surgeon challenges ban on xenotransplantation. BMJ. 1999 Jan 9; 318 (7176): 79. doi: 10.1136/bmj.318.7176.79a.
7. Hisadome Y, Eisenson DL, Santillan MR, Iwase H, Yamada K. Pretransplant Screening for Prevention of Hyperacute Graft Loss in Pig-to-primate Kidney Xenotransplantation. Transplantation. 2024 Aug 1; 108 (8): 1749–1759. doi: 10.1097/TP.0000000000004958.
8. Goerlich CE, Singh AK, Griffith BP, Mohiuddin MM. The immunobiology and clinical use of genetically engineered porcine hearts for cardiac xenotransplantation. Nat Cardiovasc Res. 2022 Aug; 1 (8): 715–726. doi: 10.1038/s44161-022-00112-x.
9. Denner J. Porcine endogenous retroviruses in xenotransplantation. Nephrol Dial Transplant. 2024 Jul 31; 39 (8): 1221–1227. doi: 10.1093/ndt/gfae023.
10. Anand RP, Layer JV, Heja D, Hirose T, Lassiter G, Firl DJ et al. Design and testing of a humanized porcine donor for xenotransplantation. Nature. 2023 Oct; 622 (7982): 393–401. doi: 10.1038/s41586-023-06594-4.
11. Peterson L, Yacoub MH, Ayares D, Yamada K, Eisenson D, Griffith BP et al. Physiological basis for xenotransplantation from genetically modified pigs to humans. Physiol Rev. 2024 Jul 1; 104 (3): 1409–1459. doi: 10.1152/physrev.00041.2023.
12. Gostimskaya I. CRISPR-Cas9: A History of Its Discovery and Ethical Considerations of Its Use in Genome Editing. Biochemistry (Mosc). 2022 Aug; 87 (8): 777– 788. doi: 10.1134/S0006297922080090.
13. Wang X, Qu J, Li J, He H, Liu Z, Huan Y. Epigenetic Reprogramming During Somatic Cell Nuclear Transfer: Recent Progress and Future Directions. Front Genet. 2020 Mar 18; 11: 205. doi: 10.3389/fgene.2020.00205.
14. Yamamoto T, Iwase H, Patel D, Jagdale A, Ayares D, Anderson D et al. Old World Monkeys are less than ideal transplantation models for testing pig organs lacking three carbohydrate antigens (Triple-Knockout). Sci Rep. 2020 Jun 17; 10 (1): 9771. doi: 10.1038/s41598-02066311-3.
15. Ariyoshi Y, Takeuchi K, Pomposelli T, Ekanayake-Alper DK, Shimizu A, Boyd L et al. Antibody reactivity with new antigens revealed in multi-transgenic triple knockout pigs may cause early loss of pig kidneys in baboons. Xenotransplantation. 2021 Jan; 28 (1): e12642. doi: 10.1111/xen.12642.
16. Eisenson D, Hisadome Y, Santillan M, Iwase H, Chen W, Shimizu A et al. Consistent survival in consecutive cases of life-supporting porcine kidney xenotransplantation using 10GE source pigs. Nat Commun. 2024 Apr 18; 15 (1): 3361. doi: 10.1038/s41467-024-47679-6.
17. Mohiuddin MM, Goerlich CE, Singh AK, Zhang T, Tatarov I, Lewis B et al. Progressive genetic modifications of porcine cardiac xenografts extend survival to 9 months. Xenotransplantation. 2022 May; 29 (3): e12744. doi: 10.1111/xen.12744.
18. Deo D, Marchioni M, Rao P. Mesenchymal stem/stromal cells in organ transplantation. Pharmaceutics. 2022 Apr 4; 14 (4): 791. doi: 10.3390/pharmaceutics14040791.
19. Han Y, Yang J, Fang J, Zhou Y, Candi E, Wang J et al. The secretion profile of mesenchymal stem cells and potential applications in treating human diseases. Signal Transduct Target Ther. 2022 Mar 21; 7 (1): 92. doi: 10.1038/s41392-022-00932-0.
20. Shravage BV, Turksen K. Autophagy in stem cell maintenance and differentiation. 1st ed. Cham, Switzerland: Springer; 2022.
21. Shirini K, Ladowski JM, Meier RPH. Xenotransplantation Literature Update: January-June 2025. Xenotransplantation. 2025 Jul-Aug; 32 (4): e70072. doi: 10.1111/xen.70072.
22. Montgomery RA, Griesemer AD, Segev DL, Sommer P. The decedent model: A new paradigm for de-risking high stakes clinical trials like xenotransplantation. Am J Transplant. 2024 Apr; 24 (4): 526–532. doi: 10.1016/j. ajt.2024.01.035.
23. Cooper DKC, Kobayashi T. Xenotransplantation experiments in brain-dead human subjects – A critical appraisal. Am J Transplant. 2024 Apr; 24 (4): 520–525. doi: 10.1016/j.ajt.2023.12.020.
24. Kawai T, Williams WW, Elias N, Fishman JA, Crisalli K, Longchamp A et al. Xenotransplantation of a Porcine Kidney for End-Stage Kidney Disease. N Engl J Med. 2025 May 15; 392 (19): 1933–1940. doi: 10.1056/NEJMoa2412747.
25. Griffith BP, Grazioli A, Singh AK, Tully A, Galindo J, Saharia KK et al. Transplantation of a genetically modified porcine heart into a live human. Nat Med. 2025 Feb; 31 (2): 589–598. doi: 10.1038/s41591-024-03429-1.
26. Tao KS, Yang ZX, Zhang X, Zhang HT, Yue SQ, Yang YL et al. Gene-modified pig-to-human liver xenotransplantation. Nature. 2025 May; 641 (8064): 1029–1036. doi: 10.1038/s41586-025-08799-1.
27. Podestà MA, Sykes M. Chimerism-Based Tolerance to Kidney Allografts in Humans: Novel
Review
For citations:
Velikiy D.A., Basok Yu.B., Grudinin N.V., Gichkun O.E., Trashkov A.P., Varlachev A.V., Shevchenko O.P. Advances in overcoming immunological and physiological barriers in xenotransplantation. Russian Journal of Transplantology and Artificial Organs. 2025;27(4):133-137. (In Russ.) https://doi.org/10.15825/1995-1191-2025-4-133-137



































