Immunological and functional features of decellularized xenogeneic heart valves after transplantation into GGTA1-KO pigs

Ramm, Robert GND; Goecke, Tobias GND; Köhler, Peter; Tudorache, Igor GND; Cebotari, Serghei ORCID; Ciubotaru, Anatol; Sarikouch, Samir GND; Höffler, Klaus; Bothe, Friederike GND; Petersen, Björn GND; Haverich, Axel GND; Niemann, Heiner GND; Hilfiker, Andres GND

Decellularization of xenogeneic heart valves might lead to excellent regenerative implants, from which many patients could benefit. However, this material carries various xenogeneic epitopes and thus bears a considerable inherent immunological risk. Here, we investigated the regenerative and immunogenic potential of xenogeneic decellularized heart valve implants using pigs deficient for the galactosyltransferase gene (GGTA1-KO) as novel large animal model. Decellularized aortic and pulmonary heart valves obtained from sheep, wild-type pigs or GGTA1-KO pigs were implanted into GGTA1-KO pigs for 3, or 6 months, respectively. Explants were analyzed histologically, immunhistologically (CD3, CD21 and CD172a) and anti-aGal antibody serum titers were determined by ELISA. Xenogeneic sheep derived implants exhibited a strong immune reaction upon implantation into GGTA1-KO pigs, characterized by massive inflammatory cells infiltrates, presence of foreign body giant cells, a dramatic increase of anti-aGal antibody titers and ultimately destruction of the graft, whereas wild-type porcine grafts induced only a mild reaction in GGTA1-KO pigs. Allogeneic implants, wild-type/wild-type and GGTA1-KO/GGTA1-KO valves did not induce a measurable immune reaction. Thus, GGTA1-KO pigs developed a ‘human-like’ immune response toward decellularized xenogeneic implants showing that immunogenicity of xenogeneic implants is not sufficiently reduced by decellularization, which detracts from their regenerative potential.

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Ramm, Robert / Goecke, Tobias / Köhler, Peter / et al: Immunological and functional features of decellularized xenogeneic heart valves after transplantation into GGTA1-KO pigs. 2021.

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