Unbridled optimism
Transplant waiting lists in Germany will stop in 1-2 years
Viktor Goloborodko, Aussiedlerbote
According to cardiac surgeon Brenner, the Munich team plans to conduct a clinical trial within one to two years. And I have already applied for approval for the experiment.
Transplantation can give hope to tens of thousands of people who depend on donated organs. Scientists have been trying for a long time to make transplants useful for humans from pig organs. Including, except for the heart, kidneys and lungs. In principle, it is possible to replace the liver, as well as parts of the pancreas, skin and cornea of the eyes, according to veterinarian Eckhard Wolf from the LMU Gene Center. A group led by Wolf, Brenner and Munich heart surgeon Bruno Reichart transplanted genetically modified pig hearts to monkeys a few years ago. Some lived for more than six months before the study stopped.
In order for their organs to be used for humans, it is necessary to change the genetic composition of donor animals. According to Wolf, without genetic adaptation, when organs are transferred to a person, an immediate rejection reaction occurs. In a particular case, ten genetic modifications were made. Among other things, we are talking about certain structures on the surface of pig cells, against which antibodies are naturally produced in humans. "Another risk is that when human blood flows through the blood vessels in the pig's heart, blood clots form. However, this is a theoretically solvable problem," the expert says.
"Other gene constructs provide the formation of an anti—rejection protein," Wolf believes. In addition, the growth hormone receptor gene is "disabled" to prevent excessive growth of the transplanted heart after transplantation. It is doubtful whether all these modifications are really necessary, experts say, but the methodology provides for just such an adaptation option.
Experiments with monkeys conducted in Munich have shown that long-term survival is possible with donor hearts if only three genetic modifications are carried out.
It is also necessary to make sure that the animals are not infected with microbes in order to prevent the transmission of viruses and other pathogens to the recipient.
When will such an operation be performed in Germany?
According to Wolf, such transplants can be expected in Germany in the next few years. "Clinical trials in the USA will certainly have a positive impact on the entire transplant industry. And they will accelerate its development in Germany as well," the expert says. According to cardiac surgeon Brenner, the Munich team plans to conduct a clinical trial within one to two years. And I have already applied for approval for the experiment.
Prospects for lung, kidney and other transplants
According to Wolf, animal organs have a decisive advantage in the success of transplantation. It is difficult to estimate how quickly the process of transplanting other organs can work. "If the heart is working, then the kidneys are working too," says Brenner. Lung transplantation is much more difficult. There is also a great need for transplanting cells that produce the hormone insulin.
In the foreseeable future, lifelong dialysis for kidney patients, huge waiting lists for donor organs and premature death due to untimely transplantation will become a thing of the past. The waiting lists for transplantation in Germany will cease to exist, since it will be possible to build up a large reserve of organs for transplantation. This is how the Hanoverian expert Niemann assesses the prospects of work in the direction of donor transplants.
The so‑called xenotransplantation has been studied since the 1980s. Pigs are particularly well suited as donors. Because their metabolism is similar to that of humans. In the USA in the 1980s, a doctor had to insert a baboon heart into a doomed newborn with a non‑functioning heart. But the girl lived only a few weeks. Pig pancreatic cells have already been transplanted in clinical trials to help people with diabetes.
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