Dissociation between anti‐porcine albumin and anti‐Gal antibody responses in non‐human primate recipients of intraportal porcine islet transplantation
Authors: Kang Hee Jung , Lee Haneulnari , Park Eun Mi , Kim Jong Min , Shin Jun‐Seop , Kim Jung‐Sik , Park Chung‐Gyu , Park Seong Hoe , Kim Sang Joon 
Published: January 2015

Background

To understand humoral responses elicited after xenotransplantation, we compared the induction of anti‐non‐Gal antibodies vs. anti‐Gal antibodies in non‐human primates (NHPs) after intraportal porcine islet transplantation (PITX).

Methods

Anti‐Gal and anti‐non‐Gal IgGs were analyzed in serial plasma samples of NHP recipients after PITX by enzyme‐linked immunosorbent assay (ELISA) using synthetic Gal and by flow cytometry using α‐1,3‐galactosyltransferase gene knockout (GTKO) porcine endothelial cells, respectively. Anti‐non‐Gal IgG was detected in some recipients after PITX. The specificity of anti‐non‐Gal IgG was investigated by two‐dimensional electrophoresis of the protein extract from GTKO porcine endothelial cells, Western blot analysis of recipient pre‐ and post‐PITX plasma, and MALDI‐TOF/TOF mass spectrometry, revealing albumin, a non‐glycosylated protein in the serum supplement of the islets solution, as a putative antigen for anti‐non‐Gal IgG. The binding of IgG antibodies to human albumin (HA), bovine albumin (BA), porcine albumin (PA), and Gal was compared by ELISA in pre‐ and post‐PITX plasma samples of 30 NHP recipients subjected to intraportal PITX, which were grouped according to the use of CD40‐CD154 blockade and sirolimus.

Results

One of the immunoblot‐matched spots was identified as BA by mass spectrometry. By ELISA, the plasma used in the immunoblot analysis revealed strong IgG binding to BA and PA, but not to HA. Anti‐PA, anti‐BA, and anti‐Gal antibodies in NHP recipients 1 month after PITX were detected in 5 (100%), 3 (60%), and 5 (100%), respectively, of the 5 recipients receiving various immunosuppression (IS) without CD40‐CD154 blockade (group I) and in 0 (0%), 0 (0%), and 4 (16%), respectively, of the 25 recipients receiving IS with CD40‐CD154 blockade and sirolimus (group II). This finding revealed significant differences between the groups (P < 0.0001, P = 0.0011 and P = 0.0013, respectively). Interestingly, among 15 recipients achieving graft survival longer than 1 month in group II, anti‐PA IgG was detected in only 1 recipient (6.7%) 180 days after PITX. However, an increase in anti‐Gal IgG was detected in 7 recipients (46.7%) despite maintenance IS with anti‐CD154 and sirolimus. This result indicates that anti‐Gal IgG is more frequently induced than anti‐PA IgG (P = 0.0352). Moreover, induction IS with anti‐CD154 and sirolimus suppressed anti‐Gal IgG, but not anti‐PA and anti‐BA IgG, responses in sensitized recipients given a repeat transplantation.

Conclusions

In NHP recipients of PITX, anti‐PA and anti‐BA IgG antibodies are elicited by porcine serum included as a supplement in porcine islet preparation. IS including CD40‐CD154 blockade and sirolimus suppresses these antibody responses in naïve recipients, but not in sensitized recipients. The elicitation of anti‐xenogenic albumin antibodies, a humoral response to a model protein antigen, is distinct from that of anti‐Gal antibodies, a response to carbohydrate antigen.