Soluble Galα(1,3)Gal conjugate combined with hDAF preserves morphology and improves function of cardiac xenografts

Backaround: Cytotoxic anti-Gal alpha(1,3)Gal antibodies play a key role in the rejection of pig organs transplanted into primates. Regimens reducing anti-Gal alpha(1,3)Gal antibodies were associated with severe side effects unable to prevent antibody rebound until soluble synthetic oligosaccharides with terminal Gal alpha(1,3)Gal inhibiting antigen binding became available. We displayed kinetics of anti-pig and anti-Gal-of.(1,3)Gal IgM and IgG antibody levels using GAS914, a Gala(1,3)Gal trisaccharide conjugated to poly-L-lysine, and investigated corresponding changes of parameters of heart function. Methods: Using a working heart model, hDAF pig hearts were perfused with human blood containing GAS914 (group 1). As controls hDAF pig hearts (group 2) and landrace pig hearts (group 3) were perfused with human blood only. Levels of anti-Gal alpha(1, 3)Gal (IgM, IgG) and anti-pig antibodies were assessed to prove the effectiveness of GAS914. As parameters of heart function, cardiac output (CO), stroke work index (SWI), coronary blood flow (CBF) and coronary resistance were measured. Creatine phosphokinases, lactate dehydrogenase and aspartate aminotransferase were evaluated as markers of myocardial damage. Histological and immunohistochemical investigations were performed at the end of perfusion. Results: In group I an immediate and extensive reduction in both IgM and IgG anti-Gal alpha(1,3)Gal was found. Anti-pig antibodies were eliminated accordingly. Antibody binding to GAS914 was complete before the start of organ perfusion. Corresponding to rapid antibody elimination in group I GAS914 not only was able to significantly prolong the beating time of the heart in hDAF pigs, but also to clearly improve functional parameters. When switching to the working heart mode hDAF pig hearts perfused with human blood containing GAS914 (group 1) revealed a CO starting at a significantly higher level than hDAF (group 2) and non-transgenic pig hearts (group 3) perfused with human blood only. Similarly, in group I SWI was significantly increased at the beginning of perfusion compared to that of Group 2 and group 3. The increase in CBF during perfusion and the corresponding fall of coronary resistance occurred without significant differences between the groups revealing the independence of hDAF and GAS914. Conclusions: Due to an immediate and profound reduction in Gal alpha(1, 3)Gal-specific antibodies, soluble Gal alpha(1,3)Gal conjugates not only prolong survival, but also improve the hemodynamic performance of he heart in DAF pigs.