Xenotransfusion

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Xenotransfusion (from Greek xenos- 'strange, foreign'), a form of xenotransplantation, was initially defined as the transfer of blood from one species into the veins of another. [1] In most cases, it is a transfer of blood between a non-human animal and a human. However, further experimentation has been done between various non-human animal species. This procedure can be performed without affecting the health of the donor, as only about 10% of their blood volume is used each time. [2] Utilizing the unlimited blood supply from animal sources eliminates the risk of transmitting infectious diseases between humans. [1]

Contents

In 1658, Dom Robert Desgabets, a French monk, introduced the idea of xenotransfusion at a scientific society meeting. This society later afforded the French Academy of Sciences. [1] Some ethical issues have been identified by the Ethics Committee of the International Xenotransplantation Association (IXA). [2] For example, the IXA sets standards and regulations for those planning to orchestrate clinical xenotransplantation trials. [3] The IXA has identified three major ethical areas that require adequate attention: favorable risk and benefit assessment supported by pre-clinical data, lack of alternative treatment for participants, and minimizing the risk of infection by ensuring the highest biosafety regulations are followed for selected animal donors. These are just a few examples of the ethics behind xenotransplantation.

History

The first recorded blood transfusion was performed between two dogs in 1665. [4] On June 15, 1667, Jean-Baptiste Denis, a French physician, and Paul Emmerez, a surgeon, performed the first documented xenotransfusion to humans. The transfusion occurred between a lamb and a 15-year-old boy. [1] [5] Carotid artery blood from the lamb was introduced to a vein in the patient's inner elbow, and the procedure ultimately resulted in a successful recovery. [5] Denis and Emmerez performed multiple xenotransfusions together. On June 24, 1667, the duo performed a transfusion on a young Swedish nobleman. [1] When they arrived, the patient had already lost his ability to speak and was practically unconscious. Shortly after the transfusion began, the patient was able to speak again. His health was improving until his condition grew progressively worse. A second transfusion took place, but it was unsuccessful, and the patient died.

Richard Lower, an English physician, performed a similar procedure on November 23, 1667. [1] [5] He successfully transfused the blood of a lamb to a 22-year-old man. [1] In both cases, the whole blood of the lamb was directly introduced into the vein of the patient. The direct introduction of blood was due to a lack of knowledge in preventative blood coagulation techniques at the time.

After several xenotransfusion procedures, some successful some not, the French Parliament prohibited the practice of these transfusions in 1670. [5] The English Parliament, as well as the Pope, followed suit and prohibited the procedures shortly after.

Ethical arguments involving the pig for xenotransfusion

Xenotransfusion uses non-human animals to aid in the shortage of blood for blood transfusion in humans. Some scientists preliminarily favor Sus scrofa domesticus (pigs) as a source of blood after having tested many different animals in order to find the best candidate for a blood donation. Pig red blood cells (pRBCs) show many characteristics similar to that of a human, including RBC diameters (pig 6 μm; human 7.2 μm), RBC counts (pig 5.7 to 6.9 million/ll; human 4.2 to 6.2 million/ll), and RBC average lifespan (human 86 days; pig 120 days). [6] Current evidence shows that pRBCs will function normally in humans due to the relation between porcine blood groups and human ABO group system. [7] In addition, it is possible to produce pigs with type O blood and to genetically modify pigs to make their blood more compatible with humans. Sus scrofa domesticus's blood may be used to save lives and to increase blood quantity. The organism is kept alive and no serious harm is involved, similar to how blood is removed from humans. One article examining the ethics of xenotransfusion notes that only 10% of the animal's blood volume is used each time; therefore, it may be considered ethically acceptable to raise pigs for periodical blood collection as it does not damage the health of the animal. Likewise, using pRBCs on humans would not cause severe harm to human health. [2] Xenotransfusion is not a necessity due to the number of blood donations; there is not a significant shortage of blood. [2]

Veterinary xenotransfusion

Transfusion of canine blood into domestic cats was performed historically and continues to be performed in some countries. [4]

Xenotransfusions have been performed on birds, though the procedure is only done to stabilize a bird in shock, due to rejection by the recipient bird's antibodies. [8]

Xenotransfusion of bovine whole blood into domestic goats has been preliminarily investigated as a potential option for anemic goats. [9] When comparing caprine-recipient bovine-donor cross matching a study found 11/15 caprine-bovine combinations compatible on both major and minor cross matching. [9] [10]

Related Research Articles

<span class="mw-page-title-main">Blood type</span> Classification of blood based on antibodies and antigens on red blood cell surfaces

A blood type is a classification of blood, based on the presence and absence of antibodies and inherited antigenic substances on the surface of red blood cells (RBCs). These antigens may be proteins, carbohydrates, glycoproteins, or glycolipids, depending on the blood group system. Some of these antigens are also present on the surface of other types of cells of various tissues. Several of these red blood cell surface antigens can stem from one allele and collectively form a blood group system.

<span class="mw-page-title-main">Blood transfusion</span> Intravenous transference of blood products

Blood transfusion is the process of transferring blood products into a person's circulation intravenously. Transfusions are used for various medical conditions to replace lost components of the blood. Early transfusions used whole blood, but modern medical practice commonly uses only components of the blood, such as red blood cells, white blood cells, plasma, platelets, and other clotting factors.

<span class="mw-page-title-main">Organ transplantation</span> Medical procedure in which an organ is removed from one body and placed in the body of a recipient

Organ transplantation is a medical procedure in which an organ is removed from one body and placed in the body of a recipient, to replace a damaged or missing organ. The donor and recipient may be at the same location, or organs may be transported from a donor site to another location. Organs and/or tissues that are transplanted within the same person's body are called autografts. Transplants that are recently performed between two subjects of the same species are called allografts. Allografts can either be from a living or cadaveric source.

<span class="mw-page-title-main">Richard Lower (physician)</span> English physician (c. 1631–1691)

Richard Lower was an English physician who heavily influenced the development of medical science. He is most remembered for his pioneering work on blood transfusion and the function of the cardiopulmonary system, which he described in his book Tractatus de Corde.

A blood bank is a center where blood gathered as a result of blood donation is stored and preserved for later use in blood transfusion. The term "blood bank" typically refers to a department of a hospital usually within a clinical pathology laboratory where the storage of blood product occurs and where pre-transfusion and blood compatibility testing is performed. However, it sometimes refers to a collection center, and some hospitals also perform collection. Blood banking includes tasks related to blood collection, processing, testing, separation, and storage.

A blood substitute is a substance used to mimic and fulfill some functions of biological blood. It aims to provide an alternative to blood transfusion, which is transferring blood or blood-based products from one person into another. Thus far, there are no well-accepted oxygen-carrying blood substitutes, which is the typical objective of a red blood cell transfusion; however, there are widely available non-blood volume expanders for cases where only volume restoration is required. These are helping doctors and surgeons avoid the risks of disease transmission and immune suppression, address the chronic blood donor shortage, and address the concerns of Jehovah's Witnesses and others who have religious objections to receiving transfused blood.

Rh disease is a type of hemolytic disease of the fetus and newborn (HDFN). HDFN due to anti-D antibodies is the proper and currently used name for this disease as the Rh blood group system actually has more than 50 antigens and not only the D-antigen. The term "Rh Disease" is commonly used to refer to HDFN due to anti-D antibodies, and prior to the discovery of anti-Rho(D) immune globulin, it was the most common type of HDFN. The disease ranges from mild to severe, and occurs in the second or subsequent pregnancies of Rh-D negative women when the biologic father is Rh-D positive.

<span class="mw-page-title-main">Xenotransplantation</span> Transplantation of cells or tissue across species

Xenotransplantation, or heterologous transplant, is the transplantation of living cells, tissues or organs from one species to another. Such cells, tissues or organs are called xenografts or xenotransplants. It is contrasted with allotransplantation, syngeneic transplantation or isotransplantation and autotransplantation. Xenotransplantation is an artificial method of creating an animal-human chimera, that is, a human with a subset of animal cells. In contrast, an individual where each cell contains genetic material from a human and an animal is called a human–animal hybrid.

The direct and indirect Coombs tests, also known as antiglobulin test (AGT), are blood tests used in immunohematology. The direct Coombs test detects antibodies that are stuck to the surface of the red blood cells. Since these antibodies sometimes destroy red blood cells they can cause anemia; this test can help clarify the condition. The indirect Coombs test detects antibodies that are floating freely in the blood. These antibodies could act against certain red blood cells; the test can be carried out to diagnose reactions to a blood transfusion.

<span class="mw-page-title-main">Pig</span> Domesticated omnivorous even-toed ungulate

The pig, often called swine, hog, or domesticpig when distinguishing from other members of the genus Sus, is an omnivorous, domesticated, even-toed, hoofed mammal. It is variously considered a subspecies of Sus scrofa or a distinct species. The pig's head-plus-body length ranges from 0.9 to 1.8 m, and adult pigs typically weigh between 50 and 350 kg, with well-fed individuals even exceeding this range. The size and weight of hogs largely depends on their breed. Compared to other artiodactyls, a pig's head is relatively long and pointed. Most even-toed ungulates are herbivorous, but pigs are omnivores, like their wild relative. Pigs grunt and make snorting sounds.

Intraoperative blood salvage (IOS), also known as cell salvage, is a specific type of autologous blood transfusion. Specifically IOS is a medical procedure involving recovering blood lost during surgery and re-infusing it into the patient. It is a major form of autotransfusion.

Dilution cloning or cloning by limiting dilution describes a procedure to obtain a monoclonal cell population starting from a polyclonal mass of cells. This is achieved by setting up a series of increasing dilutions of the parent (polyclonal) cell culture. A suspension of the parent cells is made. Appropriate dilutions are then made, depending on cell number in the starting population, as well as the viability and characteristics of the cells being cloned. After the final dilutions are produced, aliquots of the suspension are plated or placed in wells and incubated. If all works correctly, a monoclonal cell colony will be produced. Applications for the procedure include cloning of parasites, T cells, transgenic cells, macrophages. and hematopoietic stem cells.

Transplantable organs and tissues may refer to both organs and tissues that are relatively often transplanted, as well as organs and tissues which are relatively seldom transplanted. In addition to this it may also refer to possible-transplants which are still in the experimental stage.

<span class="mw-page-title-main">Heart transplantation</span> Surgical transplant procedure

A heart transplant, or a cardiac transplant, is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease when other medical or surgical treatments have failed. As of 2018, the most common procedure is to take a functioning heart, with or without both lungs, from a recently deceased organ donor and implant it into the patient. The patient's own heart is either removed and replaced with the donor heart or, much less commonly, the recipient's diseased heart is left in place to support the donor heart.

Robert Desgabets was a French Cartesian philosopher and Benedictine prior, born in Ancemont. He published two book-length philosophical works in his lifetime, Considérations sur l'état présent de la controverse touchant le T. S. Sacrement de l'autel in 1671 and Critique de la critique de la recherche de la verité in 1675.

<span class="mw-page-title-main">Paolo Brenner</span> German cardiac surgeon

Paolo Brenner is a German physician and a professor of cardiac surgery at the Department of Cardiac Surgery, Klinikum Großhadern of the Ludwig Maximilian University of Munich (LMU). He is known for his work in the fields of xenotransplantation, the advancement of artificial hearts, extracorporeal membrane oxygenation (ECMO) and lung transplantation.

Serum-derived bovine immunoglobulin/protein isolate (SBI) is a medical food product derived from bovine serum obtained from adult cows in the United States. It is sold under the name EnteraGam.

The Baudin Pig is a landrace of domestic pig, originating on Kangaroo Island, South Australia. The landrace descended from pigs released on the island in the 1800s. The entirety of the wild stock of the breed was wiped out during the Kangaroo Island bushfires, and the only remaining examples of the breed are kept at a rare breeds farm on the island.

<span class="mw-page-title-main">Keith Reemtsma</span> American surgeon

Keith Reemtsma was an American transplant surgeon, best known for the cross-species kidney transplantation operation from chimpanzee to human in 1964. With only the early immunosuppressants and no long-term dialysis, the female recipient survived nine months, long enough to return to work.

A human chimera is a human with a subset of cells with a distinct genotype than other cells, that is, having genetic chimerism. In contrast, an individual where each cell contains genetic material from a human and an animal is called a human–animal hybrid.

References

  1. 1 2 3 4 5 6 7 Roux, Françoise A.; Saï, Pierre; Deschamps, Jack-Yves (2 May 2007). "Xenotransfusions, past and present". Xenotransplantation. 14 (3): 208–216. doi:10.1111/j.1399-3089.2007.00404.x. ISSN   0908-665X. PMID   17489860. S2CID   42016125.
  2. 1 2 3 4 Roux, Françoise A.; Saï, Pierre; Deschamps, Jack-Yves (2007). "Some ethical issues regarding xenotransfusion". Xenotransplantation. 14 (3): 217–221. doi:10.1111/j.1399-3089.2007.00393.x. ISSN   0908-665X. PMID   17489861. S2CID   25416442.
  3. ↑ Cozzi, Emanuele; Tallacchini, Mariachiara; Flanagan, Enda B.; Pierson III, Richard N.; Sykes, Megan; Vanderpool, Harold Y. (2009). "Chapter 1: Key ethical requirements and progress toward the definition of an international regulatory framework". Xenotransplantation. 16 (4): 203–214. doi:10.1111/j.1399-3089.2009.00540.x. ISSN   0908-665X. PMID   19799760. S2CID   9462426.
  4. 1 2 Bovens, Catherine; Gruffydd-Jones, Tim (February 2013). "Xenotransfusion with canine blood in the feline species: review of the literature". Journal of Feline Medicine and Surgery. 15 (2): 62–67. doi: 10.1177/1098612X12460530 . PMID   22983454.
  5. 1 2 3 4 Deschamps, Jack-Yves; Roux, Francoise A.; Sai, Pierre; Gouin, Edouard (1 February 2005). "History of xenotransplantation". Xenotransplantation. 12 (2): 91–109. doi:10.1111/j.1399-3089.2004.00199.x. ISSN   0908-665X. PMID   15693840. S2CID   20495953.
  6. ↑ Cooper, David (September 2003). "Porcine red blood cells as a source of blood transfusion in humans". Xenotransplantation. 10 (5): 384–386. doi:10.1034/j.1399-3089.2003.00092.x. PMID   12950981. S2CID   35821685.
  7. ↑ Zhu, Alex (30 November 1999). "Introduction to porcine red blood cells: Implications for xenotransfusion". Seminars in Hematology. 37 (2): 143–149. doi:10.1016/s0037-1963(00)90039-8. PMID   10791883.
  8. ↑ Russo, Carmen (June 22, 2018). "Fact-Checking Jurassic World: Fallen Kingdom". Slate . Birds often receive cross-species transfusions because they do not have blood types and there are thousands of different species. These procedures are only done to buy time to stabilize a creature in shock. "Whenever you go across species, the red blood cells are destroyed, and it varies how long they last. It can be as short as half a day, or five to six days [...] But what that gives you is time to stabilize the animal and provide other life-supportive measures."
  9. 1 2 Smith, Joe S.; Viall, Austin K.; Breuer, Ryan M.; Walton, Rebecca A.; Plummer, Paul J.; Griffith, Ronald W.; Kreuder, Amanda J. (2021-03-04). "Preliminary Investigation of Bovine Whole Blood Xenotransfusion as a Therapeutic Modality for the Treatment of Anemia in Goats". Frontiers in Veterinary Science. 8. doi: 10.3389/fvets.2021.637988 . ISSN   2297-1769. PMC   7969644 . PMID   33748213.
  10. ↑ Smith, Joe S.; Viall, Austin K.; Breuer, Ryan M.; Walton, Rebecca A.; Plummer, Paul J.; Griffith, Ronald W.; Kreuder, Amanda J. (2021). "Preliminary Investigation of Bovine Whole Blood Xenotransfusion as a Therapeutic Modality for the Treatment of Anemia in Goats". Frontiers in Veterinary Science. 8: 637988. doi: 10.3389/fvets.2021.637988 . PMC   7969644 . PMID   33748213.
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