Genetic manipulation in pigsDavid H. and Cesare Galli
aMassachusetts General Hospital, Transplantation
Biology Research Center, Boston, Massachusetts, USA
Recent developments in the field of genetic engineering have made it possible to add,
and bLaboratorio di Tecnologie della Riproduzione,Avantea srl, Cremona and Clinical Veterinary
delete or exchange genes from one species to another. This technology has special
Department, University of Bologna, Bologna, Italy
relevance to the field of xenotransplantation, in which the elimination of a species-
specific disparity could make the difference between success and failure of an organ
transplant. This review focuses on developments in both the techniques and
Transplantation Biology Research Center, 13th Street,Building 149-9019, Boston, MA 02129, USA
applications of genetically modified animals.
Tel: +1 617 726 4065; fax: +1 617 726 4067;
Advances have been made using existing techniques for genetic modifications of swine
Current Opinion in Organ Transplantation 2009,
and in the development of new, emerging technologies, including enzymatic
engineering and the use of small interfering RNA. Applications of the modified animalshave provided evidence that genetically modified swine have the potential to overcomeboth physiologic and immunologic barriers that have previously impeded this field. Theuse of alpha-1,3-galactosyltransferase gene-knockout animals as donors have shownmarked improvements in xenograft survivals. SummaryTechniques for genetic engineering of swine have been directed toward avoidingnaturally existing cellular and antibody responses to species-specific antigens. Organsfrom genetically engineered animals have enjoyed markedly improved survivals innonhuman primates, especially in protocols directed toward the induction of tolerance,presumably by avoiding immunization to new antigens.
Keywordsgenetic engineering, knockout, transplantation, xenograft, xenotransplantation
Curr Opin Organ Transplant 14:148–153ß 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Techniques for genetic modifications of swine
One of the major advantages of the pig as a potential
Techniques for genetic modification are crucial for xeno-
xenograft donor is the ability of the genome of these
transplantation research. Major advances have been
animals to be modified by modern techniques of genetic
made since the first transgenic large animals, including
engineering. The breeding characteristics of these
transgenic pigs, were obtained through pronuclear micro-
animals, in particular their relatively short gestation time
injection mainly by the use of assisted reproductive
and large litter size, combined with the availability of
technologies These advances made possible the first
techniques for oocyte manipulation and artificial inse-
inactivation (knockout) of a gene in a large animal model
mination, have made it possible to carry out both
by combining genetic engineering on cultured somatic
addition of genes (i.e. transgenic animals) and elimin-
cells with somatic cell nuclear transfer (SCNT)
ation of gene expression (i.e. knockout animals) forselected genes involved in xenograft rejection. Some
of the first transgenic animals were produced for this
Pronuclear microinjection is now seldom used, having
purpose just over a decade ago whereas knockout
been largely replaced by more efficient and less expens-
animals for alpha-1,3-galactosyltransferase (Gal)
ive techniques. Klose et al. used microinjection to
have become available over the past 5 years. We intend to
insert the tumor necrosis factor-alpha-related apoptosis-
review here both the techniques available for producing
inducing ligand into pigs; ubiquitous expression levels
genetic modifications of swine and some of the most
were detected in three lines without side effects. Martin
recent data using such modified animals in the field of
et al. developed transgenic pigs that express the
human T cell inhibitory molecule, human cytotoxic T
1087-2418 ß 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Genetic manipulation in pigs Sachs and Galli
lymphocyte antigen 4-immunoglobulin, under the con-
genesis and silencing of lentiviral sequences by
trol of the neuron-specific enolase promoter. Expression
methylation and high frequency of mosaicism in founder
was found in various areas of the brain in these transgenic
pigs, including the mesencephalon, hippocampus andcortex. Kues et al. also generated transgenic
Another class of viruses used was the adeno-associated
pigs by microinjecting an autoregulatory, tetracycline-
virus (AAV). Recently, Rogers et al. produced a
responsive, bicistronic expression cassette (NTA). The
cystic fibrosis transmembrane conductance regulator
expression pattern correlated inversely with the methyl-
(CFTR)-null pig using AAV-mediated gene targeting
ation status of the NTA transcription start sites, indicat-
and SCNT. These authors generated a pig with both
ing epigenetic silencing of one of the NTA cassettes.
null (knockout) and DF508 (knock-in) modifications. Gene targeting using the AAV approach has resulted in
a very efficient strategy for obtaining knockout of the
Recently, a technique to produce multitransgenic pigs
CFTR gene that is not expressed in fibroblasts.
has been optimized, incubating genes for three fluor-escent proteins with spermatozoa, which were sub-
sequently used for insemination. Seven of the 18 piglets
SCNT has become the leading tool for generating
born were reported to be transgenic by PCR analysis
animals from genetically engineered somatic cells.
The benefits of this technique, compared with pronuclear
SCNT works better in pigs than in other large animals
microinjection, are efficiency, low cost and ease of use.
A recent innovation to make the technique
Nevertheless, the insertion is random and the transgene
more user-friendly is the zona-free system. Zona removal
can be rearranged, thus affecting the expression levels.
may be performed after enucleation for zona-free fusion,
The expression of the transgene in the long term remains
activation and culture or before enucleation
controversial Sperm-mediated gene transfer
for handmade cloning Major limitations are
(SMGT) has also been used with a nonviral episomal
represented by the lack of embryonic stem cell technol-
vector that can offer several advantages, including
ogies. Somatic cells are being used, but they have a
the prevention of insertional mutagenesis and position
limited lifespan, thus restricting the time the cells can
effects on expression. Twelve of 18 fetuses that were
be cultured in vitro for genetic manipulation. For xeno-
recovered retained the episomal reporter gene, and nine
transplantation purposes, the use of miniature pigs is
expressed it. Intracytoplasmic sperm injection-mediated
more attractive for a number of reasons. However, these
gene transfer, a variant of SMGT, in combination with
breeds do not carry the same reproductive efficiency as
SCNT produced transgenic pigs by coincubating
commercial breeds, and they are not as readily available.
sperm with the bicistronic vector, human albumin green
SCNT efficiency in miniature pigs, using miniature sow
fluorescent protein (GFP), and microinjecting the sper-
recipients, is very low. When miniature pig embryos are
matozoa directly into the ooplasm. After the transfer
transferred to commercial sows, the outcome is improved
of 702 embryos into five gilts, two out of 35 fetuses
but not to the level of the commercial breeds
recovered were transgenic. Using somatic cells from
Using a combination of SCNT with heterozygous cells
the transgenic pigs for nuclear transfer, 767 embryos were
for alpha-Gal and crossbreeding of the resulting animals,
retransferred to five recipients, resulting in six live trans-
a commercial line of pig homozygous for the knockout
genic piglets. This is not more efficient than the two
of the Gal epitope has been generated with a low level
techniques used separately; however, it can be suitable
of inbreeding that is beneficial for reproductive
when a large construct (ranging from À100 to more than
À1000 kb, i.e. YAC, BAC, microchromosome) has to betransfected
Several new technologies are becoming available that
Lentiviral gene transfer is extremely efficient, with 80–
may be of great benefit in the future to the construction of
100% of the animals being born transgenic after oocyte or
embryo infection or somatic cell culture infection. Lentiviruses have been used in a variety of experiments
to transduce cells with various transgenes. These exper-
Transposons, also called ‘jumping genes’, are class II
iments include small interfering RNA (siRNA) knock-
mobile genetic elements; they are small segments of
down for stem cells and somatic cells, and nuclear transfer
DNA able to move from one DNA to another using
(see below) for generating desired modifications. Lenti-
transposition mediated by enzymes (transposases).
viruses are unlikely to be used in clinical applications
DNA ‘cut and paste’ transposons have been used for
because of the risks associated with multiple integration.
precise and efficient delivery of DNA expression cas-
Such risks include oncogene activation, insertional muta-
settes in vertebrate cells. In a recent study it was
Copyright Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
shown that cotransfection of PEGE cells with Sleeping
(PERV); for example ‘knockdown’ of PERV expression
Beauty, Passport Tol2 and piggyBac, with their corre-
has been shown in transgenic pigs expressing siRNA
sponding transposase expression constructs, resulted
corresponding to the viral pol2 sequence On the
respectively in 13.5, five, 21 and 28-fold increases over
contrary, recently, an alternative strategy to reduce PERV
transfection without transposase. In addition to increas-
transmission was proposed using APOBEC3G, which
ing the efficiency of integration, transposase-mediated
is a single-stranded DNA cytosine deaminase that can
transgenesis precisely integrates a single copy of the
inhibit many retrovirus elements. It engages assembling
transposon into one or more locations in the genome,
retrovirus particles, accesses the RNA genome-containing
avoiding the integration of G/C-rich prokaryotic elements
virus core and upon reverse transcription, deaminates
of the vector and avoiding transgene concatemerization
cDNA cytosines to uracils, inactivating the coding capacity
that can cause shutdown of gene expression. Other
powerful tools in genome modifications are representedby Cre and FLP recombinases that catalyze a conserva-
tive DNA recombination event between two short
Most transgenic animals carry transgenes expressed in all
recombinase recognition sites (RRSs), loxP and FRT.
tissues. Under specific circumstances, and to avoid
This can permit deletion or inversion of the DNA
possible side effects due to undesired transgene expres-
between two RRSs, depending on their orientation
sion in some tissues, it may be necessary to have a promoter
. Also, in lentiviral-mediated transgenesis, the use
that is inducible or tissue-specific. Although this technol-
of some drugs such as cytokines or proteasome inhibitors
ogy has been well established in the mouse, information is
can increase lentiviral gene transfer Santoni de
only recently becoming available in the pig
Sio et al. has shown that human hematopoietic stemcells (HSCs) can be transduced to high efficiency by ashort exposure to lentivirals in the presence of stem cell
factor, thrombopoietin, interleukin-6 and Flt3L. More-
over, it was shown that the proteasome restricts lentiviral
The use of genetically modified animals in transplant
transduction in HSCs, and on using the reversible
research has necessarily lagged behind the technological
peptide–aldehyde proteasome inhibitor, MG132, and
advances that have been made in producing such animals.
the peptide–boronate inhibitor, PS-341, during the
However, the effects of these modifications are already
lentiviral-GFP transduction period, there is a substantial
drug dose-dependent increase in the frequency of trans-gene-expressing cells and in their mean fluorescence
intensity. Zinc finger nucleases show promise in improving
The first transgenic modifications of swine reportedly
the efficiency of gene targeting by introducing DNA
involved the introduction of human complement-regulat-
double-strand breaks in target genes, which then stimulate
ory proteins (CRPs) as transgenes into outbred swine. The
the cell’s endogenous homologous recombination machin-
three CRPs most extensively studied have been human
ery. Many studies have been performed on human and
decay-accelerating factor (hDAF) , CD46 and
mouse cells A strategy to speed multitransgenic
CD59 Although early studies using these transgenic
pig production is represented by the recent adaptation of
animals showed clear advantages in terms of inhibition of
the 2A system from foot and mouth disease virus to
complement-mediated graft destruction, none of these
mammalian transgenic technology In this system,
modifications was capable of preventing eventual humoral
the open reading frame consists of multiple individual
rejection on its own Subsequent studies have
cDNAs separated by sequences encoding 2A and furin
attempted to combine the use of these transgenic animals
cleavage sites. A single complex mRNA is produced and
with additional modifications or treatments designed to
translated into a single polypeptide that is cleaved into
further reduce antibody or complement-mediated activity.
individual exogenous proteins at the 2A sites.
For example, Lam et al. have reported the effect ofchronic complement inhibition by soluble complement
receptor type 1 (SCR1, TP10) to the treatment regimen for
In cells transfected with siRNA vectors, targeted mRNAs
renal transplantation of hDAF pig kidneys into cyno-
are degraded by endonuclease activity and the amount of
molgus monkeys but without significant improvement
protein translated is reduced by over 95%, thus resulting
in xenograft survival. McGregor et al. reported a
in a significant knockdown and is an alternative approach
median survival of 96 days for pig hearts from CD46
to achieving more complex and difficult knockouts. This
transgenic pigs transplanted heterotopically in baboons
technique is particularly useful when more than one copy
using rituximab and thymoglobulin as induction ther-
of the endogenous gene is present and the usual knock-
apy along with a standard immunosuppressive regimen
out approach is not feasible. This situation is indeed the
including tacrolimus, sirolimus steroids and an inhibitor of
case of pathogens such as porcine endogenous retrovirus
anti-Gal antibodies. Shimizu et al. reported on a series
Copyright Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Genetic manipulation in pigs Sachs and Galli
of pig-to-baboon renal xenografts using kidneys from
hDAF pigs and treating with extracorporeal absorption
Although the study by Hering et al. has suggested
of anti-Gal antibodies, additional inhibition of comple-
that Gal is not a problematic antigen on adult porcine
ment with cobra venom factor and strong T-cell immuno-
islets, non-Gal antigens may indeed still play a role.
suppression. Nevertheless, humoral xenograft rejection
Komoda et al. have demonstrated that islets from
occurred, characterized by both antibody deposition and
transgenic pigs expressing N-acetylglucosaminyltransfer-
ase-III enjoy prolonged survival after transplantation intocynomolgus monkeys.
The study by Shimizu et al. points out that eventhough dysregulated coagulation is part of the rejectionpicture, immune-mediated damage probably initiates the
rejection process. This hypothesis has been substantiated
by studies from Byrne et al. who showed that
Studies using the new GalT-KO organs as xenografts to
increasing immunosuppression rather than anticoagula-
nonhuman primates have been carried out in several
tion was capable of extending cardiac xenograft survival
laboratories with very divergent results, depending on
of CD46 transgenic pig hearts in baboons.
Although until the recent availability of alpha-1,3-galac-
Pig-to-primate organ xenotransplantation using chronic
tosyltransferase gene-knockout (GalT-KO) pigs, anti-Gal
antibodies were considered to be the major cause of
Chen et al. found little advantage of the use of GalT-
humoral rejection in pig-to-primate xenotransplantation,
KO pig kidneys over previous transgenic kidneys when
there were already some studies indicating that antinon-
transplanting into baboons using two potent immuno-
Gal antibodies might also play a role. One such study was
suppressive regimens. Because they found a marked
reported by Chen et al. who demonstrated that life-
evidence for elevated anti-non-Gal antibodies at the time
supporting renal xenografts from hDAF transgenic pigs
of rejection, they concluded that antibodies to non-Gal
into baboons, in which anti-Gal antibodies were chroni-
antigens might present a major barrier to xenotransplan-
cally neutralized by soluble Gal-containing polymers, anti-
tation, even using GalT-KO pigs. Kuwaki et al.
non-Gal antibodies still led to acute humoral rejections
reported improvement in the survival of heterotopically
transplanted pig hearts in baboons when GalT-KO pigswere substituted for hDAF pigs as the donors. However,
although one animal in these studies showed a survival of
Because of the difficulty of experiments involving organ
a GalT-KO heterotopic heart for 179 days even
xenografts in vivo, a number of studies have been
this survival was not markedly greater than the maximum
reported using cellular parameters of xenograft rejection
achieved in the same model using hDAF grafts, the
to examine the effects of transgenic modifications. Forte
longest of which survived 139 days In both these
et al. and Lilienfeld et al. have demonstrated
studies, the rejection observed showed evidence for
that natural killer (NK) cytotoxicity by human NK cells
initiation by antibodies, suggesting that even with T-cell
toward porcine lymphoblastoid and endothelial cells
immunosuppression, there was sufficient T-cell help to
could be inhibited markedly by the expression of human
produce T-cell-dependent antibody responses to non-
leukocyte antigen E (HLA-E) on the cell surface of these
Gal antigens. Tseng et al. analyzed the same animals
porcine cells. Although it is not clear what role NK cells
and suggested that anticoagulation with aspirin may have
play in the direct rejection of xenograft organs, they
been a major factor in delaying the onset and progression
clearly could be important in the rejection of cellular
of thrombotic microangiopathy in the longest surviving
transplants, such as those involved in the induction of
heterotopic hearts. However, Shimizu et al. demon-
tolerance through mixed chimerism Also, using
strated that these thrombotic lesions were always accom-
in-vitro assays, Diaz-Roman et al. have provided
panied by evidence for both T-cell and antibody activity,
evidence that some of the lack of protection from
making it unclear whether the thrombotic complications
complement-mediated lysis by hDAF in vivo in non-
were primary or secondary to immune reactivity in these
human primates could be due to a difference between
the complement of humans and that of nonhumanprimates. Manzi et al. have shown that transfection
Approaches directed toward tolerance induction
of a pig endothelial cell line with a truncated form of
In contrast to results obtained using immunosuppressive
human SCR1 is capable of protecting these cells from
drug regimens, Yamada et al. have demonstrated
complement-mediated lysis by human natural anti-
prolonged survival of life-supporting vascularized renal
bodies. However, transgenic pigs expressing SCR1 have
xenografts when vascularized thymic tissue was cotrans-
planted at the same time as the kidney. Although hDAF
Copyright Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
kidneys have never survived for more than 34 days, GalT-
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As evidenced from this brief review, techniques for
The authors provide a review of techniques for assisted reproduction in large
genetic engineering of swine have already produced
several genetically modified strains of animals of value
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This study demonstrated the possibility to use siRNA to knock down PERV
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transcripts, thus reducing the probability of PERV transmission during xenotrans-plantation.
55 Tseng YL, Kuwaki K, Dor FJ, et al. alpha1,3-Galactosyltransferase gene-
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37 Jonsson SR, LaRue RS, Stenglein MD, et al. The restriction of zoonotic PERV
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38 Diamond LE, Quinn CM, Martin MJ, et al. A human CD46 transgenic pig model
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39 Byrne GW, McCurry KR, Martin MJ, et al. Transgenic pigs expressing human
The results of this study indicate that the characteristic thrombotic microangio-
CD59 and decay-accelerating factor produce an intrinsic barrier to comple-
pathy seen histologically in porcine heart xenografts transplanted into baboons are
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associated with antibody-mediated rejection, which may be the primary cause of
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57 Yamada K, Yazawa K, Shimizu A, et al. Marked prolongation of porcine renal
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This chapter provides a recent and comprehensive review of the field of xeno-
ase gene-knockout donors and the cotransplantation of vascularized thymic
transplantation with emphasis on an alternative source of renal transplants.
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83 days is reported using a treatment regimen directed toward the induction oftolerance through cotransplantation of vascularized thymic tissue.
42 McGregor CG, Davies WR, Oi K, et al. Cardiac xenotransplantation: recent
preclinical progress with 3-month median survival. J Thorac Cardiovasc Surg
58 Mezrich JD, Haller GW, Arn JS, et al. Histocompatible miniature swine: an
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A physician should be consulted if Lyme disease is suspected. Only the rash is distinctive enough for a clinical diagnosis without laboratory confirmation. In the absence of an EM rash, Lyme disease may be difficult to diagnose because its symptoms and signs vary among individuals and can be similar to those of many other diseases. Conversely, other arthritic or neurologic diseases may be mis
Prof. Dr. Bernd Hoppe, Hôpital Universitaire de Cologne, Service de Une augmentation de l’élimination urinaire de l’Oxalate s’appelle « Hyperoxalurie ». Elle est une des causes principales d’une lithiase urinaire récidivante (calculs urinaires) ou d’une néphrocalcinose progressive (= Calcification ou sclérose rénale, c’est-à-dire un dépôt de cristaux d’oxalate de calc