Pig-to-human xenotransplantation of islet cells or of vascularized organs would offer a welcome treatment alternative for the ever-increasing number of patients with end-stage organ failure who are waiting for a suitable allograph. The main hurdle are preexisting antibodies, most of
which are specific for 'Linear-B', carbohydrate epitopes terminated by the unbranched Gal-?(1,3)Gal disaccharide. These antibodies are responsible for the 'hyper-acute rejection' of the xenograft by complement mediated hemorrhage. For depletion of such antibodies we have developed an
artificial injectable antigen, a glycopolymer (GAS914) with a charge neutral poly-lysine backbone (degree of polymerization n = 1000) and 25% of its side chains coupled to Linear-B-trisaccharide. With an average molecular weight of 400 to 500 kD, presenting 250 trisaccharide
epitopes per molecule, this multivalent array binds anti-?Gal antibodies with at least three orders of magnitude higher avidity on a per-saccharide basis than the monomeric epitope. In vivo experiments with non-human primates documented that rather low doses – 1 to 5 mg/kg
of GAS914 injected i.v. – efficiently reduce the load of anti-Linear-B antibodies quickly by at least 80%. This treatment can be repeated without any sensitization to GAS914. Interestingly, although the antibody levels start raising 12 h after injection, they do not reach pretreatment
levels. The polymer is degraded and excreted within hours, with a minute fraction remaining in lymphoid tissue of anti-?Gal producing animals only, probably binding to and inhibiting antibody-producing B-cells. The results of pig-to-non-human primate xenotransplantations established
GAS914 as a relevant therapeutic option for pig-to-human transplantations as well. The synthesis of GAS914 was successfully scaled up to kg amounts needed for first clinical studies. Key was the use of galactosyl transferases and UDP-galactose for the synthesis of the trisaccharide.
将猪到人体异种移植的胰岛细胞或血管化器官可为等待合适同种移植物的晚期器官功能衰竭患者提供一种受欢迎的治疗选择。主要障碍是已存在的抗体,其中大多数特异性针对以线性-B结尾的半乳糖-半乳糖二糖为终点的碳水化合物表位。这些抗体负责通过补体介导的出血引起的异种移植物的“超急性排斥”。为了清除这些抗体,我们开发了一种人工可注射抗原,一种具有电荷中性的聚赖氨酸骨架(聚合度n = 1000)和其25%的侧链偶联到线性-B三糖的糖聚合物(GAS914)。平均分子量为400至500千道因,每个分子呈现250个三糖表位,这种多价阵列以每糖基的至少三个数量级更高的亲和力结合抗-半乳糖抗体,而不是单体表位。非人灵长类动物的体内实验表明,注射i.v.的GAS914低剂量(1至5毫克/千克)能够迅速将至少80%的抗线性-B抗体负荷有效降低。这种治疗可以反复进行而不会对GAS914产生任何敏感性。有趣的是,尽管抗体水平在注射后12小时开始上升,但并未达到治疗前水平。聚合物在几小时内降解并排出体外,只有极小部分残留在仅产生抗-半乳糖的动物的淋巴组织中,可能与并抑制产生抗体的B细胞结合。猪到非人灵长类动物的异种移植结果将GAS914确立为猪到人体移植的相关治疗选择。GAS914的合成已成功扩大到首次临床研究所需的公斤级数量。关键是使用半乳糖转移酶和UDP-半乳糖合成三糖。