Science has just taken a giant step, although with caution. For the first time in history, a team of surgeons in China has successfully transplanted the lung of a genetically modified pig to a human receiver. Something that demonstrates that this is a completely viable procedure and that opens the door to follow the clinical trial to mark in the future A before and after in transplants.
A transplant that was still an experiment. The patient who received this lung was a 39 -year -old man who was in brain deathand therefore I was not going to improve or get worse because of the transplant. All this because it is not yet a technique that has been considered safe, but is in the experimentation phase. In the case of this patient, the organ could be maintained for nine days, demonstrating that the technique is viable.
However, the results, published in the prestigious magazine Nature Medicine, They are full of nuances that remind us how complex this field is.
A success that adds to others. This milest hearts, kidneys either Hígados of pork The ultimate goal is ambitious and necessary: create an almost unlimited source of organs for thousands of people who die every year in waiting lists.
The most difficult organ of all. If transplanting a kidney or pork is already a feat of medicine, doing so with a lung is to enter a new league of complexity. As explained Muhammad Mohiuddin, surgeon from the University of Maryland that led the first pork transplant to a living person, The lungs are really complex having “the largest amount of blood vessels of any transplantable organ.”
The fact of being such a vascularized organ makes the receptor’s immune system expose in a very aggressive way, which increases the risk of rejection, but it is also a challenge for coagulation and tissue damage.
A great exposure to any allergen. But in addition to being exposed to our adaptive and innate immune system through blood, it must also be taken into account that the lungs are in contact with the outside. This means that with each breath it is exposed to allergens, pollutants, viruses and bacteria, so its immune response is much more aggressive.
To get an idea, according to Dr. Leonardo Riella of the Massachusetts General Hospital, a transplanted human kidney can last between 12 and 14 years; A lung, just 5 to 7 years.
A pig with human software. To overcome these barriers, the first affiliated hospital team at the Medical University of Guangzhou used the lung of a pig that had been genetically modified. To do this, the organ had six key genetic editions. The first thing they did was eliminate three pigs to reduce the risk that the human immune system would identify it as a threat and trigger immediate rejection.
But in addition to eliminating genetic information from the fence, it was also chosen to integrate three human genes into its genome to protect the organ of the immune attack and prevent the formation of clots.
A living human being was not put at risk. Surgery was performed on May 15, 2024 in a receiver in brain death, which allowed to study the behavior of the organ without jeopardizing a living patient. During the first three days there were no signs of acute rejection, a first resounding success. However, the problems soon appeared.
24 hours after the intervention the lung began to swell. Damage was also observed due to the lack of oxygen during the transplant procedure, as well as Rejection signs mediated by antibody in the days three later. Interestingly, the team noticed that this damage seemed to have been reduced for the ninth day, at which time studied was arrested at the request of the receiver’s family.
The great criticism: a “lost opportunity.” Despite the achievement, the scientific community has indicated an important limitation in the design of the experiment. The surgeons only transplanted the left lung of the pig, leaving the right lung of the receiver, which was human and functional, in place.
This, according to some critics such as Dr. Richard N. Pierson of Harvard’s Faculty of Medicine, is a “lost opportunity.” Not insulating the pigs, it is impossible to know if it really worked enough to keep life on its own.
A first step in a marathon. Despite criticism and mixed results, experts agree that it is a fundamental advance in being a first step towards clinical pulmonary xenotransplantation. Now the way to follow is to improve the organ preservation techniques to reduce the initial damage and continue to refine the genetic modifications. The next step, according to experts, is to try in the terminal pulmonary patients who have no other treatment option.
This experiment is part of a global movement. In the United States, the FDA has already authorized clinical trials for kidney transplants and pigs of companies such as Engenesis and United Therapeutics. In fact, a man lives with A pork kidney since January of this yearmarking the survival record to date.
Images | Christopher Carson Weermeijer Robina
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