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The immune response to crosslinked tissue is reduced in decellularized xenogeneic and absent in decellularized allogeneic heart valves

The immune response to crosslinked tissue is reduced in decellularized xenogeneic and absent in decellularized allogeneic heart valves

Int J Artif Organs 2015; 38(4): 199 - 209

Article Type: ORIGINAL ARTICLE

DOI:10.5301/ijao.5000395

Authors

Ulrike Böer, Ariane Schridde, Marcel Anssar, Melanie Klingenberg, Samir Sarikouch, Ansgar Dellmann, Wolfgang Harringer, Axel Haverich, Mathias Wilhelmi

Abstract

Background

The degeneration and failure of xenogeneic heart valves, such as the Matrix P Plus valve (MP-V) consisting of decellularized porcine valves (dec-pV) and equine glutaraldehyde-fixed conduits (ga-eC) have been linked to tissue immunogenicity accompanied by antibody formation. In contrast, decellularized allograft valves (dec-aV) are well-tolerated. Here, we determined tissue-specific antibody levels in patients after implantation of MP-V or dec-aV and related them to valve failure or time period after implantation.

Methods and Results

Specific antibodies toward whole tissue-homogenates or alphaGal were determined retrospectively by ELISA analyses from patients who received MP-V with an uneventful course of 56.1 ± 5.1 months (n = 15), or with valve failure after 25.3 ± 14.6 months (n = 3), dec-aV for various times from 4 to 46 months (n = 14, uneventful) and from healthy controls (n = 4). All explanted valves were assessed histopathologically.

MP-V induced antibodies toward both tissue components with significantly higher levels toward ga-eC than toward dec-pV (68.7 and 26.65 µg/ml IgG). In patients with valve failure, levels were not significantly higher and were related to inflammatory tissue infiltration. Anti-Gal antibodies in MP-V patients were significantly increased in both, the uneventful and the failure group. In contrast, in dec-aV patients only a slight tissue-specific antibody formation was observed after 4 months (6.24 µg/ml) that normalized to control levels after 1 year.

Conclusions

The strong humoral immune response to glutaraldehyde-fixed tissues is reduced in decellularized xenogeneic valves and almost absent in decellularized allogeneic tissue up to 4.5 years after implantation.

Article History

Disclosures

Financial support: This work was supported by the Else Kroener-Fresenius foundation (grant number 2012_A58).
Conflict of interest: The authors declare that there are no conflicts of interest. A. Haverich holds shares in corlife oHG, a company for the future processing of decellularized allografts, equivalent to those used in this study.
Meeting presentations: Parts of the abstract were published at the World Conference on Regenerative Medicine, Oct 23-25, 2014 in Leipzig, Germany, and at the Spring Meeting of the European Society of Vascular Surgery, May 16-17, 2014 in London, United Kingdom.

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Authors

  • Böer, Ulrike [PubMed] [Google Scholar] 1, 2, * Corresponding Author ([email protected])
  • Schridde, Ariane [PubMed] [Google Scholar] 1
  • Anssar, Marcel [PubMed] [Google Scholar] 3
  • Klingenberg, Melanie [PubMed] [Google Scholar] 1, 2
  • Sarikouch, Samir [PubMed] [Google Scholar] 2
  • Dellmann, Ansgar [PubMed] [Google Scholar] 4
  • Harringer, Wolfgang [PubMed] [Google Scholar] 3
  • Haverich, Axel [PubMed] [Google Scholar] 1, 2
  • Wilhelmi, Mathias [PubMed] [Google Scholar] 1, 2

Affiliations

  • GMP Model Laboratory for Tissue Engineering, Hannover Medical School, Hannover - Germany
  • Division for Cardiothoracic, Transplantation- and Vascular Surgery, Hannover Medical School, Hannover - Germany
  • Division for Cardiothoracic and Vascular Surgery, Braunschweig Municipal Hospital, Braunschweig - Germany
  • Institute for Pathology, Braunschweig Municipal Hospital, Braunschweig - Germany

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