Replacement of human anterior cruciate ligaments with pig ligaments: A model for anti-non-gal antibody response in long-term xenotransplantation

Kevin R. Stone, Ussama M. Abdel-Motal, Ann W. Walgenbach, Thomas J. Turek, Uri Galili

Research output: Contribution to journalArticle

77 Citations (Scopus)


BACKGROUND. Understanding anti-non-gal antibody response is of significance for success in xenotransplantation. Long-term anti-non-gal response in humans was studied in patients transplanted with porcine patellar tendon (PT) lacking α-gal epitopes, for replacing ruptured anterior cruciate ligament (ACL). METHODS. Porcine PTs were treated with recombinant α-galactosidase to eliminate α-gal epitopes and with glutaraldehyde for moderate cross-linking of collagen fibers. The processed pig PTs were implanted to replace ruptured ACL in patients. RESULTS. In five of six evaluable subjects, the xenografts have continued to function for over two years and passed all functional stability assessments. Thus, processed porcine PT seems to be appropriate for replacing ruptured human ACL. Enzyme-linked immunosorbent assay and Western blot studies indicated that all subjects produced anti-non-gal antibodies against multiple pig xenoproteins, but not against human ligament proteins. Production of anti-non-gal antibodies peaked two to six months posttransplantation and disappeared after two years. CONCLUSIONS. These antibodies contribute to a low-level inflammatory process that aids in gradual xenograft replacement by infiltrating host fibroblasts that align with the pig collagen "scaffold" and secrete collagen matrix. The assays monitoring anti-non-gal antibodies will help to determine whether long-term survival of live organ xenografts requires complete suppression of this antibody response.

Original languageEnglish
Pages (from-to)211-219
Number of pages9
Issue number2
Publication statusPublished - Jan 2007
Externally publishedYes



  • α-Galactosidase
  • Anterior cruciate ligament
  • Anti-gal antibodies
  • Anti-non-gal antibodies
  • Pig-to-human xenotransplantation

ASJC Scopus subject areas

  • Transplantation
  • Immunology

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