Brazilian researchers estimate that the country may soon have its first patients undergoing a porcine organ transplant. Optimistic forecasts believe that this may already occur from 2025, giving hope to those who need a new organ.
In March, the government of São Paulo announced an investment of R$ 50 million for the development of research on xenotransplants, in a partnership between the IPT (Instituto de Pesquisas Tecnológicas) and the startup XenoBrasil.
Through this investment, the project structure will be built on the USP campus in São Paulo. It will be a space of 1,650 square meters, divided into three floors. On the ground floor there will be a pig facility, an animal facility where the pigs that will provide the organs will be raised. The estimate is that this pig facility will be ready by the end of 2023.
“Once the pig facility is ready, I believe that in a year it may be enough to carry out the first transplants”, says geneticist Mayana Zatz, one of the project’s coordinators.
According to Professor Silvano Raia, the project’s coordinator, USP approved the granting of the necessary resources for the construction of a temporary pig facility using biomodules, with delivery expected in 180 days. In it, pre-clinical experiments will be carried out, allowing, in two years’ time, to start raising pigs and their clinical application in the definitive pig facility.
Raia performed the first liver transplant in Brazil and the first living donor transplant in the world, both in the 1980s.
The structure will also be used in the future for other projects involving humans and animals. “This line of xenotransplantation research will be part of the first line of research of a nucleus of advanced health technologies that the IPT is implementing here on campus”, says Helena Araújo, coordinator of the institute.
Pigs were chosen because they have organs similar to humans. According to Mayana Zatz, some new technologies are making it possible to modify pig genes, so they can be organ donors.
“If we transplant the organ from a pig to a human being, acute rejection occurs. With technology, it was possible to silence three main genes in pigs that are responsible for this acute rejection. These genes were silenced, they no longer exist in embryos that we created.”
Thus, according to the researchers, it can be said that the pigs that will be born from these embryos with silenced genes will have the organ closest to the human, being able to be a donor without acute rejection.
The other advantage of pigs is that the gestation period is short, four months, and the litter has 12 to 14 young at a time. But for that, it is necessary to invest in a different breed of pig from the usual one that exists in Brazil. The researchers sought cells from pigs from New Zealand, which are more adaptable for organ transplantation.
“Our pigs reach 400 kg, they are big. A heart of this animal would not fit in the chest cavity of a human being. The animals of New Zealand do not exceed 130 kg, they have a more compatible size compared to the human body”, he explains. Mayan.
According to Raia, xenotransplantation aims to reduce or even avoid waiting lists in which many applicants die before being transplanted.
“In 2019, according to ABTO [Associação Brasileira de Transplante de Órgãos]in Brazil, 1,780 died waiting for a transplant”, says the doctor. “Just for the maintenance in hemodialysis of those enrolled for a kidney transplant, the SUS spends about R$ 2 billion per year.”
The doctor also says that organ transplant waiting lists will be respected. “It is not the person who pays the most that is transplanted. The single lists for transplants are serious in Brazil. When we have the additional organs, these will also be distributed according to the single list. That is why the state investment is justified.”
For Paulo Pêgo Fernandes, a member of the Brazilian Association of Organ Transplantation, xenotransplantation should open “a great perspective for people who need an organ”. He also highlights the participation of SUS in the organ transplant program.
“About 95% of transplants in Brazil are performed by the SUS. This is a wealth, as it allows for social equity that you don’t see in other countries.”
Brazil will begin the process of transplanting pig organs with the kidney. According to geneticist Mayana Zatz, it will not be necessary to remove the human kidney. Thus, if there is any intercurrence, the kidney can be “reconnected” and the patient can return to hemodialysis.
After the kidneys, other pig organs should gradually enter the transplant list, such as heart and liver, according to the progress of studies on immunosuppressants, drugs that prevent rejection.
“Immunosuppressants go hand in hand with xenotransplantation. There will always be a rejection of the organ, because there is no 100% compatible organ”, says Pêgo Fernandes.
Germany and the United States are also already working on the use of pig organs for transplantation. On January 7 of this year, American David Bennett, 57, received a pig heart. According to the University of Maryland, which performed the procedure, the new heart worked well for the next few weeks, with no rejection. However, Bennett died on March 8, two months after the transplant.
“He [o paciente] he was in a sorry state when the transplant was performed, he had been hooked up to a device for two months. To have a parallel, the first patient who received a human heart transplant in South Africa, in 1967, lived only 18 days”, says Mayana.
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