Xenoantibody production directed at a wide variety of T lymphocyte-dependent and T lymphocyte-independent xenoantigens remains the major immunologic obstacle for successful xenotransplantation. The B lymphocyte subpopulations and their helper factors, involved in T-cellindependent xenoantibody production are only partially understood, and their identification will contribute to the clinical applicability of xenotransplantation. Here we show, using models involving T-celldeficient athymic recipient mice, that rapidly induced, T-cell-independent xenoantibody production is mediated by marginal zone B lymphocytes and requires help from natural killer (
IntroductionSuccessful xenotransplantation may alleviate the ever-increasing need for donor organs, but severe immunologic barriers, of which xenoreactive antibodies represent the most important 1, still hamper (pre)clinical application. Pigs are now generally considered the most suitable organ donors for clinical xenotransplantation, 1 but transplantation of pig organs into nonhuman primates, currently constituting the best validated preclinical model, leads to xenograft rejection within a few hours. This hyperacute rejection is mediated by pre-existing, so-called "natural antibodies," which are directed at a specific Gal␣1,3Gal1,4GlcNAc (Gal) oligosaccharide, that is present on (especially endothelial) proteins of most lower animal species, but not of nonhuman primates or man. [2][3][4] Anti-Gal natural antibodies can rapidly activate the complement system of the recipient, leading to hyperacute rejection. 5 Several procedures have been explored in recent years to solve the problem of hyperacute rejection. 6,7 The most appealing ones were the development of genetically modified donor pig strains that either expressed transgenes of human complement regulatory proteins, able to interfere with complement activation, 8 or that lacked the ␣1,3-galactosyltransferase gene to synthesise ␣Gal. 9,10 The latter pig strain seemed particularly attractive, as Gal antigens had been found to be also strongly involved in acute vascular xenograft rejection, a second type of xenograft rejection that develops within a few days in situations where hyperacute rejection is prevented. 7,11 It was hoped, therefore, that elimination of Gal epitopes would prevent both hyperacute rejection and acute vascular rejection.A number of recent reports on the transplantation of ␣1,3-galactosyltransferase-ko pig kidney or heart grafts in nonhuman primates have shown that loss of Gal expression in donor pig organs could indeed prevent hyperacute rejection, but that T-celldependent IgG xenoantibodies were induced against non-Gal xenoantigens, unless a treatment regimen was used that resulted in specific T-cell xenotolerance. [12][13][14] In the latter case, long-term functional renal xenograft survival was obtained, but after a few months, mild focal thrombotic microangiopathy was observed, suggesting that additional modifications to the treatment regimen are needed to permit the development of the kin...