Long-Term Survival Of Human Cd55/Cd39–Expressing Porcine Corneas In Primate Xenotransplantation
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR152 | Type: Poster | DOI: 10.82333/5457-e467
Authors: Dr Chung Young Kim* 1 , Dong Hee Choi 1 , Jin Suk Ryu 1 , Won Young Jeong 2 , Jong-Min Kim 3 , Sang-Ik Cho 4 , Eun-Jee Oh 4 , Chang Ho Yoon 1 , Chung-Gyu Park 2 , Joohyun Shim 5 , Hyunil Kim 5 , Mee Kum Kim 1
1Seoul National University Hospital,Seoul,Korea, Republic Of, 2Seoul National University College of Medicine,Seoul,Korea, Republic Of, 3Seoul National University College of Medicine,Seoul,Korea, Republic Of;Cheongju University,Cheongju,Korea, Republic Of, 4The Catholic University of Korea ,Seoul,Korea, Republic Of, 5Optipharm Inc,Cheongju,Korea, Republic Of
Purpose
To compare the efficacy, safety, and immunologic compatibility of full-thickness corneal xenotransplantation using glycan knockout-only pig corneas (TKO/QKO) versus glycan knockout plus human gene knock-in corneas (QKO.hCD55.hCD39) in a non-human primate model, aiming to improve graft survival and translational potential.
Setting
Preclinical experimental study conducted at Seoul National University Hospital and affiliated research institutes, Republic of Korea.
Methods
Porcine glycan genes (GGTA1, CMAH, iGb3, β4GalNT2) were inactivated to generate TKO or QKO pigs, and human CD55/CD39 were additionally introduced in the KI group. Full-thickness corneas from TKO/QKO or QKO.hCD55.hCD39 pigs were transplanted into ten cynomolgus monkeys. Postoperative systemic and topical immunosuppression was administered. Outcomes included graft survival, transparency, rejection, corneal thickness, systemic safety, and immunologic responses including complement activation, donor-specific antibodies, and T-cell profiling.
Results
QKO.hCD55.hCD39 KI grafts demonstrated significantly prolonged survival compared with TKO/QKO grafts (p=0.001), maintaining corneal clarity and physiologic thickness for up to 16 months. KI grafts showed rapid edema resolution and sustained transparency without clinically significant rejection. Complement activation was well controlled, donor-specific antibody responses were transient, and IFN-γ–producing T-cell responses were reduced. Notably, after systemic immunosuppression was discontinued at 12 months, grafts survived for more than 6 additional months with topical therapy alone. Histology revealed markedly reduced inflammatory infiltration in KI grafts.
Conclusions
QKO.hCD55.hCD39 pig corneas demonstrate markedly improved biocompatibility, endothelial stability, and durable immune regulation compared with knockout-only corneas, enabling long-term graft survival in primates. These findings provide strong preclinical support for clinical translation of multi–gene-edited porcine corneas as an alternative donor source for corneal transplantation.