Journal
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
Volume 164, Issue 6, Pages E411-E424Publisher
MOSBY-ELSEVIER
DOI: 10.1016/j.jtcvs.2021.03.100
Keywords
alpha-gal; alpha-gal syndrome; allergy; bioprosthetic valve; chronic inflammation; early valve degradation; coronary artery disease
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Alpha-gal syndrome (AGS) is a rare allergy to red meat. This study found that alpha-gal can still be present in animal-derived medical products despite commercial decellularization processes, which could have serious implications for patients with AGS.
Background: Galactose-a-1,3-galactose (alpha-gal) is a carbohydrate that is ubiquitously expressed in all mammals except for primates and humans. Patients can become sensitized to this antigen and develop alpha-gal syndrome (AGS), or a red meat allergy. Symptoms range from generalized gastroenteritis and malaise to anaphylaxis, and in endemic areas, the prevalence can be as high as 20%. Although AGS patients commonly avoid alpha-gal by avoiding meat, patients have also developed symptoms due to animal-derived medical products and devices. With the rise in transcatheter aortic valve replacement, we investigate the immunogenicity of common cardiac materials and valves. Objective: To assess the in vitro immunoglobulin E response toward common medical products, including cardiac patch materials and bioprosthetic valves in patients with AGS. Methods: Immunoblot and immunohistochemistry techniques were applied to assess immunoglobulin E reactivity to various mammalian derived tissues and medical products for patients with AGS. Results: AGS serum showed strong reactivity to all of the commercially available, nonhuman products tested, including various decellularized cardiac patch materials and bioprosthetic aortic valves. AGS serum did not react to tissues prepared using alpha-gal knockout pigs. Conclusions: Despite commercial decellularization processes, alpha-gal continues to be present in animal-derived medical products, including bioprosthetic valves. Serum from patients with AGS demonstrates a strong affinity for these products in vitro. This may have serious potential implications for sensitized patients undergoing cardiac surgery, including early valve failure and accelerated coronary artery disease.
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