Xeno: The Promise of Transplanting Animal Organs into Humans by David K C Cooper and Robert P Lanza Oxford University Press, New York, NY 274 pages, US$ 30.00019 512 8338
The prospect of xenotransplantation brings into profile a number of fascinating facets of modern medicine: hi‐tech surgery and immunology, genetically modified donor animals, the threat of unleashing new zoonoses (animal‐to‐human infections) and a number of legal, health economics and ethical issues. All these points and more are brought together in this popular scientific book. Xeno is written for the proverbial ‘intelligent layperson’, and molecular biologists can surely be included in that definition.
David Cooper and Robert Lanza, physicians from Harvard Medical School and Advanced Cell Technology, respectively, know their field intimately and give a readable and exciting account of the developments and prospects for xenotransplantation. They are enthusiasts, but they do not skip lightly over the uncertainties or dangers. They have a gift for describing the life of a transplant surgeon, from scrubbing up for theatre to explaining the complexities of immune rejection. My only reservation is that the figures and photographs could have been displayed more imaginatively.
Xeno explains the reasons why pigs are the animals of choice as donors (in the UK, we are admonished for using the word ‘donor’ because the pigs have not given their informed consent!). The various types of immune rejection across discordant species barriers are beautifully elucidated, including a chapter on tolerance named the ‘Immunological holy grail’. While the authors are right up to date, they also have a sense of history about the pioneers of transplantation and immunological rejection. I had previously thought there were only three major immunological barriers, but I learned in chapter 6, ‘A spoonful of sugar’, that there are four: hyperacute rejection, delayed antibody‐mediated rejection, acute cellular rejection and chronic rejection. The first two are unique to xenografts (and ABO blood group mismatched human transplantation), while the latter two are in common with human‐to‐human allografts.
If xenotransplantation becomes a reality, it is likely to begin with cellular therapies rather than whole organs, which are the main emphasis of Xeno. Pig islet cells could help millions of people with insulin‐dependent diabetes mellitus; extracorporeal pig hepatocyte perfusion could tide a patient over until her or his own liver recovers or a human donor becomes available. Cellular therapies also hold promise for degenerative neurological diseases such as Parkinson's disease and stroke. But the authors of Xeno make little reference to alternative therapies, such as human stem cells or mechanical devices to aid the heart. It remains an open question, not least because of infection hazards, whether xenotransplantation will become as routine as the authors suggest.
For those who prefer a more academic book, Xenotransplantation edited by Jeff Platt (ASM Press, Washington DC, 2001) provides a learned, multi‐author volume. At the other end of the spectrum, Organ Farm by Jenny Bryan and John Clare (Carlton Books, 2001) is based on a series of superb British television programmes on xenotransplantation. It has more personal anecdotes and numerous daring colour photographs of xenotransplantation in action—a more handsome volume than Xeno at less cost. But I would recommend Xeno to the readers of EMBO reports.
- Copyright © 2001 European Molecular Biology Organization
The author is at the Department of Immunology and Molecular Pathology, University College London, London, UK. E‐mail: