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Reappraisal of biosafety risks posed by PERVs

Reappraisal of biosafety risks posed by PERVs
Reappraisal of biosafety risks posed by PERVs

Rev.Med.Virol.2008;18:53–65.

Published online7November2007in Wiley InterScience

(https://www.wendangku.net/doc/2b13435408.html,) Reviews in Medical Virology DOI:10.1002/rmv.559

Reappraisal of biosafety risks posed by PERVs

in xenotransplantation

Derrick Louz1*,Hans E.Bergmans1,Birgit P.Loos1,Rob C.Hoeben2

1GMO of?ce,Substances Expertise Centre(SEC)of the National Institute for Public Health and the

Environment(RIVM),Bilthoven,The Netherlands

2Department of Molecular Cell Biology,Leiden University Medical Centre,Leiden,The Netherlands

S U M M A R Y

Donor materials of porcine origin could potentially provide an alternative source of cells,tissues or whole organs for transplantation to humans,but is hampered by the health risk posed by infection with porcine viruses.Although pigs can be bred in such a way that all known exogenous microorganisms are eliminated,this is not feasible for all endogenous pathogens,such as the porcine endogenous retroviruses(PERVs)which are present in the germline of pigs as proviruses.Upon transplantation,PERV proviruses would be transferred to the human recipient along with the xenograft.If xenotransplantation stimulates or facilitates replication of PERVs in the new hosts,a risk exists for adaptation of the virus to humans and subsequent spread of these viruses.In a worst-case scenario,this might result in the emergence of a new viral disease.Although the concerns for disease potential of PERVs are easing,only limited pre-clinical and clinical data are available.Small-scale,well-designed and carefully controlled clinical trials would provide more evidence on the safety of this approach and allow a better appreciation of the risks involved.It is therefore important to have a framework of protective measures and monitoring protocols in place to facilitate such initially small scale clinical trials.This framework will raise ethical and social considerations regarding acceptability. Copyright#2007John Wiley&Sons,Ltd.

Received:17July2007;Revised:12September2007;Accepted:26September2007

INTRODUCTION

There is a critical shortage of human donor mate-

rial available for transplantation.Therefore there is

much interest in the use of animals as an alterna-

tive source of cells,tissues and whole organs for

transplantation into humans,that is,xenotrans-

plantation[1].The two main sources of clinical

relevance for xenotransplantation are pigs and

non-human primates(NHPs).NHPs would be

the initial choice since they are phylogenetically

most closely related and physiologically and

immunologically similar to humans.For a number

of reasons,including ethical considerations,their

small anatomical size and their limited availabil-

ity,they have been rejected as donor animals.

Also their use is associated with the risk of trans-

mission of a number of pathogens infectious for

humans[2,3].Pigs are therefore now considered

to be the most suitable source.Pigs have anatomi-

cal and physiological similarities with humans

such as the size of the organs and the circulatory

system.Also they are readily available in large

numbers and have relatively short reproduction

cycles and large litter sizes.In addition,pigs can

be bred in genetically homogeneous-speci?c

pathogen-free(SPF)herds and kept relatively

easily in a controlled,hygienic environment at

relatively low cost[1].

R E V I E

W

*Corresponding author:Derrick Louz,RIVM/SEC/GMO of?ce,P.O.

Box1,3720BA Bilthoven,The Netherlands.

E-mail:derrick.louz@rivm.nl

Abbreviations used

alphaGal,galactose-alpha-1,3-galactose;alpha1,3GT,alpha-1,3-

Galactosyltransferase;CRPs,complement regulatory proteins;Env,

envelope;FeLV,feline leukaemia virus;Gag,group-speci?c antigen;

GALV,Gibbon ape leukaemia virus;HAR,hyperacute rejection;

hDAF,human decay-accelerating factor;HERVs,human endogenous

viruses;HuPAR,human PERV-A receptor;LTRs,long terminal

repeats;MCP,membrane cofactor protein;MS,miniature swine;

MIRL,membrane inhibitor of reactive release;MLV,Murine Leukae-

mia Virus;MPK,minipig kidney;NHPs,non-human primates;

NOD/SCID,non-obese diabetic/severe combined immune de?cient;

PERVs,porcine endogenous retroviruses;Pol,polymerase;RNAi,

RNA interference;SPF,speci?c pathogen-free;XNAs,xenoreactive

antibodies.

There are several hurdles to overcome before xenotransplantation of porcine material can become clinically applicable to humans.Immuno-logical rejection remains the major obstacle.How-ever,advances in immunosuppressive therapy, and the possibility(unlike the case with NHPs) to genetically modify the donor pigs to prevent hyperacute immunological rejection may have overcome at least one important part of the immu-nological obstacle[4,5].Another major concern is the risk of cross-species infections of human recipi-ents upon exposure to the xenograft.Xenotrans-plantation is considered a serious public health concern because it has the potential to transmit porcine pathogens,in particular viruses that are not endemic in the human population[6].As the patients are under immunosuppressive treatment and pre-existing immunity is absent,in a worst-case scenario xenograft-related transmission could lead to a new viral epidemic[7].Many exogenous viruses can be eliminated by SPF breeding and selection or vaccination of source animals and ade-quate screening of the xenografts prior to trans-plantation[8].However,this does not eliminate the risk posed by endogenous viruses.

The main concern has been for transmission of porcine endogenous retroviruses(PERVs)that are present in the pig genome in multiple copies [9,10].To date three subgroups of replication com-petent subgroups of PERVs,that is,PERV-A,-B and-C have been identi?ed.Concerns regarding PERVs and microbial safety of xenotransplanta-tion were initially raised in1997when PERVs were shown to infect human cells in vitro[9,10]. These concerns were then further substantiated by evidence for in vivo transmission by PERVs after transplantation of porcine pancreatic islet cells in an immunode?cient NOD/SCID(non-obese diabetic/severe combined immune-de?-cient)mouse model[11].Xenotransplantation is therefore a potential route by which zoonotic viruses may enter the human population.Since then the risk of transmission posed by PERVs has remained a topic of concern and discussion for public health authorities.This led to a precau-tionary approach,strict regulation and even a mor-atorium on clinical trials in many countries.To date xenotransplantation is still highly experimen-tal and no long-term survival of any porcine xeno-graft into an NHP has been achieved[12].Recent advances in control of immunological rejection have prompted clinical(animal-to-human)trials of xenotransplantation of porcine cells.Although several biological,physiological and immunologi-cal hurdles still exist,transplantation of porcine tissues and whole organs to humans are under dis-cussion in several countries with pre-clinical(ani-mal-to-animal)studies under way to investigate the feasibility.Studies regarding microbiological safety are also ongoing including studies that address the risk of transmission of PERVs using in vitro cell culture models and animal-to-animal transplant model systems.Therefore xenotrans-plantation combines potential bene?ts for indivi-dual patients with a potential risk to the general public.In that context PERVs represent an unique concern that requires a thorough risk evaluation. As the risks posed by xenotransplantation need to be balanced with possible clinical bene?t this presents challenges for both public health and pol-icy making.The primary aim of this review is to address the potential for disease transmission by PERVs and discuss the degree of risk.The issues are raised with the intention to contribute to further development of consensus views on risk management measures.

MOLECULAR CHARACTERIZATION OF PORCINE ENDOGENOUS RETROVIRUSES PERVs have been classi?ed into the retroviral Beta (so-called B-or D-type)and Gamma(so-called C-type)genera.Infectious human-tropic PERVs that pose a risk of transmission belong to the PERV Gamma1family that consists of subfamilies or var-iants of PERV-A,-B and-C.Analysis of different porcine breeds and cell lines revealed the presence of30–50proviral copies that are dispersed across the genome[13,14].The majority of these pro-viruses are defective due to mutations or deletions in their coding sequences that disrupt one or more ORFs[15,16].Only a few copies of intact full-length PERVs can give rise to infectious virus. This number can vary among different breeds and even for individual animals within one breed [16].PERV-A and PERV-B have been identi?ed in the germline of all porcine breeds examined to date[9].In general PERV-A proviruses are present at a higher copy number than PERV-B.In most breeds PERV-C proviruses are present in lower numbers or even absent[10,18].The importance of such differences in proviral load in terms of risk of transmission is unknown.

54 D.Louz et al.

As typical for Gamma1retroviruses,PERV-A,-B and -C contain three ORFs coding for gag ,pol and env that are located between two LTRs (long term-inal repeats)containing regulatory elements requi-red for transcription [9,17,19](Figure 1).They all contain highly homologous gag and pol genes,but differ signi?cantly in their env sequences [20].These differences re?ect different receptor speci?cities and host tropisms.

In pigs,PERV RNA is expressed in all tissues [9,10,17,21].As most PERV loci are defective and only a few intact proviral loci exist,the presence of PERV mRNA does not necessarily coincide with a productive infection or the presence of infectious particles.Some loci generate incomplete viral transcripts not leading to the production of virions.Although not conclusive,some evidence for the presence of replication competent PERVs or low-level of in vivo replication of PERVs in pigs has been reported [22,23].

INFECTIOUS PERV PARTICLES AND

IN VITRO INFECTIVITY OF HUMAN CELLS PERV particles were originally detected after spontaneous release from porcine cell lines includ-ing minipig kidney (MPK)and PK15[10,21]in cul-ture.Mitogen-activated porcine PBMCs and fresh isolated porcine pancreas islet cells were subse-quently shown to release PERVs capable of infect-ing primary pig cells such as endothelial cells and PBMCs [11,24,25].These cells are of particular interest since they represent the major interface between the xenograft and the recipients.

In vitro host range studies were initially carried out using PERV envelope-pseudotyped defective Murine Leukaemia Virus (MLV)vectors and later combined with infectious PERV particles to deter-mine correlates between permissiveness and pro-ductive infection.These studies demonstrated that PERV-A and PERV-B are polytropic and able to infect porcine and human cells.Although many human cell lines were susceptible to infec-tion only a few,including HEK 293and HeLa cells,are permissive for productive infection [10,13,26].Productive infection of human primary cells including PBMC’s,endothelial cells and ?bro-blasts is more dif?cult and such experiments have led to some inconclusive results [27–29].PERV-C on the other hand is ecotropic and conse-quently only infects and replicates in cells from the original host species (pig)[28].Most human tropic infectious PERVs have been isolated by cocultiva-tion of porcine cell lines or primary pig cells together with permissive cells [15,30].Most of these characterised PERVs grew poorly in vitro [26,30].Titres obtained for PERVs are 100–1000times lower than other Gamma retroviruses such as MLV [31].PERV-B has never been isolated from primary pig cells which implies that the lar-ger risk is posed by PERV-A.On the other hand,PERVs derived from primary cells grew to lower titres and were less replication competent com-pared to PERVs isolated from cell lines.Interest-ingly,following cocultivation of PBMCs derived from a certain pig breed called miniature swine (MS)with human cell lines,relatively high titre human tropic recombinant PERVs have been iso-lated from PBMC’s.These PERVs exclusively con-sist of the PERV-C genome and the receptor-binding domain of PERV-A [25,32].Whether they exist or arise as exogenous viruses in individual pigs or their primary cultures or represent true genomic PERVA/C hybrid provirus sequences has to be further investigated [33,34].Although PERV-C does not infect human cells,it constitutes the major part of PERV A/C hybrids.Therefore the potential for recombination of PERV-C

with

in xenotransplantation Biosafety risks 55

human tropic PERV can have implications for the risk of transmission.

The results of in vitro host range studies using PERV envelope-pseudotyped defective MuLV suggested the wide distribution of PERV-A and-B-speci?c receptors in human tissues[10].The human receptor for PERV-A(HuPAR)has been described recently[35].Two related receptor-cod-ing sequences HuPAR-1and HuPAR-2have been identi?ed.Both homologue proteins support virus infection for PERV-A but not for PERV-B or PERV-C.Expression of these receptors in different cell types further substantiated the possibility of infec-tion of a wide range of human tissues[36].To date, the human receptor for PERV-B has not been iden-ti?ed.The potential of PERVs to make use of alter-nate entry pathways to overcome host range barriers and infect heterologous cells lacking cog-nate receptors has been recently suggested[37,38]. The ability to use alternative receptors in heterolo-gous hosts has been described for other viruses including Gamma retroviruses[39–41]. PATHOGENIC POTENTIAL,ADAPTATION AND RECOMBINATION

Although functional PERVs are present in all breeds of pigs,no sign of illness or pathology has ever been observed in vivo in the natural host.As PERVs grow poorly in human cells they are less likely to be pathogenic in humans.PERVs share,however,the pathogenic potential of related retroviruses.PERVs are related to exogenous Gamma retroviruses such as to Gibbon ape leukae-mia virus(GALV),feline leukaemia virus(FeLV) or MLV[10,17,19,42].These viruses also did not cause disease in their natural host but can cause tumours and immunode?ciencies in newly infected hosts.GALV probably arose after cross-species transmission of an endogenous mouse C-type gamma retrovirus[43].Similarly,FeLV pre-sumably originates from endogenous rodent C-type retroviruses[44].

Development of tumours by Gamma retro-viruses is associated with insertional mutagenesis, increased levels of replication and alterations in the viral LTR.In vitro infectivity titres obtained for PERVs are low.Serial passaging of PERV-A, PERV-B and hybrid PERV-A/C led to adaptation in humans cells in vitro.The adaptation was char-acterised by shorter infectious times and higher titres of infectious particles.These observations were associated with multimerisations of LTR enhancer sequences implying potential increased transcriptional activity[45–47].Similar observa-tions have been associated with increased tumourigenic potential for MLV and FeLV [48,49].In addition some evidence for immune-modulating properties by PERVs in vitro has been reported.PERVs have been shown to inhibit certain human immunological cellular functions such as cytokine production[50,51].

Another kind of risk posed by PERVs is the pos-sible recombination of PERV with human endo-genous viruses(HERVs),potentially giving rise to new viruses with new pathogenic potential. The human genome contains HERVs related to Gamma and Beta retroviruses.Theoretically, recombination between PERVs and HERVs could occur during a productive infection as a result of copackaging of HERV and PERV transcripts into a retroviral particle.However,to date no experi-mental evidence for this possibility for recombina-tion has been found in vitro[52].Therefore although based on limited in vitro data only, recombination between PERV and HERVs is not likely to represent a signi?cant risk of generating new hybrid endogenous viruses.

In conclusion,PERVs share the pathogenic potential and a number of features common to other Gamma retroviruses,at least in vitro.Which implications these observations can have for human recipients upon cross-species transmission are unknown but for the risk assessment they need to be appreciated.

GENETIC MODIFICATION OF SOURCE ANIMALS AND IMPLICATIONS

FOR THE RISK POSED BY PERVS Approaches to overcome the immunological hur-dle and to prevent xenograft rejection of vascu-larised organs include genetic modi?cation of source animals.In this section,two strategies using genetic modi?cation to minimise immunolo-gical rejection and implications for the risk of transmission of PERVs are discussed.

There are four successive phases of xenotrans-plantation rejection:hyperacute rejection,acute humoral xenograft rejection,cellular rejection and chronic rejection(reviewed in References [53–55])(Figure2).The initial and major response

56 D.Louz et al.

is hyperacute vascular rejection (HAR).HAR destroys the transplanted organ from minutes to hours after transplantation.The process is media-ted by complement activation which is triggered by binding of xenoreactive antibodies (XNAs)to the endothelial cells of the blood vessels of the graft.These XNAs are natural antibodies that are present in the circulation of all (immunecompe-tent)humans and predominantly recognise galac-tose-alpha-1,3-galactose (alphaGal)sugars that are linked to glycolipids and glycoproteins on the sur-face of porcine cells.These epitopes are synthe-sised by alpha-1,3-Galactosyltransferase (alpha1,3GT)and are considered to be the major xenoreactive epitopes involved in xenotransplantation rejection [56].These complex sugars are not synthesised by humans,apes and Old World monkeys but are expressed by New World monkeys and mammals such as pigs [57].

Inhibition of complement activation

In order to prevent HAR,transgenic pigs were developed that express human complement regu-latory proteins (CRPs)such as human decay-accel-erating factor (hDAF,CD55);membrane cofactor protein (MCP,CD46)or protectin/membrane inhi-bitor of reactive release (MIRL,CD59)[58].Activa-tion of complement as part of the innate immune system is normally kept in check by CRPs that are expressed on the surface of endothelial cells.Since CRPs are species-speci?c,the porcine homo-logous proteins do not function with the human complement cascade [59].As a result the xenograft is more severely injured as a consequence of com-plement-mediated cytotoxicity.Expression of human CRPs within the graft has been postulated to prevent HAR by overcoming uncontrolled com-plement activation [60].However,PERVs that are derived from such genetically modi?ed pigs are likely to be resistant against complement-mediated lysis,as PERVs incorporate the human CRPs into their envelopes upon budding from human CRP transgenic pig cells.Several trans-genic pigs expressing one or several human CRPs have been generated.Grafting of such human CRP transgenic organs into NHP animal models in both the absence or presence of immu-nosuppression demonstrated prolonged survival in a number of cases which is of clinical relevance for pig-to-human transplantation [61–65].Impor-tantly,incorporation of CD46,CD55or CD59into PERV particles resulted in a reduction of comple-ment-mediated lysis of these particles in vitro [66,67].Interestingly,in case of incorporation of CD59,human serum was still able to neutralise PERV infectivity ef?ciently although requiring higher serum concentrations.This suggests that the protective effect of human serum may not be abolished.The sensitivity to inactivation probably depends on the type of human CRPs being incor-porated [67].

Reduction of deposition of xenoreactive antibodies

This approach was originally based on transgenic pigs expressing enzymes inhibiting alpha1,3GT leading to a reduction in the expression of

the

Figure 2.Xenograft rejection of vascularised https://www.wendangku.net/doc/2b13435408.html,an xeno-grafts are subjected to four successive phases of immunological rejection:hyperacute rejection,acute humoral xenograft rejection,cellular rejection and chronic rejection.These phases are induced by various components of the immune system including XNAs,complement,T-lymphocytes,NK cells and macrophages (reviewed in References [53–55])

in xenotransplantation Biosafety risks 57

major xenoreactive epitope alphaGal[68,69].The second generation of genetically modi?ed pigs is based on knocking out the gene for alpha1,3GT [70–72].In the latter case,PERV particles budding from the host cells carry no alphaGal glycoproteins in their membrane.These PERVs will therefore not be recognised by XNAs of the recipient.The elim-ination of alphaGal from the viral membrane may at the same time increase the risk of infection of human recipients as PERVs would become resis-tant to neutralising antibodies and complement mediated lysis.Initial results from transplantation studies with pig alphaGal knock-out organs in NHPs demonstrated an improvement of the survi-val time of the xenografts which is encouraging from a clinical point of view[73–75].However, PERVs derived from alphaGal knock-out porcine cells indeed proved to be resistant to neutralising antibodies in vitro although at high concentrations of human serum in References[66,76].This sug-gests less effective neutralisation of such PERVs in vivo and increased risk of infection of human recipients.Notably PERVs derived from alphaGal knock-out organs showed decreased growth kinetics in vitro[77].

In conclusion,the use of genetic modi?cation to address HAR potentially increases the risk of infec-tion of the human recipient by PERVs(Figure3). Because at least in vitro,antiviral mechanisms can be less effective.Consequently,whether such modi?cations will render PERVs more infectious in patients remains uncertain.Therefore data derived from further testing by experimentation should be carefully evaluated.

STRATEGIES TO MINIMISE OR CONTROL PERV TRANSMISSION

In order to minimise the possibility of PERV trans-mission,various strategies have been developed and employed.Even if full characterisation of the pig genome was established,production of pigs completely devoid of PERV-related sequences would be technically dif?cult.All known pig breeds have been shown to contain proviral

loci Figure3.Xenograft transplantation from pigs transgenic for human CRPs or knocked-out for alpha1,3GT leading to the reduction of HAR and reduction of complement-mediated lysis of PERVs.A:PERV particles budding from the host cells incorporate alphaGal gly-coproteins in their membrane and undergo complement-mediated lysis;B:PERV particles budding from the host cells incorporating CRPs in their membrane or devoid of alphaGal glycoproteins being resistant to complement-mediated lysis

58 D.Louz et al.

although only a few of these loci have been shown to be able to generate replication competent PERVs.Whether it will be possible to eliminate all such loci by gene knock-out technology in con-junction with selective breeding remains to be established.In this regard the use of transposons and recombinases may be useful to eliminate such loci in a precise and ef?cient way from the porcine genome [78].Certain inbred herds of MS have been identi?ed that do not transmit PERVs in vitro [32].The identi?cation of such so-called non-transmitters or low-virus producing animals may circumvent the need for selective breeding or knock-out technology.These solutions do,how-ever,not exclude the possibility of recombination and complementation of intact ORFs from two defective proviral genomes leading to infectious PERVs.Theoretically,two defective RNAs can be packaged into a single viral particle to give rise to infectious virus by recombination and comple-mentation [79],but the likelihood of such an event is considered to be low.Approaches using RNA interference (RNAi)and ribozyme technologies to inactivate PERV loci or inhibit RNA expression are currently under investigation [80,81].The generation of an antiviral vaccine or the use of antiviral therapy at some stage in clinical xeno-transplantation may be valuable to reduce the risk of PERV transmission [82,83].However,with the exception of azidothymidine,none of the reverse transcriptase and protease inhibitors that are used in the clinic to date have been shown to be effective against PERVs in vitro [84].

REAPPRAISAL OF RISKS POSED BY PERVS In vitro characteristics of PERVs imply a potential for in vivo transmission.It goes without saying that in vitro infectivity may not be predictive for trans-mission in vivo or predictive for disease potential in patients.The actual risk of infection during xenotransplantation can therefore only be evalu-ated by (retrospective)clinical trials or in vivo stu-dies using appropriate animal models.

Retrospective clinical studies

To date more than 200individuals have under-gone xenotransplantation of pig cells or tissues,but not whole organs,for a variety of applications (Table 1).These patients received porcine pancrea-tic islet cell transplants,skin grafts or extracorpor-eal kidney,spleen or liver perfusion.No evidence for active transmission of PERVs was found in the blood cells of the patients [45,50,85–94].Note-worthy,persistent microchimerism,that is,survi-val of porcine cells has been observed in patients for up to 8.5years after treatment and in a few cases antibodies against PERVs were detected.These data suggest that the risk of transmission may be low although they do not exclude the pos-sibility.More importantly,for the evaluation of the risk of transmission of PERVs to humans,these studies have a number of shortcomings.The expo-sure times to porcine cells were short,as the vast majority of the patients studied underwent extra-corporeal perfusion that lasted from a few minutes up to 30h.The remaining patients received short term cellular or skin xenografts.In less than 20per

Table 1.Results from monitoring of xenotransplantation patients

Procedure

Number Immuno-Exposure Results*of patients

suppression

time Extracorporeal liver perfusion 3t4–10h Negative Bioarti?cial liver perfusion

49t2–30h Negative Extracorporeal kidney perfusion 2à15,65min Negative Extracorporeal spleen perfusion 100à50–60min Negative Porcine pancreatic islet cells 48t1–460days Negative Porcine skin grafts

15à10days Negative Embryonic/fetal neuronal cells 24

t

12months

Negative

(intracerebral)

*Results were collected from a number of studies [45,50,85–94]and based on overall interpretations for PERV infec-tivity.Data were obtained by PCR,RT-PCR and seroreactivity assays in blood samples.

in xenotransplantation

Biosafety risks 59

cent of the recipients immunosuppressive treat-ment(in most cases within the context of human organ allotransplantation)was given at only rela-tively low doses,none of the applications involved the use of transgenic porcine material.

In conclusion,these studies do not meet condi-tions that will be required for future xenotrans-plantation of whole organs.These will include long-term direct exposure between human and pig cells and the use of transgenic porcine material in conjunction with heavy immunosuppression. Thus the studies do not fully capture the risk of transmission and offer a limited possibility to extrapolate the?ndings to future clinical xeno-transplantation of whole organs.In addition,the number of recipients are statistically relatively low and monitoring has been limited to PMBCs and plasma.The results do,however,imply that PERVs are not highly infectious for humans. PERVs and animal models

Transplantation of porcine pancreatic islet cells in immunode?cient NOD/SCID and nude mice led to transfer and expression of PERVs in various tis-sues[11,95,96].These data initially demonstrated the potential of PERVs for infection,adaptation and transmission in vivo.However,in these stu-dies no productive infection could be demon-strated.More importantly,recent data indicate that the value of these results regarding the risk of transmission should be re-evaluated.The observed transmission in these studies may have been the result of microchimerism or pseudotyp-ing by murine viruses[97,98].In addition murine cells have been shown not to be susceptible to PERVs both in vitro and in vivo[99].Recent studies indicate that the mouse does not express a func-tional receptor for PERV-A,complicating the eva-luation of the risk of transmission using this animal model.Cells of several small animal spe-cies including,rat,cat and mink express receptors for PERVs[10,13,25,29].Animal models using rats, guinea pigs,minks,rhesus macaques,pig-tailed macaques and baboons that underwent different types of experiments,including direct inoculation of pig cells,tissues and organs in conjunction with strong immunosuppressive treatment did not show any evidence of PERV infection to date [7,45,100,102–108].Recently,however,the poten-tial of PERV transmission was substantiated when human hematopoietic stem cells were trans-planted into pig fetuses,producing reconstituted fused human and porcine cells[109].The chimeric cells contained genomic PERV DNA and were cap-able of transmitting PERVs to a human cell line. In conclusion,no validated animal model to study possible risks of transmission of PERVs to human recipients exists at present.The use of ani-mal models is of great importance to investigate a number of factors such as high dose immunesup-pressive regimens,and the use of porcine trans-genic organs in conjunction with immunological or therapeutic stimuli.All animal models suffer from limitations that hamper the extrapolation towards the setting of transplantation in humans. Noteworthy in this respect is the alphaGal-mediated virolysis defence component that is absent in most small animals.It has been argued that transplantation of porcine organs into NHPs represents the best animal model available.The value of this model is,however,controversial since all NHP cells analysed in vitro seem to be less permissive for PERVs than certain human cell lines[103–105].The inability of NHPs to suf?-ciently support PERV replication urges the devel-opment of a permissive small animal model. Recently a mouse model transgenic for the human PERV receptor(HuPAR-2)has been developed, which may be useful[110].

FROM SCIENCE TO RISK EVALUATION Xenotransplantation poses unique risks with respect to PERV-related transmission and disease potential in human recipients due to a number of factors.Firstly,normal natural defences are bypas-sed by engrafting porcine tissue into patients. Secondly the patient will be under heavy immune-suppressive treatment.Safety concerns are raised by the potential for xenotransplantation to intro-duce viral infections in the human community. Evidence from naturally occuring retroviral zoonosis and cross-species infections by animal retroviruses,for example,HIV,provides a basis for reasoned speculation on the risk posed by PERVs.In a worst case scenario xenograft-related PERV transmission would be the starting point of a new viral disease resulting in a public health problem.

No unequivocal evidence exists that PERVs will re?ect humans in a transplantation setting.This

60 D.Louz et al.

seems encouraging and implies that the risks posed by PERV are lower than initially thought, although the data show shortcomings in relation to the situation of whole organ transplantation. The likelihood of the emergence of an infectious disease that originates from xenograft-associated PERVs will be different for individual recipients, their immediate contacts and eventually the gener-al public.Such an event will depend on a number of variables,for example,the nature and length of exposure,the immunosuppressive regime emplo-yed and the health status of the recipient.The major scienti?c questions regarding risk of trans-mission are therefore complex.

A whole chain of events would have to take place before PERVs could pose a serious public health risk.Firstly,infectious PERVs must be repli-cating and transmitted in the xenograft.Secondly, these PERVs must be able to infect and spread within the human recipient.Thirdly,PERV trans-mission must occur from the recipient to close con-tacts and subsequently to the wider community via human-to-human transmission.Such a chain of events seems unlikely,but cannot be excluded. Due to limitations of laboratory investigations and the lack of validated animal models no conclusive results of transmission-associated risks can be expected from these approaches.Therefore the question whether PERVs will truly pose risks can only be determined by well designed and con-trolled clinical trials.

As xenotransplantation possesses the inherent potential to introduce infectious disease into society and given the fact that PERVs infect human cells,patients should be monitored for PERV infec-tion in long-term follow-up studies.In addition such clinical trials should have clear potential ther-apeutic bene?ts for the recipient and any risk to public health should be minimised.This calls for the development of a framework facilitating such trials in which risks associated with PERVs are manageable if appropriate precautions are taken. Such precautions would have to address rigorous virological testing of source animals and protocols using reliable and appropriate tests to follow-up patients and their relatives in the event an infec-tion should occur.In addition,recipients would have to consent to possible constraints of monitor-ing and any precautionary measures that would restrict personal and social contacts.Inevitably the development and the necessity to put such protocols in place will lead to practical ethical and social questions regarding acceptability. REFERENCES

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排球基本动作教案

一、开始部分 10’ 1、学生按照要求排队,师生问好。 2、体育老师点名,检查上课出勤情况。 3、宣布本课的学习内容、目标和要求,安排见习生。 X X X X X 0 O O O O X X X X X 0 O O O O △ 二、准备部分 20’ 1、教师自我介绍 学生与教师相互介绍情况。 2、为学生安排体育课的队形。 根据学生身高和特点安排队形。 3、准备活动,徒手操(4×8拍) A 头部运动 B 肩部运动 C 扩胸运动 D 体转运动 E 腹背运动 F 全身运动 G 原地高抬腿跑 H 手腕关节运动 要求:活动充分。 三、基本部分 50’ 排球 排球比赛是由两队各6名队员在被网隔开的排球场内,根据规则规定,以身体的任何部位将球击入对方场区,而不使其落入本方场区的集体的、攻防对抗的体育项目。 1、首先讲解排球选项课学习的基本理论、基本技术、 2、讲解排球选项课的期末考试内容,以供学生积极训练,积极准备。 3、讲解排球技术的基本概念: 排球技术是指在排球规则允许的条件下,运动员采用的各种合理的击球动作和为完成击球动作所必不可少的与其他配合动作的总称。 4、讲解排球技术的基本组成动作: 排球的技术主要包括:准备姿势与移动、垫球、传球、发球、扣球、拦网。 5、讲解排球运动的概念:

排球运动是由参加运动的人,以身体的任何部位(以单手或双手为主)相互在空中击球,使球不落地,既可隔网进行比赛,也可不设球网进行击球游戏的一种体育运动项目。 排球球性练习: 1、6个人一个小组,每个小组一个排球,站成一个圆圈,熟悉球性练习。 2、每人自垫球5个,然后换人。 3、在圆圈内对垫球,在圆圈内对传球。 4、不要求排球动作的正确性,只要求熟悉球性。 四、结束部分 10’ 1、点名整队。 2、小结,收拾体育器材。 3、放松操。 4、师生告别。

排球垫球的动作要领

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倾斜,用向右转腰和提左肩的动作,使两臂击球面截住球的飞行路线,垫击球的后下部。 3,背垫球 判断好球的飞行方向,迅速移动到球的落点处,背对击球方向,两 臂夹紧伸直,击球手形与正面垫球相同,击球点要高于肩部。击球 用力是通过抬头挺胸,展腹后仰,带动手臂向后上方抬送而实现的 在背垫低球时,也能够屈肘,翘手腕动作, 以虎口处将球向后上方 垫起. 4,单手垫球 单手垫球多在无法用双手垫球的情况下采用.体侧单手垫球方法 是一脚迅速向侧前方跨出一大步,重心移至跨出的腿上,以跨出腿 的同侧臂迅速伸出,用虎口或小臂击球的后下部。在体前可用手 背平面击球,手臂要伸直,有抬击动作. (二)垫球技术练习方法1,在简单条件下掌握垫球技术 (1)原地做徒手模仿垫球动作练习. (2)垫固定球.两人一组,一人持球于腹前,另一人用 垫球动作击球,体会垫球部位和用力动作.要求蹬腿抬臂协调用力. (3)自垫球.一人一球连续向上自垫,垫球高度可固定,也可高,低结合. (4)抛垫球?两人一球相距4?5米,一人将球抛至同伴的腹前,同伴将球垫回. (5)移动垫球.两人一组,一人抛出不同距离,方向,速度和高度的

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排球基本知识

排球基本知识 比赛场地长18米、宽9米,由中线将球场分为两个相等的场区,中线设置长9.50米、宽1米的球网。男子网高2.43米,女子网高2.24米。球由皮革制成外壳,内装用橡皮或类似物质制成的球胆,重260~280克。比赛方法采用每球得分制,为五局三胜,前四局每局先得25分者为胜,第五局先得15分者为胜,若出现24平或14平时,要继续比赛至某队领先2分才能取胜。双方上场的运动员必须轮转位置。上场运动员每队为6人。每方必须在3次以内将球击过网。 基本技术 1 排球基本技术概念 排球基本技术是指运动员在比赛中采用的各种合理击球动作和未完成击球动作必不可少的其他配合动作的总称。 发球、垫球、传球、扣球、和拦网是排球运动中5项完整的击球动作,又称有球技术。凡属没有触及球的各种准备姿势、移动、起跳以及前仆、滚翻、鱼跃、倒地等均为配合动作,或称无球动作。合理的击球动作和配合动作,首先要符合规则的要求,符合人体剖学和运动生物力学的原理,同时要结合个人的特点。完成动作时要做到协调、轻松、正确、省力,能够充分发挥人的体能和技能,能充分运用时间和空间的变化。 排球技术主要有步法移动和击球手法组成。排球规则允许比赛中运动员可用身体的任何部位接球。

基本技术分为六大项:准备姿势和移动、传球、垫球、发球、扣球、拦网。 1)准备姿势和移动:准备姿势就是准备迎接各种来球的身体姿势。在排球比赛中攻防的多数技术都是在准备姿势或快速移动后完成的,因此它是完成各项基本技术的基础。移动的作用是为了接近球,保持好人与球的位置关系,以保证击球动作的合理。 比赛中常用的移动步法有滑步、交叉步、跨步和跑步。 2)传球:传球是在额前上方用双手(或单手)借助蹬地、伸臂动作,通过手腕手指的弹击力量来完成的击球技术动作。传球主要作用是把接起的球传给前排队员进攻。一个队的进攻能力能否充分发挥,在很大程度上取决于该队的传球水平。为了争夺网上优势,使进攻战术快速多变,二传手更起着核心作用。 3)垫球:是在距腹前一臂距离处借助蹬地、抬臂动作,用双手前臂的前部,利用来球的反弹力将球击出的技术动作。垫球在比赛中多用于接发球、接扣球和接拦回球,是比赛中争取多得分、少失分由被动变主动的重要技术。 4)发球:由队员自己抛球,用一只手将球从网上空两标志杆内击入对方场区的技术动作。发球是比赛和进攻的开始。是排球技术中唯一不受别人制约的技术动作。攻击性强的发球不仅可以直接得分,还能破坏和削弱对方的进攻,打乱对方的部署,在心理上给对方造成威胁。

体育教案-排球正面双手垫球

体育教案-排球正面双手垫球 教学内容:排球正面双手垫球 教学目标: 1、初步学会排球正面垫球的基本技术。 2、发展协调性、灵敏性、增强全身协调能力; 3、培养学生面对任何困难都不要轻言放弃,勇于向前、顽强、果断的优良品质;且在不断 的尝试中找出最佳的方法与快捷方式,建立与培养学生的自信心。 教学重点:应放在垫球时的手型正确,击球部位准确。。 教学难点:垫球时的全身协调用力。 班级:高一·1班人数:66人器材:排球34个授课教师:安耀东 程序教学内容 教学 目标 组织队形教法学法要求时间 开始部分1、体育委员集 合,整队,报告人 数 2、宣布课的 内容任务 3、检查服装 4、安排见习生 培养体育骨 干,提高学 生自觉组织 能力 队形: ×××××××××× ×××××××××× ¤¤¤¤¤¤¤¤¤¤ ¤¤¤¤¤¤¤¤¤¤ △ 教师在旁 边观察、提 醒 统一服 装、精神 饱满 集合做到 快、静、齐 3 分 钟 准备部1、慢跑400米 2、4节徒手操 3、游戏: “滚球接力” 将学生分成人数相 等的八队,两脚开 立成一路纵队,游 使学生能尽 快进入运动 状态 活跃课堂气 氛,提高学 绕田径场慢跑一圈, 以四路纵队进行。 队形:八人一组,全班分成八组。 10 分

分 戏开始,由排头同学持排球沿后面同学的两脚之间滚向排尾,排尾接球后 又跑到排头将球滚向排尾,依次进行,以最先完成的队为胜。 生的学习兴趣。 另外两名同学做裁判员 由教师讲解、强调游戏要求和规则 学生模拟做一次 在发令前学生要做好准备,每个球都要 按要求滚。否则算犯规。 钟 基 一、徒手模仿和自垫球练习: 教师口述重点:手型正确,击球部位准确。 难点:全身协调用力,控制好来球。 动作要领: 插、夹、抬 二、抛接球和对垫球练习: 抛接球: 两人一组, 两人一球, 一人抛球, 一人接球。 学生能体会动作 学生能掌握用 力顺序及垫球基本手型 动作基本 合理 组织队形:(同做操队形) ×××××××××× ×××××××××× ¤¤¤¤¤¤¤¤¤¤ ¤¤¤¤¤¤¤¤¤¤ △ 组织队形: ××××××××××××× Δ ¤¤¤¤¤¤¤¤¤¤¤¤¤ 两人一组,两人一球,一人练习,一人在旁观察;一分钟后互换。 垫球手型的练习:集体原地徒手练习,教师进行检查纠正。 教师巡回指导及时纠正错误 同上 当初步学会垫球动1、徒手分解动作练习 2、尝试垫球 3、两人一 球进行自垫练习 4、两人一组结合球练习 5、抛接球练习 要求: 注意垫球动作要合 理;小臂要夹紧;手臂要伸直;垫击面要平 整。 蹬地和伸臂动作协调,动作要正确。 要求: 动作配合 协调。 正面双手垫球的击 球点,一般 10 分 钟

排球双手垫球动作要领

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提起,前脚掌着地,两脚和两膝内收,膝部垂直面应超出脚尖。上体前倾,重心降低,并置于前脚掌的拇指根部,两肩的垂直面超出膝部。两臂微屈内靠,两臂自然下垂,两手置于腹前。两眼注视来球,两脚要保持“静中待动”的状态,随时准备移动。 2、击球手型 目前常用的击球手型有两种。一种是叠指法,两手手指上下重叠,掌根紧靠,合掌互握,两拇指朝前相对平行靠压在上面一手的中指第二指节上。两臂伸直夹紧,注意手掌部分不能相叠。另一种是包拳法,两手抱拳互握,两拇指平行朝前,两掌根和两前臂外旋紧靠,手腕下压,使前臂形成一个垫击平面。 3、击球点、击球部位 正面双手垫球的击球点一般应尽量保持在腰腹前的 一臂距离,有两小臂腕关节以上10厘米左右桡骨内侧平 面击球为宜。击球部位过高,既不便于控制球,而且易造成“持球”或“连击”犯规;击球部位过低,垫在虎口上,球易不稳,对球的方向、力量控制不准。 4、击球动作 在判断来球移动取位的同时,应根据来球情况和击球的需要变化身体重心,使击球点保持在腹部高度的正前方,

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