Xenotransplantation [Letters]
Identifieur interne : 002522 ( Istex/Corpus ); précédent : 002521; suivant : 002523Xenotransplantation [Letters]
Auteurs :Source :
- BMJ [ 0959-8138 ] ; 2000-03-25.
English descriptors
- Teeft :
- Acellular, Acellular pertussis, Acellular pertussis vaccines, Antibiotic, Antibiotic prophylaxis, Asylum, Asylum seekers, Basic health care, Benefit millions, Better alternatives, Bowel, Bowel cancer, Bowel investigation, British society, Careful history, Case report, Chance remarks, Chest radiography, Clinical judgment, Clinical trials, Colorectal cancer, Control group, Differential diagnosis, Drug administration, Drug pockets, Endogenous retroviruses, Endoscopic, Eugenics, Fano, First faecal occult blood test, Gastroenterology, Gastrostomy, Gastrostomy insertion, General knowledge, General practitioners, Genetic engineering, High incidence, High risk, Home office, Home visit, Human cells, Human recipients, Individual symptoms, Induction agent, Infection, Infection rate, Infectious disease, Large populations, Lifestyle changes, Local infection, Many patients, Medical care, Medical students, Mental health, National screening committee, National service framework, Neurological disease, November, Organ donation, Organ procurement, Other doctors, Percutaneous, Percutaneous endoscopic gastrostomy, Percutaneous endoscopic gastrostomy insertion, Peristomal infection, Persistent porcine, Pertussis, Pertussis vaccine, Physical examination, Porcine, Port health units, Potential benefits, Practitioner, Preclik, Pregnant woman, Previous studies, Primary care, Prophylactic antibiotics, Prophylaxis, Prospective randomised, Public health authorities, Public health risk, Randomised, Resistant organisms, Responsible transplantation, Retrovirus, Retrovirus infection, Royal college, Screening, Screening programme, Screening round, Seeker, Simian viruses, Single dose, Smithkline beecham, Symptomatic bowel cancer, Systemic infections, Systemic infective complications, Telephone conversations, Therapeutic antibiotics, Total exposure, Triple screen, Triple vaccine, Tuberculosis screening, Ultimate decision, Vaccine, Vanderpool, Whole cell, Wound infection rates, Xenotransplantation, Yellow fever.
Url:
DOI: 10.1136/bmj.320.7238.868
Links to Exploration step
ISTEX:6B1B44B347B1024EEED8E51C87A094BFB389463BLe document en format XML
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pub-id-type="other">bmj;320/7238</issue-id><issue-id pub-id-type="other">7238</issue-id><issue-id pub-id-type="other">320/7238</issue-id><fpage>868</fpage><permissions><copyright-statement>© 2000 BMJ Publishing Group Ltd.</copyright-statement><copyright-year>2000</copyright-year></permissions><self-uri content-type="pdf" xlink:role="full-text" xlink:href="bmj-320-868.pdf"></self-uri><counts><page-count count="1"></page-count></counts></article-meta></front><response response-type="letter" xml:lang="EN"><front><journal-meta><journal-id journal-id-type="hwp">bmj</journal-id><journal-id journal-id-type="nlm-ta">BMJ</journal-id><journal-id journal-id-type="publisher-id">BMJ</journal-id><journal-title>BMJ</journal-title><abbrev-journal-title abbrev-type="publisher">BMJ</abbrev-journal-title><abbrev-journal-title abbrev-type="pubmed">BMJ</abbrev-journal-title><issn pub-type="ppub">0959-8138</issn><issn pub-type="epub">1468-5833</issn><publisher><publisher-name>British Medical Journal Publishing Group</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="other">R1</article-id><title-group><article-title>This new form of treatment might benefit millions</article-title></title-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Cooper</surname><given-names>David K C</given-names></name><role>resident, International Xenotransplantation Society.</role><email xlink:type="simple">cooper@helix.mgh.harvard.edu</email><xref ref-type="aff" rid="A1"></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Groth</surname><given-names>Carl G</given-names></name><role>immediate past president, International Xenotransplantation Society.</role><xref ref-type="aff" rid="A2"></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>McKenzie</surname><given-names>Ian F C</given-names></name><role>president elect, International Xenotransplantation Society.</role><xref ref-type="aff" rid="A3"></xref></contrib></contrib-group><aff id="A1">Massachusetts General Hospital, 13th Street, Boston, MA 02129, USA</aff><aff id="A2">Huddinge Hospital, Huddinge S-14186, Sweden</aff><aff id="A3">Austin Research Institute, Austin and Repatriation Hospital, Heidelberg, Victoria, Australia</aff><pub-date pub-type="ppub"><day>25</day><month>3</month><year>2000</year></pub-date><pub-date pub-type="epub"><day>25</day><month>3</month><year>2000</year></pub-date><self-uri content-type="pdf" xlink:role="full-text" xlink:href="bmj-320-868.pdf"></self-uri></article-meta></front><body><p>EDITOR—Fano has written a response in the <italic>eBMJ</italic> (and published here, the third letter) commenting on Vanderpool's article on xenotransplantation.<xref ref-type="bibr" rid="R1">1</xref> <xref ref-type="bibr" rid="R2">2</xref> He advocates a ban on xenotransplantation, largely on the grounds of the risk of the transfer of infection. Cells taken from carefully screened pigs have been used in the treatment of patients with diabetes, certain neurological diseases, and liver failure. There has been no definite evidence of the transfer of a porcine infection to human recipients.</p><p>Nevertheless, as with almost every medical or scientific advance, it will be impossible to exclude all risk, even if this is related only to hitherto unknown pig bacteria or viruses. The ultimate decision whether to use any new therapeutic agent or procedure rests on an assessment of the risk to benefit ratio. As the potential benefits to individuals or society increase, the acceptance of slightly increased risk becomes warranted. We must not reduce our obligation to take all possible steps to minimise any perceived risk to society, but we have a moral obligation to accept a small risk to the community if the new treatment leads to great benefit to many individuals in that community.</p><p>The potential benefits of xenotransplantation are immense. Many millions of people with such diverse conditions as diabetes and degenerative brain disease may have the quality of their lives vastly improved, and in those with advanced organ failure xenotransplantation will be lifesaving. In the United States over 60 000 people currently await a human donor organ but only 20 000 organs will become available this year. At least 10 people die every day while waiting. Similar figures could be quoted for other regions of the developed world.</p><p>This new form of treatment may ultimately benefit millions of patients. Rather than calling for a ban on it we suggest that support should be given to the great efforts being made to ensure that it will be not only successful but also safe.</p></body><back><ref-list><ref id="R1"><label>1.</label><citation citation-type="journal" xlink:type="simple"><person-group person-group-type="author"><name name-style="western"><surname>Vanderpool</surname> <given-names>HY</given-names></name></person-group>. <article-title>Xenotransplantation: progress and promise</article-title>. <source>BMJ</source> <year>1999</year>; <volume>319</volume>: <fpage>1311</fpage>. (13 November.)</citation></ref><ref id="R2"><label>2.</label><citation citation-type="journal" xlink:type="simple"><person-group person-group-type="author"><name name-style="western"><surname>Fano</surname> <given-names>A</given-names></name></person-group>. <article-title>Xenotransplantation: perils and plagues</article-title>. <source>eBMJ</source> <year>1999</year>. <ext-link ext-link-type="uri" xlink:href="http://www.bmj.com/cgi/eletters/319/7220/1311#EL2" xlink:type="simple">www.bmj.com/cgi/eletters/319/7220/1311#EL2</ext-link>).</citation></ref></ref-list></back></response><response response-type="letter" xml:lang="EN"><front><journal-meta><journal-id journal-id-type="hwp">bmj</journal-id><journal-id journal-id-type="nlm-ta">BMJ</journal-id><journal-id journal-id-type="publisher-id">BMJ</journal-id><journal-title>BMJ</journal-title><abbrev-journal-title abbrev-type="publisher">BMJ</abbrev-journal-title><abbrev-journal-title abbrev-type="pubmed">BMJ</abbrev-journal-title><issn pub-type="ppub">0959-8138</issn><issn pub-type="epub">1468-5833</issn><publisher><publisher-name>British Medical Journal Publishing Group</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="other">R2</article-id><title-group><article-title>Public health risk must not be dismissed</article-title></title-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Goldman</surname><given-names>Emanuel</given-names></name><role>professor.</role><email xlink:type="simple">egoldman@umdnj.edu</email><xref ref-type="aff" rid="A4"></xref></contrib></contrib-group><aff id="A4">Department of Microbiology and Molecular Genetics, New Jersey Medical School - UMDNJ, 185 South Orange Avenue, Newark, NJ 07103, USA</aff><pub-date pub-type="ppub"><day>25</day><month>3</month><year>2000</year></pub-date><pub-date pub-type="epub"><day>25</day><month>3</month><year>2000</year></pub-date><self-uri content-type="pdf" xlink:role="full-text" xlink:href="bmj-320-868.pdf"></self-uri></article-meta></front><body><p>EDITOR—Xenotransplantation of organs from animals is a seductive but inherently dangerous idea. The risk is not just to the patient, who will probably die shortly afterwards; the stakes are much higher, because the entire human population is put at risk.</p><p>Viruses that inhabit animals, some of which are intrinsic to the animal's own genome, will gain a route of entry into the human population not ordinarily available. As Vanderpool notes, <xref ref-type="bibr" rid="R3">1</xref> pig DNA contains endogenous retroviruses (the same class that causes AIDS), and these infect human tissue culture cells.<xref ref-type="bibr" rid="R4">2</xref> Vanderpool doesn't mention that postmortem analyses of two patients who died 70 and 27 days after receiving baboon livers showed two simian viruses that replicated after transplantation.<xref ref-type="bibr" rid="R5">3</xref> Our state of knowledge is far too incomplete for us to breed totally virus-free animals, because we probably don't even know all the viruses that need to be eliminated.</p><p>We do know that viruses jump species even without our help, and there are enough frightening precedents—as far back as the 1918 swine influenza pandemic that killed 20 million—to scare anyone contemplating xenotransplantation. More recently, millions of chickens had to be slaughtered in Hong Kong because of the unexpected jump to humans ofan avian influenza virus, and thousands of English cattle have been destroyed because of the jump to humans of bovine spongiform encephalopathy (“mad cow disease”).</p><p>The spectacular advance of AIDS resulted from a virus given new routes of entry: widespread increases in certain lifestyle practices provided a conduit for efficient transmission. HIV-1 probably also resulted from a simian to human virus jump. Deadly Ebola virus is another virus transmitted to humans from primates, and there are at least another 10 primate viruses that infect humans, including a deadly form of herpes. Pigs aren't much safer: about a dozen pig viruses can be transmitted to humans, often with serious results.</p><p>Not considered by Vanderpool is the fact that better alternatives exist. These includelifestyle changes (diet and exercise) that would considerably reduce the numbers of transplant candidates and presumed consent policies for human donors, which would greatly expand the pool of available organs. Research on unwanted human embryos is much more promising as a solution, but this is held hostage to abortion politics in the United States. Instead we are absurdly rushing down a path fraught with danger. Have we learnt nothing fromthe AIDS epidemic?</p></body><back><ref-list><ref id="R3"><label>1.</label><citation citation-type="journal" xlink:type="simple"><person-group person-group-type="author"><name name-style="western"><surname>Vanderpool</surname> <given-names>HY</given-names></name></person-group>. <article-title>Xenotransplantation: progress and promise</article-title>. <source>BMJ</source> <year>1999</year>; <volume>319</volume>: <fpage>1311</fpage>. (13 November.)</citation></ref><ref id="R4"><label>2.</label><citation citation-type="journal" xlink:type="simple"><person-group person-group-type="author"><name name-style="western"><surname>Patience</surname> <given-names>C</given-names></name><name name-style="western"><surname>Takeuchi</surname> <given-names>Y</given-names></name><name name-style="western"><surname>Weiss</surname> <given-names>RA</given-names></name></person-group>. <article-title>Infection of human cells by an endogenous retrovirus of pigs</article-title>. <source>Nature Med</source> <year>1997</year>; <volume>3</volume>: <fpage>282</fpage>–<lpage>286</lpage>.</citation></ref><ref id="R5"><label>3.</label><citation citation-type="journal" xlink:type="simple"><person-group person-group-type="author"><name name-style="western"><surname>Allan</surname> <given-names>JS</given-names></name><name name-style="western"><surname>Broussard</surname> <given-names>SR</given-names></name><name name-style="western"><surname>Michaels</surname> <given-names>MG</given-names></name><name name-style="western"><surname>Starzl</surname> <given-names>TE</given-names></name><name name-style="western"><surname>Leighton</surname> <given-names>KL</given-names></name><name name-style="western"><surname>Whitehead</surname> <given-names>EM</given-names></name><etal></etal></person-group>. <article-title>Amplification of simian retroviral sequences from human recipients of baboon liver transplants</article-title>. <source>AIDS Res Hum Retroviruses</source> <year>1998</year>; <volume>14</volume>: <fpage>821</fpage>–<lpage>824</lpage>.</citation></ref></ref-list></back></response><response response-type="letter" xml:lang="EN"><front><journal-meta><journal-id journal-id-type="hwp">bmj</journal-id><journal-id journal-id-type="nlm-ta">BMJ</journal-id><journal-id journal-id-type="publisher-id">BMJ</journal-id><journal-title>BMJ</journal-title><abbrev-journal-title abbrev-type="publisher">BMJ</abbrev-journal-title><abbrev-journal-title abbrev-type="pubmed">BMJ</abbrev-journal-title><issn pub-type="ppub">0959-8138</issn><issn pub-type="epub">1468-5833</issn><publisher><publisher-name>British Medical Journal Publishing Group</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="other">R3</article-id><title-group><article-title>Research in xenotransplantation will line drug industry's pockets</article-title></title-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Fano</surname><given-names>Alix</given-names></name><role>director.</role><email xlink:type="simple">alixfano@mindspring.com</email><xref ref-type="aff" rid="A5"></xref></contrib></contrib-group><aff id="A5">Campaign for Responsible Transplantation, PO Box 2751, New York, NY 10163, USA</aff><pub-date pub-type="ppub"><day>25</day><month>3</month><year>2000</year></pub-date><pub-date pub-type="epub"><day>25</day><month>3</month><year>2000</year></pub-date><self-uri content-type="pdf" xlink:role="full-text" xlink:href="bmj-320-868.pdf"></self-uri></article-meta></front><body><p>EDITOR—It is naive to believe that research in xenotransplantation “is being propelled” by drug companies' desire to alleviate human suffering rather than the promise of billions of dollars in profits from the sale of “humanised” pig parts and expensive antirejection drugs.<xref ref-type="bibr" rid="R6">1</xref> There would be safer and more cost effective ways of dealing with the perceived shortage of human organs and tissue. Aggressive investment in programmes to prevent disease; the passage of “presumed consent” laws, which have increased organ donation rates in several countries<xref ref-type="bibr" rid="R7">2</xref>; and growing human tissue to provide a safer source than animals would all help.</p><p>Given the multitude of viruses lurking in animals, it will be impossible to breed germ free “donors.” Public health authorities admit that xenotransplantation could transmit deadly animal viruses to humans. Known pig viruses include the porcine endogenous retroviruses that have infected human cells. In 1998–9 the Malaysian Nipah virus causing viral encephalitis jumped from pigs to humans, infected 269 people, killed over 100, left dozens brain damaged, and led to the mass slaughter of one million pigs. Pig viruses have not been extensively studied: there may be dozens, many with long latency periods, waiting to be discovered.</p><p>A retrospective study of 160 patients exposed to living pig tissue raised concerns<xref ref-type="bibr" rid="R8">3</xref>: 30 patients who underwent splenic perfusions gave positive results when tested for porcine endogenous retrovirus DNA; 23 had pig cells circulating in their bodies 8.5 years after treatment; and four injected with pig cells produced antibodies to porcine endogenous retroviruses, suggesting a potential active infection. The study's sponsor, Novartis, insists that patients are free of infection. But virologist Stoye and coauthors have said “the absence of infectious virus in, say, the first two hundred patients does not mean it will not occur in the two hundredand first.”<xref ref-type="bibr" rid="R9">4</xref></p><p>I am baffled as to why our public health authorities, mandated to protect public health and prevent disease, are encouraging the development of xenotransplantation while simultaneously acknowledging its epidemic potential. This could become a liability for them.</p><p>In 1998 a group of physicians pointed out that global poverty (and lack of access to basic health care and sanitation) is the world's number one health problem.<xref ref-type="bibr" rid="R10">5</xref> Today, some 50 million Americans lack access to basic health care. If we invest in xenotransplantation while ignoring the fundamental needs of a majority of the world's citizens we are simply lining the drug industry's pockets.</p></body><back><ref-list><ref id="R6"><label>1.</label><citation citation-type="journal" xlink:type="simple"><person-group person-group-type="author"><name name-style="western"><surname>Vanderpool</surname> <given-names>HY</given-names></name></person-group>. <article-title>Xenotransplantation: progress and promise</article-title>. <source>BMJ</source> <year>1999</year>; <volume>319</volume>: <fpage>1311</fpage>. (13 November.)</citation></ref><ref id="R7"><label>2.</label><citation citation-type="journal" xlink:type="simple"><person-group person-group-type="author"><name name-style="western"><surname>Kennedy</surname> <given-names>I</given-names></name><name name-style="western"><surname>Sells</surname> <given-names>RA</given-names></name><name name-style="western"><surname>Daar</surname> <given-names>AS</given-names></name><name name-style="western"><surname>Guttmann</surname> <given-names>RD</given-names></name><name name-style="western"><surname>Hoffenberg</surname> <given-names>R</given-names></name><name name-style="western"><surname>Lock</surname> <given-names>M</given-names></name><etal></etal></person-group>. <article-title>The case for “presumed consent” in organ donation</article-title>. <source>Lancet</source> <year>1998</year>; <volume>351</volume>: <fpage>1650</fpage>–<lpage>1652</lpage>.</citation></ref><ref id="R8"><label>3.</label><citation citation-type="journal" xlink:type="simple"><person-group person-group-type="author"><name name-style="western"><surname>Paradis</surname> <given-names>K</given-names></name><name name-style="western"><surname>Langford</surname> <given-names>G</given-names></name><name name-style="western"><surname>Long</surname> <given-names>Z</given-names></name><name name-style="western"><surname>Heneine</surname> <given-names>W</given-names></name><name name-style="western"><surname>Sandstrom</surname> <given-names>P</given-names></name><name name-style="western"><surname>Switzer</surname> <given-names>WM</given-names></name><etal></etal></person-group>. <article-title>Search for cross-species transmission of porcine endogenous retrovirus in patients treated with living pig tissue</article-title>. <source>Science</source> <year>1999</year>; <volume>285</volume>: <fpage>1236</fpage>–<lpage>1241</lpage>.</citation></ref><ref id="R9"><label>4.</label><citation citation-type="journal" xlink:type="simple"><person-group person-group-type="author"><name name-style="western"><surname>Stoye</surname> <given-names>JP</given-names></name><name name-style="western"><surname>Le Tissier</surname> <given-names>P</given-names></name><name name-style="western"><surname>Takeuchi</surname> <given-names>Y</given-names></name><name name-style="western"><surname>Patience</surname> <given-names>C</given-names></name><name name-style="western"><surname>Weiss</surname> <given-names>RA</given-names></name></person-group>. <article-title>Endogenous retroviruses: a potential problem for xenotransplantation</article-title>. <source>Ann NY Acad Sci</source> <year>1998</year>; <volume>862</volume>: <fpage>73</fpage>.</citation></ref><ref id="R10"><label>5.</label><citation citation-type="journal" xlink:type="simple"><person-group person-group-type="author"><name name-style="western"><surname>Guerrero</surname> <given-names>R</given-names></name><name name-style="western"><surname>Jancloes</surname> <given-names>M</given-names></name><name name-style="western"><surname>Martin</surname> <given-names>JD</given-names></name><name name-style="western"><surname>Haines</surname> <given-names>A</given-names></name><name name-style="western"><surname>Kaseje</surname> <given-names>D</given-names></name><name name-style="western"><surname>Wasserman</surname> <given-names>MP</given-names></name></person-group>. <article-title>How the cycle of poverty and ill health can be broken</article-title>. <source>BMJ</source> <year>1998</year>; <volume>316</volume>: <fpage>1456</fpage>.</citation></ref></ref-list></back></response><response response-type="reply" xml:lang="EN"><front><journal-meta><journal-id journal-id-type="hwp">bmj</journal-id><journal-id journal-id-type="nlm-ta">BMJ</journal-id><journal-id journal-id-type="publisher-id">BMJ</journal-id><journal-title>BMJ</journal-title><abbrev-journal-title abbrev-type="publisher">BMJ</abbrev-journal-title><abbrev-journal-title abbrev-type="pubmed">BMJ</abbrev-journal-title><issn pub-type="ppub">0959-8138</issn><issn pub-type="epub">1468-5833</issn><publisher><publisher-name>British Medical Journal Publishing Group</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="other">R4</article-id><title-group><article-title>Author's reply</article-title></title-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Vanderpool</surname><given-names>Harold Y</given-names></name><role>professor in the history and philosophy of medicine.</role><email xlink:type="simple">hvanderp@utmb.edu</email><xref ref-type="aff" rid="A6"></xref></contrib></contrib-group><aff id="A6">Institute for the Medical Humanities, University of Texas Medical Branch, Galveston, TX 77555, USA</aff><pub-date pub-type="ppub"><day>25</day><month>3</month><year>2000</year></pub-date><pub-date pub-type="epub"><day>25</day><month>3</month><year>2000</year></pub-date><self-uri content-type="pdf" xlink:role="full-text" xlink:href="bmj-320-868.pdf"></self-uri></article-meta></front><body><p>EDITOR—Cooper et al's letter is commendable. Research on porcine cells, tissues, and organs in xenotransplantation should continue if certain conditions are met. There should be ongoing studies of risks and increased recognition that xenotransplantation offers enormous potential for alleviating human sickness, suffering, and untimely death. To assume that xenotransplantation must be free of risk before its benefits are pursued is out of keeping with the nature of human existence and represents a preoccupation with self protection that undermines beneficence.</p><p>Goldman warns that the public health risk of xenotransplantation “must not be dismissed,” which no one seems to be doing. Goldman's points about the known infectivity of simian viruses have, as my article says, already been taken to heart by the United States Food and Drug Administration, which suspended clinical research involving primate-to-human xenografts.</p><p>Goldman ends with a list of better alternatives to xenotransplants. Better for whom and how soon? Lifestyle changes would reduce the demand for transplanted organs, but they will neither end this demand nor be voluntarily and universally adopted. Presumed consent would expand the organ donor pool, but it is a form of coercion that would also not meet the great demand.</p><p>Fano expresses the party line of the Campaign for Responsible Transplantation, which he directs and which claims to represent 2.5 million members. The campaign's publications advocate an immediate ban on xenotransplantation and charge the Food and Drug Administration with “playing Russian roulette with the public's health.”<xref ref-type="bibr" rid="R11">1</xref></p><p>Fano holds that xenotransplantation is being advanced to line “the drug industry's pockets,” not to alleviate human suffering. While few will quarrel with the influence, if not the necessity, of the profit motive, numerous researchers, surgeons, scientists, and regulators are additionally, and sometimes primarily, motivated by altruism, inquisitiveness, discovery, and the classic three factors in the Hippocratic oath: honour, fame, and enjoyment of life.</p><p>Fano is baffled that public health authorities are encouraging the development of xenotransplantation in the light of its epidemic potential. His evidence for this potential with respect to clinical trials of xenotransplantation is attributed to a study that does not support his fears.<xref ref-type="bibr" rid="R12">2</xref></p><p>This study further validates other findings that persistent porcine endogenous retrovirus infection has not been detected in recipients of xenotransplants. The 30 (of a total of 160) patients that Fano refers to as testing positive for persistent porcine endogenous retrovirus evidenced microchimerism (the remaining presence of pig cells in their bodies), not persistent porcine endogenous retrovirus infection.</p></body><back><ref-list><ref id="R11"><label>1.</label><citation citation-type="book" xlink:type="simple"><person-group person-group-type="author"><name name-style="western"><surname>Fano</surname> <given-names>A</given-names></name></person-group>. <source>CRT: re Docket N.99D-5347: precautionary measures to reduce the possible risk of transmission of zoonoses</source>. <publisher-loc>New York</publisher-loc>: <publisher-name>Campaign for Responsible Transplantation</publisher-name>, <year>2000</year>: <fpage>12</fpage>.</citation></ref><ref id="R12"><label>2.</label><citation citation-type="journal" xlink:type="simple"><person-group person-group-type="author"><name name-style="western"><surname>Paradis</surname> <given-names>K</given-names></name><name name-style="western"><surname>Langford</surname> <given-names>G</given-names></name><name name-style="western"><surname>Long</surname> <given-names>Z</given-names></name><name name-style="western"><surname>Heneine</surname> <given-names>W</given-names></name><name name-style="western"><surname>Sandstrom</surname> <given-names>P</given-names></name><name name-style="western"><surname>Switzer</surname> <given-names>WM</given-names></name><etal></etal></person-group>. <article-title>Research for cross-species transmission of porcine endogenous retrovirus in patients treated with living pig tissue</article-title>. <source>Science</source> <year>1999</year>; <volume>285</volume>: <fpage>1236</fpage>–<lpage>1241</lpage>.</citation></ref></ref-list></back></response></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Xenotransplantation [Letters]</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Xenotransplantation [Letters]</title></titleInfo><typeOfResource>text</typeOfResource><genre type="review-article" displayLabel="letter" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-L5L7X3NF-P">review-article</genre><originInfo><publisher>British Medical Journal Publishing Group</publisher><dateIssued encoding="w3cdtf">2000-03-25</dateIssued><dateCreated encoding="w3cdtf">2000-03-25</dateCreated><copyrightDate encoding="w3cdtf">2000</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><relatedItem type="host"><titleInfo><title>BMJ</title></titleInfo><titleInfo type="abbreviated"><title>BMJ</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><subject><genre>hwp-journal-coll</genre><topic>Liver disease</topic></subject><subject><genre>hwp-journal-coll</genre><topic>Immunology (including allergy)</topic></subject><subject><genre>hwp-journal-coll</genre><topic>Transplantation</topic></subject><subject><genre>hwp-journal-coll</genre><topic>Artificial and donated transplantation</topic></subject><subject><genre>hwp-journal-coll</genre><topic>Diabetes</topic></subject><identifier type="ISSN">0959-8138</identifier><identifier type="eISSN">1468-5833</identifier><identifier type="PublisherID">BMJ</identifier><identifier type="PublisherID-hwp">bmj</identifier><identifier type="PublisherID-nlm-ta">BMJ</identifier><part><date>2000</date><detail type="volume"><caption>vol.</caption><number>320</number></detail><detail type="issue"><caption>no.</caption><number>7238</number></detail><extent unit="pages"><start>868</start><total>1</total></extent></part></relatedItem><relatedItem type="constituent" otherType="response"><titleInfo><title>This new form of treatment might benefit millions</title></titleInfo><name type="personal"><namePart type="given">David K C</namePart><namePart type="family">Cooper</namePart><affiliation>Massachusetts General Hospital, 13th Street, Boston, MA 02129, USA</affiliation><affiliation>E-mail: cooper@helix.mgh.harvard.edu</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Carl G</namePart><namePart type="family">Groth</namePart><affiliation>Huddinge Hospital, Huddinge S-14186, Sweden</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Ian F C</namePart><namePart type="family">McKenzie</namePart><affiliation>Austin Research Institute, Austin and Repatriation Hospital, Heidelberg, Victoria, Australia</affiliation><role><roleTerm type="text">author</roleTerm></role></name><genre>letter</genre><originInfo><publisher>British Medical Journal Publishing Group. </publisher><dateIssued encoding="w3cdtf">2000-03-25</dateIssued></originInfo><relatedItem type="host"><titleInfo><title>BMJ</title></titleInfo><titleInfo type="abbreviated"><title>BMJ</title></titleInfo><identifier type="ISSN">0959-8138</identifier><identifier type="eISSN">1468-5833</identifier><identifier type="PublisherID">BMJ</identifier><identifier type="PublisherID-hwp">bmj</identifier><identifier type="PublisherID-nlm-ta">BMJ</identifier><part><date>2000</date></part></relatedItem><relatedItem type="isReferencedBy" displayLabel="R1"><titleInfo><title>Xenotransplantation: progress and promise</title></titleInfo><name type="personal"><namePart type="given">HY</namePart><namePart type="family">Vanderpool</namePart><role><roleTerm type="text">author</roleTerm></role></name><genre>journal</genre><note>Vanderpool HY. Xenotransplantation: progress and promise. BMJ 1999; 319: 1311. (13 November.)</note><relatedItem type="host"><titleInfo><title>BMJ</title></titleInfo><part><date>1999</date><detail type="volume"><caption>vol.</caption><number>319</number></detail><extent unit="pages"><start>1311</start></extent></part></relatedItem></relatedItem><relatedItem type="isReferencedBy" displayLabel="R2"><titleInfo><title>Xenotransplantation: perils and plagues</title></titleInfo><name type="personal"><namePart type="given">A</namePart><namePart type="family">Fano</namePart><role><roleTerm type="text">author</roleTerm></role></name><genre>journal</genre><note>Fano A. Xenotransplantation: perils and plagues. eBMJ 1999. www.bmj.com/cgi/eletters/319/7220/1311#EL2).</note><relatedItem type="host"><titleInfo><title>eBMJ</title></titleInfo><part><date>1999</date></part></relatedItem><identifier type="uri">www.bmj.com/cgi/eletters/319/7220/1311#EL2</identifier></relatedItem></relatedItem><relatedItem type="constituent" otherType="response"><titleInfo><title>Public health risk must not be dismissed</title></titleInfo><name type="personal"><namePart type="given">Emanuel</namePart><namePart type="family">Goldman</namePart><affiliation>Department of Microbiology and Molecular Genetics, New Jersey Medical School - UMDNJ, 185 South Orange Avenue, Newark, NJ 07103, USA</affiliation><affiliation>E-mail: egoldman@umdnj.edu</affiliation><role><roleTerm type="text">author</roleTerm></role></name><genre>letter</genre><originInfo><publisher>British Medical Journal Publishing Group. </publisher><dateIssued encoding="w3cdtf">2000-03-25</dateIssued></originInfo><relatedItem type="host"><titleInfo><title>BMJ</title></titleInfo><titleInfo type="abbreviated"><title>BMJ</title></titleInfo><identifier type="ISSN">0959-8138</identifier><identifier type="eISSN">1468-5833</identifier><identifier type="PublisherID">BMJ</identifier><identifier type="PublisherID-hwp">bmj</identifier><identifier type="PublisherID-nlm-ta">BMJ</identifier><part><date>2000</date></part></relatedItem><relatedItem type="isReferencedBy" displayLabel="R3"><titleInfo><title>Xenotransplantation: progress and promise</title></titleInfo><name type="personal"><namePart type="given">HY</namePart><namePart type="family">Vanderpool</namePart><role><roleTerm type="text">author</roleTerm></role></name><genre>journal</genre><note>Vanderpool HY. 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New York: Campaign for Responsible Transplantation, 2000: 12.</note><part><date>2000</date><extent unit="pages"><start>12</start></extent></part></relatedItem><relatedItem type="isReferencedBy" displayLabel="R12"><titleInfo><title>Research for cross-species transmission of porcine endogenous retrovirus in patients treated with living pig tissue</title></titleInfo><name type="personal"><namePart type="given">K</namePart><namePart type="family">Paradis</namePart><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">G</namePart><namePart type="family">Langford</namePart><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Z</namePart><namePart type="family">Long</namePart><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">W</namePart><namePart type="family">Heneine</namePart><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">P</namePart><namePart type="family">Sandstrom</namePart><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">WM</namePart><namePart type="family">Switzer</namePart><role><roleTerm type="text">author</roleTerm></role></name><genre>journal</genre><note>Paradis KLangford GLong ZHeneine WSandstrom PSwitzer WM. 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Science 1999; 285: 1236–1241.</note><relatedItem type="host"><titleInfo><title>Science</title></titleInfo><part><date>1999</date><detail type="volume"><caption>vol.</caption><number>285</number></detail><extent unit="pages"><start>1236</start><end>1241</end></extent></part></relatedItem></relatedItem></relatedItem><identifier type="istex">6B1B44B347B1024EEED8E51C87A094BFB389463B</identifier><identifier type="ark">ark:/67375/NVC-1T215RZS-P</identifier><identifier type="DOI">10.1136/bmj.320.7238.868</identifier><identifier type="href">bmj-320-868.pdf</identifier><identifier type="ArticleID">bmj.320.7238.868</identifier><identifier type="PMID">10731189</identifier><identifier type="local">bmj;320/7238/868</identifier><accessCondition type="use and reproduction" contentType="copyright">© 2000 BMJ Publishing Group Ltd.</accessCondition><recordInfo><recordContentSource authority="ISTEX" authorityURI="https://loaded-corpus.data.istex.fr" valueURI="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-7M42M2QJ-2">bmj</recordContentSource><recordOrigin>© 2000 BMJ Publishing Group Ltd.</recordOrigin></recordInfo></mods><json:item><extension>json</extension><original>false</original><mimetype>application/json</mimetype><uri>https://api.istex.fr/ark:/67375/NVC-1T215RZS-P/record.json</uri></json:item></metadata><author></author><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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