{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T18:20:45Z","timestamp":1788373245811,"version":"build-2803163510"},"reference-count":0,"publisher":"GN1 Sistemas e Publicacoes Ltd.","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ABO"],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:p>Corneal blindness affects more than 12 million individuals worldwide; however, the availability of human donor corneas meets only a small fraction of the demand. Porcine corneal xenotransplantation represents a promising alternative because of the cornea\u2019s immune privilege and the anatomical similarities between human and porcine corneas. However, the galactose-\u03b11,3-galactose antigen expressed on porcine cells induces hyperacute rejection through the activation of human anti-Gal antibodies, complement pathways, and innate immune cell infiltration. This review summarizes the mechanisms underlying corneal immune privilege and contrasts them with galactose-\u03b11,3-galactose-mediated rejection pathways. In addition, it evaluates five major mitigation strategies: GGTA1-knockout pigs, enzymatic \u03b1-galactosidase treatment, RNA interference, decellularization, and immunosuppressive approaches, including CD40-CD154 blockade and topical tacrolimus. Preclinical studies have demonstrated that GTKO corneas can maintain transparency for longer than 1 year, whereas decellularized matrices preserve corneal architecture while exhibiting low antigenicity. These findings support the future clinical translation of porcine corneal xenotransplantation.<\/jats:p>","DOI":"10.5935\/0004-2749.2025-0337","type":"journal-article","created":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T18:10:31Z","timestamp":1788372631000},"page":"1-8","source":"Crossref","is-referenced-by-count":0,"title":["The role of the alpha-gal antigen in corneal xenotransplant rejection: a review"],"prefix":"10.5935","volume":"89","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0911-7937","authenticated-orcid":false,"given":"Augusto","family":"Villar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0315-1317","authenticated-orcid":false,"given":"Heloisa","family":"Nascimento","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8415-4274","authenticated-orcid":false,"given":"Jorge","family":"Kalil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0279-8314","authenticated-orcid":false,"given":"Tha\u00eds Maria da Mata","family":"Martins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9949-9849","authenticated-orcid":false,"given":"Luiz Vicente","family":"Rizzo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1806-610X","authenticated-orcid":false,"given":"Gabriel","family":"Barbieri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4194-5409","authenticated-orcid":false,"given":"Pedro","family":"Pires","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2559-5333","authenticated-orcid":false,"given":"Lucimeire N.","family":"Carvalho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2381-3606","authenticated-orcid":false,"given":"Larissa R.","family":"Rosa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9132-2819","authenticated-orcid":false,"given":"Rodrigo","family":"Moreira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1776-6235","authenticated-orcid":false,"given":"Carmen Luz","family":"Pessuti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9045-414X","authenticated-orcid":false,"given":"Henrique","family":"Ferrer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7329-9531","authenticated-orcid":false,"given":"Jos\u00e9 \u00c1lvaro Pereira","family":"Gomes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2636-1117","authenticated-orcid":false,"given":"Silvano","family":"Raia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8422-3898","authenticated-orcid":false,"given":"Rubens","family":"Belfort Jr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3948","published-online":{"date-parts":[[2026]]},"container-title":["Arquivos Brasileiros de Oftalmologia"],"original-title":[],"link":[{"URL":"https:\/\/www.scielo.br\/j\/abo\/a\/FW9rP56n94CRfPN7mPMNHRy\/?lang=en&ilang=pt_BR","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T18:10:32Z","timestamp":1788372632000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.scielo.br\/j\/abo\/a\/FW9rP56n94CRfPN7mPMNHRy\/?lang=en&ilang=pt_BR"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":0,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026]]},"published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.5935\/0004-2749.2025-0337","relation":{},"ISSN":["0004-2749"],"issn-type":[{"value":"0004-2749","type":"print"}],"subject":[],"published":{"date-parts":[[2026]]}}}