China - United States Towards a medical duopoly

United States and China compete in groundbreaking xenotransplant research

China has entered into competition with the United States to design the winning therapies of tomorrow. This was foreshadowed by the announcement in the world press of a successful xenotransplant by an American team of a genetically modified pig kidney into a patient, in March 2024, and, in the same month, of China's successful transplant of a pig liver into a brain-dead subject. Europe is not mentioned, and it is feared that Washington and Beijing will eventually form a duopoly to share the world's healthcare markets.

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In March 2024, to read the press, major American and Chinese medical research laboratories are clashing over the transplantation of genetically modified pig organs into humans. China's announcement of a liver transplant on a brain-dead subject is met by the American media's announcement of a successful kidney transplant on a patient. A live match for first place on decisive therapy. It should be followed by many others.

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In the upcoming xenograft market, on March 15, 2024, China put itself in a position of attack when the Global Times reported, "Chinese scientists from the Department of Hepatobiliary Surgery at Xijing Hospital, affiliated with the Air Force Medical University, have successfully transplanted the liver of a genetically modified pig into a brain-dead human subject." The transplanted liver began secreting bile as soon as blood flow was restored to the subject's body. No rejection was observed, and the transplant has been functioning for over 96 hours.

The team has demonstrated the feasibility of xeno-transplantation of a genetically modified pig liver into a human body, achieving original breakthroughs in terms of innovation of scientific theory, fundamental technological challenges and military medical applications. It will play an irreplaceable role in treatment and repair, functional reconstruction and transplant substitution."¹

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The first xenotransplant was not performed in Xi'an, the capital of Shaanxi. Six months earlier, New York University's Institute of Transplantation, NYU Langone Health, had announced that, after two months of success, it had terminated an experiment to transplant a pig kidney into a brain-dead human. 

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But more than that, on March 21, 2024, in the wards of Boston's Massachusetts General Hospital, 62-year-old Rick Slayman, who had been diagnosed with end-stage renal failure, became the first recipient of a genetically modified pig kidney transplant. At the end of the first week, his doctors declared that he was recovering well, and that they believed his new kidney would be able to function for years to come, while acknowledging that many unknowns remained as to how well xenografts would hold up over time.²

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The first race for animal-to-human transplants has thus been won by the USA. However, the race is far from over, as we need to move from experimentation to routine surgical practice. We need to move towards repeatable technologies. It remains to be seen whether economically viable solutions can be found, and by whom.

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For approaches other than harvesting a kidney from an adult pig may prove possible. By integrating human stem cells into pig embryos transferred to surrogate mothers, scientists at the Guangzhou Institutes of Biomedicine and Health have succeeded in creating chimeric humanized kidney embryos containing a combination of human and pig cells. Embryos that normally developed with tubule formation after 28 days³ .

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 Similar studies  are being conducted in American laboratories. These are still only advanced scientific approaches, but they do raise ethical questions.

Europe sidelined as Washington and Beijing race for dominance in future healthcare markets

When it comes to healthcare, Washington and Beijing are now in competition. Until now, their roles have been complementary. Advanced research was carried out in American facilities, while mass-market pharmaceutical applications were left to China, but this balance is set to change. Chinese teams are proving capable of breakthroughs in advanced biomedical fields and should, in time, be able to assert themselves worldwide alongside the best American teams, at least in specific areas.

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Unfortunately, when it comes to advanced medical technologies, Europe seems to be in the second division. Barring a hypothetical leap of faith, Europe will resign itself to letting the United States and China form a duopoly in the healthcare sector and share the world.

EV

_Sources:

1. _{Chinese scientists conduct world's first transplant of pig liver into human patient, Global Times, 15/03/2024.}
2. _{Pig kidney transplanted into living person for first time, CNN, 21/03/2024.}
3. _{Chinese scientists grow humanized kidneys in pig embryos, Xinhua, 08/09/2023.}   

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