ABSTRACT Background The number of multigene‐modified donor pigs for xenotransplantation is increasing with the advent of gene‐editing technologies. However, it remains unclear which gene combination is suitable for specific organ transplantation. Methods In this study, we utilized CRISPR/Cas9 gene editing technology, piggyBac transposon system, and somatic cell cloning to construct GTKO/hCD55/hTBM/hCD39 four‐gene‐edited cloned (GEC) pigs and performed kidney transplantation from pig to rhesus monkey to evaluate the effectiveness of these GEC pigs. Results First, 107 cell colonies were obtained through drug selection, of which seven were 4‐GE colonies. Two colonies were selected for somatic cell nuclear transfer (SCNT), resulting in seven fetuses, of which four were GGTA1 biallelic knockout. Out of these four, two fetuses had higher expression of hCD55, hTBM, and hCD39. Therefore, these two fetuses were selected for two consecutive rounds of cloning, resulting in 97 live piglets. After phenotype identification, the GGTA1 gene of these pigs was inactivated, and hCD55, hTBM, and hCD39 were expressed in cells and multiple tissues. Furthermore, the numbers of monkey IgM and IgG binding to the peripheral blood mononuclear cells (PBMCs) of the 4‐GEC pigs were markedly reduced. Moreover, 4‐GEC porcine PBMCs had greater survival rates than those from wild‐type pigs through complement‐mediated cytolysis assays. In pig‐to‐monkey kidney xenotransplantation, the kidney xenograft successfully survived for 11 days. All physiological and biochemical indicators were normal, and no hyperacute rejection or coagulation abnormalities were found after transplantation. Conclusion These results indicate that the GTKO/hCD55/hTBM/hCD39 four‐gene modification effectively alleviates immune rejection, and the pig kidney can functionally support the recipient monkey's life.
