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Kern B, Ashraf MI, Reutzel-Selke A, Mengwasser J, Polenz D, Michaelis E, Pratschke J, Tullius SG, Witzel C, Sauer IM. Moderate LMWH Anticoagulation Improves Success Rate of Hind Limb Allotransplantation in Mice. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5249. [PMID: 38152709 PMCID: PMC10752453 DOI: 10.1097/gox.0000000000005249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 07/12/2023] [Indexed: 12/29/2023]
Abstract
Background The mouse hind limb model represents a powerful research tool in vascularized composite tissue allotransplantation, but its applicability is limited due to poor graft survival (62%-83%). Vascular thrombosis and massive hemorrhage are the major causes for these drop-outs. We hypothesize that because of better anticoagulation effect and lower risk of thrombocytopenia, application of low molecular weight heparin (LMWH) will minimize vascular complications and enhance graft and animal survival. Methods Fifty allogeneic hind limb transplantations were performed (C57BL/6 to DBA/2 mice) using five different anticoagulation protocols. Bleeding and thromboembolic events were recorded macroscopically by postoperative hemorrhage and livid discoloration of the graft, respectively. Graft perfusion and survival were monitored daily by capillary-refill-time of graft toes within 2-3 seconds. Vascular congestion and tissue necrosis were examined by histological evaluation of hematoxylin-eosin-stained tissue sections. Results All transplantations were technically successful. Increase in thromboembolic events and a concomitant decrease in bleeding events were observed with the decreasing concentration of heparin in the perfusion solution. Although treatment of donor and recipient with low dose of LMWH could not reduce thromboembolic events, moderate dose effectively reduced these events. Compared with the poor outcome of graft perfusion with heparin alone, additional treatment of donor and recipient with low dose of LMWH improved graft and animal survival by 18%. Interestingly, animals treated with moderate dose of LMWH demonstrated 100% graft and animal survival. Conclusions Treatment of donor and recipient mice with a moderate dose of LMWH prevents vascular complications and improves the outcome of murine hind limb transplants.
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Affiliation(s)
- Barbara Kern
- From the Department of Surgery, Campus Charité Mitte | Campus Virchow Klinikum, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Department of Plastic Surgery, Campus Charité Mitte | Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Muhammad-Imtiaz Ashraf
- From the Department of Surgery, Campus Charité Mitte | Campus Virchow Klinikum, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Anja Reutzel-Selke
- From the Department of Surgery, Campus Charité Mitte | Campus Virchow Klinikum, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Joerg Mengwasser
- From the Department of Surgery, Campus Charité Mitte | Campus Virchow Klinikum, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Department of General, Visceral and Transplant Surgery, Regenerative Medicine and Experimental Surgery, Hannover Medical School, Hannover, Germany
| | - Dietrich Polenz
- From the Department of Surgery, Campus Charité Mitte | Campus Virchow Klinikum, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Edward Michaelis
- Department of Pathology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Institute of Pathology, DRK Kliniken Berlin, Berlin, Germany
| | - Johann Pratschke
- From the Department of Surgery, Campus Charité Mitte | Campus Virchow Klinikum, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Stefan G. Tullius
- Division of Transplant Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass
- Einstein Berlin Institute of Health Visiting Fellow, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Witzel
- Department of Plastic Surgery, Campus Charité Mitte | Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Igor M. Sauer
- From the Department of Surgery, Campus Charité Mitte | Campus Virchow Klinikum, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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Fleissig YY, Beare JE, LeBlanc AJ, Kaufman CL. Evolution of the rat hind limb transplant as an experimental model of vascularized composite allotransplantation: Approaches and advantages. SAGE Open Med 2020; 8:2050312120968721. [PMID: 33194200 PMCID: PMC7607771 DOI: 10.1177/2050312120968721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/04/2020] [Indexed: 11/16/2022] Open
Abstract
As clinical experience with surgical techniques and immunosuppression in vascularized composite allotransplantation recipients has accumulated, vascularized composite allotransplantation for hand and face have become standard of care in some countries for select patients who have experienced catastrophic tissue loss. Experience to date suggests that clinical vascularized composite allotransplantation grafts undergo the same processes of allograft rejection as solid organ grafts. Nonetheless, there are some distinct differences, especially with respect to the immunologic influence of the skin and how the graft is affected by environmental and traumatic insults. Understanding the mechanisms around these similarities and differences has the potential to not only improve vascularized composite allotransplantation outcomes but also outcomes for all types of transplants and to contribute to our understanding of how complex systems of immunity and function work together. A distinct disadvantage in the study of upper extremity vascularized composite allotransplantation recipients is the low number of clinical transplants performed each year. As upper extremity transplantation is a quality of life rather than a lifesaving transplant, these numbers are not likely to increase significantly until the risks of systemic immunosuppression can be reduced. As such, experimental models of vascularized composite allotransplantation are essential to test hypotheses regarding unique characteristics of graft rejection and acceptance of vascularized composite allotransplantation allografts. Rat hind limb vascularized composite allotransplantation models have been widely used to address these questions and provide essential proof-of-concept findings which can then be extended to other experimental models, including mice and large animal models, as new concepts are translated to the clinic. Here, we review the large body of rat hind limb vascularized composite allotransplantation models in the literature, with a focus on the various surgical models that have been developed, contrasting the characteristics of the specific model and how they have been applied. We hope that this review will assist other researchers in choosing the most appropriate rat hind limb transplantation model for their scientific interests.
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Affiliation(s)
- Yoram Y Fleissig
- Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, KY, USA
| | - Jason E Beare
- The Cardiovascular Innovation Institute, The University of Louisville, Louisville, KY, USA
| | - Amanda J LeBlanc
- The Cardiovascular Innovation Institute, The University of Louisville, Louisville, KY, USA
| | - Christina L Kaufman
- Department of Cardiovascular and Thoracic Surgery, The University of Louisville, Louisville, KY, USA
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Vernon R, Wang J, Song M, Wilson N, Moris D, Cendales L. Vascularized Composite Allotransplantation: A Functional Hind Limb Model in Mice. J Surg Res 2020; 250:119-124. [DOI: 10.1016/j.jss.2019.12.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/18/2019] [Accepted: 12/28/2019] [Indexed: 02/03/2023]
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Yan Y, Wood MD, Moore AM, Snyder-Warwick AK, Hunter DA, Newton P, Poppler L, Tung TH, Johnson PJ, Mackinnon SE. Robust Axonal Regeneration in a Mouse Vascularized Composite Allotransplant Model Undergoing Delayed Tissue Rejection. Hand (N Y) 2016; 11:456-463. [PMID: 28149214 PMCID: PMC5256642 DOI: 10.1177/1558944715620791] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Nerve regeneration in vascularized composite allotransplantation (VCA) is not well understood. Allogeneic transplant models experience complete loss of nerve tissue and axonal regeneration without immunosuppressive therapy. The purpose of this study was to determine the impact of incomplete immunosuppression on nerve regeneration. Methods: In this study, transgenic mice (4 groups in total) with endogenous fluorescent protein expression in axons (Thy1-YFP) and Schwann cells (S100-GFP) were used to evaluate axonal regeneration and Schwann cell (SC) migration in orthotopic-limb VCA models with incomplete immunosuppression using Tacrolimus (FK506). Survival and complication rates were assessed to determine the extent of tissue rejection. Nerve regeneration was assessed using serial imaging of axonal progression and SC migration and viability. Histomorphometry quantified the extent of axonal regeneration. Results: Incomplete immunosuppression with FK506 resulted in delayed rejection of skin, muscle, tendon, and bone in the transplanted limb. In contrast, the nerve demonstrated robust axonal regeneration and SC viability based on strong fluorescent protein expression by SCs and axons in transgenic donors and recipients. Total myelinated axon numbers measured at 8 weeks were comparable in all VCA groups and not statistically different from the syngeneic donor control group. Conclusions: Our data suggest that nerve and SCs are much weaker antigens compared with skin, muscle, tendon, and bone in VCA. To our knowledge, this study is the first to prove the weak antigenicity of nerve tissue in the orthotopic VCA mouse model.
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Affiliation(s)
- Ying Yan
- Washington University School of Medicine, St. Louis, MO, USA
| | - Matthew D. Wood
- Washington University School of Medicine, St. Louis, MO, USA
| | - Amy M. Moore
- Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - Piyaraj Newton
- Washington University School of Medicine, St. Louis, MO, USA
| | - Louis Poppler
- Washington University School of Medicine, St. Louis, MO, USA
| | - Thomas H. Tung
- Washington University School of Medicine, St. Louis, MO, USA
| | | | - Susan E. Mackinnon
- Washington University School of Medicine, St. Louis, MO, USA,Susan E. Mackinnon, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, 660 South Euclid, Campus Box 8238, St. Louis, MO 63110, USA.
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Furtmüller GJ, Oh B, Grahammer J, Lin CH, Sucher R, Fryer ML, Raimondi G, Lee WPA, Brandacher G. Orthotopic Hind Limb Transplantation in the Mouse. J Vis Exp 2016:53483. [PMID: 26967527 PMCID: PMC4828154 DOI: 10.3791/53483] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
In vivo animal model systems, and in particular mouse models, have evolved into powerful and versatile scientific tools indispensable to basic and translational research in the field of transplantation medicine. A vast array of reagents is available exclusively in this setting, including mono- and polyclonal antibodies for both diagnostic and interventional applications. In addition, a vast number of genotyped, inbred, transgenic, and knock out strains allow detailed investigation of the individual contributions of humoral and cellular components to the complex interplay of an immune response and make the mouse the gold standard for immunological research. Vascularized Composite Allotransplantation (VCA) delineates a novel field of transplantation using allografts to replace "like with like" in patients suffering traumatic or congenital tissue loss. This surgical methodological protocol shows the use of a non-suture cuff technique for super-microvascular anastomosis in an orthotopic mouse hind limb transplantation model. The model specifically allows for comparison between established paradigms in solid organ transplantation with a novel form of transplants consisting of various different tissue components. Uniquely, this model allows for the transplantation of a viable vascularized bone marrow compartment and niche that have the potential to exert a beneficial effect on the balance of immune acceptance and rejection. This technique provides a tool to investigate alloantigen recognition and allograft rejection and acceptance, as well as enables the pursuit of functional nerve regeneration studies to further advance this novel field of transplantation.
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Affiliation(s)
- Georg J Furtmüller
- Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, Johns Hopkins University School of Medicine
| | - Byoungchol Oh
- Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, Johns Hopkins University School of Medicine
| | - Johanna Grahammer
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University
| | - Cheng-Hung Lin
- Center for Vascularized Composite Allotransplantation, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and School of Medicine
| | - Robert Sucher
- Department of General, Visceral and Transplant Surgery, Charite Berlin
| | - Madeline L Fryer
- Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, Johns Hopkins University School of Medicine
| | - Giorgio Raimondi
- Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, Johns Hopkins University School of Medicine
| | - W P Andrew Lee
- Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, Johns Hopkins University School of Medicine
| | - Gerald Brandacher
- Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, Johns Hopkins University School of Medicine;
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Zhu P, Esckilsen S, Atkinson C, Chen XP, Nadig SN. A simplified cuff technique for abdominal aortic transplantation in mice. J Surg Res 2015; 200:707-13. [PMID: 26375503 DOI: 10.1016/j.jss.2015.08.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 08/06/2015] [Accepted: 08/21/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Allograft arteriopathy is still a leading cause of late organ failure. The aortic allograft model in mice has been used to study chronic rejection and has given useful information in the development of graft arteriosclerosis. However, the technical difficulties of small vessel anastomoses still continue to limit its widespread use. We introduce a new simple method for aortic transplantation in mice. METHODS The descending aorta or infrarenal aorta from the donor mouse was anastomosed to the infrarenal aorta using a cuff technique. Aortic transplantation was performed in 30 mice, 10 isografts and 20 allografts. No immunosuppression was administered, and the recipients were sacrificed at day 28. The grafts were histologically analyzed. RESULTS Implantation of grafts could be completed in an average of 23 min. There was no technical failure in all 60 anastomoses. The overall survival rate was 93.3%. Histology of aortas revealed typical aspects of chronic rejection in the allografts at day 28. No significant lesion was observed in isografts. CONCLUSIONS We have developed an innovative, stable, and simple aortic transplantation model in mice, which is useful for vascular research in transplantation and beyond.
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MESH Headings
- Allografts/pathology
- Allografts/transplantation
- Anastomosis, Surgical
- Animals
- Aorta, Abdominal/pathology
- Aorta, Abdominal/transplantation
- Aorta, Thoracic/pathology
- Aorta, Thoracic/transplantation
- Graft Rejection/pathology
- Isografts/pathology
- Isografts/transplantation
- Male
- Mice
- Mice, Inbred BALB C/surgery
- Mice, Inbred C57BL/surgery
- Models, Animal
- Transplantation, Homologous/methods
- Transplantation, Isogeneic/methods
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Affiliation(s)
- Peng Zhu
- Division of Transplantation, Department of Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, South Carolina
| | - Scott Esckilsen
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, South Carolina
| | - Carl Atkinson
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, South Carolina; Division of Transplantation, Department of Surgery, Members of the South Carolina Investigators in Transplantation (SCIT), Charleston, SC
| | - Xiao-Ping Chen
- Division of Transplantation, Department of Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Satish N Nadig
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, South Carolina; Division of Transplantation, Department of Surgery, Members of the South Carolina Investigators in Transplantation (SCIT), Charleston, SC.
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Li Z, Le Moine A. Mouse Models of Experimental Vascularized Composite Allotransplantation. CURRENT TRANSPLANTATION REPORTS 2014. [DOI: 10.1007/s40472-014-0024-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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The neck as a preferred recipient site for vascularized composite allotransplantation in the mouse. Plast Reconstr Surg 2014; 133:133e-141e. [PMID: 24469184 DOI: 10.1097/01.prs.0000437229.69811.3a] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The mouse is still considered the premier model in basic immunologic and transplant-related research. However, because of its much smaller size, the mouse has proven to be a technically difficult and physiologically fragile model from a surgical standpoint. That is why only a few studies currently use mouse models in vascularized composite allotransplantation. The purpose of this study therefore was to develop a reproducible and reliable surgical technique in the mouse for future vascularized composite allotransplantation studies. METHODS Forty DBA/2 (H2-D) hindlimb osteomyocutanous flaps were transplanted into the right cervical region of C57BL/6 (H2-D) mice using a nonsuture cuff technique. The donor iliac artery and femoral vein were mounted with polyimide cuffs (inner diameter, 0.404 mm; wall thickness, 0.025 mm) and subsequently anastomosed to the recipient common carotid artery and external jugular vein. Immunosuppressant drugs were used postoperatively. RESULTS The overall success rate was 85.0 percent (34 of 40). The mortality rate was 12.5 percent (five of 40); all deaths resulted from perioperative bleeding. Only one arterial insufficiency was encountered after transplantation. The operative time was approximately 2 hours. Indefinite allograft survival (>120 days) could be achieved using a specific immunosuppressant regimen. CONCLUSIONS This novel mouse model allows performing vascularized composite allotransplantation with very high success and survival rates. The advantages over conventional models are multifold. A high-flow common carotid artery keeps the anastomosis patent, and diastolic suction of the heart reduces the risk of venous stasis and thrombus formation. Less destruction because of the heterotopic positioning of the hindlimb graft further reduces the associated mortality and morbidity in this fragile model.
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Brandacher G, Grahammer J, Sucher R, Lee WPA. Animal models for basic and translational research in reconstructive transplantation. ACTA ACUST UNITED AC 2012; 96:39-50. [PMID: 22457176 DOI: 10.1002/bdrc.21002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Reconstructive transplantation represents a bona fide option for select patients with devastating tissue loss, which could better restore the appearance, anatomy, and function than any other conventional treatment currently available. Despite favorable outcomes, broad clinical application of reconstructive transplantation is limited by the potential side effects of chronic multidrug immunosuppression. Thus, any reconstructive measures to improve these non-life-threatening conditions must address a delicate balance of risks and benefits. Today, several exciting novel therapeutic strategies, such as the implementation of cellular therapies including bone marrow or stem cells that integrate the concepts of immune regulation with those of nerve regeneration, are on the horizon. The development of reliable and reproducible small and large animal models is essential for the study of the unique immunological and biological aspects of vascularized composite allografts and to translate such novel immunoregulatory and tolerance-inducing strategies and therapeutic concepts from the bench to bedside. This review provides an overview of the multitude of small and large animal models that have been particularly designed for basic and translational research related to reconstructive transplantation.
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Affiliation(s)
- Gerald Brandacher
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryand 21205, USA.
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Abstract
Organ transplantation has become a successful and acceptable treatment for end-stage organ failure. Such success has allowed transplant patients to resume a normal lifestyle. The demands for transplantation have been steadily increasing, as more patients and new diseases are being deemed eligible for treatment via transplantation. However, it is clear that human organs will never meet the increasing demand of transplantation. Therefore, scientists must continue to pursue alternative therapies and explore new treatments to meet the growing demand for the limited number of organs available. Transplanting organs from animals into humans (xenotransplantation) is one such therapy. The observed enthusiasm for xenotransplantation, irrespective of the severe shortage of human organs and tissues available for transplantation, can be said to stem from at least two factors. First, there is the possibility that animal organs and tissues might be less susceptible than those of humans to the recurrence of disease processes. Second, a xenograft might be used as a vehicle for introducing novel genes or biochemical processes which could be of therapeutic value for the transplant recipient.To date, millions of lives have been saved by organ transplantation. These remarkable achievements would have been impossible without experimental transplantation research in animal models. Presently, more than 95% of organ transplantation research projects are carried out using rodents, such as rats and mice. The key factor to ensure the success of these experiments lies in state-of-the art experimental surgery. Small animal models offer unique advantages for the mechanistic study of xenotransplantation rejection. Currently, multiple models have been developed for investigating the different stages of immunological barriers in xenotransplantation. In this chapter, we describe six valuable small animal models that have been used in xenotransplantation research. The methodology for the small animal model establishment includes animal selection, preoperative care, anesthesia, postoperative care, and detailed procedures.
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A Modified Rat Model of Acute Limb Allograft Rejection. Transplant Proc 2011; 43:3987-93. [DOI: 10.1016/j.transproceed.2011.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 08/29/2011] [Accepted: 09/08/2011] [Indexed: 11/22/2022]
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Yan Y, Johnson PJ, Glaus SW, Hunter DA, Mackinnon SE, Tung TH. A novel model for evaluating nerve regeneration in the composite tissue transplant: the murine heterotopic limb transplant. Hand (N Y) 2011; 6:304-12. [PMID: 22942855 PMCID: PMC3153617 DOI: 10.1007/s11552-011-9343-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE For individuals who have experienced debilitating upper extremity injury or amputation, hand transplantation holds the potential for drastic quality of life improvement. This potential depends on adequate nerve regeneration into the transplant and reanimation of graft musculature. In this study, we demonstrate the use of a murine heterotopic limb transplant model for evaluation of nerve regeneration in a composite tissue allograft (CTA). We also compare the effects of various immunosuppressive regimens on nerve regeneration in this model. METHODS The study consisted of five groups of mice, all of which underwent heterotopic limb transplant with coaptation of the recipient and donor sciatic nerves. The groups received the following immunosuppressive regimens: group A (positive control)-syngeneic transplant, no immunosuppression; group B (negative control)-allogeneic transplant, no immunosuppression; group C-allogeneic transplant, FK-506 + MR1; group D-allogeneic transplant, MR1 + CTLA4-Ig; group E-syngeneic transplant, FK-506 treatment with preloading. RESULTS Group B animals showed signs of transplant rejection as early as 5 days postoperatively. Except for one mouse from group C and one mouse from group D, all other animals had viable transplants and nerve regeneration present in the donor sciatic nerve at the 3-week endpoint of the study. CONCLUSIONS To our knowledge, this represents the first report of the use of a mouse CTA model for evaluation of nerve regeneration. The mouse heterotopic limb transplant model will be a valuable tool for CTA research since it can be performed with more ease, and with less host morbidity and mortality than the mouse orthotopic model.
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Affiliation(s)
- Ying Yan
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8238, St. Louis, MO 63110 USA
| | - Philip J. Johnson
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8238, St. Louis, MO 63110 USA
| | - Simone W. Glaus
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8238, St. Louis, MO 63110 USA
| | - Daniel A. Hunter
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8238, St. Louis, MO 63110 USA
| | - Susan E. Mackinnon
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8238, St. Louis, MO 63110 USA
| | - Thomas H. Tung
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8238, St. Louis, MO 63110 USA
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Pomahac B, Nowinski D, Diaz-Siso JR, Bueno EM, Talbot SG, Sinha I, Westvik TS, Vyas R, Singhal D. Face Transplantation. Curr Probl Surg 2011; 48:293-357. [DOI: 10.1067/j.cpsurg.2011.01.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Miyamoto S, Sakuraba M, Asano T, Tsuchiya S, Hamamoto Y, Onoda S, Tomori Y, Yasunaga Y, Harii K. Optimal technique for microvascular anastomosis of very small vessels: Comparative study of three techniques in a rat superficial inferior epigastric arterial flap model. J Plast Reconstr Aesthet Surg 2010; 63:1196-201. [DOI: 10.1016/j.bjps.2009.05.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Revised: 05/01/2009] [Accepted: 05/27/2009] [Indexed: 11/15/2022]
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Experimental Composite Tissue Transplantation Models. Plast Reconstr Surg 2010. [DOI: 10.1007/978-1-84882-513-0_51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Long-Term Limb Allograft Survival Using a Short Course of Anti-CD45RB Monoclonal Antibody, LF 15-0195, and Rapamycin in a Mouse Model. Transplantation 2007; 84:1636-43. [DOI: 10.1097/01.tp.0000290277.23186.ad] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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18
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Predictive value and limitations of animal models for human transplantation: do we need more models for facial transplantation? Transplant Rev (Orlando) 2006. [DOI: 10.1016/j.trre.2006.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Ulusal AE, Ulusal BG, Hung LM, Wei FC. Temporary assisting suspension suture technique for successful microvascular anastomosis of extremely small and thin walled vessels for mice transplantation surgery. Plast Reconstr Surg 2006; 116:1438-41. [PMID: 16217492 DOI: 10.1097/01.prs.0000182379.88725.0d] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Dissection and microsurgical anastomosis in small and thin-walled vessels is challenging. Temporary assisting suspension suture technique was developed to overcome those difficulties in establishing successful composite tissue allotransplantation in mice. The operations were performed in 12- to 16-week-old Balb/c mice weighing 25 to 30 grams as both donor and recipient animals. Extended vascularized groin cutaneous flaps based on the superficial epigastric vessels were used. A total of 10 groin cutaneous flaps were transplanted. Three temporary assisting suspension sutures of 11-0 nylon were placed at the 12-, 4-, and 8-o'clock positions to donor and recipient artery and vein before the anastomosis. This technique allowed atraumatic dissection of delicate and thin vessels, prevented vessel wall collapse, and facilitated adequate exposure of the lumen during placement of the permanent microvascular sutures. Thus, the microvascular anastomosis was performed in an unusual manner. The temporary assisting suspension sutures were removed just before the permanent suture was tied down. The mean operation time was 1 hour and 45 minutes with an ischemia time of 1 hour. Ninety-percent success in immediate and late-term patency rates was achieved, which was confirmed by transplant survival. This technique was proven to be useful for microvascular anastomosis in thin-walled vessels and is recommended.
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Affiliation(s)
- Ali Engin Ulusal
- Department of Plastic Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei, Taiwan
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Lorenzo AR, Alvarez A, Garcia-Barreiro J, Centeno A, Lopez E, Martelo F. Design and creation of an experimental program of advanced training in reconstructive microsurgery. Microsurgery 2006; 26:421-8. [PMID: 16924624 DOI: 10.1002/micr.20265] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In this study, we design an experimental protocol for the purpose of enhancing performance in training in microsurgery. It is based on five free tissue transfer exercises in rat (epigastric cutaneous flap, saphenous fasciocutaneous flap, epigastric neurovascular flap, saphenous muscular flap, and hindlimb replantation), which simulate the principal clinical procedures of reconstructive microsurgery. The first part of the study consists of an anatomical review of the flaps of 5 rats and in the second part we have carried out the free transfer of flaps on 25 rats divided into 5 groups. To differentiate between them, we have created a mathematical function, referred to as difficulty in a microsurgical exercise, which has enabled us to establish a scale of progression for training, ranging form the easiest to the most difficult. As a conclusion, we believe that this protocol is a useful instrument as it allows for a more precise assessment of microsurgical capacity due to enhanced accuracy in the reproduction of global procedures and the fact that the quantification of progress in training is based on clinical monitoring after 7 days.
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Tung TH, Mohanakumar T, Mackinnon SE. A subcutaneous heterotopic limb transplantation model in the mouse for prolonged allograft survival. Microsurgery 2002; 21:298-305. [PMID: 11754429 DOI: 10.1002/micr.1056] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A heterotopic position of a limb allograft is advantageous in the fragile mouse model to reduce mortality but is prone to autotomy. The purpose of this study was to describe a new heterotopic limb transplantation model in the mouse for prolonged allograft survival. Eleven lower hindlimbs were transplanted in a heterotopic subcutaneous position in the groin of the recipient animal with the donor skin inset as a skin paddle for monitoring. Seven transplants were syngeneic (Balb/c) and four were allogeneic (C57Bl/6 donor). The overall success rate (acute survival < 7 days) was 73% (8/11) and the mortality rate was 18% (2/11). Five of seven syngeneic transplants survived for 60 days and were harvested for histology. Recipients of successful allogeneic transplants (n = 3) received no immunosuppression and rejected their allografts between 8 and 11 days postoperatively. Mixed lymphocyte culture and flow cytometry demonstrated secondary immune responses by pre-sensitized animals, and histology showed lymphocytic infiltration and necrosis consistent with acute rejection.
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Affiliation(s)
- T H Tung
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
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Reis ED, Roqué M, Cordon-Cardo C, Drobnjak M, Fuster V, Badimon JJ. Apoptosis, proliferation, and p27 expression during vessel wall healing: time course study in a mouse model of transluminal femoral artery injury. J Vasc Surg 2000; 32:1022-9. [PMID: 11054235 DOI: 10.1067/mva.2000.109763] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The balance between cell death and proliferation in the vessel wall influences neointimal formation, remodeling, and eventual luminal narrowing after arterial injury. In this study, the time course of apoptosis, proliferation, and expression of p27-a critical regulator of cell-cycle progression-is characterized in a mouse model of transluminal arterial injury associated with substantial neointimal formation. METHODS C57BL/6 mice underwent bilateral femoral artery injury by passage of an angioplasty guidewire. Expression of p27, Ki67 proliferative index, and apoptosis, as well as histomorphometry, were analyzed in cross sections of uninjured arteries and arteries harvested at different time intervals after injury. RESULTS In the uninjured arteries, no apoptotic cells were detected, and p27 and Ki67 were expressed in less than 5% of medial cells. After injury, apoptosis increased markedly in medial smooth muscle cells from 1 to 24 hours and decreased gradually thereafter. Ki67 proliferative index increased after 1 week, peaked at 2 weeks in both the media and neointima, and decreased thereafter. p27 expression was undetectable from 1 to 48 hours, and increased gradually from 1 to 4 weeks. Well-developed neointima was present at 2 and 4 weeks. CONCLUSIONS In vivo injury to the mouse femoral artery evokes a rapid apoptotic response and downregulation of p27, followed by gradual increase in proliferation. During later phases of arterial repair, p27 expression increases while a shift of proliferation rates toward baseline occurs. Future experiments using this model in genetically modified mice may help identify specific cell-cycle regulatory molecules as therapeutic targets for control of pathologic arterial healing.
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Affiliation(s)
- E D Reis
- Department of Surgery and The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY 10029-6574, USA
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