Glutathione supplementation to University of Wisconsin solution causes endothelial dysfunction

Flow cessation triggers endothelial dysfunction during organ cold storage conditions: strategies for pharmacologic intervention

BACKGROUND

Vascular pathologies constitute a major cause of graft rejection after organ transplantation. Recent studies have documented an improvement in transplant outcome when organs are preserved through pulsatile perfusion; however, the underlying mechanisms of these observations are poorly characterized. We hypothesized that the temporary absence of flow occurring in the context of organ cold storage conditions disrupts endothelial vasoprotective programs, and that this consequence of stasis may be a target for pharmacological modulation.

METHODS

The expression of the transcription factor Kruppel-like factor 2 (KLF2) and its vasoprotective target genes were assessed during cold storage conditions in cultured human endothelial cells and murine aortic segments. In addition, we evaluated the effect of simvastatin used as a supplement in a cold preservation solution on the expression of vasoprotective genes, and on endothelial activation and apoptosis.

RESULTS

The expression of endothelial KLF2 and its vasoprotective transcriptional targets were rapidly lost during cold preservation in vitro and ex vivo. Importantly, simvastatin treatment blocked the decay of KLF2, sustaining a vasoprotective phenotype, and preventing endothelial activation and apoptosis.

CONCLUSIONS

Flow stasis leads to acute endothelial dysfunction and apoptosis in the context of cold storage conditions. Supplementation of organ preservation solutions with pharmacologic agents that restore endothelial vasoprotective programs, by upregulating KLF2, may represent a significant advancement of current organ preservation techniques.

Hypothermic organ preservation by static storage methods: Current status and a view to the future

The donor organ shortage is the largest problem in transplantation today and is one where organ preservation technology has an important role to play. Static storage of solid organs, especially of the kidney, continues to be the most common method employed for storage and transport of organs from deceased donors. However, the increase in organs obtained from expanded criteria donors and donors with cardiac death provide new challenges in crafting effective preservation methods for the future. This article reviews the current status of static hypothermic storage methods and discusses potential avenues for future exploitation of this technology as the available organ pool is expanded into the more marginal donor categories.

Endothelial dysfunction: from molecular mechanisms to measurement, clinical implications, and therapeutic opportunities

Endothelial dysfunction has been implicated as a key factor in the development of a wide range of cardiovascular diseases, but its definition and mechanisms vary greatly between different disease processes. This review combines evidence from cell-culture experiments, in vitro and in vivo animal models, and clinical studies to identify the variety of mechanisms involved in endothelial dysfunction in its broadest sense. Several prominent disease states, including hypertension, heart failure, and atherosclerosis, are used to illustrate the different manifestations of endothelial dysfunction and to establish its clinical implications in the context of the range of mechanisms involved in its development. The size of the literature relating to this subject precludes a comprehensive survey; this review aims to cover the key elements of endothelial dysfunction in cardiovascular disease and to highlight the importance of the process across many different conditions.