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Gonzalez JM, Villarreal C, Fasci A, Rocco DD, Salazar S, Khalil A, Wearden B, Oseghale J, Garcia M, Portillo DJ, Hood RL. Evaluating the Performance of a Nonelectronic, Versatile Oxygenating Perfusion System across Viscosities Representative of Clinical Perfusion Solutions Used for Organ Preservation. Bioengineering (Basel) 2022; 10:bioengineering10010002. [PMID: 36671574 PMCID: PMC9854583 DOI: 10.3390/bioengineering10010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/08/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022]
Abstract
Introduction: On the United States' Organ Transplantation Waitlist, approximately 17 people die each day waiting for an organ. The situation continues to deteriorate as the discrepancy between harvested organs and the number of patients in need is increasing. Static cold storage is the clinical standard method for preserving a harvested organ but is associated with several drawbacks. Machine perfusion of an organ has been shown to improve preservation quality as well as preservation time over static cold storage. While there are machine perfusion devices clinically available, they are costly and limited to specific organs and preservation solutions. This study presents a versatile oxygenating perfusion system (VOPS) that supplies oxygen and pulsatile perfusion. Materials and Methods: Experiments evaluated the system's performance with a human kidney mimicking hydraulic analog using multiple compressed oxygen supply pressures and aqueous solutions with viscosities ranging from 1 to 6.5 cP, which simulated viscosities of commonly used organ preservation solutions. Results and Conclusions: The VOPS produced mean flow rates ranging from 0.6 to 28.2 mL/min and perfusion pressures from 4.8 to 96.8 mmHg, which successfully achieved the desired perfusion parameters for human kidneys. This work provides evidence that the VOPS described herein has the versatility to perfuse organs using many of the clinically available preservation solutions.
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Affiliation(s)
- Jose M. Gonzalez
- Department of Mechanical Engineering, The University of Texas at San Antonio, 1 UTSA Circle, San Antonio, TX 78249, USA
| | - Carorina Villarreal
- Department of Mechanical Engineering, The University of Texas at San Antonio, 1 UTSA Circle, San Antonio, TX 78249, USA
| | - Anjelyka Fasci
- Department of Mechanical Engineering, The University of Texas at San Antonio, 1 UTSA Circle, San Antonio, TX 78249, USA
| | - David Di Rocco
- Department of Mechanical Engineering, The University of Texas at San Antonio, 1 UTSA Circle, San Antonio, TX 78249, USA
| | - Sophia Salazar
- Department of Mechanical Engineering, The University of Texas at San Antonio, 1 UTSA Circle, San Antonio, TX 78249, USA
| | - Anis Khalil
- Department of Mechanical Engineering, The University of Texas at San Antonio, 1 UTSA Circle, San Antonio, TX 78249, USA
| | - Brandt Wearden
- Department of Mechanical Engineering, The University of Texas at San Antonio, 1 UTSA Circle, San Antonio, TX 78249, USA
| | - Jessica Oseghale
- Department of Biomedical Engineering, The University of Texas at San Antonio, 1 UTSA Circle, San Antonio, TX 78249, USA
| | - Mariana Garcia
- Department of Mechanical Engineering, The University of Texas at San Antonio, 1 UTSA Circle, San Antonio, TX 78249, USA
| | - Daniel J. Portillo
- Department of Mechanical Engineering, The University of Texas at San Antonio, 1 UTSA Circle, San Antonio, TX 78249, USA
- Correspondence: (D.J.P.); (R.L.H.)
| | - R. Lyle Hood
- Department of Mechanical Engineering, The University of Texas at San Antonio, 1 UTSA Circle, San Antonio, TX 78249, USA
- Department of Biomedical Engineering, The University of Texas at San Antonio, 1 UTSA Circle, San Antonio, TX 78249, USA
- Correspondence: (D.J.P.); (R.L.H.)
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Dholakia S, Royston E, Sharples EJ, Sankaran V, Ploeg RJ, Friend PJ. Preserving and perfusing the allograft pancreas: Past, present, and future. Transplant Rev (Orlando) 2018; 32:127-131. [DOI: 10.1016/j.trre.2018.02.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 02/09/2018] [Accepted: 02/19/2018] [Indexed: 01/12/2023]
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Zhang H, Barralet JE. Mimicking oxygen delivery and waste removal functions of blood. Adv Drug Deliv Rev 2017; 122:84-104. [PMID: 28214553 DOI: 10.1016/j.addr.2017.02.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 02/13/2017] [Accepted: 02/13/2017] [Indexed: 12/20/2022]
Abstract
In addition to immunological and wound healing cell and platelet delivery, ion stasis and nutrient supply, blood delivers oxygen to cells and tissues and removes metabolic wastes. For decades researchers have been trying to develop approaches that mimic these two immediately vital functions of blood. Oxygen is crucial for the long-term survival of tissues and cells in vertebrates. Hypoxia (oxygen deficiency) and even at times anoxia (absence of oxygen) can occur during organ preservation, organ and cell transplantation, wound healing, in tumors and engineering of tissues. Different approaches have been developed to deliver oxygen to tissues and cells, including hyperbaric oxygen therapy (HBOT), normobaric hyperoxia therapy (NBOT), using biochemical reactions and electrolysis, employing liquids with high oxygen solubility, administering hemoglobin, myoglobin and red blood cells (RBCs), introducing oxygen-generating agents, using oxygen-carrying microparticles, persufflation, and peritoneal oxygenation. Metabolic waste accumulation is another issue in biological systems when blood flow is insufficient. Metabolic wastes change the microenvironment of cells and tissues, influence the metabolic activities of cells, and ultimately cause cell death. This review examines advances in blood mimicking systems in the field of biomedical engineering in terms of oxygen delivery and metabolic waste removal.
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Affiliation(s)
- David J. Eve
- Center of Excellence for Aging and Brain Repair, Department of Neurosurgery, University of South Florida College of Medicine, Tampa, FL 33612, USA
| | - Paul R. Sanberg
- Center of Excellence for Aging and Brain Repair, Department of Neurosurgery, University of South Florida College of Medicine, Tampa, FL 33612, USA
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5
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Abstract
In comparison to procedures used for the separation of individual cell types from other organs, the process of human pancreatic islet isolation aims to digest the pancreatic exocrine matrix completely without dispersing the individual cells within the endocrine cell cluster. This objective is unique within the field of tissue separation, and outlines the challenge of islet isolation to balance two opposing priorities. Although significant progress has been made in the characterization and production of enzyme blends for islet isolation, there are still numerous areas which require improvement. The ultimate goal of enzyme production, namely the routine production of a consistent and standardized enzyme blend, has still not been realized. This seems to be mainly the result of a lack of detailed knowledge regarding the structure of the pancreatic extracellular matrix and the synergistic interplay between collagenase and different supplementary proteases during the degradation of the extracellular matrix. Furthermore, the activation of intrinsic proteolytic enzymes produced by the pancreatic acinar cells, also impacts on the chance of a successful outcome of human islet isolation. This overview discusses the challenges of pancreatic enzymatic digestion during human islet isolation, and outlines the developments in this field over the past 5 decades.
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Affiliation(s)
- Daniel Brandhorst
- Nuffield Department of Surgical Sciences, University of Oxford, United Kingdom
| | - Heide Brandhorst
- Nuffield Department of Surgical Sciences, University of Oxford, United Kingdom
| | - Paul R V Johnson
- Nuffield Department of Surgical Sciences, University of Oxford, United Kingdom
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Li X, Zhang J, Sang L, Chu Z, Dong M. Influence of the Two-Layer Preservation Method on Human Pancreatic Islet Isolation: A Meta-Analysis. Int J Artif Organs 2015; 38:117-25. [PMID: 25790972 DOI: 10.5301/ijao.5000391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2015] [Indexed: 11/20/2022]
Abstract
Introduction There has been continuous debate on whether the Two-Layer Method (TLM) is superior to the University of Wisconsin solution (UW) for preserving human pancreas prior to islet isolation. The objective of the current meta-analysis is to assess which method is superior. Methods We searched electronic databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials) for relevant human trials published in the English language from January 2000 to October 2013. Data on donor characteristics and islet isolation outcomes were extracted. Results 14 articles containing 18 human studies were included in this meta-analysis. In comparison to UW alone, TLM alone produced a significantly higher islet yield (weighted mean difference, 776.32; 95% confidence interval; 370.82-1181.82; P = .0002). TLM alone also yielded higher proportion of transplantable preparations (odds ratio, 1.60; 95% confidence interval; 1.15-2.23; P = .005). The following measures did not differ: islet viability (weighted mean difference, 2.10; −2.41-6.60; P = .360), purity (weighted mean difference, −0.92; −3.75-1.91; P = .520) and function assessed by measuring the stimulation index (weighted mean difference, 0.17; −0.21-0.55; P = .380). When comparing TLM following UW storage with UW alone, the results were similar to the previous ones. Conclusions This data indicates that the TLM can improve islet yield and increase the opportunities of human pancreatic islet transplantation. Therefore, the TLM should be recommended for preserving human pancreas prior to islet isolation.
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Barlow AD, Hosgood SA, Nicholson ML. Current state of pancreas preservation and implications for DCD pancreas transplantation. Transplantation. 2013; 95:1419-1424. [PMID: 23579769 DOI: 10.1097/tp.0b013e318285558f] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
One of the main factors limiting potential uptake of pancreas transplantation, particularly in the United Kingdom, is the shortage of grafts. There has therefore been a recent expansion, particularly in the United Kingdom, in the utilization of grafts from donation after cardiac death (DCD) donors. These grafts are subjected to a greater ischemic insult and are arguably at higher risk of poor functional outcome. Although conventional preservation techniques may be adequate for donation after brain death (DBD) and low-risk DCD pancreases, as the number of DCD pancreas transplants increase and the threshold for rejecting organs decreases, the importance of optimal preservation techniques is going to increase. Over recent years, there have been significant advances in preservation techniques for DCD kidneys, improving the outcome of these marginal grafts. However, the use of such techniques for pancreas preservation is extremely limited and mainly historical. This overview describes the background and results of the established method of pancreas preservation for DBD, namely, cold static storage, and describes the use of the two-layer method. It also reviews pulsatile machine perfusion and normothermic perfusion for pancreas preservation techniques, which have shown promise in the preservation of DCD kidney grafts. The use of these techniques in pancreas preservation is predominantly historical but warrants reevaluation as to the feasibility of applying these techniques to DCD pancreas grafts not only for preservation but also for viability assessment. Further areas for development of pancreas preservation are discussed.
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Hatayama N, Naito M, Hirai S, Yoshida Y, Kojima T, Seki K, Li XK, Itoh M. Preservation by desiccation of isolated rat hearts for 48 hours using carbon monoxide (PCO = 4,000 hPa) and oxygen (PO(2) = 3,000 hPa). Cell Transplant 2012; 21:609-15. [PMID: 22793070 DOI: 10.3727/096368911x605547] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
It is currently said that CO has anti-inflammatory and antiapoptosis effects and it has attracted attention as a medical gas. We used CO for rat hearts and conducted a preservation experiment. We isolated rat hearts, placed them into a specially made chamber, filled the chamber with a gas mixture of PCO (4,000 hPa) and PO(2) (3,000 hPa), and preserved the hearts in a refrigerator at 4°C for 48 h. We then performed a heterotrophic transplantation on the neck of each recipient rat and resuscitated the preserved hearts. We herein report our findings.
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Affiliation(s)
- Naoyuki Hatayama
- Department of Anatomy, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan.
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Brandhorst H, Iken M, Scott WE, Papas KK, Theisinger B, Johnson PR, Korsgren O, Brandhorst D. Quality of isolated pig islets is improved using perfluorohexyloctane for pancreas storage in a split lobe model. Cell Transplant 2012; 22:1477-83. [PMID: 23044229 DOI: 10.3727/096368912x657639] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pancreas transportation between donor center and islet production facility is frequently associated with prolonged ischemia impairing islet isolation and transplantation outcomes. It is foreseeable that shipment of pig pancreases from distant centralized biosecure breeding facilities to institutes that have a long-term experience in porcine islet isolation is essentially required in future clinical islet xenotransplantation. Previously, we demonstrated that perfluorohexyloctan (F6H8) is significantly more efficient to protect rat and human pancreata from ischemically induced damage compared to perfluorodecalin (PFD). To evaluate the effect of F6H8 on long-term stored pig pancreases in a prospective study, we utilized the split lobe model to minimize donor variability. Retrieved pancreases were dissected into the connecting and splenic lobe, intraductally flushed with UW solution and immersed alternately in either preoxygenated F6H8 or PFD for 8-10 h. Prior to pancreas digestion, the intrapancreatic pO2 and the ratio of ATP-to-inorganic phosphate was compared utilizing 31P-NMR spectroscopy. Isolated islets were cultured for 2-3 days at 37°C and subjected to quality assessment. Pancreatic lobes stored in preoxygenated F6H8 had a significantly higher intrapancreatic pO2 compared to pancreata in oxygen-precharged PFD (10.11 ± 3.87 vs. 1.64 ± 1.13 mmHg, p < 0.05). This correlated with a higher ATP-to-inorganic phosphate ratio (0.30 ± 0.04 vs. 0.14 ± 0.01). No effect was observed concerning yield and purity of freshly isolated islets. Nevertheless, a significantly improved glucose-stimulated insulin response, increased viability and postculture survival (57.2 ± 5.7 vs. 39.3 ± 6.4%, p < 0.01) was measured in islets isolated from F6H8-preserved pancreata. The present data suggest that F6H8 does not increase islet yield but improves quality of pig islets isolated after prolonged cold ischemia.
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Affiliation(s)
- H Brandhorst
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
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Wang Y, Mendoza-Elias JE, Qi M, Harvat TA, Ahn SJ, Lee D, Gutierrez D, Jeon H, Paushter D, Oberholzer J. Implication of mitochondrial cytoprotection in human islet isolation and transplantation. Biochem Res Int 2012; 2012:395974. [PMID: 22611495 DOI: 10.1155/2012/395974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Accepted: 01/30/2012] [Indexed: 12/23/2022] Open
Abstract
Islet transplantation is a promising therapy for type 1 diabetes mellitus; however, success rates in achieving both short- and long-term insulin independence are not consistent, due in part to inconsistent islet quality and quantity caused by the complex nature and multistep process of islet isolation and transplantation. Since the introduction of the Edmonton Protocol in 2000, more attention has been placed on preserving mitochondrial function as increasing evidences suggest that impaired mitochondrial integrity can adversely affect clinical outcomes. Some recent studies have demonstrated that it is possible to achieve islet cytoprotection by maintaining mitochondrial function and subsequently to improve islet transplantation outcomes. However, the benefits of mitoprotection in many cases are controversial and the underlying mechanisms are unclear. This article summarizes the recent progress associated with mitochondrial cytoprotection in each step of the islet isolation and transplantation process, as well as islet potency and viability assays based on the measurement of mitochondrial integrity. In addition, we briefly discuss immunosuppression side effects on islet graft function and how transplant site selection affects islet engraftment and clinical outcomes.
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Agrawal A, Bainbridge A, Powis S, Fuller B, Cady EB, Davidson BR. 31-Phosphorus magnetic resonance spectroscopy for dynamic assessment of adenosine triphosphate levels in pancreas preserved by the two-layer method. Transplant Proc 2011; 43:1801-9. [PMID: 21693282 DOI: 10.1016/j.transproceed.2011.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 02/07/2011] [Indexed: 12/21/2022]
Abstract
Cold preservation injury influences islet graft function. Reliable tools for real-time assessment of pancreas viability before islet isolation are lacking. Phosphorus magnetic resonance spectroscopy ((31)P-MRS) was used immediately after organ harvest to study rat pancreases at 4 °C to 6 °C in five randomized preservation groups: Marshall's solution, static two-layer method (TLM), continuous TLM with oxygen perfused at 0.5 L/min, and static TLM or continuous TLM both the latter following 30 minutes of warm ischemia (WI). (31)P spectra were analyzed for phosphomonoesters, inorganic phosphate (Pi) and α-, β-and γ-nucleotide triphosphate. Intergroup rates of change of [γ-adenosine triphosphate (ATP)]/[Pi] and [β-ATP]/[Pi] throughout preservation period were significantly different. For continuous TLM there was an increase relative to baseline (0.043 (SD0.033) h(-1) and 0.029 (0.029) h(-1), respectively) but a decrease for both static TLM (-0.023 (0.016) h(-1) and 0.015 (0.026), P < .001 and < .05, respectively) and Marshall's (-0.049 (0.025) h(-1) and -0.036 (0.019) h(-1), respectively, both P < .001) with respect to continuous TLM. Rate of decrease was similar for the Marshall's and static TLM groups. [γ-ATP]/[Pi] and [β-ATP]/[Pi] increased with WI continuous TLM (0.008 [0.009] h(-1) and 0.007 [0.008] hr(-1), respectively) but decreased for WI static TLM (-0.018 (0.008) h(-1) and -0.014 (0.004) hr(-1), respectively, P < .001). (31)P-MRS is an effective tool for noninvasive assessment of pancreas bioenergetics. Continuous TLM preserves cellular bioenergetics and is superior to current non-perfluorocar bone based solutions for pancreas preservation.
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Affiliation(s)
- A Agrawal
- Department of Surgery, Royal Free Hospital and University College School of Medicine, London, England.
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Qin H, Matsumoto S, Klintmalm GB, De Vol EB. A Meta-Analysis for Comparison of the Two-Layer and University of Wisconsin Pancreas Preservation Methods in Islet Transplantation. Cell Transplant 2011; 20:1127-37. [DOI: 10.3727/096368910x544942] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Conflicting results have been reported on the effectiveness of the two-layer method (TLM) compared with the University of Wisconsin (UW) method for preserving pancreata. The objective of this study was to compile the evidence for or against any difference in human islet yield and viability between these two. PubMed (January 2000 to May 2008) and Cochran Library searches were performed and 17 studies were included for the meta-analysis. Data on donor characteristics, preservation time, and outcomes were abstracted. Studies were subgrouped based on how TLM was used (UW + TLM or TLM alone), on mean cold ischemic time (CIT) (>20 h or <20 h), and on whether special chemical was used (yes or no). Meta-analysis of all studies and subgroups was performed and the pooled standardized mean differences (SMD) with 95% confidence intervals (CI) were reported. Overall, the use of TLM significantly increased islet yield [SMD, 0.74 (0.44–1.04)] and viability [SMD, 0.63 (0.14–1.12)]. The beneficial effects of TLM on islet yield were more evident when TLM was used following UW storage or when prolonged CIT was used. TLM used alone, shorter CIT, and no chemical use all resulted in similar islet viability between TLM and UW groups. Beneficial effects of TLM on islet viability were demonstrated only when TLM was used following UW storage, or with prolonged CIT, or with chemical use. In conclusion, the TLM was beneficial for prolonged pancreas preservation before human islet isolation; however, benefit of the TLM for short-term preservation was not clear.
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Affiliation(s)
- Huanying Qin
- Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, TX, USA
| | - Shinichi Matsumoto
- Baylor Institute for Immunology Research, Baylor Health Care System, Dallas, TX, USA
| | - Goran B. Klintmalm
- Baylor Regional Transplant Institute, Baylor Health Care System, Dallas, TX, USA
| | - Edward B. De Vol
- Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, TX, USA
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Juszczak MT, Elsadig A, Kumar A, Muzyamba M, Pawelec K, Powis SH, Press M. Use of perfluorodecalin for pancreatic islet culture prior to transplantation: a liquid-liquid interface culture system--preliminary report. Cell Transplant 2010; 20:323-32. [PMID: 20719067 DOI: 10.3727/096368910x514189] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Although the issue remains controversial, short-term culture is probably beneficial for islet graft quality. However, significant islet loss is invariably observed. This is related to reduced survival of large islets, which is compromised by hypoxia under standard culture conditions. We aimed to develop a method of culture, which would avoid exposure to relative hypoxia and hence maintain the quality of islets. Isolated rat islets cultured for 48 h in a liquid-liquid interface culture system (LICS) with a perfluorocarbon were compared to islets cultured under standard (C1) and suboptimal conditions (C2). Islets were tested for viability and response to a glucose challenge, and a marginal mass was transplanted into syngeneic diabetic recipients. The viability of islets after 24-h culture in LICS was higher than in C1 and C2 groups (89.0% vs. 77.5% and 64.6%, respectively) and decreased with time to reach 79.0%, 62.9%, and 53.4% after 72-h culture. The stimulation index in LICS-cultured islets was also significantly higher than in C1 and C2 groups (12.3 ± 0.4 vs. 5.8 ± 0.5 and 4.1 ± 0.2, respectively). Following transplantation of LICS-cultured islets 50% of recipients were rendered normoglycemic compared with 14.3% and 31.3% for C2 and fresh islets, respectively. Our liquid-liquid interface culture system using perfluorodecalin provides optimized culture conditions, which preserve both islet viability and their ability to engraft successfully after intraportal transplantation and could be used for islet transportation.
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Affiliation(s)
- M T Juszczak
- Department of Endocrinology and Diabetes, Royal Free Hospital, Hempsted, London, UK.
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Hatayama N, Yoshida Y, Seki K. Seventy-two-hour preservation, resuscitation, and transplantation of an isolated rat heart with high partial pressure carbon monoxide gas (PCO = 400 hPa) and high partial pressure carbon dioxide (PCO(2) = 100 hPa). Cell Transplant 2010; 19:707-12. [PMID: 20525434 DOI: 10.3727/096368910x508807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The cardiac cavity of an isolated rat heart was filled with a Krebs-Henseleit (KH) solution, and the heart was hung in a high-pressure chamber. After the high-pressure chamber had been filled with a mixed gas (PCO = 400 hPa, PCO(2) = 100 hPa, PO(2) = 900 hPa, PHe = 5600 hPa) and preserved for 72 h, we performed a cervical ectopic heart transplantation on a recipient rat and resuscitated the preserved heart. This is the first incidence in the world of a mammalian organ having been successfully preserved and resuscitated after 72 h via a desiccation method.
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Brandhorst H, Asif S, Andersson K, Theisinger B, Andersson HH, Felldin M, Foss A, Salmela K, Tibell A, Tufveson G, Korsgren O, Brandhorst D. A New Oxygen Carrier for Improved Long-Term Storage of Human Pancreata Before Islet Isolation. Transplantation 2010; 89:155-60. [DOI: 10.1097/tp.0b013e3181c9266c] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mirbolooki MR, Alexander M, Hoyt DB, Lakey JRT. Pancreatic duct: A suitable route to oxygenate tissue during pancreas hypothermic preservation? Transpl Immunol 2009; 22:191-4. [PMID: 19900551 DOI: 10.1016/j.trim.2009.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Revised: 10/27/2009] [Accepted: 11/02/2009] [Indexed: 10/20/2022]
Abstract
The effectiveness of Two-Layer Method has been questioned recently. In this study we hypothesized that pancreatic duct might be an appropriate route to oxygenate the organ and prevent cold ischemic injury. Male Sprague-Dawley rats were employed for the pancreas procurement. Pancreata were removed after 20ml ductal injection of cold Hank's Balanced Salt Solution (HBSS), or pre-oxygenated solutions of HBSS (O-HBSS), perfluorocarbon (O-PFC), and emulsified PFC (O-ePFC) and then preserved in HBSS for 24h. Spectrophotometric analysis was performed to measure ATP, adenosine diphosphate (ADP), and adenosine monophosphate (AMP). To standardize metabolite data, values were reported in terms of 'per gram protein of pancreatic tissue'. Protein was measured according to Lowry et al. ADP/ATP ratio, total adenylates and energy charge (EC) were calculated. There was a significant decrease in tissue ATP after hypothermic preservation. Pancreatic tissues lost 47.8% of their ATP values just in the first hour of preservation and 98.5% of their ATP values within 12h of preservation and ductal oxygenation could not prevent the ischemia. Unlike the other groups, ductal injection of oxygenated PFC could slow the total adenylates reduction rate that no significant difference was detected (9.6+/-2.9 vs. 14.8+/-2.1mol/g protein, NS) after 12h of preservation. Ductal injection of oxygenated PFC significantly reduced ADP/ATP ratio (8.57+/-0.6 vs. 14.2+/-2.4, p<0.03) and improved intracellular energy charge (0.36+/-0.05 vs. 0.22+/-0.03, p<0.001) as compared to HBSS group. The findings indicate that the pancreatic duct might be a suitable route for pancreatic oxygenation.
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Affiliation(s)
- M Reza Mirbolooki
- Division of Surgical Research, Department of Surgery, University of California, Irvine, United States.
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Brandhorst H, Theisinger B, Yamaya H, Henriksnäs J, Carlsson PO, Korsgren O, Brandhorst D. Perfluorohexyloctane improves long-term storage of rat pancreata for subsequent islet isolation. Transpl Int 2009; 22:1017-22. [DOI: 10.1111/j.1432-2277.2009.00905.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Miki A, Ricordi C, Messinger S, Yamamoto T, Mita A, Barker S, Haetter R, Khan A, Alejandro R, Ichii H. Toward improving human islet isolation from younger donors: rescue purification is efficient for trapped islets. Cell Transplant 2009; 18:13-22. [PMID: 19476205 DOI: 10.3727/096368909788237159] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Several reports suggest that islets isolated from younger donor pancreata are of better quality for clinical islet transplantation. The relative inefficiency of the continuous gradient purification process (CGP) is one of the major obstacles to the utilization of these younger donor pancreata. This study demonstrates the benefits of utilizing an additional purification step, rescue gradient purification (RGP), to recover trapped islets and examines the possible superiority of these rescued islets. Seventy-three human islet isolations purified by RGP following CGP were divided into two groups based on age, and the isolation results were retrospectively analyzed (group I: age < or = 40, group II: age > 40). The quality of islets from both CGP and RGP were assessed by beta-cell fractional viability (beta FV) and ADP/ATP ratio. Significant increases in the percent islet recovery from RGP and the percent trapped islets in group I compared to group II were observed. Donor age correlated negatively to the percent islets recovered from RGP (R = 0.440) and to the percent of trapped islets (R = 0.511). RGP islets had higher beta FV and better ADP/ATP ratio compared to CGP islets. In conclusion, RGP improved the efficiency in the purification of trapped islets, which often come from younger donor pancreata. The better quality of beta-cells in RGP islets encourages us to perform RGP, considering the higher quality as well as the quantity of remaining islets.
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Affiliation(s)
- A Miki
- Cell Transplant Center, Diabetes Research Institute, University of Miami Leonard M. Miller School of Medicine, Miami, FL 33136, USA
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19
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Kinasiewicz A, Śmietanka A, Gajkowska B, Weryński A. Impact of Oxygenation of Bioartificial Liver Using Perfluorocarbon Emulsion Perftoran on Metabolism of Human Hepatoma C3A Cells. ACTA ACUST UNITED AC 2009; 36:525-34. [DOI: 10.1080/10731190802554380] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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20
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Hatayama N, Yoshida Y, Seki K. A Study on the Perfusion Preservation, Resuscitation, and Transplantation of a Rat Heart Isolated for 96 Hours. Cell Transplant 2009; 18:529-34. [DOI: 10.1177/096368970901805-607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Krebs-Henseleit (KH) solution was used to fill the heart chamber of an isolated rat heart before it was immersed in perfluorocarbon (PFC), which is an inert fluid. A gas mixture (PCO2 = 150 hPa and PO2 = 850 hPa) was then aerated at a constant rate into the PFC solution, and the isolated heart was thereafter preserved for 96 h with KH solution perfused continuously at a rate of 0.1 ml/h from the aorta of the isolated heart through a cannula. After preservation, the preserved heart was heterotopically transplanted into the neck of a recipient rat and then it was resuscitated. Using this method for preserving mammalian organs, we attained reproducibility after perfusion preservation for 96 h.
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Affiliation(s)
- Naoyuki Hatayama
- Kanagawa University Faculty of Science, Hiratsukashi, 259-1293, Japan
| | - Yu Yoshida
- Kanagawa University Faculty of Science, Hiratsukashi, 259-1293, Japan
| | - Kunihiro Seki
- Kanagawa University Faculty of Science, Hiratsukashi, 259-1293, Japan
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Iken M, Brandhorst H, Korsgren O, Brandhorst D. Pig pancreas oxygenation at 20 degrees C increases islet ATP generation but deteriorates islet function. Cell Transplant 2009; 18:745-51. [PMID: 19520045 DOI: 10.3727/096368909x470838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Successful pancreas preservation during storage in oxygenated perfluorodecalin (PFD) is mainly related to oxidative ATP generation during storage. Increasing the storage temperature would accelerate this process essential for resuscitation of ischemically damaged pancreatic tissue. The present study aimed at comparing islet isolation outcome from adult pig pancreata preserved in oxygenated PFD by means of a one-layer method during storage on ice or at 20 degrees C. Resected pancreata were intraductally flushed with cold UW solution and promptly processed (n = 6) or stored for 3 h in continuously oxygenated PFD at 4 degrees C (n = 5) or 20 degrees C (n = 7). Prior to digestion-filtration pancreata were intraductally injected with UW supplemented with Serva collagenase NB8 and neutral protease. Islet quality assessment determined viability, glucose stimulation index, mitochondrial activity, intracellular ATP content, and transplant function in diabetic nude mice. Pancreata oxygenated for 3 h at 20 degrees C yielded islet numbers similar to organs oxygenated at 4 degrees C. Compared to a storage temperature of 20 degrees C, preservation at 4 degrees C reduced islet ATP content (p < 0.05) as well as islet viability (p < 0.05). Nevertheless, PFD storage at 20 degrees C decreased insulin response to glucose compared to unstored pancreata (p < 0.05). In contrast to unstored pancreata or cold-stored organs, transplantation of islets isolated after oxygenation at 20 degrees C was characterized by an early loss of transplant function in 50% of recipients (p < 0.05). The present study demonstrates that PFD storage at 20 degrees C enhances islet ATP synthesis within a short period of oxygenation but deteriorates islet function. We conclude that the present data reflect an equilibration between reduced depression of metabolic activity resulting in damage of islets and temperature-stimulated acceleration of ATP synthesis. Future studies are required to adjust the optimum storage temperature for pancreas oxygenation in different species.
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Affiliation(s)
- M Iken
- Department of Gastroenterology, Hepatology & Endocrinology, Medical School, Hanover, Germany
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22
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Cobianchi L, Fornoni A, Pileggi A, Molano RD, Sanabria NY, Gonzalez-Quintana J, Bocca N, Marzorati S, Zahr E, Hogan AR, Ricordi C, Inverardi L. Riboflavin inhibits IL-6 expression and p38 activation in islet cells. Cell Transplant 2009; 17:559-66. [PMID: 18714675 DOI: 10.3727/096368908785096060] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Riboflavin is a water-soluble vitamin that reduces the production of proinflammatory mediators and oxygen radicals. Because islet beta-cells are very sensitive to oxidative stress and to cytokines, we investigated the possible cytoprotective effects of riboflavin on insulinoma NIT-1 cells and on isolated rodent islets. NIT-1 cells and islets cultured in the presence or absence of 10 microM riboflavin were studied at baseline and after exposure to cytokines (TNF-alpha, IL-1beta, INF-gamma). Riboflavin treatment did not affect islet cell viability as assessed by flow cytometry for caspases activation. However, riboflavin prevented the cytokine-induced increase in IL-6 mRNA expression and p38 phosphorylation analyzed by real-time PCR and immunoassay, respectively. In summary, nontoxic doses of riboflavin prevent cytokines-induced p38 phosphorylation and IL-6 upregulation in islet cells. This observation, together with the safety profile of riboflavin in the clinical setting, makes it an appealing agent for islet cytoprotection in islet transplantation protocols.
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Affiliation(s)
- Lorenzo Cobianchi
- Cell Transplant Center, Diabetes Research Institute, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA
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Abstract
PURPOSE OF REVIEW Organ preservation aims at reducing ischemia-reperfusion injury and maintains or even improves its function, and, therefore, increases transplant safety and efficiency. With the chronic lack of organs for transplantation, marginal donors are more and more frequently used in Western countries. New challenges, therefore, have to be met in organ preservation. RECENT FINDINGS We summarize the effects of cold preservation on various organ grafts, with particular emphasis on the pancreas. We review the different preservation solutions currently available in the clinic, and we present the current knowledge and clinical experience in pancreas and islet transplantation. SUMMARY Overall, in whole pancreas and islet transplantation, current cold preservation solutions (University of Wisconsin solution, Celsior, histidine-tryptophan-ketoglutarate) seem to be equivalent, with only few studies showing better results with University of Wisconsin solution. Regarding preservation with the two-layer method, conflicting results have been reported, and proper prospective controlled studies have yet to be performed to gather evidence on its impact on islet yield and function. Some recent developments and future strategies in general organ preservation not yet applied to pancreas preservation are reviewed at the end of the article.
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Mancarella R, Del Guerra S, Masini M, Bugliani M, Valgimigli L, Pedulli GF, Paolini M, Canistro D, Armando A, Soleti A, Filipponi F, Mosca F, Boggi U, Del Prato S, Marchetti P, Lupi R. Beneficial Effect of the Nonpeptidyl Low Molecular Weight Radical Scavenger IAC on Cultured Human Islet Function. Cell Transplant 2008; 17:1271-6. [DOI: 10.3727/096368908787236639] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We examined a possible protective effect of the nonpeptidyl low molecular weight radical scavenger IAC [bis(1-hydroxy-2,2,6,6-tetramethyl-4-piperidinyl)decanedioate di-hydrochloride] on isolated human islet cells against isolation and culture oxidative stress. Islets isolated from pancreases of nondiabetic multiorgan donors by collagenase digestion were purified by density gradient centrifugation. After the isolation, islets were either exposed or not exposed for 7 days to 10 μmol/L IAC. We found that IAC markedly reduced oxidative stress and ameliorated islets function. These results suggest that the use of IAC could be an interesting pharmacological approach for the treatment of the islets before transplantation.
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Affiliation(s)
- Rita Mancarella
- Department of Endocrinology and Metabolism, Metabolic Unit, University of Pisa, Pisa, Italy
| | - Silvia Del Guerra
- Department of Endocrinology and Metabolism, Metabolic Unit, University of Pisa, Pisa, Italy
| | - Matilde Masini
- Department of Experimental Pathology, University of Pisa, Pisa, Italy
| | - Marco Bugliani
- Department of Endocrinology and Metabolism, Metabolic Unit, University of Pisa, Pisa, Italy
| | - Luca Valgimigli
- Department of Organic Chemistry “A. Mangini”, University of Bologna, Bologna, Italy
| | - Gian Franco Pedulli
- Department of Organic Chemistry “A. Mangini”, University of Bologna, Bologna, Italy
| | - Moreno Paolini
- Department of Pharmacology, Molecular Toxicology Unit, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Donatella Canistro
- Department of Pharmacology, Molecular Toxicology Unit, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | | | | | - Franco Filipponi
- Department of Oncology and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Franco Mosca
- Department of Oncology and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Ugo Boggi
- Department of Oncology and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Stefano Del Prato
- Department of Endocrinology and Metabolism, Metabolic Unit, University of Pisa, Pisa, Italy
| | - Piero Marchetti
- Department of Endocrinology and Metabolism, Metabolic Unit, University of Pisa, Pisa, Italy
| | - Roberto Lupi
- Department of Endocrinology and Metabolism, Metabolic Unit, University of Pisa, Pisa, Italy
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Huang X, Moore DJ, Ketchum RJ, Nunemaker CS, Kovatchev B, McCall AL, Brayman KL. Resolving the conundrum of islet transplantation by linking metabolic dysregulation, inflammation, and immune regulation. Endocr Rev 2008; 29:603-30. [PMID: 18664617 PMCID: PMC2819735 DOI: 10.1210/er.2008-0006] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Although type 1 diabetes cannot be prevented or reversed, replacement of insulin production by transplantation of the pancreas or pancreatic islets represents a definitive solution. At present, transplantation can restore euglycemia, but this restoration is short-lived, requires islets from multiple donors, and necessitates lifelong immunosuppression. An emerging paradigm in transplantation and autoimmunity indicates that systemic inflammation contributes to tissue injury while disrupting immune tolerance. We identify multiple barriers to successful islet transplantation, each of which either contributes to the inflammatory state or is augmented by it. To optimize islet transplantation for diabetes reversal, we suggest that targeting these interacting barriers and the accompanying inflammation may represent an improved approach to achieve successful clinical islet transplantation by enhancing islet survival, regeneration or neogenesis potential, and tolerance induction. Overall, we consider the proinflammatory effects of important technical, immunological, and metabolic barriers including: 1) islet isolation and transplantation, including selection of implantation site; 2) recurrent autoimmunity, alloimmune rejection, and unique features of the autoimmune-prone immune system; and 3) the deranged metabolism of the islet transplant recipient. Consideration of these themes reveals that each is interrelated to and exacerbated by the other and that this connection is mediated by a systemic inflammatory state. This inflammatory state may form the central barrier to successful islet transplantation. Overall, there remains substantial promise in islet transplantation with several avenues of ongoing promising research. This review focuses on interactions between the technical, immunological, and metabolic barriers that must be overcome to optimize the success of this important therapeutic approach.
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Affiliation(s)
- Xiaolun Huang
- Department of Surgery, University of Virginia, Charlottesville, Virginia 22908, USA
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26
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27
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Yoshida Y, Hatayama N, Sekino H, Seki K. Heterotopic Transplant of an Isolated Rat Heart Preserved for 72 h in Perfluorocarbon with CO2. Cell Transplant 2008; 17:83-9. [DOI: 10.3727/000000008783907017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The inert fluid perfluorocarbon (PFC) has been used since about 1960 in liquid respiration and artificial blood for mammals. PFC has been used to successfully resuscitate tardigrades that had been dried and exposed to a high barometric pressure of 6,000 atmospheres. Next, scientists attempted to experimentally preserve organs that had been removed from animals, dried, and immersed in PFC. Since 1998 preservation and resuscitation experiments have been conducted with mammalian hearts using 2,015 rats and 70 pigs. Among those experiments, the maximum time after desiccation until successful resuscitation was 26 days for a rat heart and 37 days for a pig heart. However, these results could not be reproduced. Finally, in 2005, this laboratory demonstrated that a rat heart removed under 2 atmospheres pressure and a CO2 partial pressure of 400 hPa, followed by desiccation for 24 h, could be revived and heterotypically transplanted. Moreover, these results were reproducible. The preservation time can be extended to 72 h if, after immersing isolated rat hearts in PFC, they are dried by air exposure under a CO2 partial pressure of 100 hPa. The present report documents the resuscitation of this heart after 72 h of preservation followed by heterotrophic transplantation.
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Affiliation(s)
- Yu Yoshida
- Faculty of Science, Kanagawa University, Hiratsukashi, 259-1293 Japan
| | - Naoyuki Hatayama
- Faculty of Science, Kanagawa University, Hiratsukashi, 259-1293 Japan
| | | | - Kunihiro Seki
- Faculty of Science, Kanagawa University, Hiratsukashi, 259-1293 Japan
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28
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Caballero-Corbalán J, Eich T, Lundgren T, Foss A, Felldin M, Källen R, Salmela K, Tibell A, Tufveson G, Korsgren O. No beneficial effect of two-layer storage compared with UW-storage on human islet isolation and transplantation. Transplantation. 2007;84:864-869. [PMID: 17984839 DOI: 10.1097/01.tp.0000284584.60600.ab] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Shipment of pancreata between distant centers is frequently associated with prolonged cold ischemia time (CIT) that leads to poorer outcomes for islet transplantation. Clinical pilot trials have indicated that oxygenation of explanted human pancreata utilizing the two-layer method (TLM) allows the use of marginal donor pancreata for islet transplantation. The present study aimed to clarify whether TLM enhances the ischemic tolerance of human pancreata. METHODS We analyzed retrospectively the outcome of 200 human islet isolations performed after TLM preservation or storage in University of Wisconsin solution (UWS). RESULTS Donor characteristics and digestion parameters did not vary significantly between TLM-preserved and UWS-stored pancreata. No differences were observed between experimental groups with regard to islet yield, purity, or dynamic glucose stimulation index after either short or prolonged CIT. However, CIT and stimulation index were negatively correlated in each experimental group. The isolation outcome in donors aged > or =60 years was not increased after TLM preservation when compared to UWS storage. No effect was observed regarding islet posttransplant function in recipients with established kidney grafts. CONCLUSIONS The present study suggests that the ischemic tolerance of human pancreata cannot be extended by TLM preservation. In addition, TLM does not seem to improve the isolation outcome for pancreata from elderly donors.
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29
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Ponte GM, Baidal DA, Romanelli P, Faradji RN, Poggioli R, Cure P, Froud T, Selvaggi G, Pileggi A, Ricordi C, Alejandro R. Resolution of severe atopic dermatitis after tacrolimus withdrawal. Cell Transplant 2007; 16:23-30. [PMID: 17436852 DOI: 10.3727/000000007783464524] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Tacrolimus is an immunosuppressive agent used in solid organ and islet transplantation. Its topical form has shown benefit in the treatment of inflammatory skin conditions. Although tacrolimus has a wide spectrum of side effects, dermatological complications related to systemic tacrolimus therapy are limited in the literature. Atopic dermatitis (AD) is a chronic pruritic cutaneous condition that usually begins in infancy and is characterized by an increased Th2 response. We report the case of a patient with type 1 diabetes mellitus (T1DM) and history of AD latent for 10 years who developed severe dermatitis and alopecia 5 months after undergoing allogeneic islet transplantation and initiating a steroid-free immunosuppressive regimen with sirolimus and tacrolimus maintenance. After exclusion of other possible causes for the progression and exacerbation of the clinical presentation of AD, discontinuation of tacrolimus and introduction of mycophenolate mofetil resulted in full remission of the symptoms. The beneficial effects of tacrolimus withdrawal suggest a cause-effect relationship between this adverse event and the utilization of the drug. Islet graft function remained stable after modification of the therapeutic regimen (stable glycemic control and unchanged C-peptide).
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Affiliation(s)
- Gaston M Ponte
- Diabetes Research Institute, University of Miami Leonard M. Miller School of Medicine, Miami, FL 33136, USA
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