1
|
Lo Faro ML, Rozenberg K, Huang H, Maslau S, Bonham S, Fischer R, Kessler B, Leuvenink H, Sharples E, Lindeman JH, Ploeg R. Kidney Tissue Proteome Profiles in Short Versus Long Duration of Delayed Graft Function - A Pilot Study in Donation After Circulatory Death Donors. Kidney Int Rep 2024; 9:1473-1483. [PMID: 38707804 PMCID: PMC11068965 DOI: 10.1016/j.ekir.2024.02.012] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction Delayed graft function (DGF) is often defined as the need for dialysis treatment in the first week after a kidney transplantation. This definition, though readily applicable, is generic and unable to distinguish between "types" of DGF or time needed to recover function that may also significantly affect longer-term outcomes. We aimed to profile biological pathways in donation after circulatory death (DCD) kidney donors that correlate with DGF and different DGF durations. Methods A total of N = 30 DCD kidney biopsies were selected from the UK Quality in Organ Donation (QUOD) biobank and stratified according to DGF duration (immediate function, IF n = 10; "short-DGF" (1-6 days), SDGF n = 10; "long-DGF" (7-22 days), LDGF n = 10). Samples were matched for donor and recipient demographics and analyzed by label-free quantitative (LFQ) proteomics, yielding identification of N = 3378 proteins. Results Ingenuity pathway analysis (IPA) on differentially abundant proteins showed that SDGF kidneys presented upregulation of stress response pathways, whereas LDGF presented impaired response to stress, compared to IF. LDGF showed extensive metabolic deficits compared to IF and SDGF. Conclusion DCD kidneys requiring dialysis only in the first week posttransplant present acute cellular injury at donation, alongside repair pathways upregulation. In contrast, DCD kidneys requiring prolonged dialysis beyond 7 days present minimal metabolic and antioxidant responses, suggesting that current DGF definitions might not be adequate in distinguishing different patterns of injury in donor kidneys contributing to DGF.
Collapse
Affiliation(s)
- M. Letizia Lo Faro
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Oxford Biomedical Research Centre, Oxford, UK
| | - Kaithlyn Rozenberg
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Oxford Biomedical Research Centre, Oxford, UK
| | - Honglei Huang
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Target Discovery Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford Biomedical Research Centre, Oxford, UK
| | - Sergei Maslau
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Sarah Bonham
- Target Discovery Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Roman Fischer
- Target Discovery Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Benedikt Kessler
- Target Discovery Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | | | | | - Rutger Ploeg
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Oxford Transplant Centre, Churchill Hospital, Oxford, UK
- Oxford Biomedical Research Centre, Oxford, UK
| |
Collapse
|
2
|
Hamelink T, Lantinga V, Ogurlu B, Pamplona C, Bennedsgaard S, Qi H, Castelein J, Eijken M, Jaynes C, Dydak U, Jespersen B, Leuvenink H, Hansen E, Laustsen C, Ringgaard S, Keller AK, Borra R, Moers C. 211.4: Magnetic resonance imaging assessment of functional differences between kidneys in vivo and during ex vivo normothermic machine perfusion. Transplantation 2023; 107:37. [PMID: 37845904 DOI: 10.1097/01.tp.0000993196.54745.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Affiliation(s)
- Tim Hamelink
- Surgery, University Medical Center Groningen, Groningen, Netherlands
- Urology, Aarhus University Hospital, Aarhus, Denmark
- School of Health Sciences, Purdue University, West Lafayette, United States
| | - Veerle Lantinga
- Surgery, University Medical Center Groningen, Groningen, Netherlands
- School of Health Sciences, Purdue University, West Lafayette, United States
| | - Baran Ogurlu
- Surgery, University Medical Center Groningen, Groningen, Netherlands
| | - Carol Pamplona
- Surgery, University Medical Center Groningen, Groningen, Netherlands
| | | | - Haiyun Qi
- Renal Medicine, Aarhus University Hospital, Aarhus, Aarhus, Denmark
| | | | - Marco Eijken
- Renal Medicine, Aarhus University Hospital, Aarhus, Aarhus, Denmark
| | - Chris Jaynes
- Surgery, University Medical Center Groningen, Groningen, Netherlands
- 34, Lives, West Lafayette, United States
| | - Ulrike Dydak
- School of Health Sciences, Purdue University, West Lafayette, United States
| | - Bente Jespersen
- Renal Medicine, Aarhus University Hospital, Aarhus, Aarhus, Denmark
| | - Henri Leuvenink
- Surgery, University Medical Center Groningen, Groningen, Netherlands
| | - Esben Hansen
- Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | - Ronald Borra
- Radiology, University Medical Center Groningen, Groningen, Netherlands
| | - Cyril Moers
- Surgery, University Medical Center Groningen, Groningen, Netherlands
| |
Collapse
|
3
|
Heeman W, Maassen H, Dijkstra K, Calon J, van Goor H, Leuvenink H, van Dam GM, Boerma EC. Real-time, multi-spectral motion artefact correction and compensation for laser speckle contrast imaging. Sci Rep 2022; 12:21718. [PMID: 36522524 PMCID: PMC9755276 DOI: 10.1038/s41598-022-26154-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
Laser speckle contrast imaging (LSCI) is so sensitive to motion that it can measure the movement of red blood cells. However, this extreme sensitivity to motion is also its pitfall as the clinical translation of LSCI is slowed down due to the inability to deal with motion artefacts. In this paper we study the effectiveness of a real-time, multi-spectral motion artefact correction and compensation by subduing an in vitro flow phantom and ex vivo porcine kidney to computer-controlled motion artefacts. On the in vitro flow phantom, the optical flow showed a good correlation with the total movement. This model results in a better signal-to-noise ratios for multiple imaging distances and the overestimation of perfusion was reduced. In the ex vivo kidney model, the perfusion overestimation was also reduced and we were still able to distinguish between ischemia and non-ischemia in the stabilized data whereas this was not possible in the non-stabilized data. This leads to a notably better perfusion estimation that could open the door to a multitude of new clinical applications for LSCI.
Collapse
Affiliation(s)
- Wido Heeman
- grid.4830.f0000 0004 0407 1981Faculty Campus Fryslân, University of Groningen, Wirdumerdijk 34, Leeuwarden, 8911 CE The Netherlands ,grid.4494.d0000 0000 9558 4598Department of Surgery, University Medical Centre Groningen, Hanzeplein 1, Groningen, 9713 GZ The Netherlands ,LIMIS Development BV, Henri Dunantweg 2, Leeuwarden, 8934 AD The Netherlands
| | - Hanno Maassen
- grid.4494.d0000 0000 9558 4598Department of Surgery, University Medical Centre Groningen, Hanzeplein 1, Groningen, 9713 GZ The Netherlands ,grid.4494.d0000 0000 9558 4598Department of Pathology and Medical Biology, University Medical Centre Groningen, Hanzeplein 1, Groningen, 9713 GZ The Netherlands
| | - Klaas Dijkstra
- grid.461051.7Centre of Expertise in Computer Vision and Data Science, NHL Stenden University of Applied Sciences, Rengerslaan 8-10, Leeuwarden, 8917 DD The Netherlands
| | - Joost Calon
- ZiuZ Visual Intelligence, Stationsweg 3, Gorredijk, 8401 DK The Netherlands
| | - Harry van Goor
- grid.4494.d0000 0000 9558 4598Department of Pathology and Medical Biology, University Medical Centre Groningen, Hanzeplein 1, Groningen, 9713 GZ The Netherlands
| | - Henri Leuvenink
- grid.4494.d0000 0000 9558 4598Department of Surgery, University Medical Centre Groningen, Hanzeplein 1, Groningen, 9713 GZ The Netherlands
| | - Gooitzen. M. van Dam
- grid.4494.d0000 0000 9558 4598Department of Surgery, University Medical Centre Groningen, Hanzeplein 1, Groningen, 9713 GZ The Netherlands
| | - E. Christiaan Boerma
- grid.4830.f0000 0004 0407 1981Faculty Campus Fryslân, University of Groningen, Wirdumerdijk 34, Leeuwarden, 8911 CE The Netherlands ,grid.414846.b0000 0004 0419 3743Department of Intensive Care, Medical Centre Leeuwarden, Henri Dunantweg 2, Leeuwarden, 8934 AD The Netherlands
| |
Collapse
|
4
|
Heeman W, Maassen H, Calon J, van Goor H, Leuvenink H, van Dam GM, Boerma EC. Real-time visualization of renal microperfusion using laser speckle contrast imaging. J Biomed Opt 2021; 26:JBO-200389RR. [PMID: 34024055 PMCID: PMC8140613 DOI: 10.1117/1.jbo.26.5.056004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 05/07/2021] [Indexed: 05/02/2023]
Abstract
SIGNIFICANCE Intraoperative parameters of renal cortical microperfusion (RCM) have been associated with postoperative ischemia/reperfusion injury. Laser speckle contrast imaging (LSCI) could provide valuable information in this regard with the advantage over the current standard of care of being a non-contact and full-field imaging technique. AIM Our study aims to validate the use of LSCI for the visualization of RCM on ex vivo perfused human-sized porcine kidneys in various models of hemodynamic changes. APPROACH A comparison was made between three renal perfusion measures: LSCI, the total arterial renal blood flow (RBF), and sidestream dark-field (SDF) imaging in different settings of ischemia/reperfusion. RESULTS LSCI showed a good correlation with RBF for the reperfusion experiment (0.94 ± 0.02; p < 0.0001) and short- and long-lasting local ischemia (0.90 ± 0.03; p < 0.0001 and 0.81 ± 0.08; p < 0.0001, respectively). The correlation decreased for low flow situations due to RBF redistribution. The correlation between LSCI and SDF (0.81 ± 0.10; p < 0.0001) showed superiority over RBF (0.54 ± 0.22; p < 0.0001). CONCLUSIONS LSCI is capable of imaging RCM with high spatial and temporal resolutions. It can instantaneously detect local perfusion deficits, which is not possible with the current standard of care. Further development of LSCI in transplant surgery could help with clinical decision making.
Collapse
Affiliation(s)
- Wido Heeman
- University of Groningen, Faculty Campus Fryslân, Leeuwarden, The Netherlands
- University Medical Centre Groningen, Department of Surgery, Groningen, The Netherlands
- LIMIS Development BV, Leeuwarden, The Netherlands
- Address all correspondence to Wido Heeman,
| | - Hanno Maassen
- University Medical Centre Groningen, Department of Surgery, Groningen, The Netherlands
- University Medical Centre Groningen, Department of Pathology and Medical Biology, Groningen, The Netherlands
| | - Joost Calon
- ZiuZ Visual Intelligence, Gorredijk, The Netherlands
| | - Harry van Goor
- University Medical Centre Groningen, Department of Pathology and Medical Biology, Groningen, The Netherlands
| | - Henri Leuvenink
- University Medical Centre Groningen, Department of Surgery, Groningen, The Netherlands
| | - Gooitzen M. van Dam
- University Medical Centre Groningen, Department of Surgery, Groningen, The Netherlands
| | - E. Christiaan Boerma
- Medical Centre Leeuwarden, Department of Intensive Care, Leeuwarden, The Netherlands
| |
Collapse
|
5
|
Lohmann S, Eijken M, Møldrup U, Møller BK, Hunter J, Moers C, Leuvenink H, Ploeg RJ, Clahsen-van Groningen MC, Hoogduijn M, Baan CC, Keller AK, Jespersen B. Ex Vivo Administration of Mesenchymal Stromal Cells in Kidney Grafts Against Ischemia-reperfusion Injury-Effective Delivery Without Kidney Function Improvement Posttransplant. Transplantation 2021; 105:517-528. [PMID: 32956281 DOI: 10.1097/tp.0000000000003429] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Mesenchymal stromal cell (MSC) therapy may improve renal function after ischemia-reperfusion injury in transplantation. Ex vivo renal intraarterial administration is a targeted delivery method, avoiding the lung vasculature, a known barrier for cellular therapies. In a randomized and blinded study, we tested the feasibility and effectiveness of MSC therapy in a donation after circulatory death autotransplantation model to improve posttransplant kidney function, using an ex vivo MSC delivery method similar to the clinical standard procedure of pretransplant cold graft flush. METHODS Kidneys exposed to 75 minutes of warm ischemia and 16 hours of static cold storage were intraarterially infused ex vivo with 10 million male porcine MSCs (Tx-MSC, n = 8) or vehicle (Tx-control, n = 8). Afterwards, the kidneys were autotransplanted after contralateral nephrectomy. Biopsies an hour after reperfusion confirmed the presence of MSCs in the renal cortex. Animals were observed for 14 days. RESULTS Postoperatively, peak plasma creatinine was 1230 and 1274 µmol/L (Tx-controls versus Tx-MSC, P = 0.69). During follow-up, no significant differences over time were detected between groups regarding plasma creatinine, plasma neutrophil gelatinase-associated lipocalin, or urine neutrophil gelatinase-associated lipocalin/creatinine ratio. At day 14, measured glomerular filtration rates were 40 and 44 mL/min, P = 0.66. Renal collagen content and fibrosis-related mRNA expression were increased in both groups but without significant differences between the groups. CONCLUSIONS We demonstrated intraarterial MSC infusion to transplant kidneys as a safe and effective method to deliver MSCs to the graft. However, we could not detect any positive effects of this cell treatment within 14 days of observation.
Collapse
Affiliation(s)
- Stine Lohmann
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Marco Eijken
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Ulla Møldrup
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Bjarne K Møller
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - James Hunter
- Nuffield Department of Surgical Sciences, Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Cyril Moers
- Department of Surgery-Organ Donation and Transplantation, University of Medical Center Groningen, Groningen, the Netherlands
| | - Henri Leuvenink
- Department of Surgery-Organ Donation and Transplantation, University of Medical Center Groningen, Groningen, the Netherlands
| | - Rutger J Ploeg
- Nuffield Department of Surgical Sciences, Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | | | - Martin Hoogduijn
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Carla C Baan
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Anna Krarup Keller
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Bente Jespersen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
6
|
van Leeuwen L, Venema L, Leuvenink H, Kessler B. POTENTIAL PROTECTIVE EFFECTS OF DOXYCYCLINE ON RENAL PROTEOME AND DEGRADOME DURING HYPOTHERMIC MACHINE PERFUSION AND REPERFUSION OF PORCINE KIDNEYS. Transplantation 2020. [DOI: 10.1097/01.tp.0000699260.80138.c8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
7
|
Sierra-Parraga JM, Merino A, Eijken M, Leuvenink H, Ploeg R, Møller BK, Jespersen B, Baan CC, Hoogduijn MJ. Reparative effect of mesenchymal stromal cells on endothelial cells after hypoxic and inflammatory injury. Stem Cell Res Ther 2020; 11:352. [PMID: 32787906 PMCID: PMC7424997 DOI: 10.1186/s13287-020-01869-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/13/2020] [Accepted: 07/31/2020] [Indexed: 01/02/2023] Open
Abstract
Background The renal endothelium is a prime target for ischemia-reperfusion injury (IRI) during donation and transplantation procedures. Mesenchymal stromal cells (MSC) have been shown to ameliorate kidney function after IRI. However, whether this involves repair of the endothelium is not clear. Therefore, our objective is to study potential regenerative effects of MSC on injured endothelial cells and to identify the molecular mechanisms involved. Methods Human umbilical vein endothelial cells (HUVEC) were submitted to hypoxia and reoxygenation and TNF-α treatment. To determine whether physical interaction or soluble factors released by MSC were responsible for the potential regenerative effects of MSC on endothelial cells, dose-response experiments were performed in co-culture and transwell conditions and with secretome-deficient MSC. Results MSC showed increased migration and adhesion to injured HUVEC, mediated by CD29 and CD44 on the MSC membrane. MSC decreased membrane injury marker expression, oxidative stress levels, and monolayer permeability of injured HUVEC, which was observed only when allowing both physical and paracrine interaction between MSC and HUVEC. Furthermore, viable MSC in direct contact with injured HUVEC improved wound healing capacity by 45% and completely restored their angiogenic capacity. In addition, MSC exhibited an increased ability to migrate through an injured HUVEC monolayer compared to non-injured HUVEC in vitro. Conclusions These results show that MSC have regenerative effects on injured HUVEC via a mechanism which requires both physical and paracrine interaction. The identification of specific effector molecules involved in MSC-HUVEC interaction will allow targeted modification of MSC to apply and enhance the therapeutic effects of MSC in IRI. ![]()
Collapse
Affiliation(s)
- Jesus M Sierra-Parraga
- Internal Medicine Department, Sector Nephrology & Transplantation, University Medical Center Rotterdam, Erasmus MC, Postbus 2040, 3000 CA, Rotterdam, the Netherlands.
| | - Ana Merino
- Internal Medicine Department, Sector Nephrology & Transplantation, University Medical Center Rotterdam, Erasmus MC, Postbus 2040, 3000 CA, Rotterdam, the Netherlands
| | - Marco Eijken
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Henri Leuvenink
- Department of Surgery - Organ Donation and Transplantation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Rutger Ploeg
- Nuffield Department of Surgical Sciences and Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Bjarne K Møller
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Bente Jespersen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Carla C Baan
- Internal Medicine Department, Sector Nephrology & Transplantation, University Medical Center Rotterdam, Erasmus MC, Postbus 2040, 3000 CA, Rotterdam, the Netherlands
| | - Martin J Hoogduijn
- Internal Medicine Department, Sector Nephrology & Transplantation, University Medical Center Rotterdam, Erasmus MC, Postbus 2040, 3000 CA, Rotterdam, the Netherlands
| |
Collapse
|
8
|
Chong AS, Rothstein DM, Issa F, Kotsch K, Leuvenink H, Tullius SG. ITS finally here! The first International Transplant Science meeting jointly organized by AST, ESOT, and TTS. Transplantation 2019. [DOI: 10.1097/tp.0000000000002940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
9
|
Sierra-Parraga JM, Munk A, Andersen C, Lohmann S, Moers C, Baan CC, Ploeg RJ, Pool M, Keller AK, Møller BK, Leuvenink H, Hoogduijn MJ, Jespersen B, Eijken M. Mesenchymal Stromal Cells Are Retained in the Porcine Renal Cortex Independently of Their Metabolic State After Renal Intra-Arterial Infusion. Stem Cells Dev 2019; 28:1224-1235. [PMID: 31280676 DOI: 10.1089/scd.2019.0105] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The regenerative capacities of mesenchymal stromal cells (MSCs) make them suitable for renal regenerative therapy. The most common delivery route of MSC is through intravenous infusion, which is associated with off-target distribution. Renal intra-arterial delivery offers a targeted therapy, but limited knowledge is available regarding the fate of MSCs delivered through this route. Therefore, we studied the efficiency and tissue distribution of MSCs after renal intra-arterial delivery to a porcine renal ischemia-reperfusion model. MSCs were isolated from adipose tissue of healthy male pigs, fluorescently labeled and infused into the renal artery of female pigs. Flow cytometry allowed MSC detection and quantification in tissue and blood. In addition, quantitative polymerase chain reaction was used to trace MSCs by their Y-chromosome. During infusion, a minor number of MSCs left the kidney through the renal vein, and no MSCs were identified in arterial blood. Ischemic and healthy renal tissues were analyzed 30 min and 8 h after infusion, and 1-4 × 104 MSCs per gram of tissue were detected, predominantly, in the renal cortex, with a viability >70%. Confocal microscopy demonstrated mainly glomerular localization of MSCs, but they were also observed in the capillary network around tubuli. The infusion of heat-inactivated (HI) MSCs, which are metabolically inactive, through the renal artery showed that HI-MSCs were distributed in the kidney in a similar manner to regular MSCs, suggesting a passive retention mechanism. Long-term MSC survival was analyzed by Y-chromosome tracing, and demonstrated that a low percentage of the infused MSCs were present in the kidney 14 days after administration, while HI-MSCs were completely undetectable. In conclusion, renal intra-arterial MSC infusion limited off-target engraftment, leading to efficient MSC delivery to the kidney, most of them being cleared within 14 days. MSC retention was independent of the metabolic state of MSC, indicating a passive mechanism.
Collapse
Affiliation(s)
- Jesus M Sierra-Parraga
- Nephrology and Transplantation, Internal Medicine Department, University Medical Center Rotterdam, Erasmus MC, Rotterdam, the Netherlands.,Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Anders Munk
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Stine Lohmann
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.,Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Cyril Moers
- Department of Surgery-Organ Donation and Transplantation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Carla C Baan
- Nephrology and Transplantation, Internal Medicine Department, University Medical Center Rotterdam, Erasmus MC, Rotterdam, the Netherlands
| | - Rutger J Ploeg
- Nuffield Department of Surgical Sciences and Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Merel Pool
- Department of Surgery-Organ Donation and Transplantation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Anna K Keller
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Bjarne K Møller
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Henri Leuvenink
- Department of Surgery-Organ Donation and Transplantation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Martin J Hoogduijn
- Nephrology and Transplantation, Internal Medicine Department, University Medical Center Rotterdam, Erasmus MC, Rotterdam, the Netherlands
| | - Bente Jespersen
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Marco Eijken
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
10
|
Pool M, Eertman T, Sierra Parraga J, 't Hart N, Roemeling-van Rhijn M, Eijken M, Jespersen B, Reinders M, Hoogduijn M, Ploeg R, Leuvenink H, Moers C. Infusing Mesenchymal Stromal Cells into Porcine Kidneys during Normothermic Machine Perfusion: Intact MSCs Can Be Traced and Localised to Glomeruli. Int J Mol Sci 2019; 20:ijms20143607. [PMID: 31340593 PMCID: PMC6678394 DOI: 10.3390/ijms20143607] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/12/2019] [Accepted: 07/22/2019] [Indexed: 12/20/2022] Open
Abstract
Normothermic machine perfusion (NMP) of kidneys offers the opportunity to perform active interventions, such as the addition of mesenchymal stromal cells (MSCs), to an isolated organ prior to transplantation. The purpose of this study was to determine whether administering MSCs to kidneys during NMP is feasible, what the effect of NMP is on MSCs and whether intact MSCs are retained in the kidney and to which structures they home. Viable porcine kidneys were obtained from a slaughterhouse. Kidneys were machine perfused during 7 h at 37 °C. After 1 h of perfusion either 0, 105, 106 or 107 human adipose tissue derived MSCs were added. Additional ex vivo perfusions were conducted with fluorescent pre-labelled bone-marrow derived MSCs to assess localisation and survival of MSCs during NMP. After NMP, intact MSCs were detected by immunohistochemistry in the lumen of glomerular capillaries, but only in the 107 MSC group. The experiments with fluorescent pre-labelled MSCs showed that only a minority of glomeruli were positive for infused MSCs and most of these glomeruli contained multiple MSCs. Flow cytometry showed that the number of infused MSCs in the perfusion circuit steeply declined during NMP to approximately 10%. In conclusion, the number of circulating MSCs in the perfusate decreases rapidly in time and after NMP only a small portion of the MSCs are intact and these appear to be clustered in a minority of glomeruli.
Collapse
Affiliation(s)
- Merel Pool
- Department of Surgery-Organ Donation and Transplantation, University Medical Center, 9713 GZ Groningen, The Netherlands.
| | - Tim Eertman
- Department of Surgery-Organ Donation and Transplantation, University Medical Center, 9713 GZ Groningen, The Netherlands
| | - Jesus Sierra Parraga
- Department of Internal Medicine, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Nils 't Hart
- Department of Pathology, University Medical Center, 9713 GZ Groningen, The Netherlands
| | | | - Marco Eijken
- Institute of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
- Department of Renal Medicine, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Bente Jespersen
- Institute of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
- Department of Renal Medicine, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Marlies Reinders
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Martin Hoogduijn
- Department of Internal Medicine, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Rutger Ploeg
- Department of Surgery-Organ Donation and Transplantation, University Medical Center, 9713 GZ Groningen, The Netherlands
- Oxford Transplant Centre, University of Oxford, OX3 7LJ Oxford, UK
| | - Henri Leuvenink
- Department of Surgery-Organ Donation and Transplantation, University Medical Center, 9713 GZ Groningen, The Netherlands
| | - Cyril Moers
- Department of Surgery-Organ Donation and Transplantation, University Medical Center, 9713 GZ Groningen, The Netherlands
| |
Collapse
|
11
|
von Horn C, Hannaert P, Hauet T, Leuvenink H, Paul A, Minor T. Cold flush after dynamic liver preservation protects against ischemic changes upon reperfusion - an experimental study. Transpl Int 2018; 32:218-224. [PMID: 30251360 PMCID: PMC7380013 DOI: 10.1111/tri.13354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/04/2018] [Accepted: 09/17/2018] [Indexed: 12/11/2022]
Abstract
Ex vivo machine perfusion of the liver after cold storage has found to be most effective if combined with controlled oxygenated rewarming up to (sub)‐normothermia. On disconnection of the warm graft from the machine, most surgeons usually perform a cold flush of the organ as protection against the second warm ischemia incurred upon implantation. Experimental evidence, however, is lacking and protective effect of deep hypothermia has been challenged for limited periods of liver ischemia in other models. A first systematic test was carried out on porcine livers, excised 30 min after cardiac arrest, subjected to 18 h of cold storage in UW and then machine perfused for 90 min with Aqix‐RSI solution. During machine perfusion, livers were gradually rewarmed up to 20 °C. One group (n = 6) was then reflushed with 4 °C cold Belzer UW solution whereas the second group (n = 6) remained without cold flush. All livers were exposed to 45 min warm ischemia at room temperature to simulate the surgical implantation period. Organ function was evaluated in an established reperfusion model using diluted autologous blood. Cold reflush after disconnection from the machine resulted in a significant increase in bile production upon blood reperfusion, along with a significant reduction in transaminases release alanine aminotransferase and of the intramitochondrial enzyme glutamate dehydrogenase. Interestingly, free radical‐mediated lipid peroxidation was also found significantly lower after cold reflush. No differences between the groups could be evidenced concerning histological injury and recovery of hepatic energy metabolism (tissue content of adenosine triphosphate). Post‐machine preservation cold reflush seems to be beneficial in this particular setting, even if the organs are warmed up only to 20 °C, without notion of adverse effects, and should therefore be implemented in the protocol.
Collapse
Affiliation(s)
- Charlotte von Horn
- Department for Surgical Research - General Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Patrick Hannaert
- IRTOMIT, INSERM U1082, Université de Médecine et de Pharmacie de Poitiers, Poitiers, France
| | - Thierry Hauet
- IRTOMIT, INSERM U1082, Université de Médecine et de Pharmacie de Poitiers, Poitiers, France
| | - Henri Leuvenink
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Andreas Paul
- Department for Surgical Research - General Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Thomas Minor
- Department for Surgical Research - General Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | | |
Collapse
|
12
|
Jager T, Poppelaars F, Damman J, Van Werkhoven M, Van Kooten C, Daha M, Hillebrands JL, Leuvenink H, Seelen M. Deficiency of early complement components protects against renal injury in a mouse model of brain death. Mol Immunol 2018. [DOI: 10.1016/j.molimm.2018.06.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
13
|
van der Most P, Damman J, Leuvenink H, Nolte I, Bakker S, de Borst M, Snieder H. SP014THE TRANSPLANTLINES KIDNEY eQTL RESOURCE. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Jeffrey Damman
- Pathology, University of Amsterdam, Amsterdam, Netherlands
| | | | - Ilja Nolte
- Epidemiology, University of Groningen, Groningen, Netherlands
| | - Stephan Bakker
- Internal Medicine, University of Groningen, Groningen, Netherlands
| | | | - Harold Snieder
- Epidemiology, University of Groningen, Groningen, Netherlands
| |
Collapse
|
14
|
von Horn C, Baba HA, Hannaert P, Hauet T, Leuvenink H, Paul A, Minor T. Controlled oxygenated rewarming up to normothermia for pretransplant reconditioning of liver grafts. Clin Transplant 2017; 31. [PMID: 28871615 DOI: 10.1111/ctr.13101] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2017] [Indexed: 12/15/2022]
Abstract
Controlled oxygenated rewarming (COR) up to 20°C during ex vivo machine perfusion limits reperfusion-induced tissue injury upon graft implantation. Rewarming up to normothermia might add further benefits and provide better prediction of post-transplantation organ function. The effect of 90 minutes of oxygenated machine perfusion with Aqix RS-I after cold storage combined with gentle rewarming up to 20°C (COR20) or 35°C (COR35) was studied in rat livers and compared with cold storage alone (CS, n = 6, resp). Postpreservation recovery was evaluated upon warm reperfusion using an established in vitro system. COR generally resulted in significantly improved energetic recovery, increased bile flow, less activities alanine aminotransferase (ALT) release, and improved histopathology upon reperfusion as compared to only cold-stored livers, without significant differences between COR20 and COR35. Parameters obtained during COR, especially during COR35, also allowed for prediction of hepatic recovery upon reperfusion. For instance, ulterior bile production upon reperfusion was found closely correlated to bile flow observed already during COR35 (R2 = 0.91). COR significantly improved liver quality after static cold storage. Elevation of machine perfusion temperature up to 35°C may prove promising to refine ex vivo evaluation of the graft prior to transplantation.
Collapse
Affiliation(s)
- Charlotte von Horn
- Department for Surgical Research, General Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Hideo A Baba
- Institute of Pathology, University Hospital Essen, Essen, Germany
| | - Patrik Hannaert
- RTOMIT, INSERM, Université de Médecine et de Pharmacie de Poitiers, Poitiers, France
| | - Thierry Hauet
- RTOMIT, INSERM, Université de Médecine et de Pharmacie de Poitiers, Poitiers, France
| | - Henri Leuvenink
- Department of Surgery, University Medical Center Groningen, The Netherlands
| | - Andreas Paul
- Department for Surgical Research, General Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Thomas Minor
- Department for Surgical Research, General Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | | |
Collapse
|
15
|
Sierra-Parraga JM, Eijken M, Hunter J, Moers C, Leuvenink H, Møller B, Ploeg RJ, Baan CC, Jespersen B, Hoogduijn MJ. Mesenchymal Stromal Cells as Anti-Inflammatory and Regenerative Mediators for Donor Kidneys During Normothermic Machine Perfusion. Stem Cells Dev 2017; 26:1162-1170. [PMID: 28557562 DOI: 10.1089/scd.2017.0030] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
There is great demand for transplant kidneys for the treatment of end-stage kidney disease patients. To expand the donor pool, organs from older and comorbid brain death donors, so-called expanded criteria donors (ECD), as well as donation after circulatory death donors, are considered for transplantation. However, the quality of these organs may be inferior to standard donor organs. A major issue affecting graft function and survival is ischemia/reperfusion injury, which particularly affects kidneys from deceased donors. The development of hypothermic machine perfusion has been introduced in kidney transplantation as a preservation technique and has improved outcomes in ECD and marginal organs compared to static cold storage. Normothermic machine perfusion (NMP) is the most recent evolution of perfusion technology and allows assessment of the donor organ before transplantation. The possibility to control the content of the perfusion fluid offers opportunities for damage control and reparative therapies during machine perfusion. Mesenchymal stromal cells (MSC) have been demonstrated to possess potent regenerative properties via the release of paracrine effectors. The combination of NMP and MSC administration at the same time is a promising procedure in the field of transplantation. Therefore, the MePEP consortium has been created to study this novel modality of treatment in preparation for human trials. MePEP aims to assess the therapeutic effects of MSC administered ex vivo by NMP in the mechanisms of injury and repair in a porcine kidney autotransplantation model.
Collapse
Affiliation(s)
- Jesus Maria Sierra-Parraga
- 1 Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC, University Medical Center , Rotterdam, the Netherlands
| | - Marco Eijken
- 2 Institute of Clinical Medicine, Department of Medicine and Nephrology C, Aarhus University , Aarhus, Denmark
| | - James Hunter
- 3 Nuffield Department of Surgical Sciences, Oxford Biomedical Research Centre, University of Oxford , Oxford, United Kingdom
| | - Cyril Moers
- 4 Department of Surgery-Organ Donation and Transplantation, University of Medical Center Groningen , Groningen, the Netherlands
| | - Henri Leuvenink
- 4 Department of Surgery-Organ Donation and Transplantation, University of Medical Center Groningen , Groningen, the Netherlands
| | - Bjarne Møller
- 5 Department of Clinical Immunology, Aarhus University Hospital , Aarhus, Denmark
| | - Rutger J Ploeg
- 3 Nuffield Department of Surgical Sciences, Oxford Biomedical Research Centre, University of Oxford , Oxford, United Kingdom
| | - Carla C Baan
- 1 Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC, University Medical Center , Rotterdam, the Netherlands
| | - Bente Jespersen
- 6 Department of Renal Medicine, Aarhus University Hospital , Aarhus, Denmark
| | - Martin J Hoogduijn
- 1 Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC, University Medical Center , Rotterdam, the Netherlands
| |
Collapse
|
16
|
Poppelaars F, van Werkhoven M, Kotimaa J, Veldhuis Z, Ausema A, Broeren S, Damman J, Hempel C, Leuvenink H, Daha M, van Son W, van Kooten C, van Os R, Hillebrands JL, Seelen M. A functional role for complement receptor C5L2 in the pathogenesis of renal ischemia-reperfusion injury. Immunobiology 2016. [DOI: 10.1016/j.imbio.2016.06.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
17
|
Mahboub P, Ottens P, Seelen M, 't Hart N, Van Goor H, Ploeg R, Martins PN, Leuvenink H. Correction: Gradual Rewarming with Gradual Increase in Pressure during Machine Perfusion after Cold Static Preservation Reduces Kidney Ischemia Reperfusion Injury. PLoS One 2016; 11:e0152006. [PMID: 26977593 PMCID: PMC4792428 DOI: 10.1371/journal.pone.0152006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
18
|
Mahboub P, Ottens P, Seelen M, t Hart N, Van Goor H, Ploeg R, Martins P, Leuvenink H. Gradual Rewarming with Gradual Increase in Pressure during Machine Perfusion after Cold Static Preservation Reduces Kidney Ischemia Reperfusion Injury. PLoS One 2015; 10:e0143859. [PMID: 26630031 PMCID: PMC4667888 DOI: 10.1371/journal.pone.0143859] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 11/09/2015] [Indexed: 01/09/2023] Open
Abstract
In this study we evaluated whether gradual rewarming after the period of cold ischemia would improve organ quality in an Isolated Perfused Kidney Model. Left rat kidneys were statically cold stored in University of Wisconsin solution for 24 hours at 4°C. After cold storage kidneys were rewarmed in one of three ways: perfusion at body temperature (38°C), or rewarmed gradually from 10°C to 38°C with stabilization at 10°C for 30 min and rewarmed gradually from 10°C to 38°C with stabilization at 25°C for 30 min. In the gradual rewarming groups the pressure was increased stepwise to 40 mmHg at 10°C and 70 mmHg at 25°C to counteract for vasodilatation leading to low perfusate flows. Renal function parameters and injury biomarkers were measured in perfusate and urine samples. Increases in injury biomarkers such as aspartate transaminase and lactate dehydrogenase in the perfusate were lower in the gradual rewarming groups versus the control group. Sodium re-absorption was improved in the gradual rewarming groups and reached significance in the 25°C group after ninety minutes of perfusion. HSP-70, ICAM-1, VCAM-1 mRNA expressions were decreased in the 10°C and 25°C groups. Based on the data kidneys that underwent gradual rewarming suffered less renal parenchymal, tubular injury and showed better endothelial preservation. Renal function improved in the gradual rewarming groups versus the control group.
Collapse
Affiliation(s)
- Paria Mahboub
- Dept of Surgery, Groningen Transplant Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Dept. of Surgery, Division of Transplantation, University of Massachusetts, Worcester, MA, United States of America
| | - Petra Ottens
- Dept of Surgery, Groningen Transplant Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marc Seelen
- Dept of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nails t Hart
- Dept of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Harry Van Goor
- Dept of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rutger Ploeg
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Paulo Martins
- Dept. of Surgery, Division of Transplantation, University of Massachusetts, Worcester, MA, United States of America
| | - Henri Leuvenink
- Dept of Surgery, Groningen Transplant Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- * E-mail:
| |
Collapse
|
19
|
Ravikumar R, Leuvenink H, Friend PJ. Normothermic liver preservation: a new paradigm? Transpl Int 2015; 28:690-9. [PMID: 25847684 DOI: 10.1111/tri.12576] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 09/29/2014] [Accepted: 03/27/2015] [Indexed: 12/14/2022]
Abstract
Despite increasing donor numbers, waiting lists and pre-transplant mortality continue to grow in many countries. The number of donor organs suitable for liver transplantation is restricted by cold preservation and ischemia-reperfusion injury (IRI). Transplantation of marginal donor organs has led to renewed interest in new techniques which have the potential to improve the quality of preservation, assess the quality of the organ and allow repair of the donor organ prior to transplantation. If successful, such techniques would not only improve the outcome of currently transplanted marginal livers, but also increase the donor pool. Experimental evidence suggests that preservation under near physiological conditions of temperature and oxygenation abrogates IRI. Normothermic perfusion maintains the organ in a physiological state, avoiding the depletion of cellular energy and the accumulation of waste products, which occurs with static cold storage. It enables viability assessment prior to transplantation thereby reducing the risk of transplanting inherently marginal organs. Here we review the use of normothermic machine perfusion as a means of organ preservation.
Collapse
Affiliation(s)
- Reena Ravikumar
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Henri Leuvenink
- Groningen Transplant Center, University Medical Center, Groningen, The Netherlands
| | - Peter J Friend
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
20
|
Thuillier R, Allain G, Celhay O, Hebrard W, Barrou B, Badet L, Leuvenink H, Hauet T. Benefits of active oxygenation during hypothermic machine perfusion of kidneys in a preclinical model of deceased after cardiac death donors. J Surg Res 2013; 184:1174-81. [DOI: 10.1016/j.jss.2013.04.071] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 04/23/2013] [Accepted: 04/26/2013] [Indexed: 11/16/2022]
|
21
|
Soendergaard P, Krogstrup NV, Secher NG, Ravlo K, Keller AK, Toennesen E, Bibby BM, Moldrup U, Ostraat EO, Pedersen M, Jorgensen TM, Leuvenink H, Norregaard R, Birn H, Marcussen N, Jespersen B. Improved GFR and renal plasma perfusion following remote ischaemic conditioning in a porcine kidney transplantation model. Transpl Int 2012; 25:1002-12. [DOI: 10.1111/j.1432-2277.2012.01522.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
22
|
Hoeger S, Bergstraesser C, Selhorst J, Fontana J, Birck R, Waldherr R, Beck G, Sticht C, Seelen MA, van Son WJ, Leuvenink H, Ploeg R, Schnuelle P, Yard BA. Modulation of brain dead induced inflammation by vagus nerve stimulation. Am J Transplant 2010; 10:477-89. [PMID: 20055812 DOI: 10.1111/j.1600-6143.2009.02951.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Because the vagus nerve is implicated in control of inflammation, we investigated if brain death (BD) causes impairment of the parasympathetic nervous system, thereby contributing to inflammation. BD was induced in rats. Anaesthetised ventilated rats (NBD) served as control. Heart rate variability (HRV) was assessed by ECG. The vagus nerve was electrically stimulated (BD + STIM) during BD. Intestine, kidney, heart and liver were recovered after 6 hours. Affymetrix chip-analysis was performed on intestinal RNA. Quantitative PCR was performed on all organs. Serum was collected to assess TNFalpha concentrations. Renal transplantations were performed to address the influence of vagus nerve stimulation on graft outcome. HRV was significantly lower in BD animals. Vagus nerve stimulation inhibited the increase in serum TNFalpha concentrations and resulted in down-regulation of a multiplicity of pro-inflammatory genes in intestinal tissue. In renal tissue vagal stimulation significantly decreased the expression of E-selectin, IL1beta and ITGA6. Renal function was significantly better in recipients that received a graft from a BD + STIM donor. Our study demonstrates impairment of the parasympathetic nervous system during BD and inhibition of serum TNFalpha through vagal stimulation. Vagus nerve stimulation variably affected gene expression in donor organs and improved renal function in recipients.
Collapse
Affiliation(s)
- S Hoeger
- Department of Medicine V (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, University of Heidelberg, and Clinic for Anaesthesiology and Intensive Care Medicine, University Hospital of Mannheim, Mannheim, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Hoeger S, Bergstraesser C, Selhorst J, Fontana J, Birck R, Waldherr R, Beck G, Sticht C, Seelen MA, van Son WJ, Leuvenink H, Ploeg R, Schnuelle P, Yard BA. Modulation of brain dead induced inflammation by vagus nerve stimulation. Am J Transplant 2010. [PMID: 20055812 DOI: 10.1111/j.1600-6143.2009.02951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Because the vagus nerve is implicated in control of inflammation, we investigated if brain death (BD) causes impairment of the parasympathetic nervous system, thereby contributing to inflammation. BD was induced in rats. Anaesthetised ventilated rats (NBD) served as control. Heart rate variability (HRV) was assessed by ECG. The vagus nerve was electrically stimulated (BD + STIM) during BD. Intestine, kidney, heart and liver were recovered after 6 hours. Affymetrix chip-analysis was performed on intestinal RNA. Quantitative PCR was performed on all organs. Serum was collected to assess TNFalpha concentrations. Renal transplantations were performed to address the influence of vagus nerve stimulation on graft outcome. HRV was significantly lower in BD animals. Vagus nerve stimulation inhibited the increase in serum TNFalpha concentrations and resulted in down-regulation of a multiplicity of pro-inflammatory genes in intestinal tissue. In renal tissue vagal stimulation significantly decreased the expression of E-selectin, IL1beta and ITGA6. Renal function was significantly better in recipients that received a graft from a BD + STIM donor. Our study demonstrates impairment of the parasympathetic nervous system during BD and inhibition of serum TNFalpha through vagal stimulation. Vagus nerve stimulation variably affected gene expression in donor organs and improved renal function in recipients.
Collapse
Affiliation(s)
- S Hoeger
- Department of Medicine V (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, University of Heidelberg, and Clinic for Anaesthesiology and Intensive Care Medicine, University Hospital of Mannheim, Mannheim, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Waanders F, Vaidya VS, van Goor H, Leuvenink H, Damman K, Hamming I, Bonventre JV, Vogt L, Navis G. Effect of renin-angiotensin-aldosterone system inhibition, dietary sodium restriction, and/or diuretics on urinary kidney injury molecule 1 excretion in nondiabetic proteinuric kidney disease: a post hoc analysis of a randomized controlled trial. Am J Kidney Dis 2008; 53:16-25. [PMID: 18823687 DOI: 10.1053/j.ajkd.2008.07.021] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2007] [Accepted: 07/07/2008] [Indexed: 11/11/2022]
Abstract
BACKGROUND Tubulointerstitial damage plays an important role in chronic kidney disease (CKD) with proteinuria. Urinary kidney injury molecule 1 (KIM-1) reflects tubular KIM-1 and is considered a sensitive biomarker for early tubular damage. We hypothesized that a decrease in proteinuria by using therapeutic interventions is associated with decreased urinary KIM-1 levels. STUDY DESIGN Post hoc analysis of a randomized, double-blind, placebo-controlled, crossover trial. SETTING & PARTICIPANTS 34 proteinuric patients without diabetes from our outpatient renal clinic. INTERVENTION Stepwise 6-week interventions of losartan, sodium restriction (low-sodium [LS] diet), their combination, losartan plus hydrochlorothiazide (HCT), and the latter plus an LS diet. OUTCOMES & MEASUREMENTS Urinary excretion of KIM-1, total protein, and N-acetyl-beta-d-glucosaminidase (NAG) as a positive control for tubular injury. RESULTS Mean baseline urine protein level was 3.8 +/- 0.4 (SE) g/d, and KIM-1 level was 1,706 +/- 498 ng/d (increased compared with healthy controls; 74 ng/d). KIM-1 level was decreased by using placebo/LS (1,201 +/- 388 ng/d; P = 0.04), losartan/high sodium (1,184 +/- 296 ng/d; P = 0.09), losartan/LS (921 +/- 176 ng/d; P = 0.008), losartan/high sodium plus HCT (862 +/- 151 ng/d; P = 0.008) and losartan/LS plus HCT (743 +/- 170 ng/d; P = 0.001). The decrease in urinary KIM-1 levels paralleled the decrease in proteinuria (R = 0.523; P < 0.001), but not blood pressure or creatinine clearance. 16 patients reached target proteinuria with protein less than 1 g/d, whereas KIM-1 levels normalized in only 2 patients. Urinary NAG level was increased at baseline and significantly decreased during the treatment periods of combined losartan plus HCT only. The decrease in urinary NAG levels was not closely related to proteinuria. LIMITATIONS Post hoc analysis. CONCLUSIONS Urinary KIM-1 level was increased in patients with nondiabetic CKD with proteinuria and decreased in parallel with proteinuria by using losartan, sodium restriction, their combination, losartan plus HCT, and the latter plus sodium restriction. These results are consistent with the hypothesis of amelioration of proteinuria-induced tubular damage. Long-term studies are warranted to evaluate whether targeting treatment on KIM-1 can improve outcomes in patients with CKD with proteinuria.
Collapse
Affiliation(s)
- Femke Waanders
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Morariu AM, Martins P, Leuvenink H, Denecke C, McGuire S, Acun Z, Malek S, Loeg RP, Tullius S. Organ quality and unspecific inflammatory graft damage accelerate the early immune response in renal allograft recipients: Synergistic effect of brain death (BD) and donor age. J Am Coll Surg 2007. [DOI: 10.1016/j.jamcollsurg.2007.06.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
26
|
Manekeller S, Leuvenink H, Sitzia M, Minor T. Oxygenated machine perfusion preservation of predamaged kidneys with HTK and Belzer machine perfusion solution: an experimental study in pigs. Transplant Proc 2006; 37:3274-5. [PMID: 16298570 DOI: 10.1016/j.transproceed.2005.09.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The objective of the present study was to evaluate the recently proposed aerobic machine preservation with the noncolloidal HTK solution by comparison with the colloidal Belzer machine perfusion solution (MPS) after procurement of marginal kidneys from non-heart-beating donors. Kidneys were harvested 40 minutes after cardiac arrest in German Landrace pigs and subjected to 18 hours of oxygenated hypothermic machine perfusion with either Belzer MPS or modified HTK via the renal artery (Psys < 40 mm Hg). During machine perfusion transrenal flow was approximatively twofold higher and calculated oxygen uptake was increased by 30% using the colloidal Belzer MPS, but overall enzyme release was comparable in both groups. After heterotopic transpantation with bilateral nephrectomy of the recipient, there were no differences with respect to initial tissue perfusion in vivo (evaluated by laser Doppler flowmetry) as well as urine production and median serum levels of urea or creatinine over 1 week of follow-up between grafts perfused with HTK or Belzer MPS. In conclusion, provision of oxygen during storage is possible by low-flow perfusion with HTK as with Belzer MPS.
Collapse
Affiliation(s)
- S Manekeller
- Division of Surgical Research, University Hospital of Bonn, Sigmund Freud Strasse 25, 53127 Bonn, Germany
| | | | | | | |
Collapse
|
27
|
Fürnsinn C, Leuvenink H, Roden M, Nowotny P, Schneider B, Rohac M, Pieber T, Clodi M, Waldhäusl W. Islet amyloid polypeptide inhibits insulin secretion in conscious rats. Am J Physiol 1994; 267:E300-5. [PMID: 8074211 DOI: 10.1152/ajpendo.1994.267.2.e300] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
To investigate the effect of islet amyloid polypeptide (IAPP, amylin) exposure on insulin secretion in vivo, the plasma glucose level of conscious rats was clamped at 11.1 mmol/l (hyperglycemic clamp) during the last 2 h of a 24-h infusion study. Group parameters were A, 24-h saline; B and C, 22-h saline followed by 2-h IAPP (B, 8.5 pmol/min; C, 85 pmol/min), and D, 24-h IAPP (85 pmol/min). Induced hyperglycemia increased plasma insulin concentration by 426 +/- 34 pmol/l in control rats (group A). This effect on plasma insulin was reduced by 31% and 53% during short-term IAPP infusion (group B, 8.5 pmol/min, 294 +/- 41 pmol/l; C, 85 pmol/min, 202 +/- 25 pmol/l; short-term effect, P < 0.0001), whereas insulin levels tended to increase after 24 h of continuous IAPP exposure (group D, 682 +/- 120 pmol/l; P < 0.05 vs. group A). Glucose infusion rate required to maintain constant hyperglycemia fell dose dependently during short-term but not during long-term IAPP infusion (mumol.kg-1.min-1: group A, 203 +/- 11; B, 154 +/- 7; C, 119 +/- 7; D, 212 +/- 9; short-term effect, P < 0.0001). In parallel, muscle glycogen content was dose dependently reduced by short-term IAPP exposure. We conclude that IAPP inhibits glucose-stimulated insulin secretion and decreases muscle glycogen storage in conscious rats in vivo.
Collapse
Affiliation(s)
- C Fürnsinn
- Department of Medicine III, University of Vienna, Austria
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Steffens AB, Leuvenink H, Scheurink AJ. Effects of monosodium glutamate (umami taste) with and without guanosine 5'-monophosphate on rat autonomic responses to meals. Physiol Behav 1994; 56:59-63. [PMID: 8084908 DOI: 10.1016/0031-9384(94)90261-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Monosodium glutamate (MSG) is used as a food additive to improve the taste of food. The effect of MSG on sweet taste is enhanced by guanosine 5'-monophosphate (GMP). Because increased palatability is known to increase the vagally mediated preabsorptive insulin response (PIR), we hypothesized that MSG and GMP will enhance the PIR. To study this, male Wistar rats were provided with permanent cannulas for venous blood sampling and intragastric drug administration. The MSG and GMP were either added to a test meal or infused into the stomach during a test meal. Blood samples were taken to measure concentrations of glucose, insulin, epinephrine (E), and norepinephrine (NE). Addition of 56 mg MSG to a control meal markedly reduced both phases of the meal-induced increase in plasma insulin and had no effects on blood glucose and plasma E and NE responses. Infusion of 56 mg MSG into the stomach at the onset of food intake reduced the PIR with no effect on glucose, E, NE, or the second phase insulin release. Addition of 2 mg MSG in combination with GMP to the test meal or gastric administration of these drugs did not affect the changes in any of the blood components measured. It is concluded that addition of a high dose of MSG to a test meal leads to a reduction in the vagal response to food.
Collapse
Affiliation(s)
- A B Steffens
- Department of Animal Physiology, University of Groningen, Haren, The Netherlands
| | | | | |
Collapse
|
29
|
Scheurink AJ, Leuvenink H, Benthem B, Steffens AB. Dexfenfluramine treatment influences plasma catecholamines and energy substrate metabolism in rats. Physiol Behav 1993; 53:879-87. [PMID: 8511203 DOI: 10.1016/0031-9384(93)90264-g] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The effect of chronic intragastric administration of dexfenfluramine (FFL, 1 mg/kg, twice a day), a drug that increases serotonergic transmission, on peripheral energy substrate metabolism was investigated. Rats were provided with permanent cannulas, allowing stress-free intragastric treatment and blood sampling. Fenfluramine-treated and control animals were submitted to strenuous swimming at days -2, 1, 4, and 7 relative to the onset of FFL treatment at day 0. Blood samples were taken before, during, and after exercise. Thereafter, possible changes in catecholamine sensitivity were investigated during intravenous infusions of norepinephrine (NE) and epinephrine. Finally, energy expenditure, including resting respiratory quotient (RQ), and carbohydrate and fat utilization were measured under baseline conditions. It was found that chronic administration of FFL led to a transient reduction in the exercise-induced increase of blood glucose concentrations. Plasma norepinephrine responses to exercise gradually increased in the FFL-treated animals. Baseline RQ was markedly increased in the FFL-treated animals, indicating an increase of carbohydrate utilization and a decrease of fat combustion. Total energy expenditure remained unchanged. The increased RQ was accompanied by increased sensitivity for NE and significantly decreased baseline concentrations of plasma free fatty acids.
Collapse
Affiliation(s)
- A J Scheurink
- Department of Animal Physiology, University of Groningen, Haren, The Netherlands
| | | | | | | |
Collapse
|
30
|
Abstract
The effects of intrahypothalamic administration of norfenfluramine (NFFL), an anorectic agent that increases serotonergic transmission, on plasma concentrations of glucose, free fatty acids (FFA), and their regulating hormones were investigated in resting and exercising rats. Infusion of 5 micrograms NFFL in 0.125 microliter aCSF/min into the nucleus paraventricularis of the hypothalamus (PVN) caused a significant increase of blood glucose, plasma epinephrine (E), and corticosterone concentrations. Plasma levels of FFA, insulin, or norepinephrine (NE) remained unchanged. Lower doses of NFFL (0.5 and 0.05 microgram/min) did not affect peripheral metabolism. The effects of NFFL in the PVN were completely prevented by prior administration of a 5-HT1 antagonist, (S)-(-)propranolol. The exercise-induced increase of plasma NE was reduced after prior administration of 5 micrograms NFFL/min into the PVN. Plasma E responses tended to be increased. The exercise-induced alterations in glucose, FFA, corticosterone, and insulin were not affected by NFFL infusion into the PVN. The data suggest that activation of serotonergic mechanisms in the PVN might change the neurohormonal response to a stressor favouring the release of adrenal hormones above activation of the neuronal branch of the sympathetic nervous system.
Collapse
Affiliation(s)
- A J Scheurink
- Department of Animal Physiology, University of Groningen, Haren, The Netherlands
| | | | | |
Collapse
|
31
|
Benthem L, Scheurink AJ, Van der Leest J, Leuvenink H, Zijlstra WG, Steffens AB. Effects of long-term d-fenfluramine treatment on energy metabolism in rats. Eur J Pharmacol 1993; 232:279-86. [PMID: 8467863 DOI: 10.1016/0014-2999(93)90785-g] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The effects of chronic intragastric administration of the anorectic agent d-fenfluramine on energy metabolism and nutrient concentrations were investigated at rest and during swimming. Rats were provided with permanent cannulas for blood sampling and intragastric administration of d-fenfluramine or saline. Energy expenditure and nutrient and hormone concentrations were determined. Under baseline conditions, d-fenfluramine increased carbohydrate utilization (14.2 vs. 7.0 mg/kg.min) and decreased fat oxidation (2.8 vs. 5.5 mg/kg.min). Plasma free fatty acid concentration was decreased (0.29 vs. 0.55 mmol/l) and lactate and insulin concentrations were increased after d-fenfluramine treatment (0.64 vs. 0.37 mmol/l and 61 vs. 33 mU/l, respectively). The shift in nutrient utilization also occurred during swimming. The exercise-induced increase in blood glucose was reduced after d-fenfluramine (+0.8 vs. +2.0 mmol/l). During swimming, free fatty acid, lactate and insulin concentrations were similar in the two groups. It is hypothesized that chronic d-fenfluramine treatment increases in the oxidation of carbohydrates and decreases the oxidation of fat as a result of a decrease in the transport of fatty acids over the mitochondrial membrane.
Collapse
Affiliation(s)
- L Benthem
- Department of Medical Physiology, University of Groningen, Netherlands
| | | | | | | | | | | |
Collapse
|