1
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Mehta SA, Saharia KK, Nellore A, Blumberg EA, Fishman JA. Infection and clinical xenotransplantation: Guidance from the Infectious Disease Community of Practice of the American Society of Transplantation. Am J Transplant 2023; 23:309-315. [PMID: 36695690 DOI: 10.1016/j.ajt.2022.12.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/20/2022] [Accepted: 12/10/2022] [Indexed: 01/04/2023]
Abstract
This guidance was developed to summarize current approaches to the potential transmission of swine-derived organisms to xenograft recipients, health care providers, or the public in clinical xenotransplantation. Limited specific data are available on the zoonotic potential of pig pathogens. It is anticipated that the risk of zoonotic infection in xenograft recipients will be determined by organisms present in source animals and relate to the nature and intensity of the immunosuppression used to maintain xenograft function. Based on experience in allotransplantation and with preclinical models, viral infections are of greatest concern, including porcine cytomegalovirus, porcine lymphotropic herpesvirus, and porcine endogenous retroviruses. Sensitive and specific microbiological assays are required for routine microbiological surveillance of source animals and xenograft recipients. Archiving of blood samples from recipients, contacts, and hospital staff may provide a basis for microbiological investigations if infectious syndromes develop. Carefully implemented infection control practices are required to prevent zoonotic pathogen exposures by clinical care providers. Informed consent practices for recipients and their close contacts must convey the lack of specific data for infectious risk assessment. Available data suggest that infectious risks of xenotransplantation are manageable and that clinical trials can advance with carefully developed protocols for pretransplant assessment, syndrome evaluation, and microbiological monitoring.
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Affiliation(s)
- Sapna A Mehta
- Transplant Infectious Diseases, NYU Langone Transplant Institute and NYU Grossman School of Medicine, New York, New York, USA
| | - Kapil K Saharia
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Anoma Nellore
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Emily A Blumberg
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jay A Fishman
- Transplant and Compromised Host Infectious Disease Program and MGH Transplant Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
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2
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Hansen-Estruch C, Bikhet MH, Javed M, Katsurada A, Satou R, Shao W, Ayares D, Venkataramanan R, Cooper DKC, Judd E, Navar LG. Renin-angiotensin-aldosterone system function in the pig-to-baboon kidney xenotransplantation model. Am J Transplant 2023; 23:353-365. [PMID: 36695679 PMCID: PMC10124771 DOI: 10.1016/j.ajt.2022.11.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 10/31/2022] [Accepted: 11/22/2022] [Indexed: 01/07/2023]
Abstract
After pig-to-baboon kidney transplantation, episodes of hypovolemia and hypotension from an unexplained mechanism have been reported. This study evaluated the renin-angiotensin-aldosterone system post-kidney xenotransplantation. Kidneys from genetically-engineered pigs were transplanted into 5 immunosuppressed baboons after the excision of the native kidneys. Immunosuppressive therapy was based on the blockade of the CD40/CD154 costimulation pathway. Plasma renin, angiotensinogen (AGT), angiotensin II (Ang II), aldosterone levels, and urine osmolality and electrolytes were measured in healthy pigs, healthy nonimmunosuppressed baboons, and immunosuppressed baboons with life-supporting pig kidney grafts. After pig kidney transplantation, plasma renin and Ang II levels were not significantly different, although Ang II trended lower, even though plasma AGT and potassium were increased. Plasma aldosterone levels were unchanged. Urine osmolality and sodium concentration were decreased. Even in the presence of increasing AGT and potassium levels, lower plasma Ang II concentrations may be because of reduced, albeit not absent, the reactivity of pig renin to cleave baboon AGT, suggesting an impaired response of the renin-angiotensin-aldosterone system to hypovolemic and hypotensive episodes. The maintenance of aldosterone may be protective. The reduced urine osmolality and sodium concentration reflect the decreased ability of the pig kidney to concentrate urine. These considerations should not prohibit successful clinical pig kidney xenotransplantation.
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Affiliation(s)
- Christophe Hansen-Estruch
- Department of Surgery, Xenotransplantation Program, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mohamed H Bikhet
- Department of Surgery, Xenotransplantation Program, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mariyam Javed
- Department of Surgery, Xenotransplantation Program, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Akemi Katsurada
- Department of Physiology and Hypertension and Renal Center, Tulane University, New Orleans, Louisiana, USA
| | - Ryousuke Satou
- Department of Physiology and Hypertension and Renal Center, Tulane University, New Orleans, Louisiana, USA
| | - Weijian Shao
- Department of Physiology and Hypertension and Renal Center, Tulane University, New Orleans, Louisiana, USA
| | | | - Raman Venkataramanan
- Clinical Pharmacokinetics Laboratory, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania, USA
| | - David K C Cooper
- Department of Surgery, Xenotransplantation Program, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Eric Judd
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
| | - Luis Gabriel Navar
- Department of Physiology and Hypertension and Renal Center, Tulane University, New Orleans, Louisiana, USA
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3
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Kassimatis T, Greenlaw R, Hunter JP, Douiri A, Flach C, Rebollo-Mesa I, Nichols LL, Qasem A, Danzi G, Olsburgh J, Drage M, Friend PJ, Neri F, Karegli J, Horsfield C, Smith RA, Sacks SH. Ex vivo delivery of Mirococept: A dose-finding study in pig kidney after showing a low dose is insufficient to reduce delayed graft function in human kidney. Am J Transplant 2021; 21:1012-1026. [PMID: 33225626 DOI: 10.1111/ajt.16265] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 05/31/2020] [Revised: 07/17/2020] [Accepted: 08/06/2020] [Indexed: 01/25/2023]
Abstract
The complement system plays a pivotal role in the pathogenesis of ischemia-reperfusion injury in solid organ transplantation. Mirococept is a potent membrane-localizing complement inhibitor that can be administered ex vivo to the donor kidney prior to transplantation. To evaluate the efficacy of Mirococept in reducing delayed graft function (DGF) in deceased donor renal transplantation, we undertook the efficacy of mirococept (APT070) for preventing ischaemia-reperfusion injury in the kidney allograft (EMPIRIKAL) trial (ISRCTN49958194). A dose range of 5-25 mg would be tested, starting with 10 mg in cohort 1. No significant difference between Mirococept at 10 mg and control was detected; hence the study was stopped to enable a further dose saturation study in a porcine kidney model. The optimal dose of Mirococept in pig kidney was 80 mg. This dose did not induce any additional histological damage compared to controls or after a subsequent 3 hours of normothermic machine perfusion. The amount of unbound Mirococept postperfusion was found to be within the systemic dose range considered safe in the Phase I trial. The ex vivo administration of Mirococept is a safe and feasible approach to treat DGF in deceased donor kidney transplantation. The porcine kidney study identified an optimal dose of 80 mg (equivalent to 120 mg in human kidney) that provides a basis for further clinical development.
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Affiliation(s)
- Theodoros Kassimatis
- Renal Unit, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Roseanna Greenlaw
- School of Immunology and Microbial Sciences, King's College London, London, UK
| | - James P Hunter
- Oxford Transplant Centre, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Abdel Douiri
- School of Population Health and Environmental Studies, King's College London, London, UK
| | - Clare Flach
- School of Population Health and Environmental Studies, King's College London, London, UK
| | - Irene Rebollo-Mesa
- School of Immunology and Microbial Sciences, King's College London, London, UK.,UCB Biopharma, Brussels, Belgium
| | - Laura L Nichols
- School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Anass Qasem
- Renal Unit, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Guilherme Danzi
- School of Immunology and Microbial Sciences, King's College London, London, UK.,Department of Nephrology, Clinic Hospital, Federal University of Pernambuco, Recife, Brazil
| | - Jonathon Olsburgh
- Department of Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Martin Drage
- Department of Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Peter J Friend
- Oxford Transplant Centre, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Flavia Neri
- Oxford Transplant Centre, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Julieta Karegli
- School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Catherine Horsfield
- Department of Histopathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Richard A Smith
- School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Steven H Sacks
- School of Immunology and Microbial Sciences, King's College London, London, UK
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4
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Leonard DA, Powell HR, Defazio MW, Shanmugarajah K, Mastroianni M, Rosales I, Farkash EA, Colvin RB, Randolph MA, Sachs DH, Kurtz JM, Cetrulo CL. Cutaneous leukocyte lineages in tolerant large animal and immunosuppressed clinical vascularized composite allograft recipients. Am J Transplant 2021; 21:582-592. [PMID: 32741100 PMCID: PMC7854956 DOI: 10.1111/ajt.16230] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/22/2020] [Accepted: 07/15/2020] [Indexed: 01/25/2023]
Abstract
Vascularized composite allografts (VCAs) can restore fully functional anatomic units in patients with limb amputations or severe facial tissue loss. However, acute rejection of the skin is frequently observed and underscores the importance of developing tolerance induction protocols. In this study, we have characterized the skin immune system in VCAs. We demonstrate infiltration of recipient leukocytes, regardless of rejection status, and in tolerant mixed hematopoietic chimeras, the co-existence of these cells with donor leukocytes in the absence of rejection. Here we characterize the dermal T cell and epidermal Langerhans cell components of the skin immune system in our porcine model of VCA tolerance, and the kinetics of cutaneous chimerism in both of these populations in VCAs transplanted to tolerant and nontolerant recipients, as well as in host skin. Furthermore, in biopsies from the first patient to receive a hand transplant in our program, we demonstrate the presence of recipient T cells in the skin of the transplanted limb in the absence of clinical or histological evidence of rejection.
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Affiliation(s)
- D. A. Leonard
- Center for Transplantation Sciences, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts,Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, Massachusetts,Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Glasgow, Scotland
| | - H. R. Powell
- Center for Transplantation Sciences, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - M. W. Defazio
- Center for Transplantation Sciences, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - K. Shanmugarajah
- Center for Transplantation Sciences, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts,Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - M. Mastroianni
- Center for Transplantation Sciences, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts,Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - I. Rosales
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - E. A. Farkash
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - R. B. Colvin
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - M. A. Randolph
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - D. H. Sachs
- Center for Transplantation Sciences, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts,Columbia Center for Translational Immunology, Columbia University Medical Center, New York, New York
| | - J. M. Kurtz
- Center for Transplantation Sciences, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts,Department of Biology, Emmanuel College, Boston, Massachusetts
| | - C. L. Cetrulo
- Center for Transplantation Sciences, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts,Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, Massachusetts,Shriners Hospital for Children, Boston, Massachusetts
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5
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Hurst DJ, Padilla LA, Cooper DKC, Cleveland DC, Paris W. Clinical trials of pediatric cardiac xenotransplantation. Am J Transplant 2021; 21:433-434. [PMID: 32946176 DOI: 10.1111/ajt.16151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Daniel J Hurst
- Department of Medical Professionalism, Ethics, and Humanities, Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - Luz A Padilla
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David K C Cooper
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David C Cleveland
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Wayne Paris
- Department of Social Work, Abilene Christian University, Abilene, Texas, USA
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6
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Schnieke A, Locke S, Linkermann A. Precondition your donor pig for your successful allograft! Am J Transplant 2020; 20:3275-3276. [PMID: 32506653 DOI: 10.1111/ajt.16108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/04/2020] [Accepted: 05/04/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Angelika Schnieke
- Chair of Livestock Biotechnology, School of Life Sciences, Technische Universität München, Freising, Germany
| | - Sophie Locke
- Division of Nephrology, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany
| | - Andreas Linkermann
- Division of Nephrology, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany.,Biotechnology Center, Technische Universität Dresden, Dresden, Germany
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7
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Kuscu C, Kuscu C, Bajwa A, Eason JD, Maluf D, Mas VR. Applications of CRISPR technologies in transplantation. Am J Transplant 2020; 20:3285-3293. [PMID: 32484284 PMCID: PMC8109183 DOI: 10.1111/ajt.16095] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/22/2020] [Accepted: 05/19/2020] [Indexed: 01/25/2023]
Abstract
In transplantation, the ever-increasing number of an organ's demand and long-term graft dysfunction constitute some of the major problems. Therefore, alternative solutions to increase the quantity and quality of the organ supply for transplantation are desired. On this subject, revolutionary Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) technology holds enormous potential for the scientific community with its expanding toolbox. In this minireview, we summarize the history and mechanism of CRISPR/Cas9 systems and explore its potential applications in cellular- and organ-level transplantation. The last part of this review includes future opportunities as well as the challenges in the transplantation field.
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Affiliation(s)
- Cem Kuscu
- Transplant Research Institute, James D. Eason Transplant Institute, Department of Surgery, School of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Canan Kuscu
- Transplant Research Institute, James D. Eason Transplant Institute, Department of Surgery, School of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Amandeep Bajwa
- Transplant Research Institute, James D. Eason Transplant Institute, Department of Surgery, School of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - James D. Eason
- Transplant Research Institute, James D. Eason Transplant Institute, Department of Surgery, School of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Daniel Maluf
- Transplant Research Institute, James D. Eason Transplant Institute, Department of Surgery, School of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Valeria R. Mas
- Transplant Research Institute, James D. Eason Transplant Institute, Department of Surgery, School of Medicine, University of Tennessee Health Science Center, Memphis, TN
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8
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Darius T, Vergauwen M, Smith T, Gerin I, Joris V, Mueller M, Aydin S, Muller X, Schlegel A, Nath J, Ludwig C, Dessy C, Many MC, Bommer G, Dutkowski P, Gianello P, Mourad M. Brief O 2 uploading during continuous hypothermic machine perfusion is simple yet effective oxygenation method to improve initial kidney function in a porcine autotransplant model. Am J Transplant 2020; 20:2030-2043. [PMID: 32012434 DOI: 10.1111/ajt.15800] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 11/24/2019] [Revised: 01/23/2020] [Accepted: 01/24/2020] [Indexed: 01/25/2023]
Abstract
With oxygenation proposed as a resuscitative measure during hypothermic models of preservation, the aim of this study was to evaluate the optimal start time of oxygenation during continuous hypothermic machine perfusion (HMP). In this porcine ischemia-reperfusion autotransplant model, the left kidney of a ±40 kg pig was exposed to 30 minutes of warm ischemia prior to 22 hours of HMP and autotransplantation. Kidneys were randomized to receive 2 hours of oxygenation during HMP either at the start (n = 6), or end of the perfusion (n = 5) and outcomes were compared to standard, nonoxygenated HMP (n = 6) and continuous oxygenated HMP (n = 8). The brief initial and continuous oxygenated HMP groups were associated with superior graft recovery compared to either standard, nonoxygenated HMP or kidneys oxygenated at the end of HMP. This correlated with significant metabolic differences in perfusate (eg, lactate, succinate, flavin mononucleotide) and tissues (eg, succinate, adenosine triphosphate, hypoxia-inducible factor-1α, nuclear factor erythroid 2-related factor 2) suggesting superior mitochondrial preservation with initial oxygenation. Brief initial O2 uploading during HMP at procurement site might be an easy and effective preservation strategy to maintain aerobic metabolism, protect mitochondria, and achieve an improved early renal graft function compared with standard HMP or oxygen supply shortly at the end of HMP preservation.
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Affiliation(s)
- Tom Darius
- Surgery and Abdominal Transplant Unit, University Clinics Saint Luc, Université Catholique de Louvain, Brussels, Belgium.,Pole de Chirurgie Expérimentale et Transplantation, Université Catholique de Louvain, Brussels, Belgium
| | - Martial Vergauwen
- Pole de Chirurgie Expérimentale et Transplantation, Université Catholique de Louvain, Brussels, Belgium
| | - Thomas Smith
- The Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham, UK
| | - Isabelle Gerin
- Walloon Excellence in Lifesciences and Biotechnology (WELBIO), Laboratory of Physiological Chemistry, de Duve Institute, Université Catholique de Louvain, Brussels, Belgium
| | - Virginie Joris
- Pole of Pharmacology and Therapeutics, Experimental and Clinical Research Institute, Université Catholique de Louvain, Brussels, Belgium
| | - Matteo Mueller
- Department of Surgery and Transplantation, Swiss HPB Center, University Hospital Zurich, Zurich, Switzerland
| | - Selda Aydin
- Department of Pathology, University Clinics Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Xavier Muller
- Department of Surgery and Transplantation, Swiss HPB Center, University Hospital Zurich, Zurich, Switzerland
| | - Andrea Schlegel
- Liver Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham, Birmingham, UK
| | - Jay Nath
- Department of Renal Transplantation, Southmead Hospital Bristol, Bristol, UK
| | - Christian Ludwig
- The Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham, UK
| | - Chantal Dessy
- Pole of Pharmacology and Therapeutics, Experimental and Clinical Research Institute, Université Catholique de Louvain, Brussels, Belgium
| | - Marie-Christine Many
- Department of Morphology, Experimental and Clinical Research Institute, Université Catholique de Louvain, Brussels, Belgium
| | - Guido Bommer
- Walloon Excellence in Lifesciences and Biotechnology (WELBIO), Laboratory of Physiological Chemistry, de Duve Institute, Université Catholique de Louvain, Brussels, Belgium
| | - Philipp Dutkowski
- Department of Surgery and Transplantation, Swiss HPB Center, University Hospital Zurich, Zurich, Switzerland
| | - Pierre Gianello
- Pole de Chirurgie Expérimentale et Transplantation, Université Catholique de Louvain, Brussels, Belgium
| | - Michel Mourad
- Surgery and Abdominal Transplant Unit, University Clinics Saint Luc, Université Catholique de Louvain, Brussels, Belgium.,Pole de Chirurgie Expérimentale et Transplantation, Université Catholique de Louvain, Brussels, Belgium
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9
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Linares-Cervantes I, Echeverri J, Cleland S, Kaths JM, Rosales R, Goto T, Kollmann D, Hamar M, Urbanellis P, Mazilescu L, Ganesh S, Adeyi OA, Yip P, Goryńska P, Bojko B, Goryński K, Grant DR, Selzner N, Wąsowicz M, Selzner M. Predictor parameters of liver viability during porcine normothermic ex situ liver perfusion in a model of liver transplantation with marginal grafts. Am J Transplant 2019; 19:2991-3005. [PMID: 31012532 DOI: 10.1111/ajt.15395] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 12/23/2018] [Revised: 04/03/2019] [Accepted: 04/18/2019] [Indexed: 01/25/2023]
Abstract
Normothermic ex situ liver perfusion (NEsLP) offers the opportunity to assess biomarkers of graft function and injury. We investigated NEsLP parameters (biomarkers and markers) for the assessment of liver viability in a porcine transplantation model. Grafts from heart-beating donors (HBD), and from donors with 30 minutes (donation after cardiac death [DCD]30'), 70 minutes (DCD70'), and 120 minutes (DCD120') of warm ischemia were studied. The HBD, DCD30', and DCD70'-groups had 100% survival. In contrast, 70% developed primary nonfunction (PNF) and died in the DCD120'-group. Hepatocellular function during NEsLP showed low lactate (≤1.1 mmol/L) in all the groups except the DCD120'-group (>2 mmol/L) at 4 hours of perfusion (P = .04). The fold-urea increase was significantly lower in the DCD120'-group (≤0.4) compared to the other groups (≥0.65) (P = .01). As for cholangiocyte function, bile/perfusate glucose ratio was significantly lower (<0.6) in all the groups except the DCD120'-group (≥0.9) after 3 hours of perfusion (<0.01). Bile/perfusate Na+ ratio was significantly higher (≥1.2) after 3 hours of perfusion in all the groups except for the DCD120'-group (≤1) (P < .01). Three hours after transplantation, the DCD120'-group had a significantly higher international normalized ratio (>5) compared to the rest of the groups (≤1.9) (P = .02). Rocuronium levels were higher at all the time-points in the animals that developed PNF during NEsLP and after transplantation. This study demonstrates that biomarkers and markers of hepatocellular and cholangiocyte function during NEsLP correlate with the degree of ischemic injury and posttransplant function.
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Affiliation(s)
- Ivan Linares-Cervantes
- Multi Organ Transplant Program, Toronto General Hospital, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,National Council for Science and Technology, Mexico City, Mexico
| | - Juan Echeverri
- Multi Organ Transplant Program, Toronto General Hospital, Toronto, Ontario, Canada.,Doctoral Program in Surgery and Morphological Sciences, Autonomous University of Barcelona, Barcelona, Spain
| | - Stuart Cleland
- Department of Anesthesiology and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada.,Department of Anaesthesia, University Hospitals, Plymouth, UK
| | - Johann Moritz Kaths
- Multi Organ Transplant Program, Toronto General Hospital, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Roizar Rosales
- Multi Organ Transplant Program, Toronto General Hospital, Toronto, Ontario, Canada
| | - Toru Goto
- Multi Organ Transplant Program, Toronto General Hospital, Toronto, Ontario, Canada
| | - Dagmar Kollmann
- Multi Organ Transplant Program, Toronto General Hospital, Toronto, Ontario, Canada.,Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Matyas Hamar
- Multi Organ Transplant Program, Toronto General Hospital, Toronto, Ontario, Canada
| | - Peter Urbanellis
- Multi Organ Transplant Program, Toronto General Hospital, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Laura Mazilescu
- Multi Organ Transplant Program, Toronto General Hospital, Toronto, Ontario, Canada
| | - Sujani Ganesh
- Multi Organ Transplant Program, Toronto General Hospital, Toronto, Ontario, Canada
| | - Oyedele A Adeyi
- Department of Pathology, Toronto General Hospital, Toronto, Ontario, Canada
| | - Paul Yip
- Department of Clinical Biochemistry, Toronto General Hospital, Toronto, Ontario, Canada
| | - Paulina Goryńska
- Department of Pharmacodynamics and Molecular Pharmacology, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Barbara Bojko
- Department of Pharmacodynamics and Molecular Pharmacology, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Krzysztof Goryński
- Department of Pharmacodynamics and Molecular Pharmacology, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - David R Grant
- Multi Organ Transplant Program, Toronto General Hospital, Toronto, Ontario, Canada
| | - Nazia Selzner
- Multi Organ Transplant Program, Toronto General Hospital, Toronto, Ontario, Canada
| | - Marcin Wąsowicz
- Department of Anesthesiology and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | - Markus Selzner
- Multi Organ Transplant Program, Toronto General Hospital, Toronto, Ontario, Canada
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10
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Watanabe Y, Galasso M, Watanabe T, Ali A, Qaqish R, Nakajima D, Taniguchi Y, Pipkin M, Caldarone L, Chen M, Kanou T, Summers C, Ramadan K, Zhang Y, Chan H, Waddell TK, Liu M, Keshavjee S, Del Sorbo L, Cypel M. Donor prone positioning protects lungs from injury during warm ischemia. Am J Transplant 2019; 19:2746-2755. [PMID: 30887696 DOI: 10.1111/ajt.15363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 11/20/2018] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 01/25/2023]
Abstract
A large proportion of controlled donation after circulatory death (cDCD) donor lungs are declined because cardiac arrest does not occur within a suitable time after the withdrawal of life-sustaining therapy. Improved strategies to preserve lungs after asystole may allow the recovery team to arrive after death actually occurs and enable the recovery of lungs from more cDCD donors. The aim of this study was to determine the effect of donor positioning on the quality of lung preservation after cardiac arrest in a cDCD model. Cardiac arrest was induced by withdrawal of ventilation under anesthesia in pigs. After asystole, animals were divided into 2 groups based on body positioning (supine or prone). All animals were subjected to 3 hours of warm ischemia. After the observation period, donor lungs were explanted and preserved at 4°C for 6 hours, followed by 6 hours of physiologic and biological lung assessment under normothermic ex vivo lung perfusion. Donor lungs from the prone group displayed significantly greater quality as reflected by better function during ex vivo lung perfusion, less edema formation, less cell death, and decreased inflammation compared with the supine group. A simple maneuver of donor prone positioning after cardiac arrest significantly improves lung graft preservation and function.
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Affiliation(s)
- Yui Watanabe
- Latner Thoracic Surgery Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada.,Toronto Lung Transplant Program, Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Marcos Galasso
- Latner Thoracic Surgery Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Tatsuaki Watanabe
- Latner Thoracic Surgery Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Aadil Ali
- Latner Thoracic Surgery Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Robert Qaqish
- Latner Thoracic Surgery Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Daisuke Nakajima
- Latner Thoracic Surgery Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Yohei Taniguchi
- Latner Thoracic Surgery Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Mauricio Pipkin
- Latner Thoracic Surgery Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Lindsay Caldarone
- Latner Thoracic Surgery Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Manyin Chen
- Latner Thoracic Surgery Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Takashi Kanou
- Latner Thoracic Surgery Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Cara Summers
- Latner Thoracic Surgery Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Khaled Ramadan
- Latner Thoracic Surgery Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Yu Zhang
- Latner Thoracic Surgery Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Harley Chan
- Guided Therapeutics, TECHNA Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Thomas K Waddell
- Latner Thoracic Surgery Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada.,Toronto Lung Transplant Program, Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Mingyao Liu
- Latner Thoracic Surgery Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Shaf Keshavjee
- Latner Thoracic Surgery Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada.,Toronto Lung Transplant Program, Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Lorenzo Del Sorbo
- Interdepartmental Division of Critical Care Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Marcelo Cypel
- Latner Thoracic Surgery Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada.,Toronto Lung Transplant Program, Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
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11
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Dromparis P, Aboelnazar NS, Wagner S, Himmat S, White CW, Hatami S, Luc JGY, Rotich S, Freed DH, Nagendran J, Mengel M, Adam BA. Ex vivo perfusion induces a time- and perfusate-dependent molecular repair response in explanted porcine lungs. Am J Transplant 2019; 19:1024-1036. [PMID: 30230229 DOI: 10.1111/ajt.15123] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 04/20/2018] [Revised: 09/13/2018] [Accepted: 09/14/2018] [Indexed: 01/25/2023]
Abstract
Ex vivo lung perfusion (EVLP) shows promise in ameliorating pretransplant acute lung injury (ALI) and expanding the donor organ pool, but the mechanisms of ex vivo repair remain poorly understood. We aimed to assess the utility of gene expression for characterizing ALI during EVLP. One hundred sixty-nine porcine lung samples were collected in vivo (n = 25), after 0 (n = 11) and 12 (n = 11) hours of cold static preservation (CSP), and after 0 (n = 57), 6 (n = 8), and 12 (n = 57) hours of EVLP, utilizing various ventilation and perfusate strategies. The expression of 53 previously described ALI-related genes was measured and correlated with function and histology. Twenty-eight genes were significantly upregulated and 6 genes downregulated after 12 hours of EVLP. Aggregate gene sets demonstrated differential expression with EVLP (P < .001) but not CSP. Upregulated 28-gene set expression peaked after 6 hours of EVLP, whereas downregulated 6-gene set expression continued to decline after 12 hours. Cellular perfusates demonstrated a greater reduction in downregulated 6-gene set expression vs acellular perfusate (P < .038). Gene set expression correlated with relevant functional and histologic parameters, including P/F ratio (P < .001) and interstitial inflammation (P < .005). Further studies with posttransplant results are warranted to evaluate the clinical significance of this novel molecular approach for assessing organ quality during EVLP.
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Affiliation(s)
- Peter Dromparis
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Nader S Aboelnazar
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Siegfried Wagner
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Sayed Himmat
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Christopher W White
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Sanaz Hatami
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jessica G Y Luc
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Silas Rotich
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Darren H Freed
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jayan Nagendran
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Michael Mengel
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Benjamin A Adam
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
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12
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Xu M, Garcia-Aroz S, Banan B, Wang X, Rabe BJ, Zhou F, Nayak DK, Zhang Z, Jia J, Upadhya GA, Manning PT, Gaut JP, Lin Y, Chapman WC. Enhanced immunosuppression improves early allograft function in a porcine kidney transplant model of donation after circulatory death. Am J Transplant 2019; 19:713-723. [PMID: 30152136 DOI: 10.1111/ajt.15098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 02/13/2018] [Revised: 07/30/2018] [Accepted: 08/14/2018] [Indexed: 01/25/2023]
Abstract
It remains controversial whether renal allografts from donation after circulatory death (DCD) have a higher risk of acute rejection (AR). In the porcine large animal kidney transplant model, we investigated the AR and function of DCD renal allografts compared to the non-DCD renal allografts and the effects of increased immunosuppression. We found that the AR was significantly increased along with elevated MHC-I expression in the DCD transplants receiving low-dose immunosuppression; however, AR and renal function were significantly improved when given high-dose immunosuppressive therapy postoperatively. Also, high-dose immunosuppression remarkably decreased the mRNA levels of ifn-g, il-6, tgf-b, il-4, and tnf-a in the allograft at day 5 and decreased serum cytokines levels of IFN-g and IL-17 at day 4 and day 5 after operation. Furthermore, Western blot analysis showed that higher immunosuppression decreased phosphorylation of signal transducer and activator of transcription 3 and nuclear factor kappa-light-chain-enhancer of activated B cells-p65, increased phosphorylation of extracellular-signal-regulated kinase, and reduced the expression of Bcl-2-associated X protein and caspase-3 in the renal allografts. These results suggest that the DCD renal allograft seems to be more vulnerable to AR; enhanced immunosuppression reduces DCD-associated AR and improves early allograft function in a preclinical large animal model.
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Affiliation(s)
- Min Xu
- Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St. Louis, MO, USA
| | - Sandra Garcia-Aroz
- Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St. Louis, MO, USA
| | - Babak Banan
- Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St. Louis, MO, USA
| | - Xuanchuan Wang
- Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St. Louis, MO, USA.,Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Brian J Rabe
- Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St. Louis, MO, USA
| | - Fangyu Zhou
- Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St. Louis, MO, USA
| | - Deepak K Nayak
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Zhengyan Zhang
- Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St. Louis, MO, USA
| | - Jianluo Jia
- Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St. Louis, MO, USA
| | - Gundumi A Upadhya
- Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Joseph P Gaut
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Yiing Lin
- Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St. Louis, MO, USA
| | - William C Chapman
- Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St. Louis, MO, USA
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13
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Darius T, Gianello P, Vergauwen M, Mourad N, Buemi A, De Meyer M, Mourad M. The effect on early renal function of various dynamic preservation strategies in a preclinical pig ischemia-reperfusion autotransplant model. Am J Transplant 2019; 19:752-762. [PMID: 30171799 DOI: 10.1111/ajt.15100] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [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: 05/30/2018] [Revised: 08/24/2018] [Accepted: 08/24/2018] [Indexed: 01/25/2023]
Abstract
The aims of this study were to determine the most optimal timing to start machine perfusion during kidney preservation to improve early graft function and to evaluate the impact of temperature and oxygen supply during machine perfusion in a porcine ischemia-reperfusion autotransplant model. The left kidney of an approximately 40-kg female Belgian Landrace pig was exposed to 30 minutes of warm ischemia via vascular clamping and randomized to 1 of 6 study groups: (1) 22-hour static cold storage (SCS) (n = 6), (2) 22-hour hypothermic machine perfusion (HMP) (n = 6), (3) 22-hour oxygenated HMP (n = 7), (4) 20-hour HMP plus 2-hour normothermic perfusion (NP) (n = 6), (5) 20-hour SCS plus 2-hour oxygenated HMP (n = 7), and (6) 20-hour SCS plus 2-hour NP (n = 6). Graft recovery measured by serum creatinine level was significantly faster for continuous HMP preservation strategies compared with SCS alone and for all end-ischemic strategies. The active oxygenated 22-hour HMP group demonstrated a significantly faster recovery from early graft function compared with the 22-hour nonactive oxygenated HMP group. Active oxygenation was also found to be an important modulator of a faster increase in renal flow during HMP preservation. Continuous oxygenated HMP applied from the time of kidney procurement until transplant might be the best preservation strategy to improve early graft function.
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Affiliation(s)
- Tom Darius
- Surgery and Abdominal Transplant Unit, Saint Luc University, Hopital Université catholique de Louvain, Brussels, Belgium
| | - Pierre Gianello
- Pôle de Chirurgie Expérimentale et Transplantation, Université catholique de Louvain, Brussels, Belgium
| | - Martial Vergauwen
- Pôle de Chirurgie Expérimentale et Transplantation, Université catholique de Louvain, Brussels, Belgium
| | - Nizar Mourad
- Pôle de Chirurgie Expérimentale et Transplantation, Université catholique de Louvain, Brussels, Belgium
| | - Antoine Buemi
- Surgery and Abdominal Transplant Unit, Saint Luc University, Hopital Université catholique de Louvain, Brussels, Belgium
| | - Martine De Meyer
- Surgery and Abdominal Transplant Unit, Saint Luc University, Hopital Université catholique de Louvain, Brussels, Belgium
| | - Michel Mourad
- Surgery and Abdominal Transplant Unit, Saint Luc University, Hopital Université catholique de Louvain, Brussels, Belgium
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14
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Kim J, Choi SH, Lee HJ, Kim HP, Kang HJ, Kim JM, Hwang ES, Park CG, Kim MK. Comparative efficacy of anti-CD40 antibody-mediated costimulation blockade on long-term survival of full-thickness porcine corneal grafts in nonhuman primates. Am J Transplant 2018; 18:2330-2341. [PMID: 29722120 DOI: 10.1111/ajt.14913] [Citation(s) in RCA: 14] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/06/2018] [Accepted: 04/23/2018] [Indexed: 01/25/2023]
Abstract
Porcine corneas may be good substitutes for human corneas in donor shortage. Therefore, we evaluated the efficacy and safety of an anti-CD40 antibody-based regimen compared with an anti-CD20 antibody-based regimen on the survival of full-thickness corneas in pig-to-rhesus xenotransplant. Thirteen Chinese rhesuses underwent full-thickness corneal xenotransplant. Six were administered anti-CD40 antibody, and the others were administered anti-CD20 antibody, basiliximab, and tacrolimus. Graft survival and changes in lymphocyte, donor-specific and anti-Galα1,3Galβ1,4GlcNAc-R (αGal) antibody, and aqueous complement levels were evaluated. Treatment with the anti-CD40 antibody (>511, >422, >273, >203, >196, 41 days) and anti-CD20 antibody (>470, 297, >260, >210, >184, 134, >97 days) resulted in long-term survival of grafts. In the anti-CD20 group, the number of activated B cells was significantly lower than that in the anti-CD40 group, and the level of aqueous complements at 6 months was significantly higher than the preoperative level. There were no differences in the levels of T cells or donor-specific and anti-αGal antibodies between the 2 groups. In the anti-CD20 group, 3 primates had adverse reactions. In conclusion, both the anti-CD40 antibody- and the anti-CD20 antibody-based protocols were effective for the long-term survival of full-thickness corneal xenografts, but the anti-CD40 antibody-based treatment had fewer adverse effects.
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Affiliation(s)
- Jaeyoung Kim
- Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Se Hyun Choi
- Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Translational Xenotransplantation Research Center, Seoul National University College of Medicine, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Hyun Ju Lee
- Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Hong Pyo Kim
- Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Hee Jung Kang
- Translational Xenotransplantation Research Center, Seoul National University College of Medicine, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Laboratory Medicine, Hallym University College of Medicine, Anyang, Gyeonggi-do, Korea
| | - Jong Min Kim
- Translational Xenotransplantation Research Center, Seoul National University College of Medicine, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Eung Soo Hwang
- Department of Microbiology and Immunology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Chung-Gyu Park
- Translational Xenotransplantation Research Center, Seoul National University College of Medicine, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Microbiology and Immunology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Mee Kum Kim
- Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Translational Xenotransplantation Research Center, Seoul National University College of Medicine, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
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15
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Michel SG, Madariaga MLL, LaMuraglia GMII, Villani V, Sekijima M, Farkash EA, Colvin RB, Sachs DH, Yamada K, Rosengard BR, Allan JS, Madsen JC. The effects of brain death and ischemia on tolerance induction are organ-specific. Am J Transplant 2018; 18:1262-1269. [PMID: 29377632 PMCID: PMC5910264 DOI: 10.1111/ajt.14674] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 12/29/2017] [Accepted: 01/18/2018] [Indexed: 01/25/2023]
Abstract
We have previously shown that 12 days of high-dose calcineurin inhibition induced tolerance in MHC inbred miniature swine receiving MHC-mismatched lung, kidney, or co-transplanted heart/kidney allografts. However, if lung grafts were procured from donation after brain death (DBD), and transplanted alone, they were rejected within 19-45 days. Here, we investigated whether donor brain death with or without allograft ischemia would also prevent tolerance induction in kidney or heart/kidney recipients. Four kidney recipients treated with 12 days of calcineurin inhibition received organs from donors rendered brain dead for 4 hours. Six heart/kidney recipients also treated with calcineurin inhibition received organs from donors rendered brain dead for 4 hours, 8 hours, or 4 hours with 4 additional hours of cold storage. In contrast to lung allograft recipients, all isolated kidney or heart/kidney recipients that received organs from DBD donors achieved long-term survival (>100 days) without histologic evidence of rejection. Proinflammatory cytokine gene expression was upregulated in lungs and hearts, but not kidney allografts, after brain death. These data suggest that the deleterious effects of brain death and ischemia on tolerance induction are organ-specific, which has implications for the application of tolerance to clinical transplantation.
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Affiliation(s)
- SG Michel
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA,Clinic of Cardiac Surgery, Ludwig-Maximilians-University Munich, Germany
| | - MLL Madariaga
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - GMII LaMuraglia
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA,Emory Transplant Center, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - V Villani
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - M Sekijima
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA,Division of Organ Replacement and Xenotransplantation Surgery, Kagoshima University, Japan
| | - EA Farkash
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA,University of Michigan Health System Department of Pathology, Ann Arbor, MI, USA
| | - RB Colvin
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - DH Sachs
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA,Center for Translational Immunology, Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - K Yamada
- Center for Translational Immunology, Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | | | - JS Allan
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA,Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - JC Madsen
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA,Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
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16
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Kaths JM, Hamar M, Echeverri J, Linares I, Urbanellis P, Cen JY, Ganesh S, Dingwell LS, Yip P, John R, Bagli D, Mucsi I, Ghanekar A, Grant D, Robinson LA, Selzner M. Normothermic ex vivo kidney perfusion for graft quality assessment prior to transplantation. Am J Transplant 2018; 18:580-589. [PMID: 28889600 DOI: 10.1111/ajt.14491] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [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: 03/29/2017] [Revised: 07/20/2017] [Accepted: 08/25/2017] [Indexed: 02/06/2023]
Abstract
Normothermic ex vivo kidney perfusion (NEVKP) represents a novel approach for graft preservation and functional improvement in kidney transplantation. We investigated whether NEVKP also allows graft quality assessment before transplantation. Kidneys from 30-kg pigs were recovered in a model of heart-beating donation (group A) after 30 minutes (group B) or 60 minutes (group C) (n = 5/group) of warm ischemia. After 8 hours of NEVKP, contralateral kidneys were resected, grafts were autotransplanted, and the pigs were followed for 3 days. After transplantation, renal function measured based on peak serum creatinine differed significantly among groups (P < .05). Throughout NEVKP, intrarenal resistance was lowest in group A and highest in group C (P < .05). intrarenal resistance at the initiation of NEVKP correlated with postoperative renal function (P < .001 at NEVKP hour 1). Markers of acid-base homeostasis (pH, HCO3- , base excess) differed among groups (P < .05) and correlated with posttransplantation renal function (P < .001 for pH at NEVKP hour 1). Similarly, lactate and aspartate aminotransferase were lowest in noninjured grafts versus donation after circulatory death kidneys (P < .05) and correlated with posttransplantation kidney function (P < .001 for lactate at NEVKP hour 1). In conclusion, assessment of perfusion characteristics and clinically available perfusate biomarkers during NEVKP allows the prediction of posttransplantation graft function. Thus, NEVKP might allow decision-making regarding whether grafts are suitable for transplantation.
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Affiliation(s)
- J Moritz Kaths
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.,Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of General, Visceral and Transplantation Surgery, Faculty of Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Mátyás Hamar
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Juan Echeverri
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Ivan Linares
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Peter Urbanellis
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Jun Yu Cen
- Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sujani Ganesh
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Luke S Dingwell
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Paul Yip
- Laboratory Medicine & Pathobiology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Rohan John
- Laboratory Medicine & Pathobiology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Darius Bagli
- Departments of Surgery (Urology) & Physiology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Istvan Mucsi
- Multi Organ Transplant Program, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anand Ghanekar
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - David Grant
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Lisa A Robinson
- Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Program in Cell Biology, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Markus Selzner
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
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17
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Kaths JM, Echeverri J, Linares I, Cen JY, Ganesh S, Hamar M, Urbanellis P, Yip P, John R, Bagli D, Mucsi I, Ghanekar A, Grant D, Robinson LA, Selzner M. Normothermic Ex Vivo Kidney Perfusion Following Static Cold Storage-Brief, Intermediate, or Prolonged Perfusion for Optimal Renal Graft Reconditioning? Am J Transplant 2017; 17:2580-2590. [PMID: 28375588 DOI: 10.1111/ajt.14294] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [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: 10/24/2016] [Revised: 02/26/2017] [Accepted: 03/26/2017] [Indexed: 01/25/2023]
Abstract
Normothermic ex vivo kidney perfusion (NEVKP) demonstrated superior results compared to hypothermic storage in donation after circulatory death (DCD) kidney transplantation. It is unknown whether an optimal perfusion time exists following hypothermic storage to allow for the recovery of renal grafts from cold ischemic injury. In a porcine model of DCD kidney autotransplantation, the impact of initial static cold storage (SCS) (8 h) followed by various periods of NEVKP recovery was investigated: group A, 8 hSCS only (control); group B, 8 hSCS + 1 hNEVKP (brief NEVKP); group C, 8 hSCS + 8 hNEVKP (intermediate NEVKP); and group D, 8 hSCS + 16 hNEVKP (prolonged NEVKP). All grafts were preserved and transplanted successfully. One animal in group D was sacrificed and excluded by postoperative day 3 due to hind limb paralysis, but demonstrated good renal function. Postoperative graft assessment during 8 days' follow-up demonstrated lowest levels of peak serum creatinine for intermediate (C) and prolonged (D) NEVKP (p = 0.027). Histological assessment on day 8 demonstrated a significant difference in tubular injury (p = 0.001), with highest values for group B. These results suggest that longer periods of NEVKP following SCS are feasible and safe for postponing surgical transplant procedure and superior to brief NEVKP, reducing the damage caused during cold ischemic storage of renal grafts.
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Affiliation(s)
- J M Kaths
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.,Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - J Echeverri
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - I Linares
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - J Y Cen
- Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - S Ganesh
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - M Hamar
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - P Urbanellis
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - P Yip
- Laboratory Medicine & Pathobiology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - R John
- Laboratory Medicine & Pathobiology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - D Bagli
- Departments of Surgery (Urology) & Physiology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - I Mucsi
- Multi Organ Transplant Program, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - A Ghanekar
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - D Grant
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - L A Robinson
- Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Program in Cell Biology, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - M Selzner
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
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18
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Shanmugarajah K, Powell H, Leonard DA, Mallard C, Albritton A, Harrington E, Randolph MA, Farkash E, Sachs DH, Kurtz JM, Cetrulo CL. The Effect of MHC Antigen Matching Between Donors and Recipients on Skin Tolerance of Vascularized Composite Allografts. Am J Transplant 2017; 17:1729-1741. [PMID: 28035752 DOI: 10.1111/ajt.14189] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 08/28/2016] [Revised: 12/16/2016] [Accepted: 12/22/2016] [Indexed: 01/25/2023]
Abstract
The emergence of skin-containing vascularized composite allografts (VCAs) has provided impetus to understand factors affecting rejection and tolerance of skin. VCA tolerance can be established in miniature swine across haploidentical MHC barriers using mixed chimerism. Because the deceased donor pool for VCAs does not permit MHC antigen matching, clinical VCAs are transplanted across varying MHC disparities. We investigated whether sharing of MHC class I or II antigens between donors and recipients influences VCA skin tolerance. Miniature swine were conditioned nonmyeloablatively and received hematopoietic stem cell transplants and VCAs across MHC class I (n = 3) or class II (n = 3) barriers. In vitro immune responsiveness was assessed, and VCA skin-resident leukocytes were characterized by flow cytometry. Stable mixed chimerism was established in all animals. MHC class II-mismatched chimeras were tolerant of VCAs. MHC class I-mismatched animals, however, rejected VCA skin, characterized by infiltration of recipient-type CD8+ lymphocytes. Systemic donor-specific nonresponsiveness was maintained, including after VCA rejection. This study shows that MHC antigen matching influences VCA skin rejection and suggests that local regulation of immune tolerance is critical in long-term acceptance of all VCA components. These results help elucidate novel mechanisms underlying skin tolerance and identify clinically relevant VCA tolerance strategies.
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Affiliation(s)
- K Shanmugarajah
- Transplantation Biology Research Center, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA.,Department of Plastic Surgery, Massachusetts General Hospital, Boston, MA
| | - H Powell
- Transplantation Biology Research Center, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA
| | - D A Leonard
- Transplantation Biology Research Center, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA.,Department of Plastic Surgery, Massachusetts General Hospital, Boston, MA
| | - C Mallard
- Transplantation Biology Research Center, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA
| | - A Albritton
- Transplantation Biology Research Center, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA
| | - E Harrington
- Transplantation Biology Research Center, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA
| | - M A Randolph
- Department of Plastic Surgery, Massachusetts General Hospital, Boston, MA
| | - E Farkash
- Transplantation Biology Research Center, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA
| | - D H Sachs
- Transplantation Biology Research Center, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA
| | - J M Kurtz
- Transplantation Biology Research Center, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA.,Department of Biology, Emmanuel College, Boston, MA
| | - C L Cetrulo
- Transplantation Biology Research Center, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA.,Department of Plastic Surgery, Massachusetts General Hospital, Boston, MA
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19
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Kaths JM, Cen JY, Chun YM, Echeverri J, Linares I, Ganesh S, Yip P, John R, Bagli D, Mucsi I, Ghanekar A, Grant DR, Robinson LA, Selzner M. Continuous Normothermic Ex Vivo Kidney Perfusion Is Superior to Brief Normothermic Perfusion Following Static Cold Storage in Donation After Circulatory Death Pig Kidney Transplantation. Am J Transplant 2017; 17:957-969. [PMID: 27647696 DOI: 10.1111/ajt.14059] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [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: 05/11/2016] [Accepted: 09/07/2016] [Indexed: 01/25/2023]
Abstract
Hypothermic preservation is known to cause renal graft injury, especially in donation after circulatory death (DCD) kidney transplantation. We investigated the impact of cold storage (SCS) versus short periods of normothermic ex vivo kidney perfusion (NEVKP) after SCS versus prolonged, continuous NEVKP with near avoidance of SCS on kidney function after transplantation. Following 30 min of warm ischemia, kidneys were removed from 30-kg Yorkshire pigs and preserved for 16 h with (A) 16 h SCS, (B) 15 h SCS + 1 h NEVKP, (C) 8 h SCS + 8 h NEVKP, and (D) 16 h NEVKP. After contralateral kidney resection, grafts were autotransplanted and pigs followed up for 8 days. Perfusate injury markers such as aspartate aminotransferase and lactate dehydrogenase remained low; lactate decreased significantly until end of perfusion in groups C and D (p < 0.001 and p = 0.002). Grafts in group D demonstrated significantly lower serum creatinine peak when compared to all other groups (p < 0.001) and 24-h creatinine clearance at day 3 after surgery was significantly higher (63.4 ± 19.0 mL/min) versus all other groups (p < 0.001). Histological assessment on day 8 demonstrated fewer apoptotic cells in group D (p = 0.008). In conclusion, prolonged, continuous NEVKP provides superior short-term outcomes following DCD kidney transplantation versus SCS or short additional NEVKP following SCS.
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Affiliation(s)
- J M Kaths
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.,Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of General, Visceral, and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - J Y Cen
- Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Y M Chun
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - J Echeverri
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - I Linares
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - S Ganesh
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - P Yip
- Laboratory Medicine & Pathobiology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - R John
- Laboratory Medicine & Pathobiology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - D Bagli
- Departments of Surgery (Urology) & Physiology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Developmental & Stem Cell Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - I Mucsi
- Multi Organ Transplant Program, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - A Ghanekar
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - D R Grant
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - L A Robinson
- Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Program in Cell Biology, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - M Selzner
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
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20
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Goldaracena N, Spetzler VN, Echeverri J, Kaths JM, Cherepanov V, Persson R, Hodges MR, Janssen HLA, Selzner N, Grant DR, Feld JJ, Selzner M. Inducing Hepatitis C Virus Resistance After Pig Liver Transplantation-A Proof of Concept of Liver Graft Modification Using Warm Ex Vivo Perfusion. Am J Transplant 2017; 17:970-978. [PMID: 27805315 DOI: 10.1111/ajt.14100] [Citation(s) in RCA: 57] [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: 06/22/2016] [Revised: 10/12/2016] [Accepted: 10/16/2016] [Indexed: 01/25/2023]
Abstract
Normothermic ex vivo liver perfusion (NEVLP) offers the potential to optimize graft function prior to liver transplantation (LT). Hepatitis C virus (HCV) is dependent on the presence of miRNA(microRNA)-122. Miravirsen, a locked-nucleic acid oligonucleotide, sequesters miR-122 and inhibits HCV replication. The aim of this study was to assess the efficacy of delivering miravirsen during NEVLP to inhibit miR-122 function in a pig LT model. Pig livers were treated with miravirsen during NEVLP or cold storage (CS). Miravirsen absorption, miR-122 sequestration, and miR-122 target gene derepression were determined before and after LT. The effect of miravirsen treatment on HCV infection of hepatoma cells was also assessed. NEVLP improved miravirsen uptake versus CS. Significant miR-122 sequestration and miR-122 target gene derepression were seen with NEVLP but not with CS. In vitro data confirmed miravirsen suppression of HCV replication after established infection and prevented HCV infection with pretreatment of cells, analogous to the pretreatment of grafts in the transplant setting. In conclusion, miravirsen delivery during NEVLP is a potential strategy to prevent HCV reinfection after LT. This is the first large-animal study to provide "proof of concept" for using NEVLP to modify and optimize liver grafts for transplantation.
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Affiliation(s)
- N Goldaracena
- Multi Organ Transplant Program-Department of Surgery, Toronto General Hospital, Toronto, ON, Canada
| | - V N Spetzler
- Multi Organ Transplant Program-Department of Surgery, Toronto General Hospital, Toronto, ON, Canada
| | - J Echeverri
- Multi Organ Transplant Program-Department of Surgery, Toronto General Hospital, Toronto, ON, Canada
| | - J M Kaths
- Multi Organ Transplant Program-Department of Surgery, Toronto General Hospital, Toronto, ON, Canada
| | - V Cherepanov
- Toronto Centre for Liver Disease, Sandra Rotman Centre for Global Research, Toronto General Hospital, Toronto, ON, Canada
| | - R Persson
- Roche Innovation Center, Copenhagen, Denmark
| | | | - H L A Janssen
- Toronto Centre for Liver Disease, Sandra Rotman Centre for Global Research, Toronto General Hospital, Toronto, ON, Canada
| | - N Selzner
- Multi Organ Transplant Program-Department of Medicine, Toronto General Hospital, Toronto, ON, Canada
| | - D R Grant
- Multi Organ Transplant Program-Department of Surgery, Toronto General Hospital, Toronto, ON, Canada
| | - J J Feld
- Toronto Centre for Liver Disease, Sandra Rotman Centre for Global Research, Toronto General Hospital, Toronto, ON, Canada
| | - M Selzner
- Multi Organ Transplant Program-Department of Surgery, Toronto General Hospital, Toronto, ON, Canada
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21
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Cooper DKC. The White House Organ Summit. Am J Transplant 2017; 17:576. [PMID: 27647663 DOI: 10.1111/ajt.14056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- D K C Cooper
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA
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22
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Tasaki M, Villani V, Shimizu A, Sekijima M, Yamada R, Hanekamp IM, Hanekamp JS, Cormack TA, Moran SG, Kawai A, Sachs DH, Yamada K. Role of Bone Marrow Maturity, Insulin-Like Growth Factor 1 Receptor, and Forkhead Box Protein N1 in Thymic Involution and Rejuvenation. Am J Transplant 2016; 16:2877-2891. [PMID: 27145342 PMCID: PMC5097038 DOI: 10.1111/ajt.13855] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 02/17/2016] [Revised: 04/12/2016] [Accepted: 04/22/2016] [Indexed: 01/25/2023]
Abstract
Thymic involution is associated with age-related changes of the immune system. Utilizing our innovative technique of transplantation of a thymus as an isolated vascularized graft in MHC-inbred miniature swine, we have previously demonstrated that aged thymi are rejuvenated after transplantation into juvenile swine. Here we have studied the role of insulin-like growth factor (IGF) and forkhead-box protein-N1 (FOXN1) as well as bone marrow (BM) in thymic rejuvenation and involution. We examined thymic rejuvenation and involution by means of histology and flow cytometry. Thymic function was assessed by the ability to induce tolerance of allogeneic kidneys. Aged thymi were rejuvenated in a juvenile environment, and successfully induced organ tolerance, while juvenile thymi in aged recipients involuted and had a limited ability to induce tolerance. However, juvenile BM inhibited the involution process of juvenile thymi in aged recipients. An elevated expression of both FOXN1 and IGF1 receptors (IGF-1R) was observed in juvenile thymi and rejuvenated thymi. Juvenile BM plays a role in promoting the local thymic milieu as indicated by its ability to inhibit thymic involution in aged animals. The expression of FOXN1 and IGF-1R was noted to increase under conditions that stimulated rejuvenation, suggesting that these factors are involved in thymic recovery.
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Affiliation(s)
- Masayuki Tasaki
- Transplantation Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Vincenzo Villani
- Transplantation Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Akira Shimizu
- Transplantation Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Mitsuhiro Sekijima
- Transplantation Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Rei Yamada
- Transplantation Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Isabel M. Hanekamp
- Transplantation Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - John S. Hanekamp
- Transplantation Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Taylor A Cormack
- Transplantation Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Shannon G. Moran
- Transplantation Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Akihiro Kawai
- Transplantation Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - David H. Sachs
- Transplantation Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Columbia Center for Translational Research, Columbia University Medical Center
| | - Kazuhiko Yamada
- Transplantation Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Columbia Center for Translational Research, Columbia University Medical Center,Correspondence author: Kazuhiko Yamada, MD, PhD., Director, Surgical Research, Columbia Center for Translational Research, Columbia University Medical Center, 650 W 168 Street, 17th Floor, Room 1706E, New York, NY 10032,
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23
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Cameron AM, Wesson RN, Ahmadi AR, Singer AL, Hu X, Okabayashi T, Wang Y, Shigoka M, Fu Y, Gao W, Raccusen LC, Montgomery RA, Williams GM, Sun Z. Chimeric Allografts Induced by Short-Term Treatment With Stem Cell Mobilizing Agents Result in Long-Term Kidney Transplant Survival Without Immunosuppression: II, Study in Miniature Swine. Am J Transplant 2016; 16:2066-76. [PMID: 26748958 DOI: 10.1111/ajt.13703] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 08/13/2015] [Revised: 12/21/2015] [Accepted: 12/27/2015] [Indexed: 01/25/2023]
Abstract
Transplantation is now lifesaving therapy for patients with end-stage organ failure but requires lifelong immunosuppression with resultant morbidity. Current immunosuppressive strategies inhibit T cell activation and prevent donor-recipient engagement. Therefore, it is not surprising that few host cells are demonstrated in donor grafts. However, our recent small animal studies found large numbers of recipient stem cells present after transplantation and pharmacological mobilization, resulting in a chimeric, repopulated organ. We now confirm these findings in a well-characterized large animal preclinical model. Here, we show that AMD3100 and FK506 mobilization of endogenous stem cells immediately post kidney transplantation combined with repeat therapy at 1, 2, and 3 months led to drug-free long-term survival in maximally immunologically mismatched swine. Three long-term recipients have stable chimeric transplants, preserved antidonor skin graft responses, and normal serum creatinine levels despite withdrawal of all medication for 3 years.
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Affiliation(s)
- A M Cameron
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - R N Wesson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - A R Ahmadi
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - A L Singer
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.,Transplant Center, Mayo Clinic, Phoenix, AZ, USA
| | - X Hu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - T Okabayashi
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Surgery, Kochi Health Center, Kochi University, Kochi, Japan
| | - Y Wang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - M Shigoka
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Y Fu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.,Transplant Center, Tianjin First Central Hospital, Tianjin, China
| | - W Gao
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.,Transplant Center, Tianjin First Central Hospital, Tianjin, China
| | - L C Raccusen
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - R A Montgomery
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - G M Williams
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Z Sun
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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24
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Ahrens HE, Petersen B, Herrmann D, Lucas-Hahn A, Hassel P, Ziegler M, Kues WA, Baulain U, Baars W, Schwinzer R, Denner J, Rataj D, Werwitzke S, Tiede A, Bongoni AK, Garimella PS, Despont A, Rieben R, Niemann H. siRNA mediated knockdown of tissue factor expression in pigs for xenotransplantation. Am J Transplant 2015; 15:1407-14. [PMID: 25808638 DOI: 10.1111/ajt.13120] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [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: 09/29/2014] [Revised: 11/07/2014] [Accepted: 11/23/2014] [Indexed: 01/25/2023]
Abstract
Acute vascular rejection (AVR), in particular microvascular thrombosis, is an important barrier to successful pig-to-primate xenotransplantation. Here, we report the generation of pigs with decreased tissue factor (TF) levels induced by small interfering (si)RNA-mediated gene silencing. Porcine fibroblasts were transfected with TF-targeting small hairpin (sh)RNA and used for somatic cell nuclear transfer. Offspring were analyzed for siRNA, TF mRNA and TF protein level. Functionality of TF downregulation was investigated by a whole blood clotting test and a flow chamber assay. TF siRNA was expressed in all twelve liveborn piglets. TF mRNA expression was reduced by 94.1 ± 4.7% in TF knockdown (TFkd) fibroblasts compared to wild-type (WT). TF protein expression in PAEC stimulated with 50 ng/mL TNF-α was significantly lower in TFkd pigs (mean fluorescence intensity TFkd: 7136 ± 136 vs. WT: 13 038 ± 1672). TF downregulation significantly increased clotting time (TFkd: 73.3 ± 8.8 min, WT: 45.8 ± 7.7 min, p < 0.0001) and significantly decreased thrombus formation compared to WT (mean thrombus coverage per viewing field in %; WT: 23.5 ± 13.0, TFkd: 2.6 ± 3.7, p < 0.0001). Our data show that a functional knockdown of TF is compatible with normal development and survival of pigs. TF knockdown could be a valuable component in the generation of multi-transgenic pigs for xenotransplantation.
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Affiliation(s)
- H E Ahrens
- Institute of Farm Animal Genetics, Friedrich-Loeffler-Institut, Mariensee, Neustadt, Germany
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25
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Martin BM, Samy KP, Lowe MC, Thompson PW, Cano J, Farris AB, Song M, Dove CR, Leopardi FV, Strobert EA, Jenkins JB, Collins BH, Larsen CP, Kirk AD. Dual islet transplantation modeling of the instant blood-mediated inflammatory reaction. Am J Transplant 2015; 15:1241-52. [PMID: 25702898 PMCID: PMC4631614 DOI: 10.1111/ajt.13098] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [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: 08/25/2014] [Accepted: 11/10/2014] [Indexed: 01/25/2023]
Abstract
Islet xenotransplantation is a potential treatment for diabetes without the limitations of tissue availability. Although successful experimentally, early islet loss remains substantial and attributed to an instant blood-mediated inflammatory reaction (IBMIR). This syndrome of islet destruction has been incompletely defined and characterization in pig-to-primate models has been hampered by logistical and statistical limitations of large animal studies. To further investigate IBMIR, we developed a novel in vivo dual islet transplant model to precisely characterize IBMIR as proof-of-concept that this model can serve to properly control experiments comparing modified xenoislet preparations. WT and α1,3-galactosyltransferase knockout (GTKO) neonatal porcine islets were studied in nonimmunosuppressed rhesus macaques. Inert polyethylene microspheres served as a control for the effects of portal embolization. Digital analysis of immunohistochemistry targeting IBMIR mediators was performed at 1 and 24 h after intraportal islet infusion. Early findings observed in transplanted islets include complement and antibody deposition, and infiltration by neutrophils, macrophages and platelets. Insulin, complement, antibody, neutrophils, macrophages and platelets were similar between GTKO and WT islets, with increasing macrophage infiltration at 24 h in both phenotypes. This model provides an objective and internally controlled study of distinct islet preparations and documents the temporal histology of IBMIR.
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Affiliation(s)
- BM Martin
- Emory Transplant Center, Emory University School of Medicine, Atlanta, GA 30322
| | - KP Samy
- Department of Surgery, Duke University School of Medicine, Durham, NC 27710
| | - MC Lowe
- Emory Transplant Center, Emory University School of Medicine, Atlanta, GA 30322
| | - PW Thompson
- Emory Transplant Center, Emory University School of Medicine, Atlanta, GA 30322
| | - J Cano
- Emory Transplant Center, Emory University School of Medicine, Atlanta, GA 30322
| | - AB Farris
- Department of Pathology & Laboratory Medicine, Emory University School of Medicine, Atlanta, GA 30322
| | - M Song
- Emory Transplant Center, Emory University School of Medicine, Atlanta, GA 30322
| | - CR Dove
- Department of Animal and Dairy Science, College of Agricultural and Environmental Sciences, University of Georgia, Athens, GA 30602
| | - FV Leopardi
- Emory Transplant Center, Emory University School of Medicine, Atlanta, GA 30322
| | - EA Strobert
- Yerkes National Primate Research Center, Atlanta, GA 30329
| | - JB Jenkins
- Yerkes National Primate Research Center, Atlanta, GA 30329
| | - BH Collins
- Department of Surgery, Duke University School of Medicine, Durham, NC 27710
| | - CP Larsen
- Emory Transplant Center, Emory University School of Medicine, Atlanta, GA 30322
| | - AD Kirk
- Emory Transplant Center, Emory University School of Medicine, Atlanta, GA 30322,Department of Surgery, Duke University School of Medicine, Durham, NC 27710
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26
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Pantin JM, Hoyt RF, Aras O, Sato N, Chen MY, Hunt T, Clevenger R, Eclarinal P, Adler S, Choyke P, Childs RW. Optimization of intrabone delivery of hematopoietic progenitor cells in a swine model using cell radiolabeling with [89]zirconium. Am J Transplant 2015; 15:606-17. [PMID: 25656824 PMCID: PMC8391069 DOI: 10.1111/ajt.13007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 08/15/2014] [Accepted: 08/28/2014] [Indexed: 01/25/2023]
Abstract
Intrabone (IB) hematopoietic cell transplantation (HCT) of umbilical cord blood in humans remains experimental and the technique has not been optimized. It is unknown whether hematopoietic progenitor cells (HPCs) injected IB are initially retained in the marrow or rapidly enter into the venous circulation before homing to the marrow. To develop an IB-injection technique that maximizes HPC marrow-retention, we tracked radiolabeled human HPCs following IB-injection into swine. We developed a method to radionuclide-label HPCs using a long-lived positron emitter (89) Zr and protamine sulfate that resulted in cellular-retention of low-dose radioactivity. This approach achieved radioactivity levels sufficient for detection by positron emission tomography with both high sensitivity and spatial resolution when fused with computed tomography. We found that conditions utilized in pilot IB-HCT clinical trials conducted by others led to both rapid drainage into the central venous circulation and cellular extravasation into surrounding muscle and soft tissues. By optimizing the needle design, using continuous real-time intra-marrow pressure monitoring, and by reducing the infusion-volume and infusion-rate, we overcame this limitation and achieved high retention of HPCs in the marrow. This method of IB cellular delivery is readily applicable in the clinic and could be utilized in future investigational IB-HCT trials aimed at maximizing marrow retention of HPCs.
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Affiliation(s)
- J. M. Pantin
- Division of Hematology and Medical Oncology, Georgia Regents University, Augusta, GA
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - R. F. Hoyt
- Laboratory of Animal Medicine and Surgery, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD
- Laboratory Animal Sciences Program, Leidos Biomedical Research, Inc., Frederick National Laboratory, Frederick
| | - O. Aras
- Imaging Sciences Training Program, Diagnostic Radiology Department, Warren Magnuson Clinical Center, National Institutes of Health, Bethesda, MD
| | - N. Sato
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - M. Y. Chen
- Advanced Cardiovascular Imaging Laboratory, Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - T. Hunt
- Laboratory of Animal Medicine and Surgery, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - R. Clevenger
- Laboratory of Animal Medicine and Surgery, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | | | - S. Adler
- Leidos Biomedical Research, Inc., Reston, VA
| | - P. Choyke
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - R. W. Childs
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD
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27
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Fontes P, Lopez R, van der Plaats A, Vodovotz Y, Minervini M, Scott V, Soltys K, Shiva S, Paranjpe S, Sadowsky D, Barclay D, Zamora R, Stolz D, Demetris A, Michalopoulos G, Marsh JW. Liver preservation with machine perfusion and a newly developed cell-free oxygen carrier solution under subnormothermic conditions. Am J Transplant 2015; 15:381-94. [PMID: 25612645 PMCID: PMC5024042 DOI: 10.1111/ajt.12991] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [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: 05/12/2014] [Revised: 07/28/2014] [Accepted: 08/23/2014] [Indexed: 01/25/2023]
Abstract
We describe a new preservation modality combining machine perfusion (MP) at subnormothermic conditions(21 °C) with a new hemoglobin-based oxygen carrier (HBOC) solution. MP (n=6) was compared to cold static preservation (CSP; n=6) in porcine orthotopic liver transplants after 9 h of cold ischemia and 5-day follow-up. Recipients' peripheral blood, serial liver biopsies, preservation solutions and bile specimens were collected before, during and after liver preservation. Clinical laboratorial and histological analyses were performed in addition to mitochondrial functional assays, transcriptomic, metabolomic and inflammatory inflammatory mediator analyses. Compared with CSP, MP animals had: (1) significantly higher survival (100%vs. 33%; p<0.05); (2) superior graft function (p<0.05);(3) eight times higher hepatic O2 delivery than O2 consumption (0.78 mL O2/g/h vs. 0.096 mL O2/g/h) during MP; and (4) significantly greater bile production (MP=378.5 ± 179.7; CS=151.6 ± 116.85). MP downregulated interferon (IFN)-α and IFN-γ in liver tissue. MP allografts cleared lactate, produced urea, sustained gluconeogenesis and produced hydrophilic bile after reperfusion. Enhanced oxygenation under subnormothermic conditions triggers regenerative and cell protective responses resulting in improved allograft function. MP at 21 °C with the HBOC solution significantly improves liver preservation compared to CSP.
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Affiliation(s)
- P. Fontes
- Department of SurgeryUniversity of Pittsburgh Medical CenterPittsburghPA,Department of SurgeryThomas E. Starzl Transplantation InstitutePittsburghPA,McGowan Institute of Regenerative MedicineUniversity of PittsburghPittsburghPA,Department of SurgeryUniversity of PittsburghPittsburghPA
| | - R. Lopez
- Department of SurgeryUniversity of Pittsburgh Medical CenterPittsburghPA,Department of SurgeryThomas E. Starzl Transplantation InstitutePittsburghPA
| | | | - Y. Vodovotz
- Department of SurgeryUniversity of PittsburghPittsburghPA
| | - M. Minervini
- Department of PathologyUniversity of Pittsburgh Medical CenterPittsburghPA
| | - V. Scott
- Department of AnesthesiaUniversity of PittsburghPittsburghPA
| | - K. Soltys
- Department of SurgeryUniversity of Pittsburgh Medical CenterPittsburghPA,Department of SurgeryThomas E. Starzl Transplantation InstitutePittsburghPA
| | - S. Shiva
- Vascular Medicine InstituteDepartment of Cardiothoracic SurgeryUniversity of PittsburghPittsburghPA
| | - S. Paranjpe
- Department of PathologyUniversity of PittsburghPittsburghPA
| | - D. Sadowsky
- Department of SurgeryUniversity of PittsburghPittsburghPA
| | - D. Barclay
- Department of SurgeryUniversity of PittsburghPittsburghPA
| | - R. Zamora
- Department of SurgeryUniversity of PittsburghPittsburghPA
| | - D. Stolz
- Department of PathologyUniversity of PittsburghPittsburghPA
| | - A. Demetris
- Department of PathologyUniversity of Pittsburgh Medical CenterPittsburghPA,Thomas E. Starzl Transplantation InstitutePittsburghPA
| | - G. Michalopoulos
- Department of PathologyUniversity of Pittsburgh Medical CenterPittsburghPA
| | - J. W. Marsh
- Department of SurgeryUniversity of Pittsburgh Medical CenterPittsburghPA,Department of SurgeryThomas E. Starzl Transplantation InstitutePittsburghPA
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28
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Tena A, Kurtz J, Leonard DA, Dobrinsky JR, Terlouw SL, Mtango N, Verstegen J, Germana S, Mallard C, Arn JS, Sachs DH, Hawley RJ. Transgenic expression of human CD47 markedly increases engraftment in a murine model of pig-to-human hematopoietic cell transplantation. Am J Transplant 2014; 14:2713-22. [PMID: 25278264 PMCID: PMC4236244 DOI: 10.1111/ajt.12918] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 06/16/2014] [Accepted: 07/06/2014] [Indexed: 01/25/2023]
Abstract
Mixed chimerism approaches for induction of tolerance of solid organ transplants have been applied successfully in animal models and in the clinic. However, in xenogeneic models (pig-to-primate), host macrophages participate in the rapid clearance of porcine hematopoietic progenitor cells, hindering the ability to achieve mixed chimerism. CD47 is a cell-surface molecule that interacts in a species-specific manner with SIRPα receptors on macrophages to inhibit phagocytosis and expression of human CD47 (hCD47) on porcine cells has been shown to inhibit phagocytosis by primate macrophages. We report here the generation of hCD47 transgenic GalT-KO miniature swine that express hCD47 in all blood cell lineages. The effect of hCD47 expression on xenogeneic hematopoietic engraftment was tested in an in vivo mouse model of human hematopoietic cell engraftment. High-level porcine chimerism was observed in the bone marrow of hCD47 progenitor cell recipients and smaller but readily measurable chimerism levels were observed in the peripheral blood of these recipients. In contrast, transplantation of WT progenitor cells resulted in little or no bone marrow engraftment and no detectable peripheral chimerism. These results demonstrate a substantial protective effect of hCD47 expression on engraftment and persistence of porcine cells in this model, presumably by modulation of macrophage phagocytosis.
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Affiliation(s)
- Aseda Tena
- Transplantation Biology Research Center, Massachusetts General Hospital, Boston, MA
| | - Josef Kurtz
- Transplantation Biology Research Center, Massachusetts General Hospital, Boston, MA,Department of Biology, Emmanuel College, Boston, MA
| | - David A. Leonard
- Transplantation Biology Research Center, Massachusetts General Hospital, Boston, MA
| | | | | | | | | | - Sharon Germana
- Transplantation Biology Research Center, Massachusetts General Hospital, Boston, MA
| | - Christopher Mallard
- Transplantation Biology Research Center, Massachusetts General Hospital, Boston, MA
| | - J. Scott Arn
- Transplantation Biology Research Center, Massachusetts General Hospital, Boston, MA
| | - David H. Sachs
- Transplantation Biology Research Center, Massachusetts General Hospital, Boston, MA
| | - Robert J. Hawley
- Transplantation Biology Research Center, Massachusetts General Hospital, Boston, MA
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