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Reiling J, Butler N, Simpson AH, Hodgkinson P, Campbell C, Lockwood D, Bridle KJ, Santrampurwala N, Britton LJ, Crawford DH, Dejong CHC, Fawcett J. Reply. Liver Transpl 2021; 27:602-603. [PMID: 37160048 DOI: 10.1002/lt.25894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/01/2020] [Indexed: 01/13/2023]
Affiliation(s)
- Janske Reiling
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Gallipoli Medical Research Institute, Greenslopes Private Hospital, Brisbane, Queensland, Australia
- Princess Alexandra Research Foundation, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Department of Surgery, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
- Queensland Liver Transplant Service, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Nick Butler
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Surgery, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Andrew H Simpson
- Visiting Medical Officer Perfusion, Department of Cardiac Anesthetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Peter Hodgkinson
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Surgery, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | | | - David Lockwood
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Surgery, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Kim J Bridle
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Gallipoli Medical Research Institute, Greenslopes Private Hospital, Brisbane, Queensland, Australia
| | - Nishreen Santrampurwala
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Gallipoli Medical Research Institute, Greenslopes Private Hospital, Brisbane, Queensland, Australia
| | - Laurence J Britton
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Gallipoli Medical Research Institute, Greenslopes Private Hospital, Brisbane, Queensland, Australia
- Department of Surgery, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
- Department of Gastroenterology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Darrell H Crawford
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Gallipoli Medical Research Institute, Greenslopes Private Hospital, Brisbane, Queensland, Australia
| | - Cornelius H C Dejong
- Queensland Liver Transplant Service, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Department of Surgery, Universitätsklinikum Aachen, Aachen, Germany
| | - Jonathan Fawcett
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Gallipoli Medical Research Institute, Greenslopes Private Hospital, Brisbane, Queensland, Australia
- Princess Alexandra Research Foundation, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Department of Surgery, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
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Reiling J, Butler N, Simpson A, Hodgkinson P, Campbell C, Lockwood D, Bridle K, Santrampurwala N, Britton L, Crawford D, Dejong CHC, Fawcett J. Assessment and Transplantation of Orphan Donor Livers: A Back-to-Base Approach to Normothermic Machine Perfusion. Liver Transpl 2020; 26:1618-1628. [PMID: 32682340 DOI: 10.1002/lt.25850] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/14/2020] [Accepted: 07/11/2020] [Indexed: 02/06/2023]
Abstract
Globally, a large proportion of donor livers are discarded due to concerns over inadequate organ quality. Normothermic machine perfusion (NMP) allows for hepatocellular and biliary viability assessment prior to transplantation and might therefore enable the safe use of these orphan donor livers. We describe here the first Australasian experience of NMP-preserved liver transplants using a 'back-to-base' approach, where NMP was commenced at the recipient hospital following initial static cold storage. In the preclinical phase, 10 human donor livers declined for transplantation (7 from donation after circulatory death [DCD] and 3 from donation after brain death [DBD]) were perfused using a custom-made NMP setup. Subsequently, 10 orphan donor livers (5 from DCD and 5 from DBD) underwent NMP and viability assessment on the OrganOx metra device (OrganOx Limited, Oxford, United Kingdom). Both hepatocellular and biliary viability criteria were used. The median donor risk index was 1.53 (1.16-1.71), and the median recipient Model for End-Stage Liver Disease score was 17 (11-21). In the preclinical phase, 'back-to-base' NMP was deemed suitable and feasible. In the clinical phase, each graft met predefined criteria for implantation during NMP and was subsequently transplanted. Five (50%) recipients developed early allograft dysfunction based on peak aspartate aminotransferase. To date, all grafts function satisfactorily, and none of the 5 recipients who received a DCD liver have developed cholangiopathy. The OrganOx metra using a back-to-base approach has enabled the safe use of 10 high-risk orphan donor livers with 100% 6-month patient and graft survival. NMP improved surgeon confidence to use orphan donor livers and has enabled a safe expansion of the donor pool.
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Affiliation(s)
- Janske Reiling
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Gallipoli Medical Research Institute, Greenslopes Private Hospital, Brisbane, Queensland, Australia
- Princess Alexandra Research Foundation, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Queensland Liver Transplant Service, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Department of Surgery, Nutrition and Toxicology Research Institute Maastricht School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Nick Butler
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Queensland Liver Transplant Service, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Andrew Simpson
- Visiting Medical Officer Perfusion, Departments of Cardiac Anesthetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Peter Hodgkinson
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Queensland Liver Transplant Service, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | | | - David Lockwood
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Queensland Liver Transplant Service, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Kim Bridle
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Gallipoli Medical Research Institute, Greenslopes Private Hospital, Brisbane, Queensland, Australia
| | - Nishreen Santrampurwala
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Gallipoli Medical Research Institute, Greenslopes Private Hospital, Brisbane, Queensland, Australia
| | - Laurence Britton
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Gallipoli Medical Research Institute, Greenslopes Private Hospital, Brisbane, Queensland, Australia
- Queensland Liver Transplant Service, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Department of Gastroenterology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Darrell Crawford
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Gallipoli Medical Research Institute, Greenslopes Private Hospital, Brisbane, Queensland, Australia
| | - Cornelius H C Dejong
- Department of Surgery, Nutrition and Toxicology Research Institute Maastricht School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
- Department of Surgery, Universitätsklinikum Aachen, Aachen, Germany
| | - Jonathan Fawcett
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Gallipoli Medical Research Institute, Greenslopes Private Hospital, Brisbane, Queensland, Australia
- Princess Alexandra Research Foundation, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Queensland Liver Transplant Service, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Britton L, Bridle K, Reiling J, Santrampurwala N, Wockner L, Ching H, Stuart K, Subramaniam VN, Jeffrey G, St Pierre T, House M, Gummer J, Trengove R, Olynyk J, Crawford D, Adams L. Hepatic iron concentration correlates with insulin sensitivity in nonalcoholic fatty liver disease. Hepatol Commun 2018; 2:644-653. [PMID: 29881816 PMCID: PMC5983226 DOI: 10.1002/hep4.1190] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 03/23/2018] [Accepted: 04/01/2018] [Indexed: 01/01/2023] Open
Abstract
Rodent and cell‐culture models support a role for iron‐related adipokine dysregulation and insulin resistance in the pathogenesis of nonalcoholic fatty liver disease (NAFLD); however, substantial human data are lacking. We examined the relationship between measures of iron status, adipokines, and insulin resistance in patients with NAFLD in the presence and absence of venesection. This study forms part of the Impact of Iron on Insulin Resistance and Liver Histology in Nonalcoholic Steatohepatitis (IIRON2) study, a prospective randomized controlled trial of venesection for adults with NAFLD. Paired serum samples at baseline and 6 months (end of treatment) in controls (n = 28) and patients who had venesection (n = 23) were assayed for adiponectin, leptin, resistin, retinol binding protein‐4, tumor necrosis factor α, and interleukin‐6, using a Quantibody, customized, multiplexed enzyme‐linked immunosorbent assay array. Hepatic iron concentration (HIC) was determined using MR FerriScan. Unexpectedly, analysis revealed a significant positive correlation between baseline serum adiponectin concentration and HIC, which strengthened after correction for age, sex, and body mass index (rho = 0.36; P = 0.007). In addition, there were significant inverse correlations between HIC and measures of insulin resistance (adipose tissue insulin resistance (Adipo‐IR), serum insulin, serum glucose, homeostasis model assessment of insulin resistance, hemoglobin A1c, and hepatic steatosis), whereas a positive correlation was noted with the insulin sensitivity index. Changes in serum adipokines over 6 months did not differ between the control and venesection groups. Conclusion: HIC positively correlates with serum adiponectin and insulin sensitivity in patients with NAFLD. Further study is required to establish causality and mechanistic explanations for these associations and their relevance in the pathogenesis of insulin resistance and NAFLD. (Hepatology Communications 2018;2:644‐653)
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Affiliation(s)
- Laurence Britton
- Gallipoli Medical Research Institute Greenslopes Private Hospital Greenslopes Australia.,University of Queensland Herston Australia.,Department of Gastroenterology Princess Alexandra Hospital Woolloongabba Australia.,QIMR Berghofer Medical Research Institute Brisbane Australia
| | - Kim Bridle
- Gallipoli Medical Research Institute Greenslopes Private Hospital Greenslopes Australia.,University of Queensland Herston Australia
| | - Janske Reiling
- Gallipoli Medical Research Institute Greenslopes Private Hospital Greenslopes Australia.,University of Queensland Herston Australia.,Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism Maastricht University Maastricht the Netherlands
| | - Nishreen Santrampurwala
- Gallipoli Medical Research Institute Greenslopes Private Hospital Greenslopes Australia.,University of Queensland Herston Australia.,QIMR Berghofer Medical Research Institute Brisbane Australia
| | - Leesa Wockner
- QIMR Berghofer Medical Research Institute Brisbane Australia
| | - Helena Ching
- Medical School, Faculty of Health Sciences University of Western Australia Crawley Australia
| | - Katherine Stuart
- Gallipoli Medical Research Institute Greenslopes Private Hospital Greenslopes Australia.,Department of Gastroenterology Princess Alexandra Hospital Woolloongabba Australia
| | - V Nathan Subramaniam
- QIMR Berghofer Medical Research Institute Brisbane Australia.,Institute of Health and Biomedical Innovation and School of Biomedical Sciences Queensland University of Technology Kelvin Grove Australia
| | - Gary Jeffrey
- Medical School, Faculty of Health Sciences University of Western Australia Crawley Australia.,Department of Hepatology Sir Charles Gairdner Hospital Perth Australia
| | - Tim St Pierre
- School of Physics University of Western Australia Crawley Australia
| | - Michael House
- School of Physics University of Western Australia Crawley Australia
| | - Joel Gummer
- Separation Science and Metabolomics Laboratory (Metabolomics Australia, Western Australia node) Murdoch University Murdoch Australia
| | - Robert Trengove
- Separation Science and Metabolomics Laboratory (Metabolomics Australia, Western Australia node) Murdoch University Murdoch Australia
| | - John Olynyk
- Department of Gastroenterology Fiona Stanley and Fremantle Hospital Group Murdoch Australia.,School of Health and Medical Sciences Edith Cowan University Joondalup Australia
| | - Darrell Crawford
- Gallipoli Medical Research Institute Greenslopes Private Hospital Greenslopes Australia.,University of Queensland Herston Australia
| | - Leon Adams
- Medical School, Faculty of Health Sciences University of Western Australia Crawley Australia.,Department of Hepatology Sir Charles Gairdner Hospital Perth Australia
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Britton L, Bridle K, Jaskowski LA, He J, Ng C, Ruelcke JE, Mohamed A, Reiling J, Santrampurwala N, Hill MM, Whitehead JP, Subramaniam VN, Crawford DH. Iron Inhibits the Secretion of Apolipoprotein E in Cultured Human Adipocytes. Cell Mol Gastroenterol Hepatol 2018; 6:215-217.e8. [PMID: 30105281 PMCID: PMC6085534 DOI: 10.1016/j.jcmgh.2018.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/02/2018] [Indexed: 12/11/2022]
Affiliation(s)
- L.J. Britton
- Gallipoli Medical Research Institute, Greenslopes Private Hospital, Greenslopes, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Department of Gastroenterology, Princess Alexandra Hospital, Queensland, Australia
- Mater Research, Translational Research Institute, Woolloongabba, Queensland, Australia
| | - Kim Bridle
- Gallipoli Medical Research Institute, Greenslopes Private Hospital, Greenslopes, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Lesley-Anne Jaskowski
- Gallipoli Medical Research Institute, Greenslopes Private Hospital, Greenslopes, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Jingjing He
- Mater Research, Translational Research Institute, Woolloongabba, Queensland, Australia
| | - Choaping Ng
- Mater Research, Translational Research Institute, Woolloongabba, Queensland, Australia
- School of Life Sciences, University of Lincoln, Lincoln, United Kingdom
| | - Jayde E. Ruelcke
- The University of Queensland Diamantina Institute, Faculty of Medicine, University of Queensland, Queensland, Australia
| | - Ahmed Mohamed
- The University of Queensland Diamantina Institute, Faculty of Medicine, University of Queensland, Queensland, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Janske Reiling
- Gallipoli Medical Research Institute, Greenslopes Private Hospital, Greenslopes, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Nishreen Santrampurwala
- Gallipoli Medical Research Institute, Greenslopes Private Hospital, Greenslopes, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Michelle M. Hill
- The University of Queensland Diamantina Institute, Faculty of Medicine, University of Queensland, Queensland, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Jonathan P. Whitehead
- Mater Research, Translational Research Institute, Woolloongabba, Queensland, Australia
- School of Life Sciences, University of Lincoln, Lincoln, United Kingdom
| | - V. Nathan Subramaniam
- Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Darrell H.G. Crawford
- Gallipoli Medical Research Institute, Greenslopes Private Hospital, Greenslopes, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
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Forrest EA, Reiling J, Lipka G, Fawcett J. Risk factors and clinical indicators for the development of biliary strictures post liver transplant: Significance of bilirubin. World J Transplant 2017; 7:349-358. [PMID: 29312864 PMCID: PMC5743872 DOI: 10.5500/wjt.v7.i6.349] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 09/18/2017] [Accepted: 11/02/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To identify risk factors associated with the formation of biliary strictures post liver transplantation over a period of 10-year in Queensland.
METHODS Data on liver donors and recipients in Queensland between 2005 and 2014 was obtained from an electronic patient data system. In addition, intra-operative and post-operative characteristics were collected and a logistical regression analysis was performed to evaluate their association with the development of biliary strictures.
RESULTS Of 296 liver transplants performed, 285 (96.3%) were from brain dead donors. Biliary strictures developed in 45 (15.2%) recipients. Anastomotic stricture formation (n = 25, 48.1%) was the commonest complication, with 14 (58.3%) of these occurred within 6-mo of transplant. A percutaneous approach or endoscopic retrograde cholangiography was used to treat 17 (37.8%) patients with biliary strictures. Biliary reconstruction was initially or ultimately required in 22 (48.9%) patients. In recipients developing biliary strictures, bilirubin was significantly increased within the first post-operative week (Day 7 total bilirubin 74 μmol/L vs 49 μmol/L, P = 0.012). In both univariate and multivariate regression analysis, Day 7 total bilirubin > 55 μmol/L was associated with the development of biliary stricture formation. In addition, hepatic artery thrombosis and primary sclerosing cholangitis were identified as independent risk factors.
CONCLUSION In addition to known risk factors, bilirubin levels in the early post-operative period could be used as a clinical indicator for biliary stricture formation.
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Affiliation(s)
- Elizabeth Ann Forrest
- Queensland Liver Transplant Service, Princess Alexandra Hospital, Brisbane, Queensland 4102, Australia
- Department of Surgery, Gold Coast Hospital and Health Service, Gold Coast, Queensland 4215, Australia
| | - Janske Reiling
- Queensland Liver Transplant Service, Princess Alexandra Hospital, Brisbane, Queensland 4102, Australia
- Faculty of Medicine, the University of Queensland, Brisbane, Queensland 4006, Australia
- Gallipoli Medical Research Institute, Greenslopes Private Hospital, Brisbane, Queensland 4120, Australia
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, AZ Maastricht 6202, The Netherlands
- PA Research Foundation, Princess Alexandra Hospital, Brisbane, Queensland 4102, Australia
| | - Geraldine Lipka
- Queensland Liver Transplant Service, Princess Alexandra Hospital, Brisbane, Queensland 4102, Australia
| | - Jonathan Fawcett
- Queensland Liver Transplant Service, Princess Alexandra Hospital, Brisbane, Queensland 4102, Australia
- Faculty of Medicine, the University of Queensland, Brisbane, Queensland 4006, Australia
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Reiling J, Forrest E, Bridle KR, Britton LJ, Santrampurwala N, Crawford DH, Dejong CH, Fawcett J. The Implications of the Shift Toward Donation After Circulatory Death in Australia. Transplant Direct 2017; 3:e226. [PMID: 29536027 PMCID: PMC5828691 DOI: 10.1097/txd.0000000000000743] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 09/08/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In recent years, an increasing number of donor livers are being declined for transplantation in Australia. The aim of this study was to evaluate the impact of donation after cardiac death and other factors associated with organ quality on liver utilization rates in Australia. METHODS Data on organ donors who donated at least 1 organ between 2005 and 2014 were obtained from the Australia and New Zealand organ donation registry. Temporal changes in donor characteristics were assessed and a logistical regression analysis was performed to evaluate their association with liver nonuse. RESULTS The number of organ donors increased from 175 in 2005 to 344 in 2014, with overall 19% being donation after cardiac death donors (P < 0.001). The percentage of livers deemed unsuitable for transplantation increased from 24% in 2005 to 41% in 2014 (P < 0.001). Donation after cardiac death was identified as the most important risk factor for nonuse with an odds ratio of 25.88 (95% confidence interval, 18.84-35.56), P < 0.001) followed by donor age, obesity, and diabetes. DISCUSSION This study shows that livers donated after circulatory death are an underused resource in Australia. Better use of these currently available organs would be a highly cost-effective way of reducing waiting list mortality in liver transplantation.
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Affiliation(s)
- Janske Reiling
- Faculty of Medicine, the University of Queensland, Brisbane, Australia
- Australian and New Zealand Organ Donation, Adelaide, Australia
- Gallipoli Medical Research Institute, Greenslopes Private Hospital, Brisbane, Australia
- Department of Surgery, NUTRIM - School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Elizabeth Forrest
- Queensland Liver Transplant Service, Princess Alexandra Hospital, Brisbane, Australia
| | | | - Laurence J. Britton
- Faculty of Medicine, the University of Queensland, Brisbane, Australia
- Gallipoli Medical Research Institute, Greenslopes Private Hospital, Brisbane, Australia
| | - Nishreen Santrampurwala
- Faculty of Medicine, the University of Queensland, Brisbane, Australia
- Gallipoli Medical Research Institute, Greenslopes Private Hospital, Brisbane, Australia
| | - Darrell H.G. Crawford
- Faculty of Medicine, the University of Queensland, Brisbane, Australia
- Gallipoli Medical Research Institute, Greenslopes Private Hospital, Brisbane, Australia
| | - Cornelis H.C. Dejong
- Department of Surgery, NUTRIM - School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
- Department of Surgery, RWTH Universitätsklinikum Aachen, Aachen, Germany
| | - Jonathan Fawcett
- Faculty of Medicine, the University of Queensland, Brisbane, Australia
- Department of Surgery, RWTH Universitätsklinikum Aachen, Aachen, Germany
- PA Research Foundation, Princess Alexandra Hospital, Brisbane, Australia
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Reiling J, Bridle KR, Schaap FG, Jaskowski L, Santrampurwala N, Britton LJ, Campbell CM, Jansen PLM, Damink SWMO, Crawford DHG, Dejong CHC, Fawcett J. The role of macrophages in the development of biliary injury in a lipopolysaccharide-aggravated hepatic ischaemia-reperfusion model. Biochim Biophys Acta Mol Basis Dis 2017; 1864:1284-1292. [PMID: 28709962 DOI: 10.1016/j.bbadis.2017.06.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 05/14/2017] [Revised: 06/28/2017] [Accepted: 06/29/2017] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Endotoxins, in the form of lipopolysaccharides (LPS), are potent inducers of biliary injury. However the mechanism by which injury develops remains unclear. We hypothesized that hepatic macrophages are pivotal in the development of endotoxin-induced biliary injury and that no injury would occur in their absence. MATERIAL AND METHODS Clodronate liposomes were used to deplete macrophages from the liver. Forty-eight rats were equally divided across six study groups: sham operation (sham), liposome treatment and sham operation (liposomes+sham), 1mg/kg LPS i.p. (LPS), liposome treatment and LPS administration (liposomes+LPS), hepatic ischaemia-reperfusion injury with LPS administration (IRI+LPS) and liposome treatment followed by IRI+LPS (liposomes+IRI+LPS). Following 6h of reperfusion, blood, bile, and liver tissue was collected for further analysis. Small bile duct injury was assessed, serum liver tests were performed and bile composition was evaluated. The permeability of the blood-biliary barrier (BBB) was assessed using intravenously administered horseradish peroxidase (HRP). RESULTS The presence of hepatic macrophages was reduced by 90% in LPS and IRI+LPS groups pre-treated with clodronate liposomes (P<0.001). Severe small bile duct injury was not affected by macrophage depletion, and persisted in the liposomes+IRI+LPS group (50% of animals) and liposomes+LPS group (75% of animals). Likewise, BBB impairment persisted following macrophage depletion. LPS-induced elevation of the chemokine Mcp-1 in bile was not affected by macrophage depletion. CONCLUSIONS Depletion of hepatic macrophages did not prevent development of biliary injury following LPS or LPS-enhanced IRI. Cholangiocyte activation rather than macrophage activation may underlie this injury. This article is part of a Special Issue entitled: Cholangiocytes in Health and Diseaseedited by Jesus Banales, Marco Marzioni, Nicholas LaRusso and Peter Jansen.
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Affiliation(s)
- J Reiling
- School of Medicine, The University of Queensland, Brisbane, Australia; Gallipoli Medical Research Institute, Greenslopes Private Hospital, Newdegate Street, Greenslopes, QLD 4120, Australia; PA Research Foundation, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia; Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands.
| | - K R Bridle
- School of Medicine, The University of Queensland, Brisbane, Australia; Gallipoli Medical Research Institute, Greenslopes Private Hospital, Newdegate Street, Greenslopes, QLD 4120, Australia
| | - F G Schaap
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; Department of General, Visceral and Transplantation Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - L Jaskowski
- School of Medicine, The University of Queensland, Brisbane, Australia; Gallipoli Medical Research Institute, Greenslopes Private Hospital, Newdegate Street, Greenslopes, QLD 4120, Australia
| | - N Santrampurwala
- School of Medicine, The University of Queensland, Brisbane, Australia; Gallipoli Medical Research Institute, Greenslopes Private Hospital, Newdegate Street, Greenslopes, QLD 4120, Australia
| | - L J Britton
- School of Medicine, The University of Queensland, Brisbane, Australia; Gallipoli Medical Research Institute, Greenslopes Private Hospital, Newdegate Street, Greenslopes, QLD 4120, Australia; Department of Gastroenterology, Princess Alexandra Hospital, 199 Ipswich Road, Wooloongabba, QLD 4102, Australia
| | - C M Campbell
- Envoi Specialist Pathologists, 5/38 Bishop St, Kelvin Grove, QLD 4059, Australia
| | - P L M Jansen
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - S W M Olde Damink
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; Department of General, Visceral and Transplantation Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - D H G Crawford
- School of Medicine, The University of Queensland, Brisbane, Australia; Gallipoli Medical Research Institute, Greenslopes Private Hospital, Newdegate Street, Greenslopes, QLD 4120, Australia
| | - C H C Dejong
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; Department of General, Visceral and Transplantation Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - J Fawcett
- School of Medicine, The University of Queensland, Brisbane, Australia; Gallipoli Medical Research Institute, Greenslopes Private Hospital, Newdegate Street, Greenslopes, QLD 4120, Australia; PA Research Foundation, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia; Queensland Liver Transplant Service, Princess Alexandra Hospital, 199 Ipswich Road, Wooloongabba, QLD 4102, Australia
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Reiling J, Bridle KR, Gijbels M, Schaap FG, Jaskowski L, Santrampurwala N, Britton LJ, Campbell CM, Olde Damink SWM, Crawford DHG, Dejong CHC, Fawcett J. Low-Dose Lipopolysaccharide Causes Biliary Injury by Blood Biliary Barrier Impairment in a Rat Hepatic Ischemia/Reperfusion Model. Liver Transpl 2017; 23:194-206. [PMID: 27880979 DOI: 10.1002/lt.24681] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 11/10/2016] [Indexed: 02/07/2023]
Abstract
This study explored whether bacterial endotoxins, in the form of lipopolysaccharides (LPS), could have an injurious effect on the biliary tract in conjunction with ischemia. A total of 64 rats were randomly assigned to 4 groups: sham operation (sham group), 1 mg/kg LPS intraperitoneal (LPS group), hepatic ischemia/reperfusion (IR; IR group), and IR combined with LPS (IR+LPS group). Following 1 or 6 hours of reperfusion, serum liver tests, bile duct histology, immunofluorescence microscopy (zonula occludens-1 [ZO-1]), bile composition (bile salts, phospholipids, lactate dehydrogenase), hepatic gene expression (bile salt transporters and inflammatory mediators), as well as serum and biliary cytokine concentrations were quantified and compared between the study groups. In addition, the integrity of the blood biliary barrier (BBB) was assayed in vivo using horseradish peroxidase (HRP). LPS administration induced severe small bile duct injury following 6 hours of reperfusion. Furthermore, total bile salts and bilirubin concentrations in serum were increased in the LPS groups compared with sham controls (LPS, + 3.3-fold and +1.9-fold; IR+LPS, + 3.8-fold and +1.7-fold, respectively). The BBB was impaired in the LPS groups as evidenced by elevated levels of HRP in bile (+4.9-fold), and decreased expression of claudin 1 (-6.7-fold) and claudin 3 (-3.6-fold). LPS was found to be a potent inducer of small bile duct injury following hepatic ischemia and 6 hours of reperfusion. This injury was associated with increased permeability of the BBB and impaired hepatic bile salt clearance. Liver Transplantation 23 194-206 2017 AASLD.
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Affiliation(s)
- Janske Reiling
- School of Medicine, The University of Queensland, Brisbane, Australia.,Gallipoli Medical Research Institute, Greenslopes Private Hospital, Brisbane, Australia.,PA Research Foundation, Princess Alexandra Hospital, Brisbane, Australia.,Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Kim R Bridle
- School of Medicine, The University of Queensland, Brisbane, Australia.,Gallipoli Medical Research Institute, Greenslopes Private Hospital, Brisbane, Australia
| | - Marion Gijbels
- Departments of Pathology.,Molecular Genetics, Cardiovascular Research Institute Maastricht, the Netherlands.,Department of Medical Biochemistry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Frank G Schaap
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Lesley Jaskowski
- School of Medicine, The University of Queensland, Brisbane, Australia.,Gallipoli Medical Research Institute, Greenslopes Private Hospital, Brisbane, Australia
| | - Nishreen Santrampurwala
- School of Medicine, The University of Queensland, Brisbane, Australia.,Gallipoli Medical Research Institute, Greenslopes Private Hospital, Brisbane, Australia
| | - Laurence J Britton
- School of Medicine, The University of Queensland, Brisbane, Australia.,Gallipoli Medical Research Institute, Greenslopes Private Hospital, Brisbane, Australia
| | | | - Steven W M Olde Damink
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.,Department of HPB Surgery and Liver Transplantation, Institute for Liver and Digestive Health, Royal Free Hospitals, University College London, London, UK
| | - Darrell H G Crawford
- School of Medicine, The University of Queensland, Brisbane, Australia.,Gallipoli Medical Research Institute, Greenslopes Private Hospital, Brisbane, Australia
| | - Cornelius H C Dejong
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.,Department of Surgery, RWTH Universitätsklinikum Aachen, Aachen, Germany
| | - Jonathan Fawcett
- School of Medicine, The University of Queensland, Brisbane, Australia.,Gallipoli Medical Research Institute, Greenslopes Private Hospital, Brisbane, Australia.,PA Research Foundation, Princess Alexandra Hospital, Brisbane, Australia.,Queensland Liver Transplant Service, Princess Alexandra Hospital, Brisbane, Australia
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9
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Britton L, Jaskowski L, Bridle K, Santrampurwala N, Reiling J, Musgrave N, Subramaniam VN, Crawford D. Heterozygous Hfe gene deletion leads to impaired glucose homeostasis, but not liver injury in mice fed a high-calorie diet. Physiol Rep 2016; 4:4/12/e12837. [PMID: 27354540 PMCID: PMC4923236 DOI: 10.14814/phy2.12837] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 03/06/2016] [Accepted: 05/26/2016] [Indexed: 12/30/2022] Open
Abstract
Heterozygous mutations of the Hfe gene have been proposed as cofactors in the development and progression of nonalcoholic fatty liver disease (NAFLD). Homozygous Hfe deletion previously has been shown to lead to dysregulated hepatic lipid metabolism and accentuated liver injury in a dietary mouse model of NAFLD. We sought to establish whether heterozygous deletion of Hfe is sufficient to promote liver injury when mice are exposed to a high‐calorie diet (HCD). Eight‐week‐old wild‐type and Hfe+/− mice received 8 weeks of a control diet or HCD. Liver histology and pathways of lipid and iron metabolism were analyzed. Liver histology demonstrated that mice fed a HCD had increased NAFLD activity score (NAS), steatosis, and hepatocyte ballooning. However, liver injury was unaffected by Hfe genotype. Hepatic iron concentration (HIC) was increased in Hfe+/− mice of both dietary groups. HCD resulted in a hepcidin‐independent reduction in HIC. Hfe+/− mice demonstrated raised fasting serum glucose concentrations and HOMA‐IR score, despite unaltered serum adiponectin concentrations. Downstream regulators of hepatic de novo lipogenesis (pAKT, SREBP‐1, Fas, Scd1) and fatty acid oxidation (AdipoR2, Pparα, Cpt1) were largely unaffected by genotype. In summary, heterozygous Hfe gene deletion is associated with impaired iron and glucose metabolism. However, unlike homozygous Hfe deletion, heterozygous gene deletion did not affect lipid metabolism pathways or liver injury in this model.
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Affiliation(s)
- Laurence Britton
- Gallipoli Medical Research Institute, Greenslopes Private Hospital, Greenslopes, Queensland, Australia The School of Medicine, University of Queensland, Herston, Queensland, Australia The Department of Gastroenterology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Lesley Jaskowski
- Gallipoli Medical Research Institute, Greenslopes Private Hospital, Greenslopes, Queensland, Australia The School of Medicine, University of Queensland, Herston, Queensland, Australia QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Kim Bridle
- Gallipoli Medical Research Institute, Greenslopes Private Hospital, Greenslopes, Queensland, Australia The School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Nishreen Santrampurwala
- Gallipoli Medical Research Institute, Greenslopes Private Hospital, Greenslopes, Queensland, Australia The School of Medicine, University of Queensland, Herston, Queensland, Australia QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Janske Reiling
- Gallipoli Medical Research Institute, Greenslopes Private Hospital, Greenslopes, Queensland, Australia The School of Medicine, University of Queensland, Herston, Queensland, Australia Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Nick Musgrave
- Sullivan and Nicolaides Pathology, Greenslopes Private Hospital, Greenslopes, Queensland, Australia
| | | | - Darrell Crawford
- Gallipoli Medical Research Institute, Greenslopes Private Hospital, Greenslopes, Queensland, Australia The School of Medicine, University of Queensland, Herston, Queensland, Australia
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10
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Reiling J, Lockwood DSR, Simpson AH, Campbell CM, Bridle KR, Santrampurwala N, Britton LJ, Crawford DHG, Dejong CHC, Fawcett J. Urea production during normothermic machine perfusion: Price of success? Liver Transpl 2015; 21:700-3. [PMID: 25690646 DOI: 10.1002/lt.24094] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 02/08/2015] [Indexed: 12/31/2022]
Affiliation(s)
- Janske Reiling
- School of Medicine, University of Queensland, Brisbane, Australia; Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Brisbane, Australia; PA Research Foundation, Princess Alexandra Hospital, Brisbane, Australia; School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
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11
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Abstract
The physical environment has a significant impact on health and safety; however, hospitals have not been designed with the explicit goal of enhancing patient safety through facility design. In April 2002, St Joseph's Community Hospital of West Bend, a member of SynergyHealth, brought together leaders in healthcare and systems engineering to develop a set of safety-driven facility design recommendations and principles that would guide the design of a new hospital facility focused on patient safety. By introducing safety-driven innovations into the facility design process, environmental designers and healthcare leaders will be able to make significant contributions to patient safety.
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Affiliation(s)
- J Reiling
- Safe by Design, 3616 Edmund Boulevard, Minneapolis, MN 55406, USA.
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