[Myocardial protective effects of luteolin on isolated rat heart in hypothermic preservation]

OBJECTIVE

To investigate the protective effect of luteolin on isolated rat heart in hypothermic preservation.

METHODS

Forty male SD rats were randomly divided into 4 groups (n = 10): control group, luteolin low-dose group (7.5 micromol/L), middle-dose group (15 micromol/L) and high dose group (30 micromol/L). Langendorff model of isolated rat heart was used. After 30 min basal perfusion, the hearts were stored in University of Wisconsin solution (UW solution) at 4 degrees C with luteolin (7.5, 15 and 30 micromol/L) or without luteolin for 12 h and followed by 60 min reperfusion. The recovery of cardiac contractile and diastolic function, coronary flow (CF), creatine kinase (CK) leakage in the coronary effluent, myocardial water content were determined. The myocardial ultrastructure was also observed.

RESULTS

The results revealed that luteolin improved the recovery of left ventricular peak systolic pressure and +/- dp/dtmax dose-dependently and increased coronary flow. The leakage of creatine kinase in the coronary effluent was significantly reduced in luteolin-added hearts. Impairment of myocardial ultrastructure after 12 h hypothermic preservation was obviously alleviated in hearts luteolin-added group compared with that in control group. There were no differences between the groups in myocardial water contents.

CONCLUSION

Luteolin as a supplementation in cardiac preservation solution can significantly improve the hypothermic preservation effects on rat heart and have myocardial protection effect, especially in luteolin-added with 30 micromol/L.

Expression and distribution of aquaporin 8 in rat hepatocytes cold stored 72 hours in modified University of Wisconsin and bes-gluconate-sucrose solutions. Study of their correlation with water content

Since few data are availble on the genetic responses to low temperatures, we investigated if cold storage of hepatocytes (0 degree C, mUW or BGS solutions, 72 h) can affect gene expression and/or cellular localization of AQP8 and their correlation with water movements. Cold preserved hepatocytes showed a significant decrease in water content (P less than 0.05) but were able to regulate their volume when they returned to physiological conditions. These changes were not related to modulation in the expression and the pattern of distribution of AQP8 suggesting that other mechanisms are involved. The study of the quantitative changes in the expression of genes coding for liver specific proteins in cold preserved hepatic cells is of interest in order to develop new preservation methods or solutions that could contribute to maintain the utility of these cells when destined to be applied in clinical models.

Pig heart preservation with antegrade intracellular crystalloid versus antegrade/retrograde miniplegia

Both histidine-tryptophan-ketoglutarate (HTK) solution and Braile miniplegia are commercially available and used with high success. The objective of this work was to compare the effects of both strategies in an animal model. Twelve pigs were divided into control, HTK, or Braile groups using a model of controlled global cardiac ischemia/reperfusion under cardiopulmonary bypass with 1 hour heart ischemia followed by 2 hour reperfusion. No significant differences were found over time or between groups for heart rate, arrhythmia, number of defibrillations required, blood gases, myocardial lactate production, myocardial oxygen consumption, nor coronary flow index. The Braile strategy was associated with a lower 120 minute postreperfusion coronary vascular resistance with higher water content, leukocyte infiltration, and oxidative damage compared with controls. Drainage of HTK solution to the venous return was followed by higher potassium and lower sodium blood concentrations. One-hour heart preservation with HTK or Braile systems followed by 2 hour reperfusion both allow for acceptable preservation of the healthy pig myocardium. Maneuvers such as leukocyte filtration or hemofiltration may further improve these conditions.

Luminescence technology in preservation and transplantation for rat islet

The development of organ preservation solutions and associated technology has been a major effort in tissue transplantation recently. However, this research takes a great deal of time and resources. In this study, a novel method for the evaluation of preservation solutions was established by using islet cells. Primary islets were obtained by hand-picking method from the luciferase transgenic (Luc-Tg) rat pancreas. The viability rate and living condition of islets preserved with several solutions were evaluated by relative photon intensity. Preserved islets were transplanted to the renal capsule of streptozotocin (STZ)-induced type 1 diabetic NOD-scid mouse, and the intraperitoneal glucose tolerance test (IPGTT) and histology were analyzed. The Luc-Tg rat islet viability was increased in a relative photon intensity-dependent manner. In the recipients of ET-Kyoto (ET-K) or University of Wisconsin (UW) solution preserved Luc-Tg rat islet at 1 day, hyperglycemia induced by glucose injection declined to the normal range. In conclusion, this study demonstrates that the ET-K preservation method allowed tissue ATP synthesis and amelioration of cold ischemic tissues damage during extended 24 h isolated-islet preservation. This simple method will be adapted easily to the clinical setting and used to maximize the utilization of islet transplantation as well as for pancreas sharing with remote centers.

[Changes in organ donor epidemiology and new strategies for kidney preservation]

Changes in the epidemiology of brain death are leading the transplant community to use more marginal grafts from so-called extended criteria donors. Current preservation techniques, while simple, are no longer adequate for these organs, which harbor chronic lesions making them very sensitive to ischemia-reperfusion injury. New preservation solutions are needed, along with machine perfusion techniques (dynamic preservation) and normothermic preservation phases.

[Improving donor heart preservation ex vivo]

There is a shortage of heart donors. Some available organs are lost through deterioration prior to transplantation. Indeed, from the moment of brain death until reperfusion in the recipient, cardiac grafts (and also kidney, lung and liver grafts) can undergo irreversible damage due to cardioplegia, the harvesting procedure, and hypothermic transport. The noxious phenomena occurring during cold ischaemia and myocardial reperfusion have been studied for more than 40 years. It was long believed that only the ischaemic phase was harmful, through depletion of energy stores, ionic imbalance, and metabolic disruption. We now know that the heart graft can also be damaged during the reperfusion phase, through calcium overload, free radical production, and mitochondrial changes. Preconditioning and post-conditioning procedures are being developed to protect the ischemic organ.

[Techniques of preparation and indications of labile blood products]

Labile blood products are obtained from samples of whole blood or aphaeresis. The techniques of preparation evolve with technological advances, which allow both an increasing automation and an intensification of the sanitary safety of the blood products. Over the last ten years, thanks to the availability of new technologies, several measures have been introduced in order to reduce the risk of transmission of pathogens and prevent the onset of transfusion-related acute lung injury (TRALI): leukoreduction, use of platelet storage solutions, inactivation of plasma and presumably of platelets in a very near future. The control of transfusion risk also depends on proper use of labile blood products. To assist the prescriber in his treatment options and to standardize practices, the French Agency for Sanitary Safety of Health Products has issued recommendations in terms of utilization of blood products that are detailed in this review of major labile blood products available.

Persufflation improves pancreas preservation when compared with the two-layer method

Islet transplantation is emerging as a promising treatment for patients with type 1 diabetes. It is important to maximize viable islet yield for each organ due to scarcity of suitable human donor pancreata, high cost, and the large dose of islets required for insulin independence. However, organ transport for 8 hours using the two-layer method (TLM) frequently results in low islet yields. Since efficient oxygenation of the core of larger organs (eg, pig, human) in TLM has recently come under question, we investigated oxygen persufflation as an alternative way to supply the pancreas with oxygen during preservation. Porcine pancreata were procured from donors after cardiac death and preserved by either TLM or persufflation for 24 hours and subsequently fixed. Biopsies collected from several regions of the pancreas were sectioned, stained with hematoxylin and eosin, and evaluated by a histologist. Persufflated tissues exhibited distended capillaries and significantly less autolysis/cell death relative to regions not exposed to persufflation or to tissues preserved with TLM. The histology presented here suggests that after 24 hours of preservation, persufflation dramatically improves tissue health when compared with TLM. These results indicate the potential for persufflation to improve viable islet yields and extend the duration of preservation, allowing more donor organs to be utilized.

Treatment outcome of 42 replanted permanent incisors with a median follow-up of 2.8 years

AIM

To evaluate the treatment outcome of avulsed and replanted permanent incisors.

MATERIAL AND METHODS

42 avulsed and replanted permanent incisors in 37 individuals were followed over a median observation period of 2.8 years (range: one year to five years). The mean age was 16.3 years at the time of replantation, with 81% of patients being younger than 20 years.

RESULTS

The tooth survival rate after replantation was 83.3% (35/42 teeth). Periodontal healing was observed in 20 teeth. External root resorption was the most frequent complication and was found in 22 of the 42 avulsed teeth: 21 teeth had replacement resorption. Of these 21 teeth, 14 teeth were still in situ at time of recall examination, seven teeth had to be extracted during the follow-up period due to progressive replacement resorption. One tooth had surface resorption. In contrast, infection-related resorption could not be observed in this sample. With regard to periodontal healing, no differences were found between teeth with short (less than 14 days) versus prolonged duration of splinting. Higher incidence of replacement resorption correlated with the extended duration of non-physiologic extraoral storage.

CONCLUSION

Use of a strict endodontic treatment protocol after replantation minimized the risk of infection-related root resorption. The occurrence of replacement resorption was mainly influenced by the duration of the non-physiologic extraoral storage time and storage medium.

A survey of Swiss swimming pool attendants' knowledge of first-aid treatment after lip and dental injuries

Although dental injuries are common occurrences at swimming pools, there are very few publications about them. The purpose of this study was to interview pool attendants at public swimming pools/bathing resorts in Switzerland on lip and dental injuries in 2007. The questions focussed on their knowledge of first aid, the frequency and accident site of lip and tooth trauma, as well as the storage medium for avulsed teeth. Questions were also asked about the presence of a "dental first-aid kit" and the poster on dental first aid. 606 public pools were contacted, and one pool attendant per pool was interviewed by telephone. 553 individuals participated; 53 declined to take part. The results show that in 2007, 40% of the interviewed pool attendants (n = 221) had witnessed at least one lip injury, and 36.9% (n = 204) at least one tooth trauma. At pools with slides, accidents were more frequent (p<0.001), and the waterslide was the most common accident site. The pool attendants provided satisfactory answers on their actions after lip and dental injuries. However, 68.7% could not adequately answer the questions on storage of avulsed teeth. Only 74 pool attendants had a dental first-aid kit. Of these, only 68 used the kits as the storage medium for avulsed teeth. 59 pool attendants were in possession of the poster on dental first aid. Overall, it was shown that pool attendants who had a dental first-aid kit and a dental first aid poster gave better answers on how to handle tooth trauma.

Short-term preservation of porcine oocytes in ambient temperature: novel approaches

The objective of this study was to evaluate the feasibility of preserving porcine oocytes without freezing. To optimize preservation conditions, porcine cumulus-oocyte complexes (COCs) were preserved in TCM-199, porcine follicular fluid (pFF) and FCS at different temperatures (4°C, 20°C, 25°C, 27.5°C, 30°C and 38.5°C) for 1 day, 2 days or 3 days. After preservation, oocyte morphology, germinal vesicle (GV) rate, actin cytoskeleton organization, cortical granule distribution, mitochondrial translocation and intracellular glutathione level were evaluated. Oocyte maturation was indicated by first polar body emission and spindle morphology after in vitro culture. Strikingly, when COCs were stored at 27.5°C for 3 days in pFF or FCS, more than 60% oocytes were still arrested at the GV stage and more than 50% oocytes matured into MII stages after culture. Almost 80% oocytes showed normal actin organization and cortical granule relocation to the cortex, and approximately 50% oocytes showed diffused mitochondria distribution patterns and normal spindle configurations. While stored in TCM-199, all these criteria decreased significantly. Glutathione (GSH) level in the pFF or FCS group was higher than in the TCM-199 group, but lower than in the non-preserved control group. The preserved oocytes could be fertilized and developed to blastocysts (about 10%) with normal cell number, which is clear evidence for their retaining the developmental potentiality after 3d preservation. Thus, we have developed a simple method for preserving immature pig oocytes at an ambient temperature for several days without evident damage of cytoplasm and keeping oocyte developmental competence.

Cryopreservation of mammalian oocytes by using sugars: Intra- and extracellular raffinose with small amounts of dimethylsulfoxide yields high cryosurvival, fertilization, and development rates

Accumulation of intra- and extracellular sugars such as trehalose, glucose, and raffinose is central to survival strategies of a variety of organisms coping with extreme conditions including freezing and almost complete drying. The objective of the present study was to investigate the potential application of intra- and extracellular raffinose in combination with low concentrations of dimethylsulfoxide (Me(2)SO) to mammalian oocyte cryopreservation. To this end, the fertilization and embryonic development of cryopreserved metaphase II (M II) mouse oocytes were studied in comparison to unfrozen controls. For cryopreservation, M II oocytes were microinjected with 0.1M raffinose, and then cooled to -196 degrees C in the presence of either 0.3M raffinose and 0.5M Me(2)SO (cryopreservation group 1) or 0.3M raffinose and 1.0M Me(2)SO (cryopreservation group 2). The control groups included untreated oocytes (untreated control) and oocytes microinjected with raffinose, but not frozen (injection control). The post-thaw survival rates were 83.9% and 80.6% for the cryopreservation group 1 and 2, respectively. The fertilization and blastocyst rates in the cryopreservation group 1 (90.0% and 77.8%, respectively) and 2 (94.6% and 72.5%, respectively) were also high and similar to the ones of the injection controls (97.8% and 78.5%, respectively) and untreated controls (98.8% and 83.6%, respectively). These results are consistent with the findings of our earlier studies and support the use of sugars as intra- and extracellular cryoprotectants. Furthermore, the results of the present study indicate that the presence of intra- and extracellular sugars alleviates high concentrations of conventional penetrating cryoprotectants, and thus minimizes their toxicity.

Myocardial protection with the use of L-arginine and N-alpha-acetyl-histidine

OBJECTIVE

Effective myocardial preservation is an important condition for cardiac surgery, especially in heart transplantation with long ischemia times. During ischemia and reperfusion, myocardial function is altered by cold-induced ischemic injury. Cold-induced ischemic injury is triggered by cold storage and the amino acid histidine, a main component of the storage solution histidine-tryptophan-ketoglutarate (HTK). Cold-induced ischemic injury generates free oxygen radicals in an iron-dependent way. We investigated the efficacy of new modifications with the addition of L-arginine and N-alpha-acetyl-histidine to the well-established HTK solution (Custodiol) using a rat heart transplant model.

MATERIALS AND METHODS

Heterotopic transplantation was performed in Lewis rats (n = 20). After 1 hour of ischemic preservation and 1 hour of reperfusion, we assessed myocardial function and energy charge potential. The modifications of HTK solution included the addition of L-arginine, partial replacement of histidine with acetyl-histidine, and reduction of chloride concentration (HTK-1). In a second group, Custodiol served as the control.

RESULTS

After 1 hour of reperfusion, left ventricular systolic pressure (106 +/- 33 vs 69 +/- 9 mm Hg; P < .05) and minimum rate of pressure development (dP/dt) (-1388 +/- 627 vs -735 +/- 219 mm Hg/s; P < .05) were significantly higher among the HTK-1 group compared with the control group. Energy charge potential did not differ significantly between the groups.

CONCLUSION

This study showed that the novel modified HTK-1 solution improved myocardial contractility and relaxation after heart transplantation.

Cryopreservation of human hepatocytes for clinical use

Cryopreservation of hepatocytes is important for use both in research and for clinical application in hepatocyte transplantation. Cryopreservation causes damage to hepatocytes with the result that cell viability and function is reduced on thawing compared to fresh cells. There are many different protocols reported for freezing human hepatocytes mainly using DMSO as cryoprotectant. In this chapter the current detailed protocols used for cryopreservation and thawing of human hepatocytes for cell transplantation at the Cell Isolation Unit at King's College Hospital, London, are described. All procedures must be performed in a clean GMP environment using materials and reagents which are of pharmaceutical grade. The cryopreservation media is UW solution with added 300 mM glucose containing 10% DMSO and the thawing solution is EMEM containing 2% HSA. Freezing is performed in a controlled-rate freezer using a stepwise cooling programme.

Consequences of head injury and static cold storage on hepatic function: ex vivo experiments using a model of isolated perfused rat liver

The purpose of the study was to evaluate the effect of head injury (HI) on the metabolic and energy functions of the liver and its consequences after cold storage. In male SD rats with HI, livers were isolated 4 days after injury and perfused either immediately (HI) or after 24 hours of cold preservation. Livers isolated from healthy rats were treated identically. The hepatic functions were explored with an isolated perfused liver model. Head injury induced a liver atrophy without significant difference in the intrahepatic energy level versus healthy rats. After cold storage, hepatic adenosine triphosphate and glycogen contents in HI rats were similar to those of healthy rats. The livers of the HI group that underwent cold preservation had a lower protein catabolism. The portal flow rate at the time of reperfusion was significantly increased in the HI group. In conclusion, static cold storage of livers harvested from HI rats revealed a net protein catabolism reduction and a modification of hepatic microcirculation.

Glomerular retrieval by cell block preparation of preservative fluid: an adjunct to biopsy diagnosis

OBJECTIVE

To investigate the possibility of glomerular retrieval from formalin left in biopsy vials and to evaluate its diagnostic value and accuracy.

STUDY DESIGN

Cell blocks were prepared from 94 consecutive formalin vials left after processing of renal biopsies from 93 patients, including 25 transplant patients. The prepared cell blocks were processed with routine biopsies and evaluated separately, and the results compared.

RESULTS

Of the 94 samples, 29 (23 nontransplant patients and 6 allograft recipients) showed the presence of glomeruli in cell blocks, with an average of 1.7 glomeruli per cell block. In nonallograft native renal biopsies, the histologic diagnosis of glomerular morphology in cell blocks correlated with routine biopsy in 18 of 22 cases. The least retrieval was seen in crescentic glomerulonephritis, diabetic glomerulosclerosis and diffuse global glomerulosclerosis, possibly due either to the tight adherence of the glomerular tuft to the crescent or to fibrosis. All 6 samples from transplant recipients showed normal glomeruli in routine histology and in cell block preparations.

CONCLUSION

Cell blocks from discarded formalin may be a useful adjunct to routine histopathology for the diagnosis of glomerular disease in centers where inadequacy of renal biopsy is frequently reported.

The protective effect of selenoprotein P on injury in rat liver transplantation

BACKGROUND/AIMS

Selenoprotein P (SeP), a plasma protein, is considered to have a protective effect against various organ damages. We investigated whether addition of SeP to storage solution could attenuate cold ischemia/reperfusion injury (IRI) in rat liver transplantation.

METHODOLOGY

After 24 hrs cold preservation in either University of Wisconsin (UW) solution with or without SeP (1 micromol/L or 10 micromol/L), the liver was flushed with warm lactated Ringer's solution. Alanine aminotransferase (ALT) level in the venous effluent was measured. Orthotopic liver transplantation (OLTx) was then performed after the same preservation as above. Blood biochemical features and tissue lipid peroxide levels were measured after OLTx, and morphometric changes analyzed by hematoxylin and eosin, and terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end-labeling (TUNEL) staining.

RESULTS

ALT levels in effluent in the SeP 10 group were significantly lower than those in other groups. Serum aspartate aminotransferase (AST) and lactate dehydrogenase (LDH) were significantly decreased in the SeP 10 group. Histological examinations showed amelioration of sinusoidal damage in the SeP 10 group at 1 hr after OLTx. Percentages of necrotic areas and apoptotic sinusoidal endothelial cells were decreased in the SeP 10 group.

CONCLUSIONS

The addition of SeP to UW solution attenuates injury in OLTx.

Hypothermic Liver Machine Perfusion With EKPS-1 Solution vs Aqix RS-I Solution: In Vivo Feasibility Study in a Pig Transplantation Model

OBJECTIVE

Hypothermic machine perfusion (HMP) is superior to simple cold storage for kidney preservation. We previous observed in a porcine liver transplantation model increased tumor necrosis factor-alpha (TNF-alpha) production eventually leading to poor recipient survival after HMP using standard kidney perfusion solution (KPS-1) compared with simple cold storage. We compared two solutions for HMP preservation of the liver: enriched KPS-1 (EKPS-1) and Aqix RS-I.

METHODS

Pig livers were obtained after cold flushing with histidine-tryptophan-ketoglutarate solution. Subsequently, the livers were subjected to dual-vessel perfusion with two preservation solutions: EKPS-1 (n = 6) and Aqix RS-I (n = 3). After HMP preservation and transplantation, graft and recipient survival, hepatocellular damage (aspartate aminotransferase concentration), TNF-alpha production, and endothelial cell damage (hyaluronic acid clearance) were recorded.

RESULTS

No primary graft nonfunction was observed. Recipient survival at postoperative day 3 was similar in both groups (33%). Aspartate aminotransferase concentration measured in serum samples after reperfusion was similar in both groups. After reperfusion, TNF-alpha concentration was higher and hyaluronic acid clearance was lower in the EKPS-1 group vs the Aqix RS-I group at 60, 120, and 180 minutes (all P < .05).

CONCLUSION

Hypothermic machine perfusion provided adequate longer term graft survival. After reperfusion, TNF-alpha production seems to be reduced, and endothelial cell dysfunction remains pronounced with Aqix RS-1 solution compared with EKPS-1 solution.

LUNG INFLATION WITH DIRECT INJECTION OF AGAROSE: A TECHNIQUE FOR SIMULTANEOUS MOLECULAR AND MORPHOMETRIC MEASUREMENTS

The usual methods for preparing lungs for morphologic study involve the instillation of fixatives that modifyproteins and RNA such that the tissue is unsuitable for molecular studies. To develop a technique suitable for molecular studies, pieces of adult rat lungs were infiltrated with agarose, glutaraldehyde, or paraformaldehyde and the consistency of alveolar inflation was compared to lungs inflated with 10% formalin. Only direct injection with 1% agarose resulted in comparable inflation of lung tissue and preserved RNA and protein. Thus, this technique enables simultaneous molecular and morphometric analysis of the lung on small pieces of lung tissue in heterogeneous lung diseases.

Reggies/flotillins regulate retinal axon regeneration in the zebrafish optic nerve and differentiation of hippocampal and N2a neurons

The reggies/flotillins--proteins upregulated during axon regeneration in retinal ganglion cells (RGCs)--are scaffolding proteins of microdomains and involved in neuronal differentiation. Here, we show that reggies regulate axon regeneration in zebrafish (ZF) after optic nerve section (ONS) in vivo as well as axon/neurite extension in hippocampal and N2a neurons in vitro through signal transduction molecules modulating actin dynamics. ZF reggie-1a, -2a, and -2b downregulation by reggie-specific morpholino (Mo) antisense oligonucleotides directly after ONS significantly reduced ZF RGC axon regeneration: RGC axons from reggie Mo retinas were markedly reduced. Moreover, the number of axon-regenerating RGCs, identified by insertion of A488-coupled dextran, decreased by 69% in retinas 7 d after Mo application. At 10 and 14 d, RGCs decreased by 53 and 33%, respectively, in correlation with the gradual inactivation of the Mos. siRNA-mediated knockdown of reggie-1 and -2 inhibited the differentiation and axon/neurite extension in hippocampal and N2a neurons. N2a cells had significantly shorter filopodia, more cells had lamellipodia and fewer neurites, defects which were rescued by a reggie-1 construct without siRNA-binding sites. Furthermore, reggie knockdown strongly perturbed the balanced activation of the Rho family GTPases Rac1, RhoA, and cdc42, influenced the phosphorylation of cortactin and cofilin, the formation of the N-WASP, cortactin and Arp3 complex, and affected p38, Ras, ERK1/2 (extracellular signal-regulated kinases 1 and 2), and focal adhesion kinase activation. Thus, as suggested by their prominent re-expression after lesion, the reggies represent neuron-intrinsic factors for axon outgrowth and regeneration, being crucial for the coordinated assembly of signaling complexes regulating cytoskeletal remodeling.

Effect of oxygenated perfluorocarbon on isolated islets during transportation

BACKGROUND

Previous studies demonstrated the efficacy of the two-layer method (TLM) using oxygenated perfluorochemicals (PFC) for pancreas preservation. The current study investigated the effect of oxygenated PFC on isolated islets during transportation.

MATERIALS AND METHODS

Purified rat islets were stored in an airtight conical tube for 24h in RPMI culture medium at 22 degrees C or University of Wisconsin solution (UW) at 4 degrees C, either with or without oxygenated PFC. After storage, the islets were assessed for in vitro viability by static incubation (SI), FDA/PI staining, and energy status (ATP, energy charge, and ADP/ATP ratio) and for in vivo viability by a transplantation study.

RESULTS

UW at 4 degrees C and RPMI medium at 22 degrees C maintained islet quality almost equally in both in vitro and in vivo assessments. The ATP levels and energy status in the groups with PFC were significantly lower than those without PFC. The groups with PFC showed a significantly higher ADP/ATP ratio than those without PFC. In the transplantation study, blood glucose levels and AUC in the UW+PFC group were significantly higher than those in UW group.

CONCLUSIONS

UW at 4 degrees C and RPMI medium at 22 degrees C maintained islet quality equally under the conditions for islet transportation. The addition of oxygenated PFC, while advantageous for pancreas preservation, is not useful for islet transportation.

Lung transplantation in pulmonary fibrosis: challenging early outcomes counterbalanced by surprisingly good outcomes beyond 15 years

Interstitial lung disease (ILD) has been reported to have a poor outcome following lung transplantation due to difficulties getting ill recipients to transplantation and challenging early postoperative outcomes. To assess long-term outcomes for this cohort, we performed a retrospective 18-year chart review of all ILD lung transplant recipients. ILD single (SLT) and bilateral sequential lung transplantations (BSLT) were compared with all other lung transplant patients and International Society for Heart and Lung Transplantation (ISHLT) Registry data over the same time period. Of 585 lung transplantations, 90 (15%) were ILD (53 SLT, 37 BSLT); 67 (74%) were idiopathic pulmonary fibrosis (IPF), 9 (10%) were sarcoidosis, 9 (10%) were lymphangioleiomyomatosis, and 5 (6%) had other indications. Mean age was 52 years (range, 34-69 years). Actuarial survival at 1, 5, 10, 15, and 18 years compared favorably to all other lung transplantations performed (77% vs 83%, 51% vs 50%, 42% vs 26%, 28% vs 17%, and 28% vs 8%, respectively). IPF actuarial survival at 1, 5, and 10 years appeared superior to ISHLT Registry data (76% vs 72%, 50% vs 44%, and 34% vs 20%, respectively). There was equivocal survival between SLT and BSLT at 1, 5, and 10 years (78% vs 68%, 49% vs 50%, and 29% vs 50%, respectively). Our ILD figures compared favorably to lung transplantation for other diseases and international standards, while survival from SLT was as successful as BSLT both in the short and the longer term. Consideration should be given to utilizing SLT to maximize the allocation of donor lungs and to decrease waiting list mortality associated with IPF.

Changes and effect of PACAP-38 on intestinal ischemia-reperfusion and autotransplantation

Tissue injury caused by cold preservation and reperfusion during small bowel transplantation remains an unsolved problem. Increasing evidence suggests that pituitary adenylate cyclase-activating polypeptide (PACAP) has protective effects in several ischemia-reperfusion (I/R) models. This study investigated the effect of PACAP-38 on oxidative stress in autotransplanted intestine. We established sham-operated, I/R, and autotransplanted groups in Wistar rats (n = 55). We applied ischemia for 1 (GI), 2 (GII), or 3 hours (GIII). In autotransplanted groups, we performed total orthotopic intestinal autotransplantation. Grafts were preserved in University of Wisconsin (UW) solution for 1 (GIV), 2 (GV), 3 (GVI), or 6 (GVII) hours and in PACAP-38-containing UW for 1 (GVIII), 2 (GIX), 3 (GX), or 6 (GXI) hours. Reperfusion lasted 3 hours in each group. Endogenous PACAP-38 values were measured by radioimmunoassay. Oxidative stress parameters malondialdehyde (MDA), reduced glutathione (GSH), and superoxide dismutase (SOD) were measured in tissue homogenates. Concentration of endogenous PACAP-38 significantly decreased in GI to GIII compared with the sham-operated animals following I/R periods (P < .05). Cold preservation in UW and reperfusion of the intestine increased the level of tissue MDA in GIV to GVII, which correlated with the duration of cold storage. The content of GSH decreased in GIV to GVII to levels that were significantly different between GIV and GVIII and between GVII and GXI. SOD activity decreased dramatically in GIV to GVII with significantly higher activity in GIX to GXI. Our findings confirmed that I/R decreased endogenous PACAP-38 concentration. Administration of PACAP-38 to UW solution mitigated the oxidative injury during intestinal autotransplantation.

Hypothermic storage of isolated human hepatocytes: a comparison between University of Wisconsin solution and a hypothermosol platform

Until now little is known about the functional integrity of human hepatocytes after hypothermic storage. In order to address this limitation, we evaluated several commercially available hypothermic preservation media for their abilities to protect freshly isolated hepatocytes during prolonged cold storage. Human hepatocytes were isolated from non-transplantable/rejected donor livers and resuspended in ice-cold University of Wisconsin solution (UW), HypoThermosol-Base (HTS-Base), or HypoThermosol-FRS (HTS-FRS) with or without the addition of fetal bovine serum. Cells were stored at 4 degrees C for 24-72 h, and evaluated for hepatocyte viability (trypan blue exclusion, or labeling with fluorochromes), cell attachment, and function. The energy status of hepatocytes was evaluated by measurement of intracellular adenosine 5'-triphosphate. To determine whether the test cells expressed metabolic functions of freshly isolated cells, the activities of major phase I (cytochromes P450, FMO) and phase II (UGT, ST) drug-metabolizing enzymes were examined. Although hepatocytes are shown to be satisfactory after 24 h storage in all of the tested solutions, the cell viability, energy status, and xenobiotic metabolism following cold preservation in HTS-FRS was consistently and, in some cases, markedly higher when compared with other systems. The same metabolites for each of the tested substrates were detected in all groups of cells. Moreover, the use of HTS-FRS eliminates the need for serum in preservation solutions. HTS-FRS represents an improved solution compared to HTS-Base and UW for extending the shipping/storage time of human hepatocytes.

Polymerized placenta hemoglobin attenuates ischemia/reperfusion injury and restores the nitroso-redox balance in isolated rat heart

Ischemia/reperfusion (I/R) injury mainly caused by oxidative stress plays a major role in cardiac damage. The extent of the I/R injury is also an important factor that determines the function of a transplanted heart. This study first examined whether hemoglobin-based oxygen carriers (HBOCs) could protect isolated rat heart from I/R injury and then elucidated the underlying mechanism. Using the Langendorff model, isolated Sprague-Dawley rat hearts were arrested and stored at 4 degrees C for 8 h and then reperfused for 2 h. Compared with St. Thomas' solution (STS) and rat self blood in STS, polymerized placenta hemoglobin (PolyPHb) in STS greatly improved heart contraction and decreased infarction size. The extent of myocardial apoptosis was also significantly decreased, which was related to reduced iNOS-derived nitric oxide production, increased protein ratio of Bcl-2/Bax, and reduced caspase-3 activity and cleavage level. Furthermore, PolyPHb in STS did not increase malondialdehyde, peroxynitrite, or mitochondrial hydrogen peroxide formation, but greatly elevated superoxide dismutase activity and preserved mitochondrial ATP synthesis, which served to maintain redox homeostasis in I/R heart. In conclusion, our results demonstrate that HBOCs protected isolated heart from I/R injury and this protection was associated with attenuation of NO-mediated myocardial apoptosis and restoration of the nitroso-redox balance.