The function of transgenic human DAF-expressing porcine livers during hemoperfusion with human blood

Extracorporal pig liver perfusion could bridge the deadly problem of acute human liver failure. However, preformed natural antibodies and complement activation (CA) are the predominant mechanisms of hyperacute xenogeneic rejection. The blockade of both pathways of CA in the xenograft, using transgenic livers expressing human decay accelerating factor on the endothelial surface results in prolonged graft survival and lower release of mediators.

Expression of human decay accelerating factor (hDAF) in transgenic pigs regulates complement activation during ex vivo liver perfusion--immunopathological findings

Ex vivo perfusions of human decay accelerating factor-expressing transgenic (n = 3), and nontransgenic (n = 6) porcine livers with human blood revealed a higher degree of organ damage in non-transgenic pig livers. Transgenic livers were protected from immunohistologically detectable complement deposition, despite corresponding IgM and IgG deposits in both groups. Complement activation and consumption of C3 and C4 turned out to be lower in transgenic pig livers. In contrast to livers of normal landrace pigs, livers from genetically manipulated pigs showed no morphological alterations after perfusion.

Resorbable polyesters in cartilage engineering: affinity and biocompatibility of polymer fiber structures to chondrocytes

The resorbable polymers polyglycolic acid (PGA) and polylactic acid (PLA) are gaining increasing importance in tissue engineering and cell transplantation. The present investigation was focused on the biocompatibility and cell retaining behavior of PGA/poly-L-lactide (PLLA) (90/10) and PLLA nonwoven structures for the in vitro development of chondrocyte-polymer constructs. The effect of the relevant monomers to chondrocytes was analyzed. Type II collagen and poly-L-lysine were compared to improve loading of PGA/PLLA and PLLA polymer nonwovens with chondrocytes. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetra-zoliumbrom ide (MTT) test was applied for quantification. At concentrations above 2 mg/mL, glycolic acid was more cytotoxic than lactic acid. As shown by pH equilibration, the cytotoxic effect is not due merely to the acidity of the alpha-hydroxy acids. Regarding the degradation products, glycolic acid, and L(+) lactic acid, nonwovens of PLLA are more biocompatible with chondrocytes than nonwovens of polyglycolide. Collagen type II and poly-L-lysine generally improved cell seeding on resorbable polymers in tissue engineering; however, their efficiency varies depending on the type of fiber structure.

[Xenogenic acceptance, a realistic fantasy?]

Over the last 5 years an unexpectedly fast progress has been achieved in the field of xenotransplantation. This gives cause for substantial hope. Thus, the wish to use animal grafts for the replacement of human organs could become a reality. However, no results exist at present to suggest a biological and immunological long term acceptance of xenografts in the near future. Xenotransplantation has the goal to improve the organ shortage dramatically and to solve the existing ethical problems of organ donation.

Quantitative analysis of the microcirculation of xenogeneic haemoperfused rat livers by intravital microscopy

Livers from male Sprague-Dawley rats were perfused with heparinised, unmodified isogeneic rat blood (n = 6) or xenogeneic human blood. The microcirculation of these livers, as the primary manifestation of hyperacute xenogeneic rejection, was directly observed and quantified by using fluorescence videomicroscopy. Bile flow and enzyme release of the isogeneic perfused livers were in the physiological range, whereas bile flow was significantly reduced and enzyme release increased during xenogeneic perfusion. In contrast to an almost physiological acinar (90.4%) and sinusoidal (93.6%) perfusion rate in the isogeneic group, a rapid breakdown of microcirculation with an acinar perfusion index of 47.5% and a sinusoidal perfusion rate of 67.1% were found in the xenogeneic group. This direct quantification of microcirculatory parameters is a step forward towards sensitive and early characterisation of the severity of the xenogeneic rejection of the liver.

Na-K/2Cl transporter inhibition for reduction of postischemic kidney failure tested in autologous reperfusion

Postischemic kidney function may be influenced by donor conditioning. The sulfamoyl-benzoate "piretanide" (P) is a diuretic agent with an inhibitory effect on the luminal Na-K-2CL-transporter system in the ascending part of the loop of Henle. A clinical pilot study demonstrated a lower rate of organ dysfunction following transplantation in humans when the donor organs were pretreated with piretanide. In an experimental ex vivo model the effect of piretanide on immediate organ function following long or short cold ischemia was studied. Porcine kidneys (n = 36) were removed after in situ transaortal hypothermic flushing with 21 Eurocollins solution. Following short storage (1 h, n = 18) or long storage (24 h, n = 18) the kidneys were reperfused with intraoperatively drawn heparinized autologous blood diluted with Ringer's lactate to a hematocrit of 25%. Urine flow was higher in the piretanide-pretreated group (p), especially after long storage. The electrolyte loss was comparable in both groups. Postischemic endogenous creatinine clearance was significantly elevated in the treatment group (4.45 +/- 0.6 ml/min per 100 mg in P vs 1.91 +/- 0.4 ml/min per 100 mg, in control, P < 0.05 Mann-Whitney test). Renal hemodynamics were improved by piretanide, resulting in significantly lower resistance and allowing higher flow during pressure-controlled perfusion. O2 consumption, representing general metabolic activity, was higher after long storage, indicating an earlier recovery from cold ischemia. In this ex vivo model, autologous reperfusion of porcine kidneys could be improved by piretanide pretreatment. Autoregulation of kidney vasculature was maintained as well as functional parameters such as creatinine clearance or gluconeogenesis. Therefore, piretanide may be used in larger clinical trials to further improve organ quality in times of donor shortage.

[Cultivation of human cartilage tissue in a 3-dimensional perfusion culture chamber: characterization of collagen synthesis]

In reconstructive head and neck surgery, there is a great need for cartilage transplants. Sufficient autologous graft is often not available. Heterologous cartilage is used frequently, although there is danger of transmitting viral infections and resorption rates are high. We have developed a three-dimensional model for the formation of cartilage in vitro. The aim of this study was to characterize the collagen synthesis under these culture conditions. Human chondrocytes were isolated by digesting septal cartilage matrix in the presence of type II collagenase, hyaluronidase, and Dnase II in Ham's F12 medium. The resulting cells were kept in monolayer culture for one week and then suspended in 2% ultra-low-melting agarose (1:1). The cell-agarose conglomerate was encapsulated with a 3% ultra-low-melting agarose solution and placed in a perfusion culture chamber. A permanent flow of fresh medium (Ham's F-12 supplemented with 50 micrograms/ml ascorbic acid and 2% fetal calf serum) was provided by a peristaltic pump which delivered 1 ml/h with on/off intervals of 30 min. Samples were recovered after two weeks. Using electron microscopy abundant collagen fibril formation was shown. The collagen fibrils were identified histologically as cartilage specific type II collagen. No mRNA expression of collagen type X was observed using in situ hybridization. The cells appeared in a round cell shape with round nucleus and only slight variations in form and size. The present results indicate that the chondrocytes maintain their differentiated phenotype and continue to synthesize typical matrix products in this three-dimensional perfusion culture chamber.(ABSTRACT TRUNCATED AT 250 WORDS)

In vivo study of leukocyte-endothelium interaction in endotoxin-induced uveitis

PURPOSE

To analyze leukocyte-endothelium interaction in iris venules of living rats and to quantify changes of leukocyte dynamics in endotoxin-induced uveitis (EIU).

METHODS

Lewis rats received an intraperitoneal injection of 100 micrograms of lipopolysaccharide (LPS; Salmonella typhimurium). Using intravital fluorescence microscopy, the iris vessels were examined, 2, 4, 6, 10, 14, 24, and 72 hours after LPS injection. A setup for intravital fluorescence microscopy of iris venules in the rat is described. Images are recorded with a video camera and stored on S-VHS videotape for off-line analysis. For contrast enhancement, erythrocytes and plasma were stained with fluorescein isothiocyanate (FITC) and FITC-hydroxyethylstarch, respectively. Rhodamine 6G was used for intravital staining of leukocytes. Resolution and magnification (x850) of the system facilitates observation of individual cells in the bloodstream in real time. Leukocytes were either flowing in the center stream, rolling along the endothelium, or firmly adherent. Image analysis provided data on microvascular leukocyte flux and leukocyte velocity.

RESULTS

The percentage of leukocytes rolling on postcapillary venular endothelium increased significantly (P < 0.05) 4 hours after endotoxin administration, as did the number of firmly adherent cells. Leukocyte-endothelium interaction reached its maximum 6 to 10 hours before an increase of inflammatory cells in the aqueous humor. The response to endotoxin was reversible, subsiding to near-normal values after 72 hours.

CONCLUSIONS

Intravital fluorescence microscopy provides data on microvascular parameters, including the number of rolling and sticking leukocytes on vascular endothelium. Inflammation of the anterior uvea was characterized with regard to leukocyte recruitment from blood to the vessel wall.

Laryngeal reconstruction using allogeneic cartilages

Preserved allogeneic cartilage has been used to reconstruct laryngeal defects. The most important problem with this approach has been graft resorption, which seems to be caused by devitalization of the grafts as a consequence of preservation. In this study, the authors compared the in vivo behavior of vital and nonvital preserved cartilage used to reconstruct the larynx of New Zealand white rabbits. The vital cartilage grafts were stored using organ culture procedures, and the nonvital grafts were stored in formaldehyde. While the formaldehyde-preserved cartilage showed inflammatory changes, the transplanted vital cartilage was well accepted and showed no evidence of immune cell infiltrations. The authors concluded that viable cartilage grafts are preferable to grafts of chemically preserved cartilage.

Engineering of cartilage tissue using bioresorbable polymer fleeces and perfusion culture

Replacement of injured or diseased skeletal tissues by either autograft or allograft cartilage has increased steadily during recent decades. The ideal method is to use autologous cartilage; however, this is extremely limited due to the scarcity of donor sites. We present a new approach to the in vitro formation of cartilage grafts for autologous grafting in reconstructive surgery. Bioresorbable polymer fleeces of polylactic acid were used as temporary cell carrier matrices to establish three-dimensional cultures of human chondrocytes. The polymer surface was coated with poly-L-lysine before cell integration. These cell-polymer tissue constructs were encapsulated with low melting point agarose and then placed in perfusion culture chambers to provide a constant supply of nutrients into the cultures. The culture medium consisted of Ham's F12 supplemented with 2% fetal calf serum and 50 micrograms/ml ascorbic acid. The cell-polymer tissues were harvested and frozen for toloudine and alcian blue staining as well as electron microscopic examination after different periods of time in culture. A monoclonal antibody specific for collagen type II was used to characterize the cell phenotype. With this culture procedure chondrocytes maintained a differentiated phenotype with synthesis of collagen and proteoglycan. Collagen fibrils with clear cross-striation were evident in electron microscopic images. The results show that our organotypic cell culture method allows the in vitro production of bioartificial cartilage for transplantation.

Infections and immunological hazards of allogeneic bone transplantation

Allogeneic transplantation of human cancellous and cortical bone is a controversially discussed concept in trauma and orthopaedic surgery. Biological and immunological arguments support transplantation of autologous material whenever this is technically possible. On the other hand, synthetic alloplastic materials for bone substitution are available free of immunological and hygienic hazards. In this context the value of allogeneic bone grafts is discussed, especially considering the problem of AIDS. If autologous corticospongious bone is to be used its supply is limited. On the other hand, alloplastic synthetic artificial bone does not meet all the requirements demanded for substitution of large osseous defects up to now. The problems of geometric and mechanical stability of these alloplastic materials still remain. Therefore, no alternative to allografting of large, stable, corticospongious fragments exists in some cases. Bone transplantation is performed without vital indication in nearly every case. Thus an optimum of hygienic security has to be claimed for recipients of allogeneic bone. The "Munich model" for bone transplantation is presented and discussed.

Beating neonatal rat cardiomyocytes as a model to study the role of xenoreactive natural antibodies in xenotransplantation

The hyperacute rejection reaction of xenogeneic organs is supposed to be triggered by xenoreactive natural antibodies of the recipient organism. In an experimental set-up allowing for rapid medium exchange, primary cultures of spontaneously beating neonatal rat cardiomyocytes were challenged with dialyzed human serum containing xenoreactive natural antibodies. After adding the serum specimens, a reproducible pattern of disturbed contractility was observed: following an initial increase in beating frequency, spontaneous contractions stopped completely. This standstill was reversible in all experiments. No signs of permanent cytotoxicity were observed. The temporary cessation of contractions was prevented by raising extracellular calcium concentration, but not by extracellular electrical stimulation. After absorption of xenoreactive natural antibodies, cellular contractions ensued without interruption. Inactivated serum specimens produced similar effects on contractility, although the duration of the standstill period was significantly shorter. The same qualitative phenomenon occurred when sera of other xenogeneic species were used. These results point to a temporary functional disturbance of parenchymal cells by xenoreactive natural antibodies, whereas no chronic cytotoxicity was conspicuous in these experiments.

Xenotransplantation and its future

Today at the beginning of the era of xenotransplantation, only simple and single observations about comparative physiology, biochemistry and anatomy are known. In addition, very few data exist which inform about the mechanisms after successful xenotransplantation. Nothing is known about the phenomena following successfully suppressed hyperacute xenogeneic rejection (HXR). Neither the elimination of a single factor nor the mitigation of whole systems has led to clinically relevant survival times (SVT). Pig organs transplanted into non-human primates survived a maximum of 22 days. The hope that transgenic manipulation and modification would be useful in prolonging the SVT of xenogeneic grafts still awaits supporting evidence. But within a short time, xenotransplantation could enable patients to receive a life saving animal organ as an alternative to an allograft. Xenotransplantation would, as a new dimension in medicine, shorten if not eliminate waiting lists. Therefore, scientists must vigorously develop xenografting as a viable alternative to allotransplantation. Xenotransplantation would not be the terrible danger that some individuals proclaim, and would also not simply be the extension of transplantation but would rather be a victory in medical research.

[Culture of human cartilage tissue using a perfusion chamber]

In the field of otolaryngology cartilage grafting is commonly performed to reconstruct skeletal defects. Knowledge of chondrocyte growth and differentiation can now be used to engineer cartilage tissue for grafting. The first condition is that chondrocytes maintain their differentiated phenotype besides being able to produce a new cartilage matrix. The target of this study was to develop a three-dimensional culture system for in-vitro formation of vital cartilage transplants. Chondrocytes were isolated by digesting the cartilage matrix with collagenase and hyaluronidase. After embedding in "low-melting" agarose, the chondrocytes were placed into a perfusion culture chamber to provide a constant supply of nutrients to the cultures. The peristaltic pump was operated with on/off intervals of 30 min. Ham's F12 supplemented with 2% FCS and 50 micrograms/ml ascorbic acid was employed as culture medium. Monoclonal antibodies specific to collagens type I and type II were used to characterise cells and matrix synthesis. Synthesis of proteoglycans and collagens was achieved using toluidine blue and azan staining. Under the described culture conditions, the chondrocytes maintained a differentiated phenotype (expression of collagen type II) with synthesis of collagens and proteoglycans. An accumulation of matrix products was achieved pericellularly. After 2-8 weeks the obtained tissue exhibited an excellent histological appearance showing the typical features of cartilage tissue. The results show that the perfusion chamber allows a quick in-vitro fabrication of a piece of pure cartilage tissue for transplantation.

Effect of growth factors on cell proliferation by human nasal septal chondrocytes cultured in monolayer

In the field of reconstructive surgery, autologous cartilage grafting is commonly performed to reconstruct skeletal defects. Because of the limited supply of fresh autologous cartilage many investigators concentrate on in vitro production of cartilage tissue. Several growth factors regulate the metabolism and activation of cartilage cells. In order to enhance the culture conditions for cartilage cells, the aim of our investigations was to characterize the influence of transforming growth factor (TGF)-beta, epidermal growth factor (EGF) and basic fibroblast growth factor (bFGF) on the proliferation of differentiated human nasal septal chondrocytes. The isolated cells were cultured in monolayer using DMEM with and without 10% FCS. The cell proliferation was assessed using tritiated thymidine. We measured an increase of the proliferation rates when the different growth factors were added. The most important stimulatory effect was due to bFGF and the less to EGF. If all growth factors were added together a fivefold increase in the proliferative activity of the cells was achieved. The effects were further enhanced by factors present in fetal calf serum. We conclude that the culture conditions for cell expansion for cartilage engineering can be optimized employing growth factors.

Immunohistological studies of complement activation after xenogeneic perfusion of a working heart model

Transplantation of organs from one species to another leads to immediate hyperacute rejection. Activation of complement is one important factor involved in this process. Whether complement activation is induced by preformed natural antibodies (PNAbs) via the classical pathway or by an "activator surface" via the alternative pathway is unclear. In order to simulate the relevant clinical situation of animal donor/human recipient we perfused working porcine hearts ex vivo with human blood. This also offered the possibility to study the process of complement activation in a precisely defined system with human complement proteins. PNAb titer and complement lytic activity of the plasma were measured. Immunohistological stainings for IgG, IgM, C1q, C4, C3d, C5-9, factor B, and properdin were performed on tissue sections of the left ventricle. PNAb titer almost totally disappeared within the first 5 min of perfusion. Complement lytic activity of the classical pathway decreased similarly within the first 3 h of xenogeneic and autologous perfusion from 70% to 40%. More detailed immunohistological studies revealed positive staining for C3d on endothelium and myocardium of ex vivo perfused xenogeneic hearts. Complement-induced cytotoxicity was proven by the presence of C5-9 (membrane attack complex). However, hardly any C1q and C4 could be found in the ex vivo xenogeneic perfused hearts. Staining for factor B was positive and proved activation via the alternative pathway. Beyond that, the presence of properdin binding even indicated an upregulation of the alternative pathway C3 convertase.(ABSTRACT TRUNCATED AT 250 WORDS)

Xenogeneic ex vivo hemoperfusion of rhesus monkey livers with human blood

This model of completely isolated ex vivo hemoperfused RM livers reflects immunologic effects of donor organs and the humoral blood components of the recipient. The reaction between the isolated organ and recirculating blood allows us to concentrate on effects and products liberated under such a selected but limited situation. The slight influence of used materials on the monitored parameters in the circuit is of no importance. The massive release of TNF alpha, IL-1 beta, IL-6, IFN gamma, and 6kPGF1 alpha between 15 and 60 minutes after reperfusion was the specific result of xenoperfusion. IL-2 increases after 60 minutes. Soluble human IL-2R seems to be eliminated from the perfusate by the RM liver to about 50% of initial values. It increases again sharply beyond 180 minutes now originating from the RM liver. During the whole perfusion time, soluble HLA-I antigen and the detected adhesion molecules decrease to 50% of their initial values.

Bone formation in coralline hydroxyapatite. Effects of pore size studied in rabbits

We analyzed osseous reactions in the rabbit femoral condyle to coralline hydroxyapatite bone substitutes of various pore sizes by radiology and histology. The results were compared to bone repair of empty cavities and to integration of allografts. Spontaneous bone repair of the empty cavities took approximately 12 weeks, while integration of the cryopreserved allografts occurred after 9 weeks. However, no signs of new bone formation were found with the 200 microns pore size hydroxyapatite. In contrast, there was substantial production of bone within the 500 microns pore size implants at 12 and 26 weeks. Our results indicate that the pore size of the coralline hydroxyapatite influenced the development of bone in the implants in the cancellous bone bed of the rabbit femoral condyle. The results also show that spontaneous bone repair should be taken into consideration when the integration of implants is evaluated.

Engineering of cartilage tissue using bioresorbable polymer carriers in perfusion culture

Bioresorbable polymer fleeces with a high internal surface area were used as temporary matrices to establish three-dimensional cultures of isolated human articular chondrocytes. The polymer surface was coated with poly-L-lysine to support cell attachment. The resulting cell-polymer tissues were cultured in perfusion culture chambers to achieve a constant supply of nutrients by diffusion. Retention and accumulation of extracellular matrix components synthesized by the chondrocytes were improved by encapsulation of the cell-polymer integrate in agarose gel. The cell-polymer tissues formed abundant collagen fibrils in vitro with a typical cross-triation clearly visible in electron microscopy analysis. Chondrocytes and intercellular matrix stained positively with monoclonal antibodies specific for differentiated chondrocytes and type II collagen. Synthesis of proteoglycans and collagen was also evident by further analysis with alcian blue and azan staining of cell-polymer tissue sections. The presented experimental tissue culture technique offers a novel concept for the in vitro formation of vital cartilage implants for reconstructive surgery or treatment of destructive joint diseases and possibly for the in vitro engineering of human tissues in general, with applications in drug testing and replacement of animal experiments.