Quantitative analysis of mitochondrial flocculent densities in rat hepatocytes during normothermic and hypothermic ischemia in vitro

The Effects of Oxygenation on Ex Vivo Kidneys Undergoing Hypothermic Machine Perfusion

BACKGROUND

Supplemental oxygenation of the standard hypothermic machine perfusion (HMP) circuit has the potential to invoke favorable changes in metabolism, optimizing cadaveric organs before transplantation.

METHODS

Eight pairs of porcine kidneys underwent 18 hours of either oxygenated (HMP/O2) or aerated (HMP/Air) HMP in a paired donation after circulatory death model of transplantation. Circulating perfusion fluid was supplemented with the metabolic tracer universally labeled glucose.Perfusate, end-point renal cortex, and medulla samples underwent metabolomic analysis using 1-dimension and 2-dimension nuclear magnetic resonance experiments in addition to gas chromatography-mass spectrometry. Analysis of C-labeled metabolic products was combined with adenosine nucleotide levels and differences in tissue architecture.

RESULTS

Metabolomic analysis revealed significantly higher concentrations of universally labeled lactate in the cortex of HMP/Air versus HMP/O2 kidneys (0.056 mM vs 0.026 mM, P < 0.05). Conversely, newly synthesized [4,5-C] glutamate concentrations were higher in the cortex of HMP/O2 kidneys inferring relative increases in tricarboxylic acid cycle activity versus HMP/Air kidneys (0.013 mmol/L vs 0.003 mmol/L, P < 0.05). This was associated with greater amounts of adenoside triphosphate in the cortex HMP/O2 versus HMP/Air kidneys (19.8 mmol/mg protein vs 2.8 mmol/mg protein, P < 0.05). Improved flow dynamics and favorable ultrastructural features were also observed in HMP/O2 kidneys. There were no differences in thiobarbituric acid reactive substances and reduced glutathione levels, tissue markers of oxidative stress, between groups.

CONCLUSIONS

The supplementation of perfusion fluid with high-concentration oxygen (95%) results in a greater degree of aerobic metabolism versus aeration (21%) in the nonphysiological environment of HMP, with reciprocal changes in adenoside triphosphate levels.

Ultrastructural changes in hepatocytes of precision-cut rat liver slices after incubation for 24 and 48 hours

Hepatocytes of precision-cut rat liver slices were studied by means of transmission electron microscopy after long-term incubation (24-48 h) in comparison with freshly prepared slices, indicating reversible and irreversible intracellular alterations of the cells. After 24 h incubation the morphological image in transversal sections of slices is characterised by a central zone of damaged and necrotic cells flanked by two to several superficial layers of viable cells. This is typical of a diffusion gradient of oxygen tension and nutrient content from the surface to the centre of the slices. In adapted cells on the surface of the slices we observed an organelle-free layer of fine granular material in the apical cytoplasm followed by parallel oriented stacks of rough endoplasmic reticulum near by. Mitochondria of essentially normal appearance in adapted cells did not contain flocculent densities, which were observed in damaged cells only. The cytoplasm of parenchymal cells consisted of defined areas of clear cytoplasmic material containing numerous branching tubular profiles of smooth endoplasmic reticulum, presumably in the regions with depleted glycogen aggregates. Subcellular signs of necrosis are destroyed mitochondria, dilated endoplasmic reticulum free of ribosomes and clumping of chromatin in the nucleus of hepatocytes. No appreciable differences of the cell organelles were observed between 24 and 48 h of incubation, but the incidence and intensity of signs of necrosis increased with the duration of incubation and the thickness of the slices. The process of these changes may reflect the phenomenon of cellular adaptation and of hypoxic cellular injury in the periphery and the centre of the slices, respectively.

Cold storage preservation and warm ischaemic injury to isolated arterial segments: endothelial cell injury

Injury to endothelial cells is thought to be important to the development of the vascular lesion of chronic rejection. It was the aim of this study to develop a semiquantitative method to assess endothelial injury in arterial grafts and to document the injury produced by cold storage preservation and additional warm ischaemia. Twelve- and 24-h cold preservation of rat aortic segments, together with an additional 1 h of warm ischaemia, were assessed. Electron micrographs of representative endothelial cells were scored for cytoplasmic, nuclear and mitochondrial injury. The overall injury score was obtained by addition of the individual scores. Storage for up to 24 h in University of Wisconsin (UW) and Terasaki did not produce any injury. Twenty-four hours of storage in Euro-Collins resulted in endothelial cell death. Injury occurred after 12 h of storage in Ross, Collins and normal saline, and the injury increased following 24 h of storage. One hour of warm ischaemia did not increase the injury. Injury to endothelial cells varies with the preservation solution used and the time of cold storage, so that both the type of solution and the storage time should be taken into account in clinical studies looking at the influence of cold ischaemia time and graft outcome.

Ischemic cell death in brain neurons

This review is directed at understanding how neuronal death occurs in two distinct insults, global ischemia and focal ischemia. These are the two principal rodent models for human disease. Cell death occurs by a necrotic pathway characterized by either ischemic/homogenizing cell change or edematous cell change. Death also occurs via an apoptotic-like pathway that is characterized, minimally, by DNA laddering and a dependence on caspase activity and, optimally, by those properties, additional characteristic protein and phospholipid changes, and morphological attributes of apoptosis. Death may also occur by autophagocytosis. The cell death process has four major stages. The first, the induction stage, includes several changes initiated by ischemia and reperfusion that are very likely to play major roles in cell death. These include inhibition (and subsequent reactivation) of electron transport, decreased ATP, decreased pH, increased cell Ca(2+), release of glutamate, increased arachidonic acid, and also gene activation leading to cytokine synthesis, synthesis of enzymes involved in free radical production, and accumulation of leukocytes. These changes lead to the activation of five damaging events, termed perpetrators. These are the damaging actions of free radicals and their product peroxynitrite, the actions of the Ca(2+)-dependent protease calpain, the activity of phospholipases, the activity of poly-ADPribose polymerase (PARP), and the activation of the apoptotic pathway. The second stage of cell death involves the long-term changes in macromolecules or key metabolites that are caused by the perpetrators. The third stage of cell death involves long-term damaging effects of these macromolecular and metabolite changes, and of some of the induction processes, on critical cell functions and structures that lead to the defined end stages of cell damage. These targeted functions and structures include the plasmalemma, the mitochondria, the cytoskeleton, protein synthesis, and kinase activities. The fourth stage is the progression to the morphological and biochemical end stages of cell death. Of these four stages, the last two are the least well understood. Quite little is known of how the perpetrators affect the structures and functions and whether and how each of these changes contribute to cell death. According to this description, the key step in ischemic cell death is adequate activation of the perpetrators, and thus a major unifying thread of the review is a consideration of how the changes occurring during and after ischemia, including gene activation and synthesis of new proteins, conspire to produce damaging levels of free radicals and peroxynitrite, to activate calpain and other Ca(2+)-driven processes that are damaging, and to initiate the apoptotic process. Although it is not fully established for all cases, the major driving force for the necrotic cell death process, and very possibly the other processes, appears to be the generation of free radicals and peroxynitrite. Effects of a large number of damaging changes can be explained on the basis of their ability to generate free radicals in early or late stages of damage. Several important issues are defined for future study. These include determining the triggers for apoptosis and autophagocytosis and establishing greater confidence in most of the cellular changes that are hypothesized to be involved in cell death. A very important outstanding issue is identifying the critical functional and structural changes caused by the perpetrators of cell death. These changes are responsible for cell death, and their identity and mechanisms of action are almost completely unknown.

Effects of ischaemia and preservation on the ultrastructure of the bronchiolar epithelium. A quantitative electron microscopic study of human and canine lungs

In ten cases of clinical human single-lung transplantation, the nontransplanted Euro-Collins-preserved contralateral lungs were examined using electron microscopy to determine the effects of ischaemia on the bronchiolar epithelium. Existing structural damage at the time of transplantation was characterized using this approach, and nine nonpreserved canine single lungs were also investigated to identify the impact of ischaemia. The study revealed a significant correlation between the duration of ischaemia and the mitochondrial surface-to-volume ratio, which can serve as a morphometric criterion for mitochondrial damage, in canine lungs. However, this correlation was not found in the human donor lungs. Further examination of human donor lungs showed slight to moderate damage to the endoplasmic reticulum and nuclear chromatin. In addition, various degrees of damage to mitochondrial structure, ranging from inconspicuous to severe, were found. The mitochondrial surface-to-volume ratio can be considered to be a suitable criterion for the quantification of ischaemic damage of the bronchiolar epithelium under experimental conditions. Ultrastructural analysis of human donor lungs revealed intact bronchiolar epithelial cell structures at the time of transplantation, reflecting adequate organ preservation with Euro-Collins solution.

Combined enzyme histochemical and ultrastructural study on cryostat sections of pig heart to detect early reperfusion damage after ischaemia

In cardiac surgery, recognition of peroperative myocardial infarction may improve patient selection for prolonged circulatory support. The value of enzyme histochemistry to discriminate between reversible and irreversible myocardial damage at short periods of reperfusion was studied in an in vivo model of regional ischaemia in pig hearts. The left anterior descending coronary artery (LADCA) was clamped for 45 min followed by 2 h reperfusion (group 1, n = 3). Post-mortem heart tissue showed markedly decreased activities of lactate dehydrogenase (LDH) and beta-hydroxybutyrate dehydrogenase (BDH) as demonstrated in cryostat sections, accompanied by massive leakage of LDH in the venous effluent. The depleted areas showed irreversible cell damage based on the presence of flocculent densities in mitochondria. In group 2 (n = 6), LADCA flow was reduced to 40 per cent of the base-line value followed by 2 h reperfusion. Heart tissue showed normal LDH and BDH activities, except for some cells surrounding blood vessels, which activity was minimally decreased. Flocculent densities in mitochondria were never observed. We conclude that enzyme histochemistry of LDH and BDH activity on cryostat sections is a useful tool for detecting irreversible myocardial cell damage as early as 2 h reperfusion after ischaemia of the pig heart. The technique has potential applications in the detection of peroperative infarction in human biopsies.

Histochemical detection of glycogen phosphorylase activity as parameter for early ischemic damage in rat heart

In the present study we have investigated whether enzyme histochemical parameters can be applied to detect early ischemic damage in rat heart after ischemia without restoration of the blood flow. Ischemia was induced by incubating heart fragments for 0, 10, 20, 30, 60, 120 and 240 min at 37 degrees C. The activity and localization of the following enzymes was studied in unfixed cryostat sections using quantitative histochemical methods: lactate dehydrogenase, creatine kinase, succinate dehydrogenase, phosphofructokinase, acid phosphatase, 5'-nucleotidase and glycogen phosphorylase. Moreover, the ultrastructure of the tissue was studied with special attention to the appearance of flocculent densities in mitochondria, which can be seen as a sign of irreversible cell damage. It was shown that glycogen phosphorylase activity in rat heart decreased after short periods (30 min) of in vitro ischemia, whereas all other enzymes studied were not decreased up to 240 min, with the exception of lactate dehydrogenase and phosphofructokinase activities which were diminished only at 240 and 120 min of ischemia, respectively. Some reaction product was found after incubating for 5'-nucleotidase activity in the absence of substrate, indicating the presence of endogenous substrate(s). This endogenous substrate disappeared from the myocytes after 20 min of ischemia. It is assumed that AMP and/or other phosphate-containing compounds play an essential role in the activation of glycogen phosphorylase. Significant reduction of glycogen phosphorylase activity is correlated with the irreversible stage of damage of myocytes as judged from the ultrastructure.

The influence of hypoxic cell-free perfusion and ischemia on cell morphology in the proximal tubular S2-segment of the rat kidney

In the present study, in-situ perfused rat kidneys were used as a model to demonstrate the different morphological changes induced by various periods of warm ischemia or of warm hypoxic cell-free perfusion. Light and electron microscopic evaluation revealed no changes in the S2 proximal tubular cells after short exposure times of up to 4 min, whereas longer periods resulted in changes ranging from slight alterations (at 10 min) to severe damage (at 60 min). Warm hypoxic cell-free perfusion induced obvious alterations in the proximal tubular cells somewhat sooner than warm ischemia. The microscopical findings were consistent with the statistics of a detailed morphometrical analysis performed on the mitochondrial diameter. The results were further substantiated by counting intramitochondrial electron-dense condensations ('flocculent densities') as indicators of irreversible cell alteration.

Changes in acid phosphatase activity in rat liver after ischemia

The effect of ischemia on the stability, i.e. the permeability of the lysosomal membrane of rat liver has been studied using quantitative histochemical analysis of acid phosphatase activity. Ischemia in vitro was performed for 0-240 min at 37 degrees C and ischemia in vivo for 60 min was followed by 1, 5, 24 and 48 h of reperfusion. Acid phosphatase activity was demonstrated in cryostat sections using naphthol AS-BI phosphoric acid as substrate and polyvinyl alcohol was added to the incubation medium to counteract diffusion phenomena. Ischemia in vitro up to 240 min did not affect the localization nor the total activity of acid phosphatase activity. After 60-min ischemia in vivo followed by 1-h reperfusion distinct areas showed decreased acid phosphatase activity. A further decrease in activity was observed after 5 h reperfusion. Final reaction product generated by acid phosphatase activity was rather diffusely distributed in border zones between normal and damaged tissue after 24 and 48 h of reperfusion following 60 min ischemia in vivo. It is concluded that not ischemia itself but rather reperfusion affects the stability of the lysosomal membrane due to the occurrence of oxygen-derived free radicals and/or imbalanced Ca2+ concentration. Restoration of the blood flow causes leakage of acid phosphatase from the lysosomes into the cytoplasm of liver parenchymal cells and from there to the blood.

The 'nothing dehydrogenase' reaction and the detection of ischaemic damage

The 'nothing dehyrogenase' reaction is defined as the reduction of tetrazolium salts in media lacking specific substrates for dehydrogenases. In this investigation, the kinetics of the 'nothing dehydrogenase' reaction were studied in cryostat sections of rat heart and liver with the use of various polyvinyl alcohol-containing incubation media. Formazan production was measured at 585 nm with a cytophotometer. The 'nothing dehydrogenase' reaction was substantially lower in the heart than in the liver which was due to low levels of endogenous lactate and the absence of proteins containing thiol groups, such as albumin, in the heart. In vitro ischaemia resulted in a reduced 'nothing dehydrogenase' reaction due to loss of NAD+, possibly as a consequence of its breakdown by glycohydrolase activity. One hour reperfusion following one hour ischaemia caused a decreased 'nothing dehydrogenase' reaction in certain areas of the liver. This reduction was a result of leakage of lactate dehydrogenase and thiol-containing molecules. It appeared at the ultrastructural level that parenchymal and endothelial cells were heavily damaged in the areas containing a low 'nothing dehydrogenase' activity. In conclusion, early ischaemic damage in liver can be detected with the 'nothing dehydrogenase' reaction.

A quantitative histochemical study of 5'-nucleotidase activity in rat liver after ischaemia

The lead salt method of Wachstein and Meisel15 has been applied using incubation media containing polyvinyl alcohol for the localization and quantification of 5'-nucleotidase (E.C.3.1.3.5) activity in cryostat sections from rat liver after ischaemia in vitro and ischaemia in vivo followed by different periods of re-perfusion. 5'-Nucleotidase activity at the bile canaliculi, especially in the pericentral areas, had already decreased after 60 min of ischaemia in vitro, although the total activity as measured densitometrically was not changed. After 120-240 min of ischaemia, a significant decrease of the total 5'-nucleotidase activity was found. At that stage, signs of irreversible cell damage were recognized. Short periods of re-perfusion (1 h) after ischaemia in vivo induced a decreased bile canalicular 5'-nucleotidase activity throughout the entire liver, but a restoration after longer periods of re-perfusion was observed (5, 24, and 48 h). Necrotic areas recognized by a decreased lactate dehydrogenase activity after all periods of re-perfusion showed decreased total 5'-nucleotidase activities. A correlation was observed between the decrease in bile canalicular 5'-nucleotidase activity and the disappearance of microvilli of the bile canaliculi. It is concluded that a decrease in the bile canalicular 5'-nucleotidase activity can be used as a very sensitive marker for ischaemic liver cell damage. Assessment of the irreversibility of the cell injury has to be determined using additional parameters such as a decreased lactate dehydrogenase activity.

Ultrastructural changes in the rat liver during Euro-Collins storage, compared with hypothermic in vitro ischemia

The ultrastructural alterations in liver tissue induced by in vitro ischemia at 4 degrees C under conditions commonly used for transplantation (Euro-Collins perfused and stored liver tissue) have been compared with changes due to hypothermic in vitro ischemia in non-perfused liver. It was found that the process of cell deterioration in non-perfused liver occurred very slowly; signs of irreversible damage appeared in sinusoidal lining cells before hepatocytes (after 24 and 96 h, respectively). Liver perfused with, and stored in Euro-Collins solution showed acceleration of the ischemical damage in both types of cell (irreversible damage to sinusoidal lining cells after 12 h and to hepatocytes after 52 h), compared with non-perfused liver. These findings indicate that the safe period for storage of rat liver in Euro-Collins before damage to the microcirculatory system is less than 12 h. It might also be questioned whether Euro-Collins treatment is the optimal procedure for tissue preservation before liver transplantation.

A histochemical study of changes in mitochondrial enzyme activities of rat liver after ischemia in vitro

Changes in the activity of three mitochondrial enzymes in rat liver after in vitro ischemia have been determined by enzyme histochemical methods. The changes were correlated with the appearance in the electron microscope of flocculent densities in the mitochondria indicative of irreversible cell injury. The flocculent densities were observed in rat liver after about 2 h of ischemia in vitro at 37 degrees C. At the same time the activity of glutamate dehydrogenase, localized in the mitochondrial matrix, started to decrease. However, the activities of succinate dehydrogenase localized in the inner membrane of mitochondria, as well as monoamine oxidase of the mitochondrial outer membrane did not change at that stage. It is concluded from the results of this study and those of others that flocculent densities are formed by denaturation of proteins of the mitochondrial matrix in which glutamate dehydrogenase takes part. It should be considered more as a sign than as the cause of cell death.