Freezing preservation of adult mammalian heart at high subzero temperatures

CPA toxicity screening of cryoprotective solutions in rat hearts

In clinical practice, donor hearts are transported on ice prior to transplant and discarded if cold ischemia time exceeds ∼5 h. Methods to extend these preservation times are critically needed, and ideally, this storage time would extend indefinitely, enabling improved donor-to-patient matching, organ utilization, and immune tolerance induction protocols. Previously, we demonstrated successful vitrification and rewarming of whole rat hearts without ice formation by perfusion-loading a cryoprotective agent (CPA) solution prior to vitrification. However, these hearts did not recover any beating even in controls with CPA loading/unloading alone, which points to the chemical toxicity of the cryoprotective solution (VS55 in Euro-Collins carrier solution) as the likely culprit. To address this, we compared the toxicity of another established CPA cocktail (VEG) to VS55 using ex situ rat heart perfusion. The CPA exposure time was 150 min, and the normothermic assessment time was 60 min. Using Celsior as the carrier, we observed partial recovery of function (atria-only beating) for both VS55 and VEG. Upon further analysis, we found that the VEG CPA cocktail resulted in 50 % lower LDH release than VS55 (N = 4, p = 0.017), suggesting VEG has lower toxicity than VS55. Celsior was a better carrier solution than alternatives such as UW, as CPA + Celsior-treated hearts spent less time in cardiac arrest (N = 4, p = 0.029). While we showed substantial improvement in cardiac function after exposure to vitrifiable concentrations of CPA by improving both the CPA and carrier solution formulation, further improvements will be required before we achieve healthy cryopreserved organs for transplant.

High Sub-Zero Organ Preservation: A Paradigm of Nature-Inspired Strategies

The field of organ preservation is filled with advancements that have yet to see widespread clinical translation, with some of the more notable strategies deriving their inspiration from nature. While static cold storage (SCS) at 2 °C to 4 °C is the current state-of-the-art, it contributes to the current shortage of transplantable organs due to the limited preservation times it affords combined with the limited ability of marginal grafts (i.e. those at risk for post-transplant dysfunction or primary non-function) to tolerate SCS. The era of storage solution optimization to minimize SCS-induced hypothermic injury has plateaued in its improvements, resulting in a shift towards the use of machine perfusion systems to oxygenate organs at normothermic, sub-normothermic, or hypothermic temperatures, as well as the use of sub-zero storage temperatures to leverage the protection brought forth by a reduction in metabolic demand. Many of the rigors that organs are subjected to at low sub-zero temperatures (-80 °C to -196 °C) commonly used for mammalian cell preservation have yet to be surmounted. Therefore, this article focuses on an intermediate temperature range (0 °C to -20 °C), where much success has been seen in the past two decades. The mechanisms leveraged by organisms capable of withstanding prolonged periods at these temperatures through either avoiding or tolerating the formation of ice has provided a foundation for some of the more promising efforts. This article therefore aims to contextualize the translation of these strategies into the realm of mammalian organ preservation.

Current techniques and the future of lung preservation

Although lung transplant remains the only option for patients suffering from end-stage lung failure, donor supply is insufficient to meet demand. Static cold preservation is the most common method to preserve lungs in transport to the recipient; however, this method does not improve lung quality and only allows for 8 h of storage. This results in lungs which become available for donation but cannot be used due to failure to meet physiologic criteria or an inability to store them for a sufficient time to find a suitable recipient. Therefore, lungs lost due to failure to meet physiological or compatibility criteria may be mitigated through preservation methods which improve lung function and storage durations. Ex situ lung perfusion (ESLP) is a recently developed method which allows for longer storage times and has been demonstrated to improve lung function such that rejected lungs can be accepted for donation. Although greater use of ESLP will help to improve donor lung utilization, the ability to cryopreserve lungs would allow for organ banking to better utilize donor lungs. However, lung cryopreservation research remains underrepresented in the literature despite its unique advantages for cryopreservation over other organs. Therefore, this review will discuss the current techniques for lung preservation, static cold preservation and ESLP, and provide a review of the cryopreservation challenges and advantages unique to lungs.

Supercooling as a viable non-freezing cell preservation method of rat hepatocytes

Supercooling preservation holds the potential to drastically extend the preservation time of organs, tissues and engineered tissue products, and fragile cell types that do not lend themselves well to cryopreservation or vitrification. Here, we investigate the effects of supercooling preservation (SCP at -4(o)C) on primary rat hepatocytes stored in cryovials and compare its success (high viability and good functional characteristics) to that of static cold storage (CS at +4(o)C) and cryopreservation. We consider two prominent preservation solutions a) Hypothermosol (HTS-FRS) and b) University of Wisconsin solution (UW) and a range of preservation temperatures (-4 to -10 (o)C). We find that there exists an optimum temperature (-4(o)C) for SCP of rat hepatocytes which yields the highest viability; at this temperature HTS-FRS significantly outperforms UW solution in terms of viability and functional characteristics (secretions and enzymatic activity in suspension and plate culture). With the HTS-FRS solution we show that the cells can be stored for up to a week with high viability (~56%); moreover we also show that the preservation can be performed in large batches (50 million cells) with equal or better viability and no loss of functionality as compared to smaller batches (1.5 million cells) performed in cryovials.

[Cardiac cryopreservation at subzero temperatures: study of systolic and diastolic function]

We studied the alterations produced in left ventricular systolic and diastolic function after applying a protocol of cryopreservation at subzero temperatures. Isolated rabbit hearts were used for the study with 5% polyethylene glycol (PM 4000) being the cryoprotective agent.

MATERIALS AND METHODS

The cryoprotectant solution CP-16 was used on the explanted heart in three phases: induction, storage and thawing. After 60 minutes at -1.6 C and thawing at 2.7 C/min, the heart was connected to a Langendorff system and perfused anterogradely with Krebs-Henseleit buffer. We analyzed the systolic and diastolic parameters before and after cryopreservation, thereby establishing a comparative statistical study.

RESULTS

Following cryopreservation we found a statistically significant increase (p < 0.05) in the peak and developed pressure of the left ventricle with an upward, left displacement of the ventricular function curve. This is indicative of improvement in systolic function. However, the diastolic function showed worsening, with a statistically significant increase (p < 0.05) in mean stiffness, decrease in differential stiffness (p < 0.05) and upward, left displacement of the diastolic pressure-volume curve.

CONCLUSIONS

On the basis of our results we concluded that: a) PM 4000 polyethylene glycol maintains the heart biological viability during cryopreservation at subzero temperatures, and b) after an cryopreservation left ventricular diastolic function worsens with an increase in systolic function.

Alteration in diastolic function following cardiac cryopreservation at subzero temperatures

BACKGROUND

We have studied the alterations produced in the diastolic function of the left ventricle after applying a protocol of cryopreservation at subzero temperatures.

METHODS

Isolated rabbit hearts and 5% polyethylene glycol (PM 4000) as the cryoprotective agent were used for the study.

RESULTS-CONCLUSIONS

Following cryopreservation we found a statistically significant increase in systolic function. However, the diastolic function shows worsening, with a statistically significant increase (p < 0.05) in mean stiffness, decrease in differential stiffness, (p < 0.05) and upward and leftward displacement of the diastolic pressure-volume curve.

Freezing preservation of the mammalian cardiac explant. VI. Effect of thawing rate on functional recovery

This study investigated the effect of thawing rate on the preservation of frozen isolated rat hearts. The hearts were flushed with a hyperosmotic cardioplegic solution, CP-14/EtOH (1.15 Osm/kg), frozen at a rate of 0.18 degree C/hr for 6 h to -3.2 degrees C. Thereafter, the hearts were thawed at rates ranging from 0.08 to 1.1 degrees C/min for 1 to 14 min until the heart temperature reached -2.1 degrees C, the melting point (MP) of the flush solution; then they were held at -1 degree C for 11 to 24 min so that the total thaw time was 25 min. Post-thaw function was assessed by working reperfusion and expressed as percentage of unstored control function. Cardiac output (CO) and other hemodynamic performance showed biphasic responses to the thaw rate. At 0.08 degree C/min rate, CO recovered to 29.1 +/- 4.1 ml/min (40.8 +/- 5.8% of control). Thawing at 0.13 degree C/min enhanced the recovery of CO to 60.5 +/- 4.9%. Between 0.13 and 0.34 degree C/min, recovery was statistically insignificant. Faster thawing at 0.59 and 1.1 degrees C/min caused progressively less recovery. Overall, 0.13 degree C/min offered the highest recovery. In conclusion, function in slowly frozen heart is intimately affected by the thawing rate; there was an optimal intermediate thawing rate and both too slow and too fast thawing were detrimental.

Freezing preservation of the mammalian cardiac explant. V. Cryoprotection by ethanol

We studied the colligative cryoprotective effect of ethanol (EtOH) in preserving the isolated rat heart frozen at -3.4 degrees C or unfrozen at -1.4 degrees C. Addition of 4.7% (v/v) EtOH to a cardioplegic solution, CP-14, raised the osmolality from 280 to 1100 mOsm/kg H2O and lowered the melting point from -0.52 to -2.1 degrees C. Freezing of the cardiac explant at -3.4 degrees C for 6 h resulted in 34.3 +/- 1.9% of the tissue water as ice; recovery of cardiac output (CO) was 50%. Polyethylene glycol, which at 5% (w/v) has been shown to cryoprotect the hearts during freezing at -1.4 degrees C, did not improve the protective effect of 4.7% EtOH. CP-14 + 4.7% EtOH did not freeze at -1.4 degrees C. After 6 h storage, CO in hearts flushed with CP-14 + 4.7% EtOH oxygenated with 95% O2/5%CO2 returned to almost control level and was much higher than that in hearts flushed with 100% O2 saturated-CP-14 + 4.7% EtOH. Storage of 8 and 12 h reduced CO to 87 +/- 9 and 60 +/- 5% of control. By employing EtOH as a colligative cryoprotectant, we preserved the adult mammalian heart frozen at -3.4 degrees C or unfrozen at -1.4 degrees C, suggesting that this small molecular weight, penetrating substance may be a suitable cryoprotectant for long-term storage of the cardiac explant at high subzero temperatures.

Freezing preservation of the mammalian cardiac explant. II. Comparing the protective effect of glycerol and polyethylene glycol

We compared the cryoprotective ability of glycerol and polyethylene glycol (PEG) during freezing. Isolated rat hearts were flushed with one of three cardioplegic solutions (CP-14, CP-15, and CP-16), frozen at -1.4 degrees C, and reperfused after thawing to assess function. After 3 h freezing, cardiac output (CO) in CP-14-flushed hearts recovered to 58.1% of control. CP-16 (CP-14 with 5% PEG) improved CO to 77.5%. Five hours of freezing abolished recovery in CP-14 hearts, but CP-15 (CP-14 with 50 mM glycerol) and CP-16 hearts produced 40.0 and 49.0% CO, respectively. With 6 h freezing, CP-15 hearts did not recover, whereas CP-16 hearts recovered 37.5% CO. In CP-14 hearts frozen for 3 h, 37.4% of the tissue water was ice that increased to 44.7% with 5 h freezing. CP-15 and CP-16 hearts had 34.4 and 30.9% tissue ice, respectively, after 5 h freezing. Tissue water contents in CP-14 and CP-15 hearts (3.83 to 3.96 g H2O/g dry) were 14 to 24% higher than that in CP-16 hearts. Six hours of freezing elevated AMP and ADP contents and reduced ATP levels in CP-15 and CP-16 hearts. Total adenine nucleotide (TAN) content of CP-15 hearts was 72% of control, while that of CP-16 hearts was normal. In conclusion, both glycerol and PEG offered cryoprotection by reducing tissue ice formation. PEG was superior by reducing tissue ice content further via dehydration and by better preserving TAN content.