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Arteriovenous Fistula Aneurysm: Bench to Bedside. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03412-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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2
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Zaid M, Sala L, Ivey JR, Tharp DL, Mueller CM, Thorne PK, Kelly SC, Silva KAS, Amin AR, Ruiz-Lozano P, Kapiloff MS, Despins L, Popescu M, Keller J, Skubic M, Ahmad S, Emter CA, Guidoboni G. Mechanism-Driven Modeling to Aid Non-invasive Monitoring of Cardiac Function via Ballistocardiography. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:788264. [PMID: 35252962 PMCID: PMC8888976 DOI: 10.3389/fmedt.2022.788264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/07/2022] [Indexed: 11/17/2022] Open
Abstract
Left ventricular (LV) catheterization provides LV pressure-volume (P-V) loops and it represents the gold standard for cardiac function monitoring. This technique, however, is invasive and this limits its applicability in clinical and in-home settings. Ballistocardiography (BCG) is a good candidate for non-invasive cardiac monitoring, as it is based on capturing non-invasively the body motion that results from the blood flowing through the cardiovascular system. This work aims at building a mechanistic connection between changes in the BCG signal, changes in the P-V loops and changes in cardiac function. A mechanism-driven model based on cardiovascular physiology has been used as a virtual laboratory to predict how changes in cardiac function will manifest in the BCG waveform. Specifically, model simulations indicate that a decline in LV contractility results in an increase of the relative timing between the ECG and BCG signal and a decrease in BCG amplitude. The predicted changes have subsequently been observed in measurements on three swine serving as pre-clinical models for pre- and post-myocardial infarction conditions. The reproducibility of BCG measurements has been assessed on repeated, consecutive sessions of data acquisitions on three additional swine. Overall, this study provides experimental evidence supporting the utilization of mechanism-driven mathematical modeling as a guide to interpret changes in the BCG signal on the basis of cardiovascular physiology, thereby advancing the BCG technique as an effective method for non-invasive monitoring of cardiac function.
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Affiliation(s)
- Mohamed Zaid
- Electrical Engineering and Computer Science, College of Engineering, University of Missouri, Columbia, MO, United States
| | - Lorenzo Sala
- Centre de Recherche Inria Saclay Île-De-France, Palaiseau, France
| | - Jan R. Ivey
- Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, MO, United States
| | - Darla L. Tharp
- Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, MO, United States
| | - Christina M. Mueller
- Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, MO, United States
| | - Pamela K. Thorne
- Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, MO, United States
| | - Shannon C. Kelly
- Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, MO, United States
| | - Kleiton Augusto Santos Silva
- Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, MO, United States
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Amira R. Amin
- Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, MO, United States
| | | | - Michael S. Kapiloff
- Departments of Ophthalmology and Medicine, Stanford Cardiovascular Institute, Stanford University, Palo Alto, CA, United States
| | - Laurel Despins
- Sinclair School of Nursing, University of Missouri, Columbia, MO, United States
| | - Mihail Popescu
- Health Management and Informatics, School of Medicine, University of Missouri, Columbia, MO, United States
| | - James Keller
- Electrical Engineering and Computer Science, College of Engineering, University of Missouri, Columbia, MO, United States
| | - Marjorie Skubic
- Electrical Engineering and Computer Science, College of Engineering, University of Missouri, Columbia, MO, United States
| | - Salman Ahmad
- Surgery, School of Medicine, University of Missouri, Columbia, MO, United States
| | - Craig A. Emter
- Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, MO, United States
| | - Giovanna Guidoboni
- Electrical Engineering and Computer Science, College of Engineering, University of Missouri, Columbia, MO, United States
- Mathematics, College of Arts and Science, University of Missouri, Columbia, MO, United States
- *Correspondence: Giovanna Guidoboni
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3
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Essentials in the diagnosis of postoperative myocardial lesions similar to or unrelated to rejection in heart transplant. REV ROMANA MED LAB 2021. [DOI: 10.2478/rrlm-2021-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Background, objectives: Histological diagnosis of control biopsies in patients with heart transplant represents a significant step of monitoring, with a great influence on adjusting immunosuppressive treatment. Histological lesions are usually related to ischemia and reperfusion, with varying degrees of intensity. This study aimed to highlight the most important aspects of the histological diagnosis and differential diagnosis of postoperative myocardial lesions associated or unrelated to rejection in heart transplant.
Materials and Methods: This retrospective study involved 53 patients who received cardiac transplant between 2000 and 2017. Patients were monitored by lesion quantification of endomyocardial biopsies, with diagnoses established based on biopsy material in the early, medium and late post-transplant periods. Hematoxylin eosin, Masson’s trichrome, and Van Gieson stains were used; immunohistochemical determinations used CD4, CD20, CD45, CD68, HLA-DR, VEGF and CD31.
Results: Ischemia and reperfusion lesions were diagnosed on all biopsies in the first 6 weeks post-transplant. Nine cases of the Quilty effect were identified, and in 12 cases, the biopsies were performed on the same spot as previous biopsies. A significant number of transplanted patients presented cytomegalovirus that was difficult to diagnose on endomyocardial biopsies.
Conclusions: The detailed study of ischemia and reperfusion lesions, as well as of changes un-related to rejection becomes a major objective in the short, medium and late post-transplant period. Overdiagnosis of rejection induces changes of the immunosuppressive therapeutic protocol, with alarming repercussions on cytomegalovirus reactivation, and risks of potentiating inflammation, myocyte destruction and the recurrence of disorders related to both inducing and aggravating heart failure.
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4
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Bobi J, Garabito M, Solanes NÚ, Cidad P, Ramos-Pérez V, Ponce A, Rigol M, Freixa X, Pérez-Martínez C, Pérez de Prado A, Fernández-Vázquez F, Sabaté M, Borrós S, López-López JR, Pérez-García MT, Roqué M. Kv1.3 blockade inhibits proliferation of vascular smooth muscle cells in vitro and intimal hyperplasia in vivo. Transl Res 2020; 224:40-54. [PMID: 32522668 DOI: 10.1016/j.trsl.2020.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 11/16/2022]
Abstract
The modulation of voltage-gated K+ (Kv) channels, involved in cell proliferation, arises as a potential therapeutic approach for the prevention of intimal hyperplasia present in in-stent restenosis (ISR) and allograft vasculopathy (AV). We studied the effect of PAP-1, a selective blocker of Kv1.3 channels, on development of intimal hyperplasia in vitro and in vivo in 2 porcine models of vascular injury. In vitro phenotypic modulation of VSMCs was associated to an increased functional expression of Kv1.3 channels, and only selective Kv1.3 channel blockers were able to inhibit porcine VSMC proliferation. The therapeutic potential of PAP-1 was then evaluated in vivo in swine models of ISR and AV. At 15-days follow-up, morphometric analysis demonstrated a substantial reduction of luminal stenosis in the allografts treated with PAP-1 (autograft 2.72 ± 1.79 vs allograft 10.32 ± 1.92 vs allograft + polymer 13.54 ± 8.59 vs allograft + polymer + PAP-1 3.06 ± 1.08 % of luminal stenosis; P = 0.006) in the swine model of femoral artery transplant. In the pig model of coronary ISR, using a prototype of PAP-1-eluting stent, no differences were observed regarding % of stenosis compared to control stents (31 ± 13 % vs 37 ± 18%, respectively; P = 0.372) at 28-days follow-up. PAP-1 treatment was safe and did not impair vascular healing in terms of delayed endothelialization, inflammation or thrombosis. However, an incomplete release of PAP-1 from stents was documented. We conclude that the use of selective Kv1.3 blockers represents a promising therapeutic approach for the prevention of intimal hyperplasia in AV, although further studies to improve their delivery method are needed to elucidate its potential in ISR.
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Affiliation(s)
- Joaquim Bobi
- Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS) and Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Manel Garabito
- Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS) and Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - NÚria Solanes
- Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS) and Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Pilar Cidad
- Departamento de Bioquímica y Biología Molecular y Fisiología and Instituto de Biología y Genética Molecular (IBGM), Universidad de Valladolid and CSIC, Valladolid, Spain
| | - Víctor Ramos-Pérez
- Grup d'Enginyeria de Materials (GEMAT), Institut Químic de Sarrià (IQS), Universitat Ramon Llull (URL), Barcelona, Spain
| | - Alberto Ponce
- Grup d'Enginyeria de Materials (GEMAT), Institut Químic de Sarrià (IQS), Universitat Ramon Llull (URL), Barcelona, Spain
| | - Montserrat Rigol
- Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS) and Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Xavier Freixa
- Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS) and Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Claudia Pérez-Martínez
- Grupo Cardiovascular (HemoLeon), Fundación Investigación Sanitaria en León y del Instituto de Biomedicina (IBIOMED), Universidad de León, Hospital Universitario de León, León, Spain
| | - Armando Pérez de Prado
- Grupo Cardiovascular (HemoLeon), Fundación Investigación Sanitaria en León y del Instituto de Biomedicina (IBIOMED), Universidad de León, Hospital Universitario de León, León, Spain
| | - Felipe Fernández-Vázquez
- Grupo Cardiovascular (HemoLeon), Fundación Investigación Sanitaria en León y del Instituto de Biomedicina (IBIOMED), Universidad de León, Hospital Universitario de León, León, Spain
| | - Manel Sabaté
- Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS) and Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Salvador Borrós
- Grup d'Enginyeria de Materials (GEMAT), Institut Químic de Sarrià (IQS), Universitat Ramon Llull (URL), Barcelona, Spain; CIBER of Biomaterials Bioengineering and Nanomedicine (CIBER-BBN), Barcelona, Spain
| | - José Ramón López-López
- Departamento de Bioquímica y Biología Molecular y Fisiología and Instituto de Biología y Genética Molecular (IBGM), Universidad de Valladolid and CSIC, Valladolid, Spain
| | - Mª Teresa Pérez-García
- Departamento de Bioquímica y Biología Molecular y Fisiología and Instituto de Biología y Genética Molecular (IBGM), Universidad de Valladolid and CSIC, Valladolid, Spain
| | - MercÈ Roqué
- Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS) and Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
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Willuweit K, Heinold A, Rashidi-Alavijeh J, Heinemann FM, Horn PA, Paul A, Gerken G, Herzer K. Immunosuppression with mTOR inhibitors prevents the development of donor-specific antibodies after liver transplant. Clin Transplant 2017; 31. [DOI: 10.1111/ctr.12974] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2017] [Indexed: 01/17/2023]
Affiliation(s)
- Katharina Willuweit
- Department of Gastroenterology and Hepatology; University Hospital Essen; University of Duisburg-Essen; Duisburg Germany
- Department of General, Visceral and Transplantation Surgery; University Hospital Essen; University of Duisburg-Essen; Duisburg Germany
| | - Andreas Heinold
- Institute for Transfusion Medicine; University Hospital Essen; University of Duisburg-Essen; Duisburg Germany
| | - Jassin Rashidi-Alavijeh
- Department of Gastroenterology and Hepatology; University Hospital Essen; University of Duisburg-Essen; Duisburg Germany
- Department of General, Visceral and Transplantation Surgery; University Hospital Essen; University of Duisburg-Essen; Duisburg Germany
| | - Falko M. Heinemann
- Institute for Transfusion Medicine; University Hospital Essen; University of Duisburg-Essen; Duisburg Germany
| | - Peter A. Horn
- Institute for Transfusion Medicine; University Hospital Essen; University of Duisburg-Essen; Duisburg Germany
| | - Andreas Paul
- Department of General, Visceral and Transplantation Surgery; University Hospital Essen; University of Duisburg-Essen; Duisburg Germany
| | - Guido Gerken
- Department of Gastroenterology and Hepatology; University Hospital Essen; University of Duisburg-Essen; Duisburg Germany
| | - Kerstin Herzer
- Department of Gastroenterology and Hepatology; University Hospital Essen; University of Duisburg-Essen; Duisburg Germany
- Department of General, Visceral and Transplantation Surgery; University Hospital Essen; University of Duisburg-Essen; Duisburg Germany
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The Influence of Immunosuppressive Agents on the Risk of De Novo Donor-Specific HLA Antibody Production in Solid Organ Transplant Recipients. Transplantation 2016; 100:39-53. [PMID: 26680372 PMCID: PMC4683034 DOI: 10.1097/tp.0000000000000869] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Production of de novo donor-specific antibodies (dnDSA) is a major risk factor for acute and chronic antibody-mediated rejection and graft loss after all solid organ transplantation. In this article, we review the data available on the risk of individual immunosuppressive agents and their ability to prevent dnDSA production. Induction therapy with rabbit antithymocyte globulin may achieve a short-term decrease in dnDSA production in moderately sensitized patients. Rituximab induction may be beneficial in sensitized patients, and in abrogating rebound antibody response in patients undergoing desensitization or treatment for antibody-mediated rejection. Use of bortezomib for induction therapy in at-risk patients is of interest, but the benefits are unproven. In maintenance regimens, nonadherent and previously sensitized patients are not suitable for aggressive weaning protocols, particularly early calcineurin inhibitor withdrawal without lymphocyte-depleting induction. Early conversion to mammalian target of rapamycin inhibitor monotherapy has been reported to increase the risk of dnDSA formation, but a combination of mammalian target of rapamycin inhibitor and reduced-exposure calcineurin inhibitor does not appear to alter the risk. Early steroid therapy withdrawal in standard-risk patients after induction has no known dnDSA penalty. The available data do not demonstrate a consistent effect of mycophenolic acid on dnDSA production. Risk minimization for dnDSA requires monitoring of adherence, appropriate risk stratification, risk-based immunosuppression intensity, and prospective DSA surveillance.
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7
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Witzke O, Sommerer C, Arns W. Everolimus immunosuppression in kidney transplantation: What is the optimal strategy? Transplant Rev (Orlando) 2016; 30:3-12. [DOI: 10.1016/j.trre.2015.09.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 08/31/2015] [Accepted: 09/01/2015] [Indexed: 12/19/2022]
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Hiemstra JA, Gutiérrez-Aguilar M, Marshall KD, McCommis KS, Zgoda PJ, Cruz-Rivera N, Jenkins NT, Krenz M, Domeier TL, Baines CP, Emter CA. A new twist on an old idea part 2: cyclosporine preserves normal mitochondrial but not cardiomyocyte function in mini-swine with compensated heart failure. Physiol Rep 2014; 2:2/6/e12050. [PMID: 24963034 PMCID: PMC4208639 DOI: 10.14814/phy2.12050] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
We recently developed a clinically relevant mini‐swine model of heart failure with preserved ejection fraction (HFpEF), in which diastolic dysfunction was associated with increased mitochondrial permeability transition (MPT). Early diastolic function is ATP and Ca2+‐dependent, thus, we hypothesized chronic low doses of cyclosporine (CsA) would preserve mitochondrial function via inhibition of MPT and subsequently maintain normal cardiomyocyte Ca2+ handling and contractile characteristics. Left ventricular cardiomyocytes were isolated from aortic‐banded Yucatan mini‐swine divided into three groups; control nonbanded (CON), HFpEF nontreated (HF), and HFpEF treated with CsA (HF‐CsA). CsA mitigated the deterioration of mitochondrial function observed in HF animals, including functional uncoupling of Complex I‐dependent mitochondrial respiration and increased susceptibility to MPT. Attenuation of mitochondrial dysfunction in the HF‐CsA group was not associated with commensurate improvement in cardiomyocyte Ca2+ handling or contractility. Ca2+ transient amplitude was reduced and transient time to peak and recovery (tau) prolonged in HF and HF‐CsA groups compared to CON. Alterations in Ca2+ transient parameters observed in the HF and HF‐CsA groups were associated with decreased cardiomyocyte shortening and shortening rate. Cellular function was consistent with impaired in vivo systolic and diastolic whole heart function. A significant systemic hypertensive response to CsA was observed in HF‐CsA animals, and may have played a role in the accelerated the development of heart failure at both the whole heart and cellular levels. Given the significant detriment to cardiac function observed in response to CsA, our findings suggest chronic CsA treatment is not a viable therapeutic option for HFpEF. In a recently developed a translational mini‐swine model of heart failure with preserved ejection fraction (HFpEF), we hypothesized inhibiting mitochondrial permeability transition using cyclosporine (CsA) would improve cardiomyocyte function and calcium handling by supporting mitochondrial function. The purpose of this study was to examine the impact of inhibiting cyclophilin D on mitochondrial function and subsequent cardiomyocyte calcium handling using a reduced, nonimmunosuppressive dose of CsA chronically. We found improved mitochondrial function following chronic CsA treatment was not associated with a parallel improvement in cardiomyocyte calcium handling and contractile function, and demonstrate for the first time impaired cardiomyocyte calcium handling and contractile function are present early in the disease process in our HFpEF model.
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Affiliation(s)
- Jessica A Hiemstra
- Department of Biomedical Science, University of Missouri- Columbia, 1600 E. RollinsW160 Veterinary Medicine, Columbia, Missouri
| | - Manuel Gutiérrez-Aguilar
- Department of Biomedical Science, University of Missouri- Columbia, 1600 E. RollinsW160 Veterinary Medicine, Columbia, Missouri Dalton Cardiovascular Research Center, University of Missouri- Columbia, 1600 E. RollinsW160 Veterinary Medicine, Columbia, Missouri
| | - Kurt D Marshall
- Department of Biomedical Science, University of Missouri- Columbia, 1600 E. RollinsW160 Veterinary Medicine, Columbia, Missouri Dalton Cardiovascular Research Center, University of Missouri- Columbia, 1600 E. RollinsW160 Veterinary Medicine, Columbia, Missouri
| | - Kyle S McCommis
- Department of Biomedical Science, University of Missouri- Columbia, 1600 E. RollinsW160 Veterinary Medicine, Columbia, Missouri Dalton Cardiovascular Research Center, University of Missouri- Columbia, 1600 E. RollinsW160 Veterinary Medicine, Columbia, Missouri
| | - Pamela J Zgoda
- Department of Biomedical Science, University of Missouri- Columbia, 1600 E. RollinsW160 Veterinary Medicine, Columbia, Missouri
| | - Noelany Cruz-Rivera
- Department of Biomedical Science, University of Missouri- Columbia, 1600 E. RollinsW160 Veterinary Medicine, Columbia, Missouri
| | - Nathan T Jenkins
- Department of Kinesiology, University of Georgia, Athens, Georgia
| | - Maike Krenz
- Dalton Cardiovascular Research Center, University of Missouri- Columbia, 1600 E. RollinsW160 Veterinary Medicine, Columbia, Missouri Department of Medical Pharmacology and Physiology, University of Missouri- Columbia, 1600 E. RollinsW160 Veterinary Medicine, Columbia, Missouri
| | - Timothy L Domeier
- Department of Medical Pharmacology and Physiology, University of Missouri- Columbia, 1600 E. RollinsW160 Veterinary Medicine, Columbia, Missouri
| | - Christopher P Baines
- Department of Biomedical Science, University of Missouri- Columbia, 1600 E. RollinsW160 Veterinary Medicine, Columbia, Missouri Dalton Cardiovascular Research Center, University of Missouri- Columbia, 1600 E. RollinsW160 Veterinary Medicine, Columbia, Missouri
| | - Craig A Emter
- Department of Biomedical Science, University of Missouri- Columbia, 1600 E. RollinsW160 Veterinary Medicine, Columbia, Missouri
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Rigol M, Solanes N, Roura S, Roqué M, Novensà L, Dantas AP, Martorell J, Sitges M, Ramírez J, Bayés-Genís A, Heras M. Allogeneic adipose stem cell therapy in acute myocardial infarction. Eur J Clin Invest 2014; 44:83-92. [PMID: 24350923 DOI: 10.1111/eci.12195] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Accepted: 10/28/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND Stem cell therapy offers a promising approach to reduce the long-term mortality rate associated with heart failure after acute myocardial infarction (AMI). To date, in vivo translational studies have not yet fully studied the immune response to allogeneic adipose tissue-derived mesenchymal stem cells (ATMSCs). We analysed the immune response and the histological and functional effects of allogeneic ATMSCs in a porcine model of reperfused AMI and determine the effect of administration timing. DESIGN Pigs that survived AMI (24/26) received intracoronary administration of culture medium after reperfusion (n = 6), ATMSCs after reperfusion (n = 6), culture medium 7 days after AMI (n = 6) or ATMSCs 7 days after AMI (n = 6). At 3-week follow-up, cardiac function, alloantibodies and histological analysis were evaluated. RESULTS Administration of ATMSCs after reperfusion and 7 days after AMI resulted in similar rates of cell engraftment; some of those cells expressed endothelial, smooth muscle and cardiomyogenic cell lineage markers. Delivery of ATMSCs after reperfusion compared with that performed at 7 days was more effective in increasing: vascular density (249 ± 64 vs. 161 ± 37 vessels/mm2; P < 0.01), T lymphocytes (1 ± 0.4 vs. 0.4 ± 0.3% of area CD3(+) ; P < 0.05) and expression of vascular endothelial growth factor (VEGF; 32 ± 7% vs. 20 ± 4% of area VEGF(+) ; P < 0.01). Allogeneic ATMSC-based therapy did not change ejection fraction but generated alloantibodies. CONCLUSIONS The present study is the first to demonstrate that allogeneic ATMSCs elicit an immune response and, when administered immediately after reperfusion, are more effective in increasing VEGF expression and neovascularization.
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Affiliation(s)
- Montserrat Rigol
- Department of Cardiology, Institut del Tòrax, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
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10
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Hiemstra JA, Liu S, Ahlman MA, Schuleri KH, Lardo AC, Baines CP, Dellsperger KC, Bluemke DA, Emter CA. A new twist on an old idea: a two-dimensional speckle tracking assessment of cyclosporine as a therapeutic alternative for heart failure with preserved ejection fraction. Physiol Rep 2013; 1:e00174. [PMID: 24744855 PMCID: PMC3970750 DOI: 10.1002/phy2.174] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 11/01/2013] [Accepted: 11/04/2013] [Indexed: 01/12/2023] Open
Abstract
We recently reported that mitochondrial dysfunction, characterized by increased mitochondrial permeability transition (MPT), was present in a translational swine model of heart failure with preserved ejection fraction (HFpEF). Cyclophilin D is a key component of the MPT pore, therefore, the purpose of this study was to test the efficacy of a novel cyclosporine (CsA) dosing scheme as a therapeutic alternative for HFpEF. Computed tomography (CT), two‐dimensional speckle tracking two‐dimensional speckle tracking (2DST), and invasive hemodynamics were used to evaluate cardiac function. CT imaging showed 14 weeks of CsA treatment caused eccentric myocardial remodeling (contrasting concentric remodeling in untreated HF animals) and elevated systemic pressures. 2DST detected left ventricular (LV) mechanics associated with systolic and diastolic dysfunction prior to the onset of significantly increased LV end diastolic pressure including: (1) decreased systolic apical rotation rate, longitudinal displacement, and longitudinal/radial/circumferential strain; (2) decreased early diastolic untwisting and longitudinal strain rate; and (3) increased late diastolic radial/circumferential mitral strain rate. LV mechanics associated with systolic and diastolic impairment was enhanced to a greater extent than seen in untreated HF animals following CsA treatment. In conclusion, CsA treatment accelerated the development of heart failure, including dilatory LV remodeling and impaired systolic and diastolic mechanics. Although our findings do not support CsA as a viable therapy for HFpEF, 2DST was effective in differentiating between progressive gradations of developing HF and detecting diastolic impairment prior to the development of overt diastolic dysfunction. We recently reported that mitochondrial dysfunction, characterized by increased mitochondrial permeability transition (MPT), was present in a translational swine model of heart failure with preserved ejection fraction (HFpEF). Cyclophilin D is a key component of the MPT pore, therefore, the purpose of this study was to test the efficacy of a novel cyclosporine (CsA) dosing scheme as a therapeutic alternative for HFpEF. CsA treatment accelerated the development of heart failure, including dilatory LV remodeling and impaired systolic and diastolic mechanics. Although our findings do not support CsA as a viable therapy for HFpEF, 2DST was effective in differentiating between progressive gradations of developing HF and detecting diastolic impairment prior to the development of overt diastolic dysfunction.
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Affiliation(s)
- Jessica A Hiemstra
- Department of Biomedical Science, University of Missouri- Columbia, Columbia, Missouri
| | - Songtao Liu
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Maryland ; Molecular Biomedical Imaging Laboratory, National Institute of Biomedical Imaging and Bioengineering, Bethesda, Maryland
| | - Mark A Ahlman
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Maryland ; Molecular Biomedical Imaging Laboratory, National Institute of Biomedical Imaging and Bioengineering, Bethesda, Maryland
| | - Karl H Schuleri
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Albert C Lardo
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Christopher P Baines
- Department of Biomedical Science, University of Missouri- Columbia, Columbia, Missouri ; Dalton Cardiovascular Research Center, University of Missouri- Columbia, Columbia, Missouri
| | - Kevin C Dellsperger
- Department of Medical Pharmacology and Physiology, University of Missouri- Columbia, Columbia, Missouri ; Department of Internal Medicine, University of Missouri- Columbia, Columbia, Missouri ; Center for Health Care Quality, University of Missouri- Columbia, 1600 E. RollinsW160 Veterinary Medicine, Columbia, 65211, Missouri
| | - David A Bluemke
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Maryland ; Molecular Biomedical Imaging Laboratory, National Institute of Biomedical Imaging and Bioengineering, Bethesda, Maryland
| | - Craig A Emter
- Department of Biomedical Science, University of Missouri- Columbia, Columbia, Missouri
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11
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Ryosaka M, Omoto K, Nozaki T, Yoshida K, Sawada Y, Hirano H, Shimizu T, Ishida H, Tanabe K. Successful Kidney Transplantation for End-Stage Renal Disease in Marfan's Syndrome. Case Rep Transplant 2013; 2013:809613. [PMID: 24093072 PMCID: PMC3777197 DOI: 10.1155/2013/809613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 08/05/2013] [Indexed: 11/18/2022] Open
Abstract
Marfan's syndrome is a systemic disorder of the connective tissue caused by mutations in the extracellular matrix protein fibrillin-1, with aortic dissection and aneurysm being its most life-threatening manifestations. Kidney transplantation for end-stage renal disease (ESRD) in patients with Marfan's syndrome has not been reported in the literature, and the rate of the incidence of dissection or aneurysm in the iliac artery is unknown. Here, we present a patient with Marfan's syndrome with ESRD due to severe renal ischemia caused by massive bleeding from thoracoabdominal aortic dissection leading to transplant surgery of a living kidney procured from the patient's mother. After kidney transplantation, the renal function normalized without vascular complications, and stable graft function along with negative results for both microhematuria and proteinuria continued for two years. Also, vascular complication such as aneurysm or dissection of the iliac artery was not observed using ultrasonography during the follow-up period. ESRD patients with Marfan's syndrome might be suitable for kidney transplantation, but long-term and careful observations are needed.
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Affiliation(s)
- Makoto Ryosaka
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Kazuya Omoto
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Taiji Nozaki
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Kazuhiko Yoshida
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Yugo Sawada
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Hajime Hirano
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Tomokazu Shimizu
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Hideki Ishida
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
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12
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Rigol M, Solanes N, Fernandez-Armenta J, Silva E, Doltra A, Duchateau N, Barcelo A, Gabrielli L, Bijnens B, Berruezo A, Brugada J, Sitges M. Development of a Swine Model of Left Bundle Branch Block for Experimental Studies of Cardiac Resynchronization Therapy. J Cardiovasc Transl Res 2013; 6:616-22. [DOI: 10.1007/s12265-013-9464-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 04/10/2013] [Indexed: 10/26/2022]
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13
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Giraud F, Marchand P, Carbonnelle D, Sartor M, Lang F, Duflos M. Synthesis of N-aryl-3-(indol-3-yl)propanamides and their immunosuppressive activities. Bioorg Med Chem Lett 2010; 20:5203-6. [PMID: 20655209 DOI: 10.1016/j.bmcl.2010.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Revised: 06/30/2010] [Accepted: 07/01/2010] [Indexed: 01/26/2023]
Abstract
N-aryl-3-(indol-3-yl)propanamides were synthesized and their immunosuppressive activities were evaluated. This study highlighted the promising potency of 3-[1-(4-chlorobenzyl)-1H-indol-3-yl]-N-(4-nitrophenyl)propanamide 15 which exhibited a significant inhibitory activity on murine splenocytes proliferation assay in vitro and on mice delayed-type hypersensitivity (DTH) assay in vivo.
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Affiliation(s)
- Francis Giraud
- Université de Nantes, Nantes Atlantique Universités, Laboratoire de Chimie Thérapeutique, Cibles et Médicaments des Infections, de l'Immunité et du Cancer, IICiMed UPRES EA 1155, Faculté de Pharmacie, Nantes, France
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14
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Rigol M, Solanes N, Farré J, Roura S, Roqué M, Berruezo A, Bellera N, Novensà L, Tamborero D, Prat-Vidal C, Huzman MAA, Batlle M, Hoefsloot M, Sitges M, Ramírez J, Dantas AP, Merino A, Sanz G, Brugada J, Bayés-Genís A, Heras M. Effects of adipose tissue-derived stem cell therapy after myocardial infarction: impact of the route of administration. J Card Fail 2010; 16:357-66. [PMID: 20350704 DOI: 10.1016/j.cardfail.2009.12.006] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Revised: 11/26/2009] [Accepted: 12/09/2009] [Indexed: 12/27/2022]
Abstract
BACKGROUND Cell-based therapies offer a promising approach to reducing the short-term mortality rate associated with heart failure after a myocardial infarction. The aim of the study was to analyze histological and functional effects of adipose tissue-derived stem cells (ADSCs) after myocardial infarction and compare 2 types of administration pathways. METHODS AND RESULTS ADSCs from 28 pigs were labeled by transfection. Animals that survived myocardial infarction (n = 19) received: intracoronary culture media (n = 4); intracoronary ADSCs (n = 5); transendocardial culture media (n = 4); or transendocardial ADSCs (n = 6). At 3 weeks' follow-up, intracoronary and transendocardial administration of ADSCs resulted in similar rates of engrafted cells (0.85 [0.19-1.97] versus 2 [1-2] labeled cells/cm(2), respectively; P = NS) and some of those cells expressed smooth muscle cell markers. The intracoronary administration of ADSCs was more effective in increasing the number of small vessels than transendocardial administration (223 +/- 40 versus 168 +/- 35 vessels/mm(2); P < .05). Ejection fraction was not modified by stem cell therapy. CONCLUSIONS This is the first study to compare intracoronary and transendocardial administration of autologous ADSCs in a porcine model of myocardial infarction. Both pathways of ADSCs delivery are feasible, producing a similar number of engrafted and differentiated cells, although intracoronary administration was more effective in increasing neovascularization.
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Affiliation(s)
- Montserrat Rigol
- Institut Clínic del Tòrax, Institut d'Investigacions Biomèdiques Agustí Pi Sunyer, Hospital Clínic, Barcelona, Spain.
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15
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Raichlin E, Edwards BS, Kremers WK, Clavell AL, Rodeheffer RJ, Frantz RP, Pereira NL, Daly RC, McGregor CG, Lerman A, Kushwaha SS. Acute cellular rejection and the subsequent development of allograft vasculopathy after cardiac transplantation. J Heart Lung Transplant 2009; 28:320-7. [PMID: 19332257 DOI: 10.1016/j.healun.2009.01.006] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Revised: 09/15/2008] [Accepted: 01/14/2009] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Cardiac allograft vasculopathy (CAV) is primarily immune-mediated. We investigated the role of cellular rejection in CAV development. METHODS The study comprised 252 cardiac transplant recipients (mean age, 49.02 +/- 17.05 years; mean follow-up, 7.61 +/- 4.49 years). Total rejection score (TRS) based on the 2004 International Society of Heart and Lung Transplantation R grading system (0R = 0, 1R = 1, 2R = 2, 3R = 3) and any rejection score (ARS; calculated as 0R = 0, 1R = 1, 2R = 1; 3R = 1, or the number of rejections of any grade) were normalized for the total number of biopsy specimens. CAV was defined as coronary stenosis of 40% or more and/or distal pruning of secondary side branches. Thirty-two patients had undergone 3-dimensional intravascular ultrasound (IVUS) at baseline and with virtual histology (VH) IVUS at 24 months. RESULTS In univariate analysis, 6-month TRS (hazard ratio [HR], 1.9; 95% confidence interval [CI], 0.99-3.90, p = 0.05) and ARS (HR, 2.22; 95% CI, 1.01-4.95; p = 0.047) were associated with increased risk of CAV. In multivariate analysis, 6-month TRS (HR, 2.84; 95% CI, 1.44-6.91, p = 0.02) was significantly associated with increased risk of CAV onset. The 12- and 24-month rejection scores were not risk factors for the onset of CAV. By Kaplan-Meier analysis, 6-month TRS exceeding 0.3 was associated with a significantly shorter time to CAV onset (p = 0.018). There was direct correlation (r = 0.44, p = 0.012) between TRS at 6 months and the percentage of necrotic core demonstrated by VH-IVUS at 24 months. CONCLUSION Recurrent cellular rejection has a cumulative effect on the onset of CAV. The mechanism may be due to increased inflammation resulting in increased plaque burden suggesting a relationship between the immune basis of cellular rejection and CAV.
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Affiliation(s)
- Eugenia Raichlin
- William J. von Liebig Transplant Center, Mayo Clinic, Rochester, Minnesota 55905, USA
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16
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Lladó L, Fabregat J, Castellote J, Ramos E, Torras J, Serrano T, Figueras J, Rafecas A. Sirolimus-based rescue therapy after rejection in liver transplantation. Clin Transplant 2009; 23:89-95. [PMID: 19200220 DOI: 10.1111/j.1399-0012.2008.00906.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Steroid-resistant acute rejection (SR-AR) and ductopenic rejection (DR) after liver transplantation are infrequent, but difficult to manage. We performed a retrospective review of patients with SR-AR or DR treated with sirolimus-based therapy. Since 2002, we have treated five patients with SR-AR and eight patients with DR. All patients had associated renal insufficiency. Six patients showed no response, of whom five died and one was retransplanted. In six cases, rejection was resolved after changing, while one improved. Therefore, the total response rate was 54%. Ten of 13 patients (77%) suffered some type of adverse event. Ten of these (77%) suffered a hematologic event. Four patients (31%) had infection. Only two patients had to discontinue treatment. Univariate analysis showed that pre-conversion bilirubin was lower in responders (Bilirubin: R: 210 +/- 205 vs. NoR: 554 +/- 159 micromol/L; p = 0.07 and Creatinine clearance higher: R: 37 +/- 11 vs. NoR: 25 +/- 11 mL/min; p = 0.09). Sirolimus trough levels one month after switching were higher in responders (R: 11 +/- 1.8 vs. NoR: 7.5 +/- 3.3 ng/mL; p = 0.03). We conclude that a dual therapy regimen of tacrolimus and sirolimus can achieve a high response rate as a rescue therapy for SR-AR and DR, provided it is begun as soon as possible.
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Affiliation(s)
- Laura Lladó
- Department of Surgery, Liver Transplant Unit Hospital, Universitari de Bellvitge, Barcelona, Spain.
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17
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Fischer R, Turnquist HR, Taner T, Thomson AW. Use of rapamycin in the induction of tolerogenic dendritic cells. Handb Exp Pharmacol 2009:215-32. [PMID: 19031028 DOI: 10.1007/978-3-540-71029-5_10] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Rapamycin (RAPA), a macrocyclic triene antibiotic pro-drug, is a clinically-utilized 'tolerance-sparing' immunosuppressant that inhibits the activity of T, B, and NK cells. Furthermore, maturation-resistance and tolerogenic properties of dendritic cells (DC) can be supported and preserved by conditioning with RAPA. Propagation of murine bone marrow (BM)-derived myeloid DC (mDC) in clinically relevant concentrations of RAPA (RAPA-DC) generates phenotypically immature DC with low levels of MHC and significantly reduced co-stimulatory molecules (especially CD86), even when exposed to inflammatory stimuli. RAPA-DC are weak stimulators of T cells and induce hyporesponsiveness and apoptosis in allo-reactive T cells. An interesting observation has been that RAPA-DC retain the ability to stimulate and enrich the regulatory T cells (Treg). Presumably as a result of these properties, alloantigen (alloAg)-pulsed recipient-derived DC are effective in subverting anti-allograft immune responses in rodent transplant models, making them an attractive subject for further investigation of their tolerance-promoting potential.
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Affiliation(s)
- Ryan Fischer
- Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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18
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Chapter 18: Enhancement of nerve regeneration and recovery by immunosuppressive agents. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2009; 87:347-62. [PMID: 19682647 DOI: 10.1016/s0074-7742(09)87018-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Clinically, little can be done to induce restoration of good to excellent neurological function following nervous system trauma, and time is required before an effective technique is developed and applied clinically. However, there are novel techniques that have not been tested experimentally or clinically that may induce significantly faster, reliable, and extensive neurological recovery following nervous system trauma than is presently possible, even for techniques currently being tested on animal models. To repair peripheral nerves following trauma in which a length of the nerve pathway is destroyed, many clinicians consider autologous sensory nerve grafts to be the "gold standard" for inducing neurological recovery. However, this technique has severe limitations, such as being effective only across gaps less than 2 cm, for repairs performed less than 2 months posttrauma, and in young patients. As a consequence, many patients suffer permanent neurological deficits or recover only limited neurological function, and they frequently develop irreversible neuropathic pain. This review examines the clinical role that immunosuppressants might play, in the presence or absence of autologous, allografts, or xenografts, in increasing the rate, success, and extent of neurological recovery following nervous system trauma.
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