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Vela M, Stringa P, González-Navarro P, Machuca M, Pascual-Miguel B, Mestre C, Arreola NM, Papa-Gobbi R, Navarro-Zapata A, Pires-Lobo SC, Andrés AM, Hernández-Oliveros F, Pérez-Martínez A. Donor's graft ex vivo T-cell depletion with fludarabine reduces graft-versus-host disease signs and improves survival after intestinal transplantation - an experimental study. Transpl Int 2020; 33:1302-1311. [PMID: 32526809 DOI: 10.1111/tri.13672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/31/2020] [Accepted: 06/05/2020] [Indexed: 11/26/2022]
Abstract
Intestinal passenger T leukocytes are responsible for graft-versus-host disease (GvHD) in intestinal transplantation (ITx). We hypothesized that ex vivo fludarabine treatment of the bowel graft would diminish the risk of GvHD and improve overall survival post-transplant. We performed isolated heterotopic small bowel transplantations from Lewis (LEW) to Brown Norway (BN) rat strains, which generated GvHD signs from the fourth day post-transplant. These symptoms included rash, weight loss, piloerection, and diarrhea. The grafts of one of the experimental groups were immersed and sealed in cold Celsior preservation solution with 1000 µm fludarabine for 1 h, prior to its implantation into recipient animals. No histological signs of intestinal tissue alterations were observed after fludarabine treatment. Fludarabine-treated bowel recipients showed significantly later and milder clinical signs of GvHD and reduced total donor cell chimerism, as determined by flow cytometry using strain-specific anti-HLA antibodies. Additionally, fludarabine treatment prolonged recipients' overall survival (13.5 days ± 0.3 days vs. 9.2 days ± 0.5). We conclude that active modification of the intestinal leukocyte composition is advantageous in our ITx animal model. Immunosuppression with fludarabine during the surgical procedure, which could be translated directly to the clinic, protects bowel recipients from GvHD and improves overall post-transplant survival.
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Affiliation(s)
- Maria Vela
- Translational Research in Paediatric Oncology, Hematopoietic Transplantation & Cell Therapy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Pablo Stringa
- Institute for Immunological and Physiopathological Studies (IIFP-CONICET-UNLP), National University of La Plata, Buenos Aires, Argentine
| | - Pablo González-Navarro
- Translational Research in Paediatric Oncology, Hematopoietic Transplantation & Cell Therapy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Mariana Machuca
- Veterinary Pathology Laboratory, Veterinary Sciences Department, National University of La Plata, Buenos Aires, Argentine
| | - Bárbara Pascual-Miguel
- Translational Research in Paediatric Oncology, Hematopoietic Transplantation & Cell Therapy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Carmen Mestre
- Translational Research in Paediatric Oncology, Hematopoietic Transplantation & Cell Therapy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Nidia M Arreola
- Transplant Group - Experimental Surgery, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Rodrigo Papa-Gobbi
- Transplant Group - Experimental Surgery, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Alfonso Navarro-Zapata
- Translational Research in Paediatric Oncology, Hematopoietic Transplantation & Cell Therapy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Sara C Pires-Lobo
- Transplant Group - Experimental Surgery, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,Paediatric Surgery Department, La Paz University Hospital, Madrid, Spain
| | - Ane M Andrés
- Transplant Group - Experimental Surgery, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,Paediatric Surgery Department, La Paz University Hospital, Madrid, Spain
| | - Francisco Hernández-Oliveros
- Transplant Group - Experimental Surgery, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,Paediatric Surgery Department, La Paz University Hospital, Madrid, Spain
| | - Antonio Pérez-Martínez
- Translational Research in Paediatric Oncology, Hematopoietic Transplantation & Cell Therapy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,Paediatric Hemato-Oncology Department, La Paz University Hospital, Madrid, Spain
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Gut Permeability and Glucose Absorption Are Affected at Early Stages of Graft Rejection in a Small Bowel Transplant Rat Model. Transplant Direct 2017; 3:e220. [PMID: 29184909 PMCID: PMC5682765 DOI: 10.1097/txd.0000000000000718] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 06/23/2017] [Indexed: 02/02/2023] Open
Abstract
Supplemental digital content is available in the text. Background Intestinal transplantation (ITx) faces many challenges due to the complexity of surgery and to the multiple immunological reactions that lead to the necessity of rigorous follow-up for early detection of acute cellular rejection (ACR). Our aim was to determine the kinetics of ACR using an experimental ITx model, with emphasis in the characterization of the process using different approaches, including the use of functional assays of absorptive and barrier function. Methods ITx in rats conducting serial sampling was performed. Clinical monitoring, graft histology, proinflammatory gene expression, and nitrosative stress determination were performed. Also, glucose absorption, barrier function using ovalbumin translocation, and contractile function were analyzed. Results The model used reproduced the different stages of ACR. Allogeneic ITx recipients showed signs of rejection from postoperative day (POD) 5, with increasing severity until 12 POD. Histological evaluation showed mild rejection in early sampling and severe rejection at late stages, with alterations in all graft layers. IL-6, CXCL 10, IFNg, and nitrite plasmas levels showed behavior coincident with histopathology. Remarkably, allogeneic grafts showed a marked alteration of glucose absorptive capacity from POD 5 that was sustained until endpoint. Coincidently, barrier function alteration was evidenced by luminal ovalbumin translocation to serum. Contractile function was progressively impaired along ACR. Conclusions Glucose absorption and barrier function are altered at early stages of ACR when histological alterations or gene expression changes were much subtle. This observation may provide simple evaluation tools that could be eventually translated to the clinics to contribute to early ACR diagnosis.
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