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Filz von Reiterdank I, Tawa P, Berkane Y, de Clermont-Tonnerre E, Dinicu AT, Pendexter C, Goutard M, Lellouch AG, Mink van der Molen AB, Coert JH, Cetrulo CL, Uygun K. Sub-zero non-freezing of vascularized composite allografts in a rodent partial hindlimb model. Cryobiology 2024; 116:104950. [PMID: 39134131 PMCID: PMC11404353 DOI: 10.1016/j.cryobiol.2024.104950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 07/09/2024] [Accepted: 08/08/2024] [Indexed: 08/21/2024]
Abstract
Ischemia is a major limiting factor in Vascularized Composite Allotransplantation (VCA) as irreversible muscular injury can occur after as early as 4-6 h of static cold storage (SCS). Organ preservation technologies have led to the development of storage protocols extending rat liver ex vivo preservation up to 4 days. Development of such a protocol for VCAs has the added challenge of inherent ice nucleating factors of the graft, therefore, this study focused on developing a robust protocol for VCA supercooling. Rodent partial hindlimbs underwent subnormothermic machine perfusion (SNMP) with several loading solutions, followed by a storage solution with cryoprotective agents (CPA) developed for VCAs. Storage occurred in suspended animation for 24h and VCAs were recovered using SNMP with modified Steen. This study shows a robust VCA supercooling preservation protocol in a rodent model. Further optimization is expected to allow for its application in a transplantation model, which would be a breakthrough in the field of VCA preservation.
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Affiliation(s)
- I Filz von Reiterdank
- Center for Engineering for Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Shriners Children's Boston, Boston, MA, USA; Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, the Netherlands; Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - P Tawa
- Shriners Children's Boston, Boston, MA, USA; Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Plastic, Reconstructive et Aesthetic Surgery, Hôpital Paris Saint-Joseph, Paris, France
| | - Y Berkane
- Center for Engineering for Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Shriners Children's Boston, Boston, MA, USA; Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Plastic, Reconstructive and Aesthetic Surgery, Hôpital Sud, CHU Rennes, University of Rennes, Rennes, France
| | - E de Clermont-Tonnerre
- Shriners Children's Boston, Boston, MA, USA; Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Plastic, Reconstructive et Aesthetic Surgery, Hôpital Paris Saint-Joseph, Paris, France
| | - A T Dinicu
- Center for Engineering for Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Shriners Children's Boston, Boston, MA, USA
| | - C Pendexter
- Center for Engineering for Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - M Goutard
- Shriners Children's Boston, Boston, MA, USA; Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Plastic, Reconstructive et Aesthetic Surgery, Hôpital Paris Saint-Joseph, Paris, France
| | - A G Lellouch
- Shriners Children's Boston, Boston, MA, USA; Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Innovative Therapies in Haemostasis, INSERM UMR-S 1140, University of Paris, F-75006, Paris, France
| | - A B Mink van der Molen
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J H Coert
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - C L Cetrulo
- Shriners Children's Boston, Boston, MA, USA; Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - K Uygun
- Center for Engineering for Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Shriners Children's Boston, Boston, MA, USA.
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2
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LaSala VR, Cordoves EM, Kalfa DM. Adaptation of cold preservation techniques to partial heart transplant. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00697-4. [PMID: 39173707 DOI: 10.1016/j.jtcvs.2024.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Revised: 08/04/2024] [Accepted: 08/07/2024] [Indexed: 08/24/2024]
Affiliation(s)
- V Reed LaSala
- Division of Cardiac, Thoracic, and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY
| | - Elizabeth M Cordoves
- Division of Cardiac, Thoracic, and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY
| | - David M Kalfa
- Division of Cardiac, Thoracic, and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY.
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3
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Gokaltun A, Asik E, Byrne D, Yarmush ML, Usta OB. Supercooled preservation of cultured primary rat hepatocyte monolayers. Front Bioeng Biotechnol 2024; 12:1429412. [PMID: 39076209 PMCID: PMC11284110 DOI: 10.3389/fbioe.2024.1429412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 06/27/2024] [Indexed: 07/31/2024] Open
Abstract
Supercooled preservation (SCP) is a technology that involves cooling a substance below its freezing point without initiating ice crystal formation. It is a promising alternative to prolong the preservation time of cells, tissues, engineered tissue products, and organs compared to the current practices of hypothermic storage. Two-dimensional (2D) engineered tissues are extensively used in in vitro research for drug screening and development and investigation of disease progression. Despite their widespread application, there is a lack of research on the SCP of 2D-engineered tissues. In this study, we presented the effects of SCP at -2 and -6°C on primary rat hepatocyte (PRH) monolayers for the first time and compared cell viability and functionality with cold storage (CS, + 4°C). We preserved PRH monolayers in two different commercially available solutions: Hypothermosol-FRS (HTS-FRS) and the University of Wisconsin (UW) with and without supplements (i.e., polyethylene glycol (PEG) and 3-O-Methyl-Α-D-Glucopyranose (3-OMG)). Our findings revealed that UW with and without supplements were inadequate for the short-term preservation of PRH monolayers for both SCP and CS with high viability, functionality, and monolayer integrity. The combination of supplements (PEG and 3-OMG) in the HTS-FRS solution outperformed the other groups and yielded the highest viability and functional capacity. Notably, PRH monolayers exhibited superior viability and functionality when stored at -2°C through SCP for up to 3 days compared to CS. Overall, our results demonstrated that SCP is a feasible approach to improving the short-term preservation of PRH monolayers and enables readily available 2D-engineered tissues to advance in vitro research. Furthermore, our findings provide insights into preservation outcomes across various biological levels, from cells to tissues and organs, contributing to the advancement of bioengineering and biotechnology.
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Affiliation(s)
- Aslihan Gokaltun
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Shriners Hospitals for Children, Boston, MA, United States
- Department of Chemical and Biological Engineering, Tufts University, Medford, MA, United States
- Department of Chemical Engineering, Hacettepe University, Ankara, Türkiye
| | - Eda Asik
- Shriners Hospitals for Children, Boston, MA, United States
- Department of Bioengineering, Hacettepe University, Ankara, Türkiye
| | - Delaney Byrne
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Shriners Hospitals for Children, Boston, MA, United States
| | - Martin L. Yarmush
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Shriners Hospitals for Children, Boston, MA, United States
- Department of Biomedical Engineering, Rutgers University, Newark, NJ, United States
| | - O. Berk Usta
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Shriners Hospitals for Children, Boston, MA, United States
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4
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Ozgur OS, Taggart MS, Mojoudi M, Pendexter C, Kharga A, Yeh H, Toner M, Longchamp A, Tessier SN, Uygun K. Optimized Partial Freezing Protocol Enables 10-Day Storage of Rat Livers. RESEARCH SQUARE 2024:rs.3.rs-4584242. [PMID: 39011100 PMCID: PMC11247935 DOI: 10.21203/rs.3.rs-4584242/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
Preserving organs at subzero temperatures with halted metabolic activity holds the potential to prolong preservation and expand the donor organ pool for transplant. Our group recently introduced partial freezing, a novel approach in high-subzero storage at -15°C, enabling 5 days storage of rodent livers through precise control over ice nucleation and unfrozen fraction. However, increased vascular resistance and tissue edema suggested a need for improvements to extend viable preservation. Here, we describe an optimized partial freezing protocol with key optimizations including increased concentration of propylene glycol to reduce ice recrystallization and maintained osmotic balance through an increase in bovine serum albumin, all while minimizing sheer stress during cryoprotectant unloading with an acclimation period. These approaches ensured the viability during preservation and recovery processes, promoting liver function and ensuring optimal preservation. This was evidenced by increased oxygen consumption, decreased vascular resistance and edema. Ultimately, we show that using the optimized protocol, livers can be stored for 10 days with comparable vascular resistance and lactate levels to 5 days, outperforming the viability of time-matched cold stored livers as the current gold standard. This study represents a significant advancement in expanding organ availability through prolonged preservation and thereby revolutionizing transplant medicine.
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Affiliation(s)
| | | | | | | | - Anil Kharga
- Massachusetts General Hospital, Harvard Medical School
| | - Heidi Yeh
- Massachusetts General Hospital, Harvard Medical School
| | - Mehmet Toner
- Massachusetts General Hospital, Harvard Medical School
| | | | | | - Korkut Uygun
- Massachusetts General Hospital, Harvard Medical School
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5
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von Reiterdank IF, Dinicu AT, Cetrulo CL, Coert JH, Mink van der Molen AB, Uygun K. Enhancing Vascularized Composite Allograft Supercooling Preservation: A Multifaceted Approach with CPA Optimization, Thermal Tracking, and Stepwise Loading Techniques. RESEARCH SQUARE 2024:rs.3.rs-4431685. [PMID: 38946999 PMCID: PMC11213217 DOI: 10.21203/rs.3.rs-4431685/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Vascularized composite allografts (VCAs) present unique challenges in transplant medicine, owing to their complex structure and vulnerability to ischemic injury. Innovative preservation techniques are crucial for extending the viability of these grafts, from procurement to transplantation. This study addresses these challenges by integrating cryoprotectant agent (CPA) optimization, advanced thermal tracking, and stepwise CPA loading strategies within an ex vivo rodent model. CPA optimization focused on various combinations, identifying those that effectively suppress ice nucleation while mitigating cytotoxicity. Thermal dynamics were monitored using invasive thermocouples and non-invasive FLIR imaging, yielding detailed temperature profiles crucial for managing warm ischemia time and optimizing cooling rates. The efficacy of stepwise CPA loading versus conventional flush protocols demonstrated that stepwise (un)loading significantly improved arterial resistance and weight change outcomes. In summary, this study presents comprehensive advancements in VCA preservation strategies, combining CPA optimization, precise thermal monitoring, and stepwise loading techniques. These findings hold potential implications for refining transplantation protocols and improving graft viability in VCA transplantation.
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Berkane Y, Filz von Reiterdank I, Tawa P, Charlès L, Goutard M, Dinicu AT, Toner M, Bertheuil N, Mink van der Molen AB, Coert JH, Lellouch AG, Randolph MA, Cetrulo CL, Uygun K. VCA supercooling in a swine partial hindlimb model. Sci Rep 2024; 14:12618. [PMID: 38824189 PMCID: PMC11144209 DOI: 10.1038/s41598-024-63041-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 05/23/2024] [Indexed: 06/03/2024] Open
Abstract
Vascularized composite allotransplantations are complex procedures with substantial functional impact on patients. Extended preservation of VCAs is of major importance in advancing this field. It would result in improved donor-recipient matching as well as the potential for ex vivo manipulation with gene and cell therapies. Moreover, it would make logistically feasible immune tolerance induction protocols through mixed chimerism. Supercooling techniques have shown promising results in multi-day liver preservation. It consists of reaching sub-zero temperatures while preventing ice formation within the graft by using various cryoprotective agents. By drastically decreasing the cell metabolism and need for oxygen and nutrients, supercooling allows extended preservation and recovery with lower ischemia-reperfusion injuries. This study is the first to demonstrate the supercooling of a large animal model of VCA. Porcine hindlimbs underwent 48 h of preservation at - 5 °C followed by recovery and normothermic machine perfusion assessment, with no issues in ice formation and favorable levels of injury markers. Our findings provide valuable preliminary results, suggesting a promising future for extended VCA preservation.
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Affiliation(s)
- Yanis Berkane
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Shriners Children's Boston, Boston, MA, USA
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hôpital Sud, CHU Rennes, University of Rennes, Rennes, France
- SITI Laboratory, UMR INSERM 1236, Rennes University Hospital, Rennes, France
| | - Irina Filz von Reiterdank
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Shriners Children's Boston, Boston, MA, USA
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Center for Engineering for Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, MA, 02114, USA
| | - Pierre Tawa
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Shriners Children's Boston, Boston, MA, USA
| | - Laura Charlès
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Shriners Children's Boston, Boston, MA, USA
| | - Marion Goutard
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Shriners Children's Boston, Boston, MA, USA
- SITI Laboratory, UMR INSERM 1236, Rennes University Hospital, Rennes, France
| | - Antonia T Dinicu
- Shriners Children's Boston, Boston, MA, USA
- Center for Engineering for Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, MA, 02114, USA
| | - Mehmet Toner
- Shriners Children's Boston, Boston, MA, USA
- Center for Engineering for Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, MA, 02114, USA
| | - Nicolas Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hôpital Sud, CHU Rennes, University of Rennes, Rennes, France
- SITI Laboratory, UMR INSERM 1236, Rennes University Hospital, Rennes, France
| | - Aebele B Mink van der Molen
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Henk Coert
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alexandre G Lellouch
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Shriners Children's Boston, Boston, MA, USA
- Innovative Therapies in Haemostasis, INSERM UMR-S 1140, University of Paris, 75006, Paris, France
| | - Mark A Randolph
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Shriners Children's Boston, Boston, MA, USA
| | - Curtis L Cetrulo
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Shriners Children's Boston, Boston, MA, USA
| | - Korkut Uygun
- Shriners Children's Boston, Boston, MA, USA.
- Center for Engineering for Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, MA, 02114, USA.
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Jain R, Ajenu EO, Lopera Higuita M, Hafiz EOA, Muzikansky A, Romfh P, Tessier SN. Real-time monitoring of mitochondrial oxygenation during machine perfusion using resonance Raman spectroscopy predicts organ function. Sci Rep 2024; 14:7328. [PMID: 38538723 PMCID: PMC10973340 DOI: 10.1038/s41598-024-57773-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/21/2024] [Indexed: 04/04/2024] Open
Abstract
Organ transplantation is a life-saving procedure affecting over 100,000 people on the transplant waitlist. Ischemia reperfusion injury (IRI) is a major challenge in the field as it can cause post-transplantation complications and limit the use of organs from extended criteria donors. Machine perfusion technology has the potential to mitigate IRI; however, it currently fails to achieve its full potential due to a lack of highly sensitive and specific assays to assess organ quality during perfusion. We developed a real-time and non-invasive method of assessing organs during perfusion based on mitochondrial function and injury using resonance Raman spectroscopy. It uses a 441 nm laser and a high-resolution spectrometer to quantify the oxidation state of mitochondrial cytochromes during perfusion. This index of mitochondrial oxidation, or 3RMR, was used to understand differences in mitochondrial recovery of cold ischemic rodent livers during machine perfusion at normothermic temperatures with an acellular versus cellular perfusate. Measurement of the mitochondrial oxidation revealed that there was no difference in 3RMR of fresh livers as a function of normothermic perfusion when comparing acellular versus cellular-based perfusates. However, following 24 h of static cold storage, 3RMR returned to baseline faster with a cellular-based perfusate, yet 3RMR progressively increased during perfusion, indicating injury may develop over time. Thus, this study emphasizes the need for further refinement of a reoxygenation strategy during normothermic machine perfusion that considers cold ischemia durations, gradual recovery/rewarming, and risk of hemolysis.
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Affiliation(s)
- Rohil Jain
- Center for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
- Shriners Children's Hospital, Boston, MA, USA
| | - Emmanuella O Ajenu
- Center for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
- Shriners Children's Hospital, Boston, MA, USA
| | - Manuela Lopera Higuita
- Center for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
- Shriners Children's Hospital, Boston, MA, USA
| | - Ehab O A Hafiz
- Department of Electron Microscopy Research, Clinical Laboratory Division, Theodor Bilharz Research Institute, Giza, Egypt
| | - Alona Muzikansky
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | | | - Shannon N Tessier
- Center for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA.
- Shriners Children's Hospital, Boston, MA, USA.
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8
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Șerban A, Năstase G, Beșchea GA, Câmpean ȘI, Fetecău C, Popescu I, Botea F, Neacșu I. Prototype isochoric preservation device for large organs. Front Bioeng Biotechnol 2024; 12:1335638. [PMID: 38524196 PMCID: PMC10959385 DOI: 10.3389/fbioe.2024.1335638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/27/2024] [Indexed: 03/26/2024] Open
Abstract
This paper presents the design and prototype of a constant volume (isochoric) vessel that can be used for the preservation of large organs in a supercooled state. This prototype is a preliminary version of a more advanced design. The device consists of a cooling bath operated by a mechanical vapor compression refrigeration unit and an isochoric chamber made of stainless steel. The preservation of organs using supercooling technology in an isochoric chamber requires a continuous temperature and pressure monitoring. While the device was initially designed for pig liver experiments, its innovative design and preservation capabilities suggest potential applications for preserving other organs as well. The isochoric reactor may be used to accommodate a variety of organ types, opening the door for further research into its multi-organ preservation capabilities. All the design details are presented in this study with the purpose of encouraging researchers in the field to build their own devices, and by this to improve the design. We chose to design the device for isochoric supercooling as the method of preservation to avoid the ice formation.
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Affiliation(s)
| | - Gabriel Năstase
- Department of Building Services, Transilvania University of Brasov, Brasov, Romania
| | | | - Ștefan-Ioan Câmpean
- Department of Building Services, Transilvania University of Brasov, Brasov, Romania
| | - Cătălin Fetecău
- Faculty of Mechanical Engineering, Dunarea de Jos University of Galati, Galati, Romania
| | - Irinel Popescu
- Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Florin Botea
- Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
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9
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von Reiterdank IF, Tawa P, Berkane Y, de Clermont-Tonnerre E, Dinicu A, Pendexter C, Goutard M, Lellouch AG, van der Molen ABM, Coert JH, Cetrulo CL, Uygun K. Sub-Zero Non-Freezing of Vascularized Composite Allografts Preservation in Rodents. RESEARCH SQUARE 2023:rs.3.rs-3750450. [PMID: 38234765 PMCID: PMC10793490 DOI: 10.21203/rs.3.rs-3750450/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Ischemia is a major limiting factor in Vascularized Composite Allotransplantation (VCA) as irreversible muscular injury can occur after as early as 4-6 hours of static cold storage (SCS). Organ preservation technologies have led to the development of storage protocols extending rat liver ex vivo preservation up to 4 days. Development of such a protocol for VCAs has the added challenge of inherent ice nucleating factors of the graft, therefore this study focused on developing a robust protocol for VCA supercooling. Rodent partial hindlimbs underwent subnormothermic machine perfusion (SNMP) with several loading solutions, followed by cryoprotective agent (CPA) cocktail developed for VCAs. Storage occurred in suspended animation for 24h and VCAs were recovered using SNMP with modified Steen. This study shows a robust VCA supercooling preservation protocol in a rodent model. Further optimization is expected to allow for its application in a transplantation model, which would be a breakthrough in the field of VCA preservation.
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Affiliation(s)
- Irina Filz von Reiterdank
- Center for Engineering in Medicine and Surgery, Derpartment of Surgery, Massachusetts General Hospital, Harvard Medical School
| | - Pierre Tawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hôpital Paris Saint-Joseph
| | - Yanis Berkane
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hôpital Sud, CHU Rennes, University of Rennes
| | | | - Antonia Dinicu
- Center for Engineering in Medicine and Surgery, Derpartment of Surgery, Massachusetts General Hospital, Harvard Medical School
| | - Casie Pendexter
- Center for Engineering in Medicine and Surgery, Derpartment of Surgery, Massachusetts General Hospital, Harvard Medical School
| | - Marion Goutard
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hôpital Paris Saint-Joseph
| | - Alexandre G Lellouch
- Innovative Therapies in Haemostasis, INSERM UMR-S 1140, University of Paris, F-75006
| | - Aebele B Mink van der Molen
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht University
| | - J Henk Coert
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht University
| | - Curtis L Cetrulo
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School
| | - Korkut Uygun
- Center for Engineering in Medicine and Surgery, Derpartment of Surgery, Massachusetts General Hospital, Harvard Medical School
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10
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Kim M, Yoon HY. The biomechanical and biological effect of supercooling on cortical bone allograft. J Vet Sci 2023; 24:e79. [PMID: 37904641 PMCID: PMC10694378 DOI: 10.4142/jvs.23183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/04/2023] [Accepted: 09/13/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND The need for a storage method capable of preserving the intrinsic properties of bones without using toxic substances has always been raised. Supercooling is a relatively recently introduced preservation method that meets this need. Supercooling refers to the phenomenon of liquid in which the temperature drops below its freezing point without solidifying or crystallizing. OBJECTIVES The purpose of this study was to identify the preservation efficiency and applicability of the supercooling technique as a cortical bone allograft storage modality. METHODS The biomechanical effects of various storage methods, including deep freezing, cryopreservation, lyophilization, glycerol preservation, and supercooling, were evaluated with the three-point banding test, axial compression test, and electron microscopy. Additionally, cortical bone allografts were applied to the radial bone defect in New Zealand White rabbits to determine the biological effects. The degree of bone union was assessed with postoperative clinical signs, radiography, micro-computed tomography, and biomechanical analysis. RESULTS The biomechanical properties of cortical bone grafts preserved using glycerol and supercooling method were found to be comparable to those of normal bone while also significantly stronger than deep-frozen, cryopreserved, and lyophilized bone grafts. Preclinical research performed in rabbit radial defect models revealed that supercooled and glycerol-preserved bone allografts exhibited significantly better bone union than other groups. CONCLUSIONS Considering the biomechanical and biological superiority, the supercooling technique could be one of the optimal preservation methods for cortical bone allografts. This study will form the basis for a novel application of supercooling as a bone material preservation technique.
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Affiliation(s)
- MuYoung Kim
- Department of Small Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, FL 32611, United States of America
| | - Hun-Young Yoon
- Department of Veterinary Surgery, College of Veterinary Medicine, Konkuk University, Seoul 05029, Korea
- KU Center for Animal Blood Medical Science, Konkuk University, Seoul 05029, Korea.
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11
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Berkane Y, Hayau J, Filz von Reiterdank I, Kharga A, Charlès L, Mink van der Molen AB, Coert JH, Bertheuil N, Randolph MA, Cetrulo CL, Longchamp A, Lellouch AG, Uygun K. Supercooling: A Promising Technique for Prolonged Organ Preservation in Solid Organ Transplantation, and Early Perspectives in Vascularized Composite Allografts. FRONTIERS IN TRANSPLANTATION 2023; 2:1269706. [PMID: 38682043 PMCID: PMC11052586 DOI: 10.3389/frtra.2023.1269706] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 09/29/2023] [Indexed: 05/01/2024]
Abstract
Ex-vivo preservation of transplanted organs is undergoing spectacular advances. Machine perfusion is now used in common practice for abdominal and thoracic organ transportation and preservation, and early results are in favor of substantially improved outcomes. It is based on decreasing ischemia-reperfusion phenomena by providing physiological or sub-physiological conditions until transplantation. Alternatively, supercooling techniques involving static preservation at negative temperatures while avoiding ice formation have shown encouraging results in solid organs. Here, the rationale is to decrease the organ's metabolism and need for oxygen and nutrients, allowing for extended preservation durations. The aim of this work is to review all advances of supercooling in transplantation, browsing the literature for each organ. A specific objective was also to study the initial evidence, the prospects, and potential applications of supercooling preservation in Vascularized Composite Allotransplantation (VCA). This complex entity needs a substantial effort to improve long-term outcomes, marked by chronic rejection. Improving preservation techniques is critical to ensure the favorable evolution of VCAs, and supercooling techniques could greatly participate in these advances.
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Affiliation(s)
- Yanis Berkane
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Shriners Children’s Boston, Harvard Medical School, Boston, MA, United States
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hôpital Sud, CHU Rennes, University of Rennes, Rennes, France
- MOBIDIC, UMR INSERM 1236, Rennes University Hospital, Rennes, France
| | - Justine Hayau
- Division of Plastic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Irina Filz von Reiterdank
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Shriners Children’s Boston, Harvard Medical School, Boston, MA, United States
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, Netherlands
- Center for Engineering for Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Anil Kharga
- Shriners Children’s Boston, Harvard Medical School, Boston, MA, United States
- Center for Engineering for Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Laura Charlès
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Shriners Children’s Boston, Harvard Medical School, Boston, MA, United States
| | - Abele B. Mink van der Molen
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - J. Henk Coert
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Nicolas Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hôpital Sud, CHU Rennes, University of Rennes, Rennes, France
- MOBIDIC, UMR INSERM 1236, Rennes University Hospital, Rennes, France
| | - Mark A. Randolph
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Shriners Children’s Boston, Harvard Medical School, Boston, MA, United States
| | - Curtis L. Cetrulo
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Shriners Children’s Boston, Harvard Medical School, Boston, MA, United States
| | - Alban Longchamp
- Shriners Children’s Boston, Harvard Medical School, Boston, MA, United States
- Center for Engineering for Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Vascular Surgery, Lausanne University Hospital, Lausanne, Switzerland
- Center for Transplant Sciences, Massachusetts General Hospital, Boston, MA, United States
| | - Alexandre G. Lellouch
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Shriners Children’s Boston, Harvard Medical School, Boston, MA, United States
| | - Korkut Uygun
- Shriners Children’s Boston, Harvard Medical School, Boston, MA, United States
- Center for Engineering for Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Center for Transplant Sciences, Massachusetts General Hospital, Boston, MA, United States
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12
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Arav A, Li S, Friedman O, Solodeev I, Aouizerate J, Kedar D, Antonio MD, Natan D, Gur E, Shani N. Long-Term Survival and Functional Recovery of Cryopreserved Vascularized Groin Flap and Below-the-Knee Rat Limb Transplants. Rejuvenation Res 2023; 26:180-193. [PMID: 37427425 DOI: 10.1089/rej.2023.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Effective cryopreservation of large tissues, limbs, and organs has the potential to revolutionize medical post-trauma reconstruction options and organ preservation and transplantation procedures. To date, vitrification and directional freezing are the only viable methods for long-term organ or tissue preservation, but are of limited clinical relevance. This work aimed to develop a vitrification-based approach that will enable the long-term survival and functional recovery of large tissues and limbs following transplantation. The presented novel two-stage cooling process involves rapid specimen cooling to subzero temperatures, followed by gradual cooling to the vitrification solution (VS) and tissue glass transition temperature. Flap cooling and storage were only feasible at temperatures equal to or slightly lower than the VS Tg (i.e., -135°C). Vascularized rat groin flaps and below-the-knee (BTK) hind limb transplants cryopreserved using this approach exhibited long-term survival (>30 days) following transplantation to rats. BTK-limb recovery included hair regrowth, normal peripheral blood flow, and normal skin, fat, and muscle histology. Above all, BTK limbs were reinnervated, enabling rats to sense pain in the cryopreserved limb. These findings provide a strong foundation for the development of a long-term large-tissue, limb and organ preservation protocol for clinical use.
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Affiliation(s)
- Amir Arav
- A.A. Technology Ltd., Tel Aviv, Israel
| | - Shujun Li
- The Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Or Friedman
- The Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Inna Solodeev
- The Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Jessie Aouizerate
- The Institute of Pathology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Daniel Kedar
- The Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Marie De Antonio
- Neuromuscular Reference Center, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | | | - Eyal Gur
- The Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Shani
- The Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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13
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Da Silveira Cavalcante L, Higuita ML, González-Rosa JM, Marques B, To S, Pendexter CA, Cronin SE, Gopinathan K, de Vries RJ, Ellett F, Uygun K, Langenau DM, Toner M, Tessier SN. Zebrafish as a high throughput model for organ preservation and transplantation research. FASEB J 2023; 37:e23187. [PMID: 37718489 PMCID: PMC10754348 DOI: 10.1096/fj.202300076r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 08/15/2023] [Accepted: 08/24/2023] [Indexed: 09/19/2023]
Abstract
Despite decades of effort, the preservation of complex organs for transplantation remains a significant barrier that exacerbates the organ shortage crisis. Progress in organ preservation research is significantly hindered by suboptimal research tools that force investigators to sacrifice translatability over throughput. For instance, simple model systems, such as single cell monolayers or co-cultures, lack native tissue structure and functional assessment, while mammalian whole organs are complex systems with confounding variables not compatible with high-throughput experimentation. In response, diverse fields and industries have bridged this experimental gap through the development of rich and robust resources for the use of zebrafish as a model organism. Through this study, we aim to demonstrate the value zebrafish pose for the fields of solid organ preservation and transplantation, especially with respect to experimental transplantation efforts. A wide array of methods were customized and validated for preservation-specific experimentation utilizing zebrafish, including the development of assays at multiple developmental stages (larvae and adult), methods for loading and unloading preservation agents, and the development of viability scores to quantify functional outcomes. Using this platform, the largest and most comprehensive screen of cryoprotectant agents (CPAs) was performed to determine their toxicity and efficiency at preserving complex organ systems using a high subzero approach called partial freezing (i.e., storage in the frozen state at -10°C). As a result, adult zebrafish cardiac function was successfully preserved after 5 days of partial freezing storage. In combination, the methods and techniques developed have the potential to drive and accelerate research in the fields of solid organ preservation and transplantation.
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Affiliation(s)
- Luciana Da Silveira Cavalcante
- Center for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston MA, USA
- Shriners Hospitals for Children - Boston, Boston MA, USA
| | - Manuela Lopera Higuita
- Center for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston MA, USA
- Shriners Hospitals for Children - Boston, Boston MA, USA
| | - Juan Manuel González-Rosa
- Cardiovascular Research Center, Massachusetts General Hospital Research Institute, Harvard Medical School, Charlestown MA, USA
| | - Beatriz Marques
- Center for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston MA, USA
| | - Samantha To
- Cardiovascular Research Center, Massachusetts General Hospital Research Institute, Harvard Medical School, Charlestown MA, USA
| | - Casie A. Pendexter
- Center for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston MA, USA
- Shriners Hospitals for Children - Boston, Boston MA, USA
| | - Stephanie E.J. Cronin
- Center for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston MA, USA
- Shriners Hospitals for Children - Boston, Boston MA, USA
| | - Kaustav Gopinathan
- Center for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston MA, USA
| | - Reinier J. de Vries
- Center for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston MA, USA
- Shriners Hospitals for Children - Boston, Boston MA, USA
| | - Felix Ellett
- Center for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston MA, USA
- Shriners Hospitals for Children - Boston, Boston MA, USA
| | - Korkut Uygun
- Center for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston MA, USA
- Shriners Hospitals for Children - Boston, Boston MA, USA
| | - David M. Langenau
- Molecular Pathology Unit and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Mehmet Toner
- Center for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston MA, USA
- Shriners Hospitals for Children - Boston, Boston MA, USA
| | - Shannon N. Tessier
- Center for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston MA, USA
- Shriners Hospitals for Children - Boston, Boston MA, USA
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14
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Năstase G, Botea F, Beșchea GA, Câmpean ȘI, Barcu A, Neacșu I, Herlea V, Popescu I, Chang TT, Rubinsky B, Șerban A. Isochoric Supercooling Organ Preservation System. Bioengineering (Basel) 2023; 10:934. [PMID: 37627819 PMCID: PMC10451689 DOI: 10.3390/bioengineering10080934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
This technical paper introduces a novel organ preservation system based on isochoric (constant volume) supercooling. The system is designed to enhance the stability of the metastable supercooling state, offering potential long-term preservation of large biological organs at subfreezing temperatures without the need for cryoprotectant additives. Detailed technical designs and usage protocols are provided for researchers interested in exploring this field. The paper also presents a control system based on the thermodynamics of isochoric freezing, utilizing pressure monitoring for process control. Sham experiments were performed using whole pig liver sourced from a local food supplier to evaluate the system's ability to sustain supercooling without ice nucleation for extended periods. The results demonstrated sustained supercooling without ice nucleation in pig liver tissue for 24 and 48 h. These findings suggest the potential of this technology for large-volume, cryoprotectant-free organ preservation with real-time control over the preservation process. The simplicity of the isochoric supercooling device and the design details provided in the paper are expected to serve as encouragement for other researchers in the field to pursue further research on isochoric supercooling. However, final evidence that these preserved organs can be successfully transplanted is still lacking.
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Affiliation(s)
- Gabriel Năstase
- Department of Building Services, Faculty of Civil Engineering, Transilvania University of Brasov, 500152 Brasov, Romania; (G.-A.B.); (Ș.-I.C.)
| | - Florin Botea
- Center of Excellence in Translational Medicine CEMT, “Dan Setlacec” Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, 022328 Bucharest, Romania; (A.B.); (V.H.); (I.P.)
- Department of Medical-Surgical and Profilactical Disciplines, “Titu Maiorescu” University, 040441 Bucharest, Romania
| | - George-Andrei Beșchea
- Department of Building Services, Faculty of Civil Engineering, Transilvania University of Brasov, 500152 Brasov, Romania; (G.-A.B.); (Ș.-I.C.)
| | - Ștefan-Ioan Câmpean
- Department of Building Services, Faculty of Civil Engineering, Transilvania University of Brasov, 500152 Brasov, Romania; (G.-A.B.); (Ș.-I.C.)
| | - Alexandru Barcu
- Center of Excellence in Translational Medicine CEMT, “Dan Setlacec” Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, 022328 Bucharest, Romania; (A.B.); (V.H.); (I.P.)
| | | | - Vlad Herlea
- Center of Excellence in Translational Medicine CEMT, “Dan Setlacec” Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, 022328 Bucharest, Romania; (A.B.); (V.H.); (I.P.)
| | - Irinel Popescu
- Center of Excellence in Translational Medicine CEMT, “Dan Setlacec” Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, 022328 Bucharest, Romania; (A.B.); (V.H.); (I.P.)
- Department of Medical-Surgical and Profilactical Disciplines, “Titu Maiorescu” University, 040441 Bucharest, Romania
| | - Tammy T. Chang
- Department of Surgery, University of California, San Francisco, CA 94143, USA;
| | - Boris Rubinsky
- Department of Mechanical Engineering, University of California, Berkeley, CA 94720, USA;
| | - Alexandru Șerban
- Department of Thermotechnics, Engines, Thermal and Refrigeration Equipment, Faculty of Mechanical Engineering and Mechatronics, University Politehnica of Bucharest, 060042 Bucharest, Romania;
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15
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William N, Mangan S, Ben RN, Acker JP. Engineered Compounds to Control Ice Nucleation and Recrystallization. Annu Rev Biomed Eng 2023; 25:333-362. [PMID: 37104651 DOI: 10.1146/annurev-bioeng-082222-015243] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
One of the greatest concerns in the subzero storage of cells, tissues, and organs is the ability to control the nucleation or recrystallization of ice. In nature, evidence of these processes, which aid in sustaining internal temperatures below the physiologic freezing point for extended periods of time, is apparent in freeze-avoidant and freeze-tolerant organisms. After decades of studying these proteins, we now have easily accessible compounds and materials capable of recapitulating the mechanisms seen in nature for biopreser-vation applications. The output from this burgeoning area of research can interact synergistically with other novel developments in the field of cryobiology, making it an opportune time for a review on this topic.
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Affiliation(s)
- Nishaka William
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada;
| | - Sophia Mangan
- Department of Chemistry and Biomolecular Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Rob N Ben
- Department of Chemistry and Biomolecular Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Jason P Acker
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada;
- Innovation and Portfolio Management, Canadian Blood Services, Edmonton, Alberta, Canada
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16
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Muth V, Gassner JMGV, Moosburner S, Lurje G, Michelotto J, Strobl F, Knaub K, Engelmann C, Tacke F, Selzner M, Pratschke J, Sauer IM, Raschzok N. Ex Vivo Liver Machine Perfusion: Comprehensive Review of Common Animal Models. TISSUE ENGINEERING. PART B, REVIEWS 2023; 29:10-27. [PMID: 35848526 DOI: 10.1089/ten.teb.2022.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The most common preservation technique for liver grafts is static cold storage. Due to the organ shortage for liver transplantation (LT), extended criteria donor (ECD) allografts are increasingly used-despite the higher risk of inferior outcome after transplantation. Ex vivo liver machine perfusion (MP) has been developed to improve the outcome of transplantation, especially with ECD grafts, and is currently under evaluation in clinical trials. We performed a literature search on PubMed and ISI Web of Science to assemble an overview of rodent and porcine animal models of ex vivo liver MP for transplantation, which is essential for the present and future development of clinical liver MP. Hypothermic, subnormothermic, and normothermic MP systems have been successfully used for rat and pig LT. In comparison with hypothermic systems, normothermic perfusion often incorporates a dialysis unit. Moreover, it enables metabolic assessment of liver grafts. Allografts experiencing warm ischemic time have a superior survival rate after MP compared with cold storage alone, irrespective of the temperature used for perfusion. Furthermore, ex vivo MP improves the outcome of regular and ECD liver grafts in animal models. Small and large animal models of ex vivo liver MP are available to foster the further development of this new technology. Impact Statement Ex vivo machine perfusion is an important part of current research in the field of liver transplantation. While evidence for improve storage is constantly rising, the development of future applications such as quality assessment and therapeutic interventions necessitates robust animal models. This review is intended to provide an overview of this technology in common large and small animal models and to give an outlook on future applications. Moreover, we describe developmental steps that can be followed by others, and which can help to decrease the number of animals used for experiments based on the replace, reduce, refine concept.
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Affiliation(s)
- Vanessa Muth
- Department of Surgery, Experimental Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Joseph M G V Gassner
- Department of Surgery, Experimental Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Clinician Scientist Program, BIH Academy, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Simon Moosburner
- Department of Surgery, Experimental Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Clinician Scientist Program, BIH Academy, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Georg Lurje
- Department of Surgery, Experimental Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Julian Michelotto
- Department of Surgery, Experimental Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Felix Strobl
- Department of Surgery, Experimental Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Kristina Knaub
- Department of Surgery, Experimental Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Cornelius Engelmann
- Department of Hepatology and Gastroenterology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Frank Tacke
- Department of Hepatology and Gastroenterology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Markus Selzner
- Department of Surgery, Abdominal Transplant and HPB Surgery, Ajmera Family Transplant Centre, Toronto General Hospital, Toronto, Canada
| | - Johann Pratschke
- Department of Surgery, Experimental Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Igor M Sauer
- Department of Surgery, Experimental Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Nathanael Raschzok
- Department of Surgery, Experimental Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Clinician Scientist Program, BIH Academy, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
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17
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Lin M, Cao H, Li J. Control strategies of ice nucleation, growth, and recrystallization for cryopreservation. Acta Biomater 2023; 155:35-56. [PMID: 36323355 DOI: 10.1016/j.actbio.2022.10.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/20/2022] [Accepted: 10/26/2022] [Indexed: 02/02/2023]
Abstract
The cryopreservation of biomaterials is fundamental to modern biotechnology and biomedicine, but the biggest challenge is the formation of ice, resulting in fatal cryoinjury to biomaterials. To date, abundant ice control strategies have been utilized to inhibit ice formation and thus improve cryopreservation efficiency. This review focuses on the mechanisms of existing control strategies regulating ice formation and the corresponding applications to biomaterial cryopreservation, which are of guiding significance for the development of ice control strategies. Herein, basics related to biomaterial cryopreservation are introduced first. Then, the theoretical bases of ice nucleation, growth, and recrystallization are presented, from which the key factors affecting each process are analyzed, respectively. Ice nucleation is mainly affected by melting temperature, interfacial tension, shape factor, and kinetic prefactor, and ice growth is mainly affected by solution viscosity and cooling/warming rate, while ice recrystallization is inhibited by adsorption or diffusion mechanisms. Furthermore, the corresponding research methods and specific control strategies for each process are summarized. The review ends with an outlook of the current challenges and future perspectives in cryopreservation. STATEMENT OF SIGNIFICANCE: Ice formation is the major limitation of cryopreservation, which causes fatal cryoinjury to cryopreserved biomaterials. This review focuses on the three processes related to ice formation, called nucleation, growth, and recrystallization. The theoretical models, key influencing factors, research methods and corresponding ice control strategies of each process are summarized and discussed, respectively. The systematic introduction on mechanisms and control strategies of ice formation is instructive for the cryopreservation development.
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Affiliation(s)
- Min Lin
- Key Laboratory for Thermal Science and Power Engineering of Ministry of Education, Tsinghua University, Beijing 100084, China; Beijing Key Laboratory for CO(2) Utilization and Reduction Technology, Tsinghua University, Beijing 100084, China
| | - Haishan Cao
- Key Laboratory for Thermal Science and Power Engineering of Ministry of Education, Tsinghua University, Beijing 100084, China; Beijing Key Laboratory for CO(2) Utilization and Reduction Technology, Tsinghua University, Beijing 100084, China.
| | - Junming Li
- Key Laboratory for Thermal Science and Power Engineering of Ministry of Education, Tsinghua University, Beijing 100084, China; Beijing Key Laboratory for CO(2) Utilization and Reduction Technology, Tsinghua University, Beijing 100084, China
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18
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Li J, Zha X, Kang Y, Zhang Z, Yan L, Song L, Wang C, Yang J. Oxygen-carrying sequential preservation mitigates liver grafts ischemia-reperfusion injury. iScience 2022; 26:105858. [PMID: 36636350 PMCID: PMC9829800 DOI: 10.1016/j.isci.2022.105858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/01/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022] Open
Abstract
Oxygen-dependent preservation has been proposed to protect liver grafts from ischemia-reperfusion injury (IRI), but its underlying mechanism remains elusive. Here, we proposed an oxygen-carrying sequential preservation (OCSP) method that combined oxygenated static cold storage (SCS) and normothermic mechanical perfusion. We demonstrated that OCSP, especially with high oxygen partial pressure level (500-650mmHg) during the oxygenated SCS phase, was associated with decreased IRI of liver grafts and improved rat survival after transplantation. A negative correlation between autophagy and endoplasmic reticulum stress response (ERSR) was found under OCSP and functional studies indicated OCSP suppressed ERSR-mediated cell apoptosis through autophagy activation. Further data showed that OCSP-induced autophagy activation and ERSR inhibition were oxygen-dependent. Finally, activated NFE2L2-HMOX1 signaling was found to induce autophagy under OCSP. Together, our findings indicate oxygen-dependent autophagy mitigates liver graft's IRI by ERSR suppression and modulates NFE2L2-HMOX1 signaling under OCSP, providing a theoretical basis for liver preservation using a composite-sequential mode.
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Affiliation(s)
- Jianbo Li
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - XiangJun Zha
- Department of Liver Surgery of West China Hospital and State Key Laboratory of Polymer Materials Engineering of Sichuan University, Chengdu610065, China
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu610041, China
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Zhongwei Zhang
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Lvnan Yan
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu610041, China
| | - Lujia Song
- Department of Respiratory and Critical Care Medicine, Med-X Center for Manufacturing, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
| | - Chengdi Wang
- Department of Respiratory and Critical Care Medicine, Med-X Center for Manufacturing, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
- Corresponding author
| | - Jiayin Yang
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu610041, China
- Corresponding author
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19
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Al-Attar R, Storey KB. Lessons from nature: Leveraging the freeze-tolerant wood frog as a model to improve organ cryopreservation and biobanking. Comp Biochem Physiol B Biochem Mol Biol 2022; 261:110747. [PMID: 35460874 DOI: 10.1016/j.cbpb.2022.110747] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/12/2022] [Accepted: 04/15/2022] [Indexed: 11/27/2022]
Abstract
The freeze-tolerant wood frog, Rana sylvatica, is one of the very few vertebrate species known to endure full body freezing in winter and thaw in early spring without any significant sign of damage. Once frozen, wood frogs show no cardiac or lung activity, brain function, or physical movement yet resume full physiological and biochemical functions within hours after thawing. The miraculous ability to tolerate such extreme stresses makes wood frogs an attractive model for identifying the molecular mechanisms that can promote freeze/thaw endurance. Recapitulating these pro-survival strategies in transplantable human cells and organs could improve viability post-thaw leading to better post-transplant outcomes, in addition to providing more time for adequate distribution of these transplantable materials across larger geographical areas. Indeed, several laboratories are beginning to mimic the pro-survival responses observed in wood frogs to preservation of human cells, tissues and organs and, to date, a few trials have been successful in extending preservation time prior to transplantation. In this review, we discuss the biology of the freeze-tolerant wood frog, current advances in biobanking based on these animals, and extend our discussion to future prospects for cryopreservation as an aid to regenerative medicine.
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Affiliation(s)
- Rasha Al-Attar
- Institute of Biochemistry and Department of Biology, Carleton University, Ottawa, Ontario, Canada; McEwen Stem Cell Institute, University Health Network, Toronto, Ontario, Canada
| | - Kenneth B Storey
- Institute of Biochemistry and Department of Biology, Carleton University, Ottawa, Ontario, Canada.
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20
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Tessier SN, de Vries RJ, Pendexter CA, Cronin SEJ, Ozer S, Hafiz EOA, Raigani S, Oliveira-Costa JP, Wilks BT, Lopera Higuita M, van Gulik TM, Usta OB, Stott SL, Yeh H, Yarmush ML, Uygun K, Toner M. Partial freezing of rat livers extends preservation time by 5-fold. Nat Commun 2022; 13:4008. [PMID: 35840553 PMCID: PMC9287450 DOI: 10.1038/s41467-022-31490-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 06/20/2022] [Indexed: 02/04/2023] Open
Abstract
The limited preservation duration of organs has contributed to the shortage of organs for transplantation. Recently, a tripling of the storage duration was achieved with supercooling, which relies on temperatures between -4 and -6 °C. However, to achieve deeper metabolic stasis, lower temperatures are required. Inspired by freeze-tolerant animals, we entered high-subzero temperatures (-10 to -15 °C) using ice nucleators to control ice and cryoprotective agents (CPAs) to maintain an unfrozen liquid fraction. We present this approach, termed partial freezing, by testing gradual (un)loading and different CPAs, holding temperatures, and storage durations. Results indicate that propylene glycol outperforms glycerol and injury is largely influenced by storage temperatures. Subsequently, we demonstrate that machine perfusion enhancements improve the recovery of livers after freezing. Ultimately, livers that were partially frozen for 5-fold longer showed favorable outcomes as compared to viable controls, although frozen livers had lower cumulative bile and higher liver enzymes.
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Affiliation(s)
- Shannon N. Tessier
- grid.38142.3c000000041936754XCenter for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA USA ,grid.415829.30000 0004 0449 5362Shriners Hospitals for Children Boston, Boston, MA USA
| | - Reinier J. de Vries
- grid.38142.3c000000041936754XCenter for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA USA ,grid.415829.30000 0004 0449 5362Shriners Hospitals for Children Boston, Boston, MA USA ,grid.7177.60000000084992262Department of Surgery, Amsterdam University Medical Centers – location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Casie A. Pendexter
- grid.38142.3c000000041936754XCenter for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA USA ,grid.415829.30000 0004 0449 5362Shriners Hospitals for Children Boston, Boston, MA USA ,Present Address: Sylvatica Biotech Inc., North Charleston, SC USA
| | - Stephanie E. J. Cronin
- grid.38142.3c000000041936754XCenter for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA USA ,grid.415829.30000 0004 0449 5362Shriners Hospitals for Children Boston, Boston, MA USA
| | - Sinan Ozer
- grid.38142.3c000000041936754XCenter for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA USA ,grid.415829.30000 0004 0449 5362Shriners Hospitals for Children Boston, Boston, MA USA
| | - Ehab O. A. Hafiz
- grid.420091.e0000 0001 0165 571XDepartment of Electron Microscopy Research, Theodor Bilharz Research Institute, Giza, Egypt
| | - Siavash Raigani
- grid.415829.30000 0004 0449 5362Shriners Hospitals for Children Boston, Boston, MA USA ,grid.32224.350000 0004 0386 9924Department of Surgery, Division of Transplantation, Massachusetts General Hospital, Boston, MA USA
| | - Joao Paulo Oliveira-Costa
- grid.38142.3c000000041936754XCenter for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Medicine and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA USA
| | - Benjamin T. Wilks
- grid.38142.3c000000041936754XCenter for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA USA ,grid.415829.30000 0004 0449 5362Shriners Hospitals for Children Boston, Boston, MA USA
| | - Manuela Lopera Higuita
- grid.38142.3c000000041936754XCenter for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA USA ,grid.415829.30000 0004 0449 5362Shriners Hospitals for Children Boston, Boston, MA USA
| | - Thomas M. van Gulik
- grid.7177.60000000084992262Department of Surgery, Amsterdam University Medical Centers – location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Osman Berk Usta
- grid.38142.3c000000041936754XCenter for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA USA ,grid.415829.30000 0004 0449 5362Shriners Hospitals for Children Boston, Boston, MA USA
| | - Shannon L. Stott
- grid.38142.3c000000041936754XCenter for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Medicine and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA USA
| | - Heidi Yeh
- grid.32224.350000 0004 0386 9924Department of Surgery, Division of Transplantation, Massachusetts General Hospital, Boston, MA USA
| | - Martin L. Yarmush
- grid.38142.3c000000041936754XCenter for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA USA ,grid.415829.30000 0004 0449 5362Shriners Hospitals for Children Boston, Boston, MA USA ,grid.430387.b0000 0004 1936 8796Department of Biomedical Engineering, Rutgers University, Piscataway, NJ USA
| | - Korkut Uygun
- grid.38142.3c000000041936754XCenter for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA USA ,grid.415829.30000 0004 0449 5362Shriners Hospitals for Children Boston, Boston, MA USA
| | - Mehmet Toner
- grid.38142.3c000000041936754XCenter for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA USA ,grid.415829.30000 0004 0449 5362Shriners Hospitals for Children Boston, Boston, MA USA
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21
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Liu Z, Zheng X, Wang J. Bioinspired Ice-Binding Materials for Tissue and Organ Cryopreservation. J Am Chem Soc 2022; 144:5685-5701. [PMID: 35324185 DOI: 10.1021/jacs.2c00203] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Cryopreservation of tissues and organs can bring transformative changes to medicine and medical science. In the past decades, limited progress has been achieved, although cryopreservation of tissues and organs has long been intensively pursued. One key reason is that the cryoprotective agents (CPAs) currently used for cell cryopreservation cannot effectively preserve tissues and organs because of their cytotoxicity and tissue destructive effect as well as the low efficiency in controlling ice formation. In stark contrast, nature has its unique ways of controlling ice formation, and many living organisms can effectively prevent freezing damage. Ice-binding proteins (IBPs) are regarded as the essential materials identified in these living organisms for regulating ice nucleation and growth. Note that controversial results have been reported on the utilization of IBPs and their mimics for the cryopreservation of tissues and organs, that is, some groups revealed that IBPs and mimics exhibited unique superiorities in tissues cryopreservation, while other groups showed detrimental effects. In this perspective, we analyze possible reasons for the controversy and predict future research directions in the design and construction of IBP inspired ice-binding materials to be used as new CPAs for tissue cryopreservation after briefly introducing the cryo-injuries and the challenges of conventional CPAs in the cryopreservation of tissues and organs.
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Affiliation(s)
- Zhang Liu
- Key Laboratory of Green Printing, Beijing National Laboratory for Molecular Science, Institute of Chemistry, Chinese Academy of Sciences, Beijing 100190, PR China
| | - Xia Zheng
- Key Laboratory of Green Printing, Beijing National Laboratory for Molecular Science, Institute of Chemistry, Chinese Academy of Sciences, Beijing 100190, PR China.,School of Future Technology, University of Chinese Academy of Sciences, Beijing 100049, PR China
| | - Jianjun Wang
- Key Laboratory of Green Printing, Beijing National Laboratory for Molecular Science, Institute of Chemistry, Chinese Academy of Sciences, Beijing 100190, PR China.,School of Future Technology, University of Chinese Academy of Sciences, Beijing 100049, PR China.,School of Chemical Sciences, University of Chinese Academy of Sciences, Beijing 100190, PR China
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22
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Tessier SN, Haque O, Pendexter CA, Cronin SEJ, Hafiz EOA, Weng L, Yeh H, Markmann JF, Taylor MJ, Fahy GM, Toner M, Uygun K. The role of antifreeze glycoprotein (AFGP) and polyvinyl alcohol/polyglycerol (X/Z-1000) as ice modulators during partial freezing of rat livers. FRONTIERS IN PHYSICS 2022; 10:1033613. [PMID: 37151819 PMCID: PMC10161798 DOI: 10.3389/fphy.2022.1033613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Introduction The current liver organ shortage has pushed the field of transplantation to develop new methods to prolong the preservation time of livers from the current clinical standard of static cold storage. Our approach, termed partial freezing, aims to induce a thermodynamically stable frozen state at high subzero storage temperatures (-10°C to -15°C), while simultaneously maintaining a sufficient unfrozen fraction to limit ice-mediated injury. Methods and results Using glycerol as the main permeating cryoprotectant agent, this research first demonstrated that partially frozen rat livers showed similar outcomes after thawing from either -10°C or -15°C with respect to subnormothermic machine perfusion metrics. Next, we assessed the effect of adding ice modulators, including antifreeze glycoprotein (AFGP) or a polyvinyl alcohol/polyglycerol combination (X/Z-1000), on the viability and structural integrity of partially frozen rat livers compared to glycerol-only control livers. Results showed that AFGP livers had high levels of ATP and the least edema but suffered from significant endothelial cell damage. X/Z-1000 livers had the highest levels of ATP and energy charge (EC) but also demonstrated endothelial damage and post-thaw edema. Glycerol-only control livers exhibited the least DNA damage on Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining but also had the lowest levels of ATP and EC. Discussion Further research is necessary to optimize the ideal ice modulator cocktail for our partial-freezing protocol. Modifications to cryoprotective agent (CPA) combinations, including testing additional ice modulators, can help improve the viability of these partially frozen organs.
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Affiliation(s)
- Shannon N. Tessier
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Shriners Hospitals for Children, Boston, MA, United States
| | - Omar Haque
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Shriners Hospitals for Children, Boston, MA, United States
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Department of Surgery, Division of Transplantation, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Casie A. Pendexter
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Shriners Hospitals for Children, Boston, MA, United States
| | - Stephanie E. J. Cronin
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Shriners Hospitals for Children, Boston, MA, United States
| | - Ehab O. A. Hafiz
- Department of Electron Microscopy Research, Theodor Bilharz Research Institute, Giza, Egypt
| | - Lindong Weng
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Shriners Hospitals for Children, Boston, MA, United States
| | - Heidi Yeh
- Department of Surgery, Division of Transplantation, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - James F. Markmann
- Department of Surgery, Division of Transplantation, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Michael J. Taylor
- Sylvatica Biotech Inc, North Charleston, SC, United States
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, United States
| | | | - Mehmet Toner
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Shriners Hospitals for Children, Boston, MA, United States
- CORRESPONDENCE: Mehmet Toner, , Korkut Uygun,
| | - Korkut Uygun
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Shriners Hospitals for Children, Boston, MA, United States
- CORRESPONDENCE: Mehmet Toner, , Korkut Uygun,
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23
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Huang H, He X, Yarmush ML. Advanced technologies for the preservation of mammalian biospecimens. Nat Biomed Eng 2021; 5:793-804. [PMID: 34426675 PMCID: PMC8765766 DOI: 10.1038/s41551-021-00784-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 06/23/2021] [Indexed: 02/07/2023]
Abstract
The three classical core technologies for the preservation of live mammalian biospecimens-slow freezing, vitrification and hypothermic storage-limit the biomedical applications of biospecimens. In this Review, we summarize the principles and procedures of these three technologies, highlight how their limitations are being addressed via the combination of microfabrication and nanofabrication, materials science and thermal-fluid engineering and discuss the remaining challenges.
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Affiliation(s)
- Haishui Huang
- Center for Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School and Shriners Hospitals for Children, Boston, MA, USA.
- Bioinspired Engineering and Biomechanics Center, The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China.
| | - Xiaoming He
- Fischell Department of Bioengineering, University of Maryland, College Park, MD, USA.
- Robert E. Fischell Institute for Biomedical Devices, University of Maryland, College Park, MD, USA.
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD, United States.
| | - Martin L Yarmush
- Center for Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School and Shriners Hospitals for Children, Boston, MA, USA.
- Department of Biomedical Engineering, Rutgers University, Piscataway, NJ, USA.
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24
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Kim MY, Yoon HY, Lee S. The Advantage of the Supercooling Storage Method for Transplantable Sources: Human Umbilical Vessel Endothelial Cells and Mouse Skin Grafts. Transplant Proc 2021; 53:1756-1761. [PMID: 34006379 DOI: 10.1016/j.transproceed.2021.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 03/17/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The safety and efficacy of preserving transplantable tissue depends on multiple factors including temperature, length of preservation, and types of solvent. Supercooling storage, in which the preservation temperature goes below the freezing point without actual freezing of the tissue, has the potential to substantially extend the preservation time of cells, tissues, and organs. Herein we studied the effect of supercooling storage on preserving the viability of transplantable biomaterials. METHODS Human umbilical vein endothelial cells (HUVECs) and mouse dorsal skin grafts were stored at 2 different temperature (4°C and -4°C). The viability of these tissues was assessed using trypan blue exclusion assay, tetrazolium salt (WST-8) assay, and proliferating cell nuclear antigen immunohistochemistry analysis at various time points. RESULTS Over time, the viability of HUVECs and mouse skin grafts decreased in each group and at both storage temperatures. The viability of HUVECs, evaluated with trypan blue exclusion assay and WST-8 assay, was better preserved during supercooled storage (-4°C) compared with refrigerated storage (4°C). Mouse skin grafts preserved under supercooled conditions showed less damage and a higher level of proliferating cell nuclear antigen expression. CONCLUSION Among various preservation techniques, supercooling storage is 1 option to maintain optimal conditions for an increased organ transplantation success rate. To maximize preservation effectiveness, further investigations into the optimal supercooling temperatures, storage solvents, and cell protectants for various cells, tissues, and organs are needed.
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Affiliation(s)
- Mu-Young Kim
- Department of Veterinary Surgery, College of Veterinary Medicine, Konkuk University, Seoul, Republic of Korea
| | - Hun-Young Yoon
- Department of Veterinary Surgery, College of Veterinary Medicine, Konkuk University, Seoul, Republic of Korea
| | - Soojung Lee
- Department of Companion Animals, Yeonsung University, Gyeonggi-do, Republic of Korea.
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25
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William N, Acker JP. High Sub-Zero Organ Preservation: A Paradigm of Nature-Inspired Strategies. Cryobiology 2021; 102:15-26. [PMID: 33905707 DOI: 10.1016/j.cryobiol.2021.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/18/2021] [Accepted: 04/11/2021] [Indexed: 01/03/2023]
Abstract
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.
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Affiliation(s)
- Nishaka William
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, T6G 2R3, Canada.
| | - Jason P Acker
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, T6G 2R3, Canada; Centre for Innovation, Canadian Blood Services, 8249 114th Street, Edmonton, AB, T6G 2R8, Canada.
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26
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Nida S, Moses JA, Anandharamakrishnan C. Isochoric Freezing and Its Emerging Applications in Food Preservation. FOOD ENGINEERING REVIEWS 2021. [DOI: 10.1007/s12393-021-09284-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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27
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Freyssin A, Fauconneau B, Chassaing D, Rioux Bilan A, Page G. Chronic intraperitoneal injection of polyethylene glycol 200 in mice induces hippocampal neuroinflammation. Drug Chem Toxicol 2021; 45:1995-2002. [PMID: 33715554 DOI: 10.1080/01480545.2021.1894738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In vivo treatment of hydrophobic substances requires the use of organic solvents, which are often toxic. Consequently, polyethylene glycols (PEGs), which are considered as nontoxic, have been widely used for many years in chemistry and biology. We used PEG 200, which was administrated by intraperitoneal (i.p.) injection once a week to mice. After 4 months of injections, at the dose of 1.67 mL/kg, a surprising increase in expression of GFAP (glial fibrillary acidic protein) and IBA1 (ionized calcium binding adaptor molecule 1), glial markers of astrocytes and microglia respectively, was observed in the mice's hippocampus. These results were associated with a dramatic increase in pro-inflammatory cytokine interleukin-1β (IL-1β) expression, all together suggesting an inflammatory process. It is important to communicate these results to the scientific community to provide awareness of this potential effect when PEG 200 is used under similar conditions as a vehicle in mice.
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Affiliation(s)
- Aline Freyssin
- EA3808 Neurovascular Unit and Cognitive Disorders, Pôle Biologie Santé, University of Poitiers, Poitiers, France
| | - Bernard Fauconneau
- EA3808 Neurovascular Unit and Cognitive Disorders, Pôle Biologie Santé, University of Poitiers, Poitiers, France
| | - Damien Chassaing
- EA3808 Neurovascular Unit and Cognitive Disorders, Pôle Biologie Santé, University of Poitiers, Poitiers, France
| | - Agnès Rioux Bilan
- EA3808 Neurovascular Unit and Cognitive Disorders, Pôle Biologie Santé, University of Poitiers, Poitiers, France
| | - Guylène Page
- EA3808 Neurovascular Unit and Cognitive Disorders, Pôle Biologie Santé, University of Poitiers, Poitiers, France
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28
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Fernández AR, Sánchez-Tarjuelo R, Cravedi P, Ochando J, López-Hoyos M. Review: Ischemia Reperfusion Injury-A Translational Perspective in Organ Transplantation. Int J Mol Sci 2020; 21:ijms21228549. [PMID: 33202744 PMCID: PMC7696417 DOI: 10.3390/ijms21228549] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 02/07/2023] Open
Abstract
Thanks to the development of new, more potent and selective immunosuppressive drugs together with advances in surgical techniques, organ transplantation has emerged from an experimental surgery over fifty years ago to being the treatment of choice for many end-stage organ diseases, with over 139,000 organ transplants performed worldwide in 2019. Inherent to the transplantation procedure is the fact that the donor organ is subjected to blood flow cessation and ischemia during harvesting, which is followed by preservation and reperfusion of the organ once transplanted into the recipient. Consequently, ischemia/reperfusion induces a significant injury to the graft with activation of the immune response in the recipient and deleterious effect on the graft. The purpose of this review is to discuss and shed new light on the pathways involved in ischemia/reperfusion injury (IRI) that act at different stages during the donation process, surgery, and immediate post-transplant period. Here, we present strategies that combine various treatments targeted at different mechanistic pathways during several time points to prevent graft loss secondary to the inflammation caused by IRI.
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Affiliation(s)
- André Renaldo Fernández
- Immunology, Universitary Hospital Marqués de Valdecilla- Research Institute IDIVAL Santander, 390008 Santander, Spain;
| | - Rodrigo Sánchez-Tarjuelo
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (R.S.-T.); (J.O.)
- Immunología de Trasplantes, Centro Nacional de Microbiología, Instituto de Salud Carlos III, 28220 Majadahonda (Madrid), Spain
| | - Paolo Cravedi
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
| | - Jordi Ochando
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (R.S.-T.); (J.O.)
- Immunología de Trasplantes, Centro Nacional de Microbiología, Instituto de Salud Carlos III, 28220 Majadahonda (Madrid), Spain
| | - Marcos López-Hoyos
- Immunology, Universitary Hospital Marqués de Valdecilla- Research Institute IDIVAL Santander, 390008 Santander, Spain;
- Red de Investigación Renal (REDINREN), 28040 Madrid, Spain
- Correspondence: ; Tel.: +34-942-292759
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29
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Parente A, Osei-Bordom DC, Ronca V, Perera MTPR, Mirza D. Organ Restoration With Normothermic Machine Perfusion and Immune Reaction. Front Immunol 2020; 11:565616. [PMID: 33193335 PMCID: PMC7641637 DOI: 10.3389/fimmu.2020.565616] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 08/20/2020] [Indexed: 12/12/2022] Open
Abstract
Liver transplantation is the only recognized effective treatment for end-stage liver disease. However, organ shortages have become the main challenge for patients and physicians within the transplant community. Waiting list mortality remains an issue with around 10% of patients dying whilst waiting for an available organ. The post-transplantation period is also associated with an adverse complication rate for these specific cohorts of high-risk patients, particularly regarding patient and graft survival. Ischaemia reperfusion injury (IRI) has been highlighted as the mechanism of injury that increases parenchymal damage, which eventually lead to significant graft dysfunction and other poor outcome indicators. The consequences of IRI in clinical practice such as reperfusion syndrome, primary non-function of graft, allograft dysfunction, ischaemic biliary damage and early biliary complications can be life-threatening. IRI dictates the development of a significant inflammatory response that drives the pathway to eventual cell death. The main mechanisms of IRI are mitochondrial damage due to low oxygen tension within the hepatic micro-environment and severe adenosine triphosphate (ATP) depletion during the ischaemic period. After the restoration of normal blood flow, this damage is further enhanced by reoxygenation as the mitochondria respond to reperfusion by releasing reactive oxygen species (ROS), which in turn activate Kupffer cells within the hepatic micro-environment, leading to a pro-inflammatory response and eventual parenchymal cell apoptosis and associated tissue degradation. Machine perfusion (MP) is one emergent strategy considered to be one of the most important advances in organ preservation, restoration and transplantation. Indeed, MP has the potential to rescue frequently discarded organs and has been shown to limit the extent of IRI, leading to suppression of the deleterious pro-inflammatory response. This immunomodulation reduces the prevalence of allograft rejection, the use of immunosuppression therapy and minimizes post-transplant complications. This review aims to update the current knowledge of MP with a focus on normothermic machine liver perfusion (NMLP) and its potential role in immune response pathways.
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Affiliation(s)
- Alessandro Parente
- Liver Unit, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Daniel-Clement Osei-Bordom
- Liver Unit, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.,Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom.,National Institute for Health Research Birmingham Liver Biomedical Research Centre, University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, United Kingdom
| | - Vincenzo Ronca
- Liver Unit, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.,Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom.,Division of Gastroenterology and Centre for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | - M Thamara P R Perera
- Liver Unit, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Darius Mirza
- Liver Unit, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.,Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
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Prolonged Cold Ischemia Time in Mouse Heart Transplantation Using Supercooling Preservation. Transplantation 2020; 104:1879-1889. [PMID: 31895334 DOI: 10.1097/tp.0000000000003089] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Supercooling preservation techniques store a donor organ below 0°C without freezing. This has great advantages in inhibiting metabolism and preserving the organ in comparison to conventional preservation at 4°C. We developed a novel supercooling technique using a liquid cooling apparatus and novel preservation and perfusion solutions. The purpose of this study was to evaluate the preservation effect of our supercooling preservation technique in a mouse heart transplantation model. METHODS Syngeneic heterotopic heart transplantation was performed in 3 groups of mice: (1) the nonpreservation group, in which the cardiac grafts were transplanted immediately after retrieval; (2) the conventional University of Wisconsin (UW) group, in which the cardiac grafts were stored in UW solution at 4°C for different periods of time; and (3) the supercooling group, in which the cardiac grafts were stored in a novel supercooling preservation solution at -8°C for different periods of time. The maximal preservation time was investigated. Twenty-four-hour sample data were collected and analyzed to compare supercooling preservation to conventional UW preservation. RESULTS Our technique yielded a stable -8°C supercooling state. Cardiac graft revival was successfully achieved after supercooling preservation for 144 hours, and long-term survival was observed after supercooling preservation for 96 hours. Posttransplant outcomes, including myocardial ischemia-reperfusion injury, oxidative stress-related damage, and myocardial cell apoptosis, were improved in comparison to conventional 4°C UW preservation. CONCLUSIONS Supercooling heart preservation at -8°C greatly prolonged the preservation time and improved the posttransplant outcomes in comparison to conventional 4°C UW preservation. Supercooling preservation is a promising technique for organ preservation.
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31
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Lautner L, Himmat S, Acker JP, Nagendran J. The efficacy of ice recrystallization inhibitors in rat lung cryopreservation using a low cost technique for ex vivo subnormothermic lung perfusion. Cryobiology 2020; 97:93-100. [PMID: 33031822 DOI: 10.1016/j.cryobiol.2020.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/02/2020] [Indexed: 02/06/2023]
Abstract
Although lung transplant remains the only option for patients with end-stage lung failure, short preservation times result in an inability to meet patient demand. Successful cryopreservation may ameliorate this problem; however, very little research has been performed on lung cryopreservation due to the inability to prevent ice nucleation or growth. Therefore, this research sought to characterize the efficacy of a small-molecule ice recrystallization inhibitor (IRI) for lung cryopreservation given its well-documented ability to control ice growth. Sprague-Dawley heart-lung blocks were perfused at room temperature using a syringe-pump. Cytotoxicity of the IRI was assessed through the subsequent perfusion with 0.4% (w/v) trypan blue followed by formalin-fixation. Ice control was assessed by freezing at a chamber rate of -5 °C/min to -20 °C and cryofixation using a low-temperature fixative. Post-thaw cell survival was determined by freezing at a chamber rate of -5 °C/min to -20 °C and thawing in a 37 °C water bath before formalin-fixation. In all cases, samples were paraffin-embedded, sliced, and stained with eosin. The IRI studied was found to be non-toxic, as cell membrane integrity following perfusion was not significantly different than controls (p = 0.9292). Alveolar ice grain size was significantly reduced by the addition of this IRI (p = 0.0096), and the addition of the IRI to DMSO significantly improved post-thaw cell membrane integrity when compared to controls treated with DMSO alone (p = 0.0034). The techniques described here provide a low-cost solution for rat ex vivo lung perfusion which demonstrated that the ice control and improved post-thaw cell survival afforded by IRI-use warrants further study.
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Affiliation(s)
- Larissa Lautner
- Department of Surgery, University of Alberta, Edmonton, AB, T6G 2B7, Canada
| | - Sayed Himmat
- Department of Surgery, University of Alberta, Edmonton, AB, T6G 2B7, Canada
| | - Jason P Acker
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, T6G 2R3, Canada; Centre for Innovation, Canadian Blood Services, 8249 114th Street, Edmonton, AB, T6G 2R8, Canada.
| | - Jayan Nagendran
- Department of Surgery, University of Alberta, Edmonton, AB, T6G 2B7, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, T6G 2B7, Canada
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32
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Panisello Rosello A, Teixeira da Silva R, Castro C, G. Bardallo R, Calvo M, Folch-Puy E, Carbonell T, Palmeira C, Roselló Catafau J, Adam R. Polyethylene Glycol 35 as a Perfusate Additive for Mitochondrial and Glycocalyx Protection in HOPE Liver Preservation. Int J Mol Sci 2020; 21:E5703. [PMID: 32784882 PMCID: PMC7461048 DOI: 10.3390/ijms21165703] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 02/08/2023] Open
Abstract
Organ transplantation is a multifactorial process in which proper graft preservation is a mandatory step for the success of the transplantation. Hypothermic preservation of abdominal organs is mostly based on the use of several commercial solutions, including UW, Celsior, HTK and IGL-1. The presence of the oncotic agents HES (in UW) and PEG35 (in IGL-1) characterize both solution compositions, while HTK and Celsior do not contain any type of oncotic agent. Polyethylene glycols (PEGs) are non-immunogenic, non-toxic and water-soluble polymers, which present a combination of properties of particular interest in the clinical context of ischemia-reperfusion injury (IRI): they limit edema and nitric oxide induction and modulate immunogenicity. Besides static cold storage (SCS), there are other strategies to preserve the organ, such as the use of machine perfusion (MP) in dynamic preservation strategies, which increase graft function and survival as compared to the conventional static hypothermic preservation. Here we report some considerations about using PEG35 as a component of perfusates for MP strategies (such as hypothermic oxygenated perfusion, HOPE) and its benefits for liver graft preservation. Improved liver preservation is closely related to mitochondria integrity, making this organelle a good target to increase graft viability, especially in marginal organs (e.g., steatotic livers). The final goal is to increase the pool of suitable organs, and thereby shorten patient waiting lists, a crucial problem in liver transplantation.
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Affiliation(s)
- Arnau Panisello Rosello
- Experimental Hepatic Ischemia-Reperfusion Unit, Institut d’Investigacions Biomèdiques de Barcelona (IIBB), Spanish National Research Council (CSIC)-IDIBAPS, CIBEREHD, 08036 Barcelona, Catalonia, Spain; (A.P.R.); (R.T.d.S.); (E.F.-P.)
- Centre Hépato-Biliaire, AP-PH, Hôpital Paul Brousse, 94800 Villejuif, France; (C.C.); (R.A.)
| | - Rui Teixeira da Silva
- Experimental Hepatic Ischemia-Reperfusion Unit, Institut d’Investigacions Biomèdiques de Barcelona (IIBB), Spanish National Research Council (CSIC)-IDIBAPS, CIBEREHD, 08036 Barcelona, Catalonia, Spain; (A.P.R.); (R.T.d.S.); (E.F.-P.)
- Center for Neuroscience and Cell Biology, Universidade Coimbra, 3000-370 Coimbra, Portugal;
| | - Carlos Castro
- Centre Hépato-Biliaire, AP-PH, Hôpital Paul Brousse, 94800 Villejuif, France; (C.C.); (R.A.)
| | - Raquel G. Bardallo
- Department of Cell Biology, Physiology and Immunology, Universitat de Barcelona, 08028 Barcelona, Catalonia, Spain; (R.G.B.); (T.C.)
| | - Maria Calvo
- Serveis Cientifico Tècnics, 08036-Campus Hospital Clínic, Universitat de Barcelona, 08919 Barcelona, Catalonia, Spain;
| | - Emma Folch-Puy
- Experimental Hepatic Ischemia-Reperfusion Unit, Institut d’Investigacions Biomèdiques de Barcelona (IIBB), Spanish National Research Council (CSIC)-IDIBAPS, CIBEREHD, 08036 Barcelona, Catalonia, Spain; (A.P.R.); (R.T.d.S.); (E.F.-P.)
| | - Teresa Carbonell
- Department of Cell Biology, Physiology and Immunology, Universitat de Barcelona, 08028 Barcelona, Catalonia, Spain; (R.G.B.); (T.C.)
| | - Carlos Palmeira
- Center for Neuroscience and Cell Biology, Universidade Coimbra, 3000-370 Coimbra, Portugal;
| | - Joan Roselló Catafau
- Experimental Hepatic Ischemia-Reperfusion Unit, Institut d’Investigacions Biomèdiques de Barcelona (IIBB), Spanish National Research Council (CSIC)-IDIBAPS, CIBEREHD, 08036 Barcelona, Catalonia, Spain; (A.P.R.); (R.T.d.S.); (E.F.-P.)
| | - René Adam
- Centre Hépato-Biliaire, AP-PH, Hôpital Paul Brousse, 94800 Villejuif, France; (C.C.); (R.A.)
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Bonaccorsi-Riani E, Brüggenwirth IMA, Buchwald JE, Iesari S, Martins PN. Machine Perfusion: Cold versus Warm, versus Neither. Update on Clinical Trials. Semin Liver Dis 2020; 40:264-281. [PMID: 32557478 DOI: 10.1055/s-0040-1713118] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Machine perfusion (MP) preservation is potentially one of the most significant improvements in the field of liver transplantation in the last 20 years, and it has been considered a promising strategy for improved preservation and ex situ evaluation of extended criteria donor (ECD) organs. However, MP preservation adds significant cost and logistical considerations to liver transplantation. MP protocols are mainly classified according to the perfusion temperature with hypothermic machine perfusion (HMP) and normothermic machine perfusion (NMP) being the two categories most studied so far. After extensive preclinical work, MP entered the clinical setting, and there are now several studies that demonstrated feasibility and safety. However, because of the limited quality of clinical trials, there is no compelling evidence of superiority in preservation quality, and liver MP is still considered experimental in most countries. MP preservation is moving to a more mature phase, where ongoing and future studies will bring new evidence in order to confirm their superiority in terms of clinical outcomes, organ utilization, and cost-effectiveness. Here, we present an overview of all preclinical MP studies using discarded human livers and liver MP clinical trials, and discuss their results. We describe the different perfusion protocols, pitfalls in MP study design, and provide future perspectives. Recent trials in liver MP have revealed unique challenges beyond those seen in most clinical studies. Randomized trials, correct trial design, and interpretation of data are essential to generate the data necessary to prove if MP will be the new gold standard method of liver preservation.
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Affiliation(s)
- E Bonaccorsi-Riani
- Abdominal Transplant Unit, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.,Pôle de Chirurgie Expérimentale et Transplantation, Université Catholique de Louvain, Brussels, Belgium
| | - I M A Brüggenwirth
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J E Buchwald
- Division of Transplant, Department of Surgery, UMass Memorial Medical Center, University of Massachusetts, Worcester, Massachusetts
| | - S Iesari
- Pôle de Chirurgie Expérimentale et Transplantation, Université Catholique de Louvain, Brussels, Belgium.,Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - P N Martins
- Division of Transplant, Department of Surgery, UMass Memorial Medical Center, University of Massachusetts, Worcester, Massachusetts
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Bhat MH, Blondin P, Vincent P, Benson JD. Low concentrations of 3-O-methylglucose improve post thaw recovery in cryopreserved bovine spermatozoa. Cryobiology 2020; 95:15-19. [PMID: 32619521 DOI: 10.1016/j.cryobiol.2020.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 12/12/2022]
Abstract
A number of studies have explored the use of membrane permeable (usually metabolizable) and membrane impermeable saccharides to protect cells in general, and sperm in particular during cryopreservation. Critical concentrations for protective levels of sugars frequently range between 50 mmol/L and 500 mmol/L, where efficacy is attributed to the sugar's membrane stabilizing and glass forming attributes and colligative effects that reduce intra- and extracellular salt concentrations during freezing. Many studies on bull sperm have demonstrated that both permeating and non-permeating sugars have negligible positive effects on post-thaw viability. Recently, however, a non-metabolizable sugar, 3-O-Methylglucose (3-OMG), was shown to protect hepatocytes during liver cryopreservation at 0.1-0.3 mol/L. Because glucose is readily transported into sperm, we hypothesized that 3-OMG could be a new class of cryoprotectant to explore in bull sperm. Here we present positive results demonstrating that 3-OMG improves post thaw viability in bull sperm, and that this effect is not likely due to improved glass forming capabilities. In particular, in experiment 1, 3-OMG was added to the Tris-egg yolk-glycerol base media at levels from 0 mmol/L to 200 mmol/L. Semen from four bulls was collected and diluted with one of the cryopreservation media, cooled, and frozen following industry standard practices. Motility and mitochondrial activity were negatively impacted when concentration of 3-OMG was more than 25 mmol/L. Therefore, we explored lower concentrations in experiment 2, where semen from eight bulls was used to evaluate concentrations 5 mmol/L, 15 mmol/L and 25 mmol/L of 3-OMG compared with control. Motility and progressive motility in 5 mmol/L 3-OMG and in the control were significantly higher than 15 mmol/L and 25 mmol/L 3-OMG, whereas mitochondrial activity and acrosome integrity in 5 mmol/L 3-OMG were significantly better than the control freezing medium. In experiment 3, to evaluate whether the improved effects of 3-OMG are due to its non-metabolizing property, or due to colligative effects, we compared post-thaw viability in semen from four bulls cryopreserved with 5 mmol/L glucose, sucrose, or 3-OMG. Motility and progressive motility was significantly improved in 3-OMG compared to glucose or sucrose groups which were comparable to the EY control. In conclusion, 3-OMG at a concentration of 5 mmol/L in Tris-egg yolk-glycerol medium improves the post thaw motility, progressive motility and viability of bull sperm. The mechanism of action is not understood but because the efficacy is maximal at low concentrations, it is not likely due to improved intra- or extracellular glass forming abilities and may demonstrate a different protective mechanism than was shown in hepatocytes.
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Affiliation(s)
- Maajid H Bhat
- Department of Biology, University of Saskatchewan, Canada
| | | | | | - James D Benson
- Department of Biology, University of Saskatchewan, Canada.
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35
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High subzero cryofixation: A technique for observing ice within tissues. Cryobiology 2020; 95:116-122. [PMID: 32450134 DOI: 10.1016/j.cryobiol.2020.05.008] [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: 12/31/2019] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 11/22/2022]
Abstract
While various fixation techniques for observing ice within tissues stored at high sub-zero temperatures currently exist, these techniques require either different fixative solution compositions when assessing different storage temperatures or alteration of the sample temperature to enable alcohol-water substitution. Therefore, high-subzero cryofixation (HSC), was developed to facilitate fixation at any temperature above -80 °C without sample temperature alteration. Rat liver sections (1 cm2) were frozen at a rate of -1 °C/min to -20 °C, stored for 1 h at -20 °C, and processed using classical freeze-substitution (FS) or HSC. FS samples were plunged in liquid nitrogen and held for 1 h before transfer to -80 °C methanol. After 1, 3, or 5 days of -80 °C storage, samples were placed in 3% glutaraldehyde on dry ice and allowed to sublimate. HSC samples were stored in HSC fixative at -20 °C for 1, 3, or 5 days prior to transfer to 4 °C. Tissue sections were paraffin embedded, sliced, and stained prior to quantification of ice size. HSC fixative permeation was linear with time and could be mathematically modelled to determine duration of fixation required for a given tissue depth. Ice grain size within the inner regions of 5 d samples was consistent between HSC and FS processing (p = 0.76); however, FS processing resulted in greater ice grains in the outer region of tissue. This differed significantly from HSC outer regions (p = 0.016) and FS inner regions (p = 0.038). No difference in ice size was observed between HSC inner and outer regions (p = 0.42). This work demonstrates that HSC can be utilized to observe ice formed within liver tissue stored at -20 °C. Unlike isothermal freeze fixation and freeze substitution alternatives, the low melting point of the HSC fixative enables its use at a variety of temperatures without alteration of sample temperature or fixative composition.
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36
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de Vries RJ, Tessier SN, Banik PD, Nagpal S, Cronin SEJ, Ozer S, Hafiz EOA, van Gulik TM, Yarmush ML, Markmann JF, Toner M, Yeh H, Uygun K. Subzero non-frozen preservation of human livers in the supercooled state. Nat Protoc 2020; 15:2024-2040. [PMID: 32433625 DOI: 10.1038/s41596-020-0319-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 03/10/2020] [Indexed: 12/20/2022]
Abstract
Preservation of human organs at subzero temperatures has been an elusive goal for decades. The major complication hindering successful subzero preservation is the formation of ice at temperatures below freezing. Supercooling, or subzero non-freezing, preservation completely avoids ice formation at subzero temperatures. We previously showed that rat livers can be viably preserved three times longer by supercooling as compared to hypothermic preservation at +4 °C. Scalability of supercooling preservation to human organs was intrinsically limited because of volume-dependent stochastic ice formation at subzero temperatures. However, we recently adapted the rat preservation approach so it could be applied to larger organs. Here, we describe a supercooling protocol that averts freezing of human livers by minimizing air-liquid interfaces as favorable sites of ice nucleation and uses preconditioning with cryoprotective agents to depress the freezing point of the liver tissue. Human livers are homogeneously preconditioned during multiple machine perfusion stages at different temperatures. Including preparation, the protocol takes 31 h to complete. Using this protocol, human livers can be stored free of ice at -4 °C, which substantially extends the ex vivo life of the organ. To our knowledge, this is the first detailed protocol describing how to perform subzero preservation of human organs.
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Affiliation(s)
- Reinier J de Vries
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA.,Department of Surgery, Amsterdam University Medical Centers-location AMC, University of Amsterdam, Amsterdam, the Netherlands.,Department of Research, Shriners Hospitals for Children-Boston, Boston, MA, USA
| | - Shannon N Tessier
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA.,Department of Research, Shriners Hospitals for Children-Boston, Boston, MA, USA
| | - Peony D Banik
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA.,Department of Research, Shriners Hospitals for Children-Boston, Boston, MA, USA
| | - Sonal Nagpal
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA.,Department of Research, Shriners Hospitals for Children-Boston, Boston, MA, USA
| | - Stephanie E J Cronin
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA.,Department of Research, Shriners Hospitals for Children-Boston, Boston, MA, USA
| | - Sinan Ozer
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA.,Department of Research, Shriners Hospitals for Children-Boston, Boston, MA, USA
| | - Ehab O A Hafiz
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA.,Department of Research, Shriners Hospitals for Children-Boston, Boston, MA, USA.,Department of Electron Microscopy Research, Theodor Bilharz Research Institute, Giza, Egypt
| | - Thomas M van Gulik
- Department of Surgery, Amsterdam University Medical Centers-location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Martin L Yarmush
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA.,Department of Research, Shriners Hospitals for Children-Boston, Boston, MA, USA
| | - James F Markmann
- Center for Transplant Sciences, Massachusetts General Hospital, Boston, MA, USA
| | - Mehmet Toner
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA.,Department of Research, Shriners Hospitals for Children-Boston, Boston, MA, USA
| | - Heidi Yeh
- Center for Transplant Sciences, Massachusetts General Hospital, Boston, MA, USA
| | - Korkut Uygun
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA. .,Department of Research, Shriners Hospitals for Children-Boston, Boston, MA, USA.
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Abstract
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.
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39
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Kang T, You Y, Jun S. Supercooling preservation technology in food and biological samples: a review focused on electric and magnetic field applications. Food Sci Biotechnol 2020; 29:303-321. [PMID: 32257514 PMCID: PMC7105587 DOI: 10.1007/s10068-020-00750-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 02/27/2020] [Accepted: 03/10/2020] [Indexed: 12/27/2022] Open
Abstract
Freezing has been widely recognized as the most common process for long-term preservation of perishable foods; however, unavoidable damages associated with ice crystal formation lead to unacceptable quality losses during storage. As an alternative, supercooling preservation has a great potential to extend the shelf-life and maintain quality attributes of fresh foods without freezing damage. Investigations for the application of external electric field (EF) and magnetic field (MF) have theorized that EF and MF appear to be able to control ice nucleation by interacting with water molecules in foods and biomaterials; however, many questions remain open in terms of their roles and influences on ice nucleation with little consensus in the literature and a lack of clear understanding of the underlying mechanisms. This review is focused on understanding of ice nucleation processes and introducing the applications of EF and MF for preservation of food and biological materials.
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Affiliation(s)
- Taiyoung Kang
- Department of Molecular Biosciences and Bioengineering, University of Hawaii at Manoa, Honolulu, Hawaii 96822 USA
| | - Youngsang You
- Department of Human Nutrition, Food and Animal Sciences, University of Hawaii at Manoa, Honolulu, Hawaii 96822 USA
| | - Soojin Jun
- Department of Human Nutrition, Food and Animal Sciences, University of Hawaii at Manoa, Honolulu, Hawaii 96822 USA
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Ex Situ Liver Machine Perfusion as an Emerging Graft Protective Strategy in Clinical Liver Transplantation: the Dawn of a New Era. Transplantation 2019; 103:2003-2011. [DOI: 10.1097/tp.0000000000002772] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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41
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de Vries RJ, Tessier SN, Banik PD, Nagpal S, Cronin SEJ, Ozer S, Hafiz EOA, van Gulik TM, Yarmush ML, Markmann JF, Toner M, Yeh H, Uygun K. Supercooling extends preservation time of human livers. Nat Biotechnol 2019; 37:1131-1136. [PMID: 31501557 PMCID: PMC6776681 DOI: 10.1038/s41587-019-0223-y] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 07/12/2019] [Indexed: 12/25/2022]
Abstract
The inability to preserve vascular organs beyond several hours contributes to the scarcity of organs for transplantation1,2. Standard hypothermic preservation at +4 °C (refs. 1,3) limits liver preservation to less than 12 h. Our group previously showed that supercooled ice-free storage at -6 °C can extend viable preservation of rat livers4,5 However, scaling supercooling preservation to human organs is intrinsically limited because of volume-dependent stochastic ice formation. Here, we describe an improved supercooling protocol that averts freezing of human livers by minimizing favorable sites of ice nucleation and homogeneous preconditioning with protective agents during machine perfusion. We show that human livers can be stored at -4 °C with supercooling followed by subnormothermic machine perfusion, effectively extending the ex vivo life of the organ by 27 h. We show that viability of livers before and after supercooling is unchanged, and that after supercooling livers can withstand the stress of simulated transplantation by ex vivo normothermic reperfusion with blood.
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Affiliation(s)
- Reinier J de Vries
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, University of Amsterdam, Amsterdam, the Netherlands
- Shriners Hospital for Children, Boston, MA, USA
| | - Shannon N Tessier
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
- Shriners Hospital for Children, Boston, MA, USA
| | - Peony D Banik
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
- Shriners Hospital for Children, Boston, MA, USA
| | - Sonal Nagpal
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
- Shriners Hospital for Children, Boston, MA, USA
| | - Stephanie E J Cronin
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
- Shriners Hospital for Children, Boston, MA, USA
| | - Sinan Ozer
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
- Shriners Hospital for Children, Boston, MA, USA
| | - Ehab O A Hafiz
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
- Shriners Hospital for Children, Boston, MA, USA
- Department of Electron Microscopy Research, Theodor Bilharz Research Institute, Giza, Egypt
| | - Thomas M van Gulik
- Department of Surgery, University of Amsterdam, Amsterdam, the Netherlands
| | - Martin L Yarmush
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
- Shriners Hospital for Children, Boston, MA, USA
| | - James F Markmann
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
- Center for Transplant Sciences, Massachusetts General Hospital, Boston, MA, USA
| | - Mehmet Toner
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
- Shriners Hospital for Children, Boston, MA, USA
| | - Heidi Yeh
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
- Center for Transplant Sciences, Massachusetts General Hospital, Boston, MA, USA
| | - Korkut Uygun
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA.
- Shriners Hospital for Children, Boston, MA, USA.
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43
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de Vries RJ, Yarmush M, Uygun K. Systems engineering the organ preservation process for transplantation. Curr Opin Biotechnol 2019; 58:192-201. [PMID: 31280087 PMCID: PMC7261508 DOI: 10.1016/j.copbio.2019.05.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/29/2019] [Accepted: 05/27/2019] [Indexed: 12/23/2022]
Abstract
Improving organ preservation and extending the preservation time would have game-changing effects on the current practice of organ transplantation. Machine perfusion has emerged as an improved preservation technology to expand the donor pool, assess graft viability and ensure adequate graft function. However, its efficacy in extending the preservation time is limited. Subzero organ preservation does hold the promise to significantly extend the preservation time and recent advances in cryobiology bring it closer to clinical translation. In this review, we aim to broaden the perspective in the field from a focus on these individual technologies to that of a systems engineering. This would enable the creation of a preservation process that integrates the benefits of machine perfusion with those of subzero preservation, with the ultimate goal to provide on demand availability of donor organs through organ banking.
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Affiliation(s)
- Reinier J de Vries
- Center for Engineering in Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Shriners Hospital for Children, Boston, MA, USA; Department of Surgery, University of Amsterdam, Amsterdam, The Netherlands
| | - Martin Yarmush
- Center for Engineering in Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Shriners Hospital for Children, Boston, MA, USA; Department of Biomedical Engineering, Rutgers University, New Brunswick, NJ, USA
| | - Korkut Uygun
- Center for Engineering in Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Shriners Hospital for Children, Boston, MA, USA.
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Taylor MJ, Weegman BP, Baicu SC, Giwa SE. New Approaches to Cryopreservation of Cells, Tissues, and Organs. Transfus Med Hemother 2019; 46:197-215. [PMID: 31244588 PMCID: PMC6558330 DOI: 10.1159/000499453] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 03/07/2019] [Indexed: 12/11/2022] Open
Abstract
In this concept article, we outline a variety of new approaches that have been conceived to address some of the remaining challenges for developing improved methods of biopreservation. This recognizes a true renaissance and variety of complimentary, high-potential approaches leveraging inspiration by nature, nanotechnology, the thermodynamics of pressure, and several other key fields. Development of an organ and tissue supply chain that can meet the healthcare demands of the 21st century means overcoming twin challenges of (1) having enough of these lifesaving resources and (2) having the means to store and transport them for a variety of applications. Each has distinct but overlapping logistical limitations affecting transplantation, regenerative medicine, and drug discovery, with challenges shared among major areas of biomedicine including tissue engineering, trauma care, transfusion medicine, and biomedical research. There are several approaches to biopreservation, the optimum choice of which is dictated by the nature and complexity of the tissue and the required length of storage. Short-term hypothermic storage at temperatures a few degrees above the freezing point has provided the basis for nearly all methods of preserving tissues and solid organs that, to date, have proved refractory to cryopreservation techniques successfully developed for single-cell systems. In essence, these short-term techniques have been based on designing solutions for cellular protection against the effects of warm and cold ischemia and basically rely upon the protective effects of reduced temperatures brought about by Arrhenius kinetics of chemical reactions. However, further optimization of such preservation strategies is now seen to be restricted. Long-term preservation calls for much lower temperatures and requires the tissue to withstand the rigors of heat and mass transfer during protocols designed to optimize cooling and warming in the presence of cryoprotective agents. It is now accepted that with current methods of cryopreservation, uncontrolled ice formation in structured tissues and organs at subzero temperatures is the single most critical factor that severely restricts the extent to which tissues can survive procedures involving freezing and thawing. In recent years, this major problem has been effectively circumvented in some tissues by using ice-free cryopreservation techniques based upon vitrification. Nevertheless, despite these promising advances there remain several recognized hurdles to be overcome before deep-subzero cryopreservation, either by classic freezing and thawing or by vitrification, can provide the much-needed means for biobanking complex tissues and organs for extended periods of weeks, months, or even years. In many cases, the approaches outlined here, including new underexplored paradigms of high-subzero preservation, are novel and inspired by mechanisms of freeze tolerance, or freeze avoidance, in nature. Others apply new bioengineering techniques such as nanotechnology, isochoric pressure preservation, and non-Newtonian fluids to circumvent currently intractable problems in cryopreservation.
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Affiliation(s)
- Michael J. Taylor
- Sylvatica Biotech, Inc., North Charleston, South Carolina, USA
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
- Department of Medicine, University of Arizona, Tucson, Arizona, USA
| | | | - Simona C. Baicu
- Sylvatica Biotech, Inc., North Charleston, South Carolina, USA
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Petrenko A, Carnevale M, Somov A, Osorio J, Rodríguez J, Guibert E, Fuller B, Froghi F. Organ Preservation into the 2020s: The Era of Dynamic Intervention. Transfus Med Hemother 2019; 46:151-172. [PMID: 31244584 PMCID: PMC6558325 DOI: 10.1159/000499610] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/04/2019] [Indexed: 12/12/2022] Open
Abstract
Organ preservation has been of major importance ever since transplantation developed into a global clinical activity. The relatively simple procedures were developed on a basic comprehension of low-temperature biology as related to organs outside the body. In the past decade, there has been a significant increase in knowledge of the sequelae of effects in preserved organs, and how dynamic intervention by perfusion can be used to mitigate injury and improve the quality of the donated organs. The present review focuses on (1) new information about the cell and molecular events impacting on ischemia/reperfusion injury during organ preservation, (2) strategies which use varied compositions and additives in organ preservation solutions to deal with these, (3) clear definitions of the developing protocols for dynamic organ perfusion preservation, (4) information on how the choice of perfusion solutions can impact on desired attributes of dynamic organ perfusion, and (5) summary and future horizons.
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Affiliation(s)
- Alexander Petrenko
- Department of Cryobiochemistry, Institute for Problems of Cryobiology and Cryomedicine, Ukraine Academy of Sciences, Kharkov, Ukraine
| | - Matias Carnevale
- Centro Binacional (Argentina-Italia) de Investigaciones en Criobiología Clínica y Aplicada (CAIC), Universidad Nacional de Rosario, Rosario, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Alexander Somov
- Department of Cryobiochemistry, Institute for Problems of Cryobiology and Cryomedicine, Ukraine Academy of Sciences, Kharkov, Ukraine
| | - Juliana Osorio
- Centro Binacional (Argentina-Italia) de Investigaciones en Criobiología Clínica y Aplicada (CAIC), Universidad Nacional de Rosario, Rosario, Argentina
| | - Joaquin Rodríguez
- Centro Binacional (Argentina-Italia) de Investigaciones en Criobiología Clínica y Aplicada (CAIC), Universidad Nacional de Rosario, Rosario, Argentina
| | - Edgardo Guibert
- Centro Binacional (Argentina-Italia) de Investigaciones en Criobiología Clínica y Aplicada (CAIC), Universidad Nacional de Rosario, Rosario, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Barry Fuller
- UCL Division of Surgery and Interventional Sciences, Royal Free Hospital, London, United Kingdom
| | - Farid Froghi
- UCL Division of Surgery and Interventional Sciences, Royal Free Hospital, London, United Kingdom
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Abstract
PURPOSE OF REVIEW Despite over 60 years of progress in the field of since the first organ transplant, insufficient organ preservation capabilities still place profound constraints on transplantation. These constraints play multiple and compounding roles in the predominant limitations of the field: the severe shortages of transplant organs, short-term and long-term posttransplant outcomes and complications, the unmet global need for development of transplant infrastructures, and economic burdens that limit patient access to transplantation and contribute to increasing global healthcare costs. This review surveys ways that advancing preservation technologies can play a role in each of these areas, ultimately benefiting thousands if not millions of patients worldwide. RECENT FINDINGS Preservation advances can create a wide range of benefits across many facets of organ transplantation, as well as related areas of transplant research. As these technologies mature, so will the policies around their use to maximize the benefits offered by organ preservation. SUMMARY Organ preservation advances stand to increase local and global access to transplantation, improve transplant outcomes, and accelerate progress in related areas such as immune tolerance induction and xenotransplantation. This area holds the potential to save the healthcare system many billions of dollars and reduce costs across many aspects of transplantation. Novel preservation technologies, along with other technologies facilitated by preservation advances, could potentially save millions of lives in the coming years.
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47
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Cryopreservation and Transplantation of Vascularized Composite Transplants. Plast Reconstr Surg 2019; 143:1074e-1080e. [DOI: 10.1097/prs.0000000000005541] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Liu T, Han Y, Lv W, Qi P, Liu W, Cheng Y, Yu J, Liu Y. GSK-3β mediates ischemia-reperfusion injury by regulating autophagy in DCD liver allografts. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2019; 12:640-656. [PMID: 31933870 PMCID: PMC6945083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 12/20/2018] [Indexed: 06/10/2023]
Abstract
To elucidate the role of autophagy in ischemia-reperfusion injury (IRI) and determine whether glycogen synthase kinase-3β (GSK-3β) plays an important role in autophagy, a donors of cardiac death (DCD) liver transplantation model was established to observe the expression of GSK-3β and autophagy in hepatocytes during liver IRI. Immunohistochemical staining and western blotting were used to detect expression of the autophagy markers, LC3 and p62, as well as study the expression of GSK-3β and AMPK. Serum enzymology changes were analyzed at different times after liver transplantation. Hypoxia-reoxygenation methods were used to mimic the process of ischemia-reperfusion injury in cultured hepatocytes. In DCD liver transplantation with a prolonged reperfusion time, LC3 expression increased, whereas p62 decreased. GSK-3β and AMPK expression in the transplanted liver tissue were consistent with changes in autophagy, ALT, and AST. In summary, inactive GSK-3β reduced liver IRI, promoted hepatocyte autophagy, and improved hepatocyte activity. Therefore, GSK-3β may regulate autophagy through the AMPK-mTOR pathway.
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Affiliation(s)
- Tingting Liu
- Department of Hepatobiliary Surgery of No. 1 Hospital of China Medical UniversityShenyang, Liaoning, PR China
- The Key Laboratory of Organ Transplantation in LiaoningShenyang, Liaoning, PR China
| | - Yang Han
- Department of Pathology of No. 1 Hospital of China Medical UniversityShenyang, Liaoning, PR China
| | - Wu Lv
- Department of General Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and InstituteNumber 44 Xiaoheyan Road, Dadong District, Shenyang 110042, Liaoning Province, PR China
| | - Pan Qi
- Department of Hepatobiliary Surgery of No. 1 Hospital of China Medical UniversityShenyang, Liaoning, PR China
- The Key Laboratory of Organ Transplantation in LiaoningShenyang, Liaoning, PR China
| | - Wenshi Liu
- Department of Hepatobiliary Surgery of No. 1 Hospital of China Medical UniversityShenyang, Liaoning, PR China
- The Key Laboratory of Organ Transplantation in LiaoningShenyang, Liaoning, PR China
| | - Ying Cheng
- Department of Hepatobiliary Surgery of No. 1 Hospital of China Medical UniversityShenyang, Liaoning, PR China
- The Key Laboratory of Organ Transplantation in LiaoningShenyang, Liaoning, PR China
| | - Jianan Yu
- Department of Hepatobiliary Surgery of No. 1 Hospital of China Medical UniversityShenyang, Liaoning, PR China
- The Key Laboratory of Organ Transplantation in LiaoningShenyang, Liaoning, PR China
| | - Yongfeng Liu
- Department of Hepatobiliary Surgery of No. 1 Hospital of China Medical UniversityShenyang, Liaoning, PR China
- The Key Laboratory of Organ Transplantation in LiaoningShenyang, Liaoning, PR China
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49
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Optimizing Livers for Transplantation Using Machine Perfusion versus Cold Storage in Large Animal Studies and Human Studies: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9180757. [PMID: 30255101 PMCID: PMC6145150 DOI: 10.1155/2018/9180757] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/01/2018] [Accepted: 08/16/2018] [Indexed: 12/25/2022]
Abstract
Background Liver allograft preservation frequently involves static cold storage (CS) and machine perfusion (MP). With its increasing popularity, we investigated whether MP was superior to CS in terms of beneficial outcomes. Methods Human studies and large animal studies that optimized livers for transplantation using MP versus CS were assessed (PubMed/Medline/EMBASE). Meta-analyses were conducted for comparisons. Study quality was assessed according to the Newcastle-Ottawa quality assessment scale and SYRCLE's risk of bias tool. Results Nineteen studies were included. Among the large animal studies, lower levels of lactate dehydrogenase (SMD -3.16, 95% CI -5.14 to -1.18), alanine transferase (SMD -2.46, 95% CI -4.03 to -0.90), and hyaluronic acid (SMD -2.48, 95% CI -4.21 to -0.74) were observed in SNMP-preserved compared to CS-preserved livers. NMP-preserved livers showing lower level of hyaluronic acid (SMD -3.97, 95% CI -5.46 to -2.47) compared to CS-preserved livers. Biliary complications (RR 0.45, 95% CI 0.28 to 0.73) and early graft dysfunction (RR 0.56, 95% CI 0.34 to 0.92) also significantly reduced with HMP preservation in human studies. No evidence of publication bias was found. Conclusions MP preservation could improve short-term outcomes after transplantation compared to CS preservation. Additional randomized controlled trials (RCTs) are needed to develop clinical applications of MP preservation.
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50
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Tessier SN, Weng L, Moyo WD, Au SH, Wong KHK, Angpraseuth C, Stoddard AE, Lu C, Nieman LT, Sandlin RD, Uygun K, Stott SL, Toner M. Effect of Ice Nucleation and Cryoprotectants during High Subzero-Preservation in Endothelialized Microchannels. ACS Biomater Sci Eng 2018; 4:3006-3015. [PMID: 31544149 DOI: 10.1021/acsbiomaterials.8b00648] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Cryopreservation is of significance in areas including tissue engineering, regenerative medicine, and organ transplantation. We investigated endothelial cell attachment and membrane integrity in a microvasculature model at high subzero temperatures in the presence of extracellular ice. The results show that in the presence of heterogeneous extracellular ice formation induced by ice nucleating bacteria, endothelial cells showed improved attachment at temperature minimums of -6 °C. However, as temperatures decreased below -6 °C, endothelial cells required additional cryoprotectants. The glucose analog, 3-O-methyl-D-glucose (3-OMG), rescued cell attachment optimally at 100 mM (cells/lane was 34, as compared to 36 for controls), while 2% and 5% polyethylene glycol (PEG) were equally effective at -10 °C (88% and 86.4% intact membranes). Finally, endothelialized microchannels were stored for 72 h at -10 °C in a preservation solution consisting of the University of Wisconsin (UW) solution, Snomax, 3-OMG, PEG, glycerol, and trehalose, whereby cell attachment was not significantly different from unfrozen controls, although membrane integrity was compromised. These findings enrich our knowledge about the direct impact of extracellular ice on endothelial cells. Specifically, we show that, by controlling the ice nucleation temperature and uniformity, we can preserve cell attachment and membrane integrity. Further, we demonstrate the strength of leveraging endothelialized microchannels to fuel discoveries in cryopreservation of thick tissues and solid organs.
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Affiliation(s)
- Shannon N Tessier
- Center for Engineering in Medicine and BioMEMS Resource Center, Surgical Services, Massachusetts General Hospital, Harvard Medical School, 114 16th Street, Charlestown, Massachusetts 02129, United States.,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts 02114, United States.,Shriners Hospital for Children, 51 Blossom Street, Boston, Massachusetts 02114, United States
| | - Lindong Weng
- Center for Engineering in Medicine and BioMEMS Resource Center, Surgical Services, Massachusetts General Hospital, Harvard Medical School, 114 16th Street, Charlestown, Massachusetts 02129, United States.,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts 02114, United States
| | - Will D Moyo
- Center for Engineering in Medicine and BioMEMS Resource Center, Surgical Services, Massachusetts General Hospital, Harvard Medical School, 114 16th Street, Charlestown, Massachusetts 02129, United States.,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts 02114, United States
| | - Sam H Au
- Center for Engineering in Medicine and BioMEMS Resource Center, Surgical Services, Massachusetts General Hospital, Harvard Medical School, 114 16th Street, Charlestown, Massachusetts 02129, United States.,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts 02114, United States
| | - Keith H K Wong
- Center for Engineering in Medicine and BioMEMS Resource Center, Surgical Services, Massachusetts General Hospital, Harvard Medical School, 114 16th Street, Charlestown, Massachusetts 02129, United States.,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts 02114, United States.,Shriners Hospital for Children, 51 Blossom Street, Boston, Massachusetts 02114, United States
| | - Cindy Angpraseuth
- Center for Engineering in Medicine and BioMEMS Resource Center, Surgical Services, Massachusetts General Hospital, Harvard Medical School, 114 16th Street, Charlestown, Massachusetts 02129, United States.,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts 02114, United States
| | - Amy E Stoddard
- Center for Engineering in Medicine and BioMEMS Resource Center, Surgical Services, Massachusetts General Hospital, Harvard Medical School, 114 16th Street, Charlestown, Massachusetts 02129, United States.,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts 02114, United States
| | - Chenyue Lu
- Massachusetts General Hospital Cancer Center, Harvard Medical School, 149 13th Street, Charlestown, Massachusetts 02129, United States
| | - Linda T Nieman
- Massachusetts General Hospital Cancer Center, Harvard Medical School, 149 13th Street, Charlestown, Massachusetts 02129, United States
| | - Rebecca D Sandlin
- Center for Engineering in Medicine and BioMEMS Resource Center, Surgical Services, Massachusetts General Hospital, Harvard Medical School, 114 16th Street, Charlestown, Massachusetts 02129, United States.,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts 02114, United States.,Shriners Hospital for Children, 51 Blossom Street, Boston, Massachusetts 02114, United States
| | - Korkut Uygun
- Center for Engineering in Medicine and BioMEMS Resource Center, Surgical Services, Massachusetts General Hospital, Harvard Medical School, 114 16th Street, Charlestown, Massachusetts 02129, United States.,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts 02114, United States.,Shriners Hospital for Children, 51 Blossom Street, Boston, Massachusetts 02114, United States
| | - Shannon L Stott
- Center for Engineering in Medicine and BioMEMS Resource Center, Surgical Services, Massachusetts General Hospital, Harvard Medical School, 114 16th Street, Charlestown, Massachusetts 02129, United States.,Massachusetts General Hospital Cancer Center, Harvard Medical School, 149 13th Street, Charlestown, Massachusetts 02129, United States.,Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts 02114, United States
| | - Mehmet Toner
- Center for Engineering in Medicine and BioMEMS Resource Center, Surgical Services, Massachusetts General Hospital, Harvard Medical School, 114 16th Street, Charlestown, Massachusetts 02129, United States.,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts 02114, United States.,Shriners Hospital for Children, 51 Blossom Street, Boston, Massachusetts 02114, United States
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