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Visser NJ, Rezaie ES, Friedrich PF, Kotsougiani D, Shin AY, Bishop AT. Effects of Surgical Angiogenesis on Segmental Bone Reconstruction With Cryopreserved Massive-Structural Allografts in a Porcine Tibia Model. J Orthop Res 2019; 37:1698-1708. [PMID: 31042307 PMCID: PMC6824922 DOI: 10.1002/jor.24318] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 04/12/2019] [Indexed: 02/04/2023]
Abstract
Cryopreserved bone allografts (CBA) used to reconstruct segmental bone defects provide immediate structural stability, but are vulnerable to infection, non-union and late stress fracture as the majority of the allograft remains largely avascular. We sought to improve the bone vascularity and bone formation of CBAs by surgical angiogenesis with an implanted arteriovenous (AV) bundle, using a porcine tibial defect model. Cryopreserved tibial bone allografts were transplanted in swine leukocyte antigen (SLA) mismatched Yucatan minipigs to reconstruct a 3.5 cm segmental tibial defect. A cranial tibial AV-bundle was placed within its intramedullary canal to induce angiogenesis. The AV bundle was patent in eight pigs and ligated in a control group of eight pigs. At 20 weeks neo-angiogenesis was evaluated by micro-angiography. Bone formation was measured by quantitative histomorphometry and micro-computed tomography. Seven of eight AV-bundles in the revascularized group were patent. One had thrombosed due to allograft displacement. Total vascular volume was higher in the revascularized allografts compared to the ligated group (p = 0.015). Revascularized allografts had increased levels of bone formation on the allograft endosteal surface compared to the ligated control group (p = 0.05). Surgical angiogenesis of porcine tibial CBAs by intramedullary implantation of an AV-bundle creates an enhanced autogenous neoangiogenic circulation and accelerates active bone formation on allograft endosteal surfaces. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1698-1708, 2019.
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Affiliation(s)
- Noortje J Visser
- Microvascular Research Laboratory, Department of Orthopedic
Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - Elisa S Rezaie
- Microvascular Research Laboratory, Department of Orthopedic
Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - Patricia F Friedrich
- Microvascular Research Laboratory, Department of Orthopedic
Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - Dimitra Kotsougiani
- Microvascular Research Laboratory, Department of Orthopedic
Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA,Department of Hand-, Plastic- and Reconstructive Surgery,
-Burn Center-, BG Trauma Center Ludwigshafen, Department of Plastic Surgery,
University of Heidelberg, Heidelberg, Germany
| | - Alexander Y Shin
- Microvascular Research Laboratory, Department of Orthopedic
Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - Allen T Bishop
- Microvascular Research Laboratory, Department of Orthopedic
Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
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Abstract
The field of vascularized composite allotransplantation-combining advances in reconstructive surgery, transplantation, and immunology-offers great promise for patients with heretofore unsolvable problems. In the last 30 years, hand transplantation has progressed through the phases of being a research subject, a controversial clinical procedure, a more widely accepted and expanding field, and now a promising endeavor undergoing refined indications. Although many lessons have been learned, few procedures in the author's experience have been as life-transformative in restoring the body image, motor and sensory functions, activities of daily living, and personal autonomy as successful hand transplantation.
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Abstract
Vascularized composite allotransplantation has become established as a clinical specialty since the first successful hand transplant was performed in 1998. Data now available indicate that hand and face transplants offer patients good functional outcomes and significant improvements in quality of life. Despite the debilitating nature of the injuries treated by such transplants, the defects are generally not life threatening, making it difficult for physicians to recommend life-long immunosuppression that can itself have grave consequences. One potential solution to this dilemma is the induction of immunologic tolerance of the tissue transplants because tolerance would eliminate the need for such immunosuppression. Transplant tolerance may also prevent chronic rejection, a significant source of late graft loss after organ transplantation.Induction of mixed hematopoietic chimerism is a robust approach to establishing such transplant tolerance, which recently led to the first clinical application of a tolerance induction protocol for kidney transplantation. In this manuscript, we review the current status of VCA and of research directed toward bringing a tolerance approach to the VCA field. We also discuss the potential clinical significance of these studies and outline the remaining obstacles to introduction of a tolerance induction protocol to clinical practice in hand or face transplantation.
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Baccarani A, Follmar KE, Erdmann D, Levin LS. Face transplantation surgical options and open problems in cadaveric models: A review article. Microsurgery 2013; 33:239-46. [DOI: 10.1002/micr.22083] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 11/28/2012] [Indexed: 11/06/2022]
Affiliation(s)
- Alessio Baccarani
- Division of Plastic Surgery, Modena University Hospital, Modena, Italy
| | - Keith E. Follmar
- Division of Plastic Surgery, Johns Hopkins University, Baltimore, MD
| | - Detlev Erdmann
- Division of Plastic Surgery, Duke University Medical Center, Durham, NC
| | - L. Scott Levin
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
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Muramatsu K, Kuriyama R, You-Xin S, Hashimoto T, Matsunaga T, Taguchi T. Chimerism studies as an approach for the induction of tolerance to extremity allografts. J Plast Reconstr Aesthet Surg 2008; 61:1009-15. [DOI: 10.1016/j.bjps.2007.12.082] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Accepted: 12/14/2007] [Indexed: 11/29/2022]
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Muramatsu K, Kuriyama R, Taguchi T. Intragraft chimerism following composite tissue allograft. J Surg Res 2008; 157:129-35. [PMID: 19201424 DOI: 10.1016/j.jss.2008.06.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Revised: 04/30/2008] [Accepted: 06/19/2008] [Indexed: 11/26/2022]
Abstract
Until now, more than 35 hand transplants have been performed in humans and have generated much public interest. Cell traffic from the recipient into the graft, so-called intragraft chimerism, appears to play a major role in graft acceptance and graft rejection. Little is known about cell migration following extremity allografts. In this review, recent experimental studies are presented for intragraft chimerism of the extremity allograft. Technical tools for detecting recipient cells in the graft were: (1) immunohistochemistry, (2) karyotyping, (3) fluorescent in situ hybridization, (4) polymerase chain reaction, and (5) transgenic animals. This study demonstrates that recipient-derived cells gradually repopulate into grafted skin, bone tissues, bone marrow, and endothelial cells, but muscle, periosteum, and cartilage tissues retain donor cell origin.
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Affiliation(s)
- Keiichi Muramatsu
- Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Japan.
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Siemionow M, Klimczak A, Unal S, Agaoglu G, Carnevale K. Hematopoietic stem cell engraftment and seeding permits multi-lymphoid chimerism in vascularized bone marrow transplants. Am J Transplant 2008; 8:1163-76. [PMID: 18444914 DOI: 10.1111/j.1600-6143.2008.02241.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Vascularized bone marrow transplantation (VBMT) across a MHC barrier under a 7-day alphabeta-TCR mAb and CsA protocol facilitated multiple hematolymphoid chimerism via trafficking of the immature (CD90) bone marrow cells (BMC) between donor and recipient compartments. Early engraftment of donor BMC [BN(RT1(n))] into the recipient BM compartment [LEW(RT1(l))] was achieved at 1 week posttransplant and this was associated with active hematopoiesis within allografted bone and correlated with high chimerism in the hematolymphoid organs. Two-way trafficking between donor and recipient BM compartments was confirmed by the presence of recipient MHC class I cells (RT1(l)) within the allografted bone up to 3 weeks posttransplant. At 10 weeks posttransplant, decline of BMC viability in allografted bone corresponded with bone fibrosis and lack of hematopoiesis. In contrast, active hematopoiesis was present in the recipient bone as evidenced by the presence of donor-specific immature (CD90/RT1(n)) cells, which correlated with chimerism maintenance. Clonogenic activity of donor-origin cells (RT1(n)) engrafted into the host BM compartment was confirmed by colony-forming units (CFU) assay. These results confirm that hematolymphoid chimerism is developed early post-VBMT by T-cell lineage and despite allografted bone fibrosis chimerism maintenance is supported by B-cell linage and active hematopoiesis of donor-origin cells in the host BM compartment.
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Affiliation(s)
- M Siemionow
- Department of Plastic Surgery, The Cleveland Clinic, Cleveland, OH, USA.
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Muramatsu K, Kuriyama R, Taguchi T. Repopulation of donor cells from the recipient following extremity graft: Studies using the LACZ transgenic rat. Microsurgery 2008; 28:279-84. [DOI: 10.1002/micr.20486] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Composite tissue allotransplantation holds a great potential for providing increased knowledge of anatomy and microsurgical experience for life-enhancing reconstructions. Many transplant cases around the world have made this a clinical reality at the present time. Composite tissue allotransplants contain multiple tissue types, including bone, muscle, vessels, nerves, skin, and immune cells and bear a huge antigenic load. Although immunosuppressive drugs are applied successfully to prevent allograft rejection, their side effects pose a barrier to worldwide use. Bone marrow therapy in many tolerance induction protocols, therefore, provides a guide to reaching the target of permanent immunotolerance. Multiple studies suggest that bone marrow is immunomodulatory and may facilitate allograft acceptance. In this review, bone marrow based therapy protocols of clinical and experimental models are presented in two major categories: solid organ and composite tissue transplantation.
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Affiliation(s)
- Maria Siemionow
- Department of Plastic and Reconstructive Surgery, Cleveland Clinic, Cleveland, OH 44195, USA.
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Abstract
In 1943, Gibson and Medawar opened the modern era of transplantation research with a paper on the problem of skin allograft rejection. Ten years later Billingham, Brent and Medawar demonstrated that it was possible to induce selective immune acceptance of skin grafts in mice, a state of tolerance. After over six decades, however, the precise mechanism of skin allograft rejection remains still ill-defined. Furthermore, it has not been possible to achieve reliably clinical tolerance allowing the widespread application of skin allotransplantation techniques. The first successful applications of skin allotransplantation have included the hand and face. However, complications from the chronic immunosuppression regimens limit the application of these techniques. Induction of tolerance to skin (and the other tissues in the allograft) would be the most effective way to overcome all these difficulties, but this is yet to be achieved reliably, stimulating some to look for other ways to surmount the current limitations. This paper summarizes alternatives to enlarge the scope of skin allotransplantation techniques, current understanding of mechanisms of skin rejection, and the utility and limitations of animal models used to study skin rejection and tolerance induction. Finally, manipulation strategies to achieve skin tolerance are outlined.
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Affiliation(s)
- Benjamin M Horner
- Transplantation Biology Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA
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Taieb A, Clavijo-Alvarez JA, Hamad GG, Lee WPA. Immunologic approaches to composite tissue allograft. J Hand Surg Am 2007; 32:1072-85. [PMID: 17826565 DOI: 10.1016/j.jhsa.2007.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2007] [Accepted: 06/13/2007] [Indexed: 02/02/2023]
Abstract
This article discusses the immunologic principles and the most promising immunologic approaches for composite tissue allograft tolerance. We have previously reviewed some of the pharmacologic approaches for composite tissue allo-transplantation. In this review, we will summarize the range of options that may address the challenge of transplantation in reconstructive surgery.
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Affiliation(s)
- Aurèle Taieb
- School of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA
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Muramatsu K, Suzuki H, You-Xin S, Hashimoto T, Matsunaga T, Taguchi T. Donor Cell Repopulation of Whole-Limb Allografts in the Rat: Detection with Green Fluorescent Protein. Plast Reconstr Surg 2007; 120:100-107. [PMID: 17572551 DOI: 10.1097/01.prs.0000263367.71106.84] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although cell traffic between donor and recipient has previously been observed during allogeneic organ transplantation, little is known about cell traffic following whole-limb allografting. Whole-limb grafts are composed of composite tissues, and thus cell repopulations of recipients may be different for each component. This study was conducted using green fluorescent protein (GFP) transgenic rats to define cell repopulation of whole-limb allografts. METHODS Twenty-four hind-limb allotransplants were performed across GFP-positive (Wistar background) and GFP-negative (Lewis) rats. Eighteen recipient animals were treated with continuous FK506 immunosuppression at a dose of 0.5 mg/kg/day up to 6 months after transplantation and assessed until 18 months posttransplantation. The expression of the GFP gene was examined under 489-nm excitation light and semiquantitatively assessed by polymerase chain reaction. RESULTS Allografted limbs showed acute rejection in nontreated recipients, but no rejection episodes occurred in FK506-treated recipients until 18 months posttransplantation. Intense GFP expression was noted in allotransplanted GFP-negative limbs at 18 months posttransplant. GFP expression was especially marked at the interfollicular epidermis in the skin component and the endothelial cells. Polymerase chain reaction using GFP-specific primers confirmed the presence of the GFP gene in these tissues. Allotransplanted GFP-positive limbs retained marked GFP expression at the muscle fiber. CONCLUSIONS The authors' results demonstrate that recipient-derived cells gradually migrate into grafted skin, endothelial cells, muscle, and bone marrow cells. Recipient-derived stem cells may contribute to this cell renewal within the graft. Repopulation of antigenic skin components in the graft with recipient cells may also help in avoiding rejection.
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Affiliation(s)
- Keiichi Muramatsu
- Yamaguchi, Japan From the Department of Orthopedic Surgery, Yamaguchi University School of Medicine
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Schuind F, Abramowicz D, Schneeberger S. Hand transplantation: the state-of-the-art. J Hand Surg Eur Vol 2007; 32:2-17. [PMID: 17084950 DOI: 10.1016/j.jhsb.2006.09.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2006] [Revised: 08/04/2006] [Accepted: 09/04/2006] [Indexed: 02/03/2023]
Abstract
The feasibility of hand transplantation has been demonstrated, both surgically and immunologically. Levels of immunosuppression comparable to regimens used in solid organ transplantation are proving sufficient to prevent graft loss. Many patients have achieved discriminative sensibility and recovery of intrinsic muscle function. In addition to restoration of function, hand transplantation offers considerable psychological benefits. The recipient's pre-operative psychological status, his motivation and his compliance with the intense rehabilitation programme are key issues. While the induction of graft specific tolerance represents a hope for the future, immunosuppression currently remains necessary and carries significant risks. Hand transplantation should, therefore, only be considered a therapeutic option for a carefully selected group of patients.
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Affiliation(s)
- F Schuind
- Service d'Orthopédie-Traumatologie, Cliniques Universitaires de Bruxelles, Hôpital Erasme, 808 route de Lennik, B-1070, Brussels, Belgium.
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Baccarani A, Follmar KE, Baumeister SP, Marcus JR, Erdmann D, Levin LS. Technical and Anatomical Considerations of Face Harvest in Face Transplantation. Ann Plast Surg 2006; 57:483-8. [PMID: 17060726 DOI: 10.1097/01.sap.0000227486.28556.3e] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Total face transplantation may become a reconstructive option in the treatment of patients with acquired facial deformity. Here, 2 face-harvesting techniques are presented in a fresh human cadaver model. In technique 1, the skin and soft tissue of the face is harvested by dissecting in a subgaleal, sub-SMAS, subplatysmal plane. In technique 2, the entire soft tissue and the bony structures of the midface are harvested by dissecting in a subperiosteal plane and performing a Le Fort III osteotomy. Each face was harvested successfully as a bipedicled flap based on the external carotid arteries, the external jugular veins, and the facial veins. Each of these 2 techniques is a theoretically viable approach to face harvest for composite allograft transplantation. These techniques represent the 2 extremes of which tissues can be harvested while maintaining vascular integrity. Each will address different reconstructive needs.
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Affiliation(s)
- Alessio Baccarani
- Division of Plastic, Reconstructive, Maxillofacial, and Oral Surgery, Duke University Medical Center, Box 3181, Durham, NC 27710, USA
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Muramatsu K, You-Xin S, Hashimoto T, Matsunaga T, Taguchi T. The role of cyclophosphamide and granulocyte colony-stimulation factor in achieving high-level chimerism in allotransplanted limbs. J Orthop Res 2006; 24:2133-40. [PMID: 16944471 DOI: 10.1002/jor.20240] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The establishment of a high-level of chimerism may be the most stable strategy for donor-specific tolerance. The purpose of this study was to evaluate the efficacy of a new protocol using cyclophosphamide (CYP) and granulocyte colony-stimulation factor (G-CSF) to induce high-level chimerism following rat whole-limb allotransplantation. Seventy-three whole-limb allotransplants from LacZ transgenic rats to LEW rats were performed. CYP was injected at day 2, and G-CSF was given from day 0 to 3. Nontreated limb allografts were rejected after 4.2 days. In FK506-treated group for 28 days, the survival time was prolonged to 64 days. In the group treated with CYP/G-CSF, limb allografts were rejected after 5.4 days and 5 of 15 recipients showed acute lethal graft-versus-host disease (GVHD). Polymerase chain reaction (PCR) study showed a high level of chimerism even within 1 week after transplantation. Fourteen of 30 recipients given CYP/G-CSF/FK506 died within 2 weeks. The limb survival was significantly prolonged, however, with three grafts surviving more than 300 days. Seven recipients (24%) showed chronic GVHD. A high-level of chimerism was maintained when limb allografts were not rejected by recipients. Limb allografting could function as a vascularized carrier for bone marrow transplantation, provide a continuous source of donor cells and contribute to a high level of chimerism in the recipient. Pretransplant CYP followed by G-CSF and FK506 treatment significantly prolonged the survival of limb allografts but frequently caused chronic GVHD in the recipients.
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Affiliation(s)
- Keiichi Muramatsu
- Department of Orthopedic Surgery, Yamaguchi University School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan.
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Muramatsu K, You-Xin S, Hashimoto T, Matsunaga T, Gondo T, Taguchi T. Prolonged survival of rat whole-limb allografts treated with cyclophosphamide, granulocyte colony-stimulation factor and FK506. Transpl Int 2006; 19:840-7. [PMID: 16961777 DOI: 10.1111/j.1432-2277.2006.00362.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We evaluated the efficacy of a new protocol using cyclophosphamide (CYP), granulocyte colony-stimulation factor (G-CSF) and FK506 to induce high level chimerism following rat whole-limb allotransplantation. The present study investigated the dose requirement and toxicity of CYP monotherapy in inducing stable bone marrow chimerism. Fifty-six whole-limb allotransplants from LacZ transgenic rats to LEW rats were performed. CYP at a dose of 100 mg to 200 mg/kg was injected 2 days before transplantation and G-CSF of 25 microg/kg/day was given for 4 days. FK506 was used for 28 days at 1 mg/kg/day. The level of chimerism was evaluated by semi-quantitative polymerase chain reaction. The survival of limb allografts in recipients treated with CYP of 150 mg/kg was significantly prolonged to 107 days. The onset of rejection was more prolonged to 158 days in recipients with CYP of 200 mg/kg, with two of eight grafts surviving >1 year and three recipients (38%) showed chronic, nonlethal GVHD with a high level of bone marrow chimerism. Limb allografting could contribute to chimerism in the recipient. Pretreatment with CYP had the dose-dependent effects of prolonging the survival of limb allografts. A CYP dose of 200 mg/kg appears to significantly prolong limb graft survival but frequently causes chronic nonlethal GVHD in the longer surviving recipients.
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Affiliation(s)
- Keiichi Muramatsu
- Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Yamaguchi, Japan.
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Muramatsu K, Kurokawa Y, Ihara K, You-Xin S, Kawai S. Donor cell engraftment in recipient lymphoid tissues after rat limb allograft. J Surg Res 2005; 124:38-44. [PMID: 15734477 DOI: 10.1016/j.jss.2004.09.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND The movement of cells from a transplanted tissue into the host organs, the so-called systemic chimerism, is a phenomenon known to occur and be associated with the development of immunologic tolerance in allotransplantation cases. The purpose of this study was to identify donor cell engraftment in recipient lymphoid tissues after performing rat hind limb allograft. MATERIALS AND METHODS Fifty-five whole-limb allotransplantations were performed in sex-mismatched pairs of rats. Syngeneic male Lewis and allogeneic Dark Agouti donors were transplanted to female Lewis recipients. FK506 was used for immunosuppression. Donor male cells could be identified in the recipient female tissues by semiquantitative polymerase chain reaction analysis for a Y chromosome-specific DNA sequence. Chimerism was assessed at 1, 24, and 48 weeks after transplantation. RESULTS There was no rejection episode in any of the limb grafts. Although levels of chimerism were highly variable in each lymphoid tissue, a gradual increase was noticed in all during the course of time. At 1 week after the transplant period, only intrasplenic chimerism was at high level (1%) in three groups. At 48 weeks after the transplant, all recipients with allografts showed very high level (10%) of chimerism in the bone marrow. Two, two, and two of six recipients showed very high levels in the spleen, lymph node, and liver, respectively, at 48 weeks. Intrathymic chimerism was higher at 24 weeks after transplant rather than at 48 weeks. CONCLUSION We demonstrated donor cell engraftment into recipient lymphoid tissues after successful whole limb transplantation. We conclude that limb allograft can work as a vascularized carrier for the bone marrow transplantation, provide a continuous source of donor cells and contribute to chimerism in the recipient.
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Affiliation(s)
- Keiichi Muramatsu
- Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Yamaguchi, Japan.
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Muramatsu K, Kurokawa Y, You-Xin S, Bishop AT, Doi K. Cell traffic between donor and recipient following rat limb allograft. J Orthop Res 2005; 23:181-7. [PMID: 15607891 DOI: 10.1016/j.orthres.2004.06.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2004] [Accepted: 06/11/2004] [Indexed: 02/04/2023]
Abstract
Although cell traffic from the graft into the recipient and from the recipient into the graft had been noticed in allogeneic organ transplantation, little is known following whole-limb allografting. This study was conducted to define cell migration between donor and recipient. Sixty-seven vascularized hind limb allotransplantations were performed in rat sex-mismatched pairs and the recipient animals were treated with FK506 immunosuppression. The ratio of donor and recipient cells was evaluated by semi-quantitative PCR using the specific primers of the Y-chromosome. Allografted limbs had no rejection episode until the final assessment. The male recipient cells were detected in female limb grafts not at 1 week but at 48 weeks after transplantation. The male donor cells were detected in the humerus and tibia in the female recipient but not in the gastrocnemius muscle and leg skin. Our results demonstrated that recipient-derived cells gradually migrated into the grafted bone, muscle and skin cells with the duration of time. Donor-derived cells migrated into the healthy bones but not into the healthy muscle and skin. Because active regeneration occurs in the grafted limb to compensate graft damage secondary to ischemia and operative intervention, recipient-derived cells may mediate a muscular and dermo-epidermal renewal.
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Affiliation(s)
- Keiichi Muramatsu
- Department of Orthopedic Surgery, Yamaguchi University School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan.
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Gabl M, Pechlaner S, Lutz M, Bodner G, Piza H, Margreiter R. Bilateral hand transplantation: bone healing under immunosuppression with tacrolimus, mycophenolate mofetil, and prednisolone. J Hand Surg Am 2004; 29:1020-7. [PMID: 15576210 DOI: 10.1016/j.jhsa.2004.05.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2003] [Accepted: 05/04/2004] [Indexed: 02/02/2023]
Abstract
PURPOSE Little is known about bone healing after composite tissue transplantation that requires pharmacologic immunosuppression. Bone integration and callus development were assessed in bilateral hand transplantation. METHODS In this study the course of callus development and callus maturation were assessed by color Doppler sonography and radiography in a double hand transplant and compared with forearm replantation. RESULTS After hand transplantation, ingrowth of small vessels at the bone junction was observed at week 3, calcified callus became visible at month 4, and bone union was completed at month 11. A similar time course of bone integration was observed after replantation. Plating offered sufficient stability. A recipient periostal flap is thought to have improved blood supply and favored development and induction of callus. CONCLUSIONS Bone healing after hand transplantation under immunosuppression with tacrolimus, mycophenolate mofetil, and prednisolone is identical to that after forearm replantation.
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Affiliation(s)
- Markus Gabl
- Department of Traumatology, Leopold Franzens University, Innsbruck, Austria
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Muramatsu K, Valenzuela RG, Bishop AT. Detection of chimerism following vascularized bone allotransplantation by polymerase chain reaction using a Y-chromosome specific primer. J Orthop Res 2003; 21:1056-62. [PMID: 14554219 DOI: 10.1016/s0736-0266(03)00108-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Chimerism following allogeneic organ transplantation is a phenomenon known to occur and be associated with development of immunologic tolerance in allotransplantation. However, little is known about graft cell migration following vascularized bone allografting. In this study, chimerism was assessed following vascularized tibia transplantation from male DA or PVG donors to female PVG rat recipients using a semi-quantitative polymerase chain reaction for the Y-chromosome. FK-506 (Tacrolimus) was administered after transplantation for immunosuppression. All immunosuppresssed PVG rat recipients of PVG bone grafts showed a high level of chimerism (1%) in the thymus, spleen, liver and cervical lymph nodes at 18 weeks post-transplant. Donor cells were also detected in the contralateral tibia and humerus. In non-immunosuppressed PVG rat recipients of DA bone grafts, donor cells were detected in the spleen in three of five rats within 2 weeks post-transplant. In these animals the bone grafts were severely rejected. In immunosuppressed PVG rat recipients of DA bone grafts, two of five, four of eight and eight of 10 rats showed low level chimerism (0.1%) in peripheral blood at 1, 12, and 18 weeks post-transplant. Six rats showed a high level of chimerism in the spleen and thymus. Histological studies revealed no rejection findings through 18 weeks post-transplant. Our results indicate that chimerism, or the presence of graft cells in host tissue, may occur in the face of acute rejection and be demonstrable following vascularized isograft and allograft living bone transplantation when chronic immunosuppression is maintained. Graft vascular patency during the short-term likely allows cellular migration, even in the face of acute rejection. Long-term survival and proliferation of graft marrow elements in host tissue may be possible with adequate immunosuppression.
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Affiliation(s)
- Keiichi Muramatsu
- Department of Orthopaedic Surgery, Mayo Clinic, 200 First Street, S.W., Rochester, MN 55905, USA
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