1
|
Kiefer J, Diehm Y, Germann G, Kneser U, Terness P, Radu CA. [Immunosuppressive effect of mitomycin C-treated peripheral mononuclear blood cells (MICs) in vascularised composite allotransplantation]. HANDCHIR MIKROCHIR P 2021; 53:389-399. [PMID: 33412589 DOI: 10.1055/a-1261-3447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Vascularized Composite Allotransplantation (VCA) enables the restoration of complex tissue defects. Since the first successful hand and face transplants were performed, clinical and experimental research has consistently improved immunosuppressive therapies. The incubation of peripheral blood mononuclear cells (PBMCs) with mitomycin C (MMC) results in immunomodulatory cells (MICs). In previous studies, the systemic application of MICs on the day of allogeneic hind limb transplantation led to a significant immunosuppression in rats. The aim of this study is to further investigate the optimal point in time of MIC application in a complex VCA model. MATERIAL AND METHODS In six groups, 60 allogeneic hind limb transplantations were performed. Fully mismatched rats were used as hind limb donors [Lewis (LEW)] and recipients [Brown-Norway (BN)]. Group A received donor-derived MICs seven days preoperatively. Group B received no immunosuppression; group C received untreated PBMCs seven days prior to transplantation. Animals in group D received cell culture media, whereas group E was treated with a standard immunosuppression consisting of tacrolimus and prednisolone. In group F, syngeneic hind limb transplantations (BN→BN) were performed. Transplant rejection was assessed clinically and histologically. RESULTS Group A showed a significantly earlier onset of allograft rejection after 3.5 ± 0.2 days (p < 0.01) when compared with control groups B, C and D (5.5 ± 0.7, 5.3 ± 0.7 und 5.7 ± 0.5). Groups E and F showedno allograft rejection. CONCLUSION This study shows that the time of application determines the immunomodulatory effects of MICs. Whereas the systemic application of MICs on the day of transplantation led to a significant immunosuppression in previous studies, this study demonstrates that preoperative injections of MICs lead to an acceleration of allotransplant rejection. Follow-up studies are necessary to investigate further modifications of application time as well as dose-effect relations and cell characteristics of these potential immunosuppressive cells.
Collapse
Affiliation(s)
- Jurij Kiefer
- BG Unfallklinik Ludwigshafen, Klinik f. Hand-, Plast. u. Rekonstr. Chirurgie, Schwerbrandverletztenzentrum
| | - Yannick Diehm
- BG Klinik Ludwigshafen, Klinik für Hand, Plastische und Rekonstruktive Chirurgie, Plastische Chirurgie der Universität Heidelberg, Schwerbrandverletztenzentrum
| | - Günter Germann
- ETHIANUM - Klinik für Plastische und Rekonstruktive Chirurgie Ästhetische Chirurgie
| | - Ulrich Kneser
- BG Unfallklinik Ludwigshafen und Ruprecht-Karls-Universität Heidelberg, Klinik für Hand, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Klinik für Plastische Chirurgie
| | - Peter Terness
- UniversitätsKlinikum Heidelberg, Abteilung für Transplantationsimmunologie
| | - Christian Andreas Radu
- BG Unfallklinik Ludwigshafen, Klinik f. Hand-, Plast. u. Rekonstr. Chirurgie, Schwerbrandverletztenzentrum
| |
Collapse
|
2
|
Sato N, Haga J, Anazawa T, Kenjo A, Kimura T, Wada I, Mori T, Marubashi S, Gotoh M. Ex vivo Pretreatment of Islets with Mitomycin C: Reduction in Immunogenic Potential of Islets by Suppressing Secretion of Multiple Chemotactic Factors. Cell Transplant 2018; 26:1392-1404. [PMID: 28901184 PMCID: PMC5680981 DOI: 10.1177/0963689717721233] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Strategies to reduce the immunogenicity of pancreatic islets and to prevent the activation of proinflammatory events are essential for successful islet engraftment. Pretransplant islet culture presents an opportunity for preconditioning to improve outcomes of islet transplantation. We previously demonstrated that ex vivo mitomycin C (MMC) pretreatment and subsequent culture significantly prolonged graft survival. Fully understanding the biological process of pretreatment could result in the development of a protocol to improve the survival of islet grafts. Microarrays were employed to conduct a comprehensive analysis of genes expressed in untreated or MMC-treated rat islets that were subsequently cultured for 3 d. A bioinformatics software was used to identify biological processes that were most affected by MMC pretreatment, and validation studies, including in vivo and in vitro assay, were performed. The gene expression analysis identified significant downregulation of annotated functions associated with cellular movement and revealed significant downregulation of multiple genes encoding proinflammatory mediators with chemotactic activity. Validation studies revealed significantly decreased levels of interleukin 6 (IL-6), monocyte chemoattractant protein 3 (MCP-3), and matrix metallopeptidase 2 (MMP2) in culture supernatants of MMC-treated islets compared with controls. Moreover, we showed the suppression of leukocyte chemotactic activity of MMC-treated islets in vitro. We also showed that MMC-treated islets secreted lower levels of chemoattractants that synergistically reduced the immunogenic potential of islets. Histological and immunohistochemical analyses of the implant site revealed that infiltration of monocytes, CD3-positive T cells, and B cells was decreased in MMC-treated islets. In conclusion, the ex vivo pretreatment of islets with MMC and subsequent culture can reduce the immunogenic potential and prolong the survival of islet grafts by inducing the suppression of multiple leukocyte chemotactic factors.
Collapse
Affiliation(s)
- Naoya Sato
- 1 Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka, Fukushima, Japan
| | - Junichiro Haga
- 1 Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka, Fukushima, Japan
| | - Takayuki Anazawa
- 2 Department of Surgery, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Akira Kenjo
- 1 Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka, Fukushima, Japan
| | - Takashi Kimura
- 1 Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka, Fukushima, Japan
| | - Ikuo Wada
- 3 Department of Cell Science, Institute of Biomedical Sciences, Fukushima Medical University, Hikarigaoka, Fukushima, Japan
| | - Tsutomu Mori
- 4 Department of Human Lifesciences, School of Nursing, Fukushima Medical University, Hikarigaoka, Fukushima, Japan
| | - Shigeru Marubashi
- 1 Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka, Fukushima, Japan
| | - Mitsukazu Gotoh
- 1 Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka, Fukushima, Japan
| |
Collapse
|
3
|
Radu CA, Kiefer J, Gebhard MM, Bigdeli AK, Schmidt VJ, Germann G, Lehnhardt M, Terness P, Kneser U, Kremer T. Local administration of Mitomycin-C-Treated peripheral blood mononuclear cells (PBMCs) prolongs allograft survival in vascularized composite allotransplantation. Microsurgery 2015; 36:417-425. [DOI: 10.1002/micr.30003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 08/15/2015] [Accepted: 10/23/2015] [Indexed: 02/02/2023]
Affiliation(s)
- Christian Andreas Radu
- Department of Hand- Plastic- and Reconstructive Surgery; Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery-University of Heidelberg, Heidelberg; Germany
| | - Jurij Kiefer
- Department of Hand- Plastic- and Reconstructive Surgery; Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery-University of Heidelberg, Heidelberg; Germany
| | - Martha Maria Gebhard
- Department of Experimental Surgery; University of Heidelberg, Heidelberg; Germany
| | - Amir Khosrow Bigdeli
- Department of Hand- Plastic- and Reconstructive Surgery; Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery-University of Heidelberg, Heidelberg; Germany
| | - Volker Jürgen Schmidt
- Department of Hand- Plastic- and Reconstructive Surgery; Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery-University of Heidelberg, Heidelberg; Germany
| | - Guenter Germann
- Department of Hand- Plastic- and Reconstructive Surgery, Clinic for Plastic and Reconstructive Surgery; Aesthetic and Preventive Medicine at Heidelberg University Hospital; Ethianum Heidelberg Germany
| | - Marcus Lehnhardt
- Department of Plastic Surgery; Burn Center, Sarcoma Reference Center, BG-University Hospital Bergmannsheil; Bochum Germany
| | - Peter Terness
- Department of Transplant Immunology; Institute for Immunology, University of Heidelberg, Heidelberg; Germany
| | - Ulrich Kneser
- Department of Hand- Plastic- and Reconstructive Surgery; Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery-University of Heidelberg, Heidelberg; Germany
| | - Thomas Kremer
- Department of Hand- Plastic- and Reconstructive Surgery; Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery-University of Heidelberg, Heidelberg; Germany
| |
Collapse
|
4
|
Radu CA, Kiefer J, Horn D, Kleist C, Dittmar L, Sandra F, Rebel M, Ryssel H, Koellensperger E, Gebhard MM, Lehnhardt M, Germann G, Terness P. Mitomycin-C-treated peripheral blood mononuclear cells (PBMCs) prolong allograft survival in composite tissue allotransplantation. J Surg Res 2012; 176:e95-e101. [PMID: 22445458 DOI: 10.1016/j.jss.2011.12.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2011] [Revised: 11/16/2011] [Accepted: 12/15/2011] [Indexed: 10/28/2022]
Abstract
BACKGROUND Composite tissue allotransplantation (CTA) was introduced as a potential treatment for complex reconstructive procedures and has become a clinical reality. Hand and face transplantation, the most widely recognized forms of CTA, have intensified immunological research in this emerging field of transplantation. Mitomycin C (MMC) is an alkylating agent that suppresses allogeneic T-cell responses. MMC-treated dendritic cells/PBMCs have been shown to induce donor-specific tolerance in solid organ allograft transplantations. METHODS Fully mismatched rats were used as hind limb donors [Lewis (RT1(1))] and recipients [Brown-Norway (RT1(n))]. Fifty-five allogeneic hind limb transplantations were accomplished in six groups. Group A (n = 10) received donor-derived MMC-treated PBMCs on transplantation day. Group B (n = 10) rats received no immunosuppression, group C (n = 10) received FK506 and prednisolon, group D consisted in isograft transplantation without immunosuppression, group E (n = 10) received non-treated PBMCs, and group F (n = 5) received PBS without any donor-derived cells. Rejection was assessed clinically and histologically. RESULTS In group A, the survival times of the allografts were prolonged to an average of 8.0 d. Rejection was significantly delayed compared with the averages of the corresponding control groups B, E, and F (5.5, 5.9, and 5.8 d). No rejection was seen in control groups C and D. CONCLUSION These results demonstrate that MMC-treated donor PBMCs significantly prolong allograft survival when administered systemically on the day of transplantation. However, the immunomodulatory effect is relatively modest with further research being required to clarify dose-effect relations, cell characteristics, and an optimized mechanism and timing for cell application.
Collapse
Affiliation(s)
- Christian Andreas Radu
- Department of Hand, Plastic, and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic and Hand Surgery, University of Heidelberg, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Abstract
OBJECTIVES We recently reported that mitomycin C (MMC) treatment and subsequent culture of islets significantly prolongs graft survival in allotransplantation and xenotransplantation models. The present study was performed to determine the changes in morphology and signal transduction in pancreatic islets after MMC treatment. METHODS Freshly isolated rat islets were treated with 10 μg/mL MMC for 30 minutes and then cultured for up to 3 days. The samples were processed for immunohistologic studies and electron microscopic examination at various times after treatment. A DNA fragmentation assay was performed to detect apoptotic cell death. Western blotting was performed to determine the effects of MMC on signal transduction. RESULTS As early as 4 hours after culture, the islets showed central damage; most cells were necrotic and stained with anti-high mobility group box 1 antibody, and a few were apoptotic. The ratio of the damaged area to the whole area was significantly decreased after MMC treatment. Western blotting showed that MMC treatment increased the levels of activated forms of p53 and p21, whereas levels of the activated forms of Akt and caspase-3 were unchanged. CONCLUSIONS Mitomycin C treatment protects islets from the progression of central damage during culture. The p53-p21 pathway might be involved in these effects. ABBREVIATIONS MMC - mitomycin C, HMGB1 - high mobility group box 1.
Collapse
|
6
|
Gunji T, Saito T, Sato Y, Matsuyama S, Ise K, Kimura T, Anazawa T, Gotoh M. Mitomycin-C Treatment Followed by Culture Produces Long-Term Survival of Islet Xenografts in a Rat-to Mouse Model. Cell Transplant 2008; 17:619-29. [DOI: 10.3727/096368908786092720] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
One of the goals of islet transplantation is to transplant viable islets without host immunosuppression. The present study was designed to determine whether pretreatment of islets with mitomycin-C (MMC) followed by culture enhances islet survival in a rat-to-mouse xenogeneic combination. WS(RT1k) rat islets pretreated with various concentrations of MMC (0, 3.2, 10, 32, 100, 320, and 1000 μg/ml) were tested for viability by in vitro insulin secretory capacity and vital staining of islets. The MMC-treated islets (10 μg/ml) cultured for various periods (4, 20, or 40 h, 3 or 7 days) were transplanted into the renal subcapsular space of STZ-induced diabetic C57BL/6 (B6: H-2b) mice. MMC-treated or nontreated islets were subjected to microarray gene analysis and immunohistological study. Evaluation of in vitro insulin secretory capacity and vital staining of islets indicated that MMC at a dose ≤32 μg/ml is nontoxic and preserves islet function. Marked prolongation of graft survival was noted with half of islet grafts surviving indefinitely (>100 days) when 10 μg/ml of MMC-treated islets was transplanted after 40 h or 3 days in culture, but not when they were transplanted within 4 h following treatment or at 7 days following treatment, indicating that there is a critical culture period necessary for successful islet graft survival. Microarray analysis suggested possible genes for this prolongation with TGF-β highly expressed in MMC-treated islets subjected to culture for 3 days. Our results indicate that MMC treatment followed by a critical culture period induces marked prolongation of rat islet xenograft survival in nonimmunosuppressed recipient mice, offering a strategy for islet transplantation without immunosuppression.
Collapse
Affiliation(s)
- Takashi Gunji
- Department of Surgery I, Fukushima Medical University, Fukushima, 960-1295, Japan
| | - Takuro Saito
- Department of Surgery I, Fukushima Medical University, Fukushima, 960-1295, Japan
| | - Yoshihiro Sato
- Department of Surgery I, Fukushima Medical University, Fukushima, 960-1295, Japan
| | - Shinichi Matsuyama
- Department of Surgery I, Fukushima Medical University, Fukushima, 960-1295, Japan
| | - Kazuya Ise
- Department of Surgery I, Fukushima Medical University, Fukushima, 960-1295, Japan
| | - Takashi Kimura
- Department of Surgery I, Fukushima Medical University, Fukushima, 960-1295, Japan
| | - Takayuki Anazawa
- Department of Surgery I, Fukushima Medical University, Fukushima, 960-1295, Japan
| | - Mitsukazu Gotoh
- Department of Surgery I, Fukushima Medical University, Fukushima, 960-1295, Japan
| |
Collapse
|
7
|
Wang D, Kleist C, Ehser S, Opelz G, Terness P. Ex vivo perfusion with mitomycin C containing solution prolongs heart graft survival in rats. Transplantation 2007; 82:1537-40. [PMID: 17164729 DOI: 10.1097/01.tp.0000235439.39872.f8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Mitomycin C (MMC) is an alkylating agent which suppresses allogeneic T-cell responses. We analyzed the effect of graft perfusion with MMC on transplant survival. Hearts from Brown-Norway (BN) rats were perfused ex vivo with MMC-containing solution, stored and implanted into Lewis (LEW) rats. In order to analyze the in vivo effect of MMC, recipients received MMC posttransplantation or were pretreated with MMC-incubated donor-derived peripheral blood mononuclear cells (PBMCs). The results show that MMC-perfusion significantly prolongs graft survival. Treatment of recipients with MMC has no effect, whereas MMC-treated donor PBMCs injected into the recipient prolong graft survival. Our findings indicate that the targeted perfusion of donor hearts with MMC-containing solution protects the graft from rejection.
Collapse
Affiliation(s)
- Daohu Wang
- Institute for Immunology, Department of Transplantation Immunology, University of Heidelberg, Heidelberg, Germany
| | | | | | | | | |
Collapse
|
8
|
Narang AS, Mahato RI. Biological and Biomaterial Approaches for Improved Islet Transplantation. Pharmacol Rev 2006; 58:194-243. [PMID: 16714486 DOI: 10.1124/pr.58.2.6] [Citation(s) in RCA: 137] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Islet transplantation may be used to treat type I diabetes. Despite tremendous progress in islet isolation, culture, and preservation, the clinical use of this modality of treatment is limited due to post-transplantation challenges to the islets such as the failure to revascularize and immune destruction of the islet graft. In addition, the need for lifelong strong immunosuppressing agents restricts the use of this option to a limited subset of patients, which is further restricted by the unmet need for large numbers of islets. Inadequate islet supply issues are being addressed by regeneration therapy and xenotransplantation. Various strategies are being tried to prevent beta-cell death, including immunoisolation using semipermeable biocompatible polymeric capsules and induction of immune tolerance. Genetic modification of islets promises to complement all these strategies toward the success of islet transplantation. Furthermore, synergistic application of more than one strategy is required for improving the success of islet transplantation. This review will critically address various insights developed in each individual strategy and for multipronged approaches, which will be helpful in achieving better outcomes.
Collapse
Affiliation(s)
- Ajit S Narang
- Department of Pharmaceutical Sciences, University of Tennessee Health Science Center, 26 S. Dunlap St., Feurt Building, Room 413, Memphis, TN 38163, USA
| | | |
Collapse
|