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Ischemia-Reperfusion Injuries Assessment during Pancreas Preservation. Int J Mol Sci 2021; 22:ijms22105172. [PMID: 34068301 PMCID: PMC8153272 DOI: 10.3390/ijms22105172] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/25/2021] [Accepted: 05/10/2021] [Indexed: 12/20/2022] Open
Abstract
Maintaining organ viability between donation and transplantation is of critical importance for optimal graft function and survival. To date in pancreas transplantation, static cold storage (SCS) is the most widely practiced method of organ preservation. The first experiments in ex vivo perfusion of the pancreas were performed at the beginning of the 20th century. These perfusions led to organ oedema, hemorrhage, and venous congestion after revascularization. Despite these early hurdles, a number of factors now favor the use of perfusion during preservation: the encouraging results of HMP in kidney transplantation, the development of new perfusion solutions, and the development of organ perfusion machines for the lung, heart, kidneys and liver. This has led to a resurgence of research in machine perfusion for whole organ pancreas preservation. This review highlights the ischemia-reperfusion injuries assessment during ex vivo pancreas perfusion, both for assessment in pre-clinical experimental models as well for future use in the clinic. We evaluated perfusion dynamics, oedema assessment, especially by impedance analysis and MRI, whole organ oxygen consumption, tissue oxygen tension, metabolite concentrations in tissue and perfusate, mitochondrial respiration, cell death, especially by histology, total cell free DNA, caspase activation, and exocrine and endocrine assessment.
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Carlbom L, Weis J, Johansson L, Korsgren O, Ahlström H. Pre-transplantation 31P-magnetic resonance spectroscopy for quality assessment of human pancreatic grafts - A feasibility study. Magn Reson Imaging 2017; 39:98-102. [PMID: 28188872 DOI: 10.1016/j.mri.2017.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 01/14/2017] [Accepted: 02/07/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate the feasibility of using 31P-MRS for objective non-invasive quality assessment of human pancreas grafts prior to transplantation or islet isolation. MATERIALS AND METHODS Pancreata from 5 human donors, 3 males and 2 females, aged 49-78years, with body mass index (BMI) 22-31kg/m2, were included. Pancreata were perfused with histidine-tryptophan-ketoglutarate solution during procurement and stored in hypothermic condition (4°C) for 21-44h. During the period of hypothermic storage repeated spectra were obtained for each graft by 31P-MRS (1.5Tesla) to measure the cold ischemia time (CIT) dependent changes of the phosphorous metabolites adenosine triphosphate (ATP), phosphomonoesters (PME), phosphodiesters (PDE) and inorganic phosphate (Pi), in the grafts. Graft temperature was measured immediately before and after MR-examination. Reference spectrum for non-viable tissue was obtained after graft exposure to room temperature. RESULTS PME/Pi, PDE/Pi and ATP/Pi spectral intensities ratios decreased with increasing CIT, reflecting the decreased viability of the grafts. PME/Pi ratio was the most discriminatory variable at prolonged CIT. 31P-MRS could be performed without significantly increasing graft temperature. CONCLUSIONS 31P-MRS may provide quantitative parameters for evaluating graft viability ex vivo, and is a promising tool for objective non-invasive assessment of the quality of human pancreas grafts prior to transplantation or islet isolation.
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Affiliation(s)
- Lina Carlbom
- Department of Surgical Sciences, Uppsala University, Sweden..
| | - Jan Weis
- Department of Surgical Sciences, Uppsala University, Sweden
| | - Lars Johansson
- Department of Surgical Sciences, Uppsala University, Sweden
| | - Olle Korsgren
- Department of Immunology, Genetics and Pathology, Uppsala University, Sweden
| | - Håkan Ahlström
- Department of Surgical Sciences, Uppsala University, Sweden
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Barlow AD, Hamed MO, Mallon DH, Brais RJ, Gribble FM, Scott MA, Howat WJ, Bradley JA, Bolton EM, Pettigrew GJ, Hosgood SA, Nicholson ML, Saeb-Parsy K. Use of Ex Vivo Normothermic Perfusion for Quality Assessment of Discarded Human Donor Pancreases. Am J Transplant 2015; 15:2475-82. [PMID: 25989187 PMCID: PMC7212093 DOI: 10.1111/ajt.13303] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 02/10/2015] [Accepted: 02/28/2015] [Indexed: 01/25/2023]
Abstract
A significant number of pancreases procured for transplantation are deemed unsuitable due to concerns about graft quality and the associated risk of complications. However, this decision is subjective and some declined grafts may be suitable for transplantation. Ex vivo normothermic perfusion (EVNP) prior to transplantation may allow a more objective assessment of graft quality and reduce discard rates. We report ex vivo normothermic perfusion of human pancreases procured but declined for transplantation, with ABO-compatible warm oxygenated packed red blood cells for 1-2 h. Five declined human pancreases were assessed using this technique after a median cold ischemia time of 13 h 19 min. One pancreas, with cold ischemia over 30 h, did not appear viable and was excluded. In the remaining pancreases, blood flow and pH were maintained throughout perfusion. Insulin secretion was observed in all four pancreases, but was lowest in an older donation after cardiac death pancreas. Amylase levels were highest in a gland with significant fat infiltration. This is the first study to assess the perfusion, injury, as measured by amylase, and exocrine function of human pancreases using EVNP and demonstrates the feasibility of the approach, although further refinements are required.
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Affiliation(s)
- AD Barlow
- Dept of Surgery, University of Cambridge, Cambridge, UK,NIHR Biomedical Research Campus, Cambridge, UK
| | - MO Hamed
- Dept of Surgery, University of Cambridge, Cambridge, UK,NIHR Biomedical Research Campus, Cambridge, UK
| | - DH Mallon
- Dept of Surgery, University of Cambridge, Cambridge, UK,NIHR Biomedical Research Campus, Cambridge, UK
| | - RJ Brais
- NIHR Biomedical Research Campus, Cambridge, UK,Dept of Histopathology, Addenbrooke’s Hospital, Cambridge, UK
| | - FM Gribble
- NIHR Biomedical Research Campus, Cambridge, UK,Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - MA Scott
- NIHR Biomedical Research Campus, Cambridge, UK,Dept of Haematology, Addenbrooke’s Hospital, Cambridge, UK
| | - WJ Howat
- NIHR Biomedical Research Campus, Cambridge, UK,Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - JA Bradley
- Dept of Surgery, University of Cambridge, Cambridge, UK,NIHR Biomedical Research Campus, Cambridge, UK
| | - EM Bolton
- Dept of Surgery, University of Cambridge, Cambridge, UK,NIHR Biomedical Research Campus, Cambridge, UK
| | - GJ Pettigrew
- Dept of Surgery, University of Cambridge, Cambridge, UK,NIHR Biomedical Research Campus, Cambridge, UK
| | - SA Hosgood
- Division of Transplant Surgery, University of Leicester, Leicester, UK
| | - ML Nicholson
- Division of Transplant Surgery, University of Leicester, Leicester, UK
| | - K Saeb-Parsy
- Dept of Surgery, University of Cambridge, Cambridge, UK,NIHR Biomedical Research Campus, Cambridge, UK
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Serkova NJ, Niemann CU. Pattern recognition and biomarker validation using quantitative1H-NMR-based metabolomics. Expert Rev Mol Diagn 2014; 6:717-31. [PMID: 17009906 DOI: 10.1586/14737159.6.5.717] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The collection of global metabolic data and their interpretation (both spectral and biochemical) using modern spectroscopic techniques and appropriate statistical approaches, are known as 'metabolic profiling', 'metabonomics' or 'metabolomics'. This review addresses 1H-nuclear magnetic resonance (NMR)-based metabolomic principles and their application in biomedical science, with special emphasis on their potential in translational research in transplantation, oncology, and drug toxicity or discovery. Various steps in metabolomics analysis are described in order to illustrate the types of biological samples, their respective handling and preparation for 1H-NMR analysis; provide a rationale for using pattern-recognition techniques (spectral database concept) versus quantitative 1H-NMR-based metabolomics (metabolite database concept); and identify necessary technological and logistical future developments that will allow 1H-NMR-based metabolomics to become an established tool in biomedical research and patient care.
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Affiliation(s)
- Natalie J Serkova
- University of Colorado Health Sciences Center, Biomedical MRI/MRS Cancer Center Core, Department of Anesthesiology, Denver, CO 80262, USA.
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Agrawal A, Bainbridge A, Powis S, Fuller B, Cady EB, Davidson BR. 31-Phosphorus magnetic resonance spectroscopy for dynamic assessment of adenosine triphosphate levels in pancreas preserved by the two-layer method. Transplant Proc 2011; 43:1801-9. [PMID: 21693282 DOI: 10.1016/j.transproceed.2011.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 02/07/2011] [Indexed: 12/21/2022]
Abstract
Cold preservation injury influences islet graft function. Reliable tools for real-time assessment of pancreas viability before islet isolation are lacking. Phosphorus magnetic resonance spectroscopy ((31)P-MRS) was used immediately after organ harvest to study rat pancreases at 4 °C to 6 °C in five randomized preservation groups: Marshall's solution, static two-layer method (TLM), continuous TLM with oxygen perfused at 0.5 L/min, and static TLM or continuous TLM both the latter following 30 minutes of warm ischemia (WI). (31)P spectra were analyzed for phosphomonoesters, inorganic phosphate (Pi) and α-, β-and γ-nucleotide triphosphate. Intergroup rates of change of [γ-adenosine triphosphate (ATP)]/[Pi] and [β-ATP]/[Pi] throughout preservation period were significantly different. For continuous TLM there was an increase relative to baseline (0.043 (SD0.033) h(-1) and 0.029 (0.029) h(-1), respectively) but a decrease for both static TLM (-0.023 (0.016) h(-1) and 0.015 (0.026), P < .001 and < .05, respectively) and Marshall's (-0.049 (0.025) h(-1) and -0.036 (0.019) h(-1), respectively, both P < .001) with respect to continuous TLM. Rate of decrease was similar for the Marshall's and static TLM groups. [γ-ATP]/[Pi] and [β-ATP]/[Pi] increased with WI continuous TLM (0.008 [0.009] h(-1) and 0.007 [0.008] hr(-1), respectively) but decreased for WI static TLM (-0.018 (0.008) h(-1) and -0.014 (0.004) hr(-1), respectively, P < .001). (31)P-MRS is an effective tool for noninvasive assessment of pancreas bioenergetics. Continuous TLM preserves cellular bioenergetics and is superior to current non-perfluorocar bone based solutions for pancreas preservation.
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Affiliation(s)
- A Agrawal
- Department of Surgery, Royal Free Hospital and University College School of Medicine, London, England.
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Scott WE, Weegman BP, Ferrer-Fabrega J, Stein SA, Anazawa T, Kirchner VA, Rizzari MD, Stone J, Matsumoto S, Hammer BE, Balamurugan AN, Kidder LS, Suszynski TM, Avgoustiniatos ES, Stone SG, Tempelman LA, Sutherland DER, Hering BJ, Papas KK. Pancreas oxygen persufflation increases ATP levels as shown by nuclear magnetic resonance. Transplant Proc 2011; 42:2011-5. [PMID: 20692395 DOI: 10.1016/j.transproceed.2010.05.091] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Islet transplantation is a promising treatment for type 1 diabetes. Due to a shortage of suitable human pancreata, high cost, and the large dose of islets presently required for long-term diabetes reversal; it is important to maximize viable islet yield. Traditional methods of pancreas preservation have been identified as suboptimal due to insufficient oxygenation. Enhanced oxygen delivery is a key area of improvement. In this paper, we explored improved oxygen delivery by persufflation (PSF), ie, vascular gas perfusion. METHODS Human pancreata were obtained from brain-dead donors. Porcine pancreata were procured by en bloc viscerectomy from heparinized donation after cardiac death donors and were either preserved by either two-layer method (TLM) or PSF. Following procurement, organs were transported to a 1.5-T magnetic resonance (MR) system for (31)P nuclear magnetic resonance spectroscopy to investigate their bioenergetic status by measuring the ratio of adenosine triphosphate to inorganic phosphate (ATP:P(i)) and for assessing PSF homogeneity by MRI. RESULTS Human and porcine pancreata can be effectively preserved by PSF. MRI showed that pancreatic tissue was homogeneously filled with gas. TLM can effectively raise ATP:P(i) levels in rat pancreata but not in larger porcine pancreata. ATP:P(i) levels were almost undetectable in porcine organs preserved with TLM. When human or porcine organs were preserved by PSF, ATP:P(i) was elevated to levels similar to those observed in rat pancreata. CONCLUSION The methods developed for human and porcine pancreas PSF homogeneously deliver oxygen throughout the organ. This elevates ATP levels during preservation and may improve islet isolation outcomes while enabling the use of marginal donors, thus expanding the usable donor pool.
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Affiliation(s)
- W E Scott
- Department of Surgery, Schulze Diabetes Institute, University of Minnesota, Minneapolis, Minnesota, USA
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George AJT, Bhakoo KK, Haskard DO, Larkman DJ, Reynolds PR. Imaging Molecular and Cellular Events in Transplantation. Transplantation 2006; 82:1124-9. [PMID: 17102760 DOI: 10.1097/01.tp.0000235530.80305.d2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Imaging methods such as nuclear medicine (including positron emission tomography), magnetic resonance imaging, ultrasound, and optical imaging can be used to provide information about the expression of genes, and the location of molecules and cells in intact animals or patients. In the setting of transplantation, this will allow monitoring of inflammatory responses, as well as the state of the graft. In this review, the advantages and disadvantages of different approaches to imaging will be discussed, as well as their potential application to transplantation.
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Affiliation(s)
- Andrew J T George
- Department of Immunology, Division of Medicine, Imperial College London, Hammersmith Campus, London, United Kingdom.
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Kanderi T, Moore WH, Wendt JA. Molecular imaging in transplantation: basic concepts and strategies for potential application. Nucl Med Commun 2005; 26:947-55. [PMID: 16208171 DOI: 10.1097/01.mnm.0000183800.89591.2c] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The potential applications of molecular imaging in the clinical arena are diverse and expanding rapidly. One such area of application is transplantation. Currently, biopsy is the gold standard for monitoring allograft well-being after transplantation of organs or tissues. However, biopsies are invasive, associated with morbidity if performed on a routine basis and can potentially miss focal rejection. AIM It is notable that none of the existing studies in the literature have examined the possible role of molecular imaging in transplantation-related indications. In this direction, this paper aims to discuss imaging strategies that could be of pertinence in monitoring immune events and improving long-term outcomes after solid organ or tissue transplantation. METHODS This paper discusses the currently available direct/surrogate imaging techniques/agents that can be used to detect chemokine receptors/ligands, leucocyte endothelial events and ischaemia-reperfusion injury in transplantation. CONCLUSION Molecular imaging methods can non-invasively detect, quantify and monitor immune phenomena, such as rejection or graft-versus-host disease, after transplantation. Molecular imaging could help in targeted biopsy and could improve graft survival by allowing for early intervention with tailored immunosuppressive regimens. Given the unprecedented progress in the field, the potential benefits of molecular imaging to the speciality of organ and tissue transplantation cannot be underestimated.
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Affiliation(s)
- Tanuja Kanderi
- Division of Nuclear Medicine, Department of Radiology, Baylor College of Medicine, Houston, Texas, USA.
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