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Siemionow M, Kulahci Y, Zor F. Novel cell-based strategies for immunomodulation in vascularized composite allotransplantation. Curr Opin Organ Transplant 2023; 28:431-439. [PMID: 37800652 DOI: 10.1097/mot.0000000000001109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
PURPOSE OF REVIEW Vascularized composite allotransplantation (VCA) has become a clinical reality in the past two decades. However, its routine clinical applications are limited by the risk of acute rejection, and the side effects of the lifelong immunosuppression. Therefore, there is a need for new protocols to induce tolerance and extend VCA survival. Cell- based therapies have emerged as an attractive strategy for tolerance induction in VCA. This manuscript reviews the current strategies and applications of cell-based therapies for tolerance induction in VCA. RECENT FINDINGS Cellular therapies, including the application of bone marrow cells (BMC), mesenchymal stem cells (MSC), adipose stem cells, regulatory T cells (Treg) cells, dendritic cells and donor recipient chimeric cells (DRCC) show promising potential as a strategy to induce tolerance in VCA. Ongoing basic science research aims to provide insights into the mechanisms of action, homing, functional specialization and standardization of these cellular therapies. Additionally, translational preclinical and clinical studies are underway, showing encouraging outcomes. SUMMARY Cellular therapies hold great potential and are supported by preclinical studies and clinical trials demonstrating safety and efficacy. However, further research is needed to develop novel cell-based immunosuppressive protocol for VCA.
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Affiliation(s)
- Maria Siemionow
- Department of Orthopeadics, University of Illinois at Chicago, Chicago, Illinois
| | - Yalcin Kulahci
- Department of Surgery, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Fatih Zor
- Department of Plastic Surgery, Indiana University, Indianapolis, Indiana, USA
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Implications of Vascularized Composite Allotransplantation in Plastic Surgery on Legal Medicine. J Clin Med 2023; 12:jcm12062308. [PMID: 36983310 PMCID: PMC10054408 DOI: 10.3390/jcm12062308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/08/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Background: When a patient receives a transplant—be it classically an organ or bone marrow or, more recently, composite allotransplantations of the limb or face—it can result in artificial chimerism. Such chimerism raises considerations in forensic medicine, a field that relies on the collection and identification of biological samples from crime scenes. Beyond this chimerism, composite allotransplantations create further challenges. Methods: After screening the literature and press releases, we provide a brief history and summary of some of the technologies used in forensic identification, explaining their advantages and pitfalls in the light of transplantation and cautioning against misidentifying those who evade justice by taking advantage of such considerations. Results: With face transplantation, patients can receive the skin, hair, salivary glands, teeth, and oral and nasal mucosa of their donors, components which hold great importance in forensic science. Modern technologies such as computer-assisted facial recognition, although gradually becoming more accurate over time, also face new challenges in this post-transplantation era as facial recognition software can be misled by surgical alterations of the face or face transplantation. With limb transplantation, there is an impact on fingerprint identification. Conclusions: Both surgical transplantation techniques and forensic technologies have seen incomprehensibly great innovation in the past century. Given the growing rate of successful composite transplantation in the USA and worldwide, it is now important for law enforcement agents to be aware of the new possibility of having two sets of genetic material, hair, saliva, fingerprints, or even facial recognition data for the same individual.
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Luo X, Zhang J, Zou S, Wang X, Chen G, Li Z, Li K, Wang M, Chen Z, Ming C, Zhu X, Gong N. Bone Fragment Co-transplantation Alongside Bone Marrow Aspirate Infusion Protects Kidney Transplant Recipients. Front Immunol 2021; 12:630710. [PMID: 33643315 PMCID: PMC7904687 DOI: 10.3389/fimmu.2021.630710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/22/2021] [Indexed: 12/20/2022] Open
Abstract
Integration of non-vascularized bone grafting and bone marrow aspirate infusion in transplantation may provide clinical benefit. Here we have incorporated bone fragment co-transplantation and bone marrow aspirate infusion (BF-BM) into living kidney transplantation (LKT). Twenty LKT recipients receiving bone fragments and bone marrow aspirates donated from their corresponding donors were enrolled into a retrospective study. A contemporaneous control group was formed of 38 out of 128 conventional LKT recipients, selected using propensity score matching by a 1:2 Greedy algorithm. Ultrasonography, contrast-enhanced ultrasonography (US/CEUS) and SPECT/CT showed that the co-transplanted bone fragments remained viable for 6 months, subsequently shrank, and finally degenerated 10 months post-transplantation. BF-BM resulted in earlier kidney recovery and more robust long-term kidney function. Throughout 5 years of follow-up, BF-BM had regulatory effects on dendritic cells (DCs), T helper (Th1/Th2) cells and regulatory T cells (Tregs). Both alloantigen-specific lymphocyte proliferation and panel reactive antibody levels were negative in all recipients with or without BF-BM. In addition, the BF-BM group experienced few complications during the 5-year follow-up (as did the donors)—this was not different from the controls. In conclusion, BF-BM is safe and benefits recipients by protecting the kidney and regulating the immune response.
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Affiliation(s)
- Xianzhang Luo
- Key Laboratory of the National Health Commission, Institute of Organ Transplantation, Tongji Medical College, The Ministry of Education and Chinese Academy of Medical Sciences, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory for Biorheological Science and Technology of Ministry of Education, Chongqing University Cancer Hospital, Chongqing, China
| | - Ji Zhang
- Key Laboratory of the National Health Commission, Institute of Organ Transplantation, Tongji Medical College, The Ministry of Education and Chinese Academy of Medical Sciences, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Sijuan Zou
- Department of Nuclear Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Xinqiang Wang
- Key Laboratory of the National Health Commission, Institute of Organ Transplantation, Tongji Medical College, The Ministry of Education and Chinese Academy of Medical Sciences, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Gen Chen
- Department of Radiology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zhen Li
- Department of Radiology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Kaiyan Li
- Department of Medical Ultrasound, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Mengqing Wang
- Key Laboratory of the National Health Commission, Institute of Organ Transplantation, Tongji Medical College, The Ministry of Education and Chinese Academy of Medical Sciences, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zhishui Chen
- Key Laboratory of the National Health Commission, Institute of Organ Transplantation, Tongji Medical College, The Ministry of Education and Chinese Academy of Medical Sciences, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Changshen Ming
- Key Laboratory of the National Health Commission, Institute of Organ Transplantation, Tongji Medical College, The Ministry of Education and Chinese Academy of Medical Sciences, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaohua Zhu
- Department of Nuclear Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Nianqiao Gong
- Key Laboratory of the National Health Commission, Institute of Organ Transplantation, Tongji Medical College, The Ministry of Education and Chinese Academy of Medical Sciences, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
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Chimerism-based experimental models for tolerance induction in vascularized composite allografts: Cleveland clinic research experience. Clin Dev Immunol 2013; 2013:831410. [PMID: 23573114 PMCID: PMC3612438 DOI: 10.1155/2013/831410] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 02/12/2013] [Accepted: 02/12/2013] [Indexed: 11/20/2022]
Abstract
The preclinical experimental models of vascularized composite allografts (VCAs) have been rapidly developed for the assessment of immunomodulatory protocols for clinical application. Recently, researchers have focused on immunomodulatory protocols which overcome the immunologic barrier between the allogeneic donor and recipient and may lead to tolerance induction. In order to test the feasibility of chimerism induction, experimental VCAs have been performed in different models including rodents, large animals, and nonhuman primates. These models differ in the complexity of transplanted tissue and in their responses to immunomodulatory protocols. In most applications, VCA contains multiple-tissue components; however, each individual component of CTA possesses unique immunologic characteristics that ultimately contribute to the chimerism induction and successful outcome of the VCA. Heterogenic character and complexity of tissue components in different VCA models determine the quality and robustness of donor-specific chimerism. As introduced in experimental studies, variable immunomodulatory options have been studied to achieve tolerance to VCA in rodents and large animal models allowing for widespread application in clinic. In this paper, based on our own experience, we have analyzed the current knowledge of tolerance-inducing strategies via chimerism induction in VCA experimental models in the context of immunomodulatory protocols and VCA complexity and their relevance and applicability to clinical practice.
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Bozkurt M, Klimczak A, Nasir S, Zor F, Krokowi̇cz L, Siemionow M. Composite osseomusculocutaneous sternum, ribs, thymus, pectoralis muscles, and skin allotransplantation model of bone marrow transplantation. Microsurgery 2012; 33:43-50. [DOI: 10.1002/micr.22023] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 06/04/2012] [Accepted: 06/08/2012] [Indexed: 11/06/2022]
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Mundinger GS, Kelamis JA, Kim SH, Magarakis M, Jones LS, Ha JS, Rodriguez ED. Tunneled superficial inferior epigastric artery (SIEA) myocutaneous/vascularized femur chimeric flaps: A model to study the role of vascularized bone marrow in composite allografts. Microsurgery 2011; 32:128-35. [DOI: 10.1002/micr.20957] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2011] [Revised: 08/05/2011] [Accepted: 08/09/2011] [Indexed: 11/12/2022]
Affiliation(s)
- Gerhard S. Mundinger
- Division of Plastic, Reconstructive and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center/University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD 21201
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Joseph A. Kelamis
- Division of Plastic, Reconstructive and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center/University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD 21201
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Soon H. Kim
- Division of Plastic, Reconstructive and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center/University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD 21201
- Department of Plastic and Reconstructive Surgery, Konkuk University, Seoul, Korea
| | - Michael Magarakis
- Division of Plastic, Reconstructive and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center/University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD 21201
| | - Luke S. Jones
- Division of Plastic, Reconstructive and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center/University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD 21201
| | - Jinny S. Ha
- Division of Plastic, Reconstructive and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center/University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD 21201
| | - Eduardo D. Rodriguez
- Division of Plastic, Reconstructive and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center/University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD 21201
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
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