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Serradilla J, Andrés Moreno AM, Talayero P, Burgos P, Machuca M, Camps Ortega O, Vallejo MT, Rubio Bolívar FJ, Bueno A, Sánchez A, Zambrano C, De la Torre Ramos CA, Rodríguez O, Largo C, Serrano P, Prieto Bozano G, Ramos E, López Santamaría M, Stringa P, Hernández F. Preclinical Study of DCD and Normothermic Perfusion for Visceral Transplantation. Transpl Int 2023; 36:11518. [PMID: 37745640 PMCID: PMC10514355 DOI: 10.3389/ti.2023.11518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/25/2023] [Indexed: 09/26/2023]
Abstract
Considering recent clinical and experimental evidence, expectations for using DCD-derived intestines have increased considerably. However, more knowledge about DCD procedure and long-term results after intestinal transplantation (ITx) is needed. We aimed to describe in detail a DCD procedure for ITx using normothermic regional perfusion (NRP) in a preclinical model. Small bowel was obtained from pigs donors after 1 h of NRP and transplanted to the recipients. Graft Intestinal samples were obtained during the procedure and after transplantation. Ischemia-reperfusion injury (Park-Chiu score), graft rejection and transplanted intestines absorptive function were evaluated. Seven of 8 DCD procedures with NRP and ITx were successful (87.5%), with a good graft reperfusion and an excellent recovery of the recipient. The architecture of grafts was well conserved during NRP. After an initial damage of Park-chiu score of 4, all grafts recovered from ischemia-reperfusion, with no or very subtle alterations 2 days after ITx. Most recipients (71.5%) did not show signs of rejection. Only two cases demonstrated histologic signs of mild rejection 7 days after ITx. Interestingly intestinal grafts showed good absorptive capacity. The study's results support the viability of intestinal grafts from DCD using NRP, contributing more evidence for the use of DCD for ITx.
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Affiliation(s)
- Javier Serradilla
- Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain
- Transplant Research Group, Institute for Health Research IdiPaz, Madrid, Spain
| | - Ane Miren Andrés Moreno
- Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain
- Transplant Research Group, Institute for Health Research IdiPaz, Madrid, Spain
| | - Paloma Talayero
- Department of Immunology, University Hospital 12 de Octubre, Madrid, Spain
| | - Paula Burgos
- Transplant Research Group, Institute for Health Research IdiPaz, Madrid, Spain
- Department of Cardiovascular Surgery, La Paz University Hospital, Madrid, Spain
| | - Mariana Machuca
- Special Pathology Laboratory, Faculty of Veterinary Sciences, National University of La Plata, La Plata, Argentina
| | - Onys Camps Ortega
- Molecular Imaging and Immunohistochemistry Laboratory, Institute for Health Research IdiPaz, Madrid, Spain
| | - María Teresa Vallejo
- Molecular Imaging and Immunohistochemistry Laboratory, Institute for Health Research IdiPaz, Madrid, Spain
| | | | - Alba Bueno
- Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain
- Transplant Research Group, Institute for Health Research IdiPaz, Madrid, Spain
| | - Alba Sánchez
- Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain
- Transplant Research Group, Institute for Health Research IdiPaz, Madrid, Spain
| | - Cristina Zambrano
- Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain
| | - Carlos Andrés De la Torre Ramos
- Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain
- Transplant Research Group, Institute for Health Research IdiPaz, Madrid, Spain
| | - Olaia Rodríguez
- Department of Biochemistry, La Paz University Hospital, IdiPaz, Madrid, Spain
| | - Carlota Largo
- Transplant Research Group, Institute for Health Research IdiPaz, Madrid, Spain
- Department of Experimental Surgery, La Paz University Hospital, Madrid, Spain
| | - Pilar Serrano
- Intestinal Rehabilitation and Transplantation Unit, La Paz University Hospital, Madrid, Spain
| | - Gerardo Prieto Bozano
- Intestinal Rehabilitation and Transplantation Unit, La Paz University Hospital, Madrid, Spain
| | - Esther Ramos
- Transplant Research Group, Institute for Health Research IdiPaz, Madrid, Spain
- Intestinal Rehabilitation and Transplantation Unit, La Paz University Hospital, Madrid, Spain
| | - Manuel López Santamaría
- Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain
- Transplant Research Group, Institute for Health Research IdiPaz, Madrid, Spain
| | - Pablo Stringa
- Transplant Research Group, Institute for Health Research IdiPaz, Madrid, Spain
- Institute for Immunological and Pathophysiological Studies (IIFP), National University of La Plata, National Council of Scientific and Technical Research (CONICET), La Plata, Argentina
| | - Francisco Hernández
- Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain
- Transplant Research Group, Institute for Health Research IdiPaz, Madrid, Spain
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2
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Abate JC, Lausada N, Vecchio Dezillio L, Moreira J, Marinoff II, Ferreyra Compagnucci MM, Andrés Moreno AM, Largo C, Rumbo M, Hernández Oliveros F, Romanin D, Stringa P. When less is more: Experimental Bishop-Koop technique for reduction in the use of laboratory animals for intestinal pathophysiological studies. Lab Anim 2023; 57:443-454. [PMID: 36748321 DOI: 10.1177/00236772231151563] [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: 02/08/2023]
Abstract
The use of animals to gain knowledge and understanding of diseases needs to be reduced and refined. In the field of intestinal research, because of the complexity of the gut immune system, living models testing is mandatory. Based on the 3Rs (replacement, reduction and refinement) principles, we aimed to developed and apply the derived-intestinal surgical procedure described by Bishop and Koop (BK) in rats to refine experimental gastrointestinal procedures and reduce the number of animals used for research employing two models of intestinal inflammation: intestinal ischemia-reperfusion injury and chemical-induced colitis. Our results show the feasibility of the application of the BK technique in rodents, with good success after surgical procedure in both small and large intestine (100% survival, clinical recovery and weight regain). A considerable reduction in the use of the number of rats in both intestinal inflammation models (80% in case of intestinal ischemia-reperfusion damage and 66.6% in chemical-induced colitis in our experimental design) was achieved. Compared with conventional experimental models described by various research groups, we report excellent reproducibility of intestinal damage and functionality, survival rate and clinical status of the animals when BK is applied.
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Affiliation(s)
- Juan Cruz Abate
- Organ Transplant Laboratory, School of Medicine, National University of La Plata, Argentina
| | - Natalia Lausada
- Organ Transplant Laboratory, School of Medicine, National University of La Plata, Argentina
| | - Leandro Vecchio Dezillio
- Institute for Immunological and Pathophysiological Studies (IIFP), School of Exact Sciences, National University of La Plata, National Council of Scientific and Technical Research (CONICET), Argentina
| | - Jeremías Moreira
- Institute of Translational Medicine, Transplantation and Bioengineering (IMETTyB), Favaloro Foundation University Hospital, Argentina
| | - Ivana Ivanoff Marinoff
- Institute for Immunological and Pathophysiological Studies (IIFP), School of Exact Sciences, National University of La Plata, National Council of Scientific and Technical Research (CONICET), Argentina
| | - Maria Malena Ferreyra Compagnucci
- Institute for Immunological and Pathophysiological Studies (IIFP), School of Exact Sciences, National University of La Plata, National Council of Scientific and Technical Research (CONICET), Argentina
| | - Ane Miren Andrés Moreno
- Department of Pediatric Surgery, La Paz University Hospital, Spain
- Transplant Group, La Paz University Hospital Health Research Institute (IdiPAZ), Spain
| | - Carlota Largo
- Department of Experimental Surgery (IdiPaz), La Paz University Hospital, Spain
| | - Martín Rumbo
- Institute for Immunological and Pathophysiological Studies (IIFP), School of Exact Sciences, National University of La Plata, National Council of Scientific and Technical Research (CONICET), Argentina
| | - Francisco Hernández Oliveros
- Department of Pediatric Surgery, La Paz University Hospital, Spain
- Transplant Group, La Paz University Hospital Health Research Institute (IdiPAZ), Spain
| | - David Romanin
- Institute for Immunological and Pathophysiological Studies (IIFP), School of Exact Sciences, National University of La Plata, National Council of Scientific and Technical Research (CONICET), Argentina
| | - Pablo Stringa
- Organ Transplant Laboratory, School of Medicine, National University of La Plata, Argentina
- Institute for Immunological and Pathophysiological Studies (IIFP), School of Exact Sciences, National University of La Plata, National Council of Scientific and Technical Research (CONICET), Argentina
- Transplant Group, La Paz University Hospital Health Research Institute (IdiPAZ), Spain
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3
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Stringa P, Vecchio Dezillio LE, Talayero P, Serradilla J, Errea A, Machuca M, Papa-Gobbi R, Camps Ortega O, Pucci Molineris M, Lausada N, Andres Moreno AM, Rumbo M, Hernández Oliveros F. Experimental Assessment of Intestinal Damage in Controlled Donation After Circulatory Death for Visceral Transplantation. Transpl Int 2023; 36:10803. [PMID: 36713114 PMCID: PMC9878676 DOI: 10.3389/ti.2023.10803] [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: 07/27/2022] [Accepted: 01/02/2023] [Indexed: 01/15/2023]
Abstract
There is an urgent need to address the shortage of potential multivisceral grafts in order to reduce the average time in waiting list. Since donation after circulatory death (DCD) has been successfully employed for other solid organs, a thorough evaluation of the use of intestinal grafts from DCD is warranted. Here, we have generated a model of Maastricht III DCD in rodents, focusing on the viability of intestinal and multivisceral grafts at five (DCD5) and twenty (DCD20) minutes of cardiac arrest compared to living and brain death donors. DCD groups exhibited time-dependent damage. DCD20 generated substantial intestinal mucosal injury and decreased number of Goblet cells whereas grafts from DCD5 closely resemble those of brain death and living donors groups in terms intestinal morphology, expression of tight junction proteins and number of Paneth and Globet cells. Upon transplantation, intestines from DCD5 showed increased ischemia/reperfusion damage compared to living donor grafts, however mucosal integrity was recovered 48 h after transplantation. No differences in terms of graft rejection, gene expression and absorptive function between DCD5 and living donor were observed at 7 post-transplant days. Collectively, our results highlight DCD as a possible strategy to increase multivisceral donation and transplantation procedures.
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Affiliation(s)
- Pablo Stringa
- Transplant Group, La Paz University Hospital Health Research Institute (IdiPAZ), Madrid, Spain,Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain,Institute for Immunological and Pathophysiological Studies (IIFP), School of Exact Sciences, National University of La Plata, National Council of Scientific and Technical Research (CONICET), La Plata, Argentina,Organ Transplant Laboratory, School of Medicine, National University of La Plata, La Plata, Argentina
| | - Leandro Emmanuel Vecchio Dezillio
- Institute for Immunological and Pathophysiological Studies (IIFP), School of Exact Sciences, National University of La Plata, National Council of Scientific and Technical Research (CONICET), La Plata, Argentina,Organ Transplant Laboratory, School of Medicine, National University of La Plata, La Plata, Argentina
| | - Paloma Talayero
- Immunology Department, 12 de Octubre University Hospital, Madrid, Spain
| | - Javier Serradilla
- Transplant Group, La Paz University Hospital Health Research Institute (IdiPAZ), Madrid, Spain,Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain
| | - Agustina Errea
- Institute for Immunological and Pathophysiological Studies (IIFP), School of Exact Sciences, National University of La Plata, National Council of Scientific and Technical Research (CONICET), La Plata, Argentina
| | - Mariana Machuca
- Special Pathology Laboratory, Faculty of Veterinary Sciences, National University of La Plata, La Plata, Argentina
| | - Rodrigo Papa-Gobbi
- Transplant Group, La Paz University Hospital Health Research Institute (IdiPAZ), Madrid, Spain,Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain,Institute for Immunological and Pathophysiological Studies (IIFP), School of Exact Sciences, National University of La Plata, National Council of Scientific and Technical Research (CONICET), La Plata, Argentina
| | - Onys Camps Ortega
- Transplant Group, La Paz University Hospital Health Research Institute (IdiPAZ), Madrid, Spain,Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain
| | - Melisa Pucci Molineris
- Biochemistry Research Institute of La Plata, School of Medicine, National University of La Plata, National Council of Scientific and Technical Research (CONICET), La Plata, Argentina
| | - Natalia Lausada
- Organ Transplant Laboratory, School of Medicine, National University of La Plata, La Plata, Argentina
| | - Ane Miren Andres Moreno
- Transplant Group, La Paz University Hospital Health Research Institute (IdiPAZ), Madrid, Spain,Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain
| | - Martin Rumbo
- Institute for Immunological and Pathophysiological Studies (IIFP), School of Exact Sciences, National University of La Plata, National Council of Scientific and Technical Research (CONICET), La Plata, Argentina
| | - Francisco Hernández Oliveros
- Transplant Group, La Paz University Hospital Health Research Institute (IdiPAZ), Madrid, Spain,Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain,Executive Operational Committee, ERN TransplantChild, Madrid, Spain,*Correspondence: Francisco Hernández Oliveros,
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4
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Stringa P, Papa-Gobbi R, Vela M, Gentilini MV, Machuca M, Klin P, Arreola NM, Serradilla J, Bueno A, Andrés AM, Ramos E, Alcolea A, Pérez-Martínez A, Prieto G, López-Santamaría M, Gondolesi G, Rumbo M, Hernández F. Native Spleen Preservation During Visceral Transplantation Inhibits Graft-Versus-Host-Disease Development: Clinical and Experimental Study. Ann Surg 2023; 277:e235-e244. [PMID: 34171860 DOI: 10.1097/sla.0000000000004979] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We aimed to assess whether native spleen preservation during visceral transplantation (VT) affects graft-versus-host-disease (GVHD) incidence. SUMMARY BACKGROUND DATA GVHD is one of the most severe and frequently lethal hematological complications after VT procedures. Because there is no specific treatment for GVHD, it is imperative to develop a strategy to reduce donor lymphocyte engraftment and proliferation. METHODS Our study included both clinical and experimental data. A total of 108 patients were divided into 3 groups: a native spleen preservation group, a native spleen removal with no donor spleen group, and a donor spleen included (allogeneic spleen) group. We also used an allogeneic VT rat model, in which recipients were divided into 2 groups: a native spleen preservation (+SP) group and a native spleen removal (-S) group. Skin rash appearance, histopathological changes, chimerism, and spleen effects on circulating allogeneic T-cells were assessed. RESULTS The patients with native spleen preservation showed a lower rate of GVHD ( P <.001) and better survival ( P <.05) than those in the other groups. Skin and histological signs of GVHD were lower in the rats in the +SP group ( P <.05). The donor T-cell frequency in the bloodstream and skin was also significantly reduced when the native spleen was preserved ( P <.01 and P <.0001, respectively). CONCLUSIONS The clinical and experimental data indicate that recipient spleen preservation protects against GVHD after VT, and donor cell clearance from the bloodstream by spleen macrophages could be the underlying mechanism. Therefore, spleen preservation should be considered in VT procedures, whenever possible.
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Affiliation(s)
- Pablo Stringa
- Transplant Group, La Paz University Hospital Health Research Institute (IdiPAZ), Madrid, Spain; Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain
- Institute for Immunological and Pathophysiological Studies (IIFP), School of Exact Sciences, National University of La Plata, National Council of Scientific and Technical Research (cONIcET), La Plata, Argentina
| | - Rodrigo Papa-Gobbi
- Transplant Group, La Paz University Hospital Health Research Institute (IdiPAZ), Madrid, Spain; Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain
| | - María Vela
- Translational Research Group in Childhood Cancer, Hematopoietic Transplant and cell Therapy, La Paz University Hospital Health Research Institute (IdiPAZ), Madrid, Spain
| | - María Virginia Gentilini
- Intestinal Failure, Rehabilitation and Transplant Unit, University Hospital Favaloro Foundation; Institute of Translational Medicine, Transplantation and Bioengineering (ImeTTyB), University Favaloro-CONICET, Buenos Aires, Argentina
| | - Mariana Machuca
- Special Pathology Laboratory, Faculty of Veterinary Sciences, National University of La Plata, La Plata, Buenos Aires, Argentina
| | - Pablo Klin
- Telemetry Unit. Favaloro Foundation. University Hospital, Buenos Aires, Argentina
| | - Nidia M Arreola
- Transplant Group, La Paz University Hospital Health Research Institute (IdiPAZ), Madrid, Spain; Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain
| | - Javier Serradilla
- Transplant Group, La Paz University Hospital Health Research Institute (IdiPAZ), Madrid, Spain; Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain
| | - Alba Bueno
- Transplant Group, La Paz University Hospital Health Research Institute (IdiPAZ), Madrid, Spain; Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain
| | - Ane M Andrés
- Transplant Group, La Paz University Hospital Health Research Institute (IdiPAZ), Madrid, Spain; Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain
| | - Esther Ramos
- Transplant Group, La Paz University Hospital Health Research Institute (IdiPAZ), Madrid, Spain; Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain
| | - Alida Alcolea
- Transplant Group, La Paz University Hospital Health Research Institute (IdiPAZ), Madrid, Spain; Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain
| | - Antonio Pérez-Martínez
- Translational Research Group in Childhood Cancer, Hematopoietic Transplant and cell Therapy, La Paz University Hospital Health Research Institute (IdiPAZ), Madrid, Spain
| | - Gerardo Prieto
- Healthcare System Emeritus, La Paz University Hospital, Madrid, Spain; and
| | - Manuel López-Santamaría
- Transplant Group, La Paz University Hospital Health Research Institute (IdiPAZ), Madrid, Spain; Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain
| | - Gabriel Gondolesi
- Special Pathology Laboratory, Faculty of Veterinary Sciences, National University of La Plata, La Plata, Buenos Aires, Argentina
| | - Martín Rumbo
- Institute for Immunological and Pathophysiological Studies (IIFP), School of Exact Sciences, National University of La Plata, National Council of Scientific and Technical Research (cONIcET), La Plata, Argentina
| | - Francisco Hernández
- Transplant Group, La Paz University Hospital Health Research Institute (IdiPAZ), Madrid, Spain; Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain
- Executive Operational Committee, ERN TRANSPLANTCHILD, Madrid, Spain
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5
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Vecchio Dezillio LE, Romanin DE, Ivanoff Marinoff IM, Vernengo J, Abate Zárate JC, Machuca MA, Gondolesi GE, Lausada NR, Stringa PL, Rumbo M. Experimental study to assess the impact of vasopressors administered during maintenance of the brain-dead donation in the quality of the intestinal graft. J Trauma Acute Care Surg 2022; 92:380-387. [PMID: 35081098 DOI: 10.1097/ta.0000000000003473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The hemodynamic maintenance of brain-dead donors will influence the quality of the organs procured for transplantation, including the intestine. Although norepinephrine (NE) and dopamine (DA) are commonly used to sustain mean arterial pressure in humans, there are no standardized protocols for their use during maintenance of brain-dead donors. Our aim was to compare the effects of each drug, in the intestinal graft quality using a rat brain-dead donation model. METHODS Wistar rats (N = 17) underwent brain death (BD) for 2 hours with NE (NE group) or with DA (DA group) administration; the control group was mechanically ventilated for 2 hours without BD. Jejunum biopsies were obtained at the end of the maintenance period. Histological damage was evaluated using Park-Chiu scale. Villi/crypt ratio, mucosal thickness, Goblet cell count, and villi density were evaluated using ImageJ software (US National Institutes of Health, Bethesda, MD). Barrier damage was assessed by bacterial translocation culture counting on liver samples. The inflammatory status of the intestine was evaluated by CD3+ counting by immunohistochemistry and gene expression analysis of interleukin (IL)-6, IL-22, and CXCL10. RESULTS Norepinephrine-treated donors had higher focal ischemic injury in the intestinal mucosa without a substantial modification of morphometrical parameters compared with DA-treated donors. CD3+ mucosal infiltration was greater in intestines procured from brain-dead donors, being highest in NE (p ˂ 0.001). Local inflammatory mediators were affected in BD: DA and NE groups showed a trend to lower expression of IL-22, whereas CXCL10 expression was higher in NE versus control group. Brain death promoted intestinal bacterial translocation, but the use of NE resulted in the highest bacterial counting in the liver (p ˂ 0.01). CONCLUSION Our results favor the use of DA instead of NE as main vasoactive drug to manage BD-associated hemodynamic instability. Dopamine may contribute to improve the quality of the intestinal graft, by better preserving barrier function and lowering immune cell infiltration.
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Affiliation(s)
- Leandro Emmanuel Vecchio Dezillio
- From the Instituto de Estudios Inmunológicos y Fisiopatológicos (IIFP-CONICET-UNLP) (L.E.V.D., D.E.R., I.M.I.M., J.V., P.L.S., M.R.), Universidad Nacional de La Plata, La Plata, Argentina; Cátedra de Trasplante de Órganos (L.E.V.D., J.C.A.Z., N.R.L., P.L.S.), Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina; Laboratorio de Patología Especial (M.A.M.), Facultad de Ciencias Veterinarias, Universidad Nacional de La Plata, La Plata, Argentina; Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMETTYB-CONICET) (G.E.G.), Buenos Aires, Argentina; and Instituto de Trasplante Multiorgánico (G.E.G.), Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
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6
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Intestinal transplantation: an overview of the recent experimental studies. Curr Opin Organ Transplant 2020; 26:240-244. [PMID: 33395113 DOI: 10.1097/mot.0000000000000845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Experimental intestinal transplantation (ITx ) has generated invaluable knowledge that has ultimately benefited the clinical activity. Herein, we appraise the recent publications pertaining to experimental ITx and highlight the main current research topics. RECENT FINDINGS During the recent years, ischemia-reperfusion injury (IRI) and Graft-versus-host disease (GVHD) have gradually replaced acute rejection as the main research topic. New additives to established preservation solutions and relatively novel approaches such as luminal interventions during cold storage may prolong the storage time and alleviate IRI. High donor age does not seem to worsen preservation injury. The ischemic susceptibility seems to differ between species, which may impact the translatability of the experimental findings. A new experimental model of modified multivisceral transplantation including the donor spleen may offer a new tool with which to study GVHD, besides the classical Lewis-Brown Norway rat combination. Flushing the graft with fludarabine may mitigate GVHD in rats. T-cell activation inhibitor-mitochondrial was downregulated in the peripheral blood leukocytes before other signs of acute and severe chronic rejection could be observed. SUMMARY Experimental research in ITx has largely shifted focus from acute rejection to IRI and GVHD. Several lines of research have matured toward clinical translation, yet no breakthrough is imminent.
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7
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Vela M, Stringa P, González-Navarro P, Machuca M, Pascual-Miguel B, Mestre C, Arreola NM, Papa-Gobbi R, Navarro-Zapata A, Pires-Lobo SC, Andrés AM, Hernández-Oliveros F, Pérez-Martínez A. Donor's graft ex vivo T-cell depletion with fludarabine reduces graft-versus-host disease signs and improves survival after intestinal transplantation - an experimental study. Transpl Int 2020; 33:1302-1311. [PMID: 32526809 DOI: 10.1111/tri.13672] [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: 03/04/2020] [Revised: 03/31/2020] [Accepted: 06/05/2020] [Indexed: 11/26/2022]
Abstract
Intestinal passenger T leukocytes are responsible for graft-versus-host disease (GvHD) in intestinal transplantation (ITx). We hypothesized that ex vivo fludarabine treatment of the bowel graft would diminish the risk of GvHD and improve overall survival post-transplant. We performed isolated heterotopic small bowel transplantations from Lewis (LEW) to Brown Norway (BN) rat strains, which generated GvHD signs from the fourth day post-transplant. These symptoms included rash, weight loss, piloerection, and diarrhea. The grafts of one of the experimental groups were immersed and sealed in cold Celsior preservation solution with 1000 µm fludarabine for 1 h, prior to its implantation into recipient animals. No histological signs of intestinal tissue alterations were observed after fludarabine treatment. Fludarabine-treated bowel recipients showed significantly later and milder clinical signs of GvHD and reduced total donor cell chimerism, as determined by flow cytometry using strain-specific anti-HLA antibodies. Additionally, fludarabine treatment prolonged recipients' overall survival (13.5 days ± 0.3 days vs. 9.2 days ± 0.5). We conclude that active modification of the intestinal leukocyte composition is advantageous in our ITx animal model. Immunosuppression with fludarabine during the surgical procedure, which could be translated directly to the clinic, protects bowel recipients from GvHD and improves overall post-transplant survival.
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Affiliation(s)
- Maria Vela
- Translational Research in Paediatric Oncology, Hematopoietic Transplantation & Cell Therapy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Pablo Stringa
- Institute for Immunological and Physiopathological Studies (IIFP-CONICET-UNLP), National University of La Plata, Buenos Aires, Argentine
| | - Pablo González-Navarro
- Translational Research in Paediatric Oncology, Hematopoietic Transplantation & Cell Therapy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Mariana Machuca
- Veterinary Pathology Laboratory, Veterinary Sciences Department, National University of La Plata, Buenos Aires, Argentine
| | - Bárbara Pascual-Miguel
- Translational Research in Paediatric Oncology, Hematopoietic Transplantation & Cell Therapy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Carmen Mestre
- Translational Research in Paediatric Oncology, Hematopoietic Transplantation & Cell Therapy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Nidia M Arreola
- Transplant Group - Experimental Surgery, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Rodrigo Papa-Gobbi
- Transplant Group - Experimental Surgery, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Alfonso Navarro-Zapata
- Translational Research in Paediatric Oncology, Hematopoietic Transplantation & Cell Therapy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Sara C Pires-Lobo
- Transplant Group - Experimental Surgery, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,Paediatric Surgery Department, La Paz University Hospital, Madrid, Spain
| | - Ane M Andrés
- Transplant Group - Experimental Surgery, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,Paediatric Surgery Department, La Paz University Hospital, Madrid, Spain
| | - Francisco Hernández-Oliveros
- Transplant Group - Experimental Surgery, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,Paediatric Surgery Department, La Paz University Hospital, Madrid, Spain
| | - Antonio Pérez-Martínez
- Translational Research in Paediatric Oncology, Hematopoietic Transplantation & Cell Therapy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,Paediatric Hemato-Oncology Department, La Paz University Hospital, Madrid, Spain
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8
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Carnevale ME, Lausada N, Juan de Paz L, Stringa P, Machuca M, Rumbo M, Guibert EE, Tiribelli C, Gondolesi GE, Rodriguez JV. The Novel N,N-bis-2-Hydroxyethyl-2-Aminoethanesulfonic Acid-Gluconate-Polyethylene Glycol-Hypothermic Machine Perfusion Solution Improves Static Cold Storage and Reduces Ischemia/Reperfusion Injury in Rat Liver Transplant. Liver Transpl 2019; 25:1375-1386. [PMID: 31121085 DOI: 10.1002/lt.25573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/16/2019] [Indexed: 01/19/2023]
Abstract
Organ transplantation is the treatment of choice against terminal and irreversible organ failure. Optimal preservation of the graft is crucial to counteract cold ischemia effects. As we developed an N,N-bis-2-hydroxyethyl-2-aminoethanesulfonic acid-gluconate-polyethylene glycol (BGP)-based solution (hypothermic machine perfusion [HMP]), we aimed to analyze the use of this solution on static cold storage (SCS) of rat livers for transplantation as compared with the histidine tryptophan ketoglutarate (HTK) preservation solution. Livers procured from adult male Sprague Dawley rats were preserved with BGP-HMP or HTK solutions. Liver total water content and metabolites were measured during the SCS at 0°C for 24 hours. The function and viability of the preserved rat livers were first assessed ex vivo after rewarming (90 minutes at 37°C) and in vivo using the experimental model of reduced-size heterotopic liver transplantation. After SCS, the water and glycogen content in both groups remained unchanged as well as the tissue glutathione concentration. In the ex vivo studies, livers preserved with the BGP-HMP solution were hemodynamically more efficient and the O2 consumption rate was higher than in livers from the HTK group. Bile production and glycogen content after 90 minutes of normothermic reperfusion was diminished in both groups compared with the control group. Cellular integrity of the BGP-HMP group was better, and the histological damage was reversible. In the in vivo model, HTK-preserved livers showed a greater degree of histological injury and higher apoptosis compared with the BGP-HMP group. In conclusion, our results suggest a better role of the BGP-HMP solution compared with HTK in preventing ischemia/reperfusion injury in the rat liver model.
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Affiliation(s)
- Matías E Carnevale
- Centro Binacional (Argentina-Italia) de Investigaciones en Criobiología Clínica y Aplicada, Universidad Nacional de Rosario, Rosario, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad Nacional de la Plata, La Plata, Argentina
| | - Natalia Lausada
- Cátedra de Trasplante, Facultad de Ciencias Médicas, Universidad Nacional de la Plata, La Plata, Argentina
| | - Leonardo Juan de Paz
- Centro Binacional (Argentina-Italia) de Investigaciones en Criobiología Clínica y Aplicada, Universidad Nacional de Rosario, Rosario, Argentina
| | - Pablo Stringa
- Cátedra de Trasplante, Facultad de Ciencias Médicas, Universidad Nacional de la Plata, La Plata, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad Nacional de la Plata, La Plata, Argentina
| | - Mariana Machuca
- Laboratorio de Patología Especial, Facultad de Ciencias Veterinarias, Universidad Nacional de la Plata, La Plata, Argentina
| | - Martin Rumbo
- Instituto de Estudios Inmunológicos y Fisiopatológicos, Universidad Nacional de la Plata, La Plata, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad Nacional de la Plata, La Plata, Argentina
| | - Edgardo E Guibert
- Centro Binacional (Argentina-Italia) de Investigaciones en Criobiología Clínica y Aplicada, Universidad Nacional de Rosario, Rosario, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad Nacional de la Plata, La Plata, Argentina
| | | | - Gabriel E Gondolesi
- Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad Nacional de la Plata, La Plata, Argentina.,Servicio de Cirugía General, Trasplante Hepático, Pancreático e Intestinal, Hospital Universitario Fundación Favaloro, Laboratorio de Microcirugía Experimental, Instituto de Medicina Traslacional, Trasplante y Bioengeniería, Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad Favaloro, Buenos Aires, Argentina
| | - Joaquin V Rodriguez
- Centro Binacional (Argentina-Italia) de Investigaciones en Criobiología Clínica y Aplicada, Universidad Nacional de Rosario, Rosario, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad Nacional de la Plata, La Plata, Argentina
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9
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Leal Denis MF, Lefevre SD, Alvarez CL, Lauri N, Enrique N, Rinaldi DE, Gonzalez-Lebrero R, Vecchio LE, Espelt MV, Stringa P, Muñoz-Garay C, Milesi V, Ostuni MA, Herlax V, Schwarzbaum PJ. Regulation of extracellular ATP of human erythrocytes treated with α-hemolysin. Effects of cell volume, morphology, rheology and hemolysis. BIOCHIMICA ET BIOPHYSICA ACTA-MOLECULAR CELL RESEARCH 2019; 1866:896-915. [PMID: 30726708 DOI: 10.1016/j.bbamcr.2019.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/10/2019] [Accepted: 01/30/2019] [Indexed: 12/17/2022]
Abstract
Alpha-hemolysin (HlyA) of uropathogenic strains of Escherichia coli irreversibly binds to human erythrocytes (RBCs) and triggers activation of ATP release and metabolic changes ultimately leading to hemolysis. We studied the regulation of extracellular ATP (ATPe) of RBCs exposed to HlyA. Luminometry was used to assess ATP release and ATPe hydrolysis, whereas changes in cell volume and morphology were determined by electrical impedance, ektacytometry and aggregometry. Exposure of RBCs to HlyA induced a strong increase of [ATPe] (3-36-fold) and hemolysis (1-44-fold), partially compensated by [ATPe] hydrolysis by ectoATPases and intracellular ATPases released by dead cells. Carbenoxolone, a pannexin 1 inhibitor, partially inhibited ATP release (43-67%). The un-acylated toxin ProHlyA and the deletion analog HlyA∆914-936 were unable to induce ATP release or hemolysis. For HlyA treated RBCs, a data driven mathematical model showed that simultaneous lytic and non-lytic release mainly governed ATPe kinetics, while ATPe hydrolysis became important after prolonged toxin exposure. HlyA induced a 1.5-fold swelling, while blocking this swelling reduced ATP release by 77%. Blocking ATPe activation of purinergic P2X receptors reduced swelling by 60-80%. HlyA-RBCs showed an acute 1.3-2.2-fold increase of Ca2+i, increased crenation and externalization of phosphatidylserine. Perfusion of HlyA-RBCs through adhesion platforms showed strong adhesion to activated HMEC cells, followed by rapid detachment. HlyA exposed RBCs exhibited increased sphericity under osmotic stress, reduced elongation under shear stress, and very low aggregation in viscous media. Overall results showed that HlyA-RBCs displayed activated ATP release, high but weak adhesivity, low deformability and aggregability and high sphericity.
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Affiliation(s)
- M F Leal Denis
- Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Química y Fisico-Química Biológicas (IQUIFIB) "Prof. Alejandro C. Paladini", Facultad de Farmacia y Bioquímica, Junín 956 Buenos Aires, Argentina.; Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Departamento de Química Analítica, Cátedra de Química Química Analítica y Fisicoquímica, Junín 956 Buenos Aires, Argentina
| | - S D Lefevre
- UMR-S1134, Integrated Biology of Red Blood Cells, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Université de la Réunion, Université des Antilles, F-75015 Paris, France.; Institut National de la Transfusion Sanguine, Laboratoire d'Excellence GR-Ex, F-75015 Paris, France
| | - C L Alvarez
- Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Química y Fisico-Química Biológicas (IQUIFIB) "Prof. Alejandro C. Paladini", Facultad de Farmacia y Bioquímica, Junín 956 Buenos Aires, Argentina.; Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Biodiversidad y Biología Experimental, Intendente Güiraldes 2160 Buenos Aires, Argentina
| | - N Lauri
- Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Química y Fisico-Química Biológicas (IQUIFIB) "Prof. Alejandro C. Paladini", Facultad de Farmacia y Bioquímica, Junín 956 Buenos Aires, Argentina.; Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Química Biológica. Cátedra de Química Biológica Superior, Junín 956 Buenos Aires, Argentina
| | - N Enrique
- Universidad Nacional de La Plata, Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Estudios Inmunológicos y Fisiopatológicos (IIFP), Facultad de Ciencias Exactas, Calle 47 y 115 La Plata, Argentina.; Universidad Nacional de la Plata, Facultad de Ciencias Exactas, Departamento de Ciencias Biológicas, Cátedra de Fisiología, Calle 47, Casco Urbano, La Plata, Argentina
| | - D E Rinaldi
- Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Química y Fisico-Química Biológicas (IQUIFIB) "Prof. Alejandro C. Paladini", Facultad de Farmacia y Bioquímica, Junín 956 Buenos Aires, Argentina.; Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Departamento de Química Biológica, Cátedra de Química Biológica, Junín 956 Buenos Aires, Argentina
| | - R Gonzalez-Lebrero
- Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Química y Fisico-Química Biológicas (IQUIFIB) "Prof. Alejandro C. Paladini", Facultad de Farmacia y Bioquímica, Junín 956 Buenos Aires, Argentina.; Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Departamento de Química Biológica, Cátedra de Química Biológica, Junín 956 Buenos Aires, Argentina
| | - L E Vecchio
- Universidad Nacional de La Plata, Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Estudios Inmunológicos y Fisiopatológicos (IIFP), Facultad de Ciencias Exactas, Calle 47 y 115 La Plata, Argentina.; Universidad Nacional de la Plata, Facultad de Ciencias Exactas, Departamento de Ciencias Biológicas, Cátedra de Fisiología, Calle 47, Casco Urbano, La Plata, Argentina
| | - M V Espelt
- Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Química y Fisico-Química Biológicas (IQUIFIB) "Prof. Alejandro C. Paladini", Facultad de Farmacia y Bioquímica, Junín 956 Buenos Aires, Argentina.; Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Química Biológica. Cátedra de Química Biológica Superior, Junín 956 Buenos Aires, Argentina
| | - P Stringa
- Universidad Nacional de La Plata, Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Estudios Inmunológicos y Fisiopatológicos (IIFP), Facultad de Ciencias Exactas, Calle 47 y 115 La Plata, Argentina.; Universidad Favaloro, Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMETTyB), Av. Entre Ríos 495, Buenos Aires, Argentina.; Universidad Nacional de La Plata, Laboratorio de Trasplante de Órganos y Tejidos, Facultad de Ciencias, Calle 60 y 120, La Plata, Argentina
| | - C Muñoz-Garay
- Instituto de Ciencias Físicas, Universidad Nacional Autónoma de México (UNAM), Av. Universidad s/n, Cuernavaca, Mexico
| | - V Milesi
- Universidad Nacional de La Plata, Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Estudios Inmunológicos y Fisiopatológicos (IIFP), Facultad de Ciencias Exactas, Calle 47 y 115 La Plata, Argentina.; Universidad Nacional de la Plata, Facultad de Ciencias Exactas, Departamento de Ciencias Biológicas, Cátedra de Fisiología, Calle 47, Casco Urbano, La Plata, Argentina
| | - M A Ostuni
- UMR-S1134, Integrated Biology of Red Blood Cells, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Université de la Réunion, Université des Antilles, F-75015 Paris, France.; Institut National de la Transfusion Sanguine, Laboratoire d'Excellence GR-Ex, F-75015 Paris, France
| | - V Herlax
- Universidad Nacional de La Plata, Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Investigaciones Bioquímicas de La Plata (INIBIOLP) "Prof. Dr. Rodolfo R. Brenner", Facultad de Ciencias Médicas, Av. 60 y Av. 120, La Plata, Argentina.; Universidad Nacional de La Plata, Facultad de Ciencias Médicas, Av. 60 y Av. 120, La Plata, Argentina
| | - P J Schwarzbaum
- Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Química y Fisico-Química Biológicas (IQUIFIB) "Prof. Alejandro C. Paladini", Facultad de Farmacia y Bioquímica, Junín 956 Buenos Aires, Argentina.; Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Química Biológica. Cátedra de Química Biológica Superior, Junín 956 Buenos Aires, Argentina..
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10
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Chatani B, Garcia J, Biaggi C, Beduschi T, Tekin A, Vianna R, Arheart K, Gonzalez IA. Comparison in outcome with tailored antibiotic prophylaxis postoperatively in pediatric intestinal transplant population. Pediatr Transplant 2018; 22:e13277. [PMID: 30091217 DOI: 10.1111/petr.13277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 07/16/2018] [Indexed: 12/23/2022]
Abstract
BIs are ubiquitous among the pediatric intestinal transplant patient population. Personalizing postoperative prophylaxis antibiotic regimens may improve outcomes in this population. A retrospective analysis of all pediatric patients who underwent intestinal transplantation was evaluated to compare standardized and tailored regimens of antibiotics provided as prophylaxis postoperatively. Patients in the standard group have both shorter time to and higher rate of BIs, which was statistically significant (P < 0.001). Of the children who developed a BI, there was no statistical difference in average times to the development of a second BI (293 vs 119 days, P = 0.211). The tailored group had prolonged times until the development of a MDRO (52.6 vs 63.9 days, P = 0.677). Although not statistically significant, the tailored group had a propensity to present with gram-negative pathogens after transplant as compared to the standard regimen group, which presented with gram-positive pathogens (P = 0.103). Children with a history of an MDRO held a 7.3 (P < 0.01) times more likelihood of death within a year of transplant. A tailored prophylactic antibiotic regimen in the post-transplant period appears to prolong the time to the first BI. Although the data do not show differences in mortality, further study may prove the impact of a tailored antibiotic regimen on morbidity and mortality rates.
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Affiliation(s)
| | - Jennifer Garcia
- Pediatric Gastroenterology, University of Miami Miller School of Medicine, Miami, Florida
| | - Chiara Biaggi
- Pediatric Gastroenterology, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Akin Tekin
- Miami Transplant Institute, Miami, Florida
| | | | - Kristopher Arheart
- Biostatistics, University of Miami Miller School of Medicine, Miami, Florida
| | - Ivan A Gonzalez
- Pediatric Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida
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