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Gondolesi GE, Rumbo C, Montes L, Novellis L, Ramisch D, Henríquez AR, Ortega M, Viano F, Schiano T, Descalzi V, Tiribelli C, Oltean M, Barros-Schelotto P, Solar H. Pathophysiology of ascites: The importance of the intestine. A surgical contribution to the understanding of a medical problem. Ann Hepatol 2024; 29:101498. [PMID: 38479458 DOI: 10.1016/j.aohep.2024.101498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 03/03/2024] [Indexed: 03/21/2024]
Abstract
The understanding of the mechanisms for the development of ascites has evolved over the years, involving the liver, peritoneum, heart, and kidneys as key responsible for its formation. In this article, we review the pathophysiology of ascites formation, introducing the role of the intestine as a major responsible for ascites production through "a game changer" case.
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Affiliation(s)
- Gabriel E Gondolesi
- General Surgery, Liver-pancreas and Intestinal transplantation. Hospital Universitario Fundación Favaloro. IMeTTyB, Universidad Favaloro-CONICET, Buenos Aires, Argentina.
| | - Carolina Rumbo
- General Surgery, Liver-pancreas and Intestinal transplantation. Hospital Universitario Fundación Favaloro. IMeTTyB, Universidad Favaloro-CONICET, Buenos Aires, Argentina
| | - Leonardo Montes
- General Surgery, Liver-pancreas and Intestinal transplantation. Hospital Universitario Fundación Favaloro. IMeTTyB, Universidad Favaloro-CONICET, Buenos Aires, Argentina
| | - Lucia Novellis
- General Surgery, Liver-pancreas and Intestinal transplantation. Hospital Universitario Fundación Favaloro. IMeTTyB, Universidad Favaloro-CONICET, Buenos Aires, Argentina
| | - Diego Ramisch
- General Surgery, Liver-pancreas and Intestinal transplantation. Hospital Universitario Fundación Favaloro. IMeTTyB, Universidad Favaloro-CONICET, Buenos Aires, Argentina
| | - Ariel Riquelme Henríquez
- General Surgery, Liver-pancreas and Intestinal transplantation. Hospital Universitario Fundación Favaloro. IMeTTyB, Universidad Favaloro-CONICET, Buenos Aires, Argentina
| | - Mariana Ortega
- General Surgery, Liver-pancreas and Intestinal transplantation. Hospital Universitario Fundación Favaloro. IMeTTyB, Universidad Favaloro-CONICET, Buenos Aires, Argentina
| | - Federico Viano
- Internal Medicine. Metabolic and Nutritional Support Unit. Sanatorio Allende, Córdoba, Argentina
| | - Thomas Schiano
- Recanati Miller Transplantation Institute Mount Sinai School of Medicine, New York, United States of America
| | - Valeria Descalzi
- General Surgery, Liver-pancreas and Intestinal transplantation. Hospital Universitario Fundación Favaloro. IMeTTyB, Universidad Favaloro-CONICET, Buenos Aires, Argentina
| | | | - Mihai Oltean
- The Transplant Institute. Sahlgrenska University Hospital, Gothenburg 413 45, Sweden
| | - Pablo Barros-Schelotto
- General Surgery, Liver-pancreas and Intestinal transplantation. Hospital Universitario Fundación Favaloro. IMeTTyB, Universidad Favaloro-CONICET, Buenos Aires, Argentina
| | - Héctor Solar
- General Surgery, Liver-pancreas and Intestinal transplantation. Hospital Universitario Fundación Favaloro. IMeTTyB, Universidad Favaloro-CONICET, Buenos Aires, Argentina
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Gondolesi GE. History of clinical intestinal transplantation. Hum Immunol 2024; 85:110788. [PMID: 38519405 DOI: 10.1016/j.humimm.2024.110788] [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] [Received: 01/15/2024] [Revised: 02/27/2024] [Accepted: 03/11/2024] [Indexed: 03/24/2024]
Abstract
The intestines have been considered the "forbidden organ" for years, and intestinal failure became the last organ failure recognized as such in the medical field. The impossibility of providing adequate nutritional support, turned these patients into recipients of just palliative comfort. In the 1960's, parenteral nutrition appeared as the most reasonable replacement therapy, but the initial success obtained with clinical kidney, heart, liver, lung and pancreas transplantation served as background to explore intestinal transplantation. The first clinical report of an isolated intestinal transplant was done by Richard Lillihei in 1967; in 1983, Thomas Starzl, performed the first multi visceral transplant, and in 1990, David Grant performed the first combined liver-intestinal transplant in an adult recipient in Canada. Since then, advances in immunosuppressive therapies and surgical innovations have allowed not only a continuous increase in indications, but also a worldwide application of all procedures, bringing clinical intestinal transplantation to reality. In this historical account, the most important contributions have been summarized, thus describing the steady progress, expansion and novelties developed over the last 56 years, since the first attempt. Clinical intestinal transplantation remains a complex and evolving field; ongoing research and technological advancements will continue shaping its future.
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Affiliation(s)
- Gabriel E Gondolesi
- Chief of General Surgery, Chief of Liver, Intestine and Pancreas Transplant, Hospital Universitario, Fundación Favaloro, Buenos Aires, Argentina.
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Immunosuppression in liver and intestinal transplantation. Best Pract Res Clin Gastroenterol 2021; 54-55:101767. [PMID: 34874848 DOI: 10.1016/j.bpg.2021.101767] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 02/07/2023]
Abstract
Immunosuppression handling plays a key role in the early and long-term results of transplantation. The development of multiple immunosuppressive drugs led to numerous clincial trials searching to reach the ideal regimen. Due to heterogeneity of the studied patient cohorts and flaws in many, even randomized controlled, study designs, the answer still stands out. Nowadays triple-drug immunosuppression containing a calcineurin inhibitor (preferentially tacrolimus), an antimetabolite (using mycophenolate moffettil or Azathioprine) and short-term steroids with or without induction therapy (using anti-IL2 receptor blocker or anti-lymphocytic serum) is the preferred option in both liver and intestinal transplantation. This chapter aims, based on a critical review of the definitions of rejection, corticoresistant rejection and standard immunosuppression to give some reflections on how to reach an optimal immunosuppressive status and to conduct trials allowing to draw solid conclusions. Endpoints of future trials should not anymore focus on biopsy proven, acute and chronic, rejection but also on graft and patient survival. Correlation between early- and long-term biologic, immunologic and histopathologic findings will be fundamental to reach in much more patients the status of operational tolerance.
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Paneth Cell Alterations During Ischemia-reperfusion, Follow-up, and Graft Rejection After Intestinal Transplantation. Transplantation 2020; 104:1952-1958. [PMID: 32265415 DOI: 10.1097/tp.0000000000003257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Ischemia-reperfusion injury is inevitable during intestinal transplantation (ITx) and executes a key role in the evolution towards rejection. Paneth cells (PCs) are crucial for epithelial immune defense and highly vulnerable to ischemia-reperfusion injury. We investigated the effect of ITx on PC after reperfusion (T0), during follow-up, and rejection. Moreover, we investigated whether PC loss was associated with impaired graft homeostasis. METHODS Endoscopic biopsies, collected according to center protocol and at rejection episodes, were retrospectively included (n = 28 ITx, n = 119 biopsies) Biopsies were immunohistochemically co-stained for PC (lysozyme) and apoptosis, and PC/crypt and lysozyme intensity were scored. RESULTS We observed a decrease in PC/crypt and lysozyme intensity in the first week after ITx (W1) compared with T0. There was a tendency towards a larger decline in PC/crypt (P = 0.08) and lysozyme intensity (P = 0.08) in W1 in patients who later developed rejection compared with patients without rejection. Follow-up biopsies showed that the PC number recovered, whereas lysozyme intensity remained reduced. This persisting innate immune defect may contribute to the well-known vulnerability of the intestine to infection. There was no clear evidence that PCs were affected throughout rejection. CONCLUSIONS This study revealed a transient fall in PC numbers in the early post-ITx period but a permanent reduction in lysozyme intensity following ITx. Further research is needed to determine the potential clinical impact of PC impairment after ITx.
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Sun D, Cao H, Yang L, Lin L, Hou B, Zheng W, Shen Z, Song H. MiR-200b in heme oxygenase-1-modified bone marrow mesenchymal stem cell-derived exosomes alleviates inflammatory injury of intestinal epithelial cells by targeting high mobility group box 3. Cell Death Dis 2020; 11:480. [PMID: 32587254 PMCID: PMC7316799 DOI: 10.1038/s41419-020-2685-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 06/09/2020] [Accepted: 06/12/2020] [Indexed: 02/06/2023]
Abstract
Heme Oxygen-1 (HO-1)-modified bone marrow mesenchymal stem cells (BMMSCs) are effective to protect and repair transplanted small bowel and intestinal epithelial cells (IECs); however, the mechanism and the role of HO-1/BMMSCs-derived exosomes is unclear. In the present study, we aimed to verify that exosomes from a HO-1/BMMSCs and IEC-6 cells (IEC-6s) co-culture system could reduce the apoptosis of IEC-6s and decrease the expression of the tight junction protein, zona occludens 1, in the inflammatory environment. Using mass spectrometry, we revealed that high mobility group box 3 (HMGB3) and phosphorylated c-Jun NH2-terminal kinase (JNK), under the influence of differentially abundant proteins identified through proteomic analysis, play critical roles in the mechanism. Further studies indicated that microRNA miR-200b, which was upregulated in exosomes derived from the co-culture of HO-1/BMMSCs and IEC-6s, exerted its role by targeting the 3′ untranslated region of Hmgb3 in this biological process. Functional experiments confirmed that miR-200b overexpression could reduce the inflammatory injury of IEC-6s, while intracellular miR-200b knockdown could significantly block the protective effect of HO-1/BMMSCs exosomes on the inflammatory injury of IEC-6s. In addition, the level of miR-200b in cells and exosomes derived from HO-1/BMMSCs stimulated by tumor necrosis factor alpha was significantly upregulated. In a rat small bowel transplantation model of allograft rejection treated with HO-1/BMMSCs, we confirmed that the level of miR-200b in the transplanted small bowel tissue was increased significantly, while the level of HMGB3/JNK was downregulated significantly. In conclusion, we identified that exosomes derived from HO-1/BMMSCs play an important role in alleviating the inflammatory injury of IECs. The mechanism is related to miR-200b targeting the abnormally increased expression of the Hmgb3 gene in IECs induced by inflammatory injury. The reduced level of HMGB3 then decreases the inflammatory injury.
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Affiliation(s)
- Dong Sun
- Tianjin First Central Hospital Clinic Institute, Tianjin Medical University, 300070, Tianjin, P.R. China.,Department of Organ Transplantation, Tianjin First Central Hospital, 300192, Tianjin, P.R. China
| | - Huan Cao
- Tianjin First Central Hospital Clinic Institute, Tianjin Medical University, 300070, Tianjin, P.R. China
| | - Liu Yang
- Tianjin First Central Hospital Clinic Institute, Tianjin Medical University, 300070, Tianjin, P.R. China.,NHC Key Laboratory of Critical Care Medicine, 300192, Tianjin, P.R. China
| | - Ling Lin
- Tianjin First Central Hospital Clinic Institute, Tianjin Medical University, 300070, Tianjin, P.R. China.,Tianjin Clinical Research Center for Organ Transplantation, Tianjin, P.R. China
| | - Bin Hou
- Tianjin First Central Hospital Clinic Institute, Tianjin Medical University, 300070, Tianjin, P.R. China
| | - Weiping Zheng
- Department of Organ Transplantation, Tianjin First Central Hospital, 300192, Tianjin, P.R. China.,Key Laboratory of Transplant Medicine, Chinese Academy of Medical Sciences, Tianjin, P.R. China
| | - Zhongyang Shen
- Department of Organ Transplantation, Tianjin First Central Hospital, 300192, Tianjin, P.R. China.,Key Laboratory of Transplant Medicine, Chinese Academy of Medical Sciences, Tianjin, P.R. China
| | - Hongli Song
- Department of Organ Transplantation, Tianjin First Central Hospital, 300192, Tianjin, P.R. China. .,Tianjin Key Laboratory of Organ Transplantation, Tianjin, P.R. China.
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Pucci Molineris M, González Polo V, Rumbo C, Fuxman C, Lowestein C, Nachman F, Rumbo M, Gondolesi G, Meier D. Acute cellular rejection in small-bowel transplantation impairs NCR + innate lymphoid cell subpopulation 3/interleukin 22 axis. Transpl Immunol 2020; 60:101288. [PMID: 32209429 DOI: 10.1016/j.trim.2020.101288] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 12/13/2022]
Abstract
Acute cellular rejection (ACR) remains as one of the main causes of graft loss and death in intestinal transplant (ITx) patients. ACR promotes intestinal injury, disruption of the mucosal barrier, bacterial translocation, and organ dysfunction. As epithelial regeneration is critical in reversing these consequences, the functional axis between the innate lymphoid cell subpopulation 3 (ILC3) and interleukin 22 plays an essential role in that process. Natural-cytotoxic-receptor-positive (NCR+) ILC3 cells have been demonstrated to induce intestinal-stem-cell proliferation along with an IL-22-dependent expansion of that population in several intestinal pathologies, though thus far not after ITx. Therefore, we intended to determine the impact of chronic immunosuppression and ACR on ILC3 cells and interleukin-22 (IL-22) production in the lamina propria after that intervention. MATERIALS AND METHODS We compared biopsies from healthy volunteers with biopsies from ITx recipients without or with mild-to-moderate ACR, using flow cytometry and the quantitative-PCR. RESULTS NCR+ ILC3 cells were found to be unaffected by immunosuppression at different time points posttransplant when patients did not experience ACR, but were diminished upon the occurrence of ACR independently of the post-ITx time. Moreover, IL-22-expression levels were notably reduced in ACR. CONCLUSION The NCR+-ILC3/IL-22 axis is impaired during ACR contributing to a delay in or lack of a complete and efficient epithelial regeneration. Thus, our findings reveal that IL-22 analogues could potentially be used as a new complementary therapeutic approach, in conjunction with immunosuppressant drugs, in order to promote mucosal regeneration upon ACR.
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Affiliation(s)
- Melisa Pucci Molineris
- Laboratorio de Investigación Traslacional e Inmunología Asociada al Trasplante, Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET, Buenos Aires, Argentina; Unidad de Insuficiencia, Rehabilitación y Trasplante Intestinal, Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina.
| | - Virginia González Polo
- Laboratorio de Investigación Traslacional e Inmunología Asociada al Trasplante, Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET, Buenos Aires, Argentina; Unidad de Insuficiencia, Rehabilitación y Trasplante Intestinal, Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina.
| | - Carolina Rumbo
- Unidad de Insuficiencia, Rehabilitación y Trasplante Intestinal, Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina.
| | - Claudia Fuxman
- Servicio de Gastroenterología, Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina.
| | - Carlos Lowestein
- Servicio de Gastroenterología, Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina.
| | - Fabio Nachman
- Servicio de Gastroenterología, Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina.
| | - Martín Rumbo
- Instituto de Estudios Inmunológicos y Fisiopatológicos, UNLP-CONICET, La Plata, Argentina.
| | - Gabriel Gondolesi
- Laboratorio de Investigación Traslacional e Inmunología Asociada al Trasplante, Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET, Buenos Aires, Argentina; Unidad de Insuficiencia, Rehabilitación y Trasplante Intestinal, Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina.
| | - Dominik Meier
- Laboratorio de Investigación Traslacional e Inmunología Asociada al Trasplante, Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET, Buenos Aires, Argentina; Unidad de Insuficiencia, Rehabilitación y Trasplante Intestinal, Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina.
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