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Berkane Y, Cascales JP, Roussakis E, Lellouch AG, Slade J, Bertheuil N, Randolph MA, Cetrulo CL, Evans CL, Uygun K. Continuous oxygen monitoring to enhance ex-vivo organ machine perfusion and reconstructive surgery. Biosens Bioelectron 2024; 262:116549. [PMID: 38971037 DOI: 10.1016/j.bios.2024.116549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 06/18/2024] [Accepted: 07/02/2024] [Indexed: 07/08/2024]
Abstract
Continuous oxygenation monitoring of machine-perfused organs or transposed autologous tissue is not currently implemented in clinical practice. Oxygenation is a critical parameter that could be used to verify tissue viability and guide corrective interventions, such as perfusion machine parameters or surgical revision. This work presents an innovative technology based on oxygen-sensitive, phosphorescent metalloporphyrin allowing continuous and non-invasive oxygen monitoring of ex-vivo perfused vascularized fasciocutaneous flaps. The method comprises a small, low-energy optical transcutaneous oxygen sensor applied on the flap's skin paddle as well as oxygen sensing devices placed into the tubing. An intermittent perfusion setting was designed to study the response time and accuracy of this technology over a total of 54 perfusion cycles. We further evaluated correlation between the continuous oxygen measurements and gold-standard perfusion viability metrics such as vascular resistance, with good agreement suggesting potential to monitor graft viability at high frequency, opening the possibility to employ feedback control algorithms in the future. This proof-of-concept study opens a range of research and clinical applications in reconstructive surgery and transplantation at a time when perfusion machines undergo rapid clinical adoption with potential to improve outcomes across a variety of surgical procedures and dramatically increase access to transplant medicine.
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Affiliation(s)
- Yanis Berkane
- Vascularized Composite Allotransplantation Laboratory, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, 02114, MA, USA; Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, 35000, France; Shriners Children's, Boston, 02114, MA, USA; MOBIDIC, UMR1236, INSERM, Rennes University, Rennes, 35000, France
| | - Juan Pedro Cascales
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Charlestown, 02129, MA, USA; Departamento de Química en Ciencias Farmacéuticas, Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, 28040, Spain
| | - Emmanuel Roussakis
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Charlestown, 02129, MA, USA
| | - Alexandre G Lellouch
- Vascularized Composite Allotransplantation Laboratory, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, 02114, MA, USA; Shriners Children's, Boston, 02114, MA, USA
| | - Julian Slade
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Charlestown, 02129, MA, USA
| | - Nicolas Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, 35000, France; MOBIDIC, UMR1236, INSERM, Rennes University, Rennes, 35000, France
| | - Mark A Randolph
- Vascularized Composite Allotransplantation Laboratory, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, 02114, MA, USA; Shriners Children's, Boston, 02114, MA, USA
| | - Curtis L Cetrulo
- Vascularized Composite Allotransplantation Laboratory, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, 02114, MA, USA; Shriners Children's, Boston, 02114, MA, USA
| | - Conor L Evans
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Charlestown, 02129, MA, USA.
| | - Korkut Uygun
- Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, 35000, France; Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, 02114, MA, USA.
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Jain R, Ajenu EO, Lopera Higuita M, Hafiz EOA, Muzikansky A, Romfh P, Tessier SN. Real-time monitoring of mitochondrial oxygenation during machine perfusion using resonance Raman spectroscopy predicts organ function. Sci Rep 2024; 14:7328. [PMID: 38538723 PMCID: PMC10973340 DOI: 10.1038/s41598-024-57773-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/21/2024] [Indexed: 04/04/2024] Open
Abstract
Organ transplantation is a life-saving procedure affecting over 100,000 people on the transplant waitlist. Ischemia reperfusion injury (IRI) is a major challenge in the field as it can cause post-transplantation complications and limit the use of organs from extended criteria donors. Machine perfusion technology has the potential to mitigate IRI; however, it currently fails to achieve its full potential due to a lack of highly sensitive and specific assays to assess organ quality during perfusion. We developed a real-time and non-invasive method of assessing organs during perfusion based on mitochondrial function and injury using resonance Raman spectroscopy. It uses a 441 nm laser and a high-resolution spectrometer to quantify the oxidation state of mitochondrial cytochromes during perfusion. This index of mitochondrial oxidation, or 3RMR, was used to understand differences in mitochondrial recovery of cold ischemic rodent livers during machine perfusion at normothermic temperatures with an acellular versus cellular perfusate. Measurement of the mitochondrial oxidation revealed that there was no difference in 3RMR of fresh livers as a function of normothermic perfusion when comparing acellular versus cellular-based perfusates. However, following 24 h of static cold storage, 3RMR returned to baseline faster with a cellular-based perfusate, yet 3RMR progressively increased during perfusion, indicating injury may develop over time. Thus, this study emphasizes the need for further refinement of a reoxygenation strategy during normothermic machine perfusion that considers cold ischemia durations, gradual recovery/rewarming, and risk of hemolysis.
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Affiliation(s)
- Rohil Jain
- Center for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
- Shriners Children's Hospital, Boston, MA, USA
| | - Emmanuella O Ajenu
- Center for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
- Shriners Children's Hospital, Boston, MA, USA
| | - Manuela Lopera Higuita
- Center for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
- Shriners Children's Hospital, Boston, MA, USA
| | - Ehab O A Hafiz
- Department of Electron Microscopy Research, Clinical Laboratory Division, Theodor Bilharz Research Institute, Giza, Egypt
| | - Alona Muzikansky
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | | | - Shannon N Tessier
- Center for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA.
- Shriners Children's Hospital, Boston, MA, USA.
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Jain R, Ajenu EO, Hafiz EOA, Romfh P, Tessier SN. Real-time monitoring of mitochondrial oxygenation during machine perfusion using resonance Raman spectroscopy predicts organ function. RESEARCH SQUARE 2023:rs.3.rs-3740098. [PMID: 38196624 PMCID: PMC10775389 DOI: 10.21203/rs.3.rs-3740098/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Organ transplantation is a life-saving procedure affecting over 100,000 people on the transplant waitlist. Ischemia reperfusion injury is a major challenge in the field as it can cause post-transplantation complications and limits the use of organs from extended criteria donors. Machine perfusion technology is used to repair organs before transplant, however, currently fails to achieve its full potential due to a lack of highly sensitive and specific assays to predict organ quality during perfusion. We developed a real-time and non-invasive method of assessing organ function and injury based on mitochondrial oxygenation using resonance Raman spectroscopy. It uses a 441 nm laser and a high-resolution spectrometer to predict the oxidation state of mitochondrial cytochromes during perfusion, which vary due to differences in storage compositions and perfusate compositions. This index of mitochondrial oxidation, or 3RMR, was found to predict organ health based on clinically utilized markers of perfusion quality, tissue metabolism, and organ injury. It also revealed differences in oxygenation with perfusates that may or may not be supplemented with packed red blood cells as oxygen carriers. This study emphasizes the need for further refinement of a reoxygenation strategy during machine perfusion that is based on a gradual recovery from storage. Thus, we present a novel platform that provides a real-time and quantitative assessment of mitochondrial health during machine perfusion of livers, which is easy to translate to the clinic.
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Affiliation(s)
- Rohil Jain
- Harvard Medical School & Massachusetts General Hospital
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Higuita ML, Jain R, Osho AA, Rabi SA, Pruett TL, Pierson RN, Iaizzo PA, Tessier SN. Novel Imaging Technologies for Accurate Assessment of Cardiac Allograft Performance. CURRENT TRANSPLANTATION REPORTS 2023; 10:100-109. [PMID: 39015560 PMCID: PMC11251714 DOI: 10.1007/s40472-023-00400-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/18/2024]
Abstract
Purpose of the Review The current lack of objective and quantitative assessment techniques to determine cardiac graft relative viability results in risk-averse decision-making, which negatively impact the utilization of cardiac grafts. The purpose of this review is to highlight the current deficiencies in cardiac allograft assessment before focusing on novel cardiac assessment techniques that exploit conventional and emerging imaging modalities, including ultrasound, magnetic resonance, and spectroscopy. Recent Findings Extensive work is ongoing by the scientific community to identify improved objective metrics and tools for cardiac graft assessment, with the goal to safely increasing the number and proportion of hearts accepted for transplantation. Summary This review briefly discusses the in situ and ex vivo tools currently available for clinical organ assessment, before focusing on the individual capabilities of ultrasound, magnetic resonance, and spectroscopy to provide insightful, non-invasive information regarding cardiac graft functional and metabolic status that may be used to predict outcome after transplantation.
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Affiliation(s)
- Manuela Lopera Higuita
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Shriners Hospitals for Children, Boston, MA, USA
| | - Rohil Jain
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Shriners Hospitals for Children, Boston, MA, USA
| | - Asishana A. Osho
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, MA, Boston, USA
| | - S. Alireza Rabi
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, MA, Boston, USA
| | - Timothy L. Pruett
- Division of Solid Organ Transplantation and Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Richard N. Pierson
- Department of Surgery and Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Paul A. Iaizzo
- Visible Heart Laboratories, Departments of Surgery and Biomedical EngineeringInstitute for Engineering in Medicine, University of Minnesota, MN 55455 Minneapolis, USA
| | - Shannon N. Tessier
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Shriners Hospitals for Children, Boston, MA, USA
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