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Salim A, Cotton BA. Victory out of tragedy: organ donation. Trauma Surg Acute Care Open 2024; 9:e001408. [PMID: 38646028 PMCID: PMC11029243 DOI: 10.1136/tsaco-2024-001408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
Major improvements in trauma care during the last decade have improved survival rates in the severely injured. The unintended consequence is the presentation of patients with non-survivable injuries in a time frame in which intervention is considered and often employed due to prognostic uncertainty. In light of this, discerning survivability in these patients remains increasingly problematic. Evidence-based cut-points of futility can guide early decisions for discontinuing aggressive treatment and use of precious resources in severely injured patients arriving in extremis.
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Affiliation(s)
- Ali Salim
- Trauma, Burn, Surgical Critical Care and Emergency General Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Bryan A Cotton
- Surgery, University of Texas John P and Katherine G McGovern Medical School, Houston, Texas, USA
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Nadig SN, Leventhal J, Gallon L, Atkinson C. Editorial: Precision therapeutics using next generation technologies in transplantation. FRONTIERS IN TRANSPLANTATION 2024; 3:1371701. [PMID: 38993759 PMCID: PMC11235258 DOI: 10.3389/frtra.2024.1371701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 02/27/2024] [Indexed: 07/13/2024]
Affiliation(s)
- Satish N. Nadig
- Department of Surgery, Microbiology/Immunology, and Pediatrics, Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern Medicine, Northwestern University, Chicago, IL, United States
| | - Joseph Leventhal
- Department of Surgery, Microbiology/Immunology, and Pediatrics, Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern Medicine, Northwestern University, Chicago, IL, United States
| | - Lorenzo Gallon
- Division of Transplant, University of Illinois, Chicago, IL, United States
| | - Carl Atkinson
- Department of Surgery, Microbiology/Immunology, and Pediatrics, Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern Medicine, Northwestern University, Chicago, IL, United States
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Kim B, Jo H, Choi BY, Ryu J. Enhanced recellularization by using albumin coating with roller bottle cell culture. Regen Ther 2023; 24:568-573. [PMID: 37954188 PMCID: PMC10637866 DOI: 10.1016/j.reth.2023.10.002] [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: 06/27/2023] [Revised: 09/12/2023] [Accepted: 10/19/2023] [Indexed: 11/14/2023] Open
Abstract
Introduction The decellularization and recellularization is a promising approach for tissue engineering and regenerative medicine. However, the decellularization process depletes important components like glycosaminoglycans (GAGs), affecting cell attachment and causing immunogenicity. Studies have explored various surface modification strategies to enhance recellularization. Methods To optimize the decellularization method, we employed whole kidney perfusion and slice kidney immersion/agitation techniques. The decellularized extracellular matrix (dECM) was then analyzed using hematoxylin and eosin (H&E) staining, scanning electron microscope (SEM), and DNA quantification. To enhance cell proliferation efficiency, albumin coating and rotating culture were applied. Also, we evaluated in vitro blood clot formation on the albumin-coated dECM by immersing it in blood. Results After decellularization, the unique structures of the kidney were preserved whether cellular components were removed. Subsequently, we utilized albumin coating and rotating culture for recellularization, and observed that albumin-coated dECM not only promoted high cell proliferation rates but also prevented blood clot formation. Conclusion The albumin-coated dECM promoted cell proliferation and reduced blood clot formation in vitro. Also, dynamic culture condition using rotating culture allowed for improved cellular penetration into the dECM, leading to a conductive environment for enhanced tissue infiltration. This new approach suggests that the combined utilization of albumin coating and rotating culture conditions can improve the efficiency of recellularization.
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Affiliation(s)
- Boyun Kim
- R&D Center, ROKIT Healthcare, Inc., Seoul, Republic of Korea
| | - Hyunwoo Jo
- R&D Center, ROKIT Healthcare, Inc., Seoul, Republic of Korea
- Department of Biomicrosystem Technology, Korea University, Seoul, Republic of Korea
| | - Bo Young Choi
- R&D Center, ROKIT Healthcare, Inc., Seoul, Republic of Korea
| | - Jina Ryu
- R&D Center, ROKIT Healthcare, Inc., Seoul, Republic of Korea
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Simpson A, Hewitt AW, Fairfax KA. Universal cell donor lines: A review of the current research. Stem Cell Reports 2023; 18:2038-2046. [PMID: 37832541 PMCID: PMC10679649 DOI: 10.1016/j.stemcr.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 10/15/2023] Open
Abstract
Human embryonic stem cells (ESCs) and induced pluripotent stem cells (iPSCs) hold promise for transplantation medicine. Diverse human leukocyte antigen (HLA) profiles necessitate autologous cells or multiple cell lines for therapeutics, incurring time and cost. Advancements in CRISPR-Cas9 and cellular therapies have led to the conceptualization of "off-the-shelf" universal cell donor lines, free of immune rejection. Overcoming immune rejection is a challenge. This review outlines strategies to modulate the major histocompatibility complex (MHC) to generate a universal cell donor line. Upon bypassing MHC mismatch, multifaceted approaches are required to generate foreign host-tolerated cells. Universal cells harbor risks, namely immune escape and tumor formation. To mitigate, we review safety mechanisms enabling donor cell inactivation or removal. Achieving a universal cell line would reduce treatment wait time, eliminate donor search, and reduce graft-versus-host disease risk without immunosuppression. The pursuit of universally tolerated cells is under way, ready to transform transplantation and regenerative medicine.
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Affiliation(s)
- Ariel Simpson
- Menzies Institute for Medical Research, School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Alex W Hewitt
- Menzies Institute for Medical Research, School of Medicine, University of Tasmania, Hobart, TAS, Australia; Centre for Eye Research Australia, The University of Melbourne, Melbourne, VIC, Australia; School of Medicine, University of Tasmania, Hobart, TAS, Australia
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Dery KJ, Yao S, Cheng B, Kupiec-Weglinski JW. New therapeutic concepts against ischemia-reperfusion injury in organ transplantation. Expert Rev Clin Immunol 2023; 19:1205-1224. [PMID: 37489289 PMCID: PMC10529400 DOI: 10.1080/1744666x.2023.2240516] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 07/20/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION Ischemia-reperfusion injury (IRI) involves a positive amplification feedback loop that stimulates innate immune-driven tissue damage associated with organ procurement from deceased donors and during transplantation surgery. As our appreciation of its basic immune mechanisms has improved in recent years, translating putative biomarkers into therapeutic interventions in clinical transplantation remains challenging. AREAS COVERED This review presents advances in translational/clinical studies targeting immune responses to reactive oxygen species in IRI-stressed solid organ transplants, especially livers. Here we focus on novel concepts to rejuvenate suboptimal donor organs and improve transplant function using pharmacologic and machine perfusion (MP) strategies. Cellular damage induced by cold ischemia/warm reperfusion and the latest mechanistic insights into the microenvironment's role that leads to reperfusion-induced sterile inflammation is critically discussed. EXPERT OPINION Efforts to improve clinical outcomes and increase the donor organ pool will depend on improving donor management and our better appreciation of the complex mechanisms encompassing organ IRI that govern the innate-adaptive immune interface triggered in the peritransplant period and subsequent allo-Ag challenge. Computational techniques and deep machine learning incorporating the vast cellular and molecular mechanisms will predict which peri-transplant signals and immune interactions are essential for improving access to the long-term function of life-saving transplants.
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Affiliation(s)
- Kenneth J. Dery
- The Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Siyuan Yao
- The Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Brian Cheng
- The Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jerzy W. Kupiec-Weglinski
- The Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Pais de Faria J, Oliveira M, Rodrigues F, Xavier MJ, Pico P, Estrada J. Pediatric Organ and Tissue Donation-A 10-Year Retrospective Study in Portugal. Transplant Proc 2023; 55:1366-1367. [PMID: 37179179 DOI: 10.1016/j.transproceed.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 04/11/2023] [Indexed: 05/15/2023]
Abstract
Organ and tissue donation can transform lives. One donor can ensure the survival of up to 8 people through their organs and improve the quality of life for dozens more through tissue donation. Portugal has an excellent transplantation rate, but deaths still occur while waiting for an organ. The study aimed to analyze pediatric organ and tissue donors nationally and evaluate brain deaths in a pediatric intensive care unit (PICU) over the past 10 years to identify any potential lost donors. We conducted a retrospective descriptive study of pediatric organ and tissue donors and diagnosed brain deaths from January 2011 to December 2021. Demographic and clinical data were analyzed, including those provided by the National Transplant Coordination. Over the past 10 years in Portugal, 121 pediatric donors (11.7 per million population) were collected, and 569 organs and tissues were collected. During the same period in the PICU, there were 125 deaths, including 20 brain deaths. Of this group, 4 were organ and tissue donors. In the non-donor group (n = 16), a potential lost donor case stands out. Pediatric specialists need to be more familiar with the donation process, which would enable the identification and optimization of all potential donors, thus minimizing the number of potentially lost organs.
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Affiliation(s)
- Joana Pais de Faria
- Pediatric Intensive Care Unit, Hospital de Dona Estefânia, Centro Hospitalar Universitário, Lisboa Central (CHULC), Lisbon, Portugal.
| | - Marta Oliveira
- Pediatric Intensive Care Unit, Hospital de Dona Estefânia, Centro Hospitalar Universitário, Lisboa Central (CHULC), Lisbon, Portugal
| | - Fernando Rodrigues
- Organ Procurement and Transplantation Office, (GCCT), Centro Hospitalar Universitário Lisboa Central (CHULC), Lisbon, Portugal
| | - Maria João Xavier
- Organ Procurement and Transplantation Office, (GCCT), Centro Hospitalar Universitário Lisboa Central (CHULC), Lisbon, Portugal
| | - Paula Pico
- Organ Procurement and Transplantation Office, (GCCT), Centro Hospitalar Universitário Lisboa Central (CHULC), Lisbon, Portugal
| | - João Estrada
- Pediatric Intensive Care Unit, Hospital de Dona Estefânia, Centro Hospitalar Universitário, Lisboa Central (CHULC), Lisbon, Portugal
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Hirao H, Kageyama S, Nakamura K, Kadono K, Kojima H, Siyuan Y, Farmer DG, Kaldas FM, Dery KJ, Kupiec-Weglinski JW. Recipient TIM4 signaling regulates ischemia reperfusion-induced ER stress and metabolic responses in liver transplantation: from mouse-to-human. FRONTIERS IN TRANSPLANTATION 2023; 2:1176384. [PMID: 38993869 PMCID: PMC11235257 DOI: 10.3389/frtra.2023.1176384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/17/2023] [Indexed: 07/13/2024]
Abstract
T-cell immunoglobulin and mucin (Tim)4 is expressed on APCs, including macrophages, as one of the main amplifiers in the mechanism of liver ischemia-reperfusion injury (IRI) following orthotopic liver transplantation (OLT). Though donor Tim4 selectively expressed on Kupffer cells serves as a checkpoint regulator of innate immune-driven IRI cascades, its role on cells outside the OLT remains unclear. To dissect the role of donor vs. recipient-specific Tim4 signaling in IR-induced stress and hepatocellular function, we employed a murine OLT model utilizing Tim4-knockout (KO) mice as either donor or recipient (WT → WT, WT → Tim4-KO, Tim4-KO → WT). In the experimental arm, disruption of donor Tim4 attenuated IRI-OLT damage, while recipient Tim4-null mutation aggravated hepatic IRI concomitant with disturbed lipid metabolism, enhanced endoplasmic reticulum stress, and activated pro-apoptotic signaling in the grafts. In the in vitro study, murine hepatocytes co-cultured with Tim4-null adipose tissue showed enhanced C/EBP homologous protein (CHOP) expression pattern and susceptibility to hepatocellular death accompanied by activated caspase cascade in response to TNF-α stimulation. In the clinical arm, liver grafts from forty-one transplant patients with enhanced TIM4 expression showed higher body mass index, augmented hepatic endoplasmic reticulum stress, enhanced pro-apoptotic markers, upregulated innate/adaptive immune responses, exacerbated hepatocellular damage, and inferior graft survival. In conclusion, although TIM4 is considered a principal villain in peri-transplant early tissue injury, recipient TIM4 signaling may serve as a savior of IR-triggered metabolic stress in mouse and human OLT recipients.
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Affiliation(s)
- Hirofumi Hirao
- Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, University of California, Los Angeles, Los Angeles, CA, United States
| | - Shoichi Kageyama
- Department of Surgery, Hepato-Biliary-Pancreatic Surgery and Transplantation, Kyoto University, Kyoto, Japan
| | - Kojiro Nakamura
- Department of Surgery, Hepato-Biliary-Pancreatic Surgery and Transplantation, Kyoto University, Kyoto, Japan
| | - Kentaro Kadono
- Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, University of California, Los Angeles, Los Angeles, CA, United States
| | - Hidenobu Kojima
- Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, University of California, Los Angeles, Los Angeles, CA, United States
| | - Yao Siyuan
- Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, University of California, Los Angeles, Los Angeles, CA, United States
| | - Douglas G. Farmer
- Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, University of California, Los Angeles, Los Angeles, CA, United States
| | - Fady M. Kaldas
- Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, University of California, Los Angeles, Los Angeles, CA, United States
| | - Kenneth J. Dery
- Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jerzy W. Kupiec-Weglinski
- Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, University of California, Los Angeles, Los Angeles, CA, United States
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