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Brubaker AL, Sellers MT, Abt PL, Croome KP, Merani S, Wall A, Abreu P, Alebrahim M, Baskin R, Bohorquez H, Cannon RM, Cederquist K, Edwards J, Huerter BG, Hobeika MJ, Kautzman L, Langnas AN, Lee DD, Manzi J, Nassar A, Neidlinger N, Nydam TL, Schnickel GT, Siddiqui F, Suah A, Taj R, Taner CB, Testa G, Vianna R, Vyas F, Montenovo MI. US Liver Transplant Outcomes After Normothermic Regional Perfusion vs Standard Super Rapid Recovery. JAMA Surg 2024:2817111. [PMID: 38568597 PMCID: PMC10993160 DOI: 10.1001/jamasurg.2024.0520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/06/2024] [Indexed: 04/06/2024]
Abstract
Importance Normothermic regional perfusion (NRP) is an emerging recovery modality for transplantable allografts from controlled donation after circulatory death (cDCD) donors. In the US, only 11.4% of liver recipients who are transplanted from a deceased donor receive a cDCD liver. NRP has the potential to safely expand the US donor pool with improved transplant outcomes as compared with standard super rapid recovery (SRR). Objective To assess outcomes of US liver transplants using controlled donation after circulatory death livers recovered with normothermic regional perfusion vs standard super rapid recovery. Design, Setting, and Participants This was a retrospective, observational cohort study comparing liver transplant outcomes from cDCD donors recovered by NRP vs SRR. Outcomes of cDCD liver transplant from January 2017 to May 2023 were collated from 17 US transplant centers and included livers recovered by SRR and NRP (thoracoabdominal NRP [TA-NRP] and abdominal NRP [A-NRP]). Seven transplant centers used NRP, allowing for liver allografts to be transplanted at 17 centers; 10 centers imported livers recovered via NRP from other centers. Exposures cDCD livers were recovered by either NRP or SRR. Main Outcomes and Measures The primary outcome was ischemic cholangiopathy (IC). Secondary end points included primary nonfunction (PNF), early allograft dysfunction (EAD), biliary anastomotic strictures, posttransplant length of stay (LOS), and patient and graft survival. Results A total of 242 cDCD livers were included in this study: 136 recovered by SRR and 106 recovered by NRP (TA-NRP, 79 and A-NRP, 27). Median (IQR) NRP and SRR donor age was 30.5 (22-44) years and 36 (27-49) years, respectively. Median (IQR) posttransplant LOS was significantly shorter in the NRP cohort (7 [5-11] days vs 10 [7-16] days; P < .001). PNF occurred only in the SRR allografts group (n = 2). EAD was more common in the SRR cohort (123 of 136 [56.1%] vs 77 of 106 [36.4%]; P = .007). Biliary anastomotic strictures were increased 2.8-fold in SRR recipients (7 of 105 [6.7%] vs 30 of 134 [22.4%]; P = .001). Only SRR recipients had IC (0 vs 12 of 133 [9.0%]; P = .002); IC-free survival by Kaplan-Meier was significantly improved in NRP recipients. Patient and graft survival were comparable between cohorts. Conclusion and Relevance There was comparable patient and graft survival in liver transplant recipients of cDCD donors recovered by NRP vs SRR, with reduced rates of IC, biliary complications, and EAD in NRP recipients. The feasibility of A-NRP and TA-NRP implementation across multiple US transplant centers supports increasing adoption of NRP to improve organ use, access to transplant, and risk of wait-list mortality.
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Affiliation(s)
- Aleah L. Brubaker
- Department of Surgery, Division of Transplant and Hepatobiliary Surgery, University of California San Diego, La Jolla, California
- CONCORD: Consortium for Donation after Circulatory Death and Normothermic Regional Perfusion Outcomes Research and Development
| | - Marty T. Sellers
- CONCORD: Consortium for Donation after Circulatory Death and Normothermic Regional Perfusion Outcomes Research and Development
- Tennessee Donor Services, Nashville
| | - Peter L. Abt
- CONCORD: Consortium for Donation after Circulatory Death and Normothermic Regional Perfusion Outcomes Research and Development
- Department of Surgery, Transplant Division, University of Pennsylvania, Philadelphia
| | - Kristopher P. Croome
- CONCORD: Consortium for Donation after Circulatory Death and Normothermic Regional Perfusion Outcomes Research and Development
- Department of Transplant, Mayo Clinic Florida, Jacksonville
| | - Shaheed Merani
- CONCORD: Consortium for Donation after Circulatory Death and Normothermic Regional Perfusion Outcomes Research and Development
- Department of Surgery, University of Nebraska Medical Center, Omaha
| | - Anji Wall
- CONCORD: Consortium for Donation after Circulatory Death and Normothermic Regional Perfusion Outcomes Research and Development
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas
| | - Phillipe Abreu
- Miami Transplant Institute, Jackson Memorial Hospital, University of Miami, Miami, Florida
| | | | - Roy Baskin
- Methodist Transplant Specialists, Dallas, Texas
| | - Humberto Bohorquez
- Department of Surgery, Ochsner School of Medicine, New Orleans, Louisiana
| | - Robert M. Cannon
- Department of Surgery, University of Alabama at Birmingham, Birmingham
| | - Kelly Cederquist
- Department of Surgery, Transplant Division, University of Pennsylvania, Philadelphia
| | - John Edwards
- Gift of Life Donor Program, Philadelphia, Pennsylvania
| | | | - Mark J. Hobeika
- J.C. Walter Jr Transplant Center, Houston Methodist Hospital, Houston, Texas
| | | | - Alan N. Langnas
- Department of Surgery, University of Nebraska Medical Center, Omaha
| | - David D. Lee
- Department of Surgery, Loyola University, Chicago, Illinois
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Joao Manzi
- Miami Transplant Institute, Jackson Memorial Hospital, University of Miami, Miami, Florida
| | - Ahmed Nassar
- Department of Surgery, Emory University, Atlanta, Georgia
- Department of Surgery, Division of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, Michigan
| | | | - Trevor L. Nydam
- CONCORD: Consortium for Donation after Circulatory Death and Normothermic Regional Perfusion Outcomes Research and Development
- Department of Surgery, Division of Transplant Surgery, University of Colorado, Aurora
| | - Gabriel T. Schnickel
- Department of Surgery, Division of Transplant and Hepatobiliary Surgery, University of California San Diego, La Jolla, California
| | - Farjad Siddiqui
- Department of Surgery, The Ohio State University, Columbus
- Department of Surgery, Emory University, Atlanta, Georgia
| | - Ashley Suah
- Department of Surgery, Emory University, Atlanta, Georgia
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Raeda Taj
- Department of Surgery, Division of Transplant and Hepatobiliary Surgery, University of California San Diego, La Jolla, California
- Department of Surgery, Transplant Division, University of Pennsylvania, Philadelphia
| | | | - Giuliano Testa
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas
| | - Rodrigo Vianna
- Miami Transplant Institute, Jackson Memorial Hospital, University of Miami, Miami, Florida
| | - Frederick Vyas
- Department of Surgery, Transplant Division, University of Pennsylvania, Philadelphia
| | - Martin I. Montenovo
- CONCORD: Consortium for Donation after Circulatory Death and Normothermic Regional Perfusion Outcomes Research and Development
- Department of Surgery, Vanderbilt University, Nashville, Tennessee
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Covarrubias K, Trageser J, Nethercot D, Schnickel GT, Brubaker AL. Utilization of Normothermic Machine Perfusion to Rescue Liver Allografts in Unallocated Unstable Donors. Transplant Direct 2024; 10:e1608. [PMID: 38481966 PMCID: PMC10937002 DOI: 10.1097/txd.0000000000001608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/29/2024] [Accepted: 02/03/2024] [Indexed: 03/17/2024] Open
Affiliation(s)
- Karina Covarrubias
- Division of Transplant and Hepatobiliary Surgery, Department of Surgery, University of California, San Diego, San Diego, CA
| | | | | | - Gabriel T. Schnickel
- Division of Transplant and Hepatobiliary Surgery, Department of Surgery, University of California, San Diego, San Diego, CA
| | - Aleah L. Brubaker
- Division of Transplant and Hepatobiliary Surgery, Department of Surgery, University of California, San Diego, San Diego, CA
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Abraham DL, Lichvar AB, Brubaker AL, Haste N, Chen V, Abeles S, Aslam S, Yam N, Horton L, Chen B, Binkin N, Law N. Risk factors for breakthrough COVID-19 infections in solid organ transplant recipients receiving tixagevimab/cilgavimab for pre-exposure prophylaxis. Transpl Infect Dis 2023; 25:e14125. [PMID: 37594213 DOI: 10.1111/tid.14125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/01/2023] [Indexed: 08/19/2023]
Affiliation(s)
- Dana L Abraham
- Department of Pharmacy, University of California San Diego Health, La Jolla, California, USA
| | - Alicia B Lichvar
- Department of Pharmacy, University of California San Diego Health, La Jolla, California, USA
- Center for Transplantation, University of California San Diego Health, La Jolla, California, USA
| | - Aleah L Brubaker
- Center for Transplantation, University of California San Diego Health, La Jolla, California, USA
| | - Nina Haste
- Department of Pharmacy, University of California San Diego Health, La Jolla, California, USA
| | - Victor Chen
- Department of Pharmacy, University of California San Diego Health, La Jolla, California, USA
| | - Shira Abeles
- Division of Transplant and Hepatobiliary Surgery, Department of Surgery, University of California San Diego Health, La Jolla, California, USA
| | - Saima Aslam
- Division of Transplant and Hepatobiliary Surgery, Department of Surgery, University of California San Diego Health, La Jolla, California, USA
| | - Nancy Yam
- Department of Pharmacy, University of California San Diego Health, La Jolla, California, USA
| | - Lucy Horton
- Division of Transplant and Hepatobiliary Surgery, Department of Surgery, University of California San Diego Health, La Jolla, California, USA
| | - Benjamin Chen
- Division of Transplant and Hepatobiliary Surgery, Department of Surgery, University of California San Diego Health, La Jolla, California, USA
| | - Nancy Binkin
- Herbert Wertheim School of Public Health and Human Longevity, University of California San Diego, La Jolla, California, USA
| | - Nancy Law
- Division of Transplant and Hepatobiliary Surgery, Department of Surgery, University of California San Diego Health, La Jolla, California, USA
- Division of Infectious Diseases and Global Health, University of California San Diego Health, La Jolla, California, USA
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4
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Brubaker AL, Bensard C, MacConmara M, Elbetanony A, Attia M, Sanchez R, Schnickel G. Extended duration of machine perfusion: Maximizing organ utilization. Liver Transpl 2023; 29:1242-1244. [PMID: 37432896 DOI: 10.1097/lvt.0000000000000212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/11/2023] [Indexed: 07/13/2023]
Affiliation(s)
- Aleah L Brubaker
- Department of Surgery, Division of Transplant and Hepatobiliary Surgery, UC San Diego, San Diego, California, USA
| | - Claire Bensard
- Department of Surgery, Division of Transplant and Hepatobiliary Surgery, UC San Diego, San Diego, California, USA
| | | | | | | | - Ramon Sanchez
- Department of Anesthesia, UC San Diego, San Diego, California, USA
| | - Gabriel Schnickel
- Department of Surgery, Division of Transplant and Hepatobiliary Surgery, UC San Diego, San Diego, California, USA
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Brubaker AL, Urey MA, Taj R, Parekh JR, Berumen J, Kearns M, Shah M, Khan A, Kono Y, Ajmera V, Barman P, Tran H, Adler ED, Silva Enciso J, Asimakopoulos F, Costello C, Bower R, Sanchez R, Pretorius V, Schnickel GT. Heart-liver-kidney transplantation for AL amyloidosis using normothermic recovery and storage from a donor following circulatory death: Short-term outcome in a first-in-world experience. Am J Transplant 2023; 23:291-293. [PMID: 36804136 DOI: 10.1016/j.ajt.2022.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/18/2022] [Accepted: 11/10/2022] [Indexed: 01/13/2023]
Abstract
AL amyloidosis is a rare condition characterized by the overproduction of an unstable free light chain, protein misfolding and aggregation, and extracellular deposition that can progress to multiorgan involvement and failure. To our knowledge, this is the first worldwide report to describe triple organ transplantation for AL amyloidosis and triple organ transplantation using thoracoabdominal normothermic regional perfusion recovery with a donation from a circulatory death (DCD) donor. The recipient was a 40-year-old man with multiorgan AL amyloidosis with a terminal prognosis without multiorgan transplantation. An appropriate DCD donor was selected for sequential heart, liver, and kidney transplants via our center's thoracoabdominal normothermic regional perfusion pathway. The liver was additionally placed on an ex vivo normothermic machine perfusion, and the kidney was maintained on hypothermic machine perfusion while awaiting implantation. The heart transplant was completed first (cold ischemic time [CIT]: 131 minutes), followed by the liver transplant (CIT: 87 minutes, normothermic machine perfusion: 301 minutes). Kidney transplantation was performed the following day (CIT: 1833 minutes). He is 8 months posttransplant without evidence of heart, liver, or kidney graft dysfunction or rejection. This case highlights the feasibility of normothermic recovery and storage modalities for DCD donors, which can expand transplant opportunities for allografts previously not considered for multiorgan transplantations.
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Affiliation(s)
- Aleah L Brubaker
- Department of Surgery, Division of Transplant and Hepatobiliary Surgery, University of California San Diego, San Diego, California, USA.
| | - Marcus A Urey
- Department of Medicine, Division of Cardiology, University of California San Diego, San Diego, California, USA
| | - Raeda Taj
- Department of Surgery, Division of Transplant and Hepatobiliary Surgery, University of California San Diego, San Diego, California, USA
| | - Justin R Parekh
- Department of Surgery, Division of Transplant and Hepatobiliary Surgery, University of California San Diego, San Diego, California, USA
| | - Jennifer Berumen
- Department of Surgery, Division of Transplant and Hepatobiliary Surgery, University of California San Diego, San Diego, California, USA
| | - Mark Kearns
- Department of Surgery, Division of Cardiothoracic Surgery, University of California San Diego, San Diego, California, USA
| | - Mita Shah
- Department of Medicine, Division of Nephrology, University of California San Diego, San Diego, California, USA
| | - Adnan Khan
- Department of Medicine, Division of Nephrology, University of California San Diego, San Diego, California, USA
| | - Yuko Kono
- Department of Medicine, Division of Hepatology, University of California San Diego, San Diego, California, USA
| | - Veeral Ajmera
- Department of Medicine, Division of Hepatology, University of California San Diego, San Diego, California, USA
| | - Pranab Barman
- Department of Medicine, Division of Hepatology, University of California San Diego, San Diego, California, USA
| | - Hao Tran
- Department of Medicine, Division of Cardiology, University of California San Diego, San Diego, California, USA
| | - Eric D Adler
- Department of Medicine, Division of Cardiology, University of California San Diego, San Diego, California, USA
| | - Jorge Silva Enciso
- Department of Medicine, Division of Cardiology, University of California San Diego, San Diego, California, USA
| | - Fotis Asimakopoulos
- Department of Medicine, Division of Bone Marrow Transplant, University of California San Diego, San Diego, California, USA
| | - Caitlin Costello
- Department of Medicine, Division of Bone Marrow Transplant, University of California San Diego, San Diego, California, USA
| | - Richard Bower
- Department of Gastroenterology, Naval Medical Center San Diego, California, USA
| | - Ramon Sanchez
- Department of Anesthesia, University of California San Diego, San Diego, California, USA
| | - Victor Pretorius
- Department of Surgery, Division of Cardiothoracic Surgery, University of California San Diego, San Diego, California, USA
| | - Gabriel T Schnickel
- Department of Surgery, Division of Transplant and Hepatobiliary Surgery, University of California San Diego, San Diego, California, USA
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Covarrubias K, Brubaker AL, Mekeel K, Pretorius V, Shah M, Adler E, Ajmera V, Schnickel GT, Aslam S. Single-center Experience on Nonlung Solid Organ Transplantation From SARS-CoV-2-positive Donors. Transplantation 2023; 107:e41-e42. [PMID: 36240442 PMCID: PMC9746228 DOI: 10.1097/tp.0000000000004400] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/06/2022] [Accepted: 09/08/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Karina Covarrubias
- Department of Surgery, Division of Transplant and Hepatobiliary Surgery, UC San Diego, San Diego, CA
| | - Aleah L. Brubaker
- Department of Surgery, Division of Transplant and Hepatobiliary Surgery, UC San Diego, San Diego, CA
| | - Kristin Mekeel
- Department of Surgery, Division of Transplant and Hepatobiliary Surgery, UC San Diego, San Diego, CA
| | - Victor Pretorius
- Department of Surgery, Division of Cardiothoracic Surgery, UC San Diego, San Diego, CA
| | - Mita Shah
- Department of Medicine, Division of Nephrology, UC San Diego, San Diego, CA
| | - Eric Adler
- Department of Medicine, Division of Cardiology, UC San Diego, San Diego, CA
| | - Veeral Ajmera
- Department of Medicine, Division of Hepatology, UC San Diego, San Diego, CA
| | - Gabriel T. Schnickel
- Department of Surgery, Division of Transplant and Hepatobiliary Surgery, UC San Diego, San Diego, CA
| | - Saima Aslam
- Department of Medicine, Division of Infectious Diseases and Global Public Health, UC San Diego, San Diego, CA
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Brubaker AL, Loomba R. Utilizing Macrosteatotic Allografts for Nonalcoholic Steatohepatitis Recipients. Liver Transpl 2022; 28:552-553. [PMID: 34806817 PMCID: PMC9683541 DOI: 10.1002/lt.26371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/17/2021] [Indexed: 01/13/2023]
Affiliation(s)
- Aleah L. Brubaker
- Division of Transplant and Hepatobiliary Surgery, Department of Surgery, University of California San Diego, La Jolla, CA
| | - Rohit Loomba
- Nonalcoholic Fatty Liver Disease Research Center, Division of Gastroenterology, Department of Medicine, University of California at San Diego, La Jolla, CA
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Cao S, Tennakoon L, Brubaker AL, Forrester JD. Infection with Two Multi-Drug-Resistant Organisms in Solid Organ Transplant Patients Is Associated with Increased Mortality and Prolonged Hospitalization. Surg Infect (Larchmt) 2022; 23:394-399. [PMID: 35357980 DOI: 10.1089/sur.2021.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Background: Solid organ transplant recipients have several risk factors for peri-operative multi-drug-resistant infection: their immune system is dampened as a result of critical illness and surgical stress that may be further impaired by induction immunotherapy and broad-spectrum antibiotic prophylaxis promotes selection for resistant pathogens. Infection with multi-drug-resistant organisms (MDRO) results in morbidity and mortality for solid organ transplant recipients. Patients and Methods: To assess in-hospital mortality and hospitalization duration associated with these infections, we analyzed cross-sectional, retrospective data from the 2016 Agency for Healthcare and Quality, Healthcare Cost and Utilization Project's National Inpatient Sample. Our analysis included 31,105 index admissions records for liver, kidney, heart, lung, and pancreas transplant recipients in the United States. Outcomes were assessed by multivariable regression analysis adjusting for covariables. Results: One percent (355/29,451) of patients with diagnosis of no MDRO infections died, 3% (40/1491) with diagnosis of one MDRO infection died, and 15% (25/166) with diagnosis of two MDRO infections died. Diagnosis of one MDRO infection was associated with a 20-day increase in hospitalization duration (95% confidence interval [CI], 17-22) but not increased odds of death (odds ratio [OR], 1.2; 95% CI, 0.5-2.5). Diagnosis of two MDRO infections was associated with an increased odds of death (OR, 9.6' 95% CI, 3.3-27.9) and a 41-day increase in hospitalization duration (95% CI, 34-49). Conclusions: Strategies to decrease peri-operative MDRO infection may improve survival and decrease duration of hospitalization for solid organ transplant patients.
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Affiliation(s)
- Siqi Cao
- School of Medicine, Department of Surgery, Stanford University, Stanford, California, USA
| | - Lakshika Tennakoon
- Division of General Surgery, Department of Surgery, Department of Surgery, Stanford University, Stanford, California, USA
| | - Aleah L Brubaker
- Division of Transplant Surgery, Department of Surgery, Stanford University, Stanford, California, USA
| | - Joseph D Forrester
- School of Medicine, Department of Surgery, Stanford University, Stanford, California, USA
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Than PA, Brubaker AL, Ebel NH, Profita EL, Esquivel CO. The Emerging Need for Combined Heart and Liver Transplantation in Congenital Heart Disease. Curr Transpl Rep 2020. [DOI: 10.1007/s40472-020-00286-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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Wong SY, Brubaker AL, Wang AX, Taiwo AA, Melcher ML. What solid organ transplant healthcare providers should know about renin-angiotensin-aldosterone system inhibitors and COVID-19. Clin Transplant 2020; 34:e13991. [PMID: 32446267 PMCID: PMC7267091 DOI: 10.1111/ctr.13991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 01/08/2023]
Abstract
The data on the outcomes of solid organ transplant recipients who have contracted coronavirus disease 2019 (COVID‐19) are still emerging. Kidney transplant recipients are commonly prescribed renin‐angiotensin‐aldosterone system (AAS) inhibitors given the prevalence of hypertension, diabetes, and cardiovascular disease. As the angiotensin‐converting enzyme 2 (ACE2) facilitates the entry of coronaviruses into target cells, there have been hypotheses that preexisting use of renin‐angiotensin‐aldosterone system (RAAS) inhibitors may increase the risk of developing severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. Given the common use of RAAS inhibitors among solid organ transplant recipients, we sought to review the RAAS cascade, the mechanism of SARS‐CoV‐2 entry, and pertinent data related to the effect of RAAS inhibitors on ACE2 to guide management of solid organ transplant recipients during the COVID‐19 pandemic. At present, there is no clear evidence to support the discontinuation of RAAS inhibitors in solid organ transplant recipients during the COVID‐19 pandemic.
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Affiliation(s)
- Sunnie Y Wong
- Division of Abdominal Transplantation, Dept. of Surgery, Stanford University, Stanford, CA, USA
| | - Aleah L Brubaker
- Division of Abdominal Transplantation, Dept. of Surgery, Stanford University, Stanford, CA, USA
| | - Aileen X Wang
- Division of Nephrology, Dept. of Medicine, Stanford University, Stanford, CA, USA
| | - Adetokunbo A Taiwo
- Division of Nephrology, Dept. of Medicine, Stanford University, Stanford, CA, USA
| | - Marc L Melcher
- Division of Abdominal Transplantation, Dept. of Surgery, Stanford University, Stanford, CA, USA
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Lee A, Mendoza J, Brubaker AL, Stoltz DJ, McKenzie R, Bonham CA, Esquivel CO, Gallo AE. Eliminating international normalized ratio threshold for transfusion in pediatric patients with acute liver failure. Clin Transplant 2020; 34:e13819. [PMID: 32037570 DOI: 10.1111/ctr.13819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/04/2020] [Accepted: 02/05/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Transfusion protocols are not well-studied for pediatric patients with acute liver failure (ALF). This study evaluates the utility of an international normalized ratio (INR)-based transfusion threshold for these patients. METHODS Forty-four ALF pediatric patients from 2009 to 2018 were reviewed and divided into two groups: (a) a threshold group including patients between 2009 and 2015 who were transfused for an INR above 3.0, per institutional policy (n = 30), and (b) a post-threshold group including patients after 2015 through 2018 who were transfused based on clinical judgment (n = 14). Preoperative INRs, preoperative transfusions, intraoperative transfusions, early reoperation, renal function, graft function and deaths were compared. RESULTS Liver failure severity was similar between threshold and post-threshold groups. Threshold patients had a lower average INR prior to transplantation, 2.8 (range 1.8-3.8) vs 4.4 (range 2.1-9.0), respectively (P = .01). Twenty-six threshold patients (87%) received preoperative FFP compared with seven post-threshold patients (50%, P = .0088). Two threshold patients (7%) received preoperative cryoprecipitate compared with five post-threshold patients (36%, P = .014). The incidence of pre-transplant bleeding, operative transfusions, and 1-year patient and graft survival did not differ significantly. CONCLUSION Clinical judgment vs an INR-based threshold for transfusions did not increase perioperative complications in children with ALF.
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Affiliation(s)
- Angela Lee
- Division of Abdominal Transplantation, Department of Surgery, Stanford University, Stanford, California
| | - Julianne Mendoza
- Division of Pediatric Anesthesiology, Department of Anesthesia, Stanford University, Stanford, California
| | - Aleah L Brubaker
- Division of Abdominal Transplantation, Department of Surgery, Stanford University, Stanford, California
| | - Daniel J Stoltz
- Division of Abdominal Transplantation, Department of Surgery, Stanford University, Stanford, California
| | - Rebecca McKenzie
- Division of Gastroenterology, Department of Pediatrics, Stanford University, Stanford, California
| | - Clark A Bonham
- Division of Abdominal Transplantation, Department of Surgery, Stanford University, Stanford, California
| | - Carlos O Esquivel
- Division of Abdominal Transplantation, Department of Surgery, Stanford University, Stanford, California
| | - Amy E Gallo
- Division of Abdominal Transplantation, Department of Surgery, Stanford University, Stanford, California
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Brubaker AL, Wu H, Lee A, Vuong P, Stoltz DJ, Chaudhuri A, James G, Grimm PC, Concepcion W, Gallo AE. Ureterostomy as an alternative to ileal conduits in pediatric kidney transplantation. Clin Transplant 2020; 34:e13777. [DOI: 10.1111/ctr.13777] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/02/2019] [Accepted: 12/27/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Aleah L. Brubaker
- Division of Abdominal Transplantation Department of Surgery Stanford University Palo Alto California
| | - Hsi‐Yang Wu
- Division of Pediatric Urology Department of Urology Stanford University Palo Alto California
| | - Angela Lee
- Division of Abdominal Transplantation Department of Surgery Stanford University Palo Alto California
| | - Phoenix Vuong
- Division of Abdominal Transplantation Department of Surgery Stanford University Palo Alto California
| | - Daniel J. Stoltz
- Division of Abdominal Transplantation Department of Surgery Stanford University Palo Alto California
| | - Abanti Chaudhuri
- Division of Nephrology Department of Pediatrics Stanford University Palo Alto California
| | - Gerri James
- Division of Nephrology Department of Pediatrics Stanford University Palo Alto California
| | - Paul C. Grimm
- Division of Nephrology Department of Pediatrics Stanford University Palo Alto California
| | - Waldo Concepcion
- Division of Abdominal Transplantation Department of Surgery Stanford University Palo Alto California
| | - Amy E. Gallo
- Division of Abdominal Transplantation Department of Surgery Stanford University Palo Alto California
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13
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Abstract
Cutaneous wound healing is a complex physiological process. This process can be altered by multiple physiological and pathological factors. Multiple pathophysiological disturbances act to impair resolution of cutaneous wound injury, including obesity, diabetes, peripheral vascular disease, and advanced age. As our longevity increases without a concomitant increase in healthy living years, it is plausible to assume that problematic wound closure will continue to consume a large portion of our health care resources. Furthermore, advanced age is associated with numerous alterations in the innate and adaptive immune responses that complicate outcomes following cutaneous injury, trauma, or infection. Thus, models that examine the impact of advanced age on cutaneous wound repair will be of great benefit to the development of potential therapeutics that target age-related aberrancies in tissue repair. Herein, we detail two animal models of tissue injury, excisional wound injury and burn injury, that can be used to evaluate wound healing in the context of advanced age. We also describe modifications of these methods to examine wound infection following either excisional or burn injury. Lastly, we discuss methods of subsequent tissue analysis following injury. Models described below can be further adapted to genetically engineered murine strains to study the effects of aging and other co-morbidities on wound healing.
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14
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Curtis BJ, Hlavin S, Brubaker AL, Kovacs EJ, Radek KA. Episodic binge ethanol exposure impairs murine macrophage infiltration and delays wound closure by promoting defects in early innate immune responses. Alcohol Clin Exp Res 2014; 38:1347-55. [PMID: 24689549 DOI: 10.1111/acer.12369] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 12/23/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND Exacerbation of cutaneous wound infections and delayed wound closure are frequent complications seen in alcohol exposed subjects who sustain injuries. We previously reported that acute alcohol exposure alters the early dermal inflammatory phase of wound healing and also several parameters of the proliferative wound healing phase in wounds from ethanol (EtOH)-treated mice for several days or weeks after EtOH exposure. Hence, it is likely that the cumulative defects arising in the early phases of the wound healing process directly contribute to the increased complications observed in intoxicated patients at the time of injury. METHODS C57BL/6 mice were given intraperitoneal EtOH (2.2 g/kg body weight) or vehicle (saline) EtOH using our episodic binge EtOH exposure protocol (3 days EtOH, 4 days off, 3 days EtOH) to yield a blood alcohol concentration (BAC) of 300 mg/dl at the time of wounding. Mice were subjected to six 3 mm full-thickness dorsal wounds and immediately treated topically with 10 μl of sterile saline (control) or diluted Staphylococcus aureus corresponding to 1 × 10(4) CFU/wound. Wounds were harvested at 24 hours post injury to evaluate wound area, neutrophil and macrophage accumulation, and the protein levels of cytokines, interleukin-6 (IL-6), IL-1β, and IL-10, and chemokines, macrophage inflammatory protein-2 (MIP-2) and MIP-1α, monocyte chemotactic protein-1 (MCP-1), and keratinocyte-derived chemokine (KC). The abundance and localization of cathelicidin-related antimicrobial peptide (CRAMP) and the kallikrein epidermal proteases (KLK5 and KLK7) were also determined. RESULTS Compared to control mice, EtOH-treated mice exhibited delayed wound closure, decreased macrophage accumulation, and impaired production of MIP-1α. Furthermore, skin from EtOH-treated mice demonstrated a reduction in the abundance of epidermal CRAMP and KLK7. CONCLUSIONS These findings suggest that EtOH exposure hinders several distinct components of the innate immune response, including phagocyte recruitment and chemokine/cytokine and AMP production. Together, these effects likely contribute to delayed wound closure and enhanced infection severity observed in intoxicated patients.
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Affiliation(s)
- Brenda J Curtis
- Health Sciences Division , Alcohol Research Program, The Burn and Shock Trauma Research Institute, Loyola University Chicago, Maywood, Illinois; Health Sciences Division , Department of Surgery, The Burn and Shock Trauma Research Institute, Loyola University Chicago, Maywood, Illinois
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15
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Rendon JL, Li X, Brubaker AL, Kovacs EJ, Gamelli RL, Choudhry MA. The role of aryl hydrocarbon receptor in interleukin-23-dependent restoration of interleukin-22 following ethanol exposure and burn injury. Ann Surg 2014; 259:582-90. [PMID: 23989051 PMCID: PMC3925750 DOI: 10.1097/sla.0b013e3182a626f2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE T-helper (Th)-17 lymphocytes play a crucial role in maintenance and regulation of gut immunity. Our laboratory has demonstrated that acute ethanol (EtOH) exposure before burn injury results in intestinal T cell suppression and enhanced bacterial translocation. BACKGROUND To extend these studies, we examined the effects of EtOH exposure and burn injury on Th17 responses within intestinal lymphoid Peyer's patches (PP). We further investigated whether restitution of interleukin (IL)-23 enhances PP cell IL-17 and IL-22 after EtOH and burn injury. METHODS Male mice, approximately 25 g, were gavaged with EtOH (2.9 mg/kg) before receiving an approximately 12.5% total body surface area full thickness burn. One day postinjury, PP mixed cells were cultured in the presence of plate-bound anti-CD3/soluble anti-CD28 in the presence or absence of IL-23 for 48 hours. Supernatants were harvested for IL-17 and IL-22 levels. RESULTS When combined with EtOH intoxication, burn injury significantly decreased IL-17 and IL-22, as compared with sham injury. IL-23 treatment successfully increased levels of IL-22 but not IL-17. This restoration was prevented when PP cells were treated with CH-223191, an aryl hydrocarbon receptor inhibitor. To further delineate the mechanism of differential IL-17 and IL-22 suppression, PP cells were treated with phorbol 12-myristate 13-acetate (PMA) and ionomycin, which signal via protein kinase C (PKC) and calcium flux. Treatment with PMA and ionomycin significantly prevented the decrease in IL-17 but not IL-22 after EtOH exposure and burn injury. CONCLUSIONS These findings suggest that IL-23-mediated restoration of IL-22 is aryl hydrocarbon receptor dependent, whereas IL-17 requires activation of protein kinase C and intracellular calcium signaling.
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Affiliation(s)
- Juan L Rendon
- From the Alcohol Research Program, Burn & Shock Trauma Research Institute, Department of Surgery and Department of Microbiology and Immunology, Cell Biology, Neurobiology & Anatomy Program, Loyola University Chicago Health Sciences Division, Maywood, IL
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16
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Affiliation(s)
- Aleah L Brubaker
- The Burn and Shock Trauma Institute and Program in Cell Biology, Neurobiology, and Anatomy and Immunology and Aging Program and Stritch School of Medicine, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
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17
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Abstract
There are many age-associated changes in the respiratory and pulmonary immune system. These changes include decreases in the volume of the thoracic cavity, reduced lung volumes, and alterations in the muscles that aid respiration. Muscle function on a cellular level in the aging population is less efficient. The elderly population has less pulmonary reserve, and cough strength is decreased in the elderly population due to anatomic changes and muscle atrophy. Clearance of particles from the lung through the mucociliary elevator is decreased and associated with ciliary dysfunction. Many complex changes in immunity with aging contribute to increased susceptibility to infections including a less robust immune response from both the innate and adaptive immune systems. Considering all of these age-related changes to the lungs, pulmonary disease has significant consequences for the aging population. Chronic lower respiratory tract disease is the third leading cause of death in people aged 65 years and older. With a large and growing aging population, it is critical to understand how the body changes with age and how this impacts the entire respiratory system. Understanding the aging process in the lung is necessary in order to provide optimal care to our aging population. This review focuses on the nonpathologic aging process in the lung, including structural changes, changes in muscle function, and pulmonary immunologic function, with special consideration of obstructive lung disease in the elderly.
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Affiliation(s)
- Erin M Lowery
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine at Loyola University Medical Center, Maywood, IL, USA
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18
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Brubaker AL, Rendon JL, Ramirez L, Choudhry MA, Kovacs EJ. Reduced neutrophil chemotaxis and infiltration contributes to delayed resolution of cutaneous wound infection with advanced age. J Immunol 2013; 190:1746-57. [PMID: 23319733 DOI: 10.4049/jimmunol.1201213] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Advanced age is associated with alterations in innate and adaptive immune responses, which contribute to an increased risk of infection in elderly patients. Coupled with this immune dysfunction, elderly patients demonstrate impaired wound healing with elevated rates of wound dehiscence and chronic wounds. To evaluate how advanced age alters the host immune response to cutaneous wound infection, we developed a murine model of cutaneous Staphylococcus aureus wound infection in young (3-4 mo) and aged (18-20 mo) BALB/c mice. Aged mice exhibit increased bacterial colonization and delayed wound closure over time compared with young mice. These differences were not attributed to alterations in wound neutrophil or macrophage TLR2 or FcγRIII expression, or age-related changes in phagocytic potential and bactericidal activity. To evaluate the role of chemotaxis in our model, we first examined in vivo chemotaxis in the absence of wound injury to KC, a neutrophil chemokine. In response to a s.c. injection of KC, aged mice recruited fewer neutrophils at increasing doses of KC compared with young mice. This paralleled our model of wound infection, where diminished neutrophil and macrophage recruitment was observed in aged mice relative to young mice despite equivalent levels of KC, MIP-2, and MCP-1 chemokine levels at the wound site. This reduced leukocyte accumulation was also associated with lower levels of ICAM-1 in wounds from aged mice at early time points. These age-mediated defects in early neutrophil recruitment may alter the dynamics of the inflammatory phase of wound healing, impacting macrophage recruitment, bacterial clearance, and wound closure.
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Affiliation(s)
- Aleah L Brubaker
- Burn and Shock Trauma Institute, Loyola University Chicago Health Sciences Division, Maywood, IL 60153, USA
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19
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Carter SR, Zahs A, Palmer JL, Brubaker AL, Wang L, Ramirez L, Choudhry MA, Yong SL, Gamelli RL, Kovacs EJ. Elevated mortality and prolonged intestinal cell death following combined radiation and burn in a mouse model. J Am Coll Surg 2012. [DOI: 10.1016/j.jamcollsurg.2012.06.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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20
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Nomellini V, Brubaker AL, Mahbub S, Palmer JL, Gomez CR, Kovacs EJ. Dysregulation of neutrophil CXCR2 and pulmonary endothelial icam-1 promotes age-related pulmonary inflammation. Aging Dis 2012; 3:234-247. [PMID: 22724082 PMCID: PMC3375080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Revised: 02/28/2012] [Accepted: 02/28/2012] [Indexed: 06/01/2023] Open
Abstract
We have previously demonstrated that aging is associated with prolonged pulmonary inflammation in a murine model of thermal injury. To further investigate these observations, we examined lung congestion, markers of neutrophil chemotaxis and adhesion, and lung endothelia responses in young and aged mice following burn injury. Analysis of lung tissue and bronchoalveolar lavage fluid 24 hours after injury revealed that more neutrophils accumulated in the lungs of aged mice (p<0.05), but did not migrate into the alveoli. We then sought to determine if accumulation of neutrophils in the lungs of aged mice was due to differences in the peripheral neutrophil pool or local changes within the lung. Following burn injury, aged mice developed a pronounced peripheral blood neutrophilia (p<0.05) in comparison to their younger counterparts. In aged animals, there was a reduced frequency and mean fluorescent intensity of neutrophil CXCR2 expression (p<0.05). Interestingly, in uninjured aged mice, peripheral blood neutrophils demonstrated elevated chemokinesis, or hyperchemokinesis, (p<0.05), but showed a minimal chemotatic response to KC. To determine if age impacts neutrophil adhesion molecules, we assessed CD62L and CD11b expression on peripheral blood neutrophils. No age-dependent difference in the frequency or mean fluorescent intensity of CD62L or CD11b was observed post-burn trauma. Examination of pulmonary vasculature adhesion molecules which interact with neutrophil selectins and integrins revealed that intracellular adhesion molecule-1 (ICAM-1) was elevated in aged mice at 24 hours after burn as compared to young mice (p<0.05). Overall, our data suggests that age-associated pulmonary congestion observed following burn injury may be due to differences in lung endothelial adhesion responses that are compounded by elevated numbers of hyperchemokinetic circulating neutrophils in aged mice.
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Affiliation(s)
- Vanessa Nomellini
- Cellular and Molecular Biochemistry Program
- Burn and Shock Trauma Institute
- Immunology and Aging Program
- Stritch School of Medicine, Loyola University Chicago- Health Sciences Division, Maywood, IL 60153, USA
| | - Aleah L. Brubaker
- Cell Biology, Neurobiology and Anatomy Program
- Burn and Shock Trauma Institute
- Immunology and Aging Program
- Stritch School of Medicine, Loyola University Chicago- Health Sciences Division, Maywood, IL 60153, USA
| | - Shegufta Mahbub
- Burn and Shock Trauma Institute
- Department of Surgery
- Immunology and Aging Program
| | - Jessica L. Palmer
- Burn and Shock Trauma Institute
- Department of Surgery
- Immunology and Aging Program
| | - Christian R. Gomez
- Stritch School of Medicine, Loyola University Chicago- Health Sciences Division, Maywood, IL 60153, USA
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21
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Brubaker AL, Schneider DF, Palmer JL, Faunce DE, Kovacs EJ. An improved cell isolation method for flow cytometric and functional analyses of cutaneous wound leukocytes. J Immunol Methods 2011; 373:161-6. [PMID: 21889511 PMCID: PMC3195830 DOI: 10.1016/j.jim.2011.08.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Revised: 08/16/2011] [Accepted: 08/17/2011] [Indexed: 11/27/2022]
Abstract
Isolation of leukocytes from full-thickness excisional wounds has proven to be a difficult process that results in poor cell yield and holds significant limitations for functional assays. Given the increased interest in the isolation, characterization and functional measurements of wound-derived cell populations, herein we describe a method for preparing wound cell suspensions with an improved yield that enables both phenotypic and functional assessments.
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Affiliation(s)
- Aleah L. Brubaker
- The Burn and Shock Trauma Institute, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
- Program of Cell Biology, Neurobiology, and Anatomy, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
- Immunology and Aging Program, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
- Stritch School of Medicine, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
| | - David F. Schneider
- The Burn and Shock Trauma Institute, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
- Department of Surgery, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
| | - Jessica L. Palmer
- The Burn and Shock Trauma Institute, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
- Department of Surgery, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
| | - Douglas E. Faunce
- The Burn and Shock Trauma Institute, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
- Department of Surgery, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
- Immunology and Aging Program, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
| | - Elizabeth J. Kovacs
- The Burn and Shock Trauma Institute, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
- Department of Surgery, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
- Program of Cell Biology, Neurobiology, and Anatomy, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
- Immunology and Aging Program, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
- Stritch School of Medicine, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
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22
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Brubaker AL, Palmer JL, Kovacs EJ. Age-related Dysregulation of Inflammation and Innate Immunity: Lessons Learned from Rodent Models. Aging Dis 2011; 2:346-360. [PMID: 22396887 PMCID: PMC3295081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Revised: 09/22/2011] [Accepted: 10/05/2011] [Indexed: 05/31/2023] Open
Abstract
In the elderly patient population, it has become increasingly evident that immune dysregulation is a contributing factor to age-related pathologies and their associated morbidity and mortality. In particular, elderly subjects are plagued by poor responses to infectious challenge and immunization and are at heightened risk for the development of autoimmune, neuroinflammatory and tumor-associated pathologies. Rodent models of aging and age-related disorders have been utilized to better describe how innate immune cell dysfunction contributes to these clinical scenarios. As the elderly population continues to increase in size, use of these aging rodent models to study immune dysregulation may translate into increased healthy living years for these individuals.
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Affiliation(s)
- Aleah L. Brubaker
- The Burn and Shock Trauma Institute, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
- Immunology and Aging Program, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
- Program of Cell Biology, Neurobiology, and Anatomy, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
- Stritch School of Medicine, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
| | - Jessica L. Palmer
- The Burn and Shock Trauma Institute, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
- Department of Surgery, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
- Immunology and Aging Program, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
| | - Elizabeth J. Kovacs
- The Burn and Shock Trauma Institute, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
- Department of Surgery, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
- Immunology and Aging Program, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
- Program of Cell Biology, Neurobiology, and Anatomy, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
- Stritch School of Medicine, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
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23
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Abstract
The relationship between advanced age and immunologic deficits is becoming an area of rapidly advancing research. Many of the clinical hurdles in the elderly population result from dysregulation of the immune system leading to the inability of the elderly to swiftly combat infection and to the increased incidence of chronic disease states and autoimmune conditions. Herein, we address the crucial alterations in the innate immune system that occur with advancing age. Specifically, we discuss how the effects of advanced age may lead to functional changes in the neutrophil, macrophage, dendritic cell, natural killer cell, and natural killer T cell populations in human and murine models that translate into aberrant innate immune responses. Furthermore, we elucidate how these changes may contribute to documented deficits in adaptive immunity as well as the pathological conditions and the increased morbidity and mortality seen in the elderly population.
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Affiliation(s)
- Shegufta Mahbub
- The Burn and Shock Trauma Institute, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
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24
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Brubaker AL, Mahbub S, Deburghgrave C, Kovacs EJ. Impact of aging on dermal wound healing. FASEB J 2010. [DOI: 10.1096/fasebj.24.1_supplement.181.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Aleah L Brubaker
- Cell Biology, Neurobiology & Anatomy
- Burn and Shock Trauma Institute
| | - Shegufta Mahbub
- Burn and Shock Trauma Institute
- Department of SurgeryLoyola University Medical CenterMaywoodIL
| | | | - Elizabeth J Kovacs
- Burn and Shock Trauma Institute
- Department of SurgeryLoyola University Medical CenterMaywoodIL
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