Dealloying-based interpenetrating-phase nanocomposites matching the elastic behavior of human bone

The long-term performance of orthopedic implants depends crucially on a close match between the mechanical behavior of bone and of the implant material. Yet, the present man-made materials with the required biocompatibility and strength are substantially stiffer than bone. This mismatch results in stress shielding, which can lead to the loss of bone mass and may even lead to a revision surgery. Here we report a new materials design strategy towards metal-polymer composites that are based on constituents with established biocompatibility and that can be matched to bone. Ti-based nanoporous alloys, prepared by liquid-metal dealloying, are infiltrated with epoxy to form interpenetrating-phase nanocomposites. At up to 260 MPa, their yield strength is technologically interesting for a deformable light-weight material. More importantly, Young’s modulus can be adjusted between 4.4 and 24 GPa, which affords matching to bone. As another parallel to bone, the strength of the composite materials is strain-rate dependent. These findings suggest that the novel composite materials may provide the basis for promising future implant materials.

Ex Vivo Costimulatory Blockade to Generate Regulatory T Cells From Patients Awaiting Kidney Transplantation

Short-term outcomes of kidney transplantation have improved dramatically, but chronic rejection and regimen-related toxicity continue to compromise overall patient outcomes. Development of regulatory T cells (Tregs) as a means to decrease alloresponsiveness and limit the need for pharmacologic immunosuppression is an active area of preclinical and clinical investigation. Nevertheless, the immunomodulatory effects of end-stage renal disease on the efficacy of various strategies to generate and expand recipient Tregs for kidney transplantation are incompletely characterized. In this study, we show that Tregs can be successfully generated from either freshly isolated or previously cryopreserved uremic recipient (responder) and healthy donor (stimulator) peripheral blood mononuclear cells using the strategy of ex vivo costimulatory blockade with belatacept during mixed lymphocyte culture. Moreover, these Tregs maintain a CD3(+) CD4(+) CD25(+) CD127(lo) surface phenotype, high levels of intracellular FOXP3 and significant demethylation of the FOXP3 Treg-specific demethylation region on allorestimulation with donor stimulator cells. These data support evaluation of this simple, brief Treg production strategy in clinical trials of mismatched kidney transplantation.

Alginate encapsulant incorporating CXCL12 supports long-term allo- and xenoislet transplantation without systemic immune suppression

Islet transplantation represents a potentially curative approach for individuals with Type I Diabetes. The requirement for systemic immune suppression to control immune-mediated rejection of transplanted islets and the limited human islet supply represent significant roadblocks to progress for this approach. Islet microencapsulation in alginate offers limited protection in the absence of systemic immunosuppression, but does not support long-term islet survival. The chemokine, CXCL12, can repel effector T cells while recruiting immune-suppressive regulatory T cells (Tregs) to an anatomic site while providing a prosurvival signal for beta-cells. We proposed that coating or encapsulating donor islets with CXCL12 would induce local immune-isolation and protect and support the function of an allo- or xenograft without systemic immune suppression. This study investigated the effect of alginate microcapsules incorporating CXCL12 on islet function. Islet transplantation was performed in murine models of insulin-dependent diabetes. Coating of islets with CXCL12 or microencapsulation of islets with alginate incorporating the chemokine, resulted in long-term allo- and xenoislet survival and function, as well as a selective increase in intragraft Tregs. These data support the use of CXCL12 as a coating or a component of an alginate encapsulant to induce sustained local immune-isolation for allo- or xenoislet transplantation without systemic immunosuppression.

Islet product characteristics and factors related to successful human islet transplantation from the Collaborative Islet Transplant Registry (CITR) 1999-2010

The Collaborative Islet Transplant Registry (CITR) collects data on clinical islet isolations and transplants. This retrospective report analyzed 1017 islet isolation procedures performed for 537 recipients of allogeneic clinical islet transplantation in 1999-2010. This study describes changes in donor and islet isolation variables by era and factors associated with quantity and quality of final islet products. Donor body weight and BMI increased significantly over the period (p<0.001). Islet yield measures have improved with time including islet equivalent (IEQ)/particle ratio and IEQs infused. The average dose of islets infused significantly increased in the era of 2007-2010 when compared to 1999-2002 (445.4±156.8 vs. 421.3±155.4×0(3) IEQ; p<0.05). Islet purity and total number of β cells significantly improved over the study period (p<0.01 and <0.05, respectively). Otherwise, the quality of clinical islets has remained consistently very high through this period, and differs substantially from nonclinical islets. In multivariate analysis of all recipient, donor and islet factors, and medical management factors, the only islet product characteristic that correlated with clinical outcomes was total IEQs infused. This analysis shows improvements in both quantity and some quality criteria of clinical islets produced over 1999-2010, and these parallel improvements in clinical outcomes over the same period.

Human monoclonal antibody MBL-HCV1 delays HCV viral rebound following liver transplantation: a randomized controlled study

Rapid allograft infection complicates liver transplantation (LT) in patients with hepatitis C virus (HCV). Pegylated interferon-α and ribavirin therapy after LT has significant toxicity and limited efficacy. The effect of a human monoclonal antibody targeting the HCV E2 glycoprotein (MBL-HCV1) on viral clearance was examined in a randomized, double-blind, placebo-controlled pilot study in patients infected with HCV genotype 1a undergoing LT. Subjects received 11 infusions of 50 mg/kg MBL-HCV1 (n=6) or placebo (n=5) intravenously with three infusions on day of transplant, a single infusion on days 1 through 7 and one infusion on day 14 after LT. MBL-HCV1 was well-tolerated and reduced viral load for a period ranging from 7 to 28 days. Median change in viral load (log10 IU/mL) from baseline was significantly greater (p=0.02) for the antibody-treated group (range -3.07 to -3.34) compared to placebo group (range -0.331 to -1.01) on days 3 through 6 posttransplant. MBL-HCV1 treatment significantly delayed median time to viral rebound compared to placebo treatment (18.7 days vs. 2.4 days, p<0.001). As with other HCV monotherapies, antibody-treated subjects had resistance-associated variants at the time of viral rebound. A combination study of MBL-HCV1 with a direct-acting antiviral is underway.

Live donor partial hepatectomy for liver transplantation: is there a learning curve?

BACKGROUND

Donor safety is the first priority in living donor liver transplantation (LDLT).

OBJECTIVE

To determine the characteristics and outcome of live liver donors who underwent donor hepatectomy from January, 1997 to May, 2007 at Massachusetts General Hospital.

METHODS

30 patients underwent LDLT between January, 1997 and May, 2007 at our institution.

RESULTS

The type of graft was the right lobe (segments 5-8) in 14, left lobe (segments 2-4) in 4, and left lateral sector (segments 2 and 3) in 12 patients. The mean donor age was 36 (range: 26-57) years. The mean follow-up was 48 (range: 18-120) months. No deaths occurred. Overall, 8 (26.6%) patients experienced a total of 14 post-operative complications. Donor complications based on graft type were as follows: left lateral sector (16.7%), left lobe (25%), and right lobe (35.7%). The experience was divided into two periods 1997-2001 (n=15) and 2002-2007 (n=15). Overall complications during 2 periods were 40% and 13.3%, respectively (p<0.001). The incidence of grade III complication also significantly decreased; 66.7% vs 33.3% (p<0.01).

CONCLUSION

Partial hepatectomy in living donors has a learning curve which appears to be approximately 15 cases. This learning curve is not restricted to the surgeons performing the procedure but involves all aspects of patient care.

Grain-boundary-induced spin disorder in nanocrystalline gadolinium

Based on experimental magnetic-field-dependent neutron scattering data, we have calculated the autocorrelation function of the spin misalignment of nanocrystalline (160)gadolinium. The analysis suggests the existence of two characteristic length scales in the spin system: the smaller one is about 5 nm and is attributed to the defect cores of the grain boundaries, whereas the larger length scale is of the order of the average crystallite size D = 21 nm and presumably describes the response of the magnetization to the magnetic anisotropy field of the individual crystallites.

Development of anti-human leukocyte antigen class 1 antibodies following allogeneic islet cell transplantation

Currently there is minimal concern that islet allograft failure could result from the development of anti-human leukocyte antigen (HLA) antibodies reactive to the allograft. We report here a case of islet allograft failure where the recipient developed immunoglobulin G anti-HLA class I antibodies reactive to HLA antigens present in two of the three islet cell donors. The patient had no detectable anti-HLA antibodies prior to the transplant but these antibodies were detected approximately 4 months posttransplant. Of concern, these antibodies developed despite induction with anti-IL2R antibodies (Zenapex) prior to intraportal islet cell infusion, low-dose tacrolimus (12-hour troughs 3 to 5 ng/mL) and rapammune (target troughs 12 to 15 ng/mL). The patient was not presensitized with blood products or a previous allograft. Her husband, however, shared antigens present in one of the islet donors and the recipient could have been presensitized to her husband during her two pregnancies. This case clearly demonstrates that islet allografts can lead to development of anti-HLA antibodies, which can cause islet allograft failure, as is the case with solid organ transplants, and hence emphasizes the need to monitor for such antibodies pre- and posttransplant. Additionally it appears that currently recommended immunosuppression may not be sufficient to inhibit a humoral response to both alloantigens and autoantigens.

Assessment of human pancreatic islets after long distance transportation

Pancreatic islet transplantation can replace functional insulin-secreting beta cells for patients with type 1 diabetes. More than 300 patients who have received islet transplantation have returned to a euglycemic condition without using insulin. Therefore, islet transplantation has gained public attention and interest. Unfortunately, shortages in organ donations, suboptional antirejection regimens, and difficulties in islet isolation limit clinical utilization of this therapy. Recently, successful islet transplantation has been reported using a centralized islet isolation facility. The advantage of this experience is that it avoids the high costs in building an isolation facility and maintaining an experienced technical team. However, a private airplane carrier was required for transporting islets back to the transplantation site in a remote hospital. The cost of this specialized transportation was still too high to be considered as a routine procedure. In this study, we report our experience using commercial carriers to deliver isolated human islets from an established isolation facility to a remote medical center.

Effect of prolonged monoclonal antibody administration on cardiac allograft survival in the rat

After heterotopic cardiac transplantation in the rat, monoclonal antibodies (MoAb) specific for rat T-cell subsets were administered until rejection. Across combined major histocompatibility complex (MHC) and non-MHC differences (WF to Lew) and isolated non-MHC differences (WF to Lew.1W) cardiac allografts were rapidly rejected in unmodified hosts (7.7 +/- 1.0 days and 12.2 +/- 0.8 days respectively). Across combined MHC and non-MHC differences, administration of MoAb OX-19 (pan T-cell) on days -1, 0, and 1 (where day 0 was the day of transplantation) and alternate days thereafter until rejection significantly prolonged allograft survival (28.5 +/- 10.2 days, P less than 0.01). Administration of MoAb W3/25 (helper T cell) and MoAb OX-39 (interleukin 2 (IL-2) receptor) prolonged allograft survival (11.3 +/- 2.6 days, P less than 0.05 and 13.3 +/- 2.0 days, P less than 0.01 respectively), whereas MoAb OX-8 (cytotoxic/suppressor T cell) administration had no effect on allograft survival. In contrast, across non-MHC differences (WF to Lew.1W) administration of MoAb OX-8 markedly prolonged allograft survival (85, greater than 100 x 3 days) whereas MoAb W3/25 administration had no effect. The effect of MoAb administration on lymphocyte subsets at rejection was assessed by flow cytometry. The relationship between depletion of targeted T-cell subsets and graft survival was variable. Across both combined MHC and non-MHC and isolated non-MHC differences MoAb OX-8 administration resulted in a marked reduction of OX-8+ cells at rejection with no prolongation of graft survival in the former and indefinite graft survival in the latter. In contrast, OX-19 administration resulted in prolonged graft survival but at rejection there were significant numbers of OX-19+ cells present. Administration of MoAb W3/25 failed to affect a significant reduction in W3/25+ cells, but allograft survival was nonetheless prolonged.

Antigen presenting function of class II MHC expressing pancreatic beta cells

Class II major histocompatibility complex (MHC) gene expression in the mouse is generally limited to thymic epithelium and bone marrow-derived cells such as B lymphocytes and cells of the macrophage/dendritic cell lineage (M phi/DC). Class II-bearing B lymphocytes and M phi/DC possess antigen presenting cell (APC) function; that is, they can stimulate T lymphocytes reactive to either antigen plus MHC or foreign MHC alone. To assess whether non-bone-marrow-derived cells can acquire APC function and elicit graft rejection through expression of class II, we studied transgenic pancreatic islet beta cells that express a foreign class II (I-E) molecule. In vivo, grafts of I-E+ transgenic islets into I-E- naive hosts are not rejected unless the host is primed by an injection of I-E+ spleen cells. In vitro, the I-E+ beta cells are unable to stimulate T lymphocytes reactive to I-E plus a peptide antigen. Paradoxically, they induce antigen specific unresponsiveness in the T cells. We propose that expression of class II on non-lymphoid cells may serve as an extrathymic mechanism for maintaining self tolerance.