Xenon Treatment Protects Against Cold Ischemia Associated Delayed Graft Function and Prolongs Graft Survival in Rats

Prolonged hypothermic storage causes ischemia‐reperfusion injury (IRI) in the renal graft, which is considered to contribute to the occurrence of the delayed graft function (DGF) and chronic graft failure. Strategies are required to protect the graft and to prolong renal graft survival. We demonstrated that xenon exposure to human proximal tubular cells (HK‐2) led to activation of range of protective proteins. Xenon treatment prior to or after hypothermia–hypoxia challenge stabilized the HK‐2 cellular structure, diminished cytoplasmic translocation of high‐mobility group box (HMGB) 1 and suppressed NF‐κB activation. In the syngeneic Lewis‐to‐Lewis rat model of kidney transplantation, xenon exposure to donors before graft retrieval or to recipients after engraftment decreased caspase‐3 expression, localized HMGB‐1 within nuclei and prevented TLR‐4/NF‐κB activation in tubular cells; serum pro‐inflammatory cytokines IL‐1β, IL‐6 and TNF‐α were reduced and renal function was preserved. Xenon treatment of graft donors or of recipients prolonged renal graft survival following IRI in both Lewis‐to‐Lewis isografts and Fischer‐to‐Lewis allografts. Xenon induced cell survival or graft functional recovery was abolished by HIF‐1α siRNA. Our data suggest that xenon treatment attenuates DGF and enhances graft survival. This approach could be translated into clinical practice leading to a considerable improvement in long‐term graft survival.     

Role of Toll‐like receptor 4 signaling in cutaneous chronic graft‐versus‐host disease

Cutaneous damage is one of the characterized manifestations in chronic graft‐versus‐host disease (cGVHD). When local effective immunity in the skin is altered to a dysimmune reaction, cutaneous injuries occur. Toll‐like receptor 4 signaling is regarded as a central mediator of inflammation and organ injury. In this study, we found that TLR4 mRNA in peripheral blood from patients with cutaneous cGVHD was markedly increased compared with that from non‐GVHD patients and healthy controls. In addition, NF‐κB expression, TLR4 downstream signaling, and TLR4‐mediated cytokines, including IL‐6 and ICAM‐1, were upregulated. Moreover, ICAM‐1 was widely distributed in skin biopsies from patients with cutaneous cGVHD. We also found that LPS induced TLR4‐mediated NF‐κB activation and IL‐6 and ICAM‐1 secretion in human fibroblasts in vitro. Thus, TLR4, NF‐κB, IL‐6, and ICAM‐1 contribute to the inflammatory response that occurs in cutaneous cGVHD, indicating the TLR4 pathway may be a novel target for cutaneous cGVHD therapy.     

Liver Ischemia Contributes to Early Islet Failure Following Intraportal Transplantation: Benefits of Liver Ischemic-Preconditioning

Early graft failure following intraportal islet transplantation (IPIT) represents a major obstacle for successful islet transplantation. Here, we examined the role of islet emboli in the induction of early graft failure and utilized a strategy of ischemic-preconditioning (IP) to prevent early islet destruction in a model of syngeneic IPIT in STZ-induced diabetic mice. Numerous focal areas of liver necrosis associated with the islet emboli were observed within 24 h post-IPIT. Pro-inflammatory cytokines, IL-1beta and IL-6, were significantly increased 3 h after IPIT, while TNF-alpha was elevated for up to 5 days post-IPIT. Caspase-3 and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling positive cells were observed in the transplanted islets trapped in areas of necrotic liver at 3 h and 1 day post-IPIT. Hyperglycemia was corrected immediately following IPIT of 200 islets, but recurrence of hyperglycemia was observed within 14 days associated with a poor response to glucose challenge. IP, a procedure of pre-exposure of the liver to transient ischemia and reperfusion, protected the liver from embolism-induced ischemic injury and prevented early islet graft failure. These data suggest that islet embolism in the portal vein is a major cause of functional loss following IPIT that can be prevented by liver IP.     

Donor kidney injury molecule‐1 promotes graft recovery by regulating systemic necroinflammation

Ischemia‐reperfusion injury during kidney transplantation predisposes to delayed graft function, rejection, and premature graft failure. Exacerbation of tissue damage and alloimmune responses may be explained by necroinflammation: an autoamplification loop of cell death and inflammation, which is mediated by the release of damage‐associated molecular patterns (eg, high‐mobility group box‐1; HMGB1) from necrotic cells that activate both innate and adaptive immune pathways. Kidney injury molecule‐1 (KIM‐1) is a phosphatidylserine receptor that is upregulated on injured proximal tubular epithelial cells and enables them to clear apoptotic and necrotic cells. Here we show a pivotal role for clearance of dying cells in regulating necroinflammation in a syngeneic murine kidney transplant model. We found persistent KIM‐1 expression in KIM‐1^+/+ kidney grafts posttransplantation. Compared to recipients of KIM‐1^+/+ kidneys, recipients of KIM‐1^?/? kidneys exhibited significantly more renal dysfunction, apoptosis and necrosis, tubular obstruction, and graft failure. KIM‐1^?/? grafts also had more inflammatory cytokines, infiltrating neutrophils, and macrophages compared to KIM‐1^+/+ grafts. Most significantly, passive release of HMGB1 from apoptotic and necrotic cells led to dramatically higher serum HMGB1 levels and increased proinflammatory macrophages in recipients of KIM‐1^?/? grafts. Our data identify an endogenous protective mechanism against necroinflammation in kidney grafts that may be of therapeutic relevance in transplantation.     

Activation of TLR signalling regulates microwave radiation‐mediated impairment of spermatogenesis in rat testis

Microwave radiation could increase the expression of pro‐inflammatory cytokines in rat Sertoli cells, which may impair spermatogenesis. However, the mechanisms that microwave radiation induces the cytokine expression in Sertoli cells remain to be clarified. The activation of TLRs by their ligands can trigger a common signalling pathway to upregulate inflammatory cytokines such as IL‐1, IL‐6, IL‐12 and TNF‐α. Microwave radiation can increase the expression of TLRs in lymphocytes. The purpose of this study was to determine the effect of microwave radiation on the TLRs in rat testis. We focus on the effect of TLR2‐5 (which is expressed relatively highly) by microwave radiation. The results showed that the expression of TLR2‐5 and the pro‐inflammatory cytokines (IL‐1β, IL‐6 and TNF‐α) was increased both in mRNA and in protein. Furthermore, p‐p38, p‐ERK1/2, p‐JNK and p‐NF‐κB p65, the key factors of TLR signalling, were also elevated by microwave exposure. And the NF‐κB can be induced more dominantly. These results suggest that TLRs signalling can be activated by microwave radiation in testis, which may provide the molecular basis for the in‐depth study.     

体外转染可溶性IL-1RI-Ig基因延长糖尿病小鼠移植胰岛细胞存活时间

目的 探讨糖尿病小鼠移植经可溶性白细胞介素1(IL-1)受体胞外段Fc融合蛋白(sIL-1RI-Ig)基因修饰的胰岛细胞对延长移植物存活时间的作用及机制.方法 将Ad-sIL-1RI-Ig体外转染Balb/c小鼠的胰岛细胞,并将其移植给糖尿病C57BL/6小鼠,观察移植物的存活时间,并检测移植局部组织炎症细胞的浸润以及炎症细胞因子的表达.结果 糖尿病小鼠移植转染sIL-1RI-Ig基因的胰岛细胞后,血糖水平很快下降至正常范围,胰岛移植物存活时间达(39±3)d,而移植正常胰岛细胞的小鼠胰岛移植物存活时间为(9±2)d(P<0.01).糖尿病小鼠移植转染sIL-1RI-Ig基因的胰岛细胞后,胰岛素分泌量随糖负荷增加而升高,并与胰岛素分泌功能正常的小鼠呈相似变化趋势(P>0.05).糖尿病小鼠移植转染sIL-1RI-Ig基因的胰岛细胞后,移植局部组织表达肿瘤坏死因子α(TNF-α)、γ干扰素(IFN-γ)和RANTES等水平明显下调;病理学观察发现移植局部组织浸润的炎症细胞明显少于移植正常胰岛细胞的小鼠.结论 sIL-1RI-Ig基因转染胰岛细胞后,可通过表达sIL-1RI-Ig,阻断IL-1的作用,降低TNF-α、IFN-γ、RANTES等细胞因子的表达,从而减轻排斥反应,延长胰岛细胞移植物的存活时间和提高胰岛素分泌功能.     

Thrombomodulin Attenuates Inflammatory Damage Due to Liver Ischemia and Reperfusion Injury in Mice in Toll‐Like Receptor 4–Dependent Manner

Liver ischemia reperfusion injury (IRI) is an important problem in liver transplantation. Thrombomodulin (TM), an effective drug for disseminated intravascular coagulation, is also known to exhibit an anti‐inflammatory effect through binding to the high‐mobility group box 1 protein (HMGB‐1) known as a proinflammatory mediator. We examined the effect of recombinant human TM (rTM) on a partial warm hepatic IRI model in wild‐type (WT) and toll‐like receptor 4 (TLR‐4) KO mice focusing on the HMGB‐1/TLR‐4 axis. As in vitro experiments, peritoneal macrophages were stimulated with recombinant HMGB‐1 protein. The rTM showed a protective effect on liver IRI. The rTM diminished the downstream signals of TLR‐4 and also HMGB‐1 expression in liver cells, as well as release of HMGB‐1 from the liver. Interestingly, neither rTM treatment in vivo nor HMGB‐1 treatment in vitro showed any effect on TLR‐4 KO mice. Parallel in vitro studies have confirmed that rTM interfered with the interaction between HMGB‐1 and TLR‐4. Furthermore, the recombinant N‐terminal lectin‐like domain 1 (D1) subunit of TM (rTMD1) also ameliorated liver IRI to the same extent as whole rTM. Not only rTM but also rTMD1 might be a novel and useful medicine for liver transplantation. This is the first report clarifying that rTM ameliorates inflammation such as IRI in a TLR‐4 pathway–dependent manner.     

Role of Natural Killer Cells in the Innate Immune System After Intraportal Islet Transplantation in Mice

Background

Both liver natural killer (NK) and NK T cells of the innate immune system play a crucial role in islet graft loss after intraportal islet transplantation, although a relationship between NK and NK T cells in islet loss has not been proven. In this study, we investigated the role of NK cells in the innate immune system in islet graft loss after intraportal islet transplantation.

Successful islet transplantation to two recipients from a single donor by targeting proinflammatory cytokines in mice

BACKGROUND: Currently, the inability to achieve successful islet transplantation from one donor to one recipient is a major obstacle facing clinical islet transplantation. We herein determined whether this limitation could be overcome by targeting pro-inflammatory cytokines with the prevention of immediate islet graft loss in association with engraftment in mice. METHODS: Isolated islets were grafted into the liver of streptozotocin-induced diabetic mice and the role of proinflammatory cytokines in the engraftment of islets was evaluated with the use of interferon (IFN)-gamma-/- mice and monoclonal antibodies against proinflammatory cytokines. RESULTS: Hyperglycemia in streptozotocin-induced diabetic mice receiving 200 syngenic islets, which were isolated from a single mouse pancreas, was ameliorated when IFN-gamma-/-, but not wild-type mice, were used as recipients. The treatment with anti-IFN-gamma antibody produced normoglycemia in diabetic wild-type mice receiving 200, but not 100 islets. However, when anti-tumor necrosis factor-alpha and anti-interleukin-1beta antibodies were administered in conjunction with anti-IFN-gamma antibody, wild-type diabetic mice receiving 100 islets became normoglycemic after transplantation. In addition, the favorable effect of the combined use of antibodies was similarly achieved in mice receiving islet allografts when rejection was prevented with anti-CD4 antibody treatment. CONCLUSIONS: These findings clearly demonstrate that successful islet transplantation from one donor to two recipients is feasible by targeting pro-inflammatory cytokines in mice, thus suggesting a potential application in clinical islet transplantation if similar mechanisms of islet graft loss could be mediated in humans.     

Suppression of osteoblast toll‐like receptor 2 signaling by endothelin‐1

Peripheral endothelin‐1 (ET‐1) levels are increased in chronic systemic disorders such as congestive cardiac failure, diabetes and chronic renal failure. Bone infections are also associated with poor prognoses in these conditions. In the present study, we examined the alterations in Toll‐like receptor 2 (TLR2) signaling induced by ET‐1 in an in vitro osteoblast cell model. The TLR2‐positive murine osteoblast cell line MC3T3‐E1 was treated with heat‐killed Listeria monocytogenes (HKLM), a TLR2 ligand, in the presence or absence of ET‐1. We examined TLR2 expression, intranuclear NF‐κB phosphorylation and interleukin 6 (IL‐6) production. ET‐1 suppressed cell surface expression of TLR2, NF‐κB phosphorylation and IL‐6 production. As TLR2 represents an important mechanism by which osteoblasts recognize bacterial pathogens, a continuously elevated ET‐1 status may impair pathogenic recognition by osteoblasts and consequently affect bone metabolism during infections. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:910–914, 2014.     

Molecular detection of circulating beta-cells after islet transplantation

Islet transplantation is a promising treatment for type 1 diabetes. However, islet grafts are submitted to multiple injuries, including immunosuppressive drug toxicity, hyperglycemia, hypoxia, unspecific inflammatory reactions, as well as allo- and autoimmune destruction. Therapeutic approaches to these damage mechanisms require early detection of islet injury, which is currently not feasible because of the lack of efficient markers. Based on the hypothesis of islet dissociation and release of islet cells into the circulation during islet injury, we designed a highly sensitive and specific molecular assay, able to detect two beta-cells per milliliter of venous blood by RT-PCR of insulin mRNA. We report that circulating beta-cells can be demonstrated up to 10 weeks after intraportal islet transplantation, as assessed after six islet grafts in four type 1 diabetic patients. Furthermore, our results suggest that the time during which circulating islet cells can be detected may depend on the graft environment and the immunosuppressive regimen. This test may allow better estimation of islet cell loss and identification of factors involved in islet graft injury.     

Identification and Characterization of microRNAs Associated With Human β‐Cell Loss in a Mouse Model

Currently there is no effective approach for monitoring early β‐cell loss during islet graft rejection following human islet transplantation (HIT). Due to ethical and technical constraints, it is difficult to directly study biomarkers of islet destruction in humans. Here, we established a humanized mouse model with induced human β‐cell death using adoptive lymphocyte transfer (ALT). Human islet grafts of ALT‐treated mice had perigraft lymphocyte infiltration, fewer insulin⁺ β cells, and increased β‐cell apoptosis. Islet‐specific miR‐375 was used to validate our model, and expression of miR‐375 was significantly decreased in the grafts and increased in the circulation of ALT‐treated mice before hyperglycemia. A NanoString expression assay was further used to profile 800 human miRNAs in the human islet grafts, and the results were validated using quantitative real‐time polymerase chain reaction. We found that miR‐4454 and miR‐199a‐5p were decreased in the human islet grafts following ALT and increased in the circulation prior to hyperglycemia. These data demonstrate that our in vivo model of induced human β‐cell destruction is a robust method for identifying and characterizing circulating biomarkers, and suggest that miR‐4454 and miR‐199a‐5p can serve as novel biomarkers associated with early human β‐cell loss following HIT.     

The role of current product release criteria for identification of human islet preparations suitable for clinical transplantation

BACKGROUND: Alloimmunity, autoimmunity, and nonspecific inflammation are known to be potential determinants for long-term islet survival and insulin independence. Sufficient islet mass is a key determinant. But islet engraftment and posttransplant survival may also depend on functional characteristics of the graft. This study investigated the significance of current product release criteria for the transplantation outcome. METHODS: Fourty five consecutive transplanted human islet preparations and their functional outcomes were analyzed. Islet mass was determined according to standard criteria: purity by light microscopy, viability by dye exclusion and Insulin secretory response to static glucose incubation. Islet graft function was monitored for > or = 1 year. Islet function was defined as full (FF), partial (PF), or nonfunction (NF) based on serum C-peptide levels and insulin independence. RESULTS: All islet grafts displayed primary function. Islet mass [IEQ/kg BW]: 7331.3 +/- 679.7 (FF), 5821.3 +/- 546.7 (PF), 6468.6 +/- 658.5 (NF), (FF vs PF p = .032) Purity [%] 86.9 +/- 3.1 (FF), 76.0 +/- 2.87 (PF), 88.2 +/- 2.3 (NF) (FF vs PF P =.045, PF vs NF, P = 0.01). (4) Viability [%]:89.2 +/- 2 (FF), 86.2 +/- 1.7 (PF), 87.3 +/- 1.8 (NF) (ns). Stimulation index (SI): 20 +/- 6.3 (FF), 80.2 +/- 28.2 (PF), 21.6 +/- 3.5 (NF) (ns) No correlation was observed between SI and any other parameter nor between SI and C-peptide levels. Islet mass significantly correlated with C-peptide levels at 6 and 12 months after transplantation for functioning grafts. CONCLUSIONS: Stringent product release criteria allow identification of islet preparations suitable for clinical transplantation. However, currently used parameters are not predictive of long-term graft function, indicating that further refined quality assessments including apoptosis and resistance to early inflammation, are required to assess the primary engrafted islet mass.     

Composite Islet-Endothelial Cell Grafts: A Novel Approach to Counteract Innate Immunity in Islet Transplantation

An instant blood-mediated inflammatory reaction (IBMIR) is elicited when islets come in contact with blood after intraportal transplantation. In contrast, endothelial cells (EC) readily tolerate contact with blood. A conceivable strategy to overcome IBMIR would be to create composite islet-EC grafts. Human islets were co-cultured with primary human aortic endothelial cells (HAEC) for 2-7 days to obtain 50-90% coverage. HAEC-coated islets were exposed to ABO-identical blood and analyzed with regard to clotting time, signs of inflammation and cell infiltration. Composite islet-HAEC graft survival was assessed after transplantation to athymic (nu/nu) nude mice. Exposed to blood, HAEC-coated islets induced less activation of coagulation and complement compared to control islets. Also, platelet and leukocyte consumption in blood was decreased. Clots with entrapped HAEC-coated islets showed less infiltration of CD11b+ cells. The extent of protection correlated to the level of HAEC coverage. Transplanted composite grafts stained positive for insulin and PECAM-1 demonstrating presence of both islets and HAEC within the islet graft 7 weeks after transplantation. Composite islet-HAEC grafts reduce all components of IBMIR. Refinement of the technique will allow introduction of composite islet-EC grafts in clinical islet transplantation, using autologous EC expanded in vitro and kept frozen until allogeneic islets become available for that specific recipient.     

Platelet glycoprotein VI-dependent thrombus stabilization is essential for the intraportal engraftment of pancreatic islets

Platelet activation and thrombus formation have been implicated to be detrimental for intraportal pancreatic islet transplants. The platelet-specific collagen receptor glycoprotein VI (GPVI) plays a key role in thrombosis through cellular activation and the subsequent release of secondary mediators. In aggregometry and in a microfluidic dynamic assay system modeling flow in the portal vein, pancreatic islets promoted platelet aggregation and triggered thrombus formation, respectively. While platelet GPVI deficiency did not affect the initiation of these events, it was found to destabilize platelet aggregates and thrombi in this process. Interestingly, while no major difference was detected in early thrombus formation after intraportal islet transplantation, genetic GPVI deficiency or acute anti-GPVI treatment led to an inferior graft survival and function in both syngeneic mouse islet transplantation and xenogeneic human islet transplantation models. These results demonstrate that platelet GPVI signaling is indispensable in stable thrombus formation induced by pancreatic islets. GPVI deficiency resulted in thrombus destabilization and inferior islet engraftment indicating that thrombus formation is necessary for a successful intraportal islet transplantation in which platelets are active modulators.