Este trabajo fue apoyado por el Health and Medical Research Council Nacional (NHMRC) de Australia Proyecto Subvención 1.029.205, por la Fundación Microsearch de Australia, y por la Fundación de Investigación Médica Myee Codrington.

Antes del comienzo de los experimentos, obtener la aprobación del Comité de Ética del cuidado animal de la institución pertinente para los experimentos planeados. Mantener los ratones en la conformidad con los requisitos de su institución. El siguiente protocolo ha sido aprobado por los comités de la Universidad de Sydney y el Hospital Royal Prince Alfred. Antes de comenzar la cirugía, todos los instrumentos deben limpiarse a fondo y se esterilizaron por inmersión en etanol al 80%. Algunas instituciones estipulan autoclave sin embargo, esto puede dañar los instrumentos de microcirugía finos en el largo plazo. Siempre que sea posible el uso de equipo desechable estéril. 1. Anestesia <ol><li> Anestesie ratón con isoflurano en un recipiente sellado y luego colocarlo en decúbito supino sobre una tabla de funcionamiento, conectando rápidamente cono de la nariz anestésico. Prueba de adecuación de la anestesia pellizcando la pata trasera para asegurar que no hay reflejo. </li><li> Shave la piel con una cuchilla quirúrgica yesterilizar con etanol al 80%. Además, clorhexidina al 2% en 70% de alcohol isopropílico se puede utilizar para la esterilización de la piel. Durante la inducción de la anestesia de la concentración de isoflurano es del 3%, pero reducir esto a 1-1,5% para el mantenimiento. Hacer pequeños ajustes a esta concentración para mantener una respiración regular y la frecuencia cardíaca. Mantenga la temperatura del animal sobre una almohadilla térmica. </li></ol> 2. Operación de donantes <ol><li> Hacer una toracotomía para exponer el corazón y los vasos cortando el pecho a través de ambos lados de la caja torácica desde el borde de costilla hasta la axila seguido de un corte transversal a nivel de la xiphisternum para formar un colgajo de la pared torácica. Levante esta solapa hacia arriba al lado de la cabeza y el pin a la placa operativo. Arranque pericardio para exponer el corazón y los vasos. </li><li> Levante la vena cava inferior con unas pinzas en una mano y con la otra inyectar 1 ml frío proximal salina heparinizada al corazón a través de la vena cava inferior, a continuación, poner una abrazadera de las arterias pequeñas en el IVC para prevenciónt flujo de la solución de perfusión a través del agujero de la aguja. </li><li> El uso de una gasa y un bastoncillo de algodón, retraiga el corazón hacia abajo para exponer la aorta ascendente y la arteria pulmonar. Pasar una hoja de un par de microtijeras a través del canal (seno transverso) posterior al haz de la aorta y la arteria pulmonar y cortar la aorta y la arteria pulmonar juntos hasta distalmente como sea posible para asegurar una longitud suficiente para la anastomosis. </li><li> Empate y dividir el IVC, la vena cava superior derecha (SVC), izquierda SVC y las venas pulmonares utilizando hilo de seda 6-0. Ate el IVC y derecha SVC separado y luego coloque un solo hilo posterior al corazón para rodear el SVC izquierda junto a las venas pulmonares y atarlo. Coseche el corazón de la zona donante mediante la reducción de los vasos distales a los lazos, a continuación, guárdelo en una solución salina estéril en frío a 4 º C hasta el trasplante. Esto da lugar a la muerte del donante por desangrado. </li></ol> 3. Operación Receptor <ol><li> Se anestesia ladestinatario que el anterior (sección 1). Afeitarse con cuidado el abdomen para evitar la irritación, a continuación, hacer una laparotomía por línea media incisión desde el pubis al xiphisternum y retraer el uso de clips de papel doblado para formar retractores. Envuelva el intestino en caliente salina empapado gasa estéril y se retraen a la parte superior derecha del abdomen. </li><li> Para exponer la aorta infra-renal y la vena cava inferior, liberar los segmentos de paquetes de aorta y vena cava inferior de la arteria renal izquierda y la vena a la bifurcación ilíaca dividiendo ellos de los vasos lumbares utilizando un dispositivo de cauterio. Tenga cuidado de que el cauterio esté a la temperatura correcta y se utiliza durante un tiempo suficiente para dividir y sellar los extremos de los vasos. </li><li> Aplicar pequeñas pinzas atraumáticas vasos a la aorta y segmentos IVC distal y proximal. Hacer una incisión en la pared frontal de la aorta por primera perforación de un agujero con una aguja 30 G; luego se corta una incisión vertical con micro tijeras para que coincida con el tamaño de la aorta de donantes. Enjuague el lumen de la aorta con solución salina heparinizada para eliminar cualquier blcoágulos ood. </li><li> Traiga el corazón del donante a la zona receptora cubierto con una gasa empapada en solución salina fría y colóquela en el lado derecho del abdomen. Asegúrese de que la aorta del donante se coloca al lado de la incisión en la aorta receptor y la arteria pulmonar del donante posicionado al lado del receptor IVC. </li><li> Anastomosan el lado de extremo a extremo de la aorta del donante a la aorta destinatario utilizando corriendo 10-0 de nylon partir de la esquina y la sutura proximal a lo largo del lado izquierdo primero, hasta llegar a la esquina distal, en cuya etapa el animal se gira 180 °. Mover suavemente el corazón del donante hacia el lado izquierdo del abdomen para exponer el lado derecho de la aorta y continuar la sutura a través del lado derecho de la pared aórtica desde el extremo distal hasta el extremo proximal. Antes de cerrar la anastomosis aórtica, lave suavemente el lumen con solución salina heparinizada para eliminar cualquier coágulo y aire. </li><li> Anastomosis de la arteria pulmonar del donante (PA) de extremo a lado con el destinatario IVC. Hacer una incisión verticamente con microtijeras en la pared frontal de la VCI en un sitio de conformidad con la anastomosis de la arteria. Anastomosan el donante PA para el destinatario IVC con el funcionamiento de suturas de nylon 10-0 a partir de el extremo distal de la pared de la izquierda dentro del lumen de la vena cava inferior. Después de alcanzar el extremo proximal, continuar suturas a lo largo de la pared lateral delantera derecha hasta el extremo distal para completar la anastomosis. Antes de cerrar la anastomosis, lave suavemente la luz para eliminar cualquier coágulo y aire. </li><li> Antes de liberar el buque, abrazaderas colocar piezas de Gelfoam alrededor de los sitios de anastomosis, y aplique una presión suave con un aplicador de algodón hasta conseguir la hemostasia. En el momento de la revascularización, liberar la pinza distal primero, seguido por la mordaza proximal. </li><li> Tras la revascularización, aplique una solución salina caliente a 37 ° C para el injerto de forma externa para ayudar a su recuperación. El injerto por lo general comienza auricular inmediatamente y vuelve espontáneamente a ritmo sinusal dentro de unos pocos minutos. Inyectar 0,6 ml de abrigopor vía subcutánea de solución salina para mantener la hidratación del destinatario. Inyectar por vía subcutánea buprenorfina para la analgesia antes de la finalización de la cirugía </li><li> Cierre la herida abdominal con una sutura continua absorbible 5-0 para ambas capas. Comience por completar la capa interna y continuará a lo largo de la piel. </li></ol> 4. Recuperación y Monitoreo de injerto <ol><li> Inyectar la ampicilina para la profilaxis de la infección y colocar el receptor sobre una almohadilla de calentamiento a 37 ° C durante la recuperación. La mayoría de los animales se recuperan rápidamente y por lo general están bebiendo y comiendo a menudo menos de 3 horas. Si el ratón muestra signos de sufrimiento, examinar de cerca para determinar la causa. Si hay una causa obvia, el tratamiento con buprenorfina y vigilar de cerca. Consulte a un veterinario si los síntomas son severos o persisten más de 8 horas y considerar la eutanasia. Si es necesario, dar continuo 12 inyecciones por hora de buprenorfina hasta que los síntomas desaparezcan. Si el ratón muestra signos de sufrimiento después de 8 horas, que sigan siendo 12inyecciones por hora de buprenorfina hasta que los que resuelven. Consulte con el veterinario si los síntomas continúan por más de 48 horas y la eutanasia si es necesario. </li><li> Monitorear injerto latido del corazón mediante palpación abdominal directa y registrar la fuerza de latido como + + + + para un injerto sano a + para tiempo débil debido al rechazo avanzada y - como no golpes debido a completar el rechazo del injerto. Monitorear los ratones diariamente durante los primeros 10 días, a continuación 3 veces por semana durante la duración del experimento. </li></ol>

<ol>
	<li>Aramaki, O., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Interleukin-10+but+not+transforming+growth+factor-beta+is+essential+for+generation+and+suppressor+function+of+regulatory+cells+induced+by+intratracheal+delivery+of+alloantigen.">Interleukin-10 but not transforming growth factor-beta is essential for generation and suppressor function of regulatory cells induced by intratracheal delivery of alloantigen.</a> Transplantation. 79, 568-576 (2005).</li><li>Chen, R. H., Bushell, A., Fuggle, S. V., Wood, K. J., Morris, P. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Expression+of+granzyme+A+and+perforin+in+mouse+heart+transplants+immunosuppressed+with+donor-specific+transfusion+and+anti-CD4+monoclonal+antibody.">Expression of granzyme A and perforin in mouse heart transplants immunosuppressed with donor-specific transfusion and anti-CD4 monoclonal antibody.</a> Transplantation. 61, 625-629 (1996).</li><li>Poulin, L. F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Interleukin-9+promotes+eosinophilic+rejection+of+mouse+heart+allografts.">Interleukin-9 promotes eosinophilic rejection of mouse heart allografts.</a> Transplantation. 76, 572-577 (2003).</li><li>Ono, K., Lindsey, E. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Improved+technique+of+heart+transplantation+in+rats.">Improved technique of heart transplantation in rats.</a> J. Thorac. Cardiovasc. Surg. 57, 225-229 (1969).</li><li>Corry, R. J., Winn, H. J., Russell, P. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Primarily+vascularized+allografts+of+heart+in+mice.">Primarily vascularized allografts of heart in mice.</a> Transplantation. 16, 343-350 (1973).</li><li>Larsen, C. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=CD40-gp39+interactions+play+a+critical+role+during+allograft+rejection.+Suppression+of+allograft+rejection+by+blockade+of+the+CD40-gp39+pathway.">CD40-gp39 interactions play a critical role during allograft rejection. Suppression of allograft rejection by blockade of the CD40-gp39 pathway.</a> Transplantation. 61, 4-9 (1996).</li><li>Saitovitch, D., Bushell, A., Mabbs, D. W., Morris, P. J., Wood, K. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Kinetics+of+induction+of+transplantation+tolerance+with+a+nondepleting+anti-Cd4+monoclonal+antibody+and+donor-specific+transfusion+before+transplantation.+A+critical+period+of+time+is+required+for+development+of+immunological+unresponsiveness.">Kinetics of induction of transplantation tolerance with a nondepleting anti-Cd4 monoclonal antibody and donor-specific transfusion before transplantation. A critical period of time is required for development of immunological unresponsiveness.</a> Transplantation. 61, 1642-1647 (1996).</li><li>Callaghan, C. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Regulation+of+allograft+survival+by+inhibitory+FcgammaRIIb+signaling.">Regulation of allograft survival by inhibitory FcgammaRIIb signaling.</a> J. Immunol. 189, 5694-5702 (2012).</li><li>Qian, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impact+of+donor+MHC+Class+I+or+Class+II+antigen+deficiency+on+first-+and+second-set+rejection+of+mouse+heart+or+liver+allografts.">Impact of donor MHC Class I or Class II antigen deficiency on first- and second-set rejection of mouse heart or liver allografts.</a> Immunology. 88, 124-129 (1996).</li><li>Wang, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Spontaneous+acceptance+of+mouse+kidney+allografts+is+associated+with+increased+Foxp3+expression+and+differences+in+the+B+and+T+cell+compartments.">Spontaneous acceptance of mouse kidney allografts is associated with increased Foxp3 expression and differences in the B and T cell compartments.</a> Transpl. Immunol. 24, 149-156 (2011).</li><li>Liu, F., Kang, S. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Heterotopic+Heart+Transplantation+in+Mice.">Heterotopic Heart Transplantation in Mice.</a> J. Vis. Exp. , (2007).</li><li>Mottram, P. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Electrocardiographic+monitoring+of+cardiac+transplants+in+mice.">Electrocardiographic monitoring of cardiac transplants in mice.</a> Cardiovasc. Res. 22, 315-321 (1988).</li></ol>

Los autores no tienen nada que revelar.

Ratón trasplante de corazón es un método microquirúrgico difícil que requiere considerable habilidad quirúrgica de dominar. El aspecto más difícil es el pequeño diámetro de los vasos. Además, es necesario limitar el tiempo de funcionamiento destinatario y sangrado. La técnica para el trasplante de corazón de ratón fue descrita por primera vez por Corry et al. en 1973 y posteriormente por Mottram et al 12. Nuestros modificaciones incluyen los siguientes puntos. En primer lugar, ...

Los modelos animales de trasplante de órganos pueden proporcionar información valiosa para mejorar el tratamiento de los pacientes con trasplante clínico. Los modelos de ratón son particularmente útiles para estudiar el mecanismo inmunológico de rechazo de trasplante de órgano o aceptación debido a la amplia gama de ratones y reactivos específicos para los ratones que no están disponibles para otros modelos animales 1-3 modificados genéticamente. Uno de los retos con los modelos de ratón de trasplante es el pequeño tamaño de los donantes y los receptores que requiere considerable habilidad técnica para lograr resultados satisfactorios. Una técnica fue descrita por primera vez para el trasplante heterotópico de corazón en ratas 4 que fue adaptado posteriormente para el trasplante de corazón de ratón por Corry et al 5. Esta técnica implicó la preparación del receptor antes de la operación de donante y sin perfusión del corazón del donante, ambos de los cuales son susceptibles de comprometer la supervivencia del corazón o t trasplantadoél recibe. El procedimiento ha sido ampliamente utilizado como se describe originalmente para examinar los mecanismos de rechazo de trasplante y la tolerancia 6-8. Otros han adaptado el procedimiento de trasplante de corazón originales de rata de Ono y Lindsey para trasplantes de corazón en ratones 9,10. Más recientemente, se publicó una técnica para el ratón trasplante de corazón que se sobrepuso a algunos de los problemas asociados con el método de Corry et al 11. El protocolo descrito aquí incorpora nuestras modificaciones, basados ​​en el método de Mottram et al 12, que incluyen: en la perfusión in situ con solución salina heparinizada fría inmediatamente después de la toracotomía y la realización de la operación de donantes antes de la operación destinatario para minimizar el tiempo de operación de receptor. Además, utilizamos pequeñas pinzas atraumáticas vasos en lugar de 6-0 corbatas de seda. Aunque las abrazaderas de los vasos tienen la desventaja de tener más espacio que son más fáciles de controlar que los lazos, que no debe ser demasiado apretado o sueltoy son menos fáciles de eliminar que abrazaderas. Nuestro método utiliza una única sutura continua para la anastomosis recipiente, aunque en el aprendizaje inicial etapas de una alternativa es usar suturas de sujeción en los extremos proximal y distal esquinas para garantizar la uniformidad de las suturas y de este modo la permeabilidad de la anastomosis.

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			<td style="width:247px;">Leica, Heerbrugg, Switzerland</td>
			<td style="width:124px;">M651</td>
			<td style="width:167px;">10x - 25x magnification</td>
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		<tr height="21">
			<td height="21" style="height:21px;">Anesthetic machine&#160;</td>
			<td>Vet Quip Pty Ltd, Sydney, Australia</td>
			<td style="width:124px;">Vett3</td>
			<td>Capable of delivering a mixture of isoflurane and oxygen in air&#160;</td>
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			<td height="21" style="height:21px;width:293px;">Operating board&#160;</td>
			<td style="width:247px;">Hardware store or office supplier</td>
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			<td>Dense cork or synthetic capable of taking pins</td>
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			<td>Pfizer, USA</td>
			<td style="width:124px;">FW25</td>
			<td>In 1ml syringe with 23 gauge needle on ice</td>
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			<td height="23" style="height:23px;width:293px;">Normal saline (37oC)</td>
			<td style="width:247px;">AstraZeneca Pty Ltd, Australia</td>
			<td style="width:124px;">4538</td>
			<td>In 1ml syringe with 23 gauge needle on warm pad</td>
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			<td height="21" style="height:21px;width:293px;">Sutures 10- nylon, 5-0 Vicryl</td>
			<td>Ethicon, Inc. NJ, USA</td>
			<td style="width:124px;">2870G/J421H</td>
			<td></td>
		</tr>
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			<td height="21" style="height:21px;">Buprenorphine (0.05mg/kg in 0.1ml saline)</td>
			<td>Reckitt Benckiser, Sydney, Australia</td>
			<td style="width:124px;"></td>
			<td>In 1ml syringe with 23 gauge needle on ice</td>
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		<tr height="21">
			<td height="21" style="height:21px;">Ampcillin (5mg/kg in 0.1 ml saline)&#160;</td>
			<td>Aspen, Sydney, Australia</td>
			<td style="width:124px;"></td>
			<td>In 1ml syringe with 23 gauge needle on ice</td>
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		<tr height="21">
			<td height="21" style="height:21px;">Gel Foam&#160;</td>
			<td>Pharmacia &#38; Upjohn Co. USA</td>
			<td style="width:124px;">801289304</td>
			<td>Cut into small pieces</td>
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		<tr height="21">
			<td height="21" style="height:21px;">High temperature cautery device&#160;</td>
			<td>Medtronic, USA</td>
			<td style="width:124px;">8444000</td>
			<td></td>
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		<tr height="21">
			<td height="21" style="height:21px;">Microsurgery instruments:</td>
			<td colspan="2">Shanghai Medical Instruments Co. Ltd.,&#160;&#160;</td>
			<td></td>
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			<td height="21" style="height:21px;">&#160;&#160;&#160;&#160;&#160;&#160;&#160; micro-needleholders</td>
			<td style="width:247px;">Shanghai, China</td>
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			<td height="21" style="height:21px;width:293px;">&#160;&#160;&#160;&#160;&#160;&#160;&#160; micro-forceps (straight tip)</td>
			<td style="width:247px;">&#160;&#160;&#160;&#160; &#34;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160; &#34;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160; &#34;</td>
			<td style="width:124px;">WA3010</td>
			<td></td>
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			<td height="21" style="height:21px;">&#160;&#160;&#160;&#160;&#160;&#160;&#160; micro-forceps (curved tip)</td>
			<td>&#160;&#160;&#160;&#160; &#34;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160; &#34;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160; &#34;</td>
			<td style="width:124px;">WA3020</td>
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			<td height="21" style="height:21px;">&#160;&#160;&#160;&#160;&#160;&#160;&#160; micro-mosquito clamps (1 pair)</td>
			<td style="width:247px;">&#160;&#160;&#160;&#160; &#34;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160; &#34;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160; &#34;</td>
			<td style="width:124px;">W40350</td>
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			<td height="21" style="height:21px;">&#160;&#160;&#160;&#160;&#160;&#160;&#160; micro-vessel atraumatic clamps (1 pair)</td>
			<td>&#160;&#160;&#160;&#160; &#34;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160; &#34;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160; &#34;</td>
			<td style="width:124px;">W40130/W40150</td>
			<td></td>
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			<td height="42" style="height:42px;width:293px;">Heating Pad/Right Temp</td>
			<td style="width:247px;">Kent Scientific Corporation, Turrington, CT 06790</td>
			<td style="width:124px;"></td>
			<td></td>
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a modified method for heterotopic mouse heart transplantion

Los ratones a menudo se utilizan como donantes de trasplante de corazón y de los beneficiarios en los estudios de la inmunología del trasplante debido a la amplia gama de ratones transgénicos y reactivos disponibles. Una dificultad se presenta debido al pequeño tamaño del animal y los desafíos técnicos considerables de la microcirugía involucrados en el trasplante de corazón. En particular, una alta tasa de fallo técnico poco después del trasplante puede ser consecuencia de la muerte del receptor y las complicaciones postoperatorias tales como parálisis de las extremidades posteriores o un corazón no late. Aquí, la técnica completa para un trasplante cardíaco heterotópico ratón se demuestra, que implica la recolección del corazón del donante y su posterior implante en un ratón receptor. El corazón del donante se cosecha inmediatamente después de la perfusión in situ con solución salina heparinizada fría y transección de la aorta ascendente y la arteria pulmonar. La operación de receptor implica la preparación de la aorta abdominal y la vena cava inferior (VCI), seguido poranastomosis de extremo a lado de la aorta del donante con la aorta destinatario utilizando un solo funcionamiento 10-0 microsutura y una anastomosis similar de la arteria pulmonar del donante con el receptor IVC. Después de la operación el animal se inyecta con 0,6 ml por vía subcutánea con solución salina normal y se le permite recuperarse de una almohadilla térmica 37 ° C. Los resultados de 227 trasplantes de corazón de ratón se resumen con una tasa de éxito a las 48 h de 86,8%. De los 13,2% de fallos dentro de 48 horas, 5 (2,2%) experimentaron parálisis de las extremidades posteriores, 10 (4,4%) tenían un corazón sin latir debido a injertar lesiones y / o trombosis isquémica, mientras que 15 (6,6%) fallecieron dentro de las 48 horas .

Después de un periodo de formación inicial, se analizaron 227 casos de ratón heterotópico trasplante de corazón en nuestro grupo. La tasa de éxito dentro de la primera 24 horas fue del 90,3% y a las 48 horas era 86,8%. De los 30 (13,2%) los fallos dentro de 48 horas, 5 (2,2%) experimentaron parálisis de las extremidades posteriores y tuvo que ser sacrificado, 10 (4,4%) tenía un corazón sin latir debido a la lesión de isquemia del injerto y / o trombosis, mientras que 15 (6,6%) fallecieron dentro de las 48 hora...

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A Modified Method for Heterotopic Mouse Heart Transplantion

A technique is demonstrated for the microsurgical procedure for heterotopic transplantation of hearts in mice, including simplified methods for donor harvesting and recipient vessel anastomosis.

Un método modificado para heterotópico Ratón Corazón TRASPLANTE

Mice are often used as heart transplant donors and recipients in studies of transplant immunology due to the wide range of transgenic mice and reagents ...

a-modified-method-for-heterotopic-mouse-heart-transplantion

Research

JoVE Journal

Medicine

11.9K vistas.  University of Sydney. A technique is demonstrated for the microsurgical procedure for heterotopic transplantation of hearts in mice, including simplified methods for donor harvesting and recipient vessel anastomosis.

Video: A Modified Method for Heterotopic Mouse Heart Transplantion

A Modified Heterotopic Swine Hind Limb Transplant Model for Translational Vascularized Composite Allotransplantation (VCA) Research

Vascularized Composite Allotransplantation (VCA) such as hand and face transplants represent a viable treatment option for complex musculoskeletal trauma and devastating tissue loss. Despite favorable and highly encouraging early and intermediate functional outcomes, rejection of the highly immunogenic skin component of a VCA and potential adverse effects of chronic multi-drug immunosuppression continue to hamper widespread clinical application of VCA. Therefore, research in this novel field needs to focus on translational studies related to unique immunologic features of VCA and to develop novel immunomodulatory strategies for immunomodulation and tolerance induction following VCA without the need for long term immunosuppression.
This article describes a reliable and reproducible translational large animal model of VCA that is comprised of an osteomyocutaneous flap in a MHC-defined swine heterotopic hind limb allotransplantation. Briefly, a well-vascularized skin paddle is identified in the anteromedial thigh region using near infrared laser angiography. The underlying muscles, knee joint, distal femur, and proximal tibia are harvested on a femoral vascular pedicle. This allograft can be considered both a VCA and a vascularized bone marrow transplant with its unique immune privileged features. The graft is transplanted to a subcutaneous abdominal pocket in the recipient animal with a skin component exteriorized to the dorsolateral region for immune monitoring.
Three surgical teams work simultaneously in a well-coordinated manner to reduce anesthesia and ischemia times, thereby improving efficiency of this model and reducing potential confounders in experimental protocols. This model serves as the groundwork for future therapeutic strategies aimed at reducing and potentially eliminating the need for chronic multi-drug immunosuppression in VCA.

A Modified Heterotopic Swine Hind Limb Transplant Model for Translational Vascularized Composite Allotransplantation VCA Research

Vascularized Composite Allotransplantations (VCA) have become a clinical reality. However, broad clinical application of VCA is limited by chronic multi-drug immunosuppression. The authors present a reliable and reproducible large animal model to translate novel immunomodulatory strategies that can minimize or potentially eliminate the need of immunosuppression in VCA.

Un modelo de trasplante heterotópico porcina Hind extremidades Modificado traslacional vascularizado compuesto Allotransplantation (VCA) Investigación

Vascularized Composite Allotransplantation (VCA) such as hand and face transplants represent a viable treatment option for complex musculoskeletal trauma ...

Investigación

Medicina

Murine Cervical Heart Transplantation Model Using a Modified Cuff Technique

Mouse models are of special interest in research since a wide variety of monoclonal antibodies and commercially defined inbred and knockout strains are available to perform mechanistic in vivo studies. While heart transplantation models using a suture technique were first successfully developed in rats, the translation into an equally widespread used murine equivalent was never achieved due the technical complexity of the microsurgical procedure. In contrast, non-suture cuff techniques, also developed initially in rats, were successfully adapted for use in mice1-3. This technique for revascularization involves two major steps I) everting the recipient vessel over a polyethylene cuff; II) pulling the donor vessel over the formerly everted recipient vessel and holding it in place with a circumferential tie. This ensures a continuity of the endothelial layer, short operating time and very high patency rates4.
Using this technique for vascular anastomosis we performed more than 1,000 cervical heart transplants with an overall success rate of 95%. For arterial inflow the common carotid artery and the proximal aortic arch were anastomosed resulting in a retrograde perfusion of the transplanted heart. For venous drainage the pulmonary artery of the graft was anastomosed with the external jugular vein of the recipient5.
Herein, we provide additional details of this technique to supplement the video.

The murine cervical heart transplantation model is well suited for immunological as well as ischemia reperfusion injury studies. We modified the procedure using a non-suture cuff technique and performed more than 1,000 successful transplants with this approach.
Herein, we provide additional details of this technique to supplement the video.

Murino Cervical Trasplante Cardiaco Modelo Usando una técnica de Cuff Modificado

Mouse models are of special interest in research since a wide variety of monoclonal antibodies and commercially defined inbred and knockout strains are ...

Murine Heterotopic Heart Transplant Technique

It is now over forty years since this technique was first reported by Corry, Wynn and Russell. Although it took some years for other labs to become proficient in and utilize this technique, it is now widely used by many laboratories around the world. A significant refinement to the original technique was developed and reported in 2001 by Niimi. Described here are the techniques that have evolved over more than a decade in the hands of three surgeons (Plenter, Grazia, Pietra) in our center. These techniques are now being passed on to a younger generation of surgeons and researchers.
Based largely on the Niimi experience, the procedures used have evolved in the fine details - details which we will endeavor to relate here in such a way that others may be able to use this very useful model. Like Niimi, we have found that a video aid to learning is a priceless resource for the beginner.

The manuscript describes the steps required to perform the heterotopic heart transplant in the mouse.

Murino heterotópico Corazón Trasplante Técnica

It is now over forty years since this technique was first reported by Corry, Wynn and Russell. Although it took some years for other labs to become ...

Transplantation of Pulmonary Valve Using a Mouse Model of Heterotopic Heart Transplantation

Tissue engineered heart valves, especially decellularized valves, are starting to gain momentum in clinical use of reconstructive surgery with mixed results. However, the cellular and molecular mechanisms of the neotissue development, valve thickening, and stenosis development are not researched extensively. To answer the above questions, we developed a murine heterotopic heart valve transplantation model. A heart valve was harvested from a valve donor mouse and transplanted to a heart donor mouse. The heart with a new valve was transplanted heterotopically to a recipient mouse. The transplanted heart showed its own heartbeat, independent of the recipient&#8217;s heartbeat. The blood flow was quantified using a high frequency ultrasound system with a pulsed wave Doppler. The flow through the implanted pulmonary valve showed forward flow with minimal regurgitation and the peak flow was close to 100 mm/sec. This murine model of heart valve transplantation is highly versatile, so it can be modified and adapted to provide different hemodynamic environments and/or can be used with various transgenic mice to study neotissue development in a tissue engineered heart valve.

In order to understand the cellular and molecular mechanisms underlying neotissue formation and stenosis development in tissue engineered heart valves, a murine model of heterotopic heart valve transplantation was developed. A pulmonary heart valve was transplanted to recipient using the heterotopic heart transplantation technique.

El trasplante de la válvula pulmonar Utilizando un modelo de ratón de heterotópico trasplante cardiaco

Tissue engineered heart valves, especially decellularized valves, are starting to gain momentum in clinical use of reconstructive surgery with mixed ...

Rat Heterotopic Abdominal Heart/Single-lung Transplantation in a Volume-loaded Configuration

Herein, we describe a novel technique for heterotopic abdominal heart-lung transplantation (HAHLT) in rats. The configuration of the transplant graft involves anastomosis of donor inferior vena cava (IVC) to recipient IVC, and donor ascending aorta (Ao) to recipient abdominal Ao. The right upper and middle lung lobes are preserved and function as conduits for blood flow from right heart to left heart.
There are several advantages to using this technique, and it lends itself to a broad range of applications. Because the graft is transplanted in a configuration that allows for dyamic volume-loading, cardiac function may be directly assessed in vivo. The use of pressure-volume conductance catheters permits characterization of load-dependent and load-independent hemodynamic parameters. The graft may be converted to a loaded configuration by applying a clamp to the recipient&#8217;s infra-hepatic IVC. We describe modified surgical techniques for both donor and recipient operations, and an ideal myocardial protection strategy. Depending on the experimental aim, this model may be adapted for use in both acute and chronic studies of graft function, immunologic status, and variable ventricular loading conditions. The conducting airways to the transplanted lung are preserved, and allow for acute lung re-ventilation. This facilitates analysis of the effects of the mixed venous and arterial blood providing coronary perfusion to the graft.
A limitation of this model is its technical complexity. There is a significant learning curve for new operators, who should ideally be mentored in the technique. A surgical training background is advantageous for those wishing to apply this model. Despite its complexity, we aim to present the model in a clear and easily applicable format. Because of the physiologic similarity of this model to orthotopic transplantation, and its broad range of study applications, the effort invested in learning the technique is likely to be worthwhile.

We describe a novel technique for heterotopic abdominal heart-lung transplantation (HAHLT) in rats. The transplant configuration results in a partially loaded graft circulation, allowing direct functional assessment. This model may be employed for acute or chronic studies of function and immunologic status of the transplanted graft.

Rata heterotópico abdominal Corazón / Trasplante de un solo pulmón en una configuración de volumen cargado

Herein, we describe a novel technique for heterotopic abdominal heart-lung transplantation (HAHLT) in rats. The configuration of the transplant graft ...

Heterotopic Cervical Heart Transplantation in Mice

The heterotopic cervical heart transplantation in mice is a valuable tool in transplant and cardiovascular research. The cuff technique greatly simplifies this model by avoiding challenging suture anastomoses of small vessels thereby reducing warm ischemia time. In comparison to abdominal graft implantation the cervical model is less invasive and the implanted graft is easily accessible for further follow-up examinations. Anastomoses are performed by pulling the ascending aorta of the graft over the cuff with the recipient&#8217;s common carotid artery and by pulling the main pulmonary artery over the cuff with the external jugular vein. Selection of appropriate cuff size and complete mobilization of the vessels are important for successful revascularization. Ischemia-reperfusion (I/R) injury can be minimized by perfusing the graft with a cardioplegic solution and by hypothermia. In this article, we provide technical details for a simplified and improved cuff technique, which should allow surgeons with basic microsurgical skills to perform the procedure with a high success rate.

The cuff technique shortens and facilitates the model of heterotopic cervical heart transplantation in mice by avoiding technically challenging suture anastomoses of small vessels. The technical details shown in this video paper should allow researches to establish this model in their laboratories.

Heterotópico cervical trasplante cardiaco en ratones

The heterotopic cervical heart transplantation in mice is a valuable tool in transplant and cardiovascular research. The cuff technique greatly simplifies ...

A Novel Microsurgical Model for Heterotopic, En Bloc Chest Wall, Thymus, and Heart Transplantation in Mice

Exploration of novel strategies in organ transplantation to prolong allograft survival and minimizing the need for long-term maintenance immunosuppression must be pursued. Employing vascularized bone marrow transplantation and co-transplantation of the thymus have shown promise in this regard in various animal models.1-11 Vascularized bone marrow transplantation allows for the uninterrupted transfer of donor bone marrow cells within the preserved donor microenvironment, and the incorporation of thymus tissue with vascularized bone marrow transplantation has shown to increase T-cell chimerism ultimately playing a supportive role in the induction of immune regulation. The combination of solid organ and vascularized composite allotransplantation can uniquely combine these strategies in the form of a novel transplant model. Murine models serve as an excellent paradigm to explore the mechanisms of acute and chronic rejection, chimerism, and tolerance induction, thus providing the foundation to propagate superior allograft survival strategies for larger animal models and future clinical application. Herein, we developed a novel heterotopic en bloc chest wall, thymus, and heart transplant model in mice using a cervical non-suture cuff technique. The experience in syngeneic and allogeneic transplant settings is described for future broader immunological investigations via an instructional manuscript and video supplement.

To study combined solid organ and vascularized composite allotransplantation, we describe a novel heterotopic en bloc chest wall, thymus, and heart transplant model in mice using a cervical non-suture cuff technique.

Un microquirúrgica Modelo Novela de heterotópico, en bloque, pared torácica, el timo y el trasplante cardiaco en ratones

Exploration of novel strategies in organ transplantation to prolong allograft survival and minimizing the need for long-term maintenance immunosuppression ...

A Simplified Model for Heterotopic Heart Valve Transplantation in Rodents

There is an urgent clinical need for heart valve replacements that can grow in children. Heart valve transplantation is proposed as a new type of transplant with the potential to deliver durable heart valves capable of somatic growth with no requirement for anticoagulation. However, the immunobiology of heart valve transplants remains unexplored, highlighting the need for animal models to study this new type of transplant. Previous rat models for heterotopic aortic valve transplantation into the abdominal aorta have been described, though they are technically challenging and costly. For addressing this challenge, a renal subcapsular transplant model was developed in rodents as a practical and more straightforward method for studying heart valve transplant immunobiology. In this model, a single aortic valve leaflet is harvested and inserted into the renal subcapsular space. The kidney is easily accessible, and the transplanted tissue is securely contained in a subcapsular space that is well vascularized and can accommodate a variety of tissue sizes. Furthermore, because a single rat can provide three donor aortic leaflets and a single kidney can provide multiple sites for transplanted tissue, fewer rats are required for a given study. Here, the transplantation technique is described, providing a significant step forward in studying the transplant immunology of heart valve transplantation.

This protocol describes a simple and efficient method for the transplantation of aortic valve leaflets under the renal capsule to allow for the study of alloreactivity of heart valves.

Un modelo simplificado para el trasplante heterotópico de válvulas cardíacas en roedores

There is an urgent clinical need for heart valve replacements that can grow in children. Heart valve transplantation is proposed as a new type of ...

A Porcine Heterotopic Heart Transplantation Protocol for Delivery of Therapeutics to a Cardiac Allograft

Cardiac transplantation is the gold standard treatment for end-stage heart failure. However, it remains limited by the number of available donor hearts and complications such as primary graft dysfunction and graft rejection. The recent clinical use of an ex vivo perfusion device in cardiac transplantation introduces a unique opportunity for treating cardiac allografts with therapeutic interventions to improve function and avoid deleterious recipient responses. Establishing a translational, large-animal model for therapeutic delivery to the entire allograft is essential for testing novel therapeutic approaches in cardiac transplantation. The porcine, heterotopic heart transplantation model in the intraabdominal position serves as an excellent model for assessing the effects of novel interventions and the immunopathology of graft rejection. This model additionally offers long-term survival for the pig, given that the graft is not required to maintain the recipient's circulation. The aim of this protocol is to provide a reproducible and robust approach for achieving ex vivo delivery of a therapeutic to the entire cardiac allograft prior to transplantation and provide technical details to perform a survival heterotopic transplant of the ex vivo perfused heart.

We present a protocol for utilizing a normothermic ex vivo sanguinous perfusion system for the delivery of therapeutics to an entire cardiac allograft in a porcine heterotopic heart transplant model.

Un protocolo de trasplante de corazón heterotópico porcino para la administración de terapias a un aloinjerto cardíaco

Cardiac transplantation is the gold standard treatment for end-stage heart failure. However, it remains limited by the number of available donor hearts ...

A Modified Cuff Technique for Mouse Cervical Heterotopic Heart Transplantation Model

Cardiac allograft rejection limits the long-term survival of patients after heart transplantation. A mouse heart transplantation model is ideal for investigating the mechanism of cardiac allograft rejection in preclinical studies because of their high homology with human genes. This understanding would help develop unique approaches to improving patients&#39; long-term survival treated with cardiac allografts. In a mouse model, abdominal donor heart implantation is commonly performed with an end-to-end&#160;anastomosis to the recipient&#39;s aorta and inferior vena cava using stitches. In this model, the donor&#39;s heart is implanted by end-to-end anastomosis to the recipient&#39;s carotid artery and jugular vein by the modified-Cuff technique. The transplantation surgery is performed without stitching and thus may increase the survival of the recipient since there is no interference with the blood supply and venous reflux of the lower body. This mouse model would help investigate the mechanisms underlying the immunological and pathological (acute/chronic) rejection of cardiac allografts.

In the present protocol, a mouse heart transplantation model is used for investigating the mechanism of cardiac allograft rejection. In this heterotopic heart transplantation model, operation efficiency is improved, and the survival of cardiac grafts is ensured by a cervical end-to-end anastomosis of heart implantation using a modified Cuff technique.

Una técnica de manguito modificado para el modelo de trasplante cardíaco heterotópico cervical de ratón

Cardiac allograft rejection limits the long-term survival of patients after heart transplantation. A mouse heart transplantation model is ideal for ...