Questo lavoro è stato sostenuto dal Consiglio nazionale della sanità e ricerca medica (NHMRC) dell&#39;Australia progetto di Grant 1.029.205, dalla Fondazione Microsearch dell&#39;Australia, e dalla Myee Codrington Research Foundation medica.

Prima dell&#39;inizio degli esperimenti, ottenere l&#39;approvazione da Animal Care comitato etico dell&#39;istituzione competente per gli esperimenti previsti. Mantenere i topi in conformità con i requisiti della vostra istituzione. Il seguente protocollo è stato approvato dai comitati Sydney University e Royal Prince Alfred Hospital. Prima di iniziare l&#39;intervento, tutti gli strumenti devono essere puliti a fondo e sterilizzati immergendo nel 80% di etanolo. Alcuni istituti prevedono la sterilizzazione in autoclave tuttavia questo potrebbe danneggiare gli strumenti di microchirurgia sottili a lungo termine. Ove possibile uso sterile materiale monouso. 1. Anestesia <ol><li> Anestetizzare mouse con isoflurano in un contenitore sigillato poi metterlo in posizione supina su una scheda operativa, che collega rapidamente cono di anestetico. Test di adeguatezza dell&#39;anestesia pizzicando il piede posteriore per garantire che non vi è alcun riflesso. </li><li> Shave la pelle con una lama chirurgica esterilizzare con l&#39;80% di etanolo. Inoltre, 2% clorexidina nel 70% di alcol isopropilico può essere utilizzata per la sterilizzazione pelle. Durante l&#39;induzione dell&#39;anestesia concentrazione isoflurano è 3% ma ridurre questo fino a 1-1,5% per manutenzione. Apportare piccole modifiche a questa concentrazione per mantenere la respirazione regolare e la frequenza cardiaca. Mantenere la temperatura dell&#39;animale su una piastra elettrica. </li></ol> 2. Funzionamento donatori <ol><li> Effettuare una toracotomia per esporre il cuore ed i vasi tagliando il torace attraverso entrambi i lati della gabbia toracica dal bordo costola fino al cavo ascellare seguita da un taglio trasversale a livello del xiphisternum per formare un lembo parete toracica. Sollevare questo lembo accanto alla testa e il pin alla scheda operativa. Strappare pericardio per esporre cuore e dei vasi. </li><li> Sollevare la vena cava inferiore con una pinza in una mano e con l&#39;altra iniettare 1 ml di soluzione fisiologica fredda prossimale eparinata al cuore attraverso la vena cava inferiore, poi mettere una fascetta piccola arteria sulla IVC di prevenzionet flusso della soluzione di perfusione attraverso il foro dell&#39;ago. </li><li> Utilizzo di garza e un cotton fioc, ritrarre il cuore verso il basso per esporre l&#39;aorta ascendente e l&#39;arteria polmonare. Passare una lama di una coppia di microscissors attraverso il canale (seno trasverso) posteriormente al fascio di aorta e l&#39;arteria polmonare e tagliare l&#39;aorta e l&#39;arteria polmonare insieme come distalmente possibile per garantire lunghezza sufficiente per anastomosi. </li><li> Legame e dividere la IVC, vena cava superiore destro (SVC), a sinistra SVC e vene polmonari con 6-0 filo di seta. Legare il IVC e SVC destra separatamente quindi inserire un singolo thread posteriore al cuore per circondare la SVC sinistra insieme a vene polmonari e legarlo. Raccolto il cuore dal sito donatore tagliando i vasi distali ai legami, poi riporla in freddo soluzione salina sterile a 4 ° C fino al momento del trapianto. Questo comporta la morte del donatore per dissanguamento. </li></ol> 3. Funzionamento del destinatario <ol><li> Anestetizzare l&#39;destinatario come sopra (sezione 1). Radersi con cura addome per evitare l&#39;irritazione, poi fare una laparotomia dalla mediana incisione dal pube al xiphisternum e ritrarre con graffette piegate a formare divaricatori. Avvolgere l&#39;intestino in soluzione salina calda imbevuta garza sterile e ritrarre in alto a destra dell&#39;addome. </li><li> Per esporre l&#39;aorta infra-renale e IVC, liberare i segmenti bundle di aorta e IVC dalla arteria renale sinistra e la vena alla biforcazione iliaca, suddividendoli dai vasi lombari utilizzando un dispositivo di cauterizzazione. Fate attenzione che la cauterizzazione è alla giusta temperatura ed utilizzato per un tempo sufficiente per dividere e sigillare le estremità dei vasi. </li><li> Applicare piccoli morsetti vasi atraumatica per l&#39;aorta e segmenti IVC distalmente e prossimalmente. Fare un&#39;incisione nella parete anteriore dell&#39;aorta dapprima fora un buco con un ago 30 G; poi tagliare un&#39;incisione verticale con microscissors per adattarsi alle dimensioni dell&#39;aorta donatore. Lavare il lume dell&#39;aorta con soluzione salina eparinizzata per rimuovere eventuali blcoaguli OOD. </li><li> Portare il cuore donatore al sito ricevente coperto con garza imbevuta di soluzione salina fredda e posizionarlo sul lato destro dell&#39;addome. Assicurarsi che l&#39;aorta donatore è posizionato vicino alla incisione sull&#39;aorta destinatario e l&#39;arteria polmonare donatore posizionato accanto al destinatario IVC. </li><li> Anastomose lato end-to-aorta donatore all&#39;aorta destinatario utilizzando esecuzione 10-0 suture in nylon partire dall&#39;angolo prossimale e sutura sul lato sinistro prima fino a raggiungere l&#39;angolo distale, in quale fase l&#39;animale è ruotato di 180 °. Spostare delicatamente il cuore del donatore al lato sinistro dell&#39;addome per esporre il lato destro dell&#39;aorta e continuare sutura attraverso il lato destro della parete aortica dall&#39;estremità distale all&#39;estremità prossimale. Prima di chiudere l&#39;anastomosi aortica, lavare delicatamente il lume con soluzione fisiologica eparinizzata per rimuovere eventuali coaguli e l&#39;aria. </li><li> Anastomose l&#39;arteria polmonare donatore (PA) end-to-side con il destinatario IVC. Praticare un&#39;incisione verticamente con microscissors nella parete anteriore della IVC in un sito in conformità con l&#39;anastomosi dell&#39;arteria. Anastomose il donatore PA al destinatario IVC con l&#39;esecuzione di 10-0 suture in nylon a partire dalla fine distale della parete sinistra all&#39;interno del lume della IVC. Dopo aver raggiunto l&#39;estremità prossimale, continuare suture lungo la parete laterale anteriore destro fino all&#39;estremità distale per completare l&#39;anastomosi. Prima di chiudere l&#39;anastomosi, lavare delicatamente il lume per eliminare eventuali grumi e aria. </li><li> Prima di rilasciare la nave morsetti, posto pezzi di Gelfoam intorno ai siti di anastomosi, e applicare una leggera pressione con un applicatore di cotone fino a raggiungere l&#39;emostasi. Al momento della rivascolarizzazione, allentare il blocco distale prima, seguita dalla pinza prossimale. </li><li> Dopo rivascolarizzazione, applicare salina calda a 37 ° C per l&#39;innesto esternamente per aiutare il recupero. L&#39;innesto di solito inizia fibrillazione immediatamente e ritorna spontaneamente a ritmo sinusale in pochi minuti. Iniettare 0,6 ml caldisalina per via sottocutanea per mantenere l&#39;idratazione del destinatario. Iniettare per via sottocutanea buprenorfina per l&#39;analgesia prima del completamento di un intervento chirurgico </li><li> Chiudere la ferita addominale con una sutura 5-0 assorbibile corsa per entrambi gli strati. Inizia completando lo strato interno e proseguire lungo la pelle. </li></ol> 4. Recupero e Graft monitoraggio <ol><li> Iniettare ampicillina per la profilassi di infezioni e collocare il recipiente su una piastra elettrica a 37 ° C per il recupero. La maggior parte degli animali recuperano rapidamente e di solito bevono e spesso mangia nel raggio di 3 ore. Se il mouse mostra segni di sofferenza, esaminare attentamente per determinare la causa. Se nessuna causa evidente, il trattamento con buprenorfina e monitorare attentamente. Consultare un veterinario se i sintomi sono gravi o persistono per più di 8 ore e prendere in considerazione l&#39;eutanasia. Se necessario, dare continuando 12 iniezioni orarie di buprenorfina fino alla scomparsa dei sintomi. Se il mouse mostra segni di sofferenza dopo 8 ore, dare continuando 12iniezioni orarie di buprenorfina fino a che non risolvono. Consultare il veterinario se i sintomi persistono per più di 48 ore e euthanize se necessario. </li><li> Controllo innesto battito cardiaco con la palpazione addominale diretta e registrare la forza del ritmo come + + + + per un innesto sano + per battere debole a causa di rifiuto avanzato e - come non battere a causa di completare il rigetto del trapianto. Controllo topi al giorno per i primi 10 giorni, poi 3 volte a settimana per tutta la durata dell&#39;esperimento. </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>

Gli autori non hanno nulla da rivelare.

Trapianto di cuore Mouse è un metodo microchirurgico impegnativo, che richiede una notevole abilità chirurgica da padroneggiare. L&#39;aspetto più difficile è il piccolo diametro dei vasi. Inoltre, è necessario limitare il tempo di funzionamento destinatario e sanguinamento. La tecnica per il mouse trapianto di cuore è stato descritto da Corry et al. nel 1973 e successivamente da Mottram et al 12. I nostri modifiche includono i seguenti punti. In primo luogo, la perfusione immediata de...

Modelli animali di trapianto di organi in grado di fornire informazioni preziose per migliorare il trattamento dei pazienti sottoposti a trapianto clinici. Modelli murini sono particolarmente utili per studiare il meccanismo immunitario di rigetto del trapianto o accettazione a causa della vasta gamma di topi e reagenti specifici per i topi che non sono disponibili per altri modelli animali 1-3 geneticamente modificati. Una sfida con i modelli murini di trapianto è la piccola dimensione dei donatori e dei riceventi che richiede notevole abilità tecnica per ottenere risultati soddisfacenti. Una tecnica è stata descritta per la prima per il trapianto eterotopico di cuori nei ratti 4 che è stato successivamente adattato per il mouse trapianto di cuore da Corry et al 5. Questa tecnica, nella redazione del destinatario prima dell&#39;operazione donatore e non perfusione del cuore del donatore, entrambi i quali sono suscettibili di compromettere la sopravvivenza del cuore o t trapiantatoegli destinatario. Il procedimento è stato ampiamente utilizzato come originariamente descritto per esaminare i meccanismi di rigetto del trapianto e tolleranza 6-8. Altri hanno adattato il ratto cuore procedura di trapianto originale di Ono e Lindsey per i trapianti di cuore nei topi 9,10. Più recentemente, è stata pubblicata una tecnica per il mouse trapianto cardiaco che ha superato alcuni dei problemi associati al metodo di Corry et al 11. Il protocollo qui descritto incorpora nostre modifiche, sulla base del metodo di Mottram et al 12, che comprendono: in situ perfusione con soluzione salina eparinizzata freddo subito dopo toracotomia ed esecuzione dell&#39;operazione donatore prima dell&#39;operazione destinatario per minimizzare il tempo di funzionamento destinatario. Inoltre, utilizziamo i piccoli morsetti vasi atraumatica invece di 6-0 cravatte di seta. Sebbene pinze nave hanno lo svantaggio di prendere più spazio che sono più facili da controllare rispetto legami, che non dovrebbe essere troppo stretto o allentatoe sono meno semplici da rimuovere rispetto morsetti. Il nostro metodo utilizza una singola sutura continua per vaso anastomosi, sebbene nella formazione iniziale fasi alternativa è quella di utilizzare suture al prossimali e distali angoli per garantire uniformità di suture e quindi la pervietà delle anastomosi.

<table border="0" cellpadding="0" cellspacing="0" width="831">
	<tbody>
		<tr height="21">
			<td height="21" style="height:21px;width:293px;">Operating microscope&#160;</td>
			<td style="width:247px;">Leica, Heerbrugg, Switzerland</td>
			<td style="width:124px;">M651</td>
			<td style="width:167px;">10x - 25x magnification</td>
		</tr>
		<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>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:293px;">Operating board&#160;</td>
			<td style="width:247px;">Hardware store or office supplier</td>
			<td style="width:124px;"></td>
			<td>Dense cork or synthetic capable of taking pins</td>
		</tr>
		<tr height="23">
			<td height="23" style="height:23px;width:293px;">Heparinised saline (5 U/ml, 4oC)</td>
			<td>Pfizer, USA</td>
			<td style="width:124px;">FW25</td>
			<td>In 1ml syringe with 23 gauge needle on ice</td>
		</tr>
		<tr height="23">
			<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>
		</tr>
		<tr height="21">
			<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>
		<tr height="21">
			<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>
		</tr>
		<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>
		</tr>
		<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>
		</tr>
		<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>
		</tr>
		<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>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">&#160;&#160;&#160;&#160;&#160;&#160;&#160; micro-needleholders</td>
			<td style="width:247px;">Shanghai, China</td>
			<td style="width:124px;">WT2020</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">&#160;&#160;&#160;&#160;&#160;&#160;&#160; micro scissors</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;">WT1020</td>
			<td></td>
		</tr>
		<tr height="21">
			<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>
		</tr>
		<tr height="21">
			<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>
			<td></td>
		</tr>
		<tr height="21">
			<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>
			<td></td>
		</tr>
		<tr height="21">
			<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>
		</tr>
		<tr height="42">
			<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>
		</tr>
	</tbody>
</table>

a modified method for heterotopic mouse heart transplantion

I topi sono spesso usati come donatori e riceventi trapianto di cuore negli studi di immunologia dei trapianti grazie alla vasta gamma di topi transgenici e reagenti disponibili. Una difficoltà è presentato a causa delle ridotte dimensioni dell&#39;animale e le considerevoli sfide tecniche della microchirurgia coinvolto nel trapianto di cuore. In particolare, un alto tasso di guasto tecnico subito dopo il trapianto può risultare dalla morte del destinatario e complicanze post-operatorie come la paralisi degli arti posteriori o un cuore non batte. Qui, la tecnica completa per il mouse eterotopico trapianto cardiaco è dimostrata, coinvolgendo raccolta del cuore del donatore e del suo successivo impianto in un topo ricevente. Il cuore del donatore viene raccolto subito dopo in situ perfusione con soluzione salina eparinizzata e freddo recisione dell&#39;aorta ascendente e l&#39;arteria polmonare. L&#39;operazione destinatario prevede la preparazione dell&#39;aorta addominale e la vena cava inferiore (IVC), seguita daend-to-side anastomosi dell&#39;aorta donatore con l&#39;aorta destinatario utilizzando una singola corsa 10-0 microsuture e una simile anastomosi dell&#39;arteria polmonare donatore con il destinatario IVC. A seguito dell&#39;operazione l&#39;animale viene iniettato con 0,6 ml di soluzione salina normale per via sottocutanea e permesso di recuperare su una piastra elettrica 37 ° C. I risultati di 227 trapianti di cuore del mouse sono riassunti con un tasso di successo a 48 ore del 86,8%. Dei fallimenti del 13,2% entro 48 ore, 5 (2,2%) hanno sperimentato la paralisi degli arti posteriori, 10 (4,4%) hanno avuto un cuore non batte a causa di innestare lesione ischemica e / o trombosi, mentre il 15 (6,6%) sono morti entro 48 ore .

Dopo un periodo di formazione iniziale, sono stati analizzati 227 casi di topo eterotopico trapianto di cuore nel nostro gruppo. Il tasso di successo nelle prime 24 ore è stata 90,3% e al 48 hr era 86,8%. Dei 30 (13,2%) guasti entro 48 ore, 5 (2,2%) hanno sperimentato paralisi degli arti posteriori e doveva essere l&#39;eutanasia, 10 (4,4%) aveva un cuore non batte a causa di lesioni ischemia trapianto e / o trombosi, mentre il 15 (6,6%) sono morti entro 48 ore. Alcuni sopravvivenza dell&#39;innesto sperimentali sono m...

Watch this Scientific Journal Video about A Modified Method for Heterotopic Mouse Heart Transplantion at JoVE.com

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 metodo modificato per eterotopica mouse Cuore Trapianto

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 Views.  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 modificata eterotopica suina Hind Arto Trapianto Modello traslazionale vascolarizzato composito allotrapianto (VCA) La ricerca

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

Ricerca

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 cervicale Cuore trapianto Modello utilizzando una tecnica Cuff Modificato

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.

Murini eterotopica cuore Tecnica Trapianto

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.

Il trapianto di valvola polmonare Utilizzando un modello murino di trapianto cardiaco eterotopico

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.

Rat eterotopico addominale Cuore / Trapianti Single-polmone in una configurazione del volume-caricato

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.

Eterotopico cervicale trapianto cardiaco nei topi

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.

A Novel microchirurgica modello per eterotopica, in blocco parete toracica, Timo, e trapianto cardiaco nei topi

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 modello semplificato per il trapianto di valvole cardiache eterotopiche nei roditori

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 protocollo di trapianto di cuore eterotopico suino per la somministrazione di terapie a un allotrapianto cardiaco

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 tecnica di bracciale modificata per il modello di trapianto di cuore eterotopico cervicale del topo

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