KF e KO sono co primi autori insieme a KS Questo lavoro è stato supportato in parte dal AHPBA Fellowship (KS), NIH K23 CA148964-01 (LZ), Johns Hopkins School of Medicine Clinical Scientist Award (LZ), Viragh Fondazione e l&#39;Skip Viragh pancreas Cancer Center della Johns Hopkins (EMJ e LZ), il Pancreas Fondazione Nazionale (LZ), il Lefkofsky Family Foundation (LZ), il SPORE NCI in tumori gastrointestinali P50 CA062924 (EMJ, LZ), la Fondazione Lustgarten (LZ), e le sovvenzioni Sol Goldman pancreas Cancer Center (KS , BHE, LZ).

Tutti gli esperimenti sugli animali conformi alle linee guida della Cura e uso Comitato Animale dell&#39;Università Johns Hopkins, e gli animali sono stati mantenuti in conformità con le linee guida dell&#39;Associazione per la valutazione e l&#39;accreditamento del Laboratorio Care (AAALAC). La procedura chirurgica viene effettuata in condizioni sterili in una sala operatoria che subisce un minimo di quindici ricambi d&#39;aria all&#39;ora. Tutti gli strumenti sono sterilizzati in autoclave prima della procedura e ancora con etanolo al 70% tra ogni mouse durante la procedura. Tutti i topi non si prevede di sopravvivere alla procedura chirurgica sono eutanasia in CO 2 per 3 min seguita da dislocazione cervicale mentre ancora sotto anestesia. 1 Cella Preparazione <ol><li> Risospendere le cellule in coltura Panc02 in tampone fosfato salino a 2 x 10 7 cellule / ml, e tenere su ghiaccio. </li></ol> 2 Preparazione del mouse <ol><li> Somministrare Ketamine (100 mg / kg) miscelato con xilazina (10 mg / kg) per via intraperitoneale a 8-12 settimane di età C57BL / 6 topi femmina in dosi frazionate. </li><li> Verificare che la punta ritiro pizzico riflesso è abolito per assicurare che il mouse è completamente anestetizzato. </li><li> Somministrare ulteriori dosi di ketamina (100 mg / kg) mescolato con xilazina (10 mg / kg) in quanto necessario per anestetizzare completamente i topi. </li><li> Applicare Puralube Vet unguento per gli occhi dei topi per evitare l&#39;essiccazione, mentre i topi sono sotto anestesia. </li><li> Radere l&#39;area chirurgica dei topi per evitare la contaminazione della ferita. </li><li> Prep zona sottocostale sinistra della incisione con il 70% di etanolo e poi iodio. </li><li> Posizionare un telo chirurgico intorno all&#39;addome per mantenere la sterilità. </li></ol> 3. laparotomia <ol><li> Fare una incisione sottocostale sinistra in linea con l&#39;orecchio sinistro attraverso la pelle e attraverso il peritoneo con un bisturi. </li><li> Esprimere la milza attraverso l&#39;incisione mediante l&#39;applicazione simultanea p digitaleressione lungo gli aspetti craniali e caudali dell&#39;incisione. </li><li> Individuare i vasi sanguigni splenici all&#39;estremità inferiore della milza. </li><li> Dividere la milza mettendo due Horizon medie dimensioni clip Ligating nel centro della milza facendo attenzione a non danneggiare i vasi sanguigni splenici ai poli splenici. </li><li> Inserire il polo superiore della milza indietro nel peritoneo per evitare la contaminazione. </li></ol> 4. Tumore iniezione <ol><li> Redigere 150 ml di tampone fosfato in un 26 G x 5/8 &quot;siringa. </li><li> Redigere 100 ml di Panc02 (2 x10 6 cellule) nella stessa siringa mantenendo la siringa in posizione verticale in qualsiasi momento durante l&#39;iniezione. </li><li> Immergere l&#39;ago in una soluzione di etanolo al 70%. L&#39;ago è immerso in etanolo al 70% per garantire la sterilità. </li><li> Iniettare le cellule lentamente nel hemispleen esposto essendo che la siringa sia mantenuta in posizione verticale in ogni momento. Lo smusso della Syringe occorre rilevare in ogni momento attraverso la capsula splenica evitare iniettando le cellule sotto la milza. Un sbiancamento dei vasi sanguigni e milza deve essere osservato dopo l&#39;iniezione. </li><li> Elevare la milza e applicare uno medio Horizon fermaglio sotto la milza per occludere i vasi sanguigni splenici. </li><li> Applicare una piccola clip Horizon per l&#39;aspetto più distale del pancreas e dei vasi splenici. </li><li> Legare il pancreas e vasi splenici dal hemispleen tagliando sopra le clip Horizon. </li><li> Posizionare il mouse sul &#39;lato, e irrigare l&#39;incisione con acqua distillata. </li></ol> 5. addominale Chiusura e recupero dall&#39;anestesia <ol><li> Chiudere il peritoneo con un punto 4-0 in esecuzione. </li><li> Applicare 2-3 clip della pelle per chiudere l&#39;incisione cutanea. </li><li> Somministrare 0,1 mg / kg di buprenorfina o di 5-10 mg / kg per via sottocutanea Carprofen per alleviare il dolore post chirurgico. </li><li> Posizionare il mouse su una piastra elettrica per recOvery fino mobile e il mouse dimostra modelli di respirazione regolare. Gli animali vengono restituiti solo alla compagnia di altri animali dopo riprendersi completamente dalla procedura chirurgica. </li></ol> 6. Necropsy Esame e raccolta del Fegato <ol><li> Tra 30 e 60 giorni dopo l&#39;intervento chirurgico, i topi cominciano a mostrare sintomi clinici di metastasi e richiederanno l&#39;eutanasia. Segni di malattia metastatica che richiedono l&#39;eutanasia umano includono addome allargata e lo sviluppo di ascite. Euthanize topi per inalazione di CO 2. </li><li> Dopo l&#39;inalazione, effettuare dislocazione cervicale. </li><li> Dopo che l&#39;animale è stato determinato per essere non reattivo, fare un&#39;incisione attraverso il peritoneo per esporre l&#39;addome con le forbici. </li><li> Utilizzo di pinze e forbici, tagliare delicatamente il fegato fuori dell&#39;addome. </li><li> Mettere il fegato in OCT, e flash congelare con azoto liquido. Conservare il fegato a -80 ° C. In alternativa, il vivor può essere fissato in 16% formalina tamponata neutra a temperatura ambiente per 24 ore e incluso in paraffina. </li></ol>

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Questo modello murino preclinico del pancreas metastasi del cancro al fegato tramite una tecnica di iniezione hemispleen è il primo modello descritto che rispecchia molte delle condizioni cliniche e immunologiche dei pazienti con malattia metastatica al fegato. Questo modello offre diversi vantaggi rispetto ad altri modelli murini. In primo luogo, a differenza dei modelli transgenici di cancro al pancreas in cui solo il 30% dei topi sviluppano metastasi al fegato e la tempistica della formazione di metastasi è abbasta...

Duttale del pancreas adenocarcinoma (PDA) è la quarta principale causa di decessi per cancro correlati negli Stati Uniti 1. La sopravvivenza a cinque anni per i pazienti con PDA metastatico è 2-12% 1. Anche se la chemioterapia adiuvante e neoadiuvante per il cancro del pancreas è oggi più efficace che mai, rimane ancora un disperato bisogno di nuove terapie. Lo sviluppo di nuove terapie richiede modelli affidabili animali preclinici. Sebbene i modelli tumorali sottocutanei sono semplici da usare, svantaggi includono l&#39;incapacità di questi tumori a metastatizzare e imitare la progressione del tumore e microambienti visto in tumori umani. Modelli geneticamente modificati, come il topo geneticamente modificato contenente Kras e p53 knock-in mutazioni oncogene (il modello KPC) 2 e il modello KPC con un lignaggio tracciante YFP (il modello PKCY) 3 consentono lo studio dei tumori presenti in natura in immunocompetetopi NT. Inoltre, il microambiente tumorale è inalterata e assomiglia più da vicino visto che nella progressione tumorale umano. Purtroppo, i tempi di sviluppo del tumore è variabile all&#39;interno di questi modelli, che lo rende difficile studiare terapie sperimentali. Inoltre, retroincroci di questi topi richiede una notevole quantità di tempo e di impegno finanziario, che non è sempre fattibile. Infine, modelli murini di xenotrapianto PDA impiantati, esigono topi, che hanno modificato o microambienti tumorali assenti immunocompromessi. Di conseguenza, l&#39;efficacia delle terapie sperimentali dimostrate in questi modelli preclinici spesso non sono riproducibili in studi clinici umani 4. Questo modello murino hemisplenectomy utilizza cellule tumorali Panc02, che sono una, metilcolantrene indotta pancreas linea di cellule tumorali altamente cancerogeno derivato da C57BL / 6 topi 5, 6. Inoltre, altre linee cellulari PDA murine derivate dal microfono KPCe può essere utilizzato in questo modello. Schulick et al. Hanno già sviluppato una tecnica hemisplenectomy e creato un modello singenico topo delle metastasi del cancro al colon 7. Questo modello hemisplenectomy (Figura 1) offre costante e pari inoculazione del tumore nei topi immunocompetenti si presta alla ricerca di nuovi agenti terapeutici 7-10.

<table border="0" cellpadding="0" cellspacing="0" width="713">
	<tbody>
		<tr height="42">
			<td height="42" style="height:42px;width:216px;">Cell culture media and components</td>
			<td style="width:197px;"></td>
			<td style="width:119px;"></td>
			<td style="width:181px;">will vary depending on cell line</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Phosphate Buffered Saline</td>
			<td style="width:197px;">Gibco by Life Technologies</td>
			<td style="width:119px;">10010-023</td>
			<td style="width:181px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">15 mL centrifigure tubes</td>
			<td style="width:197px;">Corning</td>
			<td style="width:119px;">430052</td>
			<td style="width:181px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Curved Operating Scissor</td>
			<td style="width:197px;">Roboz Surgical Store</td>
			<td style="width:119px;">RS-6835</td>
			<td style="width:181px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:216px;">Micro dissecting Graefe Forceps</td>
			<td style="width:197px;">Roboz Surgical Store</td>
			<td style="width:119px;">RS-5130</td>
			<td style="width:181px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:216px;">Needle holder (regular)</td>
			<td style="width:197px;">World Precision Instruments, Inc</td>
			<td style="width:119px;"></td>
			<td style="width:181px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:216px;">3-0 or 4-0 suture</td>
			<td style="width:197px;"></td>
			<td style="width:119px;"></td>
			<td style="width:181px;">courtesy of dept of surgery, Johns Hopkins</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:216px;">Weck Horizon Open Ligating Clip Applier, small, angled</td>
			<td style="width:197px;">Teleflex</td>
			<td style="width:119px;">137085</td>
			<td style="width:181px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:216px;">Weck Horizon Open Ligating Clip Applier, medium, angled</td>
			<td style="width:197px;">Teleflex</td>
			<td style="width:119px;">237115</td>
			<td style="width:181px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:216px;">Weck Horizon medium ligating clips</td>
			<td style="width:197px;">Teleflex</td>
			<td style="width:119px;">002200</td>
			<td style="width:181px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:216px;">Weck Horizon small ligating clips</td>
			<td style="width:197px;">Teleflex</td>
			<td style="width:119px;">001200</td>
			<td style="width:181px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:216px;">Syringe, 1 cc, tb syringe, 3/8&#34; slip tip</td>
			<td style="width:197px;">Becton Dickinson</td>
			<td style="width:119px;">309625</td>
			<td style="width:181px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:216px;">Syringe, 1 cc, tb syringe, 5/8&#34; slip tip</td>
			<td style="width:197px;">Becton Dickinson</td>
			<td style="width:119px;">309597</td>
			<td style="width:181px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">9 mm Autoclip Applier</td>
			<td style="width:197px;">Mikron</td>
			<td style="width:119px;">427630</td>
			<td style="width:181px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">9 mm Autoclip</td>
			<td style="width:197px;">Becton Dickinson</td>
			<td style="width:119px;">427631</td>
			<td style="width:181px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Heating pad</td>
			<td style="width:197px;">Sunbeam</td>
			<td style="width:119px;">CAT93</td>
			<td style="width:181px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">70% Ethanol</td>
			<td style="width:197px;"></td>
			<td style="width:119px;"></td>
			<td style="width:181px;">sold by numerous vendors</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Ketamine Hydrochloride&#160;</td>
			<td style="width:197px;">Hospira</td>
			<td style="width:119px;">22395DD</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Xylazine hydrochloride</td>
			<td style="width:197px;">Sigma</td>
			<td style="width:119px;">X1251</td>
			<td></td>
		</tr>
	</tbody>
</table>

a preclinical murine model of hepatic metastases

Numerosi modelli murini sono stati sviluppati per studiare tumori umani e far progredire la comprensione del trattamento del cancro e di sviluppo. Qui, un preclinico, modello murino di tumore pancreatico di metastasi epatiche tramite un&#39;iniezione hemispleen delle cellule tumorali pancreatiche murine singeniche è descritto. Questo modello riproduce molte delle condizioni cliniche in pazienti con malattia metastatica al fegato. Mice costantemente sviluppano metastasi nel fegato permettendo indagine del processo metastatico, testing terapia sperimentale, e la ricerca del tumore immunologia.

Cellule tumorali Panc02 iniettate nel hemispleen (Figura 1) metastasi epatiche in forma al 100% dei topi, mentre il polmone e metastasi peritoneali non vengono rispettate se la tecnica è eseguita correttamente. Questa tecnica è stata effettuata su oltre un centinaio di topi utilizzando cellule Panc02 in più, esperimenti indipendenti, e riproducibile, tutti i topi non trattati morire con metastasi epatiche tra i 30 e 60 giorni dopo la procedura hemisplenectomy (Figura 2). Per ottenere...

Watch this Scientific Journal Video about A Preclinical Murine Model of Hepatic Metastases at JoVE.com

A Preclinical Murine Model of Hepatic Metastases

Un preclinico, modello murino di metastasi epatiche effettuato tramite una tecnica di iniezione hemispleen.

Un preclinici Modello murino di metastasi epatiche

Numerous murine models have been developed to study human cancers and advance the understanding of cancer treatment and development. Here, a preclinical, ...

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28.4K Views.  The Johns Hopkins University School of Medicine.  Un preclinico, modello murino di metastasi epatiche effettuato tramite una tecnica di iniezione hemispleen. 

Video: A Preclinical Murine Model of Hepatic Metastases

Murine Bioluminescent Hepatic Tumour Model

This video describes the establishment of liver metastases in a mouse model that can be subsequently analysed by bioluminescent imaging. Tumour cells are administered specifically to the liver to induce a localised liver tumour, via mobilisation of the spleen and splitting into two, leaving intact the vascular pedicle for each half of the spleen. Lewis lung carcinoma cells that constitutively express the firefly luciferase gene (luc1) are inoculated into one hemi-spleen which is then resected 10 minutes later. The other hemi-spleen is left intact and returned to the abdomen. Liver tumour growth can be monitored by bioluminescence imaging using the IVIS whole body imaging system. Quantitative imaging of tumour growth using IVIS provides precise quantitation of viable tumour cells. Tumour cell death and necrosis due to drug treatment is indicated early by a reduction in the bioluminescent signal. This mouse model allows for investigating the mechanisms underlying metastatic tumour-cell survival and growth and can be used for the evaluation of therapeutics of liver metastasis. 

This article describes a procedure for the induction of orthotopic bioluminescent liver tumours in mice, and subsequent analysis of tumour growth confined to the liver using live whole body luminescence imaging.

Bioluminescent modello murino epatica Tumori

This video describes the establishment of liver metastases in a mouse model that can be subsequently analysed by bioluminescent imaging. Tumour cells are ...

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Gene Transfer for Ischemic Heart Failure in a Preclinical Model

Various emerging technologies are being developed for patients with heart failure. Well-established preclinical evaluations are necessary to determine their efficacy and safety.
Gene therapy using viral vectors is one of the most promising approaches for treating cardiac diseases. Viral delivery of various different genes by changing the carrier gene has immeasurable therapeutic potential.
In this video, the full process of an animal model of heart failure creation followed by gene transfer is presented using a swine model. First, myocardial infarction is created by occluding the proximal left anterior descending coronary artery. Heart remodeling results in chronic heart failure. Unique to our model is a fairly large scar which truly reflects patients with severe heart failure who require aggressive therapy for positive outcomes. After myocardial infarct creation and development of scar tissue, an intracoronary injection of virus is demonstrated with simultaneous nitroglycerine infusion. Our injection method provides simple and efficient gene transfer with enhanced gene expression. This combination of a myocardial infarct swine model with intracoronary virus delivery has proven to be a consistent and reproducible methodology, which helps not only to test the effect of individual gene, but also compare the efficacy of many genes as therapeutic candidates.

A method of gene transfer for the treatment of ischemic heart failure is described using a swine model of myocardial infarction. Our simple and reproducible method enables us to readily evaluate the efficacy of various gene transfers with a very simple and reproducible way.

Trasferimento Genico per insufficienza cardiaca ischemica in un modello preclinico

Various emerging technologies are being developed for patients with heart failure. Well-established preclinical evaluations are necessary to determine ...

Murine Model of Wound Healing

Wound healing and repair are the most complex biological processes that occur in human life. After injury, multiple biological pathways become activated. Impaired wound healing, which occurs in diabetic patients for example, can lead to severe unfavorable outcomes such as amputation. There is, therefore, an increasing impetus to develop novel agents that promote wound repair. The testing of these has been limited to large animal models such as swine, which are often impractical. Mice represent the ideal preclinical model, as they are economical and amenable to genetic manipulation, which allows for mechanistic investigation. However, wound healing in a mouse is fundamentally different to that of humans as it primarily occurs via contraction. Our murine model overcomes this by incorporating a splint around the wound. By splinting the wound, the repair process is then dependent on epithelialization, cellular proliferation and angiogenesis, which closely mirror the biological processes of human wound healing. Whilst requiring consistency and care, this murine model does not involve complicated surgical techniques and allows for the robust testing of promising agents that may, for example, promote angiogenesis or inhibit inflammation. Furthermore, each mouse acts as its own control as two wounds are prepared, enabling the application of both the test compound and the vehicle control on the same animal. In conclusion, we demonstrate a practical, easy-to-learn, and robust model of wound healing, which is comparable to that of humans.

A murine model of cutaneous wound healing that can be used to assess therapeutic compounds in physiological and pathophysiological settings.

Modello murino di guarigione delle ferite

Wound healing and repair are the most complex biological processes that occur in human life. After injury, multiple biological pathways become activated. ...

A Murine Model of Subarachnoid Hemorrhage

In this video publication a standardized mouse model of subarachnoid hemorrhage (SAH) is presented. Bleeding is induced by endovascular Circle of Willis perforation (CWp) and proven by intracranial pressure (ICP) monitoring. Thereby a homogenous blood distribution in subarachnoid spaces surrounding the arterial circulation and cerebellar fissures is achieved. Animal physiology is maintained by intubation, mechanical ventilation, and continuous on-line monitoring of various physiological and cardiovascular parameters: body temperature, systemic blood pressure, heart rate, and hemoglobin saturation. Thereby the cerebral perfusion pressure can be tightly monitored resulting in a less variable volume of extravasated blood. This allows a better standardization of endovascular filament perforation in mice and makes the whole model highly reproducible. Thus it is readily available for pharmacological and pathophysiological studies in wild type and genetically altered mice.

A standardized mouse model of subarachnoid hemorrhage by intraluminal Circle of Willis perforation is described. Vessel perforation and subarachnoid bleeding are monitored by intracranial pressure monitoring. In addition various vital parameters are recorded and controlled to maintain physiologic conditions.

Un modello murino di emorragia subaracnoidea

In this video publication a standardized mouse model of subarachnoid  hemorrhage (SAH) is presented. Bleeding is induced by endovascular Circle of  Willis ...

Murine Model for Non-invasive Imaging to Detect and Monitor Ovarian Cancer Recurrence

Epithelial ovarian cancer is the most lethal gynecologic malignancy in the United States. Although patients initially respond to the current standard of care consisting of surgical debulking and combination chemotherapy consisting of platinum and taxane compounds, almost 90% of patients recur within a few years. In these patients the development of chemoresistant disease limits the efficacy of currently available chemotherapy agents and therefore contributes to the high mortality. To discover novel therapy options that can target recurrent disease, appropriate animal models that closely mimic the clinical profile of patients with recurrent ovarian cancer are required. The challenge in monitoring intra-peritoneal (i.p.) disease limits the use of i.p. models and thus most xenografts are established subcutaneously. We have developed a sensitive optical imaging platform that allows the detection and anatomical location of i.p. tumor mass. The platform includes the use of optical reporters that extend from the visible light range to near infrared, which in combination with 2-dimensional X-ray co-registration can provide anatomical location of molecular signals. Detection is significantly improved by the use of a rotation system that drives the animal to multiple angular positions for 360 degree imaging, allowing the identification of tumors that are not visible in single orientation. This platform provides a unique model to non-invasively monitor tumor growth and evaluate the efficacy of new therapies for the prevention or treatment of recurrent ovarian cancer.

We describe a non-invasive animal imaging platform that allows the detection, quantification, and monitoring of ovarian cancer growth and recurrence. This intra-peritoneal xenograft model mimics the clinical profile of patients with ovarian cancer.

Modello murino per l&#39;imaging non invasivo per rilevare e monitorare Ovarian Cancer Ricorrenza

Epithelial ovarian cancer is the most lethal gynecologic malignancy in the United States. Although patients initially respond to the current standard of ...

Ex Vivo Treatment Response of Primary Tumors and/or Associated Metastases for Preclinical and Clinical Development of Therapeutics

The molecular analysis of established cancer cell lines has been the mainstay of cancer research for the past several decades. Cell culture provides both direct and rapid analysis of therapeutic sensitivity and resistance. However, recent evidence suggests that therapeutic response is not exclusive to the inherent molecular composition of cancer cells but rather is greatly influenced by the tumor cell microenvironment, a feature that cannot be recapitulated by traditional culturing methods. Even implementation of tumor xenografts, though providing a wealth of information on drug delivery/efficacy, cannot capture the tumor cell/microenvironment crosstalk (i.e., soluble factors) that occurs within human tumors and greatly impacts tumor response. To this extent, we have developed an ex vivo (fresh tissue sectioning) technique which allows for the direct assessment of treatment response for preclinical and clinical therapeutics development. This technique maintains tissue integrity and cellular architecture within the tumor cell/microenvironment context throughout treatment response providing a more precise means to assess drug efficacy.

Ex Vivo Treatment Response of Primary Tumors and/or Associated Metastases for Preclinical and Clinical Development of Therapeutics

Established cancer cell lines and xenografts have been the mainstay of cancer research for the past several decades. However, recent evidence suggests that therapeutic response is greatly influenced by the tumor cell microenvironment. Therefore, we have developed an ex vivo analysis of primary tumor specimens for drug development purposes.

Ex Vivo risposta al trattamento di tumori primari e / o associati per metastasi preclinici e sviluppo clinico di Therapeutics

The molecular analysis of established cancer cell lines has been the mainstay of cancer research for the past several decades. Cell culture provides both ...

Isolated Hepatic Perfusion as a Treatment for Liver Metastases of Uveal Melanoma

Isolated hepatic perfusion (IHP) is a procedure where the liver is surgically isolated and perfused with a high concentration of the chemotherapeutic agent melphalan. Briefly, the procedure starts with the setup of a percutaneous veno-venous bypass from the femoral vein to the external jugular vein. Via a laparotomy, catheters are then inserted into the proper hepatic artery and the caval vein. The portal vein and the caval vein, both supra- and infrahepatically, are then clamped. The arterial and venous catheters are connected to a heart lung machine and the liver is perfused with melphalan (1 mg/kg body weight) for 60 min. This way it is possible to locally perfuse the liver with a high dose of a chemotherapeutic agent, without leakage to the systemic circulation.
In previous studies including patients with isolated liver metastases of uveal melanoma, an overall response rate of 33-100% and a median survival between 9 and 13 months, have been reported. The aim of this protocol is to give a clear description of how to perform the procedure and to discuss IHP as a treatment option for liver metastases of uveal melanoma.

Here, we present a protocol how to perform an isolated liver perfusion (IHP) with melphalan and we also discuss IHP as a treatment option for liver metastases of uveal melanoma.

Isolata epatica perfusione come Trattamento di metastasi epatiche di melanoma uveale

Isolated hepatic perfusion (IHP) is a procedure where the liver is surgically isolated and perfused with a high concentration of the chemotherapeutic ...

Percutaneous Hepatic Perfusion (PHP) with Melphalan as a Treatment for Unresectable Metastases Confined to the Liver

Unresectable liver metastases of colorectal cancer can be treated with systemic chemotherapy, aiming to limit the disease, extend survival or turn unresectable metastases into resectable ones. Some patients however, suffer from side effects or progression under systemic treatment. For patients with metastasized uveal melanoma there are no standard systemic therapy options. For patients without extrahepatic disease, isolated liver perfusion (IHP) may enable local disease control with limited systemic side effects. Previously, this was performed during open surgery with satisfying results, but morbidity and mortality related to the open procedure, prohibited a widespread application. Therefore, percutaneous hepatic perfusion (PHP) with simultaneous chemofiltration was developed. Besides decreasing morbidity and mortality, this procedure can be repeated, hopefully leading to a higher response rate and improved survival (by local control of disease). During PHP, catheters are placed in the proper hepatic artery, to infuse the chemotherapeutic agent, and in the inferior caval vein to aspirate the chemosaturated blood returning through the hepatic veins. The caval vein catheter is a double balloon catheter that prohibits leakage into the systemic circulation. The blood returning from the hepatic veins is aspirated through the catheter fenestrations and then perfused through an extra-corporeal filtration system. After filtration, the blood is returned to the patient by a third catheter in the right internal jugular vein. During PHP a high dose of melphalan is infused into the liver, which is toxic and would lead to life threatening complications when administered systemically. Because of the significant hemodynamic instability resulting from the combination of caval vein occlusion and chemofiltration, hemodynamic monitoring and hemodynamic support is of paramount importance during this complex procedure.

Percutaneous Hepatic Perfusion PHP with Melphalan as a Treatment for Unresectable Metastases Confined to the Liver

In this manuscript, we describe percutaneous isolated hepatic perfusion with simultaneous chemofiltration as treatment for unresectable liver metastases. This procedure is performed under general anaesthesia in the angiosuite by an experienced team, consisting of an interventional radiologist, a clinical perfusionist and anaesthesiologist.

Percutanea epatica Perfusione (PHP) con melfalan come trattamento per non resecabili metastasi confinata al fegato

Unresectable liver metastases of colorectal cancer can be treated with systemic chemotherapy, aiming to limit the disease, extend survival or turn ...

Contractions of Human-iPSC-derived Cardiomyocyte Syncytia Measured with a Ca-sensitive Fluorescent Dye in Temperature-controlled 384-well Plates

Spontaneously contracting syncytia of cardiomyocytes derived from human-induced pluripotent stem cells (hiPSC-CM) are a useful model of human cardiac physiology and pharmacology. Various methods have been proposed to record this spontaneous activity and to evaluate drug effects, but many of these methods suffer from limited throughput and/or physiological relevance. We developed a high-throughput screening system to quantify the effects of exogenous compounds on hiPSC-CM's beating frequency, using a Ca-sensitive fluorescent dye and a temperature-controlled imaging multi-well plate reader. We describe how to prepare the cell plates and the compound plates and how to run the automated assay to achieve high sensitivity and reproducibility. We also describe how to transform and analyze the fluorescence data to provide reliable measures of drug effects on spontaneous rhythm. This assay can be used in drug discovery programs to guide chemical optimization away from, or toward, compounds affecting human cardiac function.

Spontaneously contracting syncytia of cardiomyocytes derived from human-induced pluripotent stem cells are useful models of human cardiac physiology and pharmacology. Here we present a high-throughput screening system to quantify the effects of exogenous compounds on beating frequency, using a Ca-sensitive fluorescent dye and a temperature-controlled imaging multi-well plate reader.

Contrazioni di umano-iPSC-derivato del Cardiomyocyte sincizi misurata con un colorante fluorescente Ca sensibile a temperatura controllata piastre da 384 pozzetti

Spontaneously contracting syncytia of cardiomyocytes derived from human-induced pluripotent stem cells (hiPSC-CM) are a useful model of human cardiac ...

Preclinical Model of Hind Limb Ischemia in Diabetic Rabbits

Peripheral vascular disease is a widespread clinical problem that affects millions of patients worldwide. A major consequence of peripheral vascular disease is the development of ischemia. In severe cases, patients can develop critical limb ischemia in which they experience constant pain and an increased risk of limb amputation. Current therapies for peripheral ischemia include bypass surgery or percutaneous interventions such as angioplasty with stenting or atherectomy to restore blood flow. However, these treatments often fail to the continued progression of vascular disease or restenosis or are contraindicated due to the overall poor health of the patient. A promising potential approach to treat peripheral ischemia involves the induction of therapeutic neovascularization to allow the patient to develop collateral vasculature. This newly formed network alleviates peripheral ischemia by restoring perfusion to the affected area. The most frequently employed preclinical model for peripheral ischemia utilizes the creation of hind limb ischemia in healthy rabbits through femoral artery ligation. In the past, however, there has been a strong disconnect between the success of preclinical studies and the failure of clinical trials regarding treatments for peripheral ischemia. Healthy animals typically have robust vascular regeneration in response to surgically induced ischemia, in contrast to the reduced vascularity and regeneration in patients with chronic peripheral ischemia. Here, we describe an optimized animal model for peripheral ischemia in rabbits that includes hyperlipidemia and diabetes. This model has reduced collateral formation and blood pressure recovery in comparison to a model with a higher cholesterol diet. Thus, the model may provide better correlation with human patients with compromised angiogenesis from the common co-morbidities that accompany peripheral vascular disease.

We describe a surgical procedure used to induce peripheral ischemia in rabbits with hyperlipidemia and diabetes. This surgery acts as a preclinical model for conditions experienced in peripheral artery disease in patients. Angiography is also described as a means to measure the extent of introduced ischemia and recovery of perfusion.

Modello preclinico di ischemia degli arti posteriori nei conigli diabetici

Peripheral vascular disease is a widespread clinical problem that affects millions of patients worldwide. A major consequence of peripheral vascular ...