Name: mouse heterotopic cervical cardiac transplantation utilizing vascular cuffs
Uploaded: 2022-06-23T14:40:00
Description: Watch this Scientific Journal Video about Mouse Heterotopic Cervical Cardiac Transplantation Utilizing Vascular Cuffs at JoVE.com

DK is supported by National Institutes of Health grants 1P01AI116501, R01HL094601, R01HL151078, Veterans Administration Merit Review grant 1I01BX002730, and The Foundation for Barnes-Jewish Hospital.

All animal handling procedures were conducted in compliance with the NIH Care and Use of Laboratory Animals guidelines and approved by the Animal Studies Committee at Washington University School of Medicine. Hearts from C57BL/6 (B6) and BALB/c mice (weighing 20-25 g) were transplanted into gender-matched B6 recipients (6-8 weeks of age). The mice were obtained from commercial sources (see Table of Materials). Syngeneic transplants were performed to evaluate cellular responses related to ischemia-reperfu...

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	<li>Abbott, C. P., Lindsey, E. S., Creech, O., Dewitt, C. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+technique+for+heart+transplantation+in+the+rat.">A technique for heart transplantation in the rat.</a> The Archives of Surgery. 89, 645-652 (1964).</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> The Journal of Thoracic and Cardiovascular Surgery. 57 (2), 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=Heart+transplantation+in+congenic+strains+of+mice.">Heart transplantation in congenic strains of mice.</a> Transplantation Proceedings. 5 (1), 733-735 (1973).</li><li>Heron, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+technique+for+accessory+cervical+heart+transplantation+in+rabbits+and+rats.">A technique for accessory cervical heart transplantation in rabbits and rats.</a> Acta Pathologica Microbiologica Scandinavica Section A Pathology. 79 (4), 366-372 (1971).</li><li>Chen, Z. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+technique+of+cervical+heterotopic+heart+transplantation+in+mice.">A technique of cervical heterotopic heart transplantation in mice.</a> Transplantation. 52 (6), 1099-1101 (1991).</li><li>Matsuura, A., Abe, T., Yasuura, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simplified+mouse+cervical+heart+transplantation+using+a+cuff+technique.">Simplified mouse cervical heart transplantation using a cuff technique.</a> Transplantation. 51 (4), 896-898 (1991).</li><li>Yu, Y., 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=Cuff+anastomosis+of+both+renal+artery+and+vein+to+minimize+thrombosis:+a+novel+method+of+kidney+transplantation+in+mice.">Cuff anastomosis of both renal artery and vein to minimize thrombosis: a novel method of kidney transplantation in mice.</a> Journal of Investigative Surgery. 35 (1), 56-60 (2022).</li><li>Tomita, Y., 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=Improved+technique+of+heterotopic+cervical+heart+transplantation+in+mice.">Improved technique of heterotopic cervical heart transplantation in mice.</a> Transplantation. 64 (11), 1598-1601 (1997).</li><li>Wang, Q., Liu, Y., Li, X. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simplified+technique+for+heterotopic+vascularized+cervical+heart+transplantation+in+mice.">Simplified technique for heterotopic vascularized cervical heart transplantation in mice.</a> Microsurgery. 25 (1), 76-79 (2005).</li><li>Oberhuber, R., 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=Murine+cervical+heart+transplantation+model+using+a+modified+cuff+technique.">Murine cervical heart transplantation model using a modified cuff technique.</a> Journal of Visualized Experiments. (92), e50753 (2014).</li><li>Ratschiller, T., 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=Heterotopic+cervical+heart+transplantation+in+mice.">Heterotopic cervical heart transplantation in mice.</a> Journal of Visualized Experiments. (102), e52907 (2015).</li><li>Mao, X., Xian, P., You, H., Huang, G., Li, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+modified+cuff+technique+for+mouse+cervical+heterotopic+heart+transplantation+model.">A modified cuff technique for mouse cervical heterotopic heart transplantation model.</a> Journal of Visualized Experiments. (180), e63504 (2022).</li><li>Li, W., 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=Intravital+2-photon+imaging+of+leukocyte+trafficking+in+beating+heart.">Intravital 2-photon imaging of leukocyte trafficking in beating heart.</a> Journal of Clinical Investigation. 122 (7), 2499-2508 (2012).</li><li>Kreisel, D., 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=In+vivo+two-photon+imaging+reveals+monocyte-dependent+neutrophil+extravasation+during+pulmonary+inflammation.">In vivo two-photon imaging reveals monocyte-dependent neutrophil extravasation during pulmonary inflammation.</a> Proceedings of the National Academy of Sciences of the United States of America. 107 (42), 18073-18078 (2010).</li><li>Li, W., 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=Visualization+of+monocytic+cells+in+regressing+atherosclerotic+plaques+by+intravital+2-photon+and+positron+emission+tomography-based+imaging-brief+report.">Visualization of monocytic cells in regressing atherosclerotic plaques by intravital 2-photon and positron emission tomography-based imaging-brief report.</a> Arteriosclerosis, Thrombosis, and Vascular Biology. 38 (5), 1030-1036 (2018).</li><li>Li, W., 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=Lung+transplant+acceptance+is+facilitated+by+early+events+in+the+graft+and+is+associated+with+lymphoid+neogenesis.">Lung transplant acceptance is facilitated by early events in the graft and is associated with lymphoid neogenesis.</a> Mucosal Immunology. 5 (5), 544-554 (2012).</li><li>Faust, N., Varas, F., Kelly, L. 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(160), e61103 (2020).</li><li>Latchana, N., Peck, J. R., Whitson, B., Black, 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=Preservation+solutions+for+cardiac+and+pulmonary+donor+grafts:+a+review+of+the+current+literature.">Preservation solutions for cardiac and pulmonary donor grafts: a review of the current literature.</a> Journal of Thoracic Disease. 6 (8), 1143-1149 (2014).</li><li>Hartley, 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=Doppler+velocity+measurements+from+large+and+small+arteries+of+mice.">Doppler velocity measurements from large and small arteries of mice.</a> American Journal of Physiology - Heart and Circulatory Physiology. 301 (2), 269-278 (2011).</li><li>Bovenkamp, P. 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Utilizing this technique, mouse heterotopic cervical cardiac transplantation can be performed in less than 40 min by an experienced microsurgeon and in approximately 60 min by an entry-level microsurgeon. While cervical heart transplantation has been studied in numerous animal models, a mouse model remains the gold standard due to multiple well-defined genetic strains, genetic alteration capabilities, and the availability of numerous reagents, including monoclonal antibodies24. The technique descr...

Abbott et al. published1 the first description of heterotopic abdominal heart transplantation in rats in 1964. These surgical techniques were refined and simplified by Ono et al. in 19692. Corry et al. first described a method for heterotopic abdominal heart transplantation in mice in 1973; similar to the previously reported rat models, this involved engraftment into the host&#39;s abdomen with revascularization by end-to-side anastomoses of the donor&#39;s pulmonary artery and ascending aorta to the recipient&#39;s inferior vena cava and abdominal aorta, respectively3. Heterotopic cervical heart transplantation in rats was described by Heron in 1971 using Teflon cuffs made from 16 G (1.6 mm outer diameter) intravenous catheters4. Chen5 and Matsuura et al.6 later reported heterotopic cervical heart transplantation in mice in 1991, whose techniques differed primarily in their method of re-anastomosis. Chen&#39;s approach involved sutured anastomoses of the donor&#39;s ascending aorta to the carotid artery of the recipient and the donor&#39;s pulmonary artery to the external jugular vein of the recipient5. Due to the advanced technical skill required for these microsurgical sutured anastomoses, a significant amount of time and experience was necessary to achieve a high success rate. Matsuura et al. described a method utilizing a non-suture cuff technique, similar to that used by Heron, which involved end-to-end anastomoses using the extra-luminal placement of cuffs. He fashioned Teflon cuffs from 22 G (0.8 mm outer diameter) and 24 G (0.67 mm outer diameter) intravenous catheters and placed them over the recipient&#39;s external jugular vein and common carotid artery, respectively6. These cuffs were then placed inside the donor&#39;s pulmonary artery and aorta and secured by tying a suture ligature around the connection. This approach translated into an improved success rate. Most importantly, it resulted in a shortening of the time required to complete both cervical anastomoses, thus reducing the warm ischemic time of the graft to less than one-third of that utilizing the abdominal suturing method. Furthermore, since the cuffs are placed around the external surface of the vessel, there is no foreign body exposed to the vessel lumen, which largely reduces the possibility of thrombosis after surgery7. Meanwhile, utilization of the cuff technique provides support around the vessels at the site of the anastomosis without requiring any suturing, which reduces the risk of bleeding after revascularization6.
Numerous revisions of this technique have been proposed. To accommodate the short length of the mouse common carotid artery (approximately 5 mm), Tomita et al.8 developed a modification of this technique with a smaller arterial cuff (0.6 mm outer diameter) while omitting holding sutures and pulling the artery directly through the cuff with fine forceps instead. Wang et al. further simplified this approach by placing 22 G and 24 G cuffs on the donor&#39;s right pulmonary artery and recipient&#39;s right common carotid artery, respectively9. Various reports have described modifications to these approaches, including the use of specialized cuffs, microsurgical clamps, vessel dilators, and cardioplegia10,11,12. Notably, all of these methods involve the retrograde circulation of blood through the heart, with blood flowing from the recipient common carotid artery to the donor aorta, the coronary arteries, the coronary sinus, then emptying into the right atrium and exiting from the pulmonary artery into the recipient external jugular vein.
Compared to engraftment in the abdomen, cervical cardiac transplantation offers multiple advantages. As previously mentioned, cervical exposure allows for quicker revascularization and shorter warm ischemic times6. The cervical method is also less invasive and is associated with shorter postoperative recovery times as it avoids a laparotomy6. Importantly, end-to-end anastomoses with cuffs can be performed instead of end-to-side anastomoses, which decreases the risk of complications such as anastomotic bleeding. The abdominal approach also poses an increased risk of developing thrombotic complications in the abdominal aorta or inferior vena cava, leading to spinal cord ischemia and hindlimb paralysis. The superficial cervical location of the transplant allows for easy access to graft viability assessment by palpation, electrocardiography, and invasive or non-invasive imaging. Although the cervical grafts resume spontaneous cardiac activity following reperfusion, they do not significantly impact the systolic and diastolic parameters of the recipient. This model provides valuable insight for studying cellular responses following transplantation, such as ischemia-reperfusion injury and graft rejection. Furthermore, this model offers an ideal approach to allow for post-transplant imaging, such as intravital two-photon microscopy or positron emission tomography (PET) imaging. To this end, our laboratory has previously reported methods to image moving tissues and organs in the mouse, including beating murine hearts and aortic arch grafts following heterotopic cervical transplantation&#160;to visualize leukocyte trafficking during ischemia-reperfusion injury and within atherosclerotic plaques, respectively13,14,15. Additionally, due to its superficial location and ease of exposure, this model is suitable for cardiac re-transplantation16.
This report describes a technique that allows for laminar blood flow with the external placement of the vascular cuffs on the vessels from which blood flow originates. This allows for a smooth transition of blood flow from one vessel to the next, avoiding the exposure of the distal vessel edge into the vascular lumen. Additionally, the technique utilizes a larger 20 G cuff, instead of previously used 22 G cuffs, for the donor pulmonary artery to ensure ample return of blood flow to the recipient.

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mouse heterotopic cervical cardiac transplantation utilizing vascular cuffs

Murine models of cardiac transplantation are frequently utilized to study ischemia-reperfusion injury, innate and adaptive immune responses after transplantation, and the impact of immunomodulatory therapies on graft rejection. Heterotopic cervical heart transplantation in mice was first described in 1991 using sutured anastomoses and subsequently modified to include cuff techniques. This modification allowed for improved success rates, and since then, there have been multiple reports that have proposed further technical improvements. However, translation into more widespread utilization remains limited due to the technical difficulty associated with graft anastomoses, which requires precision to achieve adequate length and caliber of the cuffs to avoid vascular anastomotic twisting or excessive tension, which can result in damage to the graft. The present protocol describes a modified technique for performing heterotopic cervical cardiac transplantation in mice which involves cuff placement on the recipient's common carotid artery and the donor's pulmonary artery in alignment with the direction of the blood flow.

This mouse cervical heterotopic cardiac transplantation model has been utilized to perform over 1,000 transplants in our laboratory, with a survival rate of approximately 97%. The success rate is slightly higher than previous reports using other cervical heterotopic heart transplantation techniques in mice10,11,20. This could potentially be attributed to the larger 20 G cuff placed on the donor pulmonary artery to ensure ample r...

Watch this Scientific Journal Video about Mouse Heterotopic Cervical Cardiac Transplantation Utilizing Vascular Cuffs at JoVE.com

Mouse Heterotopic Cervical Cardiac Transplantation Utilizing Vascular Cuffs

Mouse cardiac transplantation models represent valuable research tools for studying transplantation immunology. The present protocol details mouse heterotopic cervical cardiac transplantation that involves the placement of cuffs on the recipient's common carotid artery and the donor's pulmonary artery trunk to allow for laminar blood flow.

Murine models of cardiac transplantation are frequently utilized to study ischemia-reperfusion injury, innate and adaptive immune responses after ...

Our vascular cuff placement allows for laminar blood flow and we utilize a larger cuff for the donor pulmonary artery to ensure ample blood return to the recipients. These modifications used in this protocol decrease the likelihood of turbulent blood flow and thrombus formation and result in improved survival rates. This method provides valuable insight for studying immune responses after transplantation such as ischemia reperfusion injury and graft rejection.Additionally, our technique allows for easier post-transplant monitoring or re-transplantation. Demonstrating this procedure will be Dr.Wen Jun Li, an expert microsurgeon in our laboratory who developed this technique. Prepare the surgical area by shaving the hair from the chest and abdomen using an electric razor.Administer 100 units of heparin intravenously into the penile vein for males or external jugular vein for males and females. Place the mice in a supine position with forelimbs overhead. Secure the forelimbs and hindlimbs with surgical tape and disinfect the skin with 0.75%iodine and 70%ethanol.Perform an incision for the median laparosternotomy from the umbilicus to sternal angle, followed by a bilateral thoracotomy along each costal margin. Fold the anterior chest wall over the neck for full exposure of the mediastinum. Excise the thymus and expose the intrathoracic inferior vena cava.For retrograde perfusion, inject 1.5 milliliters of four degrees Celsius saline into the intrathoracic inferior vena cava with the needle oriented superiorly toward the graft. Ligate the superior vena cava using an 8-0 silk suture and divide distally. Repeat the retrograde perfusion by injecting another 1.5 milliliters of four degrees Celsius saline via the inferior vena cava.Ligate the inferior vena cava using an 8-0 silk suture and divide distally. Dissect the aortic arch and pulmonary artery trunk for graft harvesting and transect both distally. Ligate the pulmonary veins on the posterior surface of the heart using a 6-0 silk suture and divide distally.Perform graft preparation by removing the donor heart from the chest cavity. Place the excised heart in a plastic container filled with four degrees Celsius heparinized saline for one to two minutes. Transfer the graft onto a sterile plastic flask filled with ice for cuff placement.Place a one millimeter long 20 gauge angiocatheter cuff over the pulmonary artery for the donor cuff. Using fine forceps, gently fold the edges of the artery back over the cuff. Secure the folded vessel to the cuff using a 10-0 nylon tie.Store the donor heart in heparinized saline or another preservation solution at four degrees Celsius. Prepare the surgical area by shaving the hair from the cervical area using an electric razor. Apply sterile non-medicated ophthalmic ointment to the eyes to prevent corneal drying.Place the animal in a supine position with forelimbs adjacent to the body and the head turned slightly to the left. Secure the forelimbs and hindlimbs with surgical tape. Disinfect the skin with 0.75%iodine and 70%ethanol.After making a midline cervical incision from the lower mandible to the sternum, transect the right sternocleidomastoid muscle. Excise the right lobe of the inframandibular gland to create space for graft implantation. Tie a slipknot over the proximal external jugular vein using a 6-0 silk suture.Ligate the distal external jugular vein and adjacent branches using an 8-0 silk suture. Suture under the vein and cover with gauze. Make a transverse incision across the anterior wall of the external jugular vein.Place a 10-0 nylon suture through the edge of the proximal external jugular vein and the underlying tissue to secure the vein during cuff insertion. Ligate the distal right common carotid artery using an 8-0 silk suture just inferior to the carotid bifurcation. Tie a slipknot over the proximal common carotid artery using a 6-0 silk suture.Transect the artery distally between the sutures. Then place a 0.6 milliliter long 24 gauge angiocatheter cuff over the recipient's right common carotid artery. Using fine forceps, gently fold the edges of the artery back over the cuff.Secure the folded vessel to the cuff using a 10-0 nylon tie. Place the donor heart superior to the right cervical area. Drip cold saline onto the heart graft every few minutes during implantation.Place a 10-0 nylon suture through the edge of the donor aorta and through a superficial bite of the underlying tissue to secure the graft in place. Flush the donor aorta with 0.5 milliliters of 0.9%heparinized saline. Insert the recipient's common carotid artery cuff into the donor aorta.Secure the anastomosis with an 8-0 silk tie. Remove the aortic anchor suture. De-air the external jugular vein by flushing the recipient's external jugular vein with 0.5 milliliters of 0.9%heparinized saline.Perform pulmonary artery anastomosis by inserting the donor pulmonary artery cuff into the recipient's external jugular vein and secure with an 8-0 silk tie. Remove the external jugular vein anchor suture and transect the remaining posterior wall of the external jugular vein to free the graft from the underlying tissue. Ensure the graft is properly oriented without kinking or twisting of the anastomosis.Release the slipknots on the recipient's external jugular vein, followed by the common carotid artery to initiate heart graft reperfusion. The technique demonstrated in this protocol showed a survival rate of approximately 97%This could potentially be attributed to the larger 20 gauge cuff placed on the donor pulmonary artery to ensure ample return of blood flow to the recipient. Additionally, the alignment of blood flow with cuff placement in the present technique minimizes the risk of thrombosis and anastomotic turbulence.The mean recipient operation time was approximately 37 minutes with an average cold ischemia time of 20 minutes. For survival studies, cardiac grafts were assessed daily by direct visualization and digital palpation of the heartbeat. Intravital two-photon imaging was performed early after transplantation to evaluate leukocyte trafficking.It is important to check that the graft is properly positioned and oriented prior to skin closure to prevent twisting. This method can be used in re-transplantation models to identify resident immune cells in transplanted grafts that mediate alloimmune responses.

Research

JoVE Journal

Immunology and Infection

Isolation of Functional Cardiac Immune Cells

Cardiac immune cells are gaining interest for the roles they play in the pathological remodeling in many cardiac diseases.1-5  These immune cells, which ...

Differentiating Functional Roles of Gene Expression from Immune and Non-immune Cells in Mouse Colitis by Bone Marrow Transplantation

To understand the role of a gene in the development of colitis, we compared the responses of wild-type mice and gene-of-interest deficient knockout mice ...

Murine Full-thickness Skin Transplantation

Murine full-thickness skin transplantation is a well-established in vivo model to study alloimmune response and graft rejection. Despite its limited ...

In Vitro and In Vivo Assessment of T, B and Myeloid Cells Suppressive Activity and Humoral Responses from Transplant Recipients

In Vitro and In Vivo Assessment of T, B and Myeloid Cells Suppressive Activity and Humoral Responses from Transplant Recipients

The main concern in transplantation is to achieve specific tolerance through induction of regulatory cells. The understanding of tolerance mechanisms ...

Assessment of the Cytotoxic and Immunomodulatory Effects of Substances in Human Precision-cut Lung Slices

Respiratory diseases in their broad diversity need appropriate model systems to understand the underlying mechanisms and enable development of new ...

An Immunological Model for Heterotopic Heart and Cardiac Muscle Cell Transplantation in Rats

Heterotopic heart transplantation in rats has been a commonly used model for diverse immunological studies for more than 50 years. Several modifications ...

Optimization of the Cuff Technique for Murine Heart Transplantation

Murine cardiac transplantation has been performed for more than 40 years. With advancements in microsurgery, certain new techniques have been used to ...

Visualization of SARS-CoV-2 using Immuno RNA-Fluorescence In Situ Hybridization

This manuscript provides a protocol for in situ hybridization chain reaction (HCR) coupled with immunofluorescence to visualize severe acute respiratory ...

Purification and Expansion of Mouse Invariant Natural Killer T Cells for in vitro and in vivo Studies

Invariant Natural Killer T (iNKT) cells are innate-like T Lymphocytes expressing a conserved semi-invariant T cell receptor (TCR) specific for self or ...

Partial Heterotopic Hindlimb Transplantation Model in Rats

Vascularized composite allotransplantations (VCA) represent the most advanced reconstruction option for patients without autologous surgical possibilities ...