This work was funded by the American Association of Plastic Surgeons 2014 Academic Scholar Award.

すべての手術の手順は、ジョンズ・ホプキンス大学と米国農務省および公衆衛生局の要件に準拠して完了しました。このプロトコルは、ジョンズ・ホプキンス大学動物実験委員会を以下の、施設内倫理委員会は、（プロトコル番号M013M490）のガイドラインを承認しました。最終的な生存データは、以下に記載の外科的処置のために記録しました。両方のドナーとレシピエント動物は0.1ミリグラムでブプレノルフィンを使用して先制麻酔を受ける/ kgの皮下1時間前に手術し、レシピエント動物のブプレノルフィンでは、移植後に同じ用量で再投与し、最初の48時間で、必要に応じて再投与されます手術後。 1.ドナー同種移​​植片回復注：受信者の麻酔時間を最小限にするために、以前の受信者の移植よりも移植40分のドナー部分を開始し、同時に終了時間または少し耳を容易にするために受信者の準備対Lierの終了時間。 <ol><li>手順については、標準的な無菌顕微楽器や滅菌手袋を使用してください。私たちの研究室では、顕微楽器のオートクレーブ滅菌を使用しています。 </li><li> 4％でイソフルラン誘導気化器を使用して、ドナーマウス（雄）を麻酔。非外傷性の機械的なバリカンを使用すると、頸部、胸部、および腹部から毛を取り除きます。仰臥位で動物を置き、ノーズ​​コーンを介して1〜2％のイソフルランを維持します。定期的につま先のピンチ引っ込め反射を評価することによって、作業中は適切な麻酔を確認してください。 </li><li>皮膚切開の前に、広く滅菌綿棒を使用して、イソプロピルアルコールが続く防腐剤ポビドンヨードを適用することにより、手術を準備します。 </li><li>子宮頸部と腹部の皮膚を横切るハサミで浅横皮膚切開を開始します。 midaxillary線に沿って、左右両方の切開を接続します。 </li><li>顕微鉗子を使用して6-0絹縫合糸とはさみで外頚静脈を識別連結および分割するために、両側頸部を分析。その後、電気メスを使用して左右対称に、内頸静脈と総頸動脈を露出させるために胸鎖乳突筋筋肉を分割します。左側と右側総頸動脈およびバルクの方法で内頸静脈の下で6-0絹縫合糸を渡します。 注：彼らは縛られ、後にステップ1.9で分割されます。 </li><li>はっきり頸部の残りの添付ファイルを解放するためにハサミを使用して、気管の前方に位置するストラップの筋肉と関連した緩い疎性結合組織を、分割します。 </li><li>バイポーラ電気メスと鋭い解剖を使用して、鎖骨下血管を露出させ、連結する大胸筋や鎖骨（6-0絹縫合糸）を分割して近位に分割します。 </li><li>次に、静かに、動物の陰茎を把握し、撤退。ペニスの背に沿って、陰茎の背静脈を視覚化し、消毒イソプロピルアルコールで地域。 30 G針を使用して、背静脈から静脈内にヘパリンの3万台を注入し、ペニスを元の位置に戻って反動することができます。周囲の組織へのヘパリン溶液の部分的な漏れが発生することがあります。 </li><li>総頸動脈と頸静脈の周りに配置され、以前にバルクタイを使用して、左右対称に、連結と構造を分割します。 </li><li>次に横intrabdominal切開を行うためにハサミを使用しています。肝臓下の下大静脈を露出させ、肝臓下の下大静脈に冷たいユーロコリンズ心停止溶液2mlを注入する腸を骨抜き。前次のステップに進むにハートビートの肝変色や停止を可視化することにより、適切な注入を確認してください。 注：ユーロ・コリンズ液を我々の研究室で用意され、特定の試薬および器具の表を参照してください。 </li><li>使用はさみは、二国間diaph経由で胸腔内の空洞にアクセス露出した腹部からragmatic切開。肋間筋と肋骨を介して切開頭を拡張します。同時に胸の壁に沿って内胸船舶の保全性を確保しながら、心臓、胸腺、および大血管を露出し胸壁を反映しています。 </li><li>冷たいユーロコリンズ心筋保護液4mlで肝上下大静脈を注入します。 </li><li>大動脈のルートを特定し、下行大動脈に遠位にトレースします。急激に下行大動脈（最大長を保持）をカットします。 </li><li>肺動脈幹を特定し、（最大長さを維持し）、その分岐点のすぐ近位分けます。そして、冷たいユーロコリンズ心停止溶液2mlを使用して、肺動脈幹の内腔に軟質プラスチックチップカテーテルを配置することによって、肺動脈幹と心を洗い流します。 </li><li> 6-0絹縫合糸を用いて、ライゲーションおよび下大静脈、肺静脈の合流、および両側上大静脈のアクセサリ枝を分割します。そして、昇格気道を入力させないように注意しながら主茎気管支や気管に沿って添付ファイルから心臓の頭を解剖。シャープとバイポーラ電気メスを使用すると、完全にドナーマウスからそれを解放胸壁、胸腺、および心臓を解剖します。 </li><li>最後に、内胸の血管（ 図1A）を混乱させないように注意しながら、胸骨と横肋骨に沿って、はさみを使って、小さいサイズにex vivoでの同種移植片の胸壁をトリミング。血行再建以下の出血を最小限に抑えるために、osteomusculocutaneous胸骨の境界に沿って、バイポーラ電気焼灼を使用しています。 </li><li>受信者は、インセットのために準備されていない場合、ユーロコリンズ液を冷（4 Oの摂氏）の10ml中の同種移植片を配置します。受信者がインセットの準備ができている場合は、まっすぐに受信者術野への同種移植片を移します。 </li></ol> 2.受信者の準備注：受信者の麻酔時間を最小限にするために、別々の手術駅で前にドナー同種移​​植片の収穫が完了するまでの約40分を受信者の準備を開始します。 <ol><li>手順については、標準的な無菌の顕微機器の別個のセットと滅菌手袋を使用してください。 </li><li> 4％でイソフルラン誘導気化器を使用して、（男性または女性）、レシピエントマウスを麻酔。非外傷性の機械的なバリカンを使用すると、右の子宮頸部と胸部の毛を削除します。 </li><li>仰臥位と角度右上肢が若干下方に頭と右上肢の間に110度の角度を形成する際にマウスを置きます。ノーズコーンを介して1〜2％イソフルランの麻酔を維持します。 </li><li>綿の先端のアプリケーターを用いてマウスの眼に石油眼軟膏を置きます。皮膚切開の前に、広くイソプロピルアルコールが続く防腐剤ポビドンヨードを使用して、手術部位を準備します。 </li><li>はさみを使用して、右下BORに沿って正中線から皮膚切開を作ります下顎のデルと右胸部にinfero-横方向に切開を拡張します。微小血管鉗子で鈍的切開を使用して、軟組織および外から円周方向に自由に船舶により外頸静脈を動員。電気メスを使用して、すべてのブランチを分割し、同種移植のための空き領域に鋭い解剖し、電気メスを使用して、顎下腺の右葉を削除します。 </li><li>カフの上に裏返すために外頸静脈のに十分な長さを確認し、6-0絹縫合糸を用いて、静脈外頚を結紮。プレカットポリイミドカフの内腔を通って静脈に挿入し、所定の位置に血管カフ複合体を固定するためのブルドッグ微小血管クランプを使用しています。そして、近位エバートカフの上に、外頸静脈を分割し、10-0ナイロン縫合糸で所定の位置に固定し、はさみを使って。 （ 図1B） </li><li>総頸動脈を露出するようにバイポーラ電気メスと右胸鎖乳突筋を分割します。円周方向に暴徒頸部内の最遠位点に動脈頭をilize。これは、軟組織と周囲の外膜を除去するために、鉗子で血管の鈍的切開を用いて達成されます。 </li><li> 6-0絹縫合糸を用いて、ライゲーションおよび総頸動脈を分割。プレカットポリイミドカフの内腔を通って動脈をパスし、可能な限り胸郭入口に近いブルドッグ微小血管クランプで所定の位置に固定します。優しくエバートカフの上に、顕微拡張器を使用して血管を拡張、遠位血管を分割し、10-0ナイロン縫合糸で所定の位置に固定します。 （ 図1B） 注：特定の顕微拡張器は、特定の試薬および器具の表に記載されています。 </li></ol> 3.同種移植片挿入図<ol><li>逆さまや斜めの位置に受信者の子宮頸部領域内の同種移植片を配置するための標準的な滅菌機器および滅菌手袋を維持します。 </li><li>次に、AOR降順ドナーを配置受信者の動脈カフ構造体の上にチックルーメンと10-0ナイロン縫合糸（ 図1Cおよび1D）と所定の位置に固定します。 </li><li>ドナー肺動脈とレシピエントマウス（ 図1Cおよび1D）の裏返し外頸静脈カフ構造体との間の段差3.2とファッション同じ吻合を。 </li><li>まず静脈微小血管クランプ（外頸静脈クランプ）を削除し、動脈クランプ（総頸動脈クランプ）をリリース。動脈再灌流の間に、任意の出血に対処するための同種移植片の全体を検査します。出血が可視化される場合、血液の損失を最小限に抑え、バイポーラ電気メスを使用して、出血の原因を軽減するために、動脈クランプを再適用します。 </li><li>グラフトを点検し、止血を確認してください。リリースと完全に動脈微小血管クランプを取り外します。心腔の急激な体積膨張と瞬時に明らかになるであろう、再灌流の徴候を示し、aとbを待つために心を守って0.5から1分以内に開始するために食べます。心を潤すために温かい生理食塩水（35度摂氏）を使用します。 </li><li>吻合上のねじれや張力を誘発しないように、解剖学的位置に胸壁ドレープ。 6-0連続ナイロン縫合糸（ 図1E）を使用している手術創の皮膚を閉じます。 </li></ol> 4.術後ケア<ol><li>水分補給のためにすぐに手術後に0.3ミリリットルの生理食塩水を腹腔内の流体ボーラスを管理します。 </li><li>そして皮下にそれぞれ、痛みや感染症予防のためにブプレノルフィン（0.1mg / kg）およびエンロフロキサシン（5mgの/キログラム）を注入します。 </li><li>麻酔から覚めるまで加熱ランプの下で動物を置き、胸骨横臥に戻ります。リカバリ時には、適切な同種移植灌流を確保する同種移植のフィブリル化ハートビートを視覚化するために、首を点検。 </li><li>目を覚ましや臥位で一度、他のマウスの会社なし（別のケージにマウスを返します）それは、食物および水を自由に受け取ることができる場所。 、右上肢の一時的なマイナー限定的運動に、ケージの床の上にゼラチン食料源を残します。 </li><li>術後1時間レシピエントマウスを観察し、それが食物と水を自由に摂取を受け取ることができますし、活動や栄養摂取のための最初の24時間1日3回検査してケージ施設にそれを返します。最初の72時間の必要に応じて、一日2回皮下痛みと苦痛とブプレノルフィン（0.1mg / kg）で再用量の兆候がマウスを監視します。その後毎日動物を調べ、毎週、それらの重量を量ります。 </li><li>任意のマウスは、痛み、苦痛の徴候を表示したり、飼料摂取量を減少させた場合には獣医スタッフに相談してください。早期の安楽死を考えてみましょう（私たちのプロトコルで安楽死法は、頸椎脱臼に続いて、7分間のCO 2過剰摂取を採用）。 </li><li>同種移植心拍の停止はsにマウスを促す特定のエンドポイントとして定義されていますacrificed。 </li></ol>

The authors do not have any conflicts of interest or financial disclosures to declare.

含まれる同種移植の免疫学的調査に要因が、急性および慢性拒絶反応、直接的および間接的な抗原提示、受信者の感作、または混合キメラの誘導のメカニズムに限定されるものではない現象の多くがあります。19動物モデルはなってきました移植免疫学の研究のためのゴールドスタンダード、およびマウスモデルは、一般に、その低い相対獣医や住宅需要の減少、コスト、トランスジ...

Cardiac transplantation is the treatment of choice for end-stage heart failure. Both technical advancements and pharmacological innovations have propelled the field to early graft acceptance rates above 90%.12,13 Despite this, 60-80% 5-year graft survival is at a standstill and chronic rejection, characterized by transplant vasculopathy, remains inevitable.14-16 Furthermore, patients are subjected to multiple surgical procedures and lifelong immunosuppression, which are associated with chest wall deformities and medical sequelae and toxicities, respectively. The need for innovative approaches to extend allograft survival, minimize the immunosuppressive requirements, and offer reconstructive options for anatomical deformities is pressing.
Vascularized composite allotransplantation offers a unique strategy for improving heart transplant outcomes both from an immunological aspect as well as a reconstructive perspective.17 Vascularized composite allografts are also unique in a way that they have an inherent source of donor-derived hematopoietic stem cells which has shown a favorable ability to reduce immunosuppression and induce and sustain mixed chimerism.1-8 Additionally, co-transplantation of the thymus has shown to prolong survival of both, solid organ transplants and vascularized composite allografts.2,9-11 Combining these strategies with heart transplantation offers a novel solution to the aforementioned challenges facing heart transplantation.18
Murine models serve as excellent platforms for mechanistic in vivo investigation because of the availability of antibodies and well-defined inbred and knockout strains.19-21 Although heart transplantation in mice is commonly studied using a heterotopic intraabdominal microsurgical suture transplant model22-25, a heterotopic, cervical, non-suture cuff technique model has shown to be extremely replicable, reliable, and carries fewer rates of thrombosis.19,26,27 The goal of this study is to develop a heterotopic en bloc osteomyocutaneous chest wall, thymus, and heart transplant technique in mice to study the immunological mechanisms of combined solid organ and vascularized composite allotransplantation using a cervical non-suture cuff technique. This cluster allograft is perfused through the anastomosis of the donor descending aorta to the right common carotid artery and the donor pulmonary artery to the right external jugular vein. Preservation of the internal thoracic vessels and associated thymus branches is paramount to perfusing the chest wall (sternum, ribs, muscles, and skin) and thymus.

<table><tbody><tr><td>Euro-Collins Solution</td><td></td><td></td><td>The solution is not commercially purchased but rather prepared in the laboratory. To make a 500 ml solution add the ingredient listed below to a 330 ml of double distilled water. Mix well, and then fill in the rest of the 170 ml of double distilled water into the solution to a final volume of 500 ml.&lt;br/&gt; Ingredients: 1.02 g KH&lt;sub&gt;2&lt;/sub&gt;PO&lt;sub&gt;4&lt;/sub&gt;, 3.66 g K&lt;sub&gt;2&lt;/sub&gt;HPO&lt;sub&gt;4&lt;/sub&gt;, 0.56 g KCl, 0.42 g NaHCO&lt;sub&gt;3&lt;/sub&gt;, and 17.52 g of glucose.</td></tr><tr><td>Suture</td><td>Ethilon</td><td>MWI 72667</td><td>6-0 Ethilon


https://www.mwivet.com (MWI - Veterinary Supplies)</td></tr><tr><td>Polyimide Cuff Vein (21G)</td><td>Vention Medical</td><td>141-0043</td><td>http://www.ventionmedical.com/products-and-services/polyimide-tubing/</td></tr><tr><td>Polyimide Cuff Artery (24G)</td><td>Vention Medical</td><td>141-0027</td><td>http://www.ventionmedical.com/products-and-services/polyimide-tubing/</td></tr><tr><td>Soft plastic tip catheter</td><td>Terumo</td><td>SR*OX2419CA</td><td>24G x 3/4&quot;&amp;nbsp;</td></tr><tr><td>Microsurgical dilator</td><td>S&amp;amp;T</td><td>D-5a.1</td><td>Dilator, 11 cm, FH, 0.1 mm AT10d</td></tr></tbody></table>

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.

長期生存を達成した同系のC57BL / 6移植。同種移植片の設計（ 図1）は、動物の生存の観点および進行中の同種移植片の生存を評価する能力の成功であることが判明しました。これは、実行可能な、アクティブな継続的な同種移植毛の成長を残りの上を覆う皮膚を介して実証された、およびハートビートは、視覚化と指触診で評価することができました。生存データは、同系移植さ...

Watch this Scientific Journal Video about A Novel Microsurgical Model for Heterotopic, En Bloc Chest Wall, Thymus, and Heart Transplantation in Mice at JoVE.com

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

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.

マウスにおける異所のための新しい顕微モデル、エン圏胸壁、胸腺、および心臓移植

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

a-novel-microsurgical-model-for-heterotopic-en-bloc-chest-wall-thymus

Research

JoVE Journal

Medicine

9.2K ビュー.  Johns Hopkins University School of Medicine. 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.

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

Heterotopic Heart Transplantation in Mice

The mouse heterotopic heart transplantation has been used widely since it was introduced by Drs. Corry and Russell in 1973. It is particularly valuable for studying rejection and immune response now that newer transgenic and gene knockout mice are available, and a large number of immunologic reagents have been developed. The heart transplant model is less stringent than the skin transplant models, although technically more challenging. We have developed a modified technique and have completed over 1000 successful cases of heterotopic heart transplantation in mice. When making anastomosis of the ascending aorta and abdominal aorta, two stay sutures are placed at the proximal and distal apexes of recipient abdominal aorta with the donor s ascending aorta, then using 11-0 suture for anastomosis on both side of aorta with continuing sutures. The stay sutures make the anastomosis easier and 11-0 is an ideal suture size to avoid bleeding and thrombosis.
When making anastomosis of pulmonary artery and inferior vena cava, two stay sutures are made at the proximal apex and distal apex of the recipient s inferior vena cava with the donor s pulmonary artery. The left wall of the inferior vena cava and donor s pulmonary artery is closed with continuing sutures in the inside of the inferior vena cava after, one knot with the proximal apex stay suture the right wall of the inferior vena cava and the donor s pulmonary artery are closed with continuing sutures outside the inferior vena cave with 10-0 sutures. This method is easier to perform because anastomosis is made just on the one side of the inferior vena cava and 10-0 sutures is the right size to avoid bleeding and thrombosis. In this article, we provide details of the technique to supplement the video.

The mouse heterotopic heart transplantation model has been proven by many investigators to be an important method for studying mechanisms of rejection and immune response. However, the techniques involved are still challenging. By modifying standard techniques we have had success with more than 1000 transplants.

マウスにおける異所心臓移植

The mouse heterotopic heart transplantation has been used widely since it was introduced by Drs. Corry and Russell in 1973. It is particularly valuable ...

生物学

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.

変更されたカフ法を用いたマウス子宮頸心臓移植モデル

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

医学

A Modified Method for Heterotopic Mouse Heart Transplantion

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 available. A difficulty is presented due to the small size of the animal and the considerable technical challenges of the microsurgery involved in heart transplantation. In particular, a high rate of technical failure early after transplantation may result from recipient death and post-operative complications such as hind limb paralysis or a non-beating heart. Here, the complete technique for heterotopic mouse heart transplantation is demonstrated, involving harvesting the donor heart and its subsequent implantation into a recipient mouse. The donor heart is harvested immediately following in situ perfusion with cold heparinized saline and transection of the ascending aorta and pulmonary artery. The recipient operation involves preparation of the abdominal aorta and inferior vena cava (IVC), followed by end-to-side anastomosis of the donor aorta with the recipient aorta using a single running 10-0 microsuture and a similar anastomosis of the donor pulmonary artery with the recipient IVC. Following the operation the animal is injected with 0.6 ml normal saline subcutaneously and allowed to recover on a 37&#160;&#176;C heating pad. The results from 227 mouse heart transplants are summarized with a success rate at 48 hr of 86.8%. Of the 13.2% failures within 48 hr, 5 (2.2%) experienced hind limb paralysis, 10 (4.4%) had a non-beating heart due to graft ischemic injury and/or thrombosis, while 15 (6.6%) died within 48 hr.

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.

異マウスハートTransplantion用に変更する方法

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 ...

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.

ネズミ異心臓移植技術

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 ...

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.

マウスにおける異子宮頸心臓移植

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

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 improve surgical efficiency. In our lab, we have optimized the cuff technique with two major steps. First, we used the inner tube technique to insert a temporary inner tube into the external jugular vein and carotid artery blood vessel to facilitate eversion of the vessel over the cuff. Second, we performed complete heterotopic cardiac transplantation through the collaboration of two experienced surgeons. These modifications effectively reduced the operation time to 25 minutes, with a success rate of 95%. In this report, we describe these procedures in detail and provide a supplemental video. We believe that this report on the improved cuff technique will offer practical guidance for murine heterotopic heart transplantation and will enhance the utility of this mouse model for basic research.

We introduce an inner tube approach to the cuff technique for mouse cervical heterotopic heart transplantation to help evert the vessel over the cuff. We found that cooperation between two experienced surgeons markedly shortens the operation time.

マウスの心臓移植のためのカフ技術の最適化

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

免疫・感染学

A Pre-Clinical Porcine Model of Orthotopic Heart Transplantation

Fifty-years following the first successful report, cardiac transplantation remains the gold-standard treatment for eligible patients with advanced heart failure. Multiple small-animal models of heart transplantation have been used to study the acute and long-term effects of novel therapies. However, few are tested and demonstrated success in clinical trials. It is of critical importance to evaluate new therapies in a clinically relevant large-animal model for efficient and reliable translation of basic studies&#39;&#160;findings. Here, we describe a pre-clinical large-animal (porcine) model of orthotopic heart transplantation that has been firmly established and previously used to investigate novel cardioprotective strategies. This procedure focuses on acute ischemia-reperfusion injury and is a reliable method to investigate novel interventions which have been tested and validated in smaller experimental models, such as the murine model. We demonstrate its usefulness in assessing cardiac performance during the early post-transplantation period and other potential possibilities enabled by the model.

Here, we describe a pre-clinical large-animal (porcine) model of orthotopic heart transplantation that has been firmly established and utilized to investigate novel cardioprotective strategies.

オルソトピック心臓移植の前臨床ブタモデル

Fifty-years following the first successful report, cardiac transplantation remains the gold-standard treatment for eligible patients with advanced heart ...

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.

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.

血管カフを用いたマウスヘテロトピック頸部心臓移植

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

Blood Circuit Reconstruction in an Abdominal Mouse Heart Transplantation Model

The surgical technique of heterotopic abdominal heart transplantation in mice is a standard model for research in transplantation immunology. Here, the established technique for a modified blood circuit reconstruction in a heterotopic abdominal heart transplantation model is presented. This method uses the intrathoracic inferior vena cava (IIVC) instead of the pulmonary artery of the donor heart for the anastomosis to the inferior vena cava of the recipient. It is facilitating and improving success rates for abdominal heart transplantation in mice.

A novel technique for blood circuit reconstruction in a heterotopic abdominal mouse heart transplantation model is demonstrated.

腹部マウス心臓移植モデルにおける血液回路再建

The surgical technique of heterotopic abdominal heart transplantation in mice is a standard model for research in transplantation immunology. Here, the ...

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.

マウス頸部異所性心臓移植モデルのための修正カフ法

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