The authors wish to thank FORTE Project, funded by Tuscany Region (POR CReO FESR 2007-2013, Bando Unico R&#38;S 2012), the EU FP7 ECHORD++ Experiment LA-ROSES that partially supported the research activities, and the FP7 BiophotonicPlus Project &#8220;LITE&#8221; granted by Tuscany Region.

The study was conducted with the prospectively approval of the hospital&#8217;s Ethics Committee; informed consent was obtained. The study was in adherence to the tenets of the Declaration of Helsinki.
1. Donor Endothelium Preparation
<ol>
	<li>Use a donor cornea as prepared by the local eye bank at room temperature.</li>
	<li>In the surgery room, pull out the donor cornea from its delivery container and set apart the solution for tissue preservation and nutrition that is used for corneal transport.</li>
	<li>Place the donor corneo-scleral rim over an artificial anterior chamber, into which a liquid can flow and create a variable pressure; cover the cornea with the tissue retaining head.</li>
	<li>Connect the artificial anterior chamber (AAC) through a 3-way connector to a syringe filled with the cornea preservation and nutrition liquid.</li>
	<li>Use the compression ring to hold the retainer securely in place.</li>
	<li>Use the syringe connected to the AAC to maintain the intracameral pressure: fill the anterior chamber with the tissue preservation solution until reaching the optimal pressure (see 1.7). Close the connector.</li>
	<li>Test the pressure inside the anterior chamber with a finger. Change the inside pressure until reaching the right internal pressure (in the range 60&#8211;70 mmHg). Close the 3-way connector.</li>
	<li>Measure the thickness of the donor cornea with Optical Coherence Thomography (OCT). Maintain the anterior chamber with that cornea in a fixed position in front of the instrument optics and then take a full thickness-OCT acquisition.</li>
</ol>
2. Femtosecond Laser Preparation of Donor Endothelium
<ol>
	<li>Perform applanation of the donor cornea under the femtosecond laser device. Use the femtosec laser to cut the donor tissue with three subsequent cuts: posterior side cut, full lamellar and anterior side cut. Set the following parameters for the three cuts.
	<ol>
		<li>For the full lamellar cut (raster pattern, start out), set the cut depth corresponding to the thinnest point of the donor cornea (measured with the OCT as described in 1.8), always subtracting 95 &#181;m. Set the pulse energy in the range 0.8-0.9 &#181;J (depending on the working depth). Set the diameter to 8.7 mm. Set the tangential spot separation to 2 &#181;m. Set the radial spot separation to 2 &#181;m.</li>
		<li>For the anterior side cut, set the posterior depth 30 &#181;m deeper than the previous full lamellar cut. Set the pulse energy to 2.10 &#181;J; the diameter to 8.6 mm; the spot separation to 3 &#181;m, while the layer separation to 3 &#181;m.</li>
		<li>For the posterior side cut, locate the anterior depth of the posterior side cut 30 &#181;m anteriorly than full lamellar cut. Set the posterior depth to 900 &#181;m. Set the pulse energy to 2.10 &#181;J; the diameter to 8.3 mm; the spot separation to 2 &#181;m; the layer separation to 2 &#181;m.</li>
	</ol>
	</li>
</ol>
3. Recipient Eye Preparation
<ol>
	<li>Prepare the patient for surgery. Make one 4.00 mm corneal incision at 12 o&#39;clock with a 4.0 mm precalibrated blade. Make one limbal paracentesis with a 1.2 mm precalibrated blade, placed at 2 o&#39;clock. Make another one limbal paracentesis at 6 o&#39;clock with a 30&#176; stab knife.</li>
	<li>Insert an anterior chamber maintainer in the patient&#8217;s anterior chamber, through the 2 o&#39;clock paracentesis.</li>
	<li>Perform one 8.2 mm diameter circular descemetorexis with the dedicated hook.</li>
	<li>Strip the Descemet membrane and endothelium from the posterior stroma and remove the tissues with a Descemet hook.</li>
</ol>
4. Chromophore Preparation
<ol>
	<li>Put 1 mg of Indocyanine Green powder in a 1.5 ml microcentrifuge tube.</li>
	<li>Add 9 mg of sterile water (the ICG water solution is 10% w/w).</li>
	<li>Manually mix the ICG powder and the water with a metal stirrer.</li>
</ol>
5. Staining of Donor Endothelium
<ol>
	<li>Put the donor endothelium onto the wider part of a Busin-injector, with the inner side in contact with the injector surface.</li>
	<li>Stain the inner side of donor endothelium with the chromophore solution, in its peripheral part, using a spatula. The correctly stained tissue has a homogeneous greenish color. Wait 3 min before starting step 5.3.</li>
	<li>Pull the donor endothelium on the anterior part of the Busin-injector, rolled.</li>
</ol>
6. Inserting the Donor Endothelium
<ol>
	<li>Grasp and insert the folded donor endothelium using an atraumatic coaxial forceps for endothelial lenticule.</li>
	<li>Remove the anterior chamber maintainer.</li>
	<li>Suture the corneal incision and the paracentesis (performed in step 3.1) with a Nylon 10.0 single stich.</li>
	<li>Inject an air bubble to unfold the donor tissue and to press it against the recipient cornea. The air bubble must completely fill the anterior chamber space.</li>
</ol>
7. Laser Welding
<ol>
	<li>Place the donor lenticule in the center of the recipient cornea, from inside with a hook or moving the air-bubble from the outside of the cornea with a spatula.</li>
	<li>Use a diode laser emitting at 810 nm, equipped with a 300 &#181;m core diameter sterile fiber optic, with 0.22 as a numerical aperture (NA).</li>
	<li>Keep the fiber tip outside the eyeball, and deliver the laser light towards the stained endothelium, through the transparent corneal tissue. The fiber tip is in non-contact configuration.</li>
	<li>Use the following settings for the laser: single spot emission mode, 70&#8211;80 msec pulse duration, 35&#8211;40 mJ per pulse. He-Ne aiming beam on.</li>
	<li>Deliver single laser spots at the stained periphery of the donor endothelium. Deliver the spots sequentially: the final aspect is a ring of spots in the periphery of the donor lenticule. The distance between two adjacent spots center is the double of a spot diameter.</li>
	<li>Apply a contact lens on the patient eye, along with 0.3% tobramycin and 0.1% dexamethasone ophthalmic suspension.</li>
</ol>

<ol>
	<li>Tan, D. T., Dart, J. K., Holland, E. J., Kinoshita, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Corneal+transplantation.">Corneal transplantation.</a> Lancet. 379 (9827), 1749-1761 (2012).</li><li>El Husseiny, M. A., Manero, F., Gris, O., Elies, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Historical+Review+and+Update+of+Surgical+Treatment+for+Corneal+Endothelial+Diseases.">Historical Review and Update of Surgical Treatment for Corneal Endothelial Diseases.</a> Ophthalmol Ther. , (2014).</li><li>Rossi, 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=Laser+tissue+welding+in+ophthalmic+surgery.">Laser tissue welding in ophthalmic surgery.</a> J Biophotonics. 1 (4), 331-342 (2008).</li><li>Pini, 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=Combining+femtosecond+laser+ablation+and+diode+laser+welding+in+lamellar+and+endothelial+corneal+transplants.">Combining femtosecond laser ablation and diode laser welding in lamellar and endothelial corneal transplants.</a> Proc. SPIE Ophthalmic Technologies XVIII. 6 (844), 684411-1-684411-7 (2008).</li><li>Rossi, 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=All-laser'+endothelial+corneal+transplant+in+human+patients.">All-laser' endothelial corneal transplant in human patients.</a> Proc. SPIE Ophthalmic Technologies XXII. 8209, 82091O-1-82091O-3 (2012).</li><li>Rossi, F., Pini, R., Menabuoni, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Experimental+and+model+analysis+on+the+temperature+dynamics+during+diode+laser+welding+of+the+cornea.">Experimental and model analysis on the temperature dynamics during diode laser welding of the cornea.</a> J Biomed Opt. 12 (1), 014031-1-014031-7 (2007).</li><li>Menabuoni, 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=Laser-assisted+corneal+welding+in+cataract+surgery:+retrospective+study.">Laser-assisted corneal welding in cataract surgery: retrospective study.</a> J Cataract Refract Surg. 33 (9), 1608-1612 (2007).</li><li>Buzzonetti, 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=Laser+Welding+in+Penetrating+Keratoplasty+and+Cataract+Surgery+in+Pediatric+Patients.+Early+Results.">Laser Welding in Penetrating Keratoplasty and Cataract Surgery in Pediatric Patients. Early Results.</a> J Cataract Refract Surg. 39 (12), 1829-1834 (2013).</li><li>Menabuoni, 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=The+'anvil'+profile+in+femtosecond+laser-assistedpenetrating+keratoplasty.">The 'anvil' profile in femtosecond laser-assistedpenetrating keratoplasty.</a> Acta Ophthalmol. 91 (6), e494-e495 (2013).</li><li>Canovetti, A., 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=Laser-assisted+penetrating+keratoplasty:+one+year&#8217;s+results+in+patients,+using+a+laser-welded+&#8220;anvil&#8221;-profiled+graft.">Laser-assisted penetrating keratoplasty: one year&#8217;s results in patients, using a laser-welded &#8220;anvil&#8221;-profiled graft.</a> Am J Ophthalmol. 158 (4), 664-670 (2014).</li></ol>

The authors declare that they have no competing financial interests.

The &#8220;all laser&#8221; endothelial transplant is an original approach to minimally invasive corneal transplantation.
All the procedures described within the protocol were performed in the surgery room, observing the hygienic and sterilization procedure that are common practices during surgeries, such as the use of sterilized gloves, gown, mask and cap. The ICG solution was prepared in the surgery room, soon before its application in staining the donor endothelium. The ICG powder, the wate...

In this work we present an original approach to endothelial keratoplasty, based on the use of a femtosecond laser to prepare donor tissue and a near infrared diode laser to weld it onto the recipient bed. Intraoperative measurement of the donor cornea is necessary to correctly design the donor tissue dimensions. Endothelial keratoplasty has been proposed in the recent years to replace penetrating keratoplasty in treating endothelial disease1,2. The main advantage of this technique is a faster visual recovery, with respect to penetrating keratoplasty, reduced anesthesia during surgery, a decreased risk of graft rejection and the preservation of eye integrity. The main risk factor is postoperative donor lenticule dislocation. The standard technique is performed by inserting the donor endothelium in its final position where it is maintained by the injection of an air bubble: no sutures are used because of the mechanical, biophysical and dimensional characteristics of the endothelium. Moreover, visual acuity recovery can be limited mainly because of a mismatch between donor and recipient tissues due to a thick tissue transplanted.
Here we present a procedure in performing endothelial keratoplasty that can overcome those main problems. The donor endothelium can be assured in its final position by the use of the laser welding technique. This is a controlled and localized photothermal process: it can be induced at the donor/recipient interface. It has been studied in the last ten years and proposed in penetrating keratoplasty and in the transplant of endothelium3-5. The near infrared light (wavelength: 810 nm) emitted by a low power diode laser is delivered towards the biological tissue at the wound site. The cornea is naturally transparent to this wavelength: in order to make this tissue to absorb the laser light, it is necessary to stain it with a chromophore. The proposed dye is a sterile saturated water solution of Indocyanine Green (ICG). We demonstrated that when corneal tissue is properly stained with this ICG preparation, it shows an absorption peak at 810 nm6. Moreover, ICG is widely used in clinical diagnostics and its safety has been already demonstrated in human subjects. The stained cornea absorbs the diode laser light energy and the main resulting effect is a controlled temperature rise at the welding site. No thermal effects are induced in the unstained tissues. The temperature enhancement induces reversible thermal denaturation in the stromal collagen, with an immediate closuring of the wound walls upon cooling. This laser welding effect was firstly demonstrated in cataract surgery7,8 and penetrating keratoplasty9,10. An optimized approach that we are presenting in this paper has been studied for application in endothelial keratoplasty.
In the proposed surgery, single laser spots (lasting tens of msec) are delivered to the tissue, resulting in a photothermal effect localized within the spot dimension (a few hundreds of &#181;m in diameter): the induced effect is a hard laser welding, consisting of a photocoagulation of the collagen confined at the donor/host interface. The result of the collagen denaturation at the welded site is a strong adhesion between the donor and host tissues, thus providing a suturing effect that is impossible to obtain with standard technique (stitches). The tissue regains his natural appearance in a short follow up (1 month) and the adhesion between donor/host tissues is improved by the welding provided in the very early stage of the healing phase.
To avoid the other main risk of the endothelial keratoplasty, i.e. the transplant of a thick donor tissue, intrasurgical optical coherence tomography (OCT) is used: a commercial device measures the thickness of donor cornea, so that a correct cut profile can be designed with the femtosec laser. The proposed &#8220;all laser&#8221; endothelial transplant thus seems to improve the clinical results of this minimally invasive surgery.

<table border="0" cellpadding="0" cellspacing="0">
	<tbody>
		<tr>
			<td>Indocyanine Green</td>
			<td>Pulsion Medical Systems, Germany</td>
			<td>ICG-PULSION (http://www.pulsion.com/international-english/perfusion/icg-pulsion/)</td>
			<td>Alternative product: IC-GREEN, Akorn&#160; Inc., Lake Forest, Illinois- US (http://www.icginjection.com/)</td>
		</tr>
		<tr>
			<td>Femtosecond Laser&#160;</td>
			<td>Abbott Medical Optics,&#160; Abbott Laboratories Inc. Abbott Park, Illinois, USA</td>
			<td>iFS150 (http://www.abbottmedicaloptics.com/products/refractive/ilasik/ifs-advanced-femtosecond-laser)</td>
			<td></td>
		</tr>
		<tr>
			<td>Optical Coherence Tomography (OCT)</td>
			<td>Carl-Zeiss Meditec, Dublin, California- US (http://www.zeiss.com/meditec/en_de/home.html)</td>
			<td>Visante</td>
			<td></td>
		</tr>
		<tr>
			<td>Diode Laser</td>
			<td>E.l.En. Group s.pa., Calenzano-FI, Italy (http://www.elengroup.com/en/divisions/medical)</td>
			<td>Mod. WELD 800</td>
			<td></td>
		</tr>
		<tr>
			<td>Artificial Anterior Chamber</td>
			<td>CORONET, corneal graft products. Network Medical Products Ltd. Coronet House, Kearsley Road, Ripon, North Yorkshire, HG4 2SG, UK</td>
			<td>&#160;Artificial Anterior Chamber (A.A.C.) with large and small tissue-retaining heads. Code 51-935 (http://www.networkmedical.co.uk/ophthalmic_artificial_anterior_chamber.html)</td>
			<td></td>
		</tr>
		<tr>
			<td>Solution for tissue preservation and nutrition&#160;&#160;</td>
			<td>&#160;AL.CHI.MI.A. Srl, Viale Austria 14, 35020 - Ponte S. Nicol&#242; - PD 
			&#160;ITALY</td>
			<td>Carry-C media for corneal deturgescence and transport at room temperature - 12 x 50 ml (http://www.alchimiasrl.com/en/organ-culture-at-31&#176;-c-eb/carry-c-eb)</td>
			<td></td>
		</tr>
	</tbody>
</table>

an &#8220;all-laser&#8221; endothelial transplant

The &#8220;all laser&#8221; assisted endothelial keratoplasty is a procedure that is performed with a femtosecond laser used to cut the donor tissue at an intended depth, and a near infrared diode laser to weld the corneal tissue. The proposed technique enables to reach the three main goals in endothelial keratoplasty: a precise control in the thickness of the donor tissue; its easy insertion in the recipient bed and a reduced risk of donor lenticule dislocation. The donor cornea thickness is measured in the surgery room with optical coherence tomography (OCT), in order to correctly design the donor tissue dimensions. A femtosecond laser is used to cut the donor cornea. The recipient eye is prepared by manual stripping of the descemetic membrane. The donor endothelium is inserted into a Busin-injector, the peripheral inner side is stained with a proper chromophore (a water solution of Indocyanine Green) and then it is pulled in the anterior chamber. The transplanted tissue is placed in the final and correct location and then diode laser welding is induced from outside the eyeball. The procedure has been performed on more than 15 patients evidencing an improvement in surgery performances, with a good recovery of visual acuity and a reduced donor lenticule dislocation event.

The &#8220;all laser&#8221; surgical procedure is proposed to perform minimally invasive corneal transplantation. The procedure is easy to perform (see Figure 1): with respect to a standard endothelial transplant only the steps of measuring the corneal thickness, staining the donor tissue and delivering the laser light are added. The achieved advantages largely compensate an increased surgical time of a few min. The use of intraoperative OCT to measure the donor cornea thickness and the femtosecond laser...

Watch this Scientific Journal Video about An Ã¢â‚¬Å“All-laserÃ¢â‚¬Â Endothelial Transplant at JoVE.com

An &#8220;All-laser&#8221; Endothelial Transplant

An all laser procedure is proposed in the endothelial transplant. The surgical technique is based on the use of a femtosecond laser to prepare the donor tissue. Laser welding technique is then used to secure the donor endothelium in the correct position.

The &#8220;all laser&#8221; assisted endothelial keratoplasty is a procedure that is performed with a femtosecond laser used to cut the donor tissue at an ...

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9.4K Views.  Italian National Research Council. An all laser procedure is proposed in the endothelial transplant. The surgical technique is based on the use of a femtosecond laser to prepare the donor tissue. Laser welding technique is then used to secure the donor endothelium in the correct position.

Video: An “All-laser” Endothelial Transplant

Using Quantitative Real-time PCR to Determine Donor Cell Engraftment in a Competitive Murine Bone Marrow Transplantation Model

Murine bone marrow transplantation models provide an important tool in measuring hematopoietic stem cell (HSC) functions and determining genes/molecules that regulate HSCs. In these transplant model systems, the function of HSCs is determined by the ability of these cells to engraft and reconstitute lethally irradiated recipient mice. Commonly, the donor cell contribution/engraftment is measured by antibodies to donor- specific cell surface proteins using flow cytometry. However, this method heavily depends on the specificity and the ability of the cell surface marker to differentiate donor-derived cells from recipient-originated cells, which may not be available for all mouse strains. Considering the various backgrounds of genetically modified mouse strains in the market, this cell surface/ flow cytometry-based method has significant limitations especially in mouse strains that lack well-defined surface markers to separate donor cells from congenic recipient cells. Here, we reported a PCR-based technique to determine donor cell engraftment/contribution in transplant recipient mice. We transplanted male donor bone marrow HSCs to lethally irradiated congenic female mice. Peripheral blood samples were collected at different time points post transplantation. Bone marrow samples were obtained at the end of the experiments. Genomic DNA was isolated and the Y chromosome specific gene, Zfy1, was amplified using quantitative Real time PCR. The engraftment of male donor-derived cells in the female recipient mice was calculated against standard curve with known percentage of male vs. female DNAs. Bcl2 was used as a reference gene to normalize the total DNA amount. Our data suggested that this approach reliably determines donor cell engraftment and provides a useful, yet simple method in measuring hematopoietic cell reconstitution in murine bone marrow transplantation models. Our method can be routinely performed in most laboratories because no costly equipment such as flow cytometry is required.

Determining donor cell engraftment presents a challenge in mouse bone marrow transplant models that lack well-defined phenotypical markers. We described a methodology to quantify male donor cell engraftment in female transplant recipient mice. This method can be used in all mouse strains for the study of HSC functions.

Murine bone marrow transplantation models provide an important tool in measuring hematopoietic stem cell (HSC) functions and determining genes/molecules ...

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.

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 ...

Technique of Porcine Liver Procurement and Orthotopic Transplantation using an Active Porto-Caval Shunt

The success of liver transplantation has resulted in a dramatic organ shortage. Each year, a considerable number of patients on the liver transplantation waiting list die without receiving an organ transplant or are delisted due to disease progression. Even after a successful transplantation, rejection and side effects of immunosuppression remain major concerns for graft survival and patient morbidity. 
Experimental animal research has been essential to the success of liver transplantation and still plays a pivotal role in the development of clinical transplantation practice. In particular, the porcine orthotopic liver transplantation model (OLTx) is optimal for clinically oriented research for its close resemblance to human size, anatomy, and physiology. 
Decompression of intestinal congestion during the anhepatic phase of porcine OLTx is important to guarantee reliable animal survival. The use of an active porto-caval-jugular shunt achieves excellent intestinal decompression. The system can be used for short-term as well as long-term survival experiments. The following protocol contains all technical information for a stable and reproducible liver transplantation model in pigs including post-operative animal care.

Experimental animal research plays a pivotal role in the development of clinical transplantation practice. The porcine orthotopic liver transplantation model (OLTx) closely resembles human conditions and is frequently used in clinically oriented research. The following protocol contains all information for a reliable porcine OLTx model using an active porto-caval-jugular shunt.

The success of liver transplantation has resulted in a dramatic organ shortage. Each year, a considerable number of patients on the liver transplantation ...

Mouse Model of Alloimmune-induced Vascular Rejection and Transplant Arteriosclerosis

Vascular rejection that leads to transplant arteriosclerosis (TA) is the leading representation of chronic heart transplant failure. In TA, the immune system of the recipient causes damage of the arterial wall and dysfunction of endothelial cells and smooth muscle cells. This triggers a pathological repair response that is characterized by intimal thickening and luminal occlusion. Understanding the mechanisms by which the immune system causes vasculature rejection and TA may inform the development of novel ways to manage graft failure. Here, we describe a mouse aortic interposition model that can be used to study the pathogenic mechanisms of vascular rejection and TA. The model involves grafting of an aortic segment from a donor animal into an allogeneic recipient. Rejection of the artery segment involves alloimmune reactions and results in arterial changes that resemble vascular rejection. The basic technical approach we describe can be used with different mouse strains and targeted interventions to answer specific questions related to vascular rejection and TA.

We describe a protocol for aortic interposition grafting in mice. The goal of the protocol is to provide a model with which to study pathological processes and therapeutic strategies relevant to alloimmune reactions in arteries and the resultant arterial changes that contribute to organ transplant failure.

Vascular rejection that leads to transplant arteriosclerosis (TA) is the leading representation of chronic heart transplant failure. In TA, the immune ...

Murine Kidney Transplant Technique

The first mouse kidney transplant technique was published in 19731 by the Russell laboratory. 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 using the donor aorta to form the arterial anastomosis instead of the renal artery was developed and reported in 1993 by Kalina and Mottram 2 with a further advancement coming from the same laboratory in 1999 3. While one can become proficient in this model, a search of the literature reveals that many labs still experience a high proportion of graft loss due to arterial thrombosis. We describe here a technique that was devised in our laboratory that vastly reduces the arterial thrombus reported by others 4,5. This is achieved by forming a heel-and-toe cuff of the donor infra-renal aorta that facilitates a larger anastomosis and straighter blood flow into the kidney.

The goal of this manuscript is to describe the steps required to perform a kidney transplant in a mouse, paying particular attention to the details of the arterial anastomosis.

The first mouse kidney transplant technique was published in 19731 by the Russell laboratory. Although it took some years for other labs to become ...

Balloon-based Injury to Induce Myointimal Hyperplasia in the Mouse Abdominal Aorta

The use of animal models is essential for a better understanding of MH, one major cause for arterial stenosis.In this article, we demonstrate a murine balloon denudation model, which is comparable with established vessel injury models in large animals. The aorta denudation model with balloon catheters mimics the clinical setting and leads to comparable pathobiological and physiological changes. Briefly, after performing a horizontal incision in the aorta abdominalis, a balloon catheter will be inserted into the vessel, inflated, and introduced retrogradely. Inflation of the balloon will lead to intima injury and overdistension of the vessel. After removing the catheter, the aortic incision will be closed with single stiches. The model shown in this article is reproducible, easy to perform, and can be established quickly and reliably. It is especially suitable for evaluating expensive experimental therapeutic agents, which can be applied in an economical fashion. By using different knockout-mouse strains, the impact of different genes on MH development can be assessed.

This article demonstrates a murine model to study the development of myointimal hyperplasia (MH) after aortic balloon injury.

The use of animal models is essential for a better understanding of MH, one major cause for arterial stenosis.In this article, we demonstrate a murine ...

Optimized Griess Reaction for UV-Vis and Naked-eye Determination of Anti-malarial Primaquine

Primaquine (PMQ), an important anti-malarial drug, has been recommended by the World Health Organization (WHO) for the treatment of life-threatening infections caused by P. vivax and ovale. However, PMQ has unwanted adverse effects that lead&#160;to acute hemolysis in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. There is a need to develop simple and reliable methods for PMQ determination with the purpose of dosage monitoring. In early 2019, we have reported an UV-Vis and naked-eye based approach for PMQ colorimetric quantification. The detection was based on a Griess-like reaction between PMQ and anilines, which can generate colored azo products. The detection limit for direct measurement of PMQ in synthetic urine is in the nanomolar range. Moreover, this method has shown great potential for PMQ quantification from human serum samples at clinically relevant concentrations. In this protocol, we will describe the technical details regarding the syntheses and characterization of colored azo products, the reagent preparation, and the procedures for PMQ determination.

This protocol describes a novel colorimetric method for antimalarial primaquine (PMQ) detection in synthetic urines and human serums.

Primaquine (PMQ), an important anti-malarial drug, has been recommended by the World Health Organization (WHO) for the treatment of life-threatening ...

Organ Ischemia-Reperfusion Injury by Simulating Hemodynamic Changes in Rat Liver Transplant Model

Orthotopic liver transplantation (OLT) in rats is a tried and proven animal model used for preoperative, intraoperative, and postoperative studies, including ischemia-reperfusion injury (IRI) of extrahepatic organs. This model requires numerous experiments and devices. The duration of anhepatic phase is closely related to the time to develop IRI after transplantation. In this experiment, we used hemodynamic changes to induce extrahepatic organ damage in rats and determined the maximum tolerance time. The time until the most severe organ injury varied for different organs. This method can easily be replicated and can also be used to study IRI of the extrahepatic organs after liver transplantation.

This paper provides a detailed description of how to build an animal model of the anhepatic phase (liver ischemia) in rats to facilitate basic research into ischemia-reperfusion injury after liver transplantation.

Orthotopic liver transplantation (OLT) in rats is a tried and proven animal model used for preoperative, intraoperative, and postoperative studies, ...

TBase - an Integrated Electronic Health Record and Research Database for Kidney Transplant Recipients

TBase is an electronic health record (EHR) for kidney transplant recipients (KTR) combining automated data entry of key clinical data (e.g., laboratory values, medical reports, radiology and pathology data) via standardized interfaces with manual data entry during routine treatment (e.g., clinical notes, medication list, and transplantation data). By this means, a comprehensive database for KTR is created with benefits for routine clinical care and research. It enables both easy everyday clinical use and quick access for research questions with highest data quality. This is achieved by the concept of data validation in clinical routine in which clinical users and patients have to rely on correct data for treatment and medication plans and thereby validate and correct the clinical data in their daily practice. This EHR is tailored for the needs of transplant outpatient care and proved its clinical utility for more than 20 years at Charit&#233; - Universit&#228;tsmedizin Berlin. It facilitates efficient routine work with well-structured, comprehensive long-term data and allows their easy use for clinical research. To this point, its functionality covers automated transmission of routine data via standardized interfaces from different hospital information systems, availability of transplant-specific data, a medication list with an integrated check for drug-drug interactions, and semi-automated generation of medical reports among others. Key elements of the latest reengineering are a robust privacy-by-design concept, modularity, and hence portability into other clinical contexts as well as usability and platform independence enabled by HTML5 (Hypertext Markup Language) based responsive web design. This allows fast and easy scalability into other disease areas and other university hospitals. The comprehensive long-term datasets are the basis for the investigation of Machine Learning algorithms, and the modular structure allows to rapidly implement these into clinical care. Patient reported data and telemedicine services are integrated into TBase in order to meet future needs of the patients. These novel features aim to improve clinical care as well as to create new research options and therapeutic interventions.

TBase combines an electronic health record with an innovative research database for kidney transplant recipients. TBase is built upon an in-memory database platform, connected to different hospital systems, and used for regular outpatient care. It automatically integrates all relevant clinical data including transplantation-specific data creating a unique research database.

TBase is an electronic health record (EHR) for kidney transplant recipients (KTR) combining automated data entry of key clinical data (e.g., laboratory ...

Endothelial Cell Transcytosis Assay as an In Vitro Model to Evaluate Inner Blood-Retinal Barrier Permeability

Dysfunction of the blood-retinal barrier (BRB) contributes to the pathophysiology of several vascular eye diseases, often resulting in retinal edema and subsequent vision loss. The inner blood-retinal barrier (iBRB) is mainly composed of retinal vascular endothelium with low permeability under physiological conditions. This feature of low permeability is tightly regulated and maintained by low rates of paracellular transport between adjacent retinal microvascular endothelial cells, as well as transcellular transport (transcytosis) through them. The assessment of retinal transcellular barrier permeability may provide fundamental insights into iBRB integrity in health and disease. In this study, we describe an endothelial cell (EC) transcytosis assay, as an in vitro model for evaluating iBRB permeability, using human retinal microvascular endothelial cells (HRMECs). This assay assesses the ability of HRMECs to transport transferrin and horseradish peroxidase (HRP) in receptor- and caveolae-mediated transcellular transport processes, respectively. Fully confluent HRMECs cultured on porous membrane were incubated with fluorescent-tagged transferrin (clathrin-dependent transcytosis) or HRP (caveolae-mediated transcytosis) to measure the levels of transferrin or HRP transferred to the bottom chamber, indicative of transcytosis levels across the EC monolayer. Wnt signaling, a known pathway regulating iBRB, was modulated to demonstrate the caveolae-mediated HRP-based transcytosis assay method. The EC transcytosis assay described here may provide a useful tool for investigating the molecular regulators of EC permeability and iBRB integrity in vascular pathologies and for screening drug delivery systems.

Endothelial Cell Transcytosis Assay as an In Vitro Model to Evaluate Inner Blood-Retinal Barrier Permeability

This protocol illustrates an in vitro endothelial cell transcytosis assay as a model to evaluate inner blood-retinal barrier permeability by measuring the ability of human retinal microvascular endothelial cells to transport horseradish peroxidase across cells in caveolae-mediated transcellular transport processes.

Dysfunction of the blood-retinal barrier (BRB) contributes to the pathophysiology of several vascular eye diseases, often resulting in retinal edema and ...