endothelin-1 and Primary-Graft-Dysfunction

Topics: Adult; Aged; Allografts; Biomarkers; Blood Flow Velocity; Diagnostic Imaging; End Stage Liver Disease; Endothelin-1; Female; Hemodynamics; Hepatic Artery; Humans; Liver; Liver Circulation; Liver Transplantation; Male; Microcirculation; Middle Aged; Portal Vein; Primary Graft Dysfunction; Reperfusion; Severity of Illness Index

Ischemia/reperfusion injury may have deleterious short- and long-term consequences for cardiac allografts. The underlying mechanisms involve microvascular dysfunction that may culminate in primary graft failure or untreatable chronic rejection.. Here, we report that rat cardiac allograft ischemia/reperfusion injury resulted in profound microvascular dysfunction that was prevented by donor treatment with peroral single-dose simvastatin, a 3-hydroxy-3-methylglutaryl coenzyme A reductase and Rho GTPase inhibitor, 2 hours before graft procurement. During allograft preservation, donor simvastatin treatment inhibited microvascular endothelial cell and pericyte RhoA/Rho-associated protein kinase activation and endothelial cell-endothelial cell gap formation; decreased intragraft mRNA levels of hypoxia-inducible factor-1α, inducible nitric oxide synthase, and endothelin-1; and increased heme oxygenase-1. Donor, but not recipient, simvastatin treatment prevented ischemia/reperfusion injury-induced vascular leakage, leukocyte infiltration, the no-reflow phenomenon, and myocardial injury. The beneficial effects of simvastatin on vascular stability and the no-reflow phenomenon were abolished by concomitant nitric oxide synthase inhibition with N-nitro-l-arginine methyl ester and RhoA activation by geranylgeranyl pyrophosphate supplementation, respectively. In the chronic rejection model, donor simvastatin treatment inhibited cardiac allograft inflammation, transforming growth factor-β1 signaling, and myocardial fibrosis. In vitro, simvastatin inhibited transforming growth factor-β1-induced microvascular endothelial-to-mesenchymal transition.. Our results demonstrate that donor simvastatin treatment prevents microvascular endothelial cell and pericyte dysfunction, ischemia/reperfusion injury, and chronic rejection and suggest a novel, clinically feasible strategy to protect cardiac allografts.

Topics: Animals; Endothelial Cells; Endothelin-1; Enzyme Inhibitors; Gap Junctions; Graft Rejection; Heart Transplantation; Heme Oxygenase-1; Hypoxia-Inducible Factor 1, alpha Subunit; Major Histocompatibility Complex; Male; Microvessels; NG-Nitroarginine Methyl Ester; Nitric Oxide Synthase Type II; No-Reflow Phenomenon; Polyisoprenyl Phosphates; Primary Graft Dysfunction; Rats; Rats, Inbred WF; Reperfusion Injury; rho-Associated Kinases; Simvastatin

Small-for-size liver grafts are a serious obstacle for partial orthotopic liver transplantation. Activated protein C (APC), a potent anticoagulant serine protease, is known to have cell-protective properties due to its anti-inflammatory and antiapoptotic activities. This study was designed to examine the cytoprotective effects of a preservation solution containing APC on small-for-size liver grafts, with special attention paid to ischemia-reperfusion injury and shear stress in rats. APC exerted cytoprotective effects, as evidenced by (1) increased 7-day graft survival; (2) decreased initial portal pressure and improved hepatic microcirculation; (3) decreased levels of aminotransferase and improved histological features of hepatic ischemia-reperfusion injury; (4) suppressed infiltration of neutrophils and monocytes/macrophages; (5) reduced hepatic expression of tumor necrosis factor alpha and interleukin 6; (6) decreased serum levels of hyaluronic acid, which indicated attenuation of sinusoidal endothelial cell injury; (7) increased hepatic levels of nitric oxide via up-regulated hepatic endothelial nitric oxide synthesis expression together with down-regulated hepatic inducible nitric oxide synthase expression; (8) decreased hepatic levels of endothelin 1; and (9) reduced hepatocellular apoptosis by down-regulated caspase-8 and caspase-3 activities. These results suggest that a preservation solution containing APC is a potential novel and safe product for small-for-size liver transplantation, alleviating graft injury via anti-inflammatory and antiapoptotic effects and vasorelaxing conditions.

Topics: Animals; Anticoagulants; Apoptosis; Endothelin-1; Graft Survival; Hepatitis; Interleukin-6; Liver; Liver Function Tests; Liver Transplantation; Macrophages; Male; Microcirculation; Neutrophil Infiltration; Nitric Oxide; Nitric Oxide Synthase Type II; Nitric Oxide Synthase Type III; Organ Preservation Solutions; Portal Pressure; Primary Graft Dysfunction; Protein C; Rats; Rats, Wistar; Tumor Necrosis Factor-alpha

Primary graft dysfunction (PGD) causes significant morbidity following lung transplantation (LTX). Mortality is high in PGD and therapeutic strategies are limited. To investigate whether endothelin-1 (ET-1) that mediates increased vascular permeability and edema formation in lung grafts can predict PGD, ET-1 mRNA expression was examined in lung tissue biopsies of 105 donors and recipients obtained shortly before LTX. Serum ET-1 concentration was assessed by ELISA. PGD grade was diagnosed and scored by oxygenation and radiological characteristics according to ISHLT guidelines. PGD grade 3 developed in 11% of patients. ET-1 mRNA expression was significantly increased in both donor (p < 0.0001) and recipient (p = 0.01) developing PGD as compared to no PGD group. Pretransplant ET-1 serum concentrations were elevated in recipients with PGD as compared to no PGD group (p < 0.0001), although serum ET-1 was not different between donors whose grafts developed PGD grades 0-3. In regression analysis, concomitant elevated donor tissue ET-1 and recipient serum ET-1 predicted PGD grade 3. This study indicates that pretransplant ET-1 mRNA overexpression in donors associated with elevated pretransplant serum ET-1 in recipients contribute to PGD development and that their assessment might be beneficial to predict PGD and to identify recipients who could benefit from a targeted ET-1 blockade.

Topics: Adult; Endothelin-1; Enzyme-Linked Immunosorbent Assay; Female; Humans; Lung Transplantation; Male; Middle Aged; Primary Graft Dysfunction; Prospective Studies; Regression Analysis; Reverse Transcriptase Polymerase Chain Reaction; RNA, Messenger; Tissue Donors; Treatment Outcome