Practical guidelines: Lung transplantation in patients with cystic fibrosis

There are no European recommendations on issues specifically related to lung transplantation (LTX) in cystic fibrosis (CF). The main goal of this paper is to provide CF care team members with clinically relevant CF-specific information on all aspects of LTX, highlighting areas of consensus and controversy throughout Europe. Bilateral lung transplantation has been shown to be an important therapeutic option for end-stage CF pulmonary disease. Transplant function and patient survival after transplantation are better than in most other indications for this procedure. Attention though has to be paid to pretransplant morbidity, time for referral, evaluation, indication, and contraindication in children and in adults. This review makes extensive use of specific evidence in the field of lung transplantation in CF patients and addresses all issues of practical importance. The requirements of pre-, peri-, and postoperative management are discussed in detail including bridging to transplant and postoperative complications, immune suppression, chronic allograft dysfunction, infection, and malignancies being the most important. Among the contributors to this guiding information are 19 members of the ECORN-CF project and other experts. The document is endorsed by the European Cystic Fibrosis Society and sponsored by the Christiane Herzog Foundation. 

siRNA Technology in Kidney Transplantation: Current Status and Future Potential

Kidney transplantation is one of the most common transplantation operations in the world, accounting for up to 50 % of all transplantation surgeries. To curtail the damage to transplanted organs that is caused by ischemia-reperfusion injury and the recipient's immune system, small interfering RNA (siRNA) technology is being explored. Importantly, the kidney as a whole is a preferential site for non-specific systemic delivery of siRNA. To date, most attempts at siRNA-based therapy for transplantation-related conditions have remained at the in vitro stage, with only a few of them being advanced into animal models. Hydrodynamic intravenous injection of naked or carrier-bound siRNAs is currently the most common route for delivery of therapeutic constructs. To our knowledge, no systematic screens for siRNA targets most relevant for kidney transplantation have been attempted so far. A majority of researchers have arrived at one or another target of interest by analyzing current literature that dissects pathological processes taking place in transplanted organs. A majority of the genes that make up the list of 53 siRNA targets that have been tested in transplantation-related models so far belong to either apoptosis- or immune rejection-centered networks. There is an opportunity for therapeutic siRNA combinations that may be delivered within the same delivery vector or injected at the same time and, by targeting more than one pathway, or by hitting the same pathways within two different key points, will augment the effects of each other.

Renal transplantation following aorto-iliac reconstruction is a safe a strategy

Introduction: Renal transplantation is considered the treatment of choice for end-stage renal disease. However, the association of occlusive aorto-iliac disease and chronic renal failure is frequent and aorto-iliac reconstruction may be necessary prior to renal transplantation. This retrospective study reviews the results of this operative strategy.Material and Methods: Between January 2001 and June 2010, 309 patients underwent renal transplantation at our institution and 8 patients had prior aorto-iliac reconstruction using prosthetic material. There were 6 men and 2 women with a median age of 62 years (range 51-70). Five aorto-bifemoral and 2 aorto-bi-iliac bypasses were performed for stage II (n=5), stage IV (n=1) and aortic aneurysm (n=1). In one patient, iliac kissing stents and an ilio-femoral bypass were implanted. 4 cadaveric and 4 living donor renal transplantations were performed with an interval of 2 months to 10 years after revascularization.The results were analysed with respect of graft and patients survival. Differences between groups were tested by the log rank method.Results: No complications and no death occurred in the post-operative period. All bypasses remained patent during follow-up. The median time of post transplantation follow-up was 46 months for all patients and 27 months for patients with prior revascularization. In the revascularized group and control group, the graft and patient survival at 1 year were respectively 100%/96%, 100%/99% and at 5 years 86%/86%, 86%/94%, without significant differences between both groups.Discussion: Our results suggest that renal transplantation following prior aorto-iliac revascularisation with prosthetic material is safe and effective. Patients with end-stage renal disease and concomitant aorto-iliac disease should therefore be considered for renal transplantation. However, caution in the interpretation of the results is indicated due to the small sample size of our study.

Heart transplantation: current practice and outlook to the future.

QUESTIONS UNDER STUDY: The field of heart transplantation has seen substantial progress in the last 40 years. The breakthroughs in long-term survival were followed by a period of stagnation in the last decade. This review summarises current recommendations for the identification of candidates for heart transplantation and their immunological and non-immunological postoperative follow-up. RESULTS: The progress made in the treatment of patients with advanced heart failure has considerably changed the profile of candidates for heart transplantation. Patients are older, and the load of co-morbidities is more important requiring careful evaluation for candidacy. Long-standing research in the field of immunosuppression made available various drugs, which decrease the risk of acute allograft rejection and prolong survival after heart transplantation. Powerful new molecules are entering early phase clinical studies, suggesting further improvement in the near future. As a consequence, treatment of non-immunological co-morbidity after heart transplantation will gain in importance, however, the base of evidence guiding current recommendations is poor. CONCLUSIONS: The substantial progress in heart failure treatment and immunosuppression after heart transplantation has changed the profile of heart transplant recipients. The arrival of new molecules will provide additional alternatives for immunosuppressive treatment while studies have to address non-immunological treatment in order to improve long-term survival after heart transplantation.

Biocompatibilité des microcapsules d'alginate : purification d'alginate, réaction immunitaire de l'hôte et protection du receveur

L’immuno-isolation des îlots de Langerhans est proposée comme moyen d’effectuer des transplantations sans prise d’immunosuppresseurs par le patient. Cette immuno-isolation, par l’entremise d’une microcapsule composée d’alginate et de poly-L-lysine (microcapsule APA), protège le greffon d’une éventuelle attaque du système immunitaire du receveur grâce à sa membrane semi-perméable. Cette membrane empêche le système immunitaire du receveur de pénétrer la microcapsule tout en laissant diffuser librement les nutriments, le glucose et l’insuline. Avant l’application de cette technique chez l’humain, quelques défis doivent encore être relevés, dont la biocompatibilité de ce système. La biocompatibilité fait ici référence à la biocompatibilité du biomatériau utilisé pour la fabrication des microcapsules, l’alginate, mais aussi la biocompatibilité des microcapsules reliée à leur stabilité. En effet, il a été remarqué que, lors d’implantation in vivo de microcapsules fabriquées avec de l’alginate non purifiée, ceci induisait un phénomène nommé Réaction de l’Hôte contre la Microcapsule (RHM). De plus, il est connu que la stabilité des microcapsules APA peut influencer leur biocompatibilité puisqu’une microcapsule endommagée ou brisée pourrait laisser s’échapper les cellules du greffon chez le receveur. Nous croyons qu’une compréhension des processus d’initiation de la RHM en fonction de l’efficacité des procédés de purification d’alginate (et donc des quantités de contaminants présents dans l’alginate) ainsi que l’augmentation de la stabilité des microcapsules APA pourront améliorer la biocompatibilité de ce dispositif, ce que tente de démontrer les résultats présentés dans cette thèse. En effet, les résultats obtenus suggèrent que les protéines qui contaminent l’alginate jouent un rôle clé dans l’initiation de la RHM et qu’en diminuant ces quantités de protéines par l’amélioration des procédés de purification d’alginate, on améliore la biocompatibilité de l’alginate. Afin d’augmenter la stabilité des microcapsules APA, nous décrivons une nouvelle technique de fabrication des microcapsules qui implique la présence de liaisons covalentes. Ces nouvelles microcapsules APA réticulées sont très résistantes, n’affectent pas de façon négative la survie des cellules encapsulées et confinent les cellules du greffon à l’intérieur des microcapsules. Cette dernière caractéristique nous permet donc d’augmenter la biocompatibilité des microcapsules APA en protégeant le receveur contre les cellules du greffon.

Impact de l’évolution du statut nutritionnel durant l’attente d’une transplantation pulmonaire sur la mortalité postopératoire

Cette étude vise à évaluer l’impact de l’état nutritionnel et de son évolution durant l’attente d’une transplantation pulmonaire sur la mortalité et la morbidité postopératoire. Nous avons examiné les 209 dossiers de patients greffés pulmonaires au Programme de Transplantation Pulmonaire du CHUM entre 2000 et 2007 et regardé la mortalité et les complications post-transplantation en fonction de l’IMC, des apports protéino-énergétiques, de certains paramètres biochimiques et selon l’évolution pondérale durant la période d’attente. Les résultats montrent que la mortalité augmente en fonction de l’augmentation des strates d’IMC avec un risque relatif de décès au cours du séjour hospitalier de 3,31 (IC95% 1,19-9,26) pour un IMC 25-29,9 et de 8,83 (IC95% 2,98-26,18) pour un IMC ≥ 30 avec une issue postopératoire plus sombre en terme de complications chirurgicales (p=0,003), de durée de séjour aux soins intensifs (p=0,031) et de durée de séjour à l’hôpital (p<0,001) chez les patients avec IMC ≥ 30 comparativement aux patients de poids normal. Les patients ayant présenté une évolution inadéquate de l’IMC durant la période d’attente ont connu une durée de séjour hospitalier prolongée (p=0,015). Ceux dont les apports nutritionnels étaient sous-optimaux en pré-greffe ont aussi connu une durée de séjour hospitalier prolongée (p=0,002) et davantage de complications infectieuses (p=0,038), digestives (p=0,003) et chirurgicales (p=0,029) mais sans impact détectable sur la mortalité. Nos résultats suggèrent que l’obésité et l’embonpoint ainsi qu’une évolution inadéquate de l’IMC durant la période d’attente de même que des apports protéino-énergétiques sous-optimaux affectent négativement l’issue d’une transplantation pulmonaire.

Caractérisation de l’ubiquitin-fold modifier (UFM1) dans un modèle C. elegans

L’ubiquitin-fold modifier (UFM1) fait partie de la classe 1 de la famille de protéine ubiquitin-like (Ubl). UFM1 et Ub ont très peu d’homologie de séquence, mais partagent des similarités remarquables au niveau de leur structure tertiaire. Tout comme l’Ub et la majorité des autres Ubls, UFM1 se lie de façon covalente à ses substrats par l’intermédiaire d’une cascade enzymatique. Il est de plus en plus fréquemment rapporté que les protéines Ubls sont impliquées dans des maladies humaines. Le gène Ufm1 est surexprimé chez des souris de type MCP développant une ischémie myocardique et dans les îlots de Langerhans de patients atteints du diabète de type 2. UFM1 et ses enzymes spécifiques, UBA5, UFL1 et UFC1, sont conservés chez les métazoaires et les plantes suggérant un rôle important pour les organismes multicellulaires. Le Caenorhabditis elegans est le modèle animal le plus simple utilisé en biologie. Sa morphologie, ses phénotypes visibles et ses lignées cellulaires ont été décrits de façon détaillée. De plus, son cycle de vie court permet de rapidement observer les effets de certains gènes sur la longévité. Ce modèle nous permet de facilement manipuler l’expression du gène Ufm1 et de mieux connaître ses fonctions. En diminuant l’expression du gène ufm-1 chez le C.elegans, par la technique de l’ARN interférence par alimentation, nous n’avons observé aucun problème morphologique grave. Les vers ressemblaient aux vers sauvages et possédaient un nombre de progéniture normal. Cependant, les vers sauvage exposés à l’ARNi d’ufm-1 vivent significativement moins longtemps que les contrôles et ce, de façon indépendante de la voie de signalisation de l’insuline/IGF. Chez le C. elegans la longévité et la résistance au stress cellulaire sont intimement liées. Nous n’avons remarqué aucun effet d’ufm-1 sur le stress thermal, osmotique ou oxydatif, mais il est requis pour la protection contre le stress protéotoxique. Il est également nécessaire au maintien de l’intégrité neuronale au cours du vieillissement des animaux. L’ensemble de nos données nous renseigne sur les fonctions putatives du gène Ufm1.

Study of NAD(P)H fluorescence in living cardiomyocytes by spectrally resolved time-correlated single photon counting

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Decreased a2-adrenergic receptor in the brain stem and pancreatic islets during pancreatic regeneration in weanling rats

Sympathetic stimulation inhibits insulin secretion. a2-Adrenergic receptor is known to have a regulatory role in the sympathetic function. We investigated the changes in the a2-adrenergic receptors in the brain stein and pancreatic islets using [3H]Yohimbine during pancreatic regeneration in weanling rats. Brain stem and pancreatic islets of experimental rats showed a significant decrease (p<0.001) in norepinephrine (NE) content at 72 h after partial pancreatectomy. The epinephrine (EPI) content showed a significant decrease (p<0.001) in pancreatic islets while it was not detected in brain stem at 72 h after partial pancreatectomy. Scatchard analysis of [3H]Yohimbine showed a significant decrease (p<0.05) and Kd at 72 h after partial pancreatectomy in the brain stem. In the pancreatic islets, Scatchard analysis of [3H]Yohimbine showed a signiinfiBca'nnatx decrease (p<0.001) in B,nax and Kd (p<0.05) at 72 h after partial pancreatectomy. The binding parameters reversed to near sham by 7 days after pancreatectomy both in brain stein and pancreatic islets. This shows that pancreatic insulin secretion is influenced by central nervous system inputs from the brain stem. In vitro studies with yohimbine showed that the a2-adrenergic receptors are inhibitory to islet DNA synthesis and insulin secretion. Thus our results suggest that decreased a2-adrenergic receptors during pancreatic regeneration functionally regulate insulin secretion and pancreatic 13-cell proliferation in weanling rats.

Muscarinic M1 Receptor Gene Expression in Streptozotocin Induced Diabetic Rats: Regulation of Insulin Secretion By Aegle marmelose And Costus pictus Leaf Extracts

The present work is to understand the alterations of total Muscarinic and Muscarinic MI receptors in brain and pancreatic islets of Streptozotocin induced diabetic rats. The work focuses on the evaluation of the antihyperglycemic activity of aqueous extracts of Aegle marmelose and Costus pictus leaves in vivo and the changes in the total Muscarinic and Muscarinic MI receptors during diabetes and after the treatment with insulin. The insulin secretory activity of Aegle marmelose and Costus pictus leaf extracts and the effect of cholinergic receptor agonist were investigated in vitro using rat primary pancreatic islet culture. Muscarinic MI receptor kinetics and gene expression during diabetes and regulation of insulin secretion by Aegle marmelose and Costus pie/us leaf extracts will help us to elucidate the role of Muscarinic and Muscarinic MI receptors in hyperglycemia and the regulatory activity of these plant extracts on insulin secretion through Muscarinic receptors.

Preoperative predictors for postoperative problems in heart transplantation: psychiatric and psychosocial considerations

The psychiatric and psychosocial evaluation of the heart transplant candidate can identify particular predictors for postoperative problems. These factors, as identified during the comprehensive evaluation phase, provide an assessment of the candidate in context of the proposed transplantation protocol. Previous issues with compliance, substance abuse, and psychosis are clear indictors of postoperative problems. The prolonged waiting list time provides an additional period to evaluate and provide support to patients having a terminal disease who need a heart transplant, and are undergoing prolonged hospitalization. Following transplantation, the patient is faced with additional challenges of a new self-image, multiple concerns, anxiety, and depression. Ultimately, the success of the heart transplantation remains dependent upon the recipient's ability to cope psychologically and comply with the medication regimen. The limited resource of donor hearts and the high emotional and financial cost of heart transplantation lead to an exhaustive effort to select those patients who will benefit from the improved physical health the heart transplant confers.

Checklist and morphometry of benthic cnidarians from the Fernando de Noronha Archipelago, Brazil

The Fernando de Noronha Archipelago (Pernambuco State, Brazil), a national marine park, is formed by 21 islands and islets of volcanic origin. An update of the checklist of the benthic cnidarians from some of the archipelago`s reef environments, as well as a study of their corals and calcified hydroids morphometry, was the major goal of this work. Fieldwork was undertaken in February 2005 and in April 2006 and observations were carried out at 13 stations during snorkeling and/or scuba diving up to 30 m deep. Thirty-four species of cnidarians were recorded, of which 17 are new occurrences for the studied area. When added to the species previously listed in the literature, the total number of benthic cnidarians recorded for the Archipelago increases to 57. Stephanocoenia michelini, a new occurrence of zooxanthellate coral, is worthy of mention, as well as the calcified hydroid Millepora braziliensis. Mussismilia hispida tenuisepta showed several variations among its skeletal characters that surpassed the limits of intraspecific morphological variation when compared to those of Mussismilia hispida.

MKP-1 mediates glucocorticoid-induced ERK1/2 dephosphorylation and reduction in pancreatic beta-cell proliferation in islets from early lactating mothers

Maternal pancreatic islets undergo a robust increase of mass and proliferation during pregnancy, which allows a compensation of gestational insulin resistance. Studies have described that this adaptation switches to a low proliferative status after the delivery. The mechanisms underlying this reversal are unknown, but the action of glucocorticoids (GCs) is believed to play an important role because GCs counteract the pregnancy-like effects of PRL on isolated pancreatic islets maintained in cell culture. Here, we demonstrate that ERK1/2 phosphorylation (phospho-ERK1/2) is increased in maternal rat islets isolated on the 19th day of pregnancy. Phospho-ERK1/2 status on the 3rd day after delivery (L3) rapidly turns to values lower than that found in virgin control rats (CTL). MKP-1, a protein phosphatase able to dephosphorylate ERK1/2, is increased in islets from L3 rats. Chromatin immunoprecipitation assay revealed that binding of glucocorticoid receptor (GR) to MKP-1 promoter is also increased in islets from L3 rats. In addition, dexamethasone (DEX) reduced phospho-ERK1/2 and increased MKP-1 expression in RINm5F and MIN-6 cells. Inhibition of transduction with cycloheximide and inhibition of phosphatases with orthovanadate efficiently blocked DEX-induced downregulation of phospho-ERK1/2. In addition, specific knockdown of MKP-1 with siRNA suppressed the downregulation of phosphoERK1/2 and the reduction of proliferation induced by DEX. Altogether, our results indicate that downregulation of phospho-ERK1/2 is associated with reduction in proliferation found in islets of early lactating mothers. This mechanism is probably mediated by GC-induced MKP-1 expression.

Improved renal function after kidney transplantation is associated with heme oxygenase-1 polymorphism

Heme oxygenase-1 (HO-1) has a microsatellite polymorphism based on the number of guanosine-thymidine nucleotide repeats (GT) repeats that regulates expression levels and could have an impact on organ survival post-injury. We correlated HO-1 polymorphism with renal graft function. The HO-1 gene was sequenced (N = 181), and the allelic repeats were divided into subclasses: short repeats (S) (< 27 repeats) and long repeats (L) (>= 27 repeats). A total of 47.5% of the donors carried the S allele. The allograft function was statistically improved six months, two and three yr after transplantation in patients receiving kidneys from donors with an S allele. For the recipients carrying the S allele (50.3%), the allograft function was also better throughout the follow-up, but reached statistical significance only three yr after transplantation (p = 0.04). Considering only those patients who had chronic allograft nephropathy (CAN; 74 of 181), allograft function was also better in donors and in recipients carrying the S allele, two and three yr after transplantation (p = 0.03). Recipients of kidney transplantation from donors carrying the S allele presented better function even in the presence of CAN.

Dexamethasone-induced insulin resistance is associated with increased connexin 36 mRNA and protein expression in pancreatic rat islets

Augmented glucose-stimulated insulin secretion (GSIS) is an adaptive mechanism exhibited by pancreatic islets from insulin-resistant animal models. Gap junction proteins have been proposed to contribute to islet function. As such, we investigated the expression of connexin 36 (Cx36), connexin 43 (Cx43), and the glucose transporter Glut2 at mRNA and protein levels in pancreatic islets of dexamethasone (DEX)-induced insulin-resistant rats. Study rats received daily injections of DEX (1 mg/kg body mass, i.p.) for 5 days, whereas control rats (CTL) received saline solution. DEX rats exhibited peripheral insulin resistance, as indicated by the significant postabsorptive insulin levels and by the constant rate for glucose disappearance (K-ITT). GSIS was significantly higher in DEX islets (1.8-fold in 16.7 mmol/L glucose vs. CTL, p < 0.05). A significant increase of 2.25-fold in islet area was observed in DEX vs. CTL islets (p < 0.05). Cx36 mRNA expression was significantly augmented, Cx43 diminished, and Glut2 mRNA was unaltered in islets of DEX vs. CTL (p < 0.05). Cx36 protein expression was 1.6-fold higher than that of CTL islets (p < 0.05). Glut2 protein expression was unaltered and Cx43 was not detected at the protein level. We conclude that DEX-induced insulin resistance is accompanied by increased GSIS and this may be associated with increase of Cx36 protein expression.