Generation of FLT3-ITD-reactive T-cell populations from different sources

Approximately 25% of acute myeloid leukemias (AMLs) carry internal tandem duplications (ITD) of various lengths within the gene encoding the FMS-like tyrosine kinase receptor 3 (FLT3). Although varying duplication sites exist, most of these length mutations affect the protein´s juxtamembrane domain. FLT3-ITDs support leukemic transformation by constitutive phosphorylation resulting in uncontrolled activation, and their presence is associated with worse prognosis. As known form previous work, they represent leukemia- and patient-specific neoantigens that can be recognized by autologous AML-reactive CD8+ T cells (Graf et al., 2007; Graf et al., unpublished). Herein, in patient FL, diagnosed with FLT3-ITD+ AML and in first complete remission after induction chemotherapy, T cells against her leukemia´s individual FLT3-ITD were detected at a frequency up to 1.7x10-3 among peripheral blood CD8+ T lymphocytes. This rather high frequency suggested, that FLT3-ITD-reactive T cells had been expanded in vivo due to the induction of an anti-leukemia response.rnrnCell material from AML patients is limited, and the patients´ anti-leukemia T-cell repertoire might be skewed, e.g. due to complex previous leukemia-host interactions and chemotherapy. Therefore, allogeneic sources, i.e. buffy coats (BCs) from health donors and umbilical cord blood (UCB) donations, were exploited for the presence and the expansion of FLT3-ITD-reactive T-cell populations. BC- and UCB-derived CD8+ T cells, were distributed at 105 cells per well on microtiter plates and, were stimulated with antigen-presenting cells (APCs) transfected with in vitro-transcribed mRNA (IVT-mRNA) encoding selected FTL3-ITDs. APCs were autologous CD8- blood mononuclear cells, monocytes or FastDCs.rnrnBuffy coat lymphocytes from 19 healthy individuals were analyzed for CD8+ T-cell reactivity against three immunogenic FLT3-ITDs previously identified in patients VE, IN and QQ and designated as VE_, IN_ and QQ_FLT3-ITD, respectively. These healthy donors carried at least one of the HLA I alleles known to present an ITD-derived peptide from one of these FLT3-ITDs. Reactivities against single ITDs were observed in 8/19 donors. In 4 donors the frequencies of ITD-reactive T cells were determined and were estimated to be in the range of 1.25x10-6 to 2.83x10-7 CD8+ T cells. These frequencies were 1,000- to 10,000-fold lower than the frequency of autologous FLT3-ITD-reactive T cells observed in patient FL. Restricting HLA I molecules were identified in two donors. In one of them, the recognition of VE_FLT3-ITD was found to be restricted by HLA-C*07:02, which is different from the HLA allele restricting the anti-ITD T cells of patient VE. In another donor, the recognition of IN_FLT3-ITD was restricted by HLA-B*35:01, which also had been observed in patient IN (Graf et al., unpublished). By gradual 3´-fragmentation of the IN_FLT3-ITD cDNA, the 10-mer peptide CPSDNEYFYV was identified as the target of allogeneic T cells against IN_FLT3-ITD. rnLymphocytes in umbilical cord blood predominantly exhibit a naïve phenotype. Seven UCB donations were analyzed for T-cell responses against the FLT3-ITDs of patients VE, IN, QQ, JC and FL irrespective of their HLA phenotype. ITD-reactive responses against all stimulatory FLT3-ITDs were observed in 5/7 UCB donations. The frequencies of T cells against single FLT3-ITDs in CD8+ lymphocytes were estimated to be in the range of 1.8x10-5 to 3.6x10-6, which is nearly 15-fold higher than the frequencies observed in BCs. Restricting HLA I molecules were identified in 4 of these 5 positive UCB donations. They were mostly different from those observed in the respective patients. But in one UCB donation T cells against the JC_FLT3-ITD had exactly the same peptide specificity and HLA restriction as seen before in patient JC (Graf et al., 2007). Analyses of UCB responder lymphocytes led to the identification of the 10-mer peptide YESDNEYFYV, encoded by FL_FLT3-ITD, that was recognized in association with the frequent allele HLA-A*02:01. This peptide was able to stimulate and enrich ITD-reactive T cells from UCB lymphocytes in vitro. Peptide responders not only recognized the peptide, but also COS-7 cells co-transfected with FL_FLT3-ITD and HLA-A*02:01.rnrnIn conclusion, T cells against AML- and individual-specific FLT3-ITDs were successfully generated not only from patient-derived blood, but also from allogeneic sources. Thereby, ITD-reactive T cells were detected more readily and at higher frequencies in umbilical cord blood than in buffy coat lymphocytes. It occurred that peptide specificity and HLA restriction of allogeneic, ITD-reactive T cells were identical to autologous patient-derived T cells. As shown herein, allogeneic, FLT3-ITD-reactive T cells can be used for the identification of FLT3-ITD-encoded peptides, e.g. for future therapeutic vaccination studies. In addition, these T cells or their receptors can be applied to adoptive transfer.

Strumenti di prevenzione e riduzione degli sprechi alimentari. Un piano nazionale per l'Italia

Negli ultimi anni lo spreco alimentare ha assunto un’importanza crescente nel dibattito internazionale, politico ed accademico, nel contesto delle tematiche sulla sostenibilità dei modelli di produzione e consumo, sull’uso efficiente delle risorse e la gestione dei rifiuti. Nei prossimi anni gli Stati Membri dell’Unione Europea saranno chiamati ad adottare specifiche strategie di prevenzione degli sprechi alimentari all’interno di una cornice di riferimento comune. Tale cornice è quella che si va delineando nel corso del progetto Europeo di ricerca “FUSIONS” (7FP) che, nel 2014, ha elaborato un framework di riferimento per la definizione di “food waste” allo scopo di armonizzare le diverse metodologie di quantificazione adottate dai paesi membri. In questo scenario, ai fini della predisposizione di un Piano Nazionale di Prevenzione degli Sprechi Alimentari per l’Italia, il presente lavoro applica per la prima volta il “definitional framework” FUSIONS per l’analisi dei dati e l’identificazione dei principali flussi nei diversi anelli della filiera e svolge un estesa consultazione degli stakeholder (e della letteratura) per identificare le possibili misure di prevenzione e le priorità di azione. I risultati ottenuti evedenziano (tra le altre cose) la necessità di predisporre e promuovere a livello nazionale l’adozione di misure uniformi di quantificazione e reporting; l’importanza del coinvolgimento degli stakeholder nel contesto di una campagna nazionale di prevenzione degli sprechi alimentari; l’esigenza di garantire una adeguata copertura economica per le attività di pianificazione e implementazione delle misure di prevenzione da parte degli enti locali e di un coordinamento a livello nazionale della programmazione regionale; la necessità di una armonizzazione/semplificazione del quadro di riferimento normativo (fiscale, igienico-sanitario, procedurale) che disciplina la donazione delle eccedenze alimentari; l’urgenza di approfondire il fenomeno degli sprechi alimentari attraverso la realizzazione di studi di settore negli stadi a valle della filiera.

Funktionelle und strukturelle Charakterisierung des Ovastacins in vivo und in vitro

Die Metalloprotease Ovastacin, ein Vertreter der Astacin-Familie, wurde erstmals 2004 beschrieben. Im Ovar von Säugetieren ist Ovastacin-mRNA im Zeitfenster vom Stadium der Sekundärfollikel bis kurz nach der Befruchtung der Eizelle zu finden. Der Expressionsort und -zeitpunkt sowie die Sequenzähnlichkeit von über 60% mit sogenannten „Schlüpfenzymen“ (engl. hatching enzymes), die man in den Eizellen und Zygoten niederer Wirbeltiere und Wirbelloser gefunden hatte, ließen die Vermutung aufkommen, es könnte sich hier um das Säugerhomolog dieser Proteasen handeln. Generell lösen hatching Enzyme die derben embryonalen Hüllstrukturen (bei Säugern die Zona pellucida, ZP) beim Schlüpfvorgang auf. Die essentielle Bedeutung des Ovastacins für die Befruchtung wird durch die um ca. 30% reduzierte Fruchtbarkeit von Ovastacin defizienten Mäusen belegt. Hochinteressant war in diesem Zusammenhang die Entdeckung des Ovastacins in den Cortikalgranula der Oocyten sowie seine Fähigkeit, das Zona pellucida Protein 2 zu schneiden. Die dadurch bewirkte Verhärtung der Zona pellucida verhindert das Eindringen weiterer Spermien, das heißt sie baut eine Barriere gegen Polyspermie auf. Ziel dieser Arbeit war es, Belege für die physiologische Funktion des Ovastacins zu finden. Vor allem galt es, potentielle Aktivatoren zu identifizieren, da das Enzym wie alle Astacine als inaktive Vorstufe gebildet wird, die proteolytisch aktiviert werden muss. Zu diesem Zweck exprimierte ich rekombinantes Pro-Ovastacin in Insektenzellen. Aktivierungsstudien in vitro zeigten, dass ein saures Milieu zu einer Aktivierung führt, ohne die Abspaltung des Propeptids zu bewirken. Sequenzalignments und ein homologes Strukturmodell des Ovastacins wiesen auf Trypsin- oder Elastase-ähnliche Serinproteasen als potentielle Aktivierungsenzyme hin. Tatsächlich konnte mit diesen beiden Proteasetypen zum ersten Mal aktives Ovastacin aus Pro-Ovastacin erzeugt werden. Trypsin kommt als physiologischer Aktivator allerdings nicht in Betracht, da es bisher in keinem der Gewebe nachgewiesen werden konnte, in dem Ovastacin exprimiert wird. Die neutrophile Elastase dagegen konnte in der Leber, im Herz sowie im Blutplasma nachgewiesen werden. Mit Hilfe spezifischer Antikörper konnte das Herz als Expressionsort für Ovastacin bestätigt werden. Somit wäre Elastase ein potentieller physiologischer Aktivator von Ovastacin. Die Identifikation des Ovastacins in Geweben wie Leber, Herz, Nabelschnur und im Blutplasma weist auf eine Rolle der Protease in proteolytischen Netzwerken außerhalb der Spermien-Ei-Interaktion hin. Die Bedeutung der biologischen Kontrolle des Ovastacins bei der Befruchtung der Säugereizelle wird durch die Beobachtung untermauert, dass das Leberprotein Fetuin B als physiologischer Ovastacininhibitor fungiert und dadurch eine vorzeitige Verhärtung der Zona pellucida verhindert, die andernfalls die Penetration von Spermien prinzipiell verhindern würde.

Das Biobankgeheimnis : Schutz der Persönlichkeitsrechte in der biomedizinischen Forschung

Biobanken sind Sammlungen von Körpersubstanzen, die mit umfangreichen gesundheits- und lebensstilbezogenen sowie geneologischen Daten ihrer Spender verknüpft sind. Sie dienen der Erforschung weit verbreiteter Krankheiten. Diese sog. Volkskrankheiten sind multifaktoriell bedingte Krankheiten. Dies bedeutet, dass diese Krankheiten das Ergebnis eines komplizierten Zusammenspiels von umwelt- und verhaltensrelevanten Faktoren mit individuellen genetischen Prädispositionen sind. Forschungen im Bereich von Pharmakogenomik und Pharmakogenetik untersuchen den Einfluss von Genen und Genexpressionen auf die individuelle Wirksamkeit von Medikamenten sowie auf die Entstehung ungewollter Nebenwirkungen und könnten so den Weg zu einer individualisierten Medizin ebnen. Menschliches Material ist ein wichtiger Bestandteil dieser Forschungen und die Nachfrage nach Sammlungen, die Proben mit Daten verknüpfen, steigt. Einerseits sehen Mediziner in Biobanken eine Chance für die Weiterentwicklung der medizinischen Forschung und des Gesundheitswesens. Andererseits lösen Biobanken auch Ängste und Misstrauen aus. Insbesondere wird befürchtet, dass Proben und Daten unkontrolliert verwendet werden und sensible Bereiche des Persönlichkeitsrechts und der persönlichen Identität betroffen sind. Diese Gefahren und Befürchtungen sind nicht neu, sondern bestanden schon in der Vergangenheit bei jeglicher Form der Spende von Körpersubstanzen. Neu ist aber der Umfang an Informationen, der durch die Genanalyse entsteht und den Spender in ganz besonderer Weise betreffen kann. Bei der Speicherung und Nutzung der medizinischen und genetischen Daten ergibt sich somit ein Spannungsfeld insbesondere zwischen dem Recht der betroffenen Datenspender auf informationelle Selbstbestimmung und den Forschungsinteressen der Datennutzer. Im Kern dreht sich die ethisch-rechtliche Bewertung der Biobanken um die Frage, ob diese Forschung zusätzliche Regeln braucht, und falls ja, wie umfassend diese sein müssten. Im Zentrum dieser Diskussion stehen dabei v.a. ethische Fragen im Zusammenhang mit der informierten Einwilligung, dem Datenschutz, der Wiederverwendung von Proben und Daten, der Information der Spender über Forschungsergebnisse und der Nutzungsrechte an den Daten. Ziel dieser Arbeit ist es, vor dem Hintergrund des Verfassungsrechts, insbesondere dem Recht auf informationelle Selbstbestimmung, das Datenschutzrecht im Hinblick auf die Risiken zu untersuchen, die sich aus der Speicherung, Verarbeitung und Kommunikation von persönlichen genetischen Informationen beim Aufbau von Biobanken ergeben. Daraus ergibt sich die weitere Untersuchung, ob und unter welchen Voraussetzungen die sich entgegenstehenden Interessen und Rechte aus verfassungsrechtlichem Blickwinkel in Einklang zu bringen sind. Eine wesentliche Frage lautet, ob die bisherigen rechtlichen Rahmenbedingungen ausreichen, um den Schutz der gespeicherten höchstpersönlichen Daten und zugleich ihre angemessene Nutzung zu gewährleisten. Das Thema ist interdisziplinär im Schnittfeld von Datenschutz, Verfassungsrecht sowie Rechts- und Medizinethik angelegt. Aus dem Inhalt: Naturwissenschaftliche und empirische Grundlagen von Biobanken – Überblick über Biobankprojekte in Europa und im außereuropäischen Ausland – Rechtsgrundlagen für Biobanken - Recht auf informationelle Selbstbestimmung - Recht auf Nichtwissen - Forschungsfreiheit - Qualitätssicherung und Verfahren – informierte Einwilligung – globale Einwilligung - Datenschutzkonzepte - Forschungsgeheimnis –– Biobankgeheimnis - Biobankgesetz

Prozessierung des humanen GARP–Rezeptors und die physiologischen Auswirkungen

GARP (Glycoprotein A Repetitions Predominant) ist ein Oberflächenrezeptor auf regulatorischen T–Zellen (TRegs), der den latenten TGF–β (Transforming Growth Factor–β) bindet. Ein Funktionsverlust von T Regs hat gravierende Autoimmunerkrankungen wie das Immunodysregulation Polyendocrinopathy Enteropathy X–linked Syndrome (IPEX), Multiple Sklerose (MS) oder Rheumatoide Arthritis (RA) zur Folge. GARP stellt über eine Erhöhung der Aktivierbarkeit von TGF–β den regulatorischen Phänotyp von TRegs sicher und inhibiert die Ausbreitung von autoreaktiven TH17 Zellen.rn In dieser Arbeit stand die Regulation von GARP selbst im Mittelpunkt. Es konnte gezeigt werden, dass es sich innerhalb der kiefertragenden Vertebraten um ein strikt konserviertes Protein handelt. Datenbankanalysen machten deutlich, dass es zuerst in basalen Knochenfischen zusammen mit anderen Komponenten der adaptiven Immunantwort auftritt. Ein 3D–Modell, welches über Homologiemodellierung erstellt wurde, gab Aufschluss über die Struktur des Rezeptors und mögliche intramolekulare Disulfidbrücken. Für in vitro Versuche wurde eine lösliche Variante von GARP durch einen Austausch der Transmembrandomäne durch C–terminale Meprin α Domänen konstruiert. Diese Variante wurde in der eukaryotischen Zellkultur zuverlässig in den Überstand sezerniert und konnte chromatografisch gereinigt werden. Mit diesem rekombinanten GARP wurden Prozessierungsversuche mit Autoimmunpathogenese assoziierten Proteasen durchgeführt. Dabei zeigte sich, dass die Serinproteasen Trypsin, Neutrophile Elastase und Plasmin, sowie die Metalloprotease MMP2 in der Lage sind, GARP vollständig zu degradieren. In TGF–β sensitiven Proliferationsuntersuchungen stellte sich heraus, dass die entstandenen Fragmente immer noch in der Lage waren die Aktivierbarkeit von TGF–β zu erhöhen. Neben der Degradierung durch die oben genannten Proteasen konnte ebenfalls beobachtet werden, dass MMP9 und Ovastacin in der Lage sind GARP spezifisch zu schneiden. Ovastacin mRNA wurde in dieser Arbeit das erste Mal außerhalb der Oocyte, in T–Zellen beschrieben. Mit GARP wurde zudem das zweite Proteinsubstrat, neben dem Zona Pellucida Protein 2 identifiziert. Das durch MMP9 erzeugte N–terminale Fragment besitzt zwar die Eigenschaft, an TGF–β zu binden, kann aber die Aktivierbarkeit von TGF–β nicht mehr wie das intakte GARP erleichtern. rnDiese Arbeit zeigte, dass GARP durch Proteolyse reguliert wird, wobei die entstehenden Fragmente unterschiedlichen Einfluss auf die Aktivierbarkeit von TGF–β haben. Dieses Wissen bildet die Grundlage für weitere Untersuchungen im translationalen Forschungsbereich, um die gewonnenen Erkenntnisse zur Immunmodulation in der Therapie verschiedener Krankheiten einsetzen zu können.rn

500 ml of blood loss does not decrease non-invasive tissue oxygen saturation (StO2) as measured by near infrared spectroscopy - A hypothesis generating pilot study in healthy adult women

Background The goal when resuscitating trauma patients is to achieve adequate tissue perfusion. One parameter of tissue perfusion is tissue oxygen saturation (StO2), as measured by near infrared spectroscopy. Using a commercially available device, we investigated whether clinically relevant blood loss of 500 ml in healthy volunteers can be detected by changes in StO2 after a standardized ischemic event. Methods We performed occlusion of the brachial artery for 3 minutes in 20 healthy female blood donors before and after blood donation. StO2 and total oxygenated tissue hemoglobin (O2Hb) were measured continuously at the thenar eminence. 10 healthy volunteers were assessed in the same way, to examine whether repeated vascular occlusion without blood donation exhibits time dependent effects. Results Blood donation caused a substantial decrease in systolic blood pressure, but did not affect resting StO2 and O2Hb values. No changes were measured in the blood donor group in the reaction to the vascular occlusion test, but in the control group there was an increase in the O2Hb rate of recovery during the reperfusion phase. Conclusion StO2 measured at the thenar eminence seems to be insensitive to blood loss of 500 ml in this setting. Probably blood loss greater than this might lead to detectable changes guiding the treating physician. The exact cut off for detectable changes and the time effect on repeated vascular occlusion tests should be explored further. Until now no such data exist.

[Renal transplantation - new developments]

Renal transplantation has become an established option for renal replacement therapy in many patients with end stage renal disease. Living donation is a possibility for timely transplantation, hampered in 20 % of all possible donors and recipients byincompatible blood groups. AB0-incompatible renal transplantation overcomes this hurdle with acceptable allograft survival compared to conventional living-donor renal transplantation. During the last 10 years, the number of patients awaiting renal transplantation older than 65 years has nearly doubled. The decision to transplant those patients and their medical treatment is a growing challenge in transplantation. On the other hand donor age is increasing with potential negative consequences for long-term outcome of organ function. Antibody-mediated humoral rejection have been identified lately as an important cause for allograft failure during long-term follow up of renal transplant patients. New immunological methods to detect donor-specific antibodies, like solid-phase assays (Luminex®), have increased the knowledge and understanding of humoral rejection processes. This will lead hopefully to modified immunosuppressive strategies to minimize organ failure due to chronic rejection.

Frog oocytes to unveil the structure and supramolecular organization of human transport proteins

Structural analyses of heterologously expressed mammalian membrane proteins remain a great challenge given that microgram to milligram amounts of correctly folded and highly purified proteins are required. Here, we present a novel method for the expression and affinity purification of recombinant mammalian and in particular human transport proteins in Xenopus laevis frog oocytes. The method was validated for four human and one murine transporter. Negative stain transmission electron microscopy (TEM) and single particle analysis (SPA) of two of these transporters, i.e., the potassium-chloride cotransporter 4 (KCC4) and the aquaporin-1 (AQP1) water channel, revealed the expected quaternary structures within homogeneous preparations, and thus correct protein folding and assembly. This is the first time a cation-chloride cotransporter (SLC12) family member is isolated, and its shape, dimensions, low-resolution structure and oligomeric state determined by TEM, i.e., by a direct method. Finally, we were able to grow 2D crystals of human AQP1. The ability of AQP1 to crystallize was a strong indicator for the structural integrity of the purified recombinant protein. This approach will open the way for the structure determination of many human membrane transporters taking full advantage of the Xenopus laevis oocyte expression system that generally yields robust functional expression.

Synthesis, maturation, and trafficking of human Na+-dicarboxylate cotransporter NaDC1 requires the chaperone activity of cyclophilin B

Renal excretion of citrate, an inhibitor of calcium stone formation, is controlled mainly by reabsorption via the apical Na(+)-dicarboxylate cotransporter NaDC1 (SLC13A2) in the proximal tubule. Recently, it has been shown that the protein phosphatase calcineurin inhibitors cyclosporin A (CsA) and FK-506 induce hypocitraturia, a risk factor for nephrolithiasis in kidney transplant patients, but apparently through urine acidification. This suggests that these agents up-regulate NaDC1 activity. Using the Xenopus lævis oocyte and HEK293 cell expression systems, we examined first the effect of both anti-calcineurins on NaDC1 activity and expression. While FK-506 had no effect, CsA reduced NaDC1-mediated citrate transport by lowering heterologous carrier expression (as well as endogenous carrier expression in HEK293 cells), indicating that calcineurin is not involved. Given that CsA also binds specifically to cyclophilins, we determined next whether such proteins could account for the observed changes by examining the effect of selected cyclophilin wild types and mutants on NaDC1 activity and cyclophilin-specific siRNA. Interestingly, our data show that the cyclophilin isoform B is likely responsible for down-regulation of carrier expression by CsA and that it does so via its chaperone activity on NaDC1 (by direct interaction) rather than its rotamase activity. We have thus identified for the first time a regulatory partner for NaDC1, and have gained novel mechanistic insight into the effect of CsA on renal citrate transport and kidney stone disease, as well as into the regulation of membrane transporters in general.

Platelet Recruitment during Multiple Donor Platelet Apheresis Differs between Cell Separators

SUMMARY: BACKGROUND: Recruitment of platelets (PLT) during donor PLT apheresis may facilitate the harvest of multiple units within a single donation. METHODS: We compared two PLT apheresis procedures (Amicus and Trima Accel) in a prospective, randomized, paired cross-over study in 60 donors. The 120 donations were compared for depletion of circulating PLT in the donors, PLT yields and PLT recruitment. A recruitment was defined as ratio of total PLT yield and donor PLT depletion > 1. RESULTS: Despite comparable differences of pre- and post-apheresis PLT counts (87 × 10(9)/l in Trima Accel vs. 92 × 10(9)/l in Amicus, p = 0.383), PLT yields were higher with Trima Accel (7.48 × 10(11) vs. 6.06 × 10(11), p < 0.001), corresponding to a higher PLT recruitment (1.90 vs. 1.42, p < 0.001). We observed a different increase of WBC counts after aphereses, which was more pronounced with Trima Accel than with Amicus (1.30 × 10(9)/l vs. 0.46 × 10(9)/l, p < 0.001). CONCLUSION: Both procedures induced PLT recruitment. This was higher in Trima Accel, contributing to a higher yield in spite of a comparable depletion of circulating PLT in the donors. This recruitment facilitates the harvest of multiple units within a single donation and seems to be influenced by the procedure utilized. The different increases of circulating donor white blood cells after donation need further investigation.

Increased level of antibodies cross-reacting with Ves v 5 and CRISP-2 in MAR-positive patients

Anti-sperm antibodies (ASA) have been described to be involved in immunological infertility. A possible antigen for ASA is the human cysteine-rich secretory protein 2 (CRISP-2), a sperm surface protein important in sperm-oocyte interaction. Furthermore, anti-CRISP-2 antibodies were shown to decrease fertility rates in vitro. Recently, we have reported cross-reacting antibodies recognizing CRISP-2 and antigen 5 from yellow jacket venom (Ves v 5) in human serum.

Cardiac transplantation with hearts from donors after circulatory declaration of death: haemodynamic and biochemical parameters at procurement predict recovery following cardioplegic storage in a rat model

OBJECTIVES: Donation after circulatory declaration of death (DCDD) could significantly improve the number of cardiac grafts for transplantation. Graft evaluation is particularly important in the setting of DCDD given that conditions of cardio-circulatory arrest and warm ischaemia differ, leading to variable tissue injury. The aim of this study was to identify, at the time of heart procurement, means to predict contractile recovery following cardioplegic storage and reperfusion using an isolated rat heart model. Identification of reliable approaches to evaluate cardiac grafts is key in the development of protocols for heart transplantation with DCDD. METHODS: Hearts isolated from anaesthetized male Wistar rats (n = 34) were exposed to various perfusion protocols. To simulate DCDD conditions, rats were exsanguinated and maintained at 37°C for 15-25 min (warm ischaemia). Isolated hearts were perfused with modified Krebs-Henseleit buffer for 10 min (unloaded), arrested with cardioplegia, stored for 3 h at 4°C and then reperfused for 120 min (unloaded for 60 min, then loaded for 60 min). Left ventricular (LV) function was assessed using an intraventricular micro-tip pressure catheter. Statistical significance was determined using the non-parametric Spearman rho correlation analysis. RESULTS: After 120 min of reperfusion, recovery of LV work measured as developed pressure (DP)-heart rate (HR) product ranged from 0 to 15 ± 6.1 mmHg beats min(-1) 10(-3) following warm ischaemia of 15-25 min. Several haemodynamic parameters measured during early, unloaded perfusion at the time of heart procurement, including HR and the peak systolic pressure-HR product, correlated significantly with contractile recovery after cardioplegic storage and 120 min of reperfusion (P < 0.001). Coronary flow, oxygen consumption and lactate dehydrogenase release also correlated significantly with contractile recovery following cardioplegic storage and 120 min of reperfusion (P < 0.05). CONCLUSIONS: Haemodynamic and biochemical parameters measured at the time of organ procurement could serve as predictive indicators of contractile recovery. We believe that evaluation of graft suitability is feasible prior to transplantation with DCDD, and may, consequently, increase donor heart availability.

Follicle flushing in monofollicular in vitro fertilization almost doubles the number of transferable embryos

Follicle flushing has been proved to be ineffective in polyfollicular in vitro fertilization. To analyze the effect of flushing in monofollicular in vitro fertilization we aspirated and then flushed the follicles in 164 cycles. Total oocyte yield/aspiration was 44.5% in the aspirate, 20.7% in the 1(st) flush, 10.4% in the 2(nd) flush and 4.3% in the 3(rd) flush. By flushing, the total oocyte yield increased (p < 0.01) by 80.9%, from 44.5 to 80.5%. The total transfer rate increased (p < 0.01) by 91.0%, from 20.1 to 38.4%. The results indicate that the oocyte yield and the number of transferable embryos can be increased significantly by flushing.

Exogenous gonadotropins have little impact on follicular but considerable effect on serum cytokine concentrations – a comparison between Natural Cycle and stimulated IVF using a multiplexed assay platform

Introduction: Throughout follicular growth and subsequent corpus luteum formation the leukocyte number increases and follicular vascularisation changes. These processes are enhanced under exogenous stimulation with gonadotropins. Cytokines released by leukocytes contribute to further recruitment and vascularisation of the follicle, and they play an important role in regulating ovarian steroidogenesis by influencing theca and granulosa–lutein cell function. Changes in cytokine and vascular endothelial growth factor (VEGF) concentrations in the ovary as a consequence of gonadotropin stimulation may negatively influence oocyte quality. In this project we have compared the intrafollicular production of inflammatory cytokines and growth factors between natural IVF cycles (NC) and classical, gonadotropin-stimulated IVF cycles (gsIVF). Material and Methods: Serum on the day of oocyte retrieval and follicular fluid (FF) were collected in 37 NC and 39 gsIVF cycles. Thirteen women within this population underwent one NC and one gsIVF cycle each. A total of 14 cytokines from Bio-Plex panels I and II were determined in matched serum and FF samples using Luminex xMAP technology on the Bio-Plex(R) platform, using the serum protocol. Results: Tumour necrosis factor-alpha, RANTES, eotaxin and interferon-gamma-induced protein-10 levels were lower in FF than in serum, and thus not further investigated. Interleukin (IL)-6, -8, -10, -15, -18, monocyte chemotactic protein-1 (MCP-1), VEGF and leukaemia inhibitory factor (LIF) showed higher median concentrations in FF than in serum, indicating possible ovarian production. Moreover, most of these showed higher evels in the gsIVF than in the NC groups in the serum, but not in the follicular fluid. IL-8 was reduced in gsIVF cycles. Conclusion: The fact that serum but not FF levels of the studied cytokines were higher in the stimulated than in the natural cycles can be attributed to the increased number of active follicles present after controlled ovarian stimulation.

Effect of donor-specific transfusions on the outcome of renal allografts in the cyclosporine era

Despite the introduction of new immunosuppressive agents, a steady decline of functioning renal allografts after living donation is observed. Thus nonpharmacological strategies to prevent graft loss have to be reconsidered, including donor-specific transfusions (DST). We introduced a cyclosporine-based DST protocol for renal allograft recipients from living-related/unrelated donation. From 1993 to 2003, 200 ml of whole blood, or the respective mononuclear cells from the potential living donor were administered twice to all of our 61 recipient candidates. The transplanted subjects were compared with three groups of patients without DST from the Collaborative Transplant Study (Heidelberg, Germany) during a 6-year period. Six patients were sensitized without delay for a subsequent cadaveric kidney. DST patients had less often treatment for rejection and graft survival was superior compared with subjects from the other Swiss transplant centers (n = 513) or from Western Europe (n = 7024). To diminish the probability that superior results reflect patient selection rather than effects of DST, a 'matched-pair' analysis controlling for relevant factors of transplant outcome was performed. Again, this analysis indicated that recipients with DST had better outcome. Thus, our observation suggests that DST improve the outcome of living kidney transplants even when modern immunosuppressive drugs are prescribed.