Novel NMP split liver model recapitulates human IRI and demonstrates ferroptosis modulators as a new therapeutic strategy

Background Almost 9%of deceased donor livers are discarded as marginal donor livers (MDL) due to concern of severe ischemia reperfusion injury (IRI). Emerging data supports ferroptosis (iron regulated hepatocellular death) as an IRI driver, however lack of robust preclinical model limits therapeutic...

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Veröffentlicht in:Pediatric transplantation 2022-03, Vol.26 (2), p.e14164-n/a
Hauptverfasser: Nazzal, Mustafa, Madsen, Erik C., Armstrong, Austin, Nispen, Johan, Murali, Vidul, Song, Eric, Voigt, Marcus, Madnawat, Himani, Welu, Adam, Manithody, Chandrashekhara, Suri, Anandini, Krebs, Joseph, Gilbert, Ester, Samaddar, Ashish, Blackall, Douglas, Carpenter, Danielle, Varma, Chintalapati, Teckman, Jeffrey, Jain, Ajay Kumar
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container_end_page n/a
container_issue 2
container_start_page e14164
container_title Pediatric transplantation
container_volume 26
creator Nazzal, Mustafa
Madsen, Erik C.
Armstrong, Austin
Nispen, Johan
Murali, Vidul
Song, Eric
Voigt, Marcus
Madnawat, Himani
Welu, Adam
Manithody, Chandrashekhara
Suri, Anandini
Krebs, Joseph
Gilbert, Ester
Samaddar, Ashish
Blackall, Douglas
Carpenter, Danielle
Varma, Chintalapati
Teckman, Jeffrey
Jain, Ajay Kumar
description Background Almost 9%of deceased donor livers are discarded as marginal donor livers (MDL) due to concern of severe ischemia reperfusion injury (IRI). Emerging data supports ferroptosis (iron regulated hepatocellular death) as an IRI driver, however lack of robust preclinical model limits therapeutic testing. In this manuscript we describe the development of a novel rigorous internal control system utilizing normothermic perfusion of split livers to test ferroptosis regulators modulating IRI. Methods Upon institutional approval, split human MDLs were placed on our normothermic perfusion machine, Perfusion Regulated Organ Therapeutics with Enhanced Controlled Testing (PROTECT), pumping arterial and portal blood. Experiment 1 compared right (UR) and left (UL) lobes to validate PROTECT. Experiment 2 assessed ferroptosis regulator Deferoxamine in Deferoxamine Agent Treated (DMAT) vs. No Agent Internal Control (NAIC) lobes. Liver serology, histology, and ferroptosis genes were assessed. Results Successful MDL perfusion validated PROTECT with no ALT or AST difference between UR and UL (∆ALT UR: 235, ∆ALT UL: 212; ∆AST UR: 576, ∆AST UL: 389). Liver injury markers increased in NAIC vs. DMAT (∆ALT NAIC: 586, ∆ALT DMAT: ‐405; ∆AST NAIC: 617, ∆AST DMAT: ‐380). UR and UL had similar expression of ferroptosis regulators RPL8,HO‐1 and HIFα. Significantly decreased intrahepatic iron (p = .038), HO‐1 and HIFα in DMAT (HO‐1 NAIC: 6.93, HO‐1 DMAT: 2.74; HIFαNAIC: 8.67, HIFαDMAT: 2.60)and no hepatocellular necrosis or immunohistochemical staining (Ki67/Cytokeratin‐7) differences were noted. Conclusion PROTECT demonstrates the therapeutic utility of a novel normothermic perfusion split liver system for drug discovery and rapid translatability of therapeutics, driving a paradigm change in organ recovery and transplant medicine. Our study using human livers, provides preliminary proof of concept for the novel role of ferroptosis regulators in driving IRI.
doi_str_mv 10.1111/petr.14164
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Emerging data supports ferroptosis (iron regulated hepatocellular death) as an IRI driver, however lack of robust preclinical model limits therapeutic testing. In this manuscript we describe the development of a novel rigorous internal control system utilizing normothermic perfusion of split livers to test ferroptosis regulators modulating IRI. Methods Upon institutional approval, split human MDLs were placed on our normothermic perfusion machine, Perfusion Regulated Organ Therapeutics with Enhanced Controlled Testing (PROTECT), pumping arterial and portal blood. Experiment 1 compared right (UR) and left (UL) lobes to validate PROTECT. Experiment 2 assessed ferroptosis regulator Deferoxamine in Deferoxamine Agent Treated (DMAT) vs. No Agent Internal Control (NAIC) lobes. Liver serology, histology, and ferroptosis genes were assessed. Results Successful MDL perfusion validated PROTECT with no ALT or AST difference between UR and UL (∆ALT UR: 235, ∆ALT UL: 212; ∆AST UR: 576, ∆AST UL: 389). Liver injury markers increased in NAIC vs. DMAT (∆ALT NAIC: 586, ∆ALT DMAT: ‐405; ∆AST NAIC: 617, ∆AST DMAT: ‐380). UR and UL had similar expression of ferroptosis regulators RPL8,HO‐1 and HIFα. Significantly decreased intrahepatic iron (p = .038), HO‐1 and HIFα in DMAT (HO‐1 NAIC: 6.93, HO‐1 DMAT: 2.74; HIFαNAIC: 8.67, HIFαDMAT: 2.60)and no hepatocellular necrosis or immunohistochemical staining (Ki67/Cytokeratin‐7) differences were noted. Conclusion PROTECT demonstrates the therapeutic utility of a novel normothermic perfusion split liver system for drug discovery and rapid translatability of therapeutics, driving a paradigm change in organ recovery and transplant medicine. Our study using human livers, provides preliminary proof of concept for the novel role of ferroptosis regulators in driving IRI.</description><identifier>ISSN: 1397-3142</identifier><identifier>EISSN: 1399-3046</identifier><identifier>DOI: 10.1111/petr.14164</identifier><identifier>PMID: 34633130</identifier><language>eng</language><publisher>Denmark: Wiley Subscription Services, Inc</publisher><subject>Cytokeratin ; Deferoxamine ; Donor Selection ; Ferroptosis ; Graft Survival ; Humans ; Immunomodulation ; In Vitro Techniques ; Iron ; Ischemia ; ischemia reperfusion injury ; Liver ; Liver - blood supply ; Liver Function Tests ; liver transplant ; Liver Transplantation ; Liver transplants ; Organ Preservation - methods ; Organ removal ; Perfusion ; Perfusion - methods ; Reperfusion ; Reperfusion Injury - prevention &amp; control ; Serology</subject><ispartof>Pediatric transplantation, 2022-03, Vol.26 (2), p.e14164-n/a</ispartof><rights>2021 Wiley Periodicals LLC</rights><rights>2021 Wiley Periodicals LLC.</rights><rights>2022 John Wiley &amp; Sons A/S. Published by John Wiley &amp; Sons Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3574-a2f7c442127bcf28ef4e7aadd3a0cae0ab1d4aa04e798788afe6910883f22c993</citedby><cites>FETCH-LOGICAL-c3574-a2f7c442127bcf28ef4e7aadd3a0cae0ab1d4aa04e798788afe6910883f22c993</cites><orcidid>0000-0002-9420-5722 ; 0000-0002-8437-6085</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fpetr.14164$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fpetr.14164$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34633130$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nazzal, Mustafa</creatorcontrib><creatorcontrib>Madsen, Erik C.</creatorcontrib><creatorcontrib>Armstrong, Austin</creatorcontrib><creatorcontrib>Nispen, Johan</creatorcontrib><creatorcontrib>Murali, Vidul</creatorcontrib><creatorcontrib>Song, Eric</creatorcontrib><creatorcontrib>Voigt, Marcus</creatorcontrib><creatorcontrib>Madnawat, Himani</creatorcontrib><creatorcontrib>Welu, Adam</creatorcontrib><creatorcontrib>Manithody, Chandrashekhara</creatorcontrib><creatorcontrib>Suri, Anandini</creatorcontrib><creatorcontrib>Krebs, Joseph</creatorcontrib><creatorcontrib>Gilbert, Ester</creatorcontrib><creatorcontrib>Samaddar, Ashish</creatorcontrib><creatorcontrib>Blackall, Douglas</creatorcontrib><creatorcontrib>Carpenter, Danielle</creatorcontrib><creatorcontrib>Varma, Chintalapati</creatorcontrib><creatorcontrib>Teckman, Jeffrey</creatorcontrib><creatorcontrib>Jain, Ajay Kumar</creatorcontrib><title>Novel NMP split liver model recapitulates human IRI and demonstrates ferroptosis modulators as a new therapeutic strategy</title><title>Pediatric transplantation</title><addtitle>Pediatr Transplant</addtitle><description>Background Almost 9%of deceased donor livers are discarded as marginal donor livers (MDL) due to concern of severe ischemia reperfusion injury (IRI). Emerging data supports ferroptosis (iron regulated hepatocellular death) as an IRI driver, however lack of robust preclinical model limits therapeutic testing. In this manuscript we describe the development of a novel rigorous internal control system utilizing normothermic perfusion of split livers to test ferroptosis regulators modulating IRI. Methods Upon institutional approval, split human MDLs were placed on our normothermic perfusion machine, Perfusion Regulated Organ Therapeutics with Enhanced Controlled Testing (PROTECT), pumping arterial and portal blood. Experiment 1 compared right (UR) and left (UL) lobes to validate PROTECT. Experiment 2 assessed ferroptosis regulator Deferoxamine in Deferoxamine Agent Treated (DMAT) vs. No Agent Internal Control (NAIC) lobes. Liver serology, histology, and ferroptosis genes were assessed. Results Successful MDL perfusion validated PROTECT with no ALT or AST difference between UR and UL (∆ALT UR: 235, ∆ALT UL: 212; ∆AST UR: 576, ∆AST UL: 389). Liver injury markers increased in NAIC vs. DMAT (∆ALT NAIC: 586, ∆ALT DMAT: ‐405; ∆AST NAIC: 617, ∆AST DMAT: ‐380). UR and UL had similar expression of ferroptosis regulators RPL8,HO‐1 and HIFα. Significantly decreased intrahepatic iron (p = .038), HO‐1 and HIFα in DMAT (HO‐1 NAIC: 6.93, HO‐1 DMAT: 2.74; HIFαNAIC: 8.67, HIFαDMAT: 2.60)and no hepatocellular necrosis or immunohistochemical staining (Ki67/Cytokeratin‐7) differences were noted. Conclusion PROTECT demonstrates the therapeutic utility of a novel normothermic perfusion split liver system for drug discovery and rapid translatability of therapeutics, driving a paradigm change in organ recovery and transplant medicine. Our study using human livers, provides preliminary proof of concept for the novel role of ferroptosis regulators in driving IRI.</description><subject>Cytokeratin</subject><subject>Deferoxamine</subject><subject>Donor Selection</subject><subject>Ferroptosis</subject><subject>Graft Survival</subject><subject>Humans</subject><subject>Immunomodulation</subject><subject>In Vitro Techniques</subject><subject>Iron</subject><subject>Ischemia</subject><subject>ischemia reperfusion injury</subject><subject>Liver</subject><subject>Liver - blood supply</subject><subject>Liver Function Tests</subject><subject>liver transplant</subject><subject>Liver Transplantation</subject><subject>Liver transplants</subject><subject>Organ Preservation - methods</subject><subject>Organ removal</subject><subject>Perfusion</subject><subject>Perfusion - methods</subject><subject>Reperfusion</subject><subject>Reperfusion Injury - prevention &amp; control</subject><subject>Serology</subject><issn>1397-3142</issn><issn>1399-3046</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kV9r2zAUxcVYWbp2L_sARbCXMnCrf7HlxxGyNdC1pXTP4ka-blxsy5PklHz7KnHXhz7sIrji6HcOgkPIV84ueJrLAaO_4Irn6gM55rIsM8lU_vFwLzLJlZiRzyE8MZYQrT6RmVS5lFyyY7K7cVts6c3vOxqGtom0bbboaeeqpHq0MDRxbCFioJuxg56u7lcU-opW2Lk-RH94qtF7N0QXmrC37g3OBwrp0B6fadyghwHH2Fg6eR53p-Sohjbgl9d9Qv78XD4srrLr21-rxY_rzMp5oTIQdWGVElwUa1sLjbXCAqCqJDALyGDNKwXAklrqQmuoMS8501rWQtiylCfkfModvPs7Yoima4LFtoUe3RiMmGtWKsbnOqHf3qFPbvR9-p0Ruch5XiY2Ud8nynoXgsfaDL7pwO8MZ2ZfiNkXYg6FJPjsNXJcd1i9of8aSACfgOemxd1_oszd8uF-Cn0BWxWX4A</recordid><startdate>202203</startdate><enddate>202203</enddate><creator>Nazzal, Mustafa</creator><creator>Madsen, Erik C.</creator><creator>Armstrong, Austin</creator><creator>Nispen, Johan</creator><creator>Murali, Vidul</creator><creator>Song, Eric</creator><creator>Voigt, Marcus</creator><creator>Madnawat, Himani</creator><creator>Welu, Adam</creator><creator>Manithody, Chandrashekhara</creator><creator>Suri, Anandini</creator><creator>Krebs, Joseph</creator><creator>Gilbert, Ester</creator><creator>Samaddar, Ashish</creator><creator>Blackall, Douglas</creator><creator>Carpenter, Danielle</creator><creator>Varma, Chintalapati</creator><creator>Teckman, Jeffrey</creator><creator>Jain, Ajay Kumar</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9420-5722</orcidid><orcidid>https://orcid.org/0000-0002-8437-6085</orcidid></search><sort><creationdate>202203</creationdate><title>Novel NMP split liver model recapitulates human IRI and demonstrates ferroptosis modulators as a new therapeutic strategy</title><author>Nazzal, Mustafa ; Madsen, Erik C. ; Armstrong, Austin ; Nispen, Johan ; Murali, Vidul ; Song, Eric ; Voigt, Marcus ; Madnawat, Himani ; Welu, Adam ; Manithody, Chandrashekhara ; Suri, Anandini ; Krebs, Joseph ; Gilbert, Ester ; Samaddar, Ashish ; Blackall, Douglas ; Carpenter, Danielle ; Varma, Chintalapati ; Teckman, Jeffrey ; Jain, Ajay Kumar</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3574-a2f7c442127bcf28ef4e7aadd3a0cae0ab1d4aa04e798788afe6910883f22c993</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Cytokeratin</topic><topic>Deferoxamine</topic><topic>Donor Selection</topic><topic>Ferroptosis</topic><topic>Graft Survival</topic><topic>Humans</topic><topic>Immunomodulation</topic><topic>In Vitro Techniques</topic><topic>Iron</topic><topic>Ischemia</topic><topic>ischemia reperfusion injury</topic><topic>Liver</topic><topic>Liver - blood supply</topic><topic>Liver Function Tests</topic><topic>liver transplant</topic><topic>Liver Transplantation</topic><topic>Liver transplants</topic><topic>Organ Preservation - methods</topic><topic>Organ removal</topic><topic>Perfusion</topic><topic>Perfusion - methods</topic><topic>Reperfusion</topic><topic>Reperfusion Injury - prevention &amp; control</topic><topic>Serology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nazzal, Mustafa</creatorcontrib><creatorcontrib>Madsen, Erik C.</creatorcontrib><creatorcontrib>Armstrong, Austin</creatorcontrib><creatorcontrib>Nispen, Johan</creatorcontrib><creatorcontrib>Murali, Vidul</creatorcontrib><creatorcontrib>Song, Eric</creatorcontrib><creatorcontrib>Voigt, Marcus</creatorcontrib><creatorcontrib>Madnawat, Himani</creatorcontrib><creatorcontrib>Welu, Adam</creatorcontrib><creatorcontrib>Manithody, Chandrashekhara</creatorcontrib><creatorcontrib>Suri, Anandini</creatorcontrib><creatorcontrib>Krebs, Joseph</creatorcontrib><creatorcontrib>Gilbert, Ester</creatorcontrib><creatorcontrib>Samaddar, Ashish</creatorcontrib><creatorcontrib>Blackall, Douglas</creatorcontrib><creatorcontrib>Carpenter, Danielle</creatorcontrib><creatorcontrib>Varma, Chintalapati</creatorcontrib><creatorcontrib>Teckman, Jeffrey</creatorcontrib><creatorcontrib>Jain, Ajay Kumar</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nazzal, Mustafa</au><au>Madsen, Erik C.</au><au>Armstrong, Austin</au><au>Nispen, Johan</au><au>Murali, Vidul</au><au>Song, Eric</au><au>Voigt, Marcus</au><au>Madnawat, Himani</au><au>Welu, Adam</au><au>Manithody, Chandrashekhara</au><au>Suri, Anandini</au><au>Krebs, Joseph</au><au>Gilbert, Ester</au><au>Samaddar, Ashish</au><au>Blackall, Douglas</au><au>Carpenter, Danielle</au><au>Varma, Chintalapati</au><au>Teckman, Jeffrey</au><au>Jain, Ajay Kumar</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Novel NMP split liver model recapitulates human IRI and demonstrates ferroptosis modulators as a new therapeutic strategy</atitle><jtitle>Pediatric transplantation</jtitle><addtitle>Pediatr Transplant</addtitle><date>2022-03</date><risdate>2022</risdate><volume>26</volume><issue>2</issue><spage>e14164</spage><epage>n/a</epage><pages>e14164-n/a</pages><issn>1397-3142</issn><eissn>1399-3046</eissn><abstract>Background Almost 9%of deceased donor livers are discarded as marginal donor livers (MDL) due to concern of severe ischemia reperfusion injury (IRI). Emerging data supports ferroptosis (iron regulated hepatocellular death) as an IRI driver, however lack of robust preclinical model limits therapeutic testing. In this manuscript we describe the development of a novel rigorous internal control system utilizing normothermic perfusion of split livers to test ferroptosis regulators modulating IRI. Methods Upon institutional approval, split human MDLs were placed on our normothermic perfusion machine, Perfusion Regulated Organ Therapeutics with Enhanced Controlled Testing (PROTECT), pumping arterial and portal blood. Experiment 1 compared right (UR) and left (UL) lobes to validate PROTECT. Experiment 2 assessed ferroptosis regulator Deferoxamine in Deferoxamine Agent Treated (DMAT) vs. No Agent Internal Control (NAIC) lobes. Liver serology, histology, and ferroptosis genes were assessed. Results Successful MDL perfusion validated PROTECT with no ALT or AST difference between UR and UL (∆ALT UR: 235, ∆ALT UL: 212; ∆AST UR: 576, ∆AST UL: 389). Liver injury markers increased in NAIC vs. DMAT (∆ALT NAIC: 586, ∆ALT DMAT: ‐405; ∆AST NAIC: 617, ∆AST DMAT: ‐380). UR and UL had similar expression of ferroptosis regulators RPL8,HO‐1 and HIFα. Significantly decreased intrahepatic iron (p = .038), HO‐1 and HIFα in DMAT (HO‐1 NAIC: 6.93, HO‐1 DMAT: 2.74; HIFαNAIC: 8.67, HIFαDMAT: 2.60)and no hepatocellular necrosis or immunohistochemical staining (Ki67/Cytokeratin‐7) differences were noted. Conclusion PROTECT demonstrates the therapeutic utility of a novel normothermic perfusion split liver system for drug discovery and rapid translatability of therapeutics, driving a paradigm change in organ recovery and transplant medicine. Our study using human livers, provides preliminary proof of concept for the novel role of ferroptosis regulators in driving IRI.</abstract><cop>Denmark</cop><pub>Wiley Subscription Services, Inc</pub><pmid>34633130</pmid><doi>10.1111/petr.14164</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-9420-5722</orcidid><orcidid>https://orcid.org/0000-0002-8437-6085</orcidid></addata></record>
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source MEDLINE; Wiley Online Library Journals Frontfile Complete
subjects Cytokeratin
Deferoxamine
Donor Selection
Ferroptosis
Graft Survival
Humans
Immunomodulation
In Vitro Techniques
Iron
Ischemia
ischemia reperfusion injury
Liver
Liver - blood supply
Liver Function Tests
liver transplant
Liver Transplantation
Liver transplants
Organ Preservation - methods
Organ removal
Perfusion
Perfusion - methods
Reperfusion
Reperfusion Injury - prevention & control
Serology
title Novel NMP split liver model recapitulates human IRI and demonstrates ferroptosis modulators as a new therapeutic strategy
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