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Porcine extrahepatic vascular endothelial asialoglycoprotein receptor 1 mediates xenogeneic platelet phagocytosis in vitro and in human-to-pig ex vivo xenoperfusion.

Transplantation

April 2015

1 Department of Clinical Research, University of Bern, Bern, Switzerland. 2 Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland. 3 Clinic of Plastic and Hand Surgery, University Hospital, Bern, Switzerland. 4 Clinic of Cardiovascular Surgery, University Hospital, Bern, Switzerland. 5 Department of Surgery, Schulze Diabetes Institute, University of Minnesota, Minneapolis, MN. 6 Division of Immunology and Allergology, University Hospital and Medical Faculty, Geneva, Switzerland.

Background: Asialoglycoprotein receptor-1 (ASGR1) mediates capture and phagocytosis of platelets in pig-to-primate liver xenotransplantation. However, thrombocytopenia is also observed in xenotransplantation or xenoperfusion of other porcine organs than liver. We therefore assessed ASGR1 expression as well as ASGR1-mediated xenogeneic platelet phagocytosis in vitro and ex vivo on porcine aortic, femoral arterial, and liver sinusoidal endothelial cells (PAEC/PFAEC/PLSEC).

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Isolated rabbit hearts were perfused as autoperfusing working preparations with human blood to simulate discordant hyperacute xenograft rejection. Perfusion with unmodified human blood resulted in immediate thrombotic failure of the hearts. This process was initiated by immunoglobulin M heterophile human anti-rabbit antibody, mediated by the classic pathway of complement and platelet-activating factor, and effected by platelets.

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Ten rabbit kidneys were perfused at 80 mm Hg, 37 degrees C, with oxygenated recirculating heparinized human blood. These experiments were compared to another ten perfusion experiments where 1 unit/ml porcine plasmin was added to the human blood one hour before the perfusion, at which time the fibrinolytic activity was significant and the fibrinogen concentration under the detection limit. Rejection, determined as time until blood flow decreased to 2 ml/min, was not significantly delayed by addition of plasmin.

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Five rabbit kidneys were perfused with heparinized human blood, five with platelet-rich, leucocyte-poor blood, five with platelet-poor, leucocyte-rich blood, and five with platelet-poor, leucocyte-poor, heparinized human blood. The kidneys were perfused at a constant pressure of 80 mm Hg and the time until the flow decreased to 2 ml/min was determined. Removal of platelets from the blood significantly delayed rejection.

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