The isolated perfused human skin flap: design, perfusion technique, metabolism, and vascular reactivity

The design, isolated perfusion technique, and reactivity of a novel human skin-flap model are described. A transverse paraumbilical skin flap based on perforator vessels from the deep epigastric system was designed utilizing the tissue usually discarded following abdominal dermolipectomy. Within 3 hours of devascularization, a gassed (95% O2, 5% CO2), 37 degrees C Krebs-Henseleit buffer containing albumin (65 gm/liter) was pumped into the cannulated arterial pedicle of the skin flap and subsequently collected from the venous pedicle. Vascular resistance was continuously monitored and remained stable throughout the 4-hour perfusion. Lactate release was maintained throughout perfusion and was markedly increased by addition of insulin to the perfusate. Addition of norepinephrine to the perfusate resulted in a significant (p less than 0.05) dose-response increase in vascular resistance, and acetylcholine significantly (p less than 0.05) attenuated resistance in flaps preconstricted with norepinephrine. The results of these studies indicate that the isolated perfused human skin flap remained metabolically active with functionally intact vascular endothelium and smooth muscle throughout the 4-hour perfusion. The availability of this technique will, for the first time, permit laboratory study of human skin-flap pathophysiology and pharmacology.     

Continuous hypothermic perfusion of rabbit kidneys.

Addition of cryoprotective agents to whole organs is possible only by vascular perfusion with the cryoprotectant dissolved in a suitable perfusion fluid.Vascular resistance, organ weight gain, release of lactate dehydrogenase (LDH), and post-transplant function was studied during and after hypothermic perfusion at +6 °C of rabbit kidneys with six different perfusion fluids. A mixture of dextran and bovine serum albumin (BSA), BSA alone in various concentrations, and human serum albumin were tested as colloids, and the effect of perfusate osmolality was investigated.The dextran-BSA mixture was found to be superior to 4.5 and 6.0% BSA alone in terms of better perfusion characteristics, better post-transplant function, and lower LDH release. Perfusion characteristics during perfusion with human serum albumin and subsequent graft function were not different from those observed in experiments with dextran-BSA, but the LDH release was lower.Perfusate osmolality was increased by the addition of glucose or mannitol. Perfusion characteristics during perfusion with the hypertonic perfusates were not different from those observed during isotonic perfusion, but post-transplant function seemed to be better after perfusion with the fluid made hypertonic with glucose, whereas addition of mannitol seemed to be deleterious.Thus a perfusion fluid of extracellular electrolyte composition, containing human serum albumin as a colloid and made hypertonic with glucose, can be used as a vehicle for cryoprotectants during their addition to rabbit kidneys.     

Impaired microvascular perfusion: a consequence of vascular dysfunction and a potential cause of insulin resistance in muscle

Insulin has an exercise-like action to increase microvascular perfusion of skeletal muscle and thereby enhance delivery of hormone and nutrient to the myocytes. With insulin resistance, insulin's action to increase microvascular perfusion is markedly impaired. This review examines the present status of these observations and techniques available to measure such changes as well as the possible underpinning mechanisms. Low physiological doses of insulin and light exercise have been shown to increase microvascular perfusion without increasing bulk blood flow. In these circumstances, blood flow is proposed to be redirected from the nonnutritive route to the nutritive route with flow becoming dominant in the nonnutritive route when insulin resistance has developed. Increased vasomotion controlled by vascular smooth muscle may be part of the explanation by which insulin mediates an increase in microvascular perfusion, as seen from the effects of insulin on both muscle and skin microvascular blood flow. In addition, vascular dysfunction appears to be an early development in the onset of insulin resistance, with the consequence that impaired glucose delivery, more so than insulin delivery, accounts for the diminished glucose uptake by insulin-resistant muscle. Regular exercise may prevent and ameliorate insulin resistance by increasing "vascular fitness" and thereby recovering insulin-mediated capillary recruitment.     

Distribution and removal of glycerol by vascular albumin perfusion in rabbit kidneys.

A simple perfusion circuit for gradual glycerolization and deglycerolization of rabbit kidneys is described; it has been used to study vascular resistance and glycerol distribution during perfusion at +10 °C with a perfusate of extracellular composition.An attempt was made to diminish the dramatic rise in vascular resistance during deglycerolization of rabbit kidneys, seen in previous experiments, by increasing the perfusate colloid osmotic pressure and decreasing the rate of change of cryoprotectant concentration during the last third of removal. These modifications of the method did not improve perfusion characteristics or post-transplant function.Melting points of perfusates and different parts of the kidney were determined by differential thermal analysis before glycerolization, after glycerolization to 3 m and after subsequent deglycerolization. The variations of tissue melting temperatures were found to be identical with variations in the perfusate, thus indicating a complete distribution and removal of cryoprotective concentrations of glycerol.     

Damaging effect of subzero temperature (-4 degrees C) on rabbit renal function

The effect of exposing rabbit kidneys to -4 degrees C for 1 hr in the unfrozen state was evaluated by means of measurement of tissue slice K/Na ratio and whole organ creatinine clearance. Freezing was prevented in one series (groups SC1-SC3) by supercooling with temperature monitoring and in a second series by a 2 M mixture of propylene glycol and glycerol. The latter agent was introduced prior to storage and later removed before the viability testing using a perfusion method (groups CPA1-CPA4). The results indicated a significant loss of slice and whole organ function during this short period of supercooling. The injury did not appear to result from either the rapidity of cooling or the formation of ice. There was some loss of function resulting from perfusion itself. Since this injury was evident in the whole organ but not in the tissue slice it may be ascribed to a vascular affect. When this damage was taken into account the data indicated that cryoprotective agents appeared to protect against any additional damage resulting from 1 hr storage at -4 degrees C.     

Evaluation and preservation of vascular architectures in decellularized whole rat kidneys

Organ transplantation is the gold standard treatment for end-stage organ failure. Due to the severe shortage of transplantable organs, only a tiny fraction of patients may receive timely organ transplantation every year. Decellularization-recellularization technology using allogeneic and xenogeneic organs is currently conceived to be a promising solution to generate functionally transplantable organs in vitro. This approach, however, still faces tremendous technological challenges, one of them being the ability to evaluate and preserve the integrity of vascular architectures upon decellularization and cryostorage of the whole organ matrices so that the off-the-shelf organ grafts are available on demand for clinical applications. In the present study, we report a Micro-CT imaging method for evaluating the integrity of vasculature of the decellularized whole organ scaffolds with/without freezing/thawing. The method uses radiopaque Microfil perfusion and x-ray fluoroscopy to acquire high-resolution angiography of the organ matrix. The whole rat kidney is decellularized using a new multistep perfusion protocol with the combined use of Triton X-100 and DNase. The decellularized kidney matrix is then cryopreserved after the pretreatment with different cryoprotectant solutions. The reconstructed tomographic images from Micro-CT confirm various structural alterations in the vasculature of the whole decellularized kidney matrix with/without frozen storage. The freezing damage to the vascular architectures can be reduced by perfusing cryoprotectant solutions into the whole kidney matrix. Ice-free cryopreservation with the vitrification solution VS83 can successfully preserve the integrity of the whole kidney matrix's vasculature after frozen storage.     

Preparation of radiolabelled very-low-density lipoprotein in high yield by extended rat liver perfusion

A method is described using an extended (8 h), rat liver perfusion that produces approx. 100 mg of selectively radiolabelled, mature, very-low-density lipoprotein suitable for use in subsequent whole organ perfusion experiments.     

Autonomic nervous control of the circulatory system in the air-breathing fish Channa argus

The control of the cardiovascular system with particular emphasis on the regulation of blood distribution in the gills and air-breathing organ was studied in the air-breathing teleost Channa argus. Perfused head preparations were used in addition to experiments with isolated strip preparations of arteries and heart chambers. The distribution of adrenergic nerves was investigated using Falck-Hillarp fluorescence histochemistry. This preliminary study shows an adrenergic control system composed of chromaffin cells and adrenergic nerves similar to that found in other teleosts investigated, although the systemic arteries (coeliac artery, dorsal aorta and the vasculature of the air-breathing organ) appear to lack an adrenergic innervation. The reactions of isolated artery strip preparations to acetylcholine and adrenaline resemble those seen in other teleosts, and there is a prominent inhibitory effect of L-isoprenaline suggestive of arterial beta-adrenoceptors. The general vascular resistance of the gill apparatus-air-breathing organ increases in response to acetylcholine or adrenaline, and there is a redistribution of perfusion flow from the air-breathing organ circuit (anterior venous outflow from the first and second pair of gills and the air-breathing organ) to the general systemic circuit (dorsal aortic outflow from the third and fourth pair of gills). Stimulation of the vagal branch entering the air-breathing organ mimics the effects of acetylcholine or adrenaline. This innervation is probably non-adrenergic since no adrenergic nerve fibres could be demonstrated in the vasculature of the air-breathing organ using the histochemical technique. An adrenergic control of the vasculature of the air-breathing organ is not likely, since the concentration of adrenaline needed to affect the vasculature is not reached in the plasma even during "stress".     

Retrograde perfusion and filling of mouse coronary vasculature as preparation for micro computed tomography imaging

Visualization of the vasculature is becoming increasingly important for understanding many different disease states. While several techniques exist for imaging vasculature, few are able to visualize the vascular network as a whole while extending to a resolution that includes the smaller vessels. Additionally, many vascular casting techniques destroy the surrounding tissue, preventing further analysis of the sample. One method which circumvents these issues is micro-Computed Tomography (μCT). μCT imaging can scan at resolutions <10 microns, is capable of producing 3D reconstructions of the vascular network, and leaves the tissue intact for subsequent analysis (e.g., histology and morphometry). However, imaging vessels by ex vivo μCT methods requires that the vessels be filled with a radiopaque compound. As such, the accurate representation of vasculature produced by μCT imaging is contingent upon reliable and complete filling of the vessels. In this protocol, we describe a technique for filling mouse coronary vessels in preparation for μCT imaging. Two predominate techniques exist for filling the coronary vasculature: in vivo via cannulation and retrograde perfusion of the aorta (or a branch off the aortic arch), or ex vivo via a Langendorff perfusion system. Here we describe an in vivo aortic cannulation method which has been specifically designed to ensure filling of all vessels. We use a low viscosity radiopaque compound called Microfil which can perfuse through the smallest vessels to fill all the capillaries, as well as both the arterial and venous sides of the vascular network. Vessels are perfused with buffer using a pressurized perfusion system, and then filled with Microfil. To ensure that Microfil fills the small higher resistance vessels, we ligate the large branches emanating from the aorta, which diverts the Microfil into the coronaries. Once filling is complete, to prevent the elastic nature of cardiac tissue from squeezing Microfil out of some vessels, we ligate accessible major vascular exit points immediately after filling. Therefore, our technique is optimized for complete filling and maximum retention of the filling agent, enabling visualization of the complete coronary vascular network--arteries, capillaries, and veins alike.     

Analysis of the introduction and removal of glycerol in rabbit kidneys using a Krogh cylinder model

In 1982, Rubinsky and Cravalho described a Krogh cylinder model for the analysis of cryoprotectant transport in a perfused organ. By application of the Kedem-Katchalsky equations, changes in tissue volume caused by movements of water and solute were used to predict changes in capillary radius (Cryobiology 19, 70-82, 1982). We have now measured the changes in vascular resistance that are produced when sucrose or glycerol is introduced into the perfusate flowing through rabbit kidneys at 10 degrees C, and have analyzed these data by means of the Rubinsky-Cravalho semiempirical model. The sucrose data provided an estimate of hydraulic conductivity and the dimensions of the Krogh tissue units. Three rates of addition of glycerol, 10, 30, and 90 mM/min to a final concentration of 3 M, were studied. The vascular resistance fell to approximately 40% of its initial value (radius approximately 128% of initial value) with all three rates of addition, and then returned toward its normal value while the glycerol concentration was still increasing. This behavior could be explained either by a sudden change in solute permeability at that capillary radius, or by an inverse dependence of reflection coefficient upon solute concentration. Evidence is presented that favors the latter interpretation. The best fits for the apparent hydraulic conductivity and apparent solute permeability for glycerol are 1 X 10(-6) cm/sec atm and 6 X 10(-8) cm/sec, respectively, with the reflection coefficient falling from 1.0 when the glycerol concentration is zero to 0.1 when it is 3 M. The model is used to predict tissue concentrations of glycerol throughout each experiment.     

Vascular resistance and vasoactivity of gills and pulmonary artery of the salamander,Ambystoma tigrinum

Summary In order to understand the blood flow patterns and their regulation in the gills and pulmonary artery ofAmbystoma tigrinum, the vascular resistance and vasoactivity of the two major branchial perfusion pathways and a vascular plexus in the pulmonary artery were investigated using an isolated-tissue perfusion method. Acetylcholine and epinephrine were both pressor agents in all three vascular segments. Angiotensin II also constricted the branchial respiratory vasculature. Norephinephrine was primarily a vasodilator in the branchial respiratory vasculature, however, it had no effect on the shunt vessels of the gill or the pulmonary arterial plexus. Both gill circulations were insensitive to alterations in CO₂ and pH. Anoxia produced a slight vasodilation of the branchial respiratory vessels but had no effect on the shunt vasculature. Mild hypoxia had no effect on either branchial circulations. The results suggest that: (1) blood flow through the respiratory section of the gill may vary between 8 and 47% of total gill flow, (2) the major perfusion pathway to the lung is probably from the efferent artery of the third gill through the ductus arteriosus and then into the pulmonary artery, (3) O₂, CO₂ and pH exert no local control of branchial perfusion, (4) both cholinergic and adrenergic regulation of branchial and proximal pulmonary arterial vascular resistance is possible, (5) a rise in circulating norepinephrine should increase blood flow to the respiratory section of the gill.Abbreviations AII angiotensin II - ACh acetylcholine - EPi epinephrine - NE norepinephrine     

A novel porous mechanical framework for modelling the interaction between coronary perfusion and myocardial mechanics

The strong coupling between the flow in coronary vessels and the mechanical deformation of the myocardial tissue is a central feature of cardiac physiology and must therefore be accounted for by models of coronary perfusion. Currently available geometrically explicit vascular models fail to capture this interaction satisfactorily, are numerically intractable for whole organ simulations, and are difficult to parameterise in human contexts. To address these issues, in this study, a finite element formulation of an incompressible, poroelastic model of myocardial perfusion is presented. Using high-resolution ex vivo imaging data of the coronary tree, the permeability tensors of the porous medium were mapped onto a mesh of the corresponding left ventricular geometry. The resultant tensor field characterises not only the distinct perfusion regions that are observed in experimental data, but also the wide range of vascular length scales present in the coronary tree, through a multi-compartment porous model. Finite deformation mechanics are solved using a macroscopic constitutive law that defines the coupling between the fluid and solid phases of the porous medium. Results are presented for the perfusion of the left ventricle under passive inflation that show wall-stiffening associated with perfusion, and that show the significance of a non-hierarchical multi-compartment model within a particular perfusion territory.     

Harmonic analysis of perfusion pumps

The controversy over the use of nonpulsatile versus pulsatile pumps for maintenance of normal organ function during ex vivo perfusion has continued for many years, but resolution has been limited by lack of a congruent mathematical definition of pulsatility. We hypothesized that the waveform frequency and amplitude, as well as the underlying mean distending pressure are all key parameters controlling vascular function. Using discrete Fourier Analysis, our data demonstrate the complexity of the pulmonary arterial pressure waveform in vivo and the failure of commonly available perfusion pumps to mimic in vivo dynamics. In addition, our data show that the key harmonic signatures are intrinsic to the perfusion pumps, are similar for flow and pressure waveforms, and are unchanged by characteristics of the downstream perfusion circuit or perfusate viscosity.     

Preservation methods for kidney and liver

With the successful testing of the immunosuppressive effects of cyclosporine in transplant patients in 1978, the field of organ transplants began an exponential growth. With that, the field of organ preservation became increasingly important as the need to increase preservation time and improve graft function became paramount. However, for every patient that receives a transplanted organ, there are 4 more on the waiting list. In addition, a patient dies from the lack of a transplant almost every 1½ hour. To alleviate this donor crisis, there is a need to expand the donor pool to marginal donor organs. The main reason these organs are underutilized is because the current method of static preservation, simple cold storage, is ineffective. This article will provide a general review of the methods of preservation including simple cold storage, hypothermic machine perfusion, normothermic machine perfusion, and oxygen persufflation. In addition, the article will provide a review of how these dynamic preservation methods have improved the recovery and preservation of marginal donor organs including donation after cardiac death and fatty livers.     

The application of fluidics technology for organ preservation

A prototype design of a portable, pulsatile, perfusion preservation device based on a novel application of fluidics technology was tested to evaluate its ability to oxygenate preservation solution and to examine the relationship between organ resistance, perfusion pressure, and perfusion flow characteristics. The effects of organ resistance on pulse rate, perfusion pressure, and perfusion flow were modeled. Interstitial PO2 in canine hearts stored at 4 degrees C for 12 hours in the fluidics device (n = 5) and in static hypothermic storage (n = 5) was also compared. Increasing outflow resistance did not have an effect on operating frequency of the fluidics actuator. Perfusion pressure rose as outflow resistance was increased, and the flow of preservation solution decreased proportionately. The PO2 of the preservation solution increased to 300 mm Hg in two hours and reached a plateau that exceeded 400 mm Hg within six hours. The aortic flow profile during pulsatile perfusion resembled a square wave function with a mean pulse duration of 0.30 +/- 0.05 seconds. Oxygen delivery by the fluidics perfusion device exceeded the oxygen requirements of the hypothermically preserved organs at all resistance levels. Initial interstitial PO2 in the hearts of both groups was greater than 150 mm Hg. In perfused hearts, PO2 declined 30% by the 12th hour, whereas complete depletion of oxygen was noted in the static storage group within six hours. The fluidics organ perfusion/transport apparatus weighs less than 18 kg, uses no electrical power, and can operate continuously for 10 to 12 hours expending 780 L of oxygen.     

Skeletal muscle vasoconstriction produced by prostaglandin synthesis inhibitors; dependence on pump perfusion

A comparison was made of the effect of prostaglandin synthesis inhibitors (PGSI) on systemic blood pressure and hindlimb muscle vascular resistance of anesthetized dogs under different experimental conditions. When muscle blood flow was monitored using an extracorporeal or noncannulating electromagnetic blood flow probe, indomethacin (5 mg/kg i.v.) increased blood pressure slightly, but did not change vascular resistance. Administration of PGSI (indomethacin, meclofenamate, or naproxen, 5 mg/kg i.v.) after 2 hr of pump perfusion of the hindlimb caused a 22% increase in blood pressure, and 39% increase in vascular resistance 30 min afterwards. When administered immediately after instituting pump perfusion, indomethacin caused no significant change in blood pressure or vascular resistance at the 30 min interval, but at 60 min vascular resistance was increased. A similar vasoconstrictor response to indomethacin was obtained when it was infused in a lower dose intraarterially to the hindlimb, or when given i.v. after ligation of the renal pedicles. The results indicate that pump perfusion results in elaboration of a nonrenal prostaglandin(s) which maintains a vasodilator influence on the skeletal muscle vascular bed.     

Intestinal perfusion in vivo for the study of absorptive processes.

1. Intestinal absorption can be studied by in vitro and in vivo techniques. Among the in vivo ones, intestinal perfusion is the one more employed. 2. Intestinal perfusion could be performed by a simple perfusion of an intestinal segment or by a double perfusion of the intestine and the vascular bed simultaneously. 3. The double perfusion has the advantage of measuring the substrate appearance in the vascular circuit. 4. In this review we compare the different techniques described in the literature, paying attention to their advantages. 5. The best method is the one that maintains the animal alive throughout the experiment, because it provides information about intestinal absorption under conditions similar to the natural ones.     

Optimization of microCT imaging and blood vessel diameter quantitation of preclinical specimen vasculature with radiopaque polymer injection medium

Vascular networks within a living organism are complex, multi-dimensional, and challenging to image capture. Radio-angiographic studies in live animals require a high level of infrastructure and technical investment in order to administer costly perfusion mediums whose signals metabolize and degrade relatively rapidly, diminishing within a few hours or days. Additionally, live animal specimens must not be subject to long duration scans, which can cause high levels of radiation exposure to the specimen, limiting the quality of images that can be captured. Lastly, despite technological advances in live-animal specimen imaging, it is quite difficult to minimize or prevent movement of a live animal, which can cause motion artifacts in the final data output. It is demonstrated here that through the use of postmortem perfusion protocols of radiopaque silicone polymer mediums and ex-vivo organ harvest, it is possible to acquire a high level of vascular signal in preclinical specimens through the use of micro-computed tomographic (microCT) imaging. Additionally, utilizing high-order rendering algorithms, it is possible to further derive vessel morphometrics for qualitative and quantitative analysis.