The importance of adipose-derived stem cells and vascularized tissue regeneration in the field of tissue transplantation

The importance of stem cells in regenerating or repairing damaged or diseased tissues is well established, but three factors have to be considered in employing stem cells clinically. The first is how to harvest, handle, and multiply them non-invasively, easily, and effectively. From this standpoint, adipose-derived stem cells are considered to be the best to work with among mesenchymal stem cells; since they were first reported in 2001, their pluripotency, proliferative efficiency, and low donor morbidity have been amply confirmed. The second factor is how to differentiate stem cells into the required cells and use them effectively to construct three-dimensional tissues; here, tissue-specific scaffolds and signaling systems are essential. The third factor is how to ensure survival of the differentiated cells and regenerated tissues. Regenerated tissues need to contain vascular systems to allow both the tissues themselves and the differentiated cells to survive. Thus, we believe that the vascularization of regenerated tissues will be an important field of research in the near future. In this paper, we focus on adipose-derived stem cells and vascularized tissue regeneration within the context of tissue transplantation.     

Disinfection of human musculoskeletal allografts in tissue banking: a systematic review

Musculoskeletal allografts are typically disinfected using antibiotics, irradiation or chemical methods but protocols vary significantly between tissue banks. It is likely that different disinfection protocols will not have the same level of microorganism kill; they may also have varying effects on the structural integrity of the tissue, which could lead to significant differences in terms of clinical outcome in recipients. Ideally, a disinfection protocol should achieve the greatest bioburden reduction with the lowest possible impact on tissue integrity. A systematic review of three databases found 68 laboratory and clinical studies that analyzed the microbial bioburden or contamination rates of musculoskeletal allografts. The use of peracetic acid–ethanol or ionizing radiation was found to be most effective for disinfection of tissues. The use of irradiation is the most frequently published method for the terminal sterilization of musculoskeletal allografts; it is widely used and its efficacy is well documented in the literature. However, effective disinfection results were still observed using the BioCleanse? Tissue Sterilization process, pulsatile lavage with antibiotics, ethylene oxide, and chlorhexidine. The variety of effective methods to reduce contamination rate or bioburden, in conjunction with limited high quality evidence provides little support for the recommendation of a single bioburden reduction method.     

The emergence and pitfalls of international tissue banking

The rapid growth of tissue banking and associated international organisations following the fall of the Berlin wall in 1991 is described. This surge in collaboration led to a world-wide constructive movement to use and to produce human tissues. As the years progressed industrialisation, led by the USA, improved the quality of tissue allografts but led higher costs and consolidation within the developing industry. The growth of litigation more than kept pace with the industrial progress. One landmark case is described, the outcome of which could revolutionise the current practices now applied to eliminate possible viral contamination of implanted tissue grafts.     

The tissue banking in cancer and stem cell research

The Sapio Award was established in 1999 by the Sapio Group along with several Italian universities and research centers to recognize Italian scientists who have made a major contribution to the discovery or development of novel technologies in the fields of biotechnology, social and health services, nonotechnology and biosecurity in agricultural production and scientific distribution. The 2006 edition of the award meeting centered around the issues of tissue banks and biorepositories and translational medicine. The organizing committee divided this edition into a pre-meeting held in Milan on October 18, 2006 and a master meeting on October 19, 2006, held at the ISS in Rome. A summary of these meetings is given.     

Disinfection of human cardiac valve allografts in tissue banking: systematic review report

Cardiovascular allografts are usually disinfected using antibiotics, but protocols vary significantly between tissue banks. It is likely that different disinfection protocols will not have the same level of efficacy; they may also have varying effects on the structural integrity of the tissue, which could lead to significant differences in terms of clinical outcome in recipients. Ideally, a disinfection protocol should achieve the greatest bioburden reduction with the lowest possible impact on tissue integrity. We conducted a systematic review of methods applied to disinfect cardiovascular tissues. The use of multiple broad spectrum antibiotics in conjunction with an antifungal agent resulted in the greatest reduction in bioburden. Antibiotic incubation periods were limited to less than 24 h, and most protocols incubated tissues at 4 °C, however one study demonstrated a greater reduction of microbial load at 37 °C. None of the reviewed studies looked at the impact of these disinfection protocols on the risk of infection or any other clinical outcome in recipients.     

Disinfection of human skin allografts in tissue banking: a systematic review report

The use of skin allografts to temporarily replace lost or damaged skin is practiced worldwide. Naturally occurring contamination can be present on skin or can be introduced at recovery or during processing. This contamination can pose a threat to allograft recipients. Bacterial culture and disinfection of allografts are mandated, but the specific practices and methodologies are not dictated by standards. A systematic review of literature from three databases found 12 research articles that evaluated bioburden reduction processes of skin grafts. The use of broad spectrum antibiotics and antifungal agents was the most frequently identified disinfection method reported demonstrating reductions in contamination rates. It was determined that the greatest reduction in the skin allograft contamination rates utilized 0.1 % peracetic acid or 25 kGy of gamma irradiation at lower temperatures.     

Advances of radiation sterilisation in tissue banking

Under the auspices of the IAEA tissue banking programme on “Radiation Sterilisation of Tissue Graft” conducted from 1985 to 2004, many scientists and surgeons were involved in various regional research and development (R&D) projects mainly in dealing with radiation dose selection, radiation effects on human tissues and quality system in radiation sterilisation. New findings on radiation effects, tissue processing and preservation were shared during the regional and interregional meetings and workshops. Many tissue banks started to use radiation (25 kGy) to sterilize tissue grafts for tissue safety and efficacy and still continue to use it. The IAEA Code of Practice for Radiation Sterilization of Tissues Allografts developed in 2007 offered simpler methods to conduct radiation dose setting and dose validation experiments for tissue grafts. Advances in dose selection and dose mapping are continued under the quality management system when banks need to be certified to continue their operation. The combination of good tissue processing and preservation as well as good radiation practice will ensure the tissue products are properly sterilised thus safe and of high quality. Experience in meeting challenges in using radiation sterilisation and achievements reported by the tissue bankers are shared here.     

40 years of tissue banking in Estonia

A survey is given of the development of tissue banking in Estonia during40 years, in which we address methods of tissue preservation, application ofpreserved skeletal tissues in orthopaedics as well as issues of clinical andexperimental research in this area. Preparation and use of demineralized andmorselized bone allografts has been significant during the last ten years.Progress of endoprosthetic joint surgery has essentially increased the need forbone transplantation in orthopaedics.     

Homograft banking in Singapore: two years of cardiovascular tissue banking in Southeast Asia

Established in 2008, the National Cardiovascular Homograft Bank (NCHB) has been instrumental in creating an available supply of cardiovascular tissues for implantation in Singapore. This article introduces its collaboration with Singapore General Hospital Skin Bank Unit. The procedure of homograft recovery, processing, cryopreservation and quality assurance are presented. Since its establishment, the NCHB has followed the guidelines set by the Ministry of Health Singapore and the American Association of Tissue Banks. A total of 57 homografts had been recovered and 40 homografts were determined to be suitable for clinical use. The most significant reasons for non-clinical use are positive microbiological culture or unsuitable graft condition. Crucial findings prompted reviews and implementation of new procedures to improve the safety of homograft recipients. These include (1) a change in antibiotic decontamination regime from penicillin and streptomycin to amikacin and vancomycin after a review and (2) mandating histopathogical examination since the discovery of cardiac sarcoidosis in a previously undiagnosed donor. Further, the NCHB also routinely performs dengue virus screening, for donors suspected of dengue infection. Cultural factors which affect the donation rate are also briefly explored. By 2010, 31 homografts had been implanted into recipients with congenital or acquired heart valve conditions. More than half of these recipients were children. Post-operative outcomes had been encouraging, with no report of adverse events attributed to implanted homografts.     

Donation transplants and tissue banking in Mexico

Knowledge about transplants in Mexico goes back to the Aztec period.Today the need for organ and tissue transplants in Mexico is high; theestimatednumber is 100,000 patients, but there are only 2 donors per million population,for corneas. The organ, tissue and cell transplantation law which was modifiedin 2,000, establishes that when a person dies, he will be a potential donor oforgans and tissues. This new law will give hope to many patients, since it isexpected to increase significantly the amount of organs and tissues fortransplants. At present Mexico has 178 hospitals that are authorized to carryout organ and tissue transplants, and 53 Tissue Banks.     

The current limitations on tissue banking from an academic perspective

For research on human physiology and pathologies the most relevant results come from human tissue, necessitating the creation of more tissue banks. This need is acknowledged by academics, clinical researchers and the pharmaceutical industry. For academics, the major obstacles to establishing tissue banks are the somewhat cumbersome ethical procedures, a perceived lack of demand for human tissue and insufficient knowledge about supply and its demographic differences. The causes are inter-related: confusing and time-consuming ethics applications cause some researchers to avoid human tissue work and expend research efforts on animal studies, leading to a false presumption of a lower level of demand for human tissue. Lack of knowledge about why rates of donation are low, and why there are differences in donation for different organs, leads to an uncertainty about supply. This too poses a problem for tissue bank establishment, and further research into this area is required.     

Comparison of automated and conventional microbiological examination of donated human cardiac tissue in heart valve banking

Most tissue banks use the conventional method; however, the automated method has advantages over the conventional method. The aim of this study was to compare the conventional and automated methods of culture in human cardiac tissue using an artificial contamination model. Myocardial samples were contaminated with sequential concentration (10⁴ to 10^?1 CFU/mL) with Pseudomonas aeruginosa, Escherichia coli, Staphylococcus aureus and Candida albicans. Cultures were obtained from solution were the fragment was immersed and minced tissue, before and after the routine decellularization solution, with automated and conventional culture methods. Automated and conventional methods were compared and a p value ≤?0.05 was considered significant. Staphylococcus aureus presented a significantly higher growth in the automated method, as well as faster than the conventional (p?<?0.05). The positivity for growth in the automated method was higher in concentrated inoculum (>?10² CFU/mL) (p?<?0.05). The growth in the automated method was significantly faster than conventional when inoculum concentration was above 10³ CFU/mL. The automated culture method is faster than conventional method with a higher positivity in a contaminated model of myocardial and transport solution used in tissue banks.     

The importance of air quality in human biometeorology

Often we encounter a misunderstanding based on the assertion that the criterion of air quality is excluded from studies into meteorology and climatology. In contrast to this, it must be stressed that the admixtures and pollutants pertaining to air quality criteria belong to the atmosphere and therefore, of course, to the field of meteorology, and due to their possible effects also to human biometeorology. A normal weather forecast should include data concerning the concentrations of ozone, nitrogen dioxide, and other substances. Biometeorological weather classifications should also include mention of air quality rather more than previously. For instance, the classification after Bucher used in Germany is referred to and supplemented with respect to air quality. Analogous relationships hold true for the global classification of climates. As an example, the well-known classification after Koeppen is supplemented according to air quality.     

Overview on radiation and tissue banking in Latin America

The International Atomic Energy Agency (IAEA) played an important role in the establishment of new tissue banks and the improvement of already existing ones in Latin America. The Agency strongly supported, through regional, interregional and national technical cooperation projects, providing equipment, expert missions and training for the production and application of human tissues for transplantation. From 1999 to 2005 five regional courses were given in Buenos Aires under the modality of 1-year distance learning training courses and 1-week face to face courses. The courses were organized by the IAEA, through the National Atomic Energy Commission (CNEA) and the Faculty of Medicine of Buenos Aires University as Post Graduate Specialization Course. In 2005 the Latin American countries joined with Spain and Portugal, and created the Ibero American Network Council of Donation and Transplant (Red Consejo Iberoamericano de Donación y Trasplantes—RCIDT). The objective of this network is to cooperate among twenty-one Ibero American countries in organizational and legislative aspects, training of professionals, and ethical and social issues related to the donation and transplantation of organs, tissues and cells. The members of this Network work actively to harmonize the regulations and the control of donation and transplantation of human organs, tissues and cells. At present, in Latin America, more than 220 facilities of tissues banks are operating and tissue allografts are being produced by single and multi-tissue banks. The efforts made by the governments and professionals from the region allow the tissue banks to operate under quality systems and introduce new technologies.     

The land ethic at the turn of the millennium

Aldo Leopold's land ethic has proved more complex and subtle than he envisioned. Nevertheless, Leopold launched what, facing a new millennium, has proved urgent on the global agenda: an environmental ethics concerned in theory and practice about appropriate respect for values carried by the natural world and human responsibilities for the sustaining of these values. A blending of anthropocentric and biocentric values continues to be vital. These duties toward nature involve analysis of ecosystem integrity and evolutionary dynamism at both scientific and philosophical levels; any responsible environmental policy must be based on plausible accounts of ecosystems and a sustainable biosphere. Humans and this planet have entwined destinies. We now envision an Earth ethic beyond the land ethic.