The impact of the International Atomic Energy Agency (IAEA) program on radiation and tissue banking in Asia and the Pacific and the Latin American regions

The technical assistance program of the International Atomic Energy Agency (IAEA) for its member states in the framework of the implementation of its program on radiation and tissue banking focuses on ensuring the availability of quality radiation-sterilised tissue grafts. The IAEA also helps its member states to develop quality control capabilities in order to ensure the safe use of the processed tissues in certain medical treatments. The majority of developing countries does not have such capacity, and must import expensive sterilised tissues from developed countries. The IAEA’s core contribution to its program on radiation and tissue banking in Asia and the Pacific and the Latin American regions is a technology for sterilisation by gamma radiation and a training program for tissue bank operators and medical personnel. The Agency develops capabilities for radiation sterilisation of tissue grafts, both for reducing the pre-processing bacterial load, and as a terminal sterilisation process. Sterilising tissue grafts offers a clear advantage in terms of safety. Moreover, compared to alternative sterilisation methods, radiation sterilisation is considered particularly safe in relation to environmental concerns, and the deposition of harmful residuals in the tissue, which occurs for example in the use of chemical such as ethylene oxide gas. Radiation sterilisation, thus, has become the method of choice for an increasing number of tissue banks. Radiation sterilisation of tissue grafts is a critical component in the chain connecting donors to recipients of high quality tissue grafts. Due to this fact, the IAEA has evolved as the only organisation in the UN System with expertise related to tissue banking.     

The International Atomic Energy Agency (IAEA) Program on Radiation and Tissue Banking: a Successful Program for Developing Countries

Since its inception the IAEA program in radiation and tissue banking supported the establishment of twenty five tissue banks in different countries. Now more than 103 tissue banks are now operating in these countries. The production of sterilized tissues has grown in an exponential mode within the IAEA program. From 1988 until the end of 2000 the production of sterilized tissues was 224,706 grafts, with an estimated value of at least $51,768,553 million dollars at the mean current charge rate in non-commercial banks in Europe and USA. During the period 1997–2002 several countries from Asia and the Pacific region produced more than 155,000 grafts, with an estimated value of about $36.7 million dollars. Training was considered to be one of the most important tasks to be supported. A total of 192 students were registered in the training program and 146 students graduated with a University Diploma. For many developing countries an additional benefit is not having to import expensive sterilized tissues from developed countries, but the exposure of orthopedic and plastic surgeons working, to new methods of using allografts in specific surgical treatments.     

The impact of the International Atomic Energy Agency (IAEA) program on radiation and tissue banking in Korea

In 1971, first bone bank was established at the Department of Orthopaedic Surgery in Catholic University of Korea. The first clinical case was reported at the Journal of Korean Orthopaedic Association in 1973. Subsequently, more than 60 surgical bone banks were established in the university and teaching hospitals throughout country. In 1990, the Korea Biomaterial Research Institute (KBRI) organised the IAEA/RCA training course on tissue banking. In this course students from 17 countries participated. In 1994 the first collaboration for cadaver tissue recovery was performed. It is important to single out that the various religious groups in Korea have favourable attitudes towards tissue donation, which contributes to the success of the tissue banking programs in the country. The demands of allograft were getting increased in the Korean medical and dental society. Currently, 62 hospital based bone banks, 5 processing tissue banks, 1 regional tissue bank and more than 30 tissue distributors are working in Korea. Based on the U.S.A. usage of more than 1,000,000 grafts per year, 100,000–200,000 grafts will be needed in Korea. Those findings indicate a greatly increased need for training of tissue bank operators. The Korean society will need at least 20–30 tissue bank operators for training in every year. The National Training Centre (NTC) for tissue bank operators and medical personal using the IAEA Curriculum in the Korean languages was established in 2003. From 2004 to 2006, NTC have been trained 40 tissue bank operators. They have produced at least 10,000 tissues per year. These figures indicate a cost saving of US$ 10 million. Within 5 years, NTC will train 100 tissue bank operators. These individuals and their respective banks will provide an increasing number of high quality grafts to the communities they serve at a cost far less than if they were acquired from abroad.     

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.     

The Future Role of the International Atomic Energy Authority (IAEA) in Tissue Banking

The International Atomic Energy Agency, an agency of the United Nations, has supported tissue banking programmes in 28 countries to further extend the use of ionising radiation for medical sterilisation applications. Up to 1998, some 115,000 tissue allografts have been produced and clinically used. A new thematic approach has now been introduced to set strict criteria to govern future developments. The emphasis will be on appropriate training and the introduction of Quality Systems in order to achieve international standards. Countries wishing to gain further support will be required to demonstrate the need and performance. To ensure a training mode appropriate to a global organisation, a multi-media training curriculum has been developed, which can be delivered by distance learning methods. Following its successful launch in the Asia Pacific region, the curriculum is now being translated into Spanish for use in Latin American countries. The Republic of Korea government too has provided resources for translation into their language and to initiate a national programme. In other countries national networks are being set up for improving public and professional awareness, training and tissue distribution. Collaboration with international organisations is another new area of development.     

Setting up a Tissue Bank in India: The Tata Memorial Hospital Experience

In India, the procurement of tissues for transplantation is governed by the Transplantation of Human Organs Act, 1994. However, although this law exists, it is primarily applied to organ transplantation and rules and regulations that are specific to tissue banking have yet to be developed.The Tata Memorial Hospital (TMH) Tissue Bank was started in 1988 as part of an International Atomic Energy Agency (IAEA) programme to promote the use of ionising radiation for the sterilisation of biological tissues. It represents the Government of India within this project and was the first such facility in the country. It is registered with the Health Services Maharashtra State and provides lyophilised amnion, dura mater, skin and bone that have been terminally sterilised with exposure to 25 kGy of gamma radiation from a Cobalt 60 source. These are obtained either from cadavers or live donors.To date the TMH Tissue Bank has provided 6328 allografts for use as biological dressings or in various reconstructive procedures.The TMH Tissue Bank has helped initiate a Tissue Bank at the Defence Laboratory (DL), Jodhpur. At present these are the only two Banks in the country using radiation for terminal sterilisation of banked tissues.The availability of safe, clinically useful and cost effective grafts have resulted in changes in surgical treatment with a concomitant increase in demand for grafts and an interest in developing more tissue banks. The availability of donor tissue however, continues to be a major limitation.     

Tissue Banking in India: Gamma-Irradiated Allografts

In India, the procurement of tissues for transplantation is governed by the Transplantation of Human Organs Act, 1994. Although this law exists, it is primarily applied to organ transplantation and rules and regulations that are specific to tissue banking which have yet to be developed. The Tata Memorial Hospital (TMH) Tissue Bank was started in 1988 as part of an International Atomic Energy Agency (IAEA) programme to promote the use of ionising radiation for the sterilisation of biological tissues. It represents the Government of India within this project and was the first facility in the country to use radiation for the sterilisation of allografts. It is registered with the Health Services Maharashtra State and provides freeze-dried, gamma irradiated amnion, dura mater, skin and bone. The tissues are obtained either from cadavers or live donors. To date the TMH Tissue Bank has provided 6328 allografts which have found use as biological dressings and in various reconstructive procedures. The TMH Tissue Bank has helped initiate a Tissue Bank at the Defence Laboratory (DL), Jodhpur. At present these are the only two Banks in the country using radiation for the terminal sterilisation of preserved tissues. The availability of safe, clinically useful and cost effective grafts has stimulated innovative approaches to surgery. There is an increased demand for banked tissues and a heightened interest in the development of tissue banks. Inadequate infrastructure for donor referral programmes and the lack of support for tissue transplant co-ordinators however, continue to limit the availability of donor tissue.     

Comparative morphology and biochemistry of pancreatic tissue fragments transplanted into the anterior eye chamber and subcutaneous regions of the rat

The present study was designed to compare the morphological changes occurring in pancreatic tissue fragments transplanted into the anterior eye chamber (AEC) and the subcutaneous (SC) regions of the rat. Pancreatic tissue segments were removed from the tail end of the pancreas of neonatal rats and transplanted into the AEC and SC region of the neck of homologous rats. Five weeks after transplantation, the grafts were removed and processed for light microscopy, immunohistochemistry and radioimmunoassay. In both pancreatic tissue grafts, the acinar cells degenerated completely after transplantation. In contrast to this, insulin-, glucagon-, somatostatin- and pancreatic polypeptide-positive cells and pancreatic ducts survived equally well in both the AEC and SC grafts. The pattern and percentage distribution of insulin-, glucagon-, somatostatin- and PP-producing cells in the AEC and SC grafts was similar to that observed in normal pancreas. However, the percentage distribution of glucagon- and PP-containing cells was significantly (p < 0.03) lower in SC grafts when compared to normal. Radioimmunoassay showed that the AEC and SC pancreatic tissue grafts contained large quantities of insulin and glucagon. However, the insulin content of AEC was slightly but not significantly higher than that of SC grafts. The protein content of pancreatic tissue grafts in these transplantation sites was still significantly (p < 0.05) lower compared to normal. Lymphatic infiltration was also more conspicuous in SC grafts compared to AEC grafts. This infiltration by lymphatic cells was confined only to the endocrine portion of the graft. In conclusion, pancreatic tissue grafts survived in both the AEC and SC regions of rats but the AEC appears to be more conducive to graft survival than the SC region.     

Xenografting of adult mammalian testis tissue

Xenografting of testis tissue from immature males from several mammalian species to immunodeficient mouse hosts results in production of fertilization-competent sperm. However, the efficiency of testis tissue xenografting from adult donors has not been critically evaluated. Testis tissue xenografting from sexually mature animals could provide an option to preserve the genetic material from valuable males when semen for cryopreservation cannot be collected. To assess the potential use of this technique for adult individuals, testes from adult animals of six species (pig, goat, cattle, donkey, horse and rhesus monkey) were ectopically grafted to host mice. Grafts were recovered and analyzed at three time points: less than 12 weeks, between 12 and 24 weeks and more than 24 weeks after grafting. Histological analysis of the grafts revealed effects of species and donor tissue maturity: all grafts from species with greater daily sperm production (pig and goat) were found to have degenerated tubules or grafts were completely degenerated. None of the xenografts from mature adult bull and monkeys contained differentiated spermatogenic cells when examined more than 12 weeks post-grafting but tubules with Sertoli cells only remained. In grafts from a young adult bull, Sertoli cells persisted much longer than with the mature adult grafts. In grafts from a young adult horse, spermatogenesis proceeded to meiosis. In grafts from a young adult donkey and monkey, however, complete spermatogenesis was found in the grafts. These results show that testis tissue grafts from mature adult donors did not support germ cell differentiation but seminiferous tubules with Sertoli cells only survived in some species. The timing and progression of tubular degeneration after grafting of adult testis tissue appear to be related to the intensity of spermatogenesis at the time of grafting. Testis tissue from sub-adult donors survives better as xenograft than tissue from mature adult donors, and complete spermatogenesis can occur albeit with species-specific differences.     

Force deficit of vascularized skeletal muscle grafts in rabbits

Through autografting experiments on 9-g rectus femoris (RFM) muscles in rabbits, we substantiated a previous observation that the maximum isometric tetanic force (Po) and specific Po (N/cm2) of neurovascular-intact grafts are not different from grafts made with neurovascular repair. We then tested the hypotheses that the specific Po of vascularized grafts is significantly less than that of control RFM muscles and the deficit in the specific Po is associated with increases in connective tissue and interstitial space. The specific Po of the grafts was 65% of the value for control RFM muscles. Connective tissue protein concentration of grafts was 3.8 times greater than the control value of 16.6 +/- 3 micrograms/mg wet mass, but this only accounted for a 5% correction in specific Po. The volume of interstitial space did not differ between grafts and control muscles. We conclude that the deficit of 35% in specific Po of vascularized grafts compared with control values is partially explained by an increase in connective tissue, but a 30% unresolved deficit remains.     

Multimedia materials for education, training, and advocacy in international health: experiences with the Schistosomiasis Control Initiative CD-ROM

We describe an innovative use of multimedia materials to support training and advocacy within a schistosomiasis control programme. The Schistosomiasis Control Initiative (SCI) at Imperial College London works with selected sub-Saharan African countries to develop schistosomiasis control programmes. Two elements of the SCI programme were supported by multimedia materials developed at the Wellcome Trust in collaboration with the SCI: (1) training of programme managers, district health officers, and those delivering practical elements of the programme; and (2) advocacy targeted at decision-makers and donors. Evaluation of the materials revealed high reported ratings for both user satisfaction and impact from use of the product. From this experience we draw out several general messages about development of multimedia materials and how these will play a growing future role in promoting training within international health.     

New trends in microbial technology

Microbial technology includes not only the production of materials in bioreactors, or the production of new catalysts by genetic engineering but extends to aspects of both human and animal health care, waste and pollution management, enhanced oil recovery, mineral leaching, advanced plant breeding, diagnostics and analytical equipment, biosensors, bioelectronics and renewable energy system based on biomass feedstocks. National strategies of industrialized countries are being developed which identify microbial technology as a substantial factor in the attainment of industrial and economic goals. Although extremely promising microbial technology is not a quick fix and its application will only arise as a result of systematic programme of research and development. Such programme requires a broad base of disciplinary underpinning in molecular biology, genetics and bioengineering. The development of expertise of this kind in the tertiary educational institutions is the essential starting point. It should be developed by appropriate programmes and networking systems.     

Development and Involution of Thymus Grafts in Rats with reference to Age and Sex

Two weeks after grafting, whole thymus implants had the characteristic appearance of a normal young thymus. They increased in weight until 6 weeks post-operation and then underwent involution. Maximum weights attained by grafts in male hosts were significantly higher than those attained in female hosts. Initial rates of graft involution were higher in males than in females. Weights attained by grafts in young hosts of either sex reached maxima that were significantly higher than those attained by grafts of the same age in old hosts. The number of thymuses grafted separately into a single host did not influence the weight of the host's own thymus or the mass of individual grafts. However, when multiple grafts were linked together on transplantation, they behaved as an individual graft with respect to general morphology, growth rate and maximum size. With respect to growth and involution, it is suggested that thymic lymphopoiesis is mainly regulated by intrinsic factors emanating from the tissue which survives implantation. Further, the regulators appear to be clone-specific.     

Human saphenous vein and coronary bypass surgery: ultrastructural aspects of conventional and "no-touch" vein graft preparations

Coronary artery bypass graft surgery (CABG) is routinely used to restore blood flow to diseased cardiac muscle due to coronary artery disease. The patency of conventional grafts decreases with time, which is due to thrombosis and formation of neointima. A primary cause of graft failure is the mechanical damage inflicted to the graft during harvesting, including removal of surrounding tissue accompanied by high pressure saline distension to overcome vasospasm (both causing considerable mechanical trauma). The aim of this study was to compare the ultrastructural features of human saphenous vein (SV) grafts harvested conventionally and grafts prepared using an atraumatic 'no-touch' harvesting technique introduced by Souza (1996). The results of this study showed a better preservation of the lumenal endothelium and medial vascular smooth muscle (SM) in 'no-touch' versus conventional grafts. A 'fast' (within 30 min) response of SM cells to conventional harvesting was noted where features of both SM cell division and apoptosis were observed. It is concluded that the 'preserved' nature of the 'no-touch' aortocoronary SV grafts renders them less susceptible to thrombotic and atherosclerotic factors than grafts harvested conventionally. These features are suggested to contribute to the improved early patency rate described using the no-touch technique of SV harvesting.     

Tissue graft rejection in mice

A tissue slice-to-kidney bed grafting system is used to study the mechanism of specific tissue rejection (in this case, rejection of liver tissue) over a series of histocompatibility barriers other than the H-2 barrier. Using the method described, it is possible to obtain a pattern or time-course picture of the immunological process, rather than a mean survival time. It is clear from histological observations of these patterns that, although there are considerable differences in numbers of liver grafts which survive for long period's across the several histocompatibility barriers studied, some grafts in almost every case survive the immunological challenge elicited by the genetic barriers. Grafts of liver tissue are therefore similar, but not identical, in survival patterns to grafts of tumor, ovary, and skin. These studies also indicate that immunological mechanisms controlling rejection of tissue over H barriers other than H-2 differ from those controlling rejection over the major histocompatibility barrier in the mouse.     

Does anterior (non-polarizing region) tissue signal in the developing chick limb?

The morphogenetic properties of embryonic chick limb bud tissue from anterior positions and from the posterior (polarizing) region are compared. Quail grafts, which possess the distinctive nucleolar cell marker, and γ-irradiation are used. Supernumerary limb structures induced by anterior tissue wedge grafts are found to be nearly exclusively graft, donor tissue derived. This contrasts with the duplicate limb structures formed in response to posterior (polarizing region) tissue grafts in which host cells predominate. Distinction between anterior and posterior tissue properties was also demonstrated using doses of radiation (～ 12 Gy = 1200 rad) which inhibit cell proliferation, but have negligible effects on avian polarizing activity. These doses, however, are found to completely abolish morphogenetic activity by chick or quail anterior tissue grafts. The results of anterior (nonpolarizing) region tissue grafts are best interpreted as graft self-differentiation under the influence of a posterior signalling region, whose properties in the limb bud are demonstrably unique.     

The development of dopamine overflow from foetal nigral grafts in the intact rat striatum and their influence on contralateral striatal dopamine overflow.

In this study, cell suspensions of foetal rat ventral mesencephalic dopaminergic tissue were grafted to the intact (non-lesioned) striatum of adult rats. Differential pulse voltammetry at carbon-fibre micro electrodes (12 microm diameter) was employed to first, monitor the development of dopamine overflow over a 20 week period within the grafts and secondly, their influence on contralateral striatal dopamine overflow. At 8 and 20 weeks, animals were pre-treated with pargyline and both striata were monitored for dopamine overflow for 90 min following d-amphetamine administration. Amphetamine led to a significant increase in dopamine overflow in both the grafted striatum and the contralateral striatum. The time course of dopamine overflow in both the grafted striatum and the striatum contralateral to the graft was similar in all groups of animals. Although the actual concentration of dopamine measured in 20 week old grafts was more (approximately 21%) than that measured in 8 week old grafts, there was no significant difference between the two time points. The concentration of dopamine measured in the striatum contralateral to 8 week old grafts was significantly lower (approximately 43%) than that measured in the striatum of a normal control rats. There was no significant difference between the concentration of dopamine measured in the striatum contralateral to 20 week old grafts and normal control rats. In conclusion, dopamine overflow from a ventral mesencephalic graft does not change significantly between 8 and 20 weeks following grafting. However, the grafted tissue causes a decrease of d-amphetamine-induced dopamine overflow in the contralateral side 8 weeks following grafting, which is restored 12 weeks later.     

Morphometric and histologic studies after transplantation of avital xenogenic tissues

The reaction of subcutaneous soft tissue on xenogenic grafts was studied by means of morphometric and histological methods. Xenogenic grafts of human dura and bovine vessels were prepared with fibrin tissue adhesives and with a Lys-Pro-derivative which is an angiogenic factor in other animal models. The best results could be demonstrated in the animal group in which the Lys-Pro-derivative was used, 7, 28, and 87 d after operation.     

Distinct in vivo CD8 and CD4 T cell responses against normal and malignant tissues

Normal tissue and tumour grafts expressing the same alloantigens often elicit distinct immune responses whereby only normal tissue is rejected. To investigate the mechanisms that underlie these distinct outcomes, we compared the responses of adoptively transferred HY-specific conventional (CD8 and CD4) or regulatory T (Treg) cells in mice bearing HY-expressing tumour, syngeneic male skin graft or both. For local T cell priming, T cell re-circulation, graft localization and retention, skin grafts were more efficient than tumours. Skin grafts were also capable of differentiating CD4 T cells into functional Th1 cells. Donor T cell responses were inversely correlated with tumour progression. When skin graft and tumour transplants were performed sequentially, contemporary graft and tumour burden enhanced CD8 but reduced CD4 T cell responses causing accelerated skin-graft rejection without influencing tumour growth. Although both skin grafts and tumours were able to expand HY-specific Treg cells in draining lymph node (dLN), the proportion of tumour-infiltrating Treg cells was significantly higher than that within skin grafts, correlating with accelerated tumour growth. Moreover, there was a higher level of HY antigen presentation by host APC in tumour-dLN than in graft-dLN. Finally, tumour tissues expressed a significant higher level of IDO, TGFβ, IL10 and Arginase I than skin grafts, indicating that malignant but not normal tissue represents a stronger immunosuppressive environment. These comparisons provide important insight into the in vivo mechanisms that conspire to compromise tumour-specific adaptive immunity and identify new targets for cancer immunotherapy.     

Analysis of gene expression in bovine testis tissue prior to ectopic testis tissue xenografting and during the grafting period

The purpose of this study was to identify factors that contribute to bovine testis development and donor age-dependent differences in the abilities of bovine ectopic testis tissue grafts to produce elongated spermatids. We used real-time RT-PCR and microarrays to evaluate and to identify the expression of genes that are involved in Sertoli and germ cell development in bovine testis tissues. Testis tissues were obtained from 2-, 4-, and 8-wk-old bull calves and were grafted immediately. Grafted bovine testis tissue was removed from mice, RNA was isolated from the grafts, and real-time RT-PCR was used to evaluate gene expression during the grafting period. In addition, the gene expression in the donor tissue was analyzed using Affymetrix Bovine GeneChips, to identify differentially expressed genes. Examination of the testis tissue grafts indicated that Sertoli cell-specific gene expression was lower in 8-wk donor tissue grafts compared to the donors of other ages. Furthermore, the expression of KIT, which is a germ cell-specific gene, was low in testis tissue grafts. Microarray analysis of the donor tissue showed that several genes that are involved in angiogenesis or tissue growth were differentially expressed in 2-, 4-, and 8-wk-old bovine testes. The levels of expression of the genes for angiogenin, transgelin, thrombomodulin, early growth response 1, insulin-like growth factor 2, and insulin-like growth factor-binding protein 3 were lower in testis tissues from older animals. Using these data, it will be possible in the future to manipulate the testis xenograft microenvironment so as to improve the efficiency of sperm production within the graft.