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  • Krawczyk, M., et al. (author)
  • Liver Transplantation for Hepatic Trauma: A Study From the European Liver Transplant Registry
  • 2016
  • In: Transplantation. - : Ovid Technologies (Wolters Kluwer Health). - 0041-1337. ; 100:11, s. 2372-2381
  • Journal article (peer-reviewed)abstract
    • Background. Liver transplantation is the most extreme form of surgical management of patients with hepatic trauma, with very limited literature data supporting its use. The aim of this study was to assess the results of liver transplantation for hepatic trauma. Methods. This retrospective analysis based on European Liver Transplant Registry comprised data of 73 recipients of liver transplantation for hepatic trauma performed in 37 centers in the period between 1987 and 2013. Mortality and graft loss rates at 90 days were set as primary and secondary outcome measures, respectively. Results. Mortality and graft loss rates at 90 days were 42.5% and 46.6%, respectively. Regarding general variables, cross-clamping without extracorporeal veno-venous bypass was the only independent risk factor for both mortality (P = 0.031) and graft loss (P = 0.034). Regarding more detailed factors, grade of liver trauma exceeding IV increased the risk ofmortality (P = 0.005) and graft loss (P = 0.018). Moreover, a tendency above the level of significance was observed for the negative impact of injury severity score (ISS) onmortality (P = 0.071). The optimal cutoff for ISS was 33, with sensitivity of 60.0%, specificity of 80.0%, positive predictive value of 75.0%, and negative predictive value of 66.7%. Conclusions. Liver transplantation seems to be justified in selected patients with otherwise fatal severe liver injuries, particularly in whom cross-clamping without extracorporeal bypass can be omitted. The ISS cutoff less than 33 may be useful in the selection process.
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  • Hansen, Steffen Foss, et al. (author)
  • Nanotechnology meets circular economy
  • 2022
  • In: Nature Nanotechnology. - : Springer Science and Business Media LLC. - 1748-3387 .- 1748-3395. ; 17:7, s. 682-685
  • Journal article (other academic/artistic)
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  • Moberg, L, et al. (author)
  • Production of tissue factor by pancreatic islet cells as a trigger of detrimental thrombotic reactions in clinical islet transplantation
  • 2002
  • In: The Lancet. - 1474-547X. ; 360:9350, s. 2039-2045
  • Journal article (peer-reviewed)abstract
    • Background Intraportal transplantation of pancreatic islets offers improved glycaemic control and insulin independence in type 1 diabetes mellitus, but intraportal thrombosis remains a possible complication. The thrombotic reaction may explain why graft loss occurs and islets from more than one donor are needed, since contact between human islets and ABO-compatible blood in vitro triggers a thrombotic reaction that damages the islets. We investigated the possible mechanism and treatment of such thrombotic reactions. Methods Coagulation activation and islet damage were monitored in four patients undergoing clinical islet transplantation according to a modified Edmonton protocol. Expression of tissue factor (TF) in the islet preparations was investigated by immunohistochemistry, immunoprecipitation, electron microscopy, and RT-PCR. To assess TF activity in purified islets, human islets were mixed with non-anticoagulated ABO-compatible blood in tubing loops coated with heparin. Findings Coagulation activation and subsequent release of insulin were found consistently after clinical islet transplantation, even in the absence of signs of intraportal thrombosis. The endocrine, but not the exocrine, cells of the pancreas were found to synthesise and secrete active TF. The clotting reaction triggered by pancreatic islets in vitro could be abrogated by blocking the active site of TF with specific antibodies or site-inactivated factor Vlla, a candidate drug for inhibition of TF activity in vivo. Interpretation Blockade of TF represents a new therapeutic approach that might increase the success of islet transplantation in patients with type 1 diabetes, in terms of both the risk of intraportal thrombosis and the need for islets from more than one donor.
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  • Brandhorst, Heide, et al. (author)
  • Large-Scale Comparison of Liberase HI and Collagenase NB1 Utilized for Human Islet Isolation
  • 2010
  • In: Cell Transplantation. - 0963-6897 .- 1555-3892. ; 19:1, s. 3-8
  • Journal article (peer-reviewed)abstract
    • For more than a decade Liberase HI was commonly used as the standard enzyme blend for clinical human islet isolation until enforced replacement by collagenase NB1 (NB1). This change resulted initially in a reduction in islet isolation outcome and transplant activities worldwide. This retrospective study was initiated to compare the efficiency of NB1 premium grade with Liberase in 197 human islet isolations. All pancreata were processed between January 2006 and June 2008 utilizing the same procedures for isolation and quality assessment except the administration of preselected lots of either Liberase (n = 101) or NB1 (n = 96). Utilizing Liberase significantly more digested tissue and purified islet yield was produced compared to NB1. In contrast, the use of NB1 was associated with significantly higher purity and glucose stimulation index during dynamic perifusion. The expression of proinflammatory markers was almost identical except tissue factor expression that was higher after utilization of Liberase. No difference was found in the percentage of pancreata fulfilling the criteria for clinical islet transplantation. The results suggest that Liberase is more efficient for pancreas dissociation than collagenase NB1 but seems to be more harmful to exocrine cells and islet tissue.
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  • Foss, Stein, et al. (author)
  • First Scandinavian Protocol for Controlled Donation After Circulatory Death Using Normothermic Regional Perfusion
  • 2018
  • In: Transplantation direct. - : LIPPINCOTT WILLIAMS & WILKINS. - 2373-8731. ; 4:7
  • Journal article (peer-reviewed)abstract
    • Background. Donation after circulatory death (DCD) can increase the pool of available organs for transplantation. This pilot study evaluates the implementation of a controlled DCD (cDCD) protocol using normothermic regional perfusion in Norway. Methods. Patients aged 16 to 60 years that are in coma with documented devastating brain injury in need of mechanical ventilation, who would most likely attain cardiac arrest within 60 minutes after extubation, were eligible. With the acceptance from the next of kin and their wish for organ donation, life support was withdrawn and cardiac arrest observed. After a 5-minute no-touch period, extracorporeal membrane oxygenation for post mortem regional normothermic regional perfusion was established. Cerebral and cardiac reperfusion was prevented by an aortic occlusion catheter. Measured glomerular filtration rates 1 year postengraftment were compared between cDCD grafts and age-matched grafts donated after brain death (DBD). Results. Eight cDCD were performed from 2014 to 2015. Circulation ceased median 12 (range, 6-24) minutes after withdrawal of life-sustaining treatment. Fourteen kidneys and 2 livers were retrieved and subsequently transplanted. Functional warm ischemic time was 26 (20-51) minutes. Regional perfusion was applied for 97 minutes (54-106 minutes). Measured glomerular filtration rate 1 year postengraftment was not significantly different between cDCD and donation after brain death organs, 75 (65-76) vs 60 (37-112) mL/min per 1.73 m(2) (P = 0.23). No complications have been observed in the 2 cDCD livers. Conclusion. A protocol for cDCD is successfully established in Norway. Excellent transplant outcomes have encouraged us to continue this work addressing the shortage of organs for transplantation.
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  • Goto, M, et al. (author)
  • Refinement of the automated method for human islet isolation and presentation of a closed system for in vitro islet culture
  • 2004
  • In: Transplantation. - 1534-6080 .- 0041-1337. ; 78, s. 1367-1375
  • Journal article (peer-reviewed)abstract
    • Background. The procedure of human islet isolation needs further optimization and standardization. Here, we describe techniques to enhance enzymatic digestion and minimize mechanical forces during the digestion process. The isolation protocol has also been modified to meet current GMP (cGMP) standards. Moreover, the impact of donor- and process-related factors was correlated to the use of islets for clinical transplantation. Methods. One hundred twelve standardized consecutive islet isolations were evaluated. Metyltioninklorid and indermil (topical tissue adhesive) were applied to detect leakage of collagenase injected and to repair the damaged pancreatic glands. The effects of dye and glue were evaluated in terms of islet yield, islet function using the perifusion assay, and success rate of the isolation. To analyze key factors for successful isolations, both univariate and multivariate regression analysis were performed. Results. Both Metyltioninklorid and Indermil were effective to prevent leakage of enzyme solutions from the pancreatic glands. Both islet yield and success rate were higher when these tools were applied (4,516.1 +/- 543.0 vs. 3,447.7 +/- 323.5, P=0.02; 50.0% vs. 21.3%, P=0.02, respectively). No adverse effects on islet function or collagenase activity were observed. Multivariate regression analysis identified the maximal recorded amylase >100 U/L (P=0.026), BMI (P=0.03), and the use of catecholamine (P=0.04) as crucial donor-related factors. In addition, cold ischemia time (P=0.005), the dissection procedure using whole glands with duodenum (P=0.02), and the local procurement team (P=0.03) were identified as crucial isolation-related variables. Conclusions. A standardized technique of islet isolation is presented applying novel means to improve enzymatic digestion and to meet cGMP standards.
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  • Hansen, Steffen Foss, et al. (author)
  • To be or not to be a nanomaterial
  • 2022
  • In: Journal of Nanoparticle Research. - : Springer Science and Business Media LLC. - 1388-0764 .- 1572-896X. ; 24:12
  • Journal article (peer-reviewed)abstract
    • In early 2021, the new definition of the term “nanomaterial” proposed by the European Commission (EC) was subject to a stakeholder consultation and in June 2022, the EC published its updated definition. Based on an independent analysis of the different versions of the definition and the results of the stakeholder consultation, the aim of this paper is to identify key aspects to be considered when deciding whether a material should be regarded as a nanomaterial. More than 130 comments submitted during the stakeholder consultation by various organizations, companies, citizens, and authorities were analyzed. We find that the introduction of new terms such as “solid particles” has added clarity to terms used in the former definition. Our analysis shows that stakeholders seemed inclined to maintain the default number-based 50% threshold value, but were opposed to (1) the possible flexibility of varying the threshold in specific sectorial legislation, (2) the default inclusion of carbonaceous materials < 1 nm, and (3) the use of volume specific surface area (VSSA) other than for excluding materials from being defined as nanomaterials. Overall, we find that the updated definition addresses many of the limitations of the former definition. However, the updated definition also creates new challenges that will have to be addressed via development of new regulatory guidance. Apart from the relatively minor change of the VSSA threshold from 5 to 6 m2/cm3, it generally seems that no arguments from the stakeholder consultation made the EC reconsider its position. Graphical Abstract: [Figure not available: see fulltext.].
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  • Imsland, A.K, et al. (author)
  • Temperature and salinity effects on plasma insulin-like growth factor-1 concentrations and growth in juvenile turbot (Scophthalmus maximus).
  • 2007
  • In: Aquaculture. - : Elsevier BV. - 0044-8486. ; 271:1-4, s. 546-552
  • Journal article (peer-reviewed)abstract
    • The effects of temperature and salinity on plasma IGF-I levels and its interrelationship with growth, daily feed intake and feed conversion of juvenile turbot (initial mean weight 14 g) were investigated by rearing fish at 10, 14, 18 and 22 °C and 15, 25 and 33.5‰ for 3 months. The plasma IGF-I levels increased with increasing temperatures reaching a plateau around 18 °C. Further, both temperature and salinity had a significant effect on growth, daily feed intake and feed conversion efficiency in juvenile turbot. Growth, food consumption, and food conversion efficiency were highest at 18 °C and 15‰, and lowest at 10 °C and 33.5‰. Although there was a high variation between IGF-I values within all groups there was a positive relationship between IGF-I levels and specific growth rates and daily feed intake. The levels of IGF-I were almost three times higher for fish with higher growth rates than for those with lower growth. In addition, the results show evidence for an increased appetite in fish with high plasma IGF-I levels. Interestingly, there was no correlation between environmental salinity and IGF-I levels, although decreased salinity improves growth and feed conversion efficiency.
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  • Morken, Nils-Halvdan, 1969, et al. (author)
  • Obstetric and neonatal outcome of pregnancies fathered by males on immunosuppression after solid organ transplantation.
  • 2015
  • In: American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. - : Elsevier BV. - 1600-6143. ; 15:6, s. 1666-73
  • Journal article (peer-reviewed)abstract
    • Immunosuppressive drugs may influence spermatogenesis, but little is known about outcome of pregnancies fathered by transplanted males. We estimated risk of adverse outcomes in pregnancies (with data after the first trimester) fathered by males that had undergone organ transplantation and were treated with immunosuppression. A population-based study, linking data from the Norwegian transplant registry and the Medical Birth Registry of Norway during 1967-2009 was designed. All Norwegian men undergoing solid organ transplantation were included. Odds ratios for major malformations, preeclampsia, preterm delivery (<37 weeks) and small-for-gestational-age were obtained using logistic regression. A total of 2463 transplanted males, fathering babies of 4614 deliveries before and 474 deliveries after transplantation were identified. The risk of preeclampsia was increased (AOR: 7.4, 95% CI: 1.1-51.4,) after transplantation compared to prior to transplantation. No increased risk was found for congenital malformations or other outcomes when compared with pregnancies before transplantation or with the general population (2 511 506 births). Our results indicate an increased risk of preeclampsia mediated through the transplanted and immunosuppressed father. Importantly, no increased risk was found for other adverse obstetric outcomes or malformations, which may reassure male transplant recipients planning to father children.
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  • Arvidsson, Rickard, 1984, et al. (author)
  • Prospective environmental risk screening of seven advanced materials based on production volumes and aquatic ecotoxicity
  • 2022
  • In: NanoImpact. - : Elsevier BV. - 2452-0748. ; 25
  • Journal article (peer-reviewed)abstract
    • The number and volume of advanced materials being manufactured is increasing. In order to mitigate future impacts from such materials, assessment methods that can provide early indications of potential environmental risk are required. This paper presents a further development and testing of an environmental risk screening method based on two proxy measures: aquatic ecotoxicity and global annual production volumes. In addition to considering current production volumes, this further developed method considers potential future production volumes, thereby enabling prospective environmental risk screening. The proxy measures are applied to seven advanced materials: graphene, graphene oxide, nanocellulose, nanodiamond, quantum dots, nano-sized molybdenum disulfide, and MXenes. Only MXenes show high aquatic ecotoxicity, though the number of test results is still very limited. While current production volumes are relatively modest for most materials, several of the materials (graphene, graphene oxide, nanocellulose, nano-sized molybdenum disulfide, and MXenes) have the potential to become high-volume materials in the future. For MXenes, with both high aquatic ecotoxicity and high potential future production volumes, more detailed environmental risk assessments should be considered. For the other materials with high potential future production volumes, the recommendation is to continuously monitor their aquatic ecotoxicity data. Based on the application of the proxy measures combined with future scenarios for production volumes, we recommend this environmental risk screening method be used in the early development of advanced materials to prioritize which advanced materials should be subject to more detailed environmental assessments.
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  • Bjerke, Joakim, et al. (author)
  • Peak knee flexion angles during stair descent in TKA patients
  • 2014
  • In: The Journal of Arthroplasty. - : Elsevier. - 0883-5403 .- 1532-8406. ; 29:4, s. 707-711
  • Journal article (peer-reviewed)abstract
    • Reduced peak knee flexion during stair descent (PKSD) is demonstrated in subjects with total knee arthroplasty (TKA), but the underlying factors are not well studied. 3D gait patterns during stair descent, peak passive knee flexion (PPKF), quadriceps strength, pain, proprioception, demographics, and anthropometrics were assessed in 23 unilateral TKA-subjects ~ 19 months post-operatively, and in 23 controls. PKSD, PPKF and quadriceps strength were reduced in the TKA-side, but also in the contralateral side. A multiple regression analysis identified PPKF as the only predictor (57%) to explain the relationship with PKSD. PPKF was, however sufficient for normal PKSD. Deficits in quadriceps strength in TKA-group suggest that strength is also contributing to smaller PKSD. Increased hip adduction at PKSD may indicate both compensatory strategy and reduced hip strength.
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  • Cruchley, S., et al. (author)
  • Cautionary note on use of focused ion beam sectioning as technique for characterising oxidation damage in Ni based superalloys
  • 2014
  • In: Materials at High Temperature. - : Science Reviews 2000 Ltd.. - 0960-3409 .- 1878-6413. ; 31:1, s. 27-33
  • Journal article (peer-reviewed)abstract
    • Previous observations on Ni based superalloys, obtained through the use of focused ion beam (FIB) sample preparation and imaging, have reported the presence of subsurface voids after oxidation. In this present study, oxidised specimens of the Ni based superalloy, RR1000, were subjected to conventional sample preparation as well as both dual and single beam FIB preparation, with the aim of re-examining the previous observations of subsurface void formation. It is clear from FIB preparations that features previously interpreted as networks of voids have been demonstrated to be internal oxides by varying the sample tilt angles and imaging signal using either secondary electrons (SEs) or secondary ions (SIs). Conventional preparation methods illustrate the presence of subsurface alumina intrusions and the absence of voids, supporting previous evidence. The positive identification of voids and oxides by FIB can be complex and prone to misinterpretation and thus, the use of several imaging conditions and tilt angles must be used, along with conventional preparation methods, to confirm or refute the presence of voids underneath oxides.
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  • Eriksson, Olof, et al. (author)
  • Positron emission tomography in clinical islet transplantation
  • 2009
  • In: American Journal of Transplantation. - : Elsevier BV. - 1600-6135 .- 1600-6143. ; 9:12, s. 2816-2824
  • Journal article (peer-reviewed)abstract
    • The fate of islets in clinical transplantation is unclear. To elude on this positron emission tomography combined with computed tomography (PET/CT) was performed for 60 min during islet transplantation in five patients receiving six transplants. A fraction of the islets (23%) were labeled with 18F-fluorodeoxyglucose ([(18)F]FDG) and carefully mixed with unlabeled islets just prior to intraportal transplantation. The peak radioactivity concentration in the liver was found at 19 min after start of islet infusion and corresponded to only 75% of what was expected, indicating that islets are lost during the transplantation procedure. No accumulation of radioactivity was found in the lungs. A nonphysiological peak of C-peptide was found in plasma during and immediately after transplantation in all subjects. Distribution in the liver was heterogeneous with wide variations in location and concentration. Islets found in areas with concentrations of >400 IEQ/cc liver tissue varied between 1% and 32% of the graft in different subjects. No side effects attributed to the PET/CT procedure were found. Clinical outcome in all patients was comparable to that previously observed indicating that the [(18)F]FDG labeling procedure did not harm the islets. The technique has potential to be used to assess approaches to enhance islet survival and engraftment in clinical transplantation.
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  • Flahou, Bram, et al. (author)
  • Evidence for a primate origin of zoonotic Helicobacter suis colonizing domesticated pigs.
  • 2018
  • In: The ISME journal. - : Springer Science and Business Media LLC. - 1751-7370 .- 1751-7362. ; 12:1, s. 77-86
  • Journal article (peer-reviewed)abstract
    • Helicobacter suis is the second most prevalent Helicobacter species in the stomach of humans suffering from gastric disease. This bacterium mainly inhabits the stomach of domesticated pigs, in which it causes gastric disease, but it appears to be absent in wild boars. Interestingly, it also colonizes the stomach of asymptomatic rhesus and cynomolgus monkeys. The origin of modern human-, pig- or non-human primate-associated H. suis strains in these respective host populations was hitherto unknown. Here we show that H. suis in pigs possibly originates from non-human primates. Our data suggest that a host jump from macaques to pigs happened between 100000 and 15000 years ago and that pig domestication has had a significant impact on the spread of H. suis in the pig population, from where this pathogen occasionally infects humans. Thus, in contrast to our expectations, H. suis appears to have evolved in its main host in a completely different way than its close relative Helicobacter pylori in humans.
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  • Henry, C., et al. (author)
  • Entrepreneurial Leadership and Gender : Exploring Theory and Practice in Global Contexts
  • 2015
  • In: Journal of small business management (Print). - : John Wiley & Sons. - 0047-2778 .- 1540-627X. ; 53:3, s. 581-586
  • Journal article (peer-reviewed)abstract
    • This article reflects on extant scholarship on entrepreneurial leadership and gender, as published in both the Journal of Small Business Management and elsewhere. As such, it lays the foundation for the special issue, and contributes to current knowledge in the field. Our selected papers-summarized and critiqued in this article-collectively offer a contemporary view of women's entrepreneurial leadership at the global level that should usefully contribute to extending scholarly debates. In this regard, we highlight the diversity and complexity of women's entrepreneurial leadership, and demonstrate that it is both economically and contextually embedded, worthy of further scholarly attention. 
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  • Henry, C., et al. (author)
  • Women’s entrepreneurship policy : A 13-nation cross-country comparison
  • 2017
  • In: Entrepreneurial ecosystems and growth of women's entrepreneurship. - : Edward Elgar Publishing. - 9781785364624 - 9781785364617 ; , s. 244-278
  • Book chapter (other academic/artistic)abstract
    • Public policy is a key element within the entrepreneurial ecosystem in that policy has the potential to shape venture creation behavior and entrepreneurial outcomes. In response to studies documenting a gender gap in entrepreneurial activity, government attention to women’s entrepreneurship has increased in the past two decades. Nevertheless, there are few cross-cultural studies to inform policy development. This 13-nation study draws on gender and institutional theory to report on the status of female-focused SME/entrepreneurship policies and to ask: How - and to what extent - do women’s entrepreneurship policies differ among countries? A common methodological approach is used to identify gaps in the policy-practice nexus, highlighting countries where policy is weak but practice is strong and vice versa. Recommendations for future research are advanced. 
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  • Johansson, Helena, et al. (author)
  • Tissue factor produced by the endocrine cells of the islets of Langerhans is associated with a negative outcome of clinical islet transplantation
  • 2005
  • In: Diabetes. - : American Diabetes Association. - 0012-1797 .- 1939-327X. ; 54:6, s. 1755-62
  • Journal article (peer-reviewed)abstract
    • There are strong indications that only a small fraction of grafts successfully engraft in clinical islet transplantation. One explanation may be the instant blood-mediated inflammatory reaction (IBMIR) elicited by tissue factor, which is produced by the endocrine cells. In the present study, we show that islets intended for islet transplantation produce tissue factor in both the transmembrane and the alternatively spliced form and that the membrane-bound form is released as microparticles often associated with both insulin and glucagon granules. A low-molecular mass factor VIIa (FVIIa) inhibitor that indirectly blocks both forms of tissue factor was shown in vitro to be a promising drug to eliminate the IBMIR. Thrombin-antithrombin complex (TAT) and FVIIa-antithrombin complex (FVIIa-AT) were measured in nine patients who together received 20 infusions of isolated human islets. Both the TAT and FVIIa-AT complexes increased rapidly within 15-60 min after infusion. When the initial TAT and FVIIa-AT levels were plotted against the increase in C-peptide concentration after 7 days, patients with an initially strong IBMIR showed no significant increase in insulin synthesis after 7 days. In conclusion, tissue factor present in both the islets and the culture medium and elicits IBMIR, which affects the function of the transplanted islets.
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  • Lund, T., et al. (author)
  • Resolvin E1 Reduces Proinflammatory Markers in Human Pancreatic Islets in vitro
  • 2010
  • In: Experimental and clinical endocrinology & diabetes. - : Georg Thieme Verlag KG. - 0947-7349 .- 1439-3646. ; 118:4, s. 237-244
  • Journal article (peer-reviewed)abstract
    • In clinical islet transplantation, inflammatory responses initiated by the transplanted islets and by the host immune system cause acute and chronic graft loss. The resolution of acute inflammation is an active process mediated by specific signals and mediators such as resolvin E1 (RvE1). We investigated the effect of RvE1 on i) the inflammatory status of human pancreatic islets, ii) islet viability and apoptosis, and iii) the instant blood-mediated inflammatory reaction (IBMIR) in vitro. Pro-inflammatory cytokines and tissue factor (TF) in isolated human islets were determined by real-time RT-qPCR (mRNA levels), CBA and Gyrolab bioaffy (protein levels) after lipopolysaccaride (LPS) stimulation. Islet viability was measured using insulin secretion in a dynamic model, ADP/ATP ratio and total ATP content. Apoptosis was measured using commercial kits after stimulation with proinflammatory cytokines. To assess effect on IBMIR, human islets were mixed with non-anticoagulated, RvE1 or vehicle pretreated ABO-compatible blood in heparin-coated tubing loops. Treatment of human islets with RvE1 (500nM) for 24 h reduced LPS-induced increase in mRNA and protein levels of selected pro-inflammatory markers (IL-8, MCP-1, and TF). RvE1 lowered the ADP/ATP ratio, but had no effect on insulin secretion. RvE1 reduced the apoptotic effect of proinflammatory cytokines. Additionally, RvE1 reduced platelet consumption and TAT complex formation during the first 5 min after islet-blood contact. RvE1 suppresses proinflammatory markers and lowers the ADP/ATP ratio in human islets in vitro. RvE1 demonstrates antiapoptotic effects in a proinflammatory milieu. Additionally, RvE1 has modest dampening effects on IBMIR. We conclude that RvE1 may have potential in clinical islet transplantation.
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