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N M Kneteman

Publications and source records attributed to N M Kneteman.

At least 55 records · Page 3Linked to original sources
PubMed1995

The impact of surgical technique on the development of graft versus host disease in a rat small intestinal transplant model.

The small intestine and its mesentery contain a large amount of lymphoid tissue that can mediate graft-versus-host disease (GVHD) in small intestinal transplant recipients. To assess the impact of surgical technique and the retention of the recipient's small intestine on GVHD intensity, 12 adult Lewis rats received heterotopic small bowel transplants and 12 received orthotopic small bowel transplants from Brown Norway donors. Twelve Lewis to Lewis heterotopic small-bowel-transplanted animals served as the control group. All recipients were given cyclosporine (10 mg/kg/alternate days) subcutaneously. The parameters followed were: weight gain and feed intake; clinical signs of GVHD; relative spleen weight; popliteal lymph node enlargement assay; and histological evaluation of spleen, liver, skin, native intestine, and transplanted intestine. According to the clinical scoring system, heterotopically transplanted animals were found to have a more severe GVHD than the orthotopic group. There were statistically significant differences between the relative spleen weights of the heterotopic transplant group and the control group (P = 0.001, 0.004, and 0.007 on days 7, 14, and 21, respectively) and between the heterotopic and orthotopic groups at 7 days (P = 0.037). Lymph node enlargement assays were statistically different between heterotopic and orthotopic groups (P = 0.019, 0.020, and 0.007 on days 7, 14, and 21, respectively). Histological evaluation of skin biopsy specimens also demonstrated that GVHD was indeed more severe in the heterotopic transplanted group when compared with orthotopically transplanted animals. These findings confirm that retention of the native small intestine in the heterotopic intestinal transplant model significantly increases the severity of GVHD following transplantation.

Animals↗
PubMed1995

Human pancreas preservation prior to islet isolation. Cold ischemic tolerance.

We have retrospectively evaluated islet isolation records collected from 230 consecutive adult pancreases with 146 pancreases fulfilling all criteria for our evaluation. Fifty-six pancreases procured by our local organ procurement team (33 before in situ vascular flush and 23 after in situ vascular flush with University of Wisconsin [UW] solution) were compared with 90 pancreases received from distant centers that were shipped in UW solution after in situ vascular flushing. Cold storage of 3-26 hr preceded islet isolation using collagenase digestion and Ficoll purification. Recoveries of islets were assessed by duplicate counts of dithizone-stained aliquots before and after purification. Isolations were considered successful if > 100,000 viable islets (islet equivalents to 150 microns) were recovered after purification. Islet function was assessed by in vitro glucose-stimulated perifusion and islets were considered viable if the stimulation index (glucose stimulated over basal insulin secretion) was > 2. Eighty-three percent of the isolations from locally procured, UW-flushed pancreases were successful, as compared with 86% for pancreases that were stored for 3 to 8 hr, 73% for 8 to 16 hr of storage, and 38% for isolations following > 16 hr of cold storage. Increasing the duration of cold storage prior to islet isolation was associated with an increased proportion of failed isolations and decreased measures of islet viability. The actual numbers of islets per gram of pancreas before and after purification were significantly reduced if the hypothermic cold storage was > 16 hr. In vitro viability of isolated islets during glucose-stimulated perifusion showed a higher percentage of viable islets from pancreases with shorter durations of cold storage. For pancreases with > 16 hr of cold storage prior to islet isolation, islet viability was significantly reduced. We conclude that, with the current methods available to recover and store cadaver donor pancreases and the methods currently used to isolate human islets, yields of purified islets decline significantly from human pancreases that have been subjected to cold storage of > 16-18 hr.

Adenosine↗
PubMed1994

Cadaver pancreas recovery technique. Impact on islet recovery and in vitro function.

Previous studies in rodent and canine animal models have suggested a detrimental impact on islet recovery and function when pancreas excision is preceded by in situ vascular flushing with cold preservation solutions. We studied the efficacy of islet isolation from 19 consecutive cadaver pancreases procured alternately by initial pancreatectomy before in situ flush (group 1, our standard procurement technique, n = 9) or pancreas removal following in situ vascular flushing with cold University of Wisconsin solution (group 2, n = 10). Once procured, pancreases were weighed, the main pancreatic duct was cannulated, and 150 ml of collagenase solution was injected. The pancreases were transported to the isolation laboratory and processed within 2 hr. Islets were counted and sized after dithizone staining, and the islet equivalents were calculated. Aliquots of isolated islets were cryopreserved using established techniques. Islet function of both freshly isolated and frozen-thawed islets was assessed using a glucose-stimulated perifusion system. Significantly more pancreas was harvested after University of Wisconsin flush (90.6 +/- 6.9 g for group 1 versus 66.7 +/- 4 for group 2, P < 0.05). The quantity of islets per gram of processed pancreas released during enzymatic digestion from each of the experimental groups did not differ significantly (4.5 +/- 0.6 x 10(3) islet equivalents per gram for primary pancreatectomy versus 4.0 +/- 0.4 x 10(3) University of Wisconsin flush). Similarly, following Ficoll purification, the overall yields of islets did not differ significantly. Total islet yield in the primary pancreatectomy group was 181 +/- 25 x 10(3) islet equivalents (2.7 +/- 0.3 x 10(3) IE/g) versus 217 +/- 41 x 10(3) for the University of Wisconsin flush group (2.9 +/- 0.8 x 10(3) islet equivalents/g; P not significant). No differences were observed in in vitro viability. Perifusion stimulation indexes (peak/basal insulin release) were 5.9 +/- 1.3 for group 1 and 7.1 +/- 1.5 for group 2. These results conflict with published results in animal models and indicate that large numbers of viable islets can be recovered from cadaver pancreas utilizing either procurement technique. The decreased operating time, simplicity, and safety favor the use of total pancreatectomy after limited in situ vascular flushing as the method of choice for pancreas procurement for subsequent islet isolation.

Cadaver↗
PubMed1994

Effect of cyclosporin treatment on metabolic and hormonal responses to mixed meal plus oral glucose in dogs with intrasplenic pancreatic islet autograft.

We evaluated the effect of immunosuppressive concentrations of cyclosporin A (CsA), given intramuscularly, on the levels of glucose, insulin, C-peptide, glucagon, pancreatic polypeptide (PP), lactate, alanine and beta-hydroxy-butyrate in a group of pancreatectomized mongrel dogs with intrasplenic islet autografts, given mixed meal and oral glucose, while on or off CsA therapy. In whole blood, HPLC-measured drug levels ranged from 412 to 803 ng/ml. Basal glucose and insulin concentrations did not differ significantly between non-pancreatectomized, control dogs and transplanted animals, whether on or off CsA. After the meal challenge, glucose levels were significantly higher in transplanted animals than in normal dogs, and no additional deleterious effect of CsA was observed. Similar insulin and C-peptide responses were found in animals either on or off CsA treatment. Fasting and post-meal concentrations of glucagon, PP and intermediate metabolites were not affected by the drug. These results suggest that intramuscular CsA, given at doses known to sustain islet allograft function, has no detrimental effect on the hormonal and metabolic responses to mixed meal and oral glucose in dogs with intrasplenic islet autografts.

3-Hydroxybutyric Acid↗
PubMed1993

Therapeutic monitoring of rapamycin: a new immunosuppressive drug.

Rapamycin (RAPA) is a new immunosuppressive drug with a potency similar to that of FK506 and up to a 100-fold greater than that of cyclosporine (CsA). RAPA has shown to be efficacious in the prolongation of allograft survival in a number of animal models. In early studies, RAPA was administered on a dose/weight basis, with little attention given to its effective blood concentration. Details describing the approaches used to establish a therapeutic range for the drug in animal transplant models are described. Guidelines for therapeutic monitoring of the drug are proposed. It is hoped that such preclinical work in animals will facilitate establishment of monitoring protocols for the drug in clinical trials.

Animals↗
PubMed1993

The effect of cryopreservation on the survival and MHC antigen expression of murine islet allografts.

Cryopreservation is an effective method of islet storage that can facilitate clinical trials of islet transplantation. In the present study we examined the effect of cryopreservation on the survival of islet allografts and the quantity of islet MHC antigen expression. Islets isolated from CBA/J (H-2k) mice were transplanted into streptozotocin-induced diabetic BALB/c (H-2d) mice treated with or without antilymphocyte serum (ALS). Frozen/thawed (F/T) grafts were cooled slowly to -40 degrees C, stored at -196 degrees C, and thawed rapidly. Fresh and F/T isograft controls reversed diabetes promptly and maintained normoglycemia > 100 days. Allografts of fresh and F/T islets induced normoglycemia initially, but graft failure ensued at 18.2 +/- 1.5 and 16.4 +/- 1.9 days, respectively. ALS treatment prolonged allograft survival significantly to 35.3 +/- 3.9 and 37.5 +/- 6.3 days for fresh and F/T islets, respectively. Following cryopreservation, the quantity of class I antigen expression was reduced by 40%, while the quantity of class II expression was variable. These data indicate that murine islet MHC class I expression is reduced after cryopreservation. This decrease was not associated with altered survival of allogeneic grafts.

Animals↗