The Future of Microsurgery: Vascularized Composite Allotransplantation and Engineering Vascularized Tissue.

Background: Microsurgical techniques have revolutionized the field of reconstructive surgery and are the mainstay for complex soft tissue reconstruction. However, their limitations have promoted the development of viable alternatives. This article seeks to explore technologies that have the potential of revolutionizing microsurgical reconstruction as it is currently known, reflect on current and future vascularized composite allotransplantation (VCA) practices, as well as describe the basic science within emerging technologies and their potential translational applications. Methods: A literature review was performed of the technologies that may represent the future of microsurgery: vascularized tissue engineering (VCA) and flap-specific tissue engineering. Results: VCA has shown great promise and has already been employed in the clinical setting (especially in face and limb transplantation). Immunosuppression, logistics, cost, and regulatory pathways remain barriers to overcome to make it freely available. Vascularized and flap-specific tissue engineering remain a laboratory reality but have the potential to supersede VCA. The capability of creating an off-the-shelf free flap matching the required tissue, size, and shape is a significant advantage. However, these technologies are still at the early stage and require significant advancement before they can be translated into the clinical setting. Conclusion: VCA, vascularized tissue engineering, and flap-specific bioengineering represent possible avenues for the evolution of current microsurgical techniques. The next decade will elucidate which of these three strategies will evolve into a tangible translational option and hopefully bring a paradigm shift of reconstructive surgery.

In situ recruitment of regulatory T cells promotes donor-specific tolerance in vascularized composite allotransplantation.

Vascularized composite allotransplantation (VCA) encompasses face and limb transplantation, but as with organ transplantation, it requires lifelong regimens of immunosuppressive drugs to prevent rejection. To achieve donor-specific immune tolerance and reduce the need for systemic immunosuppression, we developed a synthetic drug delivery system that mimics a strategy our bodies naturally use to recruit regulatory T cells (Treg) to suppress inflammation. Specifically, a microparticle-based system engineered to release the Treg-recruiting chemokine CCL22 was used in a rodent hindlimb VCA model. These "Recruitment-MP" prolonged hindlimb allograft survival indefinitely (>200 days) and promoted donor-specific tolerance. Recruitment-MP treatment enriched Treg populations in allograft skin and draining lymph nodes and enhanced Treg function without affecting the proliferative capacity of conventional T cells. With implications for clinical translation, synthetic human CCL22 induced preferential migration of human Treg in vitro. Collectively, these results suggest that Recruitment-MP promote donor-specific immune tolerance via local enrichment of suppressive Treg.

Treg-inducing microparticles promote donor-specific tolerance in experimental vascularized composite allotransplantation.

For individuals who sustain devastating composite tissue loss, vascularized composite allotransplantation (VCA; e.g., hand and face transplantation) has the potential to restore appearance and function of the damaged tissues. As with solid organ transplantation, however, rejection must be controlled by multidrug systemic immunosuppression with substantial side effects. As an alternative therapeutic approach inspired by natural mechanisms the body uses to control inflammation, we developed a system to enrich regulatory T cells (Tregs) in an allograft. Microparticles were engineered to sustainably release TGF-ß1, IL-2, and rapamycin, to induce Treg differentiation from naïve T cells. In a rat hindlimb VCA model, local administration of this Treg-inducing system, referred to as TRI-MP, prolonged allograft survival indefinitely without long-term systemic immunosuppression. TRI-MP treatment reduced expression of inflammatory mediators and enhanced expression of Treg-associated cytokines in allograft tissue. TRI-MP also enriched Treg and reduced inflammatory Th1 populations in allograft draining lymph nodes. This local immunotherapy imparted systemic donor-specific tolerance in otherwise immunocompetent rats, as evidenced by acceptance of secondary skin grafts from the hindlimb donor strain and rejection of skin grafts from a third-party donor strain. Ultimately, this therapeutic approach may reduce, or even eliminate, the need for systemic immunosuppression in VCA or solid organ transplantation.

Micro and nanoparticle drug delivery systems for preventing allotransplant rejection.

Despite decades of advances in transplant immunology, tissue damage caused by acute allograft rejection remains the primary cause of morbidity and mortality in the transplant recipient. Moreover, the long-term sequelae of lifelong immunosuppression leaves patients at risk for developing a host of other deleterious conditions. Controlled drug delivery using micro- and nanoparticles (MNPs) is an effective way to deliver higher local doses of a given drug to specific tissues and cells while mitigating systemic effects. Herein, we review several descriptions of MNP immunotherapies aimed at prolonging allograft survival. We also discuss developments in the field of biomimetic drug delivery that use MNP constructs to induce and recruit our bodies' own suppressive immune cells. Finally, we comment on the regulatory pathway associated with these drug delivery systems. Collectively, it is our hope the studies described in this review will help to usher in a new era of immunotherapy in organ transplantation.

Selective improvement of tumor necrosis factor capture in a cytokine hemoadsorption device using immobilized anti-tumor necrosis factor.

Sepsis is a harmful hyper-inflammatory state characterized by overproduction of cytokines. Removal of these cytokines using an extracorporeal device is a potential therapy for sepsis. We are developing a cytokine adsorption device (CAD) filled with porous polymer beads which efficiently depletes middle-molecular weight cytokines from a circulating solution. However, removal of one of our targeted cytokines, tumor necrosis factor (TNF), has been significantly lower than other smaller cytokines. We addressed this issue by incorporating anti-TNF antibodies on the outer surface of the beads. We demonstrated that covalent immobilization of anti-TNF increases overall TNF capture from 55% (using unmodified beads) to 69%. Passive adsorption increases TNF capture to over 99%. Beads containing adsorbed anti-TNF showed no significant loss in their ability to remove smaller cytokines, as tested using interleukin-6 (IL-6) and interleukin-10 (IL-10). We also detail a novel method for quantifying surface-bound ligand on a solid substrate. This assay enabled us to rapidly test several methods of antibody immobilization and their appropriate controls using dramatically fewer resources. These new adsorbed anti-TNF beads provide an additional level of control over a device which previously was restricted to nonspecific cytokine adsorption. This combined approach will continue to be optimized as more information becomes available about which cytokines play the most important role in sepsis.

Experimental validation of a theoretical model of cytokine capture using a hemoadsorption device.

Sepsis, a systemic inflammatory response in the presence of an infection, is characterized by overproduction of inflammatory mediators called cytokines. Removal of these cytokines using an extracorporeal hemoadsorption device is a potential therapy for sepsis. We are developing a cytokine adsorption device (CAD) filled with microporous polymer beads and have previously published a mathematical model which predicts the time course of cytokine removal by the device. The goal of this study was to show that the model can experimentally predict the rate of cytokine capture associated with key design and operational parameters of the CAD. We spiked IL-6, IL-10, and TNF into horse serum and perfused it through an appropriately scaled-down CAD and measured the change in concentration of the cytokines over time. These data were fit to the mathematical model to determine a single model parameter, Gamma( i ), which is only a function of the cytokine-polymer interaction and the cytokine effective diffusion coefficient in the porous matrix. We compared Gamma( i ) values, which by definition should not change between experiments. Our results indicate that the Gamma( i ) value for a specific cytokine was statistically independent of all other parameters in the model, including initial cytokine concentration, flow rate, serum reservoir volume, CAD size, and bead size. Our results also indicate that competitive adsorption of cytokines and other middle-molecular weight proteins, which is neglected in the model, does not affect the rate of removal of a given cytokine. The model of cytokine capture in the CAD developed in this study will be integrated with a systems model of sepsis to simulate the progression of sepsis in humans and to develop a therapeutic CAD design and intervention protocol that improves patient outcomes in sepsis.

Heteroatom Derivatives of Cyclopentadienylaluminum: X-ray Crystal Structure of (eta(5)-C(5)H(5))(2,6-t-Bu-4-Me-C(6)H(2)O)(2)Al.

The cyclopentadienylaluminum aryloxide derivatives bis(cyclopentadienyl)(2,6-di-tert-butyl-4-methylphenoxy)aluminum (1) and (eta(5)-cyclopentadienyl)bis(2,6-di-tert-butyl-4-methylphenoxy)aluminum (2) have been prepared via the alcoholysis of tricyclopentadienylaluminum with 2,6-di-tert-butyl-4-methylphenol. The X-ray crystal structure of 2 was determined. The molecule crystallizes in the monoclinic space group C2/c with a = 15.4870(6) Å, b = 11.5404(5) Å, c = 18.3294(7) Å, beta = 103.0990(10) degrees, Z = 4, and V = 3190.7(2) Å(3) (R[I > 2sigma(I)] = 0.0755, R(w) = 0.1489). In the solid state, the cyclopentadienyl ring is bound eta(5) to the aluminum atom. Ab initio calculations on model compounds indicate that the pentahapto geometry of the cyclopentadienyl ring is due to the electron-withdrawing nature of the aryloxide ligands which allows greater pi-interaction between the aluminum center and the cyclopentadienyl ligand.

Synthesis and Characterization of Dimeric, Trimeric, and Tetrameric Gallophosphonates and Gallophosphates.

THF/toluene solutions of phosphonic or phosphoric acids were reacted with (t)Bu(3)Ga at low temperature to yield the cyclic dimers [(t)Bu(2)GaO(2)P(OH)R](2) (R = Ph, Me, (t)Bu, H, OH; 1-5). Poor crystallinity and variable thermal stabilities of 1-5 necessitated derivatization with Me(3)SiNMe(2) to yield [(t)Bu(2)GaO(2)P(OSiMe(3))R](2) (R = Ph, Me, (t)Bu, H, OSiMe(3); 6-10), which were more amenable to purification and characterization. In solution, trans isomers were predominant for 6 and 7 at ambient temperature, whereas the cis isomer of 8 was predominant. NMR spectroscopy demonstrated cis-trans interconversion for 6-8 and crossover experiments showed interconversion to occur by, or be accompanied with, an intermolecular exchange process. Thermolysis of 3 in refluxing toluene yielded the cluster [((t)BuGa)(2)((t)Bu(2)Ga)(O(3)P(t)Bu)(2){O(2)P(OH)(t)Bu}] (11), which was converted to [((t)BuGa)(2)((t)Bu(2)Ga)(O(3)P(t)Bu)(2){O(2)P(OSiMe(3))(t)Bu}] (12) with Me(3)SiNMe(2). Thermolysis of 1-3 in refluxing diglyme, or solid-state pyrolysis at 250 degrees C in vacuo, yielded [(t)BuGaO(3)PR](4) (R = Ph, (t)Bu, Me; 13-15). The gallophosphate [(t)BuGaO(3)P(OSiMe(3))](4) (16) was similarly obtained by reaction of (t)Bu(3)Ga with H(3)PO(4) in refluxing diglyme, followed by trimethylsilylation with Me(3)SiNMe(2). Compounds 13-16 possess cuboidal Ga(4)P(4)O(12) cores analogous to double-four-ring secondary building units in the gallophosphates cloverite, gallophosphate-A, and ULM-5. The thermal, hydrolytic, and oxidative stabilities of 13-16 are discussed, as are observed intermolecular exchange processes. In addition to characterization of 1-16 by multinuclear ((1)H, (13)C, (31)P) NMR spectroscopy, infrared spectroscopy, mass spectrometry, and elemental analysis, molecular structures for compounds 6, 8, 10, 12, 14, 15, and 16 were determined by X-ray crystallography.