Orthotopic Hind Limb Transplantation in the Mouse

Summary

This novel model for orthotopic hind limb transplantation in the mouse, applying a non-suture cuff technique for super-microvascular anastomosis, provides a powerful tool for in vivo mechanistic immunological research related to vascularized composite allotransplantation (VCA).

Abstract

In vivo animal model systems, and in particular mouse models, have evolved into powerful and versatile scientific tools indispensable to basic and translational research in the field of transplantation medicine. A vast array of reagents is available exclusively in this setting, including mono- and polyclonal antibodies for both diagnostic and interventional applications. In addition, a vast number of genotyped, inbred, transgenic, and knock out strains allow detailed investigation of the individual contributions of humoral and cellular components to the complex interplay of an immune response and make the mouse the gold standard for immunological research.

Vascularized Composite Allotransplantation (VCA) delineates a novel field of transplantation using allografts to replace "like with like" in patients suffering traumatic or congenital tissue loss. This surgical methodological protocol shows the use of a non-suture cuff technique for super-microvascular anastomosis in an orthotopic mouse hind limb transplantation model. The model specifically allows for comparison between established paradigms in solid organ transplantation with a novel form of transplants consisting of various different tissue components. Uniquely, this model allows for the transplantation of a viable vascularized bone marrow compartment and niche that have the potential to exert a beneficial effect on the balance of immune acceptance and rejection. This technique provides a tool to investigate alloantigen recognition and allograft rejection and acceptance, as well as enables the pursuit of functional nerve regeneration studies to further advance this novel field of transplantation.

Introduction

The late nineties heralded the pioneering days of reconstructive transplantation with the first successful hand transplant performed in France in 1998. Since then, the use of VCAs for reconstruction of devastating tissue defects has been successfully employed in a wide spectrum of patients. To date, the world counts 76 recipients of 112 upper extremities as well as 31 faces ^1-3. In addition, several other types of VCAs such as abdominal wall ⁴, larynx ⁵, trachea ⁶, vascularized joints ⁷, and even penis ⁸ have been performed. Furthermore, the live birth of a baby was recently reported after uterus transp....

Protocol

All experiments were conducted in accordance with the Guide for the Care and Use of Laboratory Animals of the National Institute of Health (NIH) and were approved by the Johns Hopkins University Animal Care and Use Committee (JHUACUC). The specific procedures were performed under the approved ACUC protocol MO13M108. 

1. Donor Operation

1. Administer analgesia at the appropriate time point for each pharmacological formulation prior to surgery. As per the approved animal care and use protocol use 0.1 mg/kg BW of buprenorphine subcutaneously 1 hr prior to skin incision.
2. Sedate the donor with isoflurane applied through a chamber attached to ....

Results

Performing vascularized composite allotransplantation in a mouse model using a non-suture cuff technique allows to achieve excellent and long term graft and animal survival as shown in Figure 1. Furthermore, it represents a reliable method of obtaining reproducible outcomes of gradual allograft rejection in vascularized composite allotransplantation as documented by the images shown in Figure 2. H&E histology of tissues obtained from animals undergoin.......

Discussion

Vascularized Composite Allotransplantation, such as upper extremity and face transplantation for reconstruction of devastating tissue defects, has evolved as a valid treatment option for patients not amendable to conventional reconstructive procedures. Technical advances in the field of reconstructive microsurgery as well as a vast experience with potent immunosuppressive and immune modulatory therapies in solid organ transplantation, now enables long-term allograft survival in this unique patient population ^3,21

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Suture, 6-0 Nylon	MWI	31849
Suture, 6-0 Polysorb	MWI	72667
Suture, 10-0 Nylon	Aero Surgical	TK-107038
Polyimide Tubing, Size 25	Vention Medical	141-0023
Polyimide Tubing, Size 27	Vention Medical	141-0015
Microvascular Clamps (Single)	Synovis	00396
Microvascular Clamps (Double)	Synovis	00414
Micro-Scissors	Synovis	SAS-18
Micro-Forceps	Synovis	FRS-15 RM-8
Micro-Dilators	Synovis	FRS-15 RM-8d.1
Micro-Needledriver	Synovis	C-14
Micro-Clamp Applicator	Synovis	CAF-4
Micro-Flushing Needle	Hamilton		10MM, 30°, 33G
Lactated Ringers Solution	Fisher Scientific	NC9968051
Buprenorphine			DEA Number required; Obtained from hosptial pharmacy.
Enrofloxacin; Baytril	Bayer Health Care	186599
Heparin			Obtained from hosptial pharmacy