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Reduction of Hepatic Ischemia/Reperfusion Injury by a Soluble P-Selectin Glycoprotein Ligand-1

Dulkanchainun, Tom S. MD*; Goss, John A. MD; Imagawa, David K. MD, PhD*†; Shaw, Gray D. PhD; Anselmo, Dean M. BA; Kaldas, Fady BS; Wang, Tao MD; Zhao, Delai MD; Busuttil, Ashley A. BA; Kato, Hirohisa MD, PhD; Murray, Natalie G. B. MD*†; Kupiec-Weglinski, Jerzy W. MD, PhD; Busuttil, Ronald W. MD, PhD

Scientific Papers

Objective The authors' goal was to determine the effects of specific binding and blockade of P- and E-selectins by a soluble P-selectin glycoprotein ligand-1 (PSGL-1) in rat models of hepatic in vivo warm ischemia and ex vivo cold ischemia. The authors also sought to determine the effect of selectin blockade on isograft survival in a syngeneic rat orthotopic liver transplant model.

Summary Background Data Ischemia/reperfusion (I/R) injury is a major factor in poor graft function after liver transplantation, which may profoundly influence early graft function and late changes. It is hypothesized that I/R injury leads to the upregulation of P-selectin, which is then rapidly translocated to endothelial cell surfaces within 5 minutes of reperfusion of the liver, initiating steps leading to tethering of polymorphonuclear neutrophil leukocytes to the vascular intima. Local production by leukocytes of interleukin-1, tumor necrosis factor-alpha, or both induces P-selectin expression on the endothelium and continues the cascade of events, which increases cell adherence and infiltration of the organ.

Methods To examine directly the effects of selectins in a warm hepatic I/R injury model, 100 μg of PSGL-1 or saline was given through the portal vein at the time of total hepatic inflow occlusion. The effects of PSGL-1 in cold ischemia were assessed using an isolated perfused rat liver after 6 hours of 4°C storage in University of Wisconsin (UW) solution, with or without the instillation of PSGL-1 before the storage. To evaluate the effect of selectin blockade on liver transplant survival, syngeneic orthotopic liver transplants were performed between inbred male Sprague-Dawley rats after 24 hours of cold ischemic storage in UW solution. A separate group of animals received two doses of 100 μg of PSGL-1 through the portal vein before storage and before reperfusion of the transplanted liver. Recipient survival was assessed at 7 days, and the Kaplan-Meier product limit estimate method was used for univariate calculations of time-dependent recipient survival events.

Results In an in vivo warm rat liver ischemia model, perfusion with PSGL-1 afforded considerable protection from I/R injury, as demonstrated by decreased transaminase release, reduced histologic hepatocyte damage, and suppressed neutrophil infiltration, versus controls (p < 0.05). When cold stored livers were reperfused, PSGL-1 reduced the degree of hepatocyte transaminase release, reduced neutrophil infiltration, and decreased histologic hepatocyte damage (p < 0.05 vs. UW-only controls). On reperfuslon, livers treated with PSGL-1 demonstrated increased portal vein blood flow and bile production (p < 0.05 vs. UW-only controls). In addition, 90% of the rats receiving liver isografts stored in UW solution supplemented with PSGL-1 survived 7 days versus 50% of those whose transplanted syngeneic livers had been stored in UW alone (p < 0.05).

Conclusions Selectins play an important role in I/R injury of the liver. Early modulation of the interaction between P-selectin and its ligand decreases hepatocyte injury, neutrophil adhesion, and subsequent migration in both warm and cold rat liver ischemia models. In addition, the use of PSGL-1 before ischemic storage and before transplantation prevents hepatic injury, as documented by a significant increase in liver isograft survival. These findings have important clinical ramifications: early inhibition of alloantigen-independent mechanisms during the I/R damage may influence both short- and long-term survival of liver allografts.

From the University of California-Irvine Department of Surgery, Orange, California;* the Dumont-UCLA Transplant Center, UCLA School of Medicine, Los Angeles, California;† and the Genetics Institute Inc., Cambridge, Massachusetts‡

Presented at the 109th Annual Meeting of the Southern Surgical Association, November 30 to December 3, 1997, The Homestead, Hot Springs, Virginia.

Address reprint requests to Ronald W. Busuttil, MD, PhD, Division of Liver and Pancreas Transplantation, UCLA School of Medicine, CHS 77-120, 10833 Le Conte Ave., Los Angeles, CA 90095.

Accepted for publication December 1997.

© Lippincott-Raven Publishers.