新的裝置可以延長(zhǎng)心臟移植前的生存能力

新的裝置可以延長(zhǎng)心臟移植前的生存能力

Organ transplantations face many hurdles – a major one being time. From the moment an organ is taken out of a donor and put into ice, the cells in that organ begin to die. This race against time is more often than not lost. The issue is particularly problematic for hearts, with around 70 percent of viable hearts failing to make it into a recipient in time.

器官移植面臨許多障礙，其中最主要的是時(shí)間。從器官?gòu)木璜I(xiàn)者體內(nèi)取出并放入冰塊的那一刻起，器官中的細(xì)胞就開(kāi)始死亡。這種與時(shí)間的賽跑往往是失敗的。這個(gè)問(wèn)題對(duì)心臟來(lái)說(shuō)尤其成問(wèn)題，大約70%的可存活心臟無(wú)法及時(shí)成為受體。

"The standard of care for heart preservation and transportation is a cooler with a limited preservation time of 4 hours from the time the heart is cross-clamped to the time it reaches the recipient patient. Ischemia (restriction of blood supply to the tissue, causing a lack of oxygen to the tissue, and resulting in cell death) begins immediately after the heart is disconnected from the body. Thus the heart has to be transported immediately to the recipient within the 4-hour period," lead author Dr Rafael Veraza, from the University of Texas Health at San Antonio, told IFLScience.

“心臟保存和運(yùn)輸?shù)淖o(hù)理標(biāo)準(zhǔn)是一個(gè)冷卻器，從心臟交叉夾緊到到達(dá)受體病人有4小時(shí)的有限保存時(shí)間。缺血(限制組織的血液供應(yīng)，導(dǎo)致組織缺氧，導(dǎo)致細(xì)胞死亡)在心臟與身體分離后立即開(kāi)始。因此，心臟必須在4小時(shí)內(nèi)被立即運(yùn)送到受者體內(nèi)。”該研究的第一作者、來(lái)自圣安東尼奧德克薩斯大學(xué)衛(wèi)生學(xué)院的Rafael Veraza博士告訴IFLScience。

Alfredo Carpineti

"In effect, by limiting the time to 4 hours, the geographical location where hearts can be matched to the proper recipient, is limited. With a device that can extend the preservation time beyond 4 hours up to 24 hours, it extends the geographic location where hearts can be transported to the proper recipient."

“實(shí)際上，通過(guò)將時(shí)間限制在4個(gè)小時(shí)，心臟可以匹配到合適的接受者的地理位置是有限的。利用一種可以將心臟保存時(shí)間從4小時(shí)延長(zhǎng)到24小時(shí)的設(shè)備，心臟可以被運(yùn)送到合適的接受者那里。”

At the American Association for the Advancement of Science (AAAS) meeting in Seattle, the team presented the results from their new approach that might just slow down the clock. The team announced that their preservation device shows no damage to the heart muscle cells, called cardiomyocytes, after 24 hours in the machine. The tech, called ULiSSES™ (Universal Limb/organ Stasis System for Extended Storage), uses perfusion to keep the cells fed and oxygenated. This delays cell death, which is key to extending the transplant clock.

在西雅圖召開(kāi)的美國(guó)科學(xué)促進(jìn)協(xié)會(huì)(AAAS)會(huì)議上，研究小組展示了他們的新方法的結(jié)果，這種方法可能會(huì)減慢時(shí)間。研究小組宣布，他們的保存設(shè)備顯示，在24小時(shí)后，心肌細(xì)胞沒(méi)有受到損傷。這項(xiàng)技術(shù)被稱為ULiSSES™(通用肢體/器官停滯系統(tǒng)，用于擴(kuò)展存儲(chǔ))，使用灌注來(lái)保持細(xì)胞的充盈和充氧。這延緩了細(xì)胞死亡，這是延長(zhǎng)移植時(shí)鐘的關(guān)鍵。

“Histology results demonstrated intact cardiomyocyte nuclei, no visible cardiomyocyte damage and no signs of inflammatory cell infiltration,” Dr Veraza wrote in the abstract. “Our proof of concept demonstrates that using a novel oxygenated perfusion machine for 24 hours can maintain cardiac muscle integrity after cardiac death.”

Veraza博士在摘要中寫(xiě)道:“組織學(xué)結(jié)果顯示心肌細(xì)胞核完整，心肌細(xì)胞無(wú)明顯損傷，無(wú)炎癥細(xì)胞浸潤(rùn)跡象。”“我們的概念證明表明，使用新型氧灌注機(jī)24小時(shí)可以保持心臟死亡后心肌的完整性。”

The experiment was performed on five pig hearts placed in ULiSSES™ immediately after their death. The machine kept the hearts beating at 60 pulses per minute and at a temperature of 4°C (39.2°F). The team flooded the hearts with oxygenated Krebs-Henseleit solution, which provided the oxygen and nutrients for the cells.

實(shí)驗(yàn)是在五只死后立即放入U(xiǎn)LiSSES™的豬心臟上進(jìn)行的。在4°C(39.2°F)的溫度下，心臟以每分鐘60次的速度跳動(dòng)。研究小組用含氧的Krebs-Henseleit溶液注入心臟，為細(xì)胞提供氧氣和營(yíng)養(yǎng)。

The team is currently investigating the limitations of such a device as well as if a heart that has been preserved in ice for one hour and then placed in the device remains viable for the full 24-hour period. Perfusion as a method has recently been used in extending the viability of livers, and investigations are underway to find out more about the efficacies of these transplants in humans. Still, more studies are needed to test the device's efficacy on human hearts, which will require official approvals.

研究小組目前正在研究這種裝置的局限性，以及在冰中保存一小時(shí)，然后放置在裝置中的心臟是否可以在24小時(shí)內(nèi)存活。灌注作為一種方法最近已被用于擴(kuò)大肝臟的生存能力，目前正在進(jìn)行調(diào)查，以發(fā)現(xiàn)更多關(guān)于這些移植在人類中的有效性。盡管如此，還需要更多的研究來(lái)測(cè)試該設(shè)備對(duì)人類心臟的功效，這將需要官方的批準(zhǔn)。

In the United States, 114,000 people are currently on the waiting lists for a lifesaving transplant, with a new name added every 10 minutes. On average, the lack of available viable organs costs the lives of 20 people every day.

在美國(guó)，目前有11.4萬(wàn)人在等待一項(xiàng)挽救生命的移植手術(shù)，每10分鐘就會(huì)增加一個(gè)新名字。平均而言，缺乏可用的可存活器官每天導(dǎo)致20人死亡。