Background. Kidney ischemia from Donation after Circulatory Death shifts cells to anaerobic metabolism. Mesenchymal Stromal Cells (MSC) have immunomodulatory properties that are mediated by soluble factors. We hypothesize that MSC pretransplant graft conditioning during HMP prevents ischemic injury. Aim To evaluate the effects of MSC pretransplant graft conditioning on early effectors of ischemia injury. Methods: Fisher rats were kidney donors, Lewis rats were MSC donors. After 20 min of warm ischemia by abdominal aorta clamping, bilateral nephrectomy was performed, one kidney was perfused for 4 h at 4°C with Belzer UW solution (group A) or Belzer UW solution plus 3 millions MSC (group B), the other kidney was the control (group C). Gene renal expression of 6 kidneys for each group was studied by microarray analysis at the end of 4 h perfusion. To confirm array results Real time PCR was performed to evaluate in grafts RPS3A, protein that regulates cell growth and death, NDFUS8, protein required in the electron transfer process, SLC16A1, principal lactate transporter. Malondialdehyde, marker of oxidative stress and Lactate (La) were measured in the collected perfusion fluid. Results: Array analysis showed in rat kidneys of group B versus (vs) A the upregulation of genes signaling pathways involved in SRP-dependent cotranslational protein targeting to membrane, the citric acid cycle and respiratory electron transport, ATP synthesis, ribosome synthesis. RPS3A and NDFUS8 protein levels in graft were significantly lower in group A vs B and C, SLC16A1 was lower in A and B vs C , but in B was higher vs A. In the collected fluid MDA levels were significantly lower and La higher in B vs A respectively. Conclusion: These results demonstrate that MSC infusion before transplantation may protect from ischemia injury upregulating genes involved in energy saving.

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