High Subzero Equilibrium VCA Cryopreservation - PROJECT SUMMARY/ ABSTRACT
Short tissue preservation times impose numerous constraints on transplantation by contributing to organ
shortage, exacerbating ischemic injury and graft rejection, and diminishing the length and quality of life for
transplant recipients. For vascular composite allograft (VCA) the current standard of preservation for clinical
transplantation, of a few hours of hypothermic static storage in UW solution, on ice, deprives VCA of the desired
quality and limits VCA use due to the small time window between procurement and transplantation and hindered
donor-recipient matching. Therefore, this preservation proposal to the NIAID’s Division of Transplantation
focuses on the VCA due to (i) The vast and urgent need for VCA in reconstructive transplantation, and (b) The
fact that VCA is a favorable initial system to develop long-term preservation solutions for organ systems in
general, from a technical perspective (evidence suggests extremities are extra cold tolerant vs. internal vital
organs) as well as from safety and regulatory perspectives (less life threatening risks vs. vital organ transplants).
In this Phase 2 study we will continue to develop a Nature-inspired, non-toxic solution to dramatically extend
preservation times of limbs and other VCA to over 5 days, while seeking to be the first to achieve organ
preservation via a controlled, partially frozen state at high subzero temperatures (-5 to -30°C), integrated
with machine perfusion and programmed metabolic depression. This unexplored, highly promising methodology
is based on the best strategies employed by freeze-tolerant and hibernating animals in nature, augmented with
complementary strategies developed using recent scientific understanding and bioengineering principles.
Importantly, we will build on the successful demonstration of feasibility in Phase 1 and the results that Sylvatica
and MGH/Harvard have in collaboration demonstrated with regard to high subzero partial freezing preservation:
(1) 120h storage, at -20°C, of simple in vitro VCA model with viabilities above the 80% target, (2) cryopreservation
in a simple blood vessel model with good viability and normal morphology after at least 3 days, and (3) successful
initial scale-up in whole livers for 3 days. Therefore, the objective of this Phase 2 proposal is to demonstrate,
using animal and human models of limb preservation, prolonged cryopreservation of VCA of 5 days or longer,
with good functional outcome post storage and recovery. Across five specific aims, we will first employ simple, yet
rich cellular and vascular models of VCA for cryostatis cocktail and protocol optimization, and initial scaling up, with the
central goal of enabling high subzero preservation, while actively suppressing metabolism and enhancing stress
tolerance. Best cryostasis protocols will be subsequently validated using, first a model of rat forelimb preservation
and assessment through sub-and normothermic machine perfusion, and then, orthotopic allotransplantation, with
comprehensive characterization of upper extremity functional and behavioral recovery. Following, the best
learnings from the animal model preservation/transplantation will be used for the proof of concept for high
subzero partial freezing of human fingers and hands, with full pseudo transplantation quality assessment.