Health care professionals: what do they know about organ donation?

BACKGROUND: Although donor detection is influenced by the legal system and family refusal, underreporting due to erroneous knowledge of donation criteria and a lack of familiarity with the procedure among medical professionals is also a contributing factor. OBJECTIVE: To investigate the outlook of critical health professionals participating in our postgraduate courses (2001 to 2006) about organ donation. METHODS: We administered an in-depth survey, evaluating attitudes, knowledge, roles, and experiences related to organ and tissue donation and transplantation, to 350 participants before and after the postgraduate courses. RESULTS: We collected 690 surveys from 350 attendees. In the first survey, 280 (80%) of them showed a positive attitude toward organ donation, 210 (60%) toward tissue donation, and 24 (7%) declared lack of knowledge about the subject. Only 175 (50%) had relatives who had donated organs. Sixty-three participants (18%) believed brain death is not equivalent to death, 176 (50%) claimed a lack of adequate training in this area, and 211 (60%) felt uncomfortable approaching families for donation. Only 88 (25%) were able to state the percentage of people receiving an organ in Spain, and 36 (10%) reported the correct number. After the course, the participants declared progress in attitudes toward and comfort levels with donation. Furthermore, family refusal in our hospital decreased from 33% to 8% to 11%. CONCLUSION: Continuous training of health care professionals about transplant, the legal system, and communication skills are crucial for successful organ and tissue donation.

The combination of DNA vectors expressing IL-12 + IL-18 elicits high protective immune response against cutaneous leishmaniasis after priming with DNA-p36/LACK and the cytokines, followed by a booster with a vaccinia virus recombinant expressing p36/LACK.

Protocols of immunization based on the DNA prime/vaccinia virus (VV) boost regime with recombinants expressing relevant antigens have been shown to elicit protection against a variety of pathogens in animal model systems, and various phase I clinical trials have been initiated with this vaccination approach. We have previously shown that mice immunized with a DNA vector expressing p36/LACK of Leishmania infantum followed by a booster with VVp36/LACK induced significant protection against Leishmania major infection. To further improve this protocol of immunization, here we investigated whether the cytokines interleukin-12 (IL-12) and IL-18 could enhance protection against L. major infection in BALB/c mice. We found that priming with DNA vectors expressing p36/LACK and either IL-12 or IL-18, followed by a booster with a VV recombinant expressing the same L. infantum LACK antigen, elicit a higher cellular immune response than by using the same protocol in the absence of the cytokines. The cytokine IL-12 triggered a higher number of IFN-gamma-secreting cells specific for p36 protein than IL-18. When immunized animals were challenged with promastigotes, the highest protection against L. major infection was observed in animals primed with DNAp36 + DNA IL-12 + DNA IL-18 and boosted with VVp36. This protection correlated with a Th1 type of immune response. Our findings revealed that in prime/booster protocols, co-expressing IL-12 and IL-18 during priming is an efficient approach to protect against leishmaniasis. This combined prime/booster immunization regime could have wide use in fighting against parasitic and other infectious diseases.

A heterologous prime-boost regime using DNA and recombinant vaccinia virus expressing the Leishmania infantum P36/LACK antigen protects BALB/c mice from cutaneous leishmaniasis.

A heterologous prime-boost vaccination with DNA vectors and vaccinia virus recombinants (VVr) has been shown to enhance specific cellular immune responses and to elicit significant protection against pathogens in animal models. In this study, we have analyzed, in the leishmaniasis cutaneous murine model, the effectiveness of this prime-boost strategy by immunizing with a DNA vector followed by boost with a VVr expressing the same Leishmania infantum P36/LACK antigen. After DNA priming and VVr boost, we challenged susceptible BALB/c mice with live L. major promastigotes, and examined the increase in footpad lesion size and parasite load in draining lymph nodes. Compared to controls, we observed reduction of up to 70% in lesion size and 1000-fold in parasite load. DNA prime-VVr boost before challenge elicited a Th1 type immune response in spleen cells from immunized animals. This DNA/VVr vaccination approach could be of utility in the prophylaxis against leishmaniasis.