European quality system for tissue banking.

AIM: The aims of this project were to analyze the factors that influence quality and safety of tissues for transplantation and to develop the method to ensure standards of quality and safety in relation to tissue banking as demanded by European Directive 2004/23/EC and its technical annexes. It is organized in 4 Working Groups, the objectives of each one being focused in a specific area. STANDARDS: The Guide of Recommendations for Tissue Banking is structured into 4 parts: (1) quality systems that apply to tissue banking and general quality system requirements, (2) regulatory framework in Europe, (3) standards available, and (4) recommendations of the fundamental quality and safety keypoints. REGISTRY: This Working Group handled design of a multinational musculoskeletal tissue registry prototype. TRAINING: This Working Group handled design and validation of a specialized training model structured into online and face-to-face courses. The model was improved with suggestions from students, and 100% certification was obtained. AUDIT: The Guide for Auditing Tissue Establishments provides guidance for auditors, a self-assessment questionnaire, and an audit report form. The effectiveness and sustainability of the outputs were assessed. Both guides are useful for experienced tissue establishments and auditors and also for professionals that are starting in the field. The registry prototype proves it is possible to exchange tissues between establishments throughout Europe. The training model has been effective in educating staff and means having professionals with excellent expertise. Member states could adapt/adopt it. The guides should be updated periodically and perhaps a European organization should take responsibility for this and even create a body of auditors.

Efficacy and kinetics of glycerol inactivation of HIV-1 in split skin grafts.

Allogeneic split skin grafts are used widely in the treatment of burns. The relative simplicity of glycerol preservation of skin suggests it will be used increasingly in areas of high HIV-1 seroprevalence. The ability of glycerol preservation to inactivate HIV-1 present in skin graft infected in vitro was determined using a macrophage tropic strain HIV-1 as a cell-free virus suspension, within infected PBMCs, or within in vitro HIV-1 infected fresh cadaveric split skin. Different temperatures and concentrations of glycerol were used and infectivity determined by coculture with mitogen activated peripheral blood mononuclear cells (PBMCs) and measurement of reverse transcriptase activity after 7-10 days. Cell-free HIV-1 was inactivated within 30 min at 4 degrees C in glycerol concentrations of 70% or higher. During similar exposure cell- or skin-associated HIV-1 titer was reduced but not eliminated with 70% and 85% glycerol at 4 degrees C. HIV-1 was recovered consistently from skin stored in 85% glycerol at 4 degrees C for up to 72 hr but virus isolation was infrequent after storage for more than 5 days. At 20 degrees C or 37 degrees C, 70% or 85% glycerol could inactivate cell- or skin-associated HIV-1 within 8 hr. The initial glycerolization procedures and the storage at 4 degrees C eliminated effectively HIV-1 from skin.

The 1998 Lindberg Award. Comparison of glycerol preservation with cryopreservation methods on HIV-1 inactivation.

Cryopreservation and glycerol preservation are 2 successful methods for long-term preservation of human cadaver skin. Preservation is subjected to strict criteria to minimize the risk of disease transmission. This investigation compares the effects of glycerol preservation and cryopreservation on the inactivation of HIV-1. The effects of glycerol preservation and cryopreservation on inactivation of both extracellular and intracellular HIV-1Ba-L were investigated. After exposing HIV-1Ba-L-infected material to various concentrations of glycerol or to 10% dimethyl sulfoxide followed by cryopreservation, uninfected peripheral blood mononuclear cells were added to the treated material. At different time points during the culture, supernatants were taken to quantify HIV-1Ba-L and reverse transcriptase levels to determine HIV-1Ba-L infectivity. Cell-free HIV-1Ba-L was inactivated within 30 minutes in 70% and 85% glycerol. Also, intracellular HIV-1Ba-L in infected peripheral blood mononuclear cells or infected cadaver skin was completely inactivated by glycerol treatment in vitro. Cryopreservation did not show any extracellular or intracellular HIV-1Ba-L inactivation. Glycerol preservation--but not cryopreservation--of human cadaveric donor skin can inactivate both extracellular and intracellular HIV-1.

Microbiological evaluation of glycerolized cadaveric donor skin.

BACKGROUND: Human cadaveric donor skin is commonly used for the treatment of extensive burns. To minimize the risk of transfer of bacteria, viruses, and prions to the recipient, the donor and cadaver skin are screened according to standard transplantation protocols. METHODS: Since 1984, glycerol in a concentration of 85% has been used as a preservative of cadaver skin; here, data on bacteriological contamination of cadaver skin of 1929 skin donors are reviewed. RESULTS: Results show a reduction of contamination with 70% when antibiotics were used during the processing procedure. Overall, 10.1+/-4.1% of the cadaver skin showed initial bacterial contamination, but after prolonged storage all skin eventually showed no bacterial growth. The most commonly detected bacteria species was Staphylococcus epidermidis (76.7+/-7.0%). The spore-forming Bacillus species was most resistant to inactivation by glycerol, but eventually also this species was no longer detected. CONCLUSIONS: In conclusion, preservation of skin in 85% glycerol reduces the risk of bacterial transfer to the recipient and allows an increase in yield of cadaver skin of approximately 10%.

Immunogenicity of glycerol-preserved human cadaver skin in vitro.

Donor allograft skin preserved in 85% glycerol is used as a temporary coverage for large burn wounds. Glycerol treatment does not affect the structural integrity of the skin; cells are well preserved but dead. However, cells expressing major histocompatibility class II molecules can still be observed. In this study we investigated the mechanism underlying the clinical observation that glycerol-treated alloskin will be destroyed but after a prolonged period. We compared the in vitro immunogenicity of untreated and 85% glycerol-treated human skin cells. Human purified blood T cells did not proliferate when cultured with allogeneic treated skin cells, whereas untreated cells induced a distinct response. A moderate response was measured after adding T cells and viable antigen presenting cells, such as monocytes, to the allogeneic treated skin cells. However, the response on untreated skin cells was much higher. These results favor the suggestion that after transplantation of glycerol preserved skin is performed, an inflammatory process mediated by infiltrating host monocytes occurs rather than a rejection process mediated by T cells.

Migration of rat skin dendritic cells.

This study examines the in vivo migration of rat skin dendritic cells (including Langerhans cells) after skin transplantation. As donor animals, PVG-RT7b rats were used. The leukocytes of these rats bear an epitope of the leukocyte common antigen that can be recognized by use of the antibody His 41. The cells of allogeneic (ACI) recipient strains do not label with this antibody. Four days after transplantation of PVG-RT7b skin on allogeneic recipients, His 41+ cells showing a dendritic morphology were present in the T cell area of the draining lymph nodes. During culture of rat skin explants, dendritic cells migrated spontaneously into the medium. These in vitro migrated cells showed a high capacity to stimulate allogeneic T cells. When these cells, obtained from PVG-RT7b skin, were injected into the hind footpads of allogeneic recipients, they migrated to the same compartments of the draining lymph node. These data indicate that the cells that migrate from a transplanted allogeneic skin grafts are the same cells that migrate in vitro from explants. Most probably, they initiate graft rejection in the draining lymph nodes of the recipient.

Effect of low dose UVB irradiation on the migratory properties and functional capacities of human skin dendritic cells.

We recently described the 'spontaneous' migration of skin dendritic cells out of human split skin during culture. Since newly infiltrating cells from the circulation are excluded, this in vitro model is very suitable for studying the effect of UVB irradiation on the migratory properties, phenotype and functional capacities of skin cells. In the present study, we show that UVB irradiation of the skin before the culture period results in a significantly lower number of migrated cells that could be obtained compared with untreated skin. Relatively more dendritic cells of the population that migrated from UVB-irradiated skin were of dermal origin, as indicated by a higher percentage of CD1b+ cells. These data imply that UVB irradiation inhibits migration, especially of the epidermal Langerhans cells. Ultrastructural analysis of the irradiated skin revealed that the UVB dose used did not cause any directly visible damage to the cells. However, the cell population that had migrated from UVB-irradiated skin showed a significantly lower capacity to stimulate allogeneic T cells. This was not due to a lower expression of MHC class II on these cells. The percentage of cells expressing B7.1, B7.2 and LFA-3 was decreased in the population migrated from irradiated skin. The possible mechanism underlying the UVB-induced suppression is discussed.

Morphology of glycerol-preserved human cadaver skin.

Donor allograft skin preserved in 85 per cent glycerol has been used successfully as a temporary coverage for large burn wounds. The glycerol preservation is a method with low costs and has practical advantages such as antibacterial and virucidal effects. This report shows that the glycerol treatment did not affect the fundamental structural integrity of the skin. Intact keratinocytes and Langerhans cells with their characteristic Birbeck granules were still present in the glycerol-treated skin. After treatment with glycerol, the cells in the prepared epidermal cell suspensions were non-viable. MHC class II positive and CD1a positive cells could still be identified in situ and in the suspension.

Migratory properties and functional capacities of human skin dendritic cells.

The different cell types which migrated 'spontaneously' out of human skin explants during different periods of culture were characterized. Before culture, CD1a+ dendritic cells were observed not only in the epidermis but also in the dermis, whereas CD1b+ dendritic cells were present exclusively in the dermis. The populations of migrating cells were harvested and phenotyped on 3 successive days of culture. They always contained high percentages of CD1a+ cells. The other cells that migrated were T cells and macrophages. A relatively high proportion of the CD1a+ cells that migrated during the first 24 h culture period was also CD1b+. The number of cells which were positive for both CD1a and CD1b decreased in the following 2 days of culture. However, the purified CD1a+ cell populations isolated on the 3 consecutive days did not show any difference in their capacity to stimulate allogeneic T cells. The CD1a+ cells possess potent allo-activating capacities that are independent of whether or not they are positive for CD1b+. Three days after culture about half of the CD1a+ cells were still present in the epidermis and dermis, but no CD1b+ cells could be detected in the dermis. This suggests that the CD1b+ cells represent a population of active migrating cells.

Isolation and characterization of migratory human skin dendritic cells.

A method is described to isolate and characterize human skin dendritic cells (DC). This method is based on the migratory capacities of these cells. The cells migrated 'spontaneously' out of split-skin explants into the medium during a 24-h culture period and contained up to 75% CD1a+ cells. After removal of co-migrated T cells and macrophages, the highly enriched (> 95% CD1a+) DC showed potent allo-antigen-presenting capacities. About 25% of the CD1a+ cells were also positive for the dermal DC marker CD1b, whereas only 15-20% of the cells contained Birbeck granules, the characteristic cell organelle of the epidermal Langerhans cell. Before culture, CD1a+ DC were observed on cryostat sections not only in the epidermis but also in the dermis. After culture, the number of CD1a+ cells in both epidermis and dermis had decreased. Not all the cells had migrated during the culture period; some CD1a+ cells could still be detected in the epidermis and dermis after culture. Thus, using this method, potent allo-stimulating CD1a+ cells, migrating from both epidermis and dermis, can be obtained without the use of enzymes.

Virucidal effect of glycerol as used in donor skin preservation.

Glycerol has been used for a long time as a viral preservation medium in tissue samples at a 50 per cent concentration, however after a limited time span viruses could no longer be detected. This fact combined with the dehydrating action of glycerol, raised the suspicion that glycerol in a higher concentration could be virucidal. To test this hypothesis, experiments were done at various concentrations of glycerol at three different temperatures (4, 20 and 37 degrees C), using the following viruses: herpes simplex virus, a virus with an envelope, comparable to human immunodeficiency virus; and poliovirus as an example of small, hard to inactivate viruses without an envelope. Glycerol will dehydrate the skin, the extracted water being replaced by glycerol, preserving the original structure. The remaining water is optimally distributed throughout the tissue. However, the possibility exists that glycerol influences the enzymatic processes of nucleic acid breakdown. Plasmid DNA pBR322 was added to HeLa-cells in the presence and absence of glycerol. The outcome of the experiments showed that glycerol has a strong virucidal action. Preservation in 85 per cent glycerol was preferred, because using this concentration the glycerolized allograft skin retained its suppleness and was easy to manipulate during operations.