Targeting connexins with Gap27 during cold storage of the human donor uterus protects against cell death

PLoS One. 2020 Dec 10;15(12):e0243663. doi: 10.1371/journal.pone.0243663. eCollection 2020.

Abstract

Uterus transplantation is an experimental infertility treatment for women with uterine factor infertility. During donor uterus retrieval and subsequent storage, ischemia and other stressors are likely to occur, resulting in the delayed restoration of organ function and increased graft rejection. The uterus expresses connexin-based hemichannels, the opening of which can promote ischemic cell death, as well as gap junctions that may expand cell death by bystander signaling. We investigated if connexin channel inhibition with connexin channel inhibitor Gap27 could protect the uterus against cell death during the storage period. The study involved 9 female patients undergoing gender-change surgery. Before uterus removal, it was exposed to in situ warm ischemia with or without reperfusion. Uterus biopsies were taken before, during, and after ischemia, with or without reperfusion, and were subsequently stored under cold (4ᵒC) or warm (37ᵒC) conditions. TUNEL cell death assay was done at various time points along the combined in vivo/ex vivo experimental timeline. We found that Gap27 protected against storage-related cell death under cold but not warm conditions when the uterus had experienced in situ ischemia/reperfusion. For in situ brief ischemia without reperfusion, Gap27 reduction of cell death was delayed and significantly less, suggesting that protection critically depends on processes initiated when the organ was still in the donor. Thus, the inclusion of the connexin channel inhibitor Gap27 during cold storage protects the uterus against cell death, and the degree of protection depends on the history of exposure to warm ischemia. Gap27 protection may be indicated for uteri from deceased donors, in which ischemia is likely because life-saving organs have retrieval priority.

MeSH terms

  • Adolescent
  • Adult
  • Cell Death / drug effects
  • Connexins / antagonists & inhibitors*
  • Connexins / metabolism
  • Connexins / pharmacology
  • Female
  • Humans
  • Oligopeptides / pharmacology*
  • Organ Preservation / methods*
  • Protective Agents / pharmacology*
  • Tissue Donors
  • Transgender Persons
  • Uterus / cytology
  • Uterus / drug effects
  • Uterus / physiology*
  • Uterus / transplantation
  • Young Adult

Substances

  • Connexins
  • Oligopeptides
  • Protective Agents
  • gap 27 peptide

Grants and funding

The author(s) received no specific funding for this work.