We are grateful to the laboratory of Dr. Robert S. Kerbel (University of Toronto, Sunnybrook Research Institute, Toronto, Canada) for technical help and expertise in the development of this procedure. We would also like to thank Dr. Sandra Sexton and the Roswell Park Cancer Institute Department of Laboratory Animal Resources. This work was supported by an award from the Roswell Park Alliance Foundation (to JMLE).

1. Orthotopic Kidney Tumor Implantation
<ol>
	<li>Cell Culture
	<ol>
		<li>Prior to orthotopic implantation, grow mouse RENCALUC cells as a monolayer to 75% confluency.</li>
		<li>Following trypsinization and resuspension in 5% FBS containing media, centrifuge cells at 1,000 rpm, 4&#160;&#176;C for 5 min, repeating 3 times to wash in PBS. Then resuspend the cells in serum-free media to a concentration of 5 x 104 RENCALUC/5 &#956;l&#160;serum-free media. 
		Note: Depending on the variant or cell line used, cells can be resuspended in a 1:1 ratio of matrigel and serum free media to slow highly aggressive mouse cell growth and dissemination after implantation. </li>
	</ol>
	</li>
	<li>Surgery and cell implantation 
	Note: All animal studies described therein, including maintenance and determination of experimental endpoints, were performed according to an Institutional Animal Care and Use Committee (IACUC) protocol approved by Roswell Park Cancer Institute.
	<ol>
		<li>Anesthetize one Balb/C mouse using Isoflurane (2-3%). Pinch foot and check for reflex to ensure sufficient anesthetization. Apply vet ointment to the eyes to prevent drying. Place mouse in right lateral recumbency and shave left side between fore- and hind-limb. Apply alcohol and iodine along dorsal lumbar area to aseptically prepare area for incision.</li>
		<li>Use surgical scissors to initiate a 1 cm skin incision in a longitudinal direction between the last rib and the hip joint. Loosen connective tissue under the skin using a blunt dissection scissor. Use surgical scissors to make a 0.5 cm incision in a longitudinal direction in the abdominal wall. Use curved forceps to gently push down around open wound &#8211; this will exteriorize the kidney and allow for gentle immobilization of organ prior to injection.</li>
		<li>Load the Hamilton syringe with 5 &#956;l&#160;the prepared cell mixture. For sub-capsular implantations, two implantation methods can be employed:
		<ol>
			<li>Superficial:&#160; Running parallel to the longitudinally orientated kidney, insert needle under the kidney capsule (but above the parenchyma) with the beveled edge up. Once needle is in place, inject all of the cells until small white bubble forms. Slowly remove needle from capsule and immediately blot over injection with a sterile cotton tipped applicator to absorb any leakage and prevent cell dissemination.</li>
			<li>Internal: With beveled edge up and starting from the side of kidney opposite to final implantation site, insert needle through interior of kidney until needle is visible (but not puncturing) the sub-capsular space. Inject all of the cells until white bubble forms and swab injection site to prevent any leakage.</li>
		</ol>
		</li>
		<li>Gently return the kidney to the body cavity. Close the abdominal body wall using absorbable 5-0 Vicryl suture. Once complete, pull the skin layer together and place 2-3 wound clips. Ensure clips are firm and evenly spaced to ensure no wound exposure. Prior to recovery administer 500 &#956;l of 0.9% NaCl and 100 &#956;l of Buprenorphine (0.01 mg/ml) subcutaneously using a 25 G needle. Routinely monitor clip placement and stability, and remove after 10 days.</li>
	</ol>
	</li>
</ol>
2. Nephrectomy/Primary Tumor Removal
<ol>
	<li>Follow identical protocol for mouse anesthetization, immobilization, incision, and exposure of kidney as described in sections 1.2.1 and 1.2.2 (above).</li>
	<li>Use a second pair of forceps to isolate the kidney by gently removing the connecting fat tissue from the caudal end and the adrenal gland from the cranial end of the kidney. While gently grasping the kidney, use absorbable 5-0 Vicryl suture to make a double knot around the ureter, renal artery, and vein. Slowly secure and then cut above the knot to remove the kidney. If any sign of immediately blood loss, or there is a risk of insufficient hold of suture on ureter, artery, and vein, then use cauterizer instead of&#160; scissors to cut above knot. &#160;</li>
	<li>Once kidney is removed, carefully check for any bleeding from the tied artery and use cauterizer if necessary. Close the abdominal body wall using 5-0 Vicryl. Pull the skin layer together and place 2-3 wound clips following same precautions as described in 1.2.4. Closely monitor animal daily following surgery for signs of distress, bleeding, or limited mobility. Follow institutional guidelines for animal safely.</li>
</ol>
3. Monitoring Metastatic Progression and Localization at Endpoint
<ol>
	<li>Metastatic disease quantification: Bioluminescent monitoring
	<ol>
		<li>See methodology previously described in JOVE for monitoring metastasis using cells transfected with luciferase and quantified using the Xenogen IVIS imaging system 11,12.</li>
	</ol>
	</li>
	<li>Visual necropsy guide for comparative assessment of metastatic distribution
	<ol>
		<li>Sacrifice animals according to institutional guidelines using endpoints including signs of distress, labored breathing, weight loss, etc. 
		Note: Close monitoring of animals is critical as spontaneous metastatic progression can be highly variable and rapid. </li>
		<li>Use surgical scissors to initiate an incision above the urethra that continues up the thoracic cavity to lower mandible. Use blunt-ended scissors to separate the skin from the muscle of the abdominal wall.</li>
		<li>Initiate incisions along arms and legs. Peel skin away. Closely examine the skin fascia and abdominal wall for nodules, then the superficial lymph nodes: inguinal, brachial, axillary and superficial cervical.</li>
		<li>Make an incision in the abdominal wall and cut along the left and right lateral sides up to the diaphragm. With one horizontal cut remove the front portion of the abdominal wall to bare the viscera.</li>
		<li>Examine the undisturbed appearance of the viscera for grossly notable tumors. Also note the contents of the stomach and intestines; if they are empty, the mouse may not have been able to eat. If the contents are dark, this may indicate evidence of upper/lower gastrointestinal hemorrhage.</li>
		<li>Visually score each organ for tumor presence or absence, assigning a total score for each mouse group (4 animals per group is used as example in Figure 1D-i). 
		Notes: 1) Enlargement of lymph nodes does not necessarily mean that it is a tumor growth; if it is greatly sized, very firm, and a whitish color, it is likely a metastatic nodule. 2) Excessive milky or cloudy liquid in the abdomen indicates ascites. Ascites may include solid accumulations on the abdominal organs, particularly between the lobes of the liver and the stomach. 3) for organs such as the lungs, multiple nodules can be present and counted for comparisons between individual animals (see&#160;13 for example).</li>
		<li>Identify gross tumors or abnormalities of the individual abdominal organs: liver, spleen, kidneys and pancreas by carefully removing and washing with PBS from a squirt bottle.</li>
		<li>After removing the abdominal organs, inspect the abdominal lymph nodes, including the lumbar, sacral, renal, and mesenteric lymph node.</li>
		<li>Assess diaphragm for evidence of metastatic spread. 
		Note: Extensive spread on the diaphragm can cause it to lose its contractility, leading to labored or loss of breathing.</li>
		<li>Remove diaphragm and make two lateral incisions in the thoracic cavity, removing the frontal portion to expose the lungs and heart.</li>
		<li>Remove lungs and heart by gently grasping and lifting the esophagus and cutting the trachea above the heart. Assess tissues for nodules. Squeeze heart. Lack of springy consistency may indicate tumor present.</li>
		<li>Use surgical scissors to cut linearly through skull. Gently remove small pieces of cranium until the whole brain is exposed. Look throughout brain for visible nodules or abnormalities discolorations.</li>
	</ol>
	</li>
</ol>

<ol>
	<li>Francia, G., Cruz-Munoz, W., Man, S., Xu, P., Kerbel, R. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mouse+models+of+advanced+spontaneous+metastasis+for+experimental+therapeutics.">Mouse models of advanced spontaneous metastasis for experimental therapeutics.</a> Nat. Rev. Cancer. 11, 135-141 (2011).</li><li>Souza, B. M., Chaves, K. B., Chammas, R., Schor, N., Bellini, M. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endostatin+neoadjuvant+gene+therapy+extends+survival+in+an+orthotopic+metastatic+mouse+model+of+renal+cell+carcinoma.">Endostatin neoadjuvant gene therapy extends survival in an orthotopic metastatic mouse model of renal cell carcinoma.</a> Biomed. Pharmacother. 66, 237-241 (2012).</li><li>Amagai, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Combination+therapy+of+interleukin-2+and+sorafenib+improves+survival+benefits+and+prevents+spontaneous+pulmonary+metastasis+in+murine+renal+cell+carcinoma+models.">Combination therapy of interleukin-2 and sorafenib improves survival benefits and prevents spontaneous pulmonary metastasis in murine renal cell carcinoma models.</a> Jpn. J. Clin. Oncol. 40, 503-507 (2010).</li><li>Steeg, P. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Preclinical+Drug+Development+Must+Consider+the+Impact+on+Metastasis.">Preclinical Drug Development Must Consider the Impact on Metastasis.</a> Clin. Cancer Res. 15, 4529-4530 (2009).</li><li>Guerin, E., Man, S., Xu, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+model+of+postsurgical+advanced+metastatic+breast+cancer+more+accurately+replicates+the+clinical+efficacy+of+antiangiogenic+drugs.">A model of postsurgical advanced metastatic breast cancer more accurately replicates the clinical efficacy of antiangiogenic drugs.</a> Cancer Res. 73, 2743-2748 (2013).</li><li>Day, C. P., Carter, J., Bonomi, C., Hollingshead, M., Merlino, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Preclinical+therapeutic+response+of+residual+metastatic+disease+is+distinct+from+its+primary+tumor+of+origin.">Preclinical therapeutic response of residual metastatic disease is distinct from its primary tumor of origin.</a> Int. J. Cancer. 130, 190-199 (2012).</li><li>Ebos, J. M., Kerbel, R. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Antiangiogenic+therapy:+impact+on+invasion,+disease+progression,+and+metastasis.">Antiangiogenic therapy: impact on invasion, disease progression, and metastasis.</a> Nat. Rev. Clin. Oncol. 8, 210-221 (2011).</li><li>Naito, S., Walker, S. M., Fidler, I. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=In+vivo+selection+of+human+renal+cell+carcinoma+cells+with+high+metastatic+potential+in+nude+mice.">In vivo selection of human renal cell carcinoma cells with high metastatic potential in nude mice.</a> Clin. Exp. Metastasis. 7, 381-389 (1989).</li><li>Fidler, I. J., Naito, S., Pathak, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Orthotopic+implantation+in+essential+for+the+selection,+growth+and+metastasis+of+human+renal+cell+cancer+in+nude+mice.">Orthotopic implantation in essential for the selection, growth and metastasis of human renal cell cancer in nude mice.</a> Cancer Metastasis Rev. 9, 145-165 (1990).</li><li>Saiki, I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Characterization+of+the+invasive+and+metastatic+phenotype+in+human+renal+cell+carcinoma.">Characterization of the invasive and metastatic phenotype in human renal cell carcinoma.</a> Clin. Exp. 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The authors have nothing to disclose.&#160;

The purpose of this protocol is to assess clinically relevant spontaneous metastatic disease using a syngeneic tumor mouse model to describe implantation/resection techniques. Currently, the majority of preclinical studies evaluating novel experimental therapeutics do not include study of metastatic disease and only few recapitulate the stages of primary tumor growth, surgical resection, and eventual spontaneous metastatic spread. To date, genetically engineered mouse models (GEMMs) generated to elicit spontaneous renal ...

The major cause of mortality in patients with renal cell carcinoma (RCC) is systemic metastatic disease that typically occurs following surgical removal of a primary tumor growing in the kidney. However, very few preclinical tumor models evaluating experimental therapeutics in mice include metastatic disease, and fewer still faithfully recapitulate the clinical stages of localized growth, surgery, and spontaneous micro-metastatic initiation and progression&#160;1-3. This gap in testing has become increasingly important in the evaluation of new therapies as sometimes striking anti-tumor effects seen in animal models have not always translated into similarly successful treatment of patients&#160;4. Such differences in results may stem from differential drug efficacies between localized ectopic or orthotopic primary tumor models and late-stage metastatic disease 5-7. In the case of RCC, only a few studies have employed established animal protocols that include spontaneous recurrent disease that mimics patients who typically have had tumor-bearing kidneys wholly or partially removed&#160;2,3. The reasons for this dearth in mouse model testing vary. First, there is the high animal cost and inherent variability of tumor cell selection and metastatic potential. For example, human kidney cell lines tend to rarely metastasize, and must be selected over multiple rounds of orthotopic primary implantation and metastatic selection to derive variants that consistently disseminate and form distant lesions (see description of such a human cell line derivation&#160;8-10). Conversely,&#160; mouse cells in immunocompetent models tend to behave aggressively, and low cell numbers must be injected with matrigel to reduce immediate systemic spread 3. Second, technical difficulties in performing proper implantation, surgical resection (nephrectomy), and tracking (and quantifying) spontaneous metastatic growth can be challenging and several critical variables need consideration when employing this technique (see Discussion for details). The purpose of this protocol is to describe the essential steps (as well as potential pitfalls) of orthotopic implantation, resection (nephrectomy), and monitoring of spontaneous metastatic RCC disease and to offer a guideline for standardized (and more widespread) use among scientific laboratories that assess the efficacy of experimental therapeutics.

<table border="0" cellpadding="0" cellspacing="0" width="830">
	<colgroup>
		<col />
		<col />
		<col />
		<col />
	</colgroup>
	<tbody>
		<tr height="21">
			<td height="21" style="height:21px;width:397px;">DMEM-high glucose with Pyr. And L-Glutamine</td>
			<td style="width:147px;">Corning</td>
			<td style="width:119px;">10-013-CV</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:397px;">FBS</td>
			<td style="width:147px;">Invitrogen</td>
			<td style="width:119px;">10437-028</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:397px;">0.25% Trypsin EDTA</td>
			<td style="width:147px;">Corning</td>
			<td style="width:119px;">25-053-CL</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:397px;">1x DPBS without Calcium &#38; Magnesium</td>
			<td style="width:147px;">Corning</td>
			<td style="width:119px;">21-031-CV</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:397px;">Matrigel</td>
			<td style="width:147px;">BD Biosciences</td>
			<td style="width:119px;">354234</td>
			<td>must be kept on ice</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:397px;">Artifical tears-lubricant opthalmic ointment</td>
			<td style="width:147px;">Akorn Animal Health</td>
			<td style="width:119px;">17478-162-35</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:397px;">Pocket pro pet trimmer</td>
			<td style="width:147px;">Braintree scientific</td>
			<td style="width:119px;">CLP9931B</td>
			<td></td>
		</tr>
		<tr height="24">
			<td height="24" style="height:24px;width:397px;">Alcohol swab</td>
			<td style="width:147px;">VWR</td>
			<td style="width:119px;">326895</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:397px;">Betadine solution swab</td>
			<td style="width:147px;">VWR</td>
			<td style="width:119px;">67618-152-01</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">MICRO DISSECTING sissors straight,blunt - 25mm blades - 4.5&#34;&#160;</td>
			<td style="width:147px;">Southpointe surgical</td>
			<td style="width:119px;">RS-5982</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:397px;">Iris Forceps, serrated, curved, 10cm long</td>
			<td style="width:147px;">Kent scientific</td>
			<td style="width:119px;">INS15915</td>
			<td>need two of these</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:397px;">10&#181;l Hamilton syringe</td>
			<td style="width:147px;">Hamilton</td>
			<td style="width:119px;">7635-01</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:397px;">30G, 45 degree, RN needle</td>
			<td style="width:147px;">Hamilton</td>
			<td style="width:119px;">7803-07</td>
			<td></td>
		</tr>
		<tr height="24">
			<td height="24" style="height:24px;width:397px;">Sterile cotton tipped appicator</td>
			<td style="width:147px;">VWR</td>
			<td style="width:119px;">10805-144</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:397px;">High temperature cautery kit</td>
			<td style="width:147px;">Kent scientific</td>
			<td style="width:119px;">INS500392</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:397px;">5-0 coated Vicryl, conventional cutting needle&#160;</td>
			<td style="width:147px;">Ethicon</td>
			<td style="width:119px;">J834</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:397px;">Reflex clip applier for 7mm clips</td>
			<td style="width:147px;">Kent scientific</td>
			<td style="width:119px;">INS500343</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:397px;">Reflex clips, 7mm, non-sterile</td>
			<td style="width:147px;">Kent scientific</td>
			<td style="width:119px;">INS500344</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:397px;">Removing forceps, 12cm lone</td>
			<td style="width:147px;">Kent scientific</td>
			<td style="width:119px;">INS500347</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:397px;">0.9% Sodium Chloride</td>
			<td style="width:147px;">Baxter Healthcare</td>
			<td style="width:119px;">2B1322</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:397px;">Buprenorphine 0.01mg/mL</td>
			<td style="width:147px;"></td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:397px;">25G 5/8&#34; needle</td>
			<td style="width:147px;">VWR</td>
			<td style="width:119px;">BD305122</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:397px;">1mL syringe w/out needle</td>
			<td style="width:147px;">VWR</td>
			<td style="width:119px;">BD309659</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:397px;">D-Luciferin</td>
			<td style="width:147px;">Gold Bio technology</td>
			<td style="width:119px;">LUCK-1G</td>
			<td></td>
		</tr>
	</tbody>
</table>

modeling spontaneous metastatic renal cell carcinoma (mrcc) in mice following nephrectomy

One of the key challenges to improved testing of new experimental therapeutics in renal cell carcinoma (RCC) is the development of models that faithfully recapitulate early- and late-stage metastatic disease progression. Typical tumor implantation models utilize ectopic or orthotopic primary tumor implantation, but few include systemic spontaneous metastatic disease that mimics the clinical setting. This protocol describes the key steps to develop RCC disease progression stages similar to patients. First, it uses a highly metastatic mouse tumor cell line in a syngeneic model to show orthotopic tumor cell implantation. Methods include superficial and internal implantation into the sub-capsular space with cells combined with matrigel to prevent leakage and early spread. Next it describes the procedures for excision of tumor-bearing kidney (nephrectomy), with critical pre- and post- surgical mouse care. Finally, it outlines the steps necessary to monitor and assess micro-and macro-metastatic disease progression, including bioluminescent imaging as well provides a detailed visual necropsy guide to score systemic disease distribution. The goal of this protocol description is to facilitate the widespread use of clinically relevant metastatic RCC models to improve the predictive value of future therapeutic testing.&#160;

Figure 1A shows a schematic outlining the procedures detailed in this protocol summary. Several important factors must be considered for each step. For example, in Step 1 it shows two methods for sub-capsular tumor cell implantation into the kidney. Tumor cells can be implanted into the sub-capsular space with a small white-bubble confirming the localized placement of cells with leakage prevented by careful removal of needle and swabbing excess escaping fluid (Figure 1B-i). To prevent le...

Watch this Scientific Journal Video about Modeling Spontaneous Metastatic Renal Cell Carcinoma mRCC in Mice Following Nephrectomy at JoVE.com

Modeling Spontaneous Metastatic Renal Cell Carcinoma mRCC in Mice Following Nephrectomy

Models of spontaneous metastatic renal cell carcinoma (RCC) disease progression can be used for evaluating treatments in a clinically relevant setting. This protocol demonstrates different procedures for orthotopic kidney tumor cell implantation, proper nephrectomy, and finally outlines a necropsy guide for visual and bioluminescent scoring of metastatic burden and localization.

Modeling Spontaneous Metastatic Renal Cell Carcinoma (mRCC) in Mice Following Nephrectomy

One of the key challenges to improved testing of new experimental therapeutics in renal cell carcinoma (RCC) is the development of models that faithfully ...

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16.5K 조회수.  Roswell Park Cancer Institute.  자발 전이성 신장 세포 암종 (RCC) 질병 진행의 모델은 관련 임상 설정에서 치료를 평가하는 데 사용될 수있다. 이 프로토콜은 동소 신장 종양 세포 주입, 적절한 절제를위한 다른 절차를 설명하고, 마지막으로 전이성 부담 및 현지화의 시각 및 생물 발광 점수에 대한 부검 가이드를 간략하게 설명합니다. 

비디오: Modeling Spontaneous Metastatic Renal Cell Carcinoma mRCC in Mice Following Nephrectomy

Single Port Donor Nephrectomy

In 2007, Rane presented the first single port nephrectomy for a small non-functioning kidney at the World Congress of Endourology. Since that time, the use of single port surgery for nephrectomy has expanded to include donor nephrectomy. Over the next two years the technique was adopted for many others types of nephrectomies to include donor nephrectomy. We present our technique for single port donor nephrectomy using the Gelpoint device. We have successfully performed this surgery in over 100 patients and add this experience to our experience of over 1000 laparoscopic nephrectomies. With the proper equipment and technique, single port donor nephrectomy can be performed safely and effectively in the majority of live donors. We have found that our operative times and most importantly our transplant outcomes have not changed significantly with the adoption of the single port donor nephrectomy. We believe that single port donor nephrectomy represents a step forward in the care of living donors.

Single port laparoscopic surgery is changing the standard of care in surgical care like nothing since the laparoscopic technique was introduced 20 years ago. We present out technique of single port donor nephrectomy using the Gelpoint device. We have successfully performed this surgery in 100 patients.

In 2007, Rane presented the first single port nephrectomy for a small non-functioning kidney at the World Congress of Endourology.  Since that time, the ...

Modeling Stroke in Mice - Middle Cerebral Artery Occlusion with the Filament Model

Stroke is among the most frequent causes of death and adult disability, especially in highly developed countries. However, treatment options to date are very limited. To meet the need for novel therapeutic approaches, experimental stroke research frequently employs rodent models of focal cerebral ischaemia. Most researchers use permanent or transient occlusion of the middle cerebral artery (MCA) in mice or rats.
Proximal occlusion of the middle cerebral artery (MCA) via the intraluminal suture technique (so called filament or suture model) is probably the most frequently used model in experimental stroke research. The intraluminal MCAO model offers the advantage of inducing reproducible transient or permanent ischaemia of the MCA territory in a relatively non-invasive manner. Intraluminal approaches interrupt the blood flow of the entire territory of this artery. Filament occlusion thus arrests flow proximal to the lenticulo-striate arteries, which supply the basal ganglia. Filament occlusion of the MCA results in reproducible lesions in the cortex and striatum and can be either permanent or transient. In contrast, models inducing distal (to the branching of the lenticulo-striate arteries) MCA occlusion typically spare the striatum and primarily involve the neocortex. In addition these models do require craniectomy. In the model demonstrated in this article, a silicon coated filament is introduced into the common carotid artery and advanced along the internal carotid artery into the Circle of Willis, where it blocks the origin of the middle cerebral artery. In patients, occlusions of the middle cerebral artery are among the most common causes of ischaemic stroke. Since varying ischemic intervals can be chosen freely in this model depending on the time point of reperfusion, ischaemic lesions with varying degrees of severity can be produced. Reperfusion by removal of the occluding filament at least partially models the restoration of blood flow after spontaneous or therapeutic (tPA) lysis of a thromboembolic clot in humans.
In this video we will present the basic technique as well as the major pitfalls and confounders which may limit the predictive value of this model.

Filamentous occlusion of the Middle cerebral artery is a common model for studying ischemic stroke in mice.

Stroke is among the most frequent causes of death and adult disability, especially in highly developed countries. However, treatment options to date are ...

Mammary Transplantation of Stromal Cells and Carcinoma Cells in C57BL/6J Mice

The influence of stromal cells, including fibroblasts on mammary tumor progression has been well documented through the use of mouse models, in particular through transplantation of stromal cells and epithelial cells in the mammary gland of mice. Current transplantation models often involve the use of immunocompromised mice due to the different genetic backgrounds of stromal cells and epithelial cells. Extracellular matrices are often used to embed the two different cell types for consistent cell-cell interactions, but involve the use of Matrigel or rat tail collagen, which are immunogenic substrates. The lack of functional T cells from immunocompromised mice prevents accurate assessment of stromal cells on mammary tumor progression in vivo, with important implications on drug development and efficacy. Moreover, immunocompromised mice are costly, hard to breed and require special care conditions. To overcome these obstacles, we have developed an approach to orthotopically transplant stromal cell and epithelial cells into mice from the same genetic background to induce consistent tumor formation. This system involves harvesting normal, carcinoma associated fibroblasts, PyVmT mammary carcinoma cells and collagen from donor C57BL/6J mice. The cells are then embedded in collagen and transplanted in the inguinal mammary glands of female C57BL/6J mice. Transplantation of PyVmT cells alone form palpable tumors 30-40 days post transplantation. Endpoint analysis at 60 days indicates that co-transplantation with fibroblasts enhances mammary tumor growth compared to PyVmT cells transplanted alone. While cells and matrix from C57BL/6J mice were used in these studies, the isolation of cells and matrix and transplantation approach may be applied towards mice from different genetic backgrounds demonstrating versatility. In summary, this system may be used to investigate molecular interactions between stromal cells and epithelial cells, and overcomes critical limitations in immunocompromised mouse models.

In this report, we demonstrate a system to isolate and culture donor cells from the mouse mammary gland, and orthotopically transplant these cells in recipient mice to analyze stromal: epithelial interactions during mammary tumor development.

The influence of stromal cells, including fibroblasts on mammary tumor progression has been well documented through the use of mouse models, in particular ...

Multi-photon Imaging of Tumor Cell Invasion in an Orthotopic Mouse Model of Oral Squamous Cell Carcinoma

Loco-regional invasion of head and neck cancer is linked to metastatic risk and presents a difficult challenge in designing and implementing patient management strategies. Orthotopic mouse models of oral cancer have been developed to facilitate the study of factors that impact invasion and serve as model system for evaluating anti-tumor therapeutics. In these systems, visualization of disseminated tumor cells within oral cavity tissues has typically been conducted by either conventional histology or with in vivo bioluminescent methods. A primary drawback of these techniques is the inherent inability to accurately visualize and quantify early tumor cell invasion arising from the primary site in three dimensions. Here we describe a protocol that combines an established model for squamous cell carcinoma of the tongue (SCOT) with two-photon imaging to allow multi-vectorial visualization of lingual tumor spread. The OSC-19 head and neck tumor cell line was stably engineered to express the F-actin binding peptide LifeAct fused to the mCherry fluorescent protein (LifeAct-mCherry). Fox1nu/nu mice injected with these cells reliably form tumors that allow the tongue to be visualized by ex-vivo application of two-photon microscopy. This technique allows for the orthotopic visualization of the tumor mass and locally invading cells in excised tongues without disruption of the regional tumor microenvironment. In addition, this system allows for the quantification of tumor cell invasion by calculating distances that invaded cells move from the primary tumor site. Overall this procedure provides an enhanced model system for analyzing factors that contribute to SCOT invasion and therapeutic treatments tailored to prevent local invasion and distant metastatic spread. This method also has the potential to be ultimately combined with other imaging modalities in an in vivo setting.

A comprehensive overview of the techniques involved in generating a mouse model of oral cancer and quantitative monitoring of tumor invasion within the tongue through multi-photon microscopy of labeled cells is presented. This system can serve as a useful platform for the molecular assessment and drug efficacy of anti-invasive compounds.

Loco-regional invasion of head and neck cancer is linked to metastatic risk and presents a difficult challenge in designing and implementing patient ...

Modeling Intracerebral Hemorrhage in Mice: Injection of Autologous Blood or Bacterial Collagenase

Spontaneous intracerebral hemorrhage (ICH) defines a potentially life-threatening neurological malady that accounts for 10-15% of all stroke-related hospitalizations and for which no effective treatments are available to date1,2. Because of the heterogeneity of ICH in humans, various preclinical models are needed to thoroughly explore prospective therapeutic strategies3. Experimental ICH is commonly induced in rodents by intraparenchymal injection of either autologous blood or bacterial collagenase4. The appropriate model is selected based on the pathophysiology of hemorrhage induction and injury progression. The blood injection model mimics a rapidly progressing hemorrhage. Alternatively, bacterial collagenase enzymatically disrupts the basal lamina of brain capillaries, causing an active bleed that generally evolves over several hours5. Resultant perihematomal edema and neurofunctional deficits can be quantified from both models. In this study, we described and evaluated a modified double injection model of autologous whole blood6 as well as an ICH injection model of bacterial collagenase7, both of which target the basal ganglia (corpus striatum) of male CD-1 mice. We assessed neurofunctional deficits and brain edema at 24 and 72 hr after ICH induction. Intrastriatal injection of autologous blood (30 &mu;l) or bacterial collagenase (0.075U) caused reproducible neurofunctional deficits in mice and significantly increased brain edema at 24 and 72 hr after surgery (p&lt;0.05). In conclusion, both models yield consistent hemorrhagic infarcts and represent basic methods for preclinical ICH research.

Clinically relevant animal models of intracerebral hemorrhage (ICH) are needed to extend our knowledge of hemorrhagic stroke and to examine novel therapeutic strategies. In this study, we describe and evaluate two ICH models that implement unilateral injections of either autologous whole blood or bacterial collagenase into the basal ganglia (corpus striatum) of mice.

Spontaneous intracerebral hemorrhage (ICH) defines a potentially life-threatening neurological malady that accounts for 10-15% of all stroke-related ...

Generation of Subcutaneous and Intrahepatic Human Hepatocellular Carcinoma Xenografts in Immunodeficient Mice

In vivo experimental models of hepatocellular carcinoma (HCC) that recapitulate the human disease provide a valuable platform for research into disease pathophysiology and for the preclinical evaluation of novel therapies. We present a variety of methods to generate subcutaneous or orthotopic human HCC xenografts in immunodeficient mice that could be utilized in a variety of research applications. With a focus on the use of primary tumor tissue from patients undergoing surgical resection as a starting point, we describe the preparation of cell suspensions or tumor fragments for xenografting. We describe specific techniques to xenograft these tissues i) subcutaneously; or ii) intrahepatically, either by direct implantation of tumor cells or fragments into the liver, or indirectly by injection of cells into the mouse spleen. We also describe the use of partial resection of the native mouse liver at the time of xenografting as a strategy to induce a state of active liver regeneration in the recipient mouse that may facilitate the intrahepatic engraftment of primary human tumor cells. The expected results of these techniques are illustrated. The protocols described have been validated using primary human HCC samples and xenografts, which typically perform less robustly than the well-established human HCC cell lines that are widely used and frequently cited in the literature. In comparison with cell lines, we discuss factors which may contribute to the relatively low chance of primary HCC engraftment in xenotransplantation models and comment on technical issues that may influence the kinetics of xenograft growth. We also suggest methods that should be applied to ensure that xenografts obtained accurately resemble parent HCC tissues.

Human tumor xenografts in immunodeficient mice are valuable tools to study cancer biology. Specific protocols to generate subcutaneous and intrahepatic xenografts from human hepatocellular carcinoma cells or tumor fragments are described. Liver regeneration induced by partial hepatectomy in recipient mice is presented as a strategy to facilitate intrahepatic engraftment.

In  vivo experimental models of hepatocellular carcinoma (HCC) that recapitulate  the human disease provide a valuable platform for research into disease  ...

Induction of Invasive Transitional Cell Bladder Carcinoma in Immune Intact Human MUC1 Transgenic Mice:  A Model for Immunotherapy Development

A preclinical model of invasive bladder cancer was developed in human mucin 1 (MUC1) transgenic (MUC1.Tg) mice for the purpose of evaluating immunotherapy and/or cytotoxic chemotherapy. To induce bladder cancer, C57BL/6 mice (MUC1.Tg and wild type) were treated orally with the carcinogen N-butyl-N-(4-hydroxybutyl)nitrosamine (OH-BBN) at 3.0 mg/day, 5 days/week for 12 weeks. To assess the effects of OH-BBN on serum cytokine profile during tumor development, whole blood was collected via submandibular bleeds prior to treatment and every four weeks. In addition, a MUC1-targeted peptide vaccine and placebo were administered to groups of mice weekly for eight weeks. Multiplex fluorometric microbead immunoanalyses of serum cytokines during tumor development and following vaccination were performed. At termination, interferon gamma (IFN-&#947;)/interleukin-4 (IL-4) ELISpot analysis for MUC1 specific T-cell immune response and histopathological evaluations of tumor type and grade were performed. The results showed that: (1) the incidence of bladder cancer in both MUC1.Tg and wild type mice was 67%; (2) transitional cell carcinomas (TCC) developed at a 2:1 ratio compared to squamous cell carcinomas (SCC); (3) inflammatory cytokines increased with time during tumor development; and (4) administration of the peptide vaccine induces a Th1-polarized serum cytokine profile and a MUC1 specific T-cell response. All tumors in MUC1.Tg mice were positive for MUC1 expression, and half of all tumors in MUC1.Tg and wild type mice were invasive. In conclusion, using a team approach through the coordination of the efforts of pharmacologists, immunologists, pathologists and molecular biologists, we have developed an immune intact transgenic mouse model of bladder cancer that expresses hMUC1.

An N-butyl-N-(4-hydroxybutyl)nitrosamine-induced bladder cancer model was developed in human mucin 1 (MUC1) transgenic mice for the purpose of testing MUC1-directed immunotherapy. After administering a MUC1-targeted peptide vaccine, a cytotoxic T lymphocyte response to MUC1 was confirmed by measuring serum cytokine levels and T-cell specific activity.

A preclinical model of invasive bladder cancer was developed in human mucin 1 (MUC1) transgenic (MUC1.Tg) mice for the purpose of evaluating immunotherapy ...

Initiation of Metastatic Breast Carcinoma by Targeting of the Ductal Epithelium with Adenovirus-Cre: A Novel Transgenic Mouse Model of Breast Cancer

Breast cancer is a heterogeneous disease involving complex cellular interactions between the developing tumor and immune system, eventually resulting in exponential tumor growth and metastasis to distal tissues and the collapse of anti-tumor immunity. Many useful animal models exist to study breast cancer, but none completely recapitulate the disease progression that occurs in humans. In order to gain a better understanding of the cellular interactions that result in the formation of latent metastasis and decreased survival, we have generated an inducible transgenic mouse model of YFP-expressing ductal carcinoma that develops after sexual maturity in immune-competent mice and is driven by consistent, endocrine-independent oncogene expression. Activation of YFP, ablation of p53, and expression of an oncogenic form of K-ras was achieved by the delivery of an adenovirus expressing Cre-recombinase into the mammary duct of sexually mature, virgin female mice. Tumors begin to appear 6 weeks after the initiation of oncogenic events. After tumors become apparent, they progress slowly for approximately two weeks before they begin to grow exponentially. After 7-8 weeks post-adenovirus injection, vasculature is observed connecting the tumor mass to distal lymph nodes, with eventual lymphovascular invasion of YFP+ tumor cells to the distal axillary lymph nodes. Infiltrating leukocyte populations are similar to those found in human breast carcinomas, including the presence of &#945;&#946; and &#947;&#948; T cells, macrophages and MDSCs. This unique model will facilitate the study of cellular and immunological mechanisms involved in latent metastasis and dormancy in addition to being useful for designing novel immunotherapeutic interventions to treat invasive breast cancer.

Activation of latent mutations with adenovirus-Cre into the mammary ductal system results in a clinically relevant metastatic breast cancer. Incorporation of a YFP promoter allows tracking of distal metastatic tumor cells. This model is useful to study latent metastasis, anti-tumor immunity, and for designing novel immunotherapies to treat breast cancer.

Breast cancer is a heterogeneous disease involving complex cellular interactions between the developing tumor and immune system, eventually resulting in ...

Modeling Stroke in Mice: Permanent Coagulation of the Distal Middle Cerebral Artery

Stroke is the third most common cause of death and a main cause of acquired adult disability in developed countries. Only very limited therapeutical options are available for a small proportion of stroke patients in the acute phase. Current research is intensively searching for novel therapeutic strategies and is increasingly focusing on the sub-acute and chronic phase after stroke because more patients might be eligible for therapeutic interventions in a prolonged time window. These delayed mechanisms include important pathophysiological pathways such as post-stroke inflammation, angiogenesis, neuronal plasticity and regeneration. In order to analyze these mechanisms and to subsequently evaluate novel drug targets, experimental stroke models with clinical relevance, low mortality and high reproducibility are sought after. Moreover, mice are the smallest mammals in which a focal stroke lesion can be induced and for which a broad spectrum of transgenic models are available. Therefore, we describe here the mouse model of transcranial, permanent coagulation of the middle cerebral artery via electrocoagulation distal of the lenticulostriatal arteries, the so-called &#8220;coagulation model&#8221;. The resulting infarct in this model is located mainly in the cortex; the relative infarct volume in relation to brain size corresponds to the majority of human strokes. Moreover, the model fulfills the above-mentioned criteria of reproducibility and low mortality. In this video we demonstrate the surgical methods of stroke induction in the &#8220;coagulation model&#8221; and report histological and functional analysis tools.

Various murine models of middle cerebral artery occlusion (MCAO) are widely used in experimental brain research. Here, we demonstrate the model of transcranial permanent distal MCAO which produces consistent cortical infarction of a size corresponding to damage imposed by the majority of human ischemic strokes.

Stroke is the third most common cause of death and a main cause of acquired adult disability in developed countries. Only very limited therapeutical ...

Modeling Chemotherapy Resistant Leukemia In Vitro

It is well established that the bone marrow microenvironment provides a unique site of sanctuary for hematopoietic diseases that both initiate and progress in this site. The model presented in the current report utilizes human primary bone marrow stromal cells and osteoblasts as two representative cell types from the marrow niche that influence tumor cell phenotype. The in vitro co-culture conditions described for human leukemic cells with these primary niche components support the generation of a chemoresistant subpopulation of tumor cells that can be efficiently recovered from culture for analysis by diverse techniques. A strict feeding schedule to prevent nutrient fluxes followed by gel type 10 cross-linked dextran (G10) particles recovery of the population of tumor cells that have migrated beneath the adherent bone marrow stromal cells (BMSC) or osteoblasts (OB) generating a "phase dim" (PD) population of tumor cells, provides a consistent source of purified therapy resistant leukemic cells. This clinically relevant population of tumor cells can be evaluated by standard methods to investigate apoptotic, metabolic, and cell cycle regulatory pathways as well as providing a more rigorous target in which to test novel therapeutic strategies prior to pre-clinical investigations targeted at minimal residual disease.

Modeling Chemotherapy Resistant Leukemia In Vitro

The current report summarizes a protocol that can be utilized to model the influence of the bone marrow microenvironment niche on leukemic cells with emphasis placed on enrichment of the most chemoresistant subpopulation.