Tatsuaki Akino

Longer survival of rat limb allograft. Combined immunosuppression of FK-506 and 15-deoxyspergualin.

We studied the individual and synergistic effect of 3 immunosuppressive drugs, FK-506 (1 mg/kg/day), 15-deoxyspergualin (2.5 mg/kg/day) and cyclosporine (15 mg/kg/day) in a DA/Lewis rat limb allotransplantation model. 74 right hindlimb transplantations were performed. The median time for onset of rejection was 4 days in animals without immunosuppression, 37 days in animals receiving cyclosporine immunosuppression for 30 days, 61 days in animals receiving FK-506 for 30 days, 36 days in animals receiving a 30-day course of cyclosporine and, in the first 15 days, a course of 15-deoxyspergualin, and 76 days in animals receiving a 30-day course of FK-506 and 15-deoxyspergualin in the first 15 days. The combination of cyclosporine with 15-deoxyspergualin did not prolong graft survival and no synergistic effect was evident. In contrast, survival time in rat limb allografts receiving FK-506 and 15-deoxyspergualin was longer than in those receiving single FK-506 therapy. Our findings suggest a positive synergistic immunosuppressive effect with FK-506 and 15-deoxyspergualin in limb allotransplantation.

Treatment of chronic regional pain syndrome using manipulation therapy and regional anesthesia

In a 4-year period, 17 consecutive patients with posttraumatic chronic regional pain syndrome were treated with a new technique, Movelat manipulation therapy. At average follow-up of 8 months, satisfactory results were achieved in 15 patients (88%), but 2 patients, 1 with digital nerve injury and 1 with ulnar nerve injury, did not respond to the therapy. Factors associated with good clinical response include chronic regional pain syndrome type I, i.e., dystrophy produced by a trauma to the hand but not involving a specific nerve injury, early-stage disease (within 3 months after trauma), and involvement of the upper limbs. Complications were rare and mild (pain over the tourniquet site in 3%, temporary dizziness in 1%). This therapy is simple and safe and recommended for early treatment of chronic regional pain syndrome.

Nerve-regenerating effect of 15-deoxyspergualin : Peripheral nerve allotransplants in the rat

We studied the effect of two immunosuppressive agents, 15-deoxyspergualin and cyclosporine A, on various nerve allografts in inbred rats whose major histocompatibility complex was mismatched. As allografts, we used the sciatic nerve (20 mm) and the saphenous nerve (20 mm). We found that 1) fresh peripheral nerve allografts with a short course of 15-deoxyspergualin and cyclosporine A therapy induced more regenerated axons than autografts did, 2) a short course of 15-deoxyspergualin therapy provided better nerve regeneration than cyclosporine A therapy in all forms of nerve allografts and large caliber nerve allografts induced more regenerated axons.