Cited by 312Organ Transplantation Techniques and OutcomesTraumatic Brain Injury and Neurovascular DisturbancesOrgan Donation and Transplantation

The DOI matches its Crossref record; 77 of the 77 references it cites were found in a registry or an index; 4 of the 15 sources its claims cite were checked for support.

Restoration of brain circulation and cellular functions hours post-mortem

Open access

Abstract

The brains of humans and other mammals are highly vulnerable to interruptions in blood flow and decreases in oxygen levels. Here we describe the restoration and maintenance of microcirculation and molecular and cellular functions of the intact pig brain under ex vivo normothermic conditions up to four hours post-mortem. We have developed an extracorporeal pulsatile-perfusion system and a haemoglobin-based, acellular, non-coagulative, echogenic, and cytoprotective perfusate that promotes recovery from anoxia, reduces reperfusion injury, prevents oedema, and metabolically supports the energy requirements of the brain. With this system, we observed preservation of cytoarchitecture; attenuation of cell death; and restoration of vascular dilatory and glial inflammatory responses, spontaneous synaptic activity, and active cerebral metabolism in the absence of global electrocorticographic activity. These findings demonstrate that under appropriate conditions the isolated, intact large mammalian brain possesses an underappreciated capacity for restoration of microcirculation and molecular and cellular activity after a prolonged post-mortem interval.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

The paper reports that an extracorporeal pulsatile-perfusion system (BrainEx) with a hemoglobin-based, acellular, cytoprotective perfusate restored microcirculation and selected molecular and cellular functions in intact porcine brains after 4 hours postmortem, maintained for 6 hours of ex vivo normothermic perfusion. It found preserved cytoarchitecture, reduced cell death, restored vascular/glial/synaptic and metabolic activity, but no global electrocorticographic activity.

Key findings

  • After 4 h postmortem and 6 h perfusion (10 h total), BEx-perfused brains showed patent microvasculature, preserved hippocampal/neocortical/cerebellar cytoarchitecture, reduced activated caspase 3, and maintained neuronal, glial, and myelin architecture compared with 10 h PMI and control-perfusate brains.
  • BEx restored vascular dilatory response to nimodipine, glial inflammatory response to LPS (increased IL-1α, IL-1β, IL-6, and IL-8 relative to other conditions), spontaneous excitatory postsynaptic currents, and active cerebral metabolism.
  • At normothermia, average oxygen and glucose expenditure was approximately 2 mL/min/100 g and 6.5 mg/min/100 g tissue, respectively, with an arteriovenous lactate gradient of approximately −1 mmol/L.
  • Hippocampal CA3 pyramidal neurons after BEx perfusion had membrane capacitance 125±43 pF, input resistance 195±63 MΩ, membrane time constant 32.3±8.4 ms, resting potential −71.2±7.0 mV, spike threshold −48±0.6 mV, spike amplitude 80.3±6.1 mV, and spike duration 1.58±0.24 ms; global ECoG remained isoelectric.

Methods

  • Isolated, largely ex cranio porcine brains from 6–8 month old domestic pigs were perfused 4 h postmortem for 6 h under normothermic ex vivo conditions using a custom pulsatile-perfusion system and either control perfusate or BEx perfusate; comparison groups were unperfused 10 h PMI and flushed 1 h PMI.
  • The study used approximately 300 post-mortem pig brains during technology development, with 32 independent brains undergoing BEx perfusion for the reported data; analyses included ultrasonography, micro-CT angiography, MRI, histology/immunohistochemistry, electron microscopy, patch-clamp electrophysiology, ECoG, LPS-induced cytokine/chemokine multiplex assays, and arteriovenous metabolic measurements.
  • Data are reported as means ± SEM and analyzed with two-tailed paired/unpaired t-tests, one-way ANOVA with Dunnett’s post hoc, Kruskal-Wallis with Benjamini-Krieger-Yekutieli post hoc, or Chi-square tests, with significance set at P ≤ 0.05.

Limitations

  • The paper states that no global ECoG/EEG activity reemerged, that it is uncertain whether longer perfusion could restore global activity, and that inhibitory agents in the BEx perfusate may dampen network activity; it also states that restoration of molecular/cellular processes should not be extrapolated to normal brain function or awareness.
  • The paper states that delayed cellular death starting 72 h to weeks after ischemia cannot be excluded, that younger animals may have greater resilience to anoxic injury, and that further development, optimization, longer perfusion studies, and ethical standard operating procedures are needed.
  • Evident from the text: this is an isolated ex vivo porcine brain model without integrated brain function, and several analyses rely on representative images or small independent-brain sample sizes (e.g., n=3 for some imaging/EM/electrophysiology experiments), which limits generalization.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1038/s41586-019-1099-1

Cites

77 of 77 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

91 Own result · 39 Own method · 17 Own interpretation · 4 Sources not found · 4 No basis given · 1 Supported so far · 1 Partly supported · 1 Couldn’t confirm · accuracy not yet measured

Show all 75 claims

  • It may state two separate claims as one. 62
  • The quote only partly states this claim. 8
  • Probably not a substantial claim. 48
83 of 83
  • The paper relies on this without support.

    Absence of global electrical activity detectable by BIS and ECoG indicates absence of remnant awareness.

    “electrical activity was also examined to confirm that the brain did not display activity consistent with remnant awareness.”
    “No such electrical activity was ever observed.”
1 of 1

Citations

Cites

Show all 51 references

Research works printed but not linked: 1

  1. Schmidt, V. Comparative Anatomy of the Pig Brain: an Integrative Magnetic Resonance Imaging (MRI) Study of the Porcine Brain with Special Emphasis on the External Morphology of the Cerebral Cortex. Thesis, Justus-Liebig-Universität Gießen (2015).

Cited by

Sorted by citations

Items 301–312 of 312

Metadata

Authors
Vrselja, Z., Daniele, S. G., Silbereis, J., Talpo, F., Morozov, Y. M., Sousa, A. M. M., Tanaka, B. S., Skarica, M., Pletikos, M., Kaur, N., Zhuang, Z. W., Liu, Z., Alkawadri, R., Sinusas, A. J., Latham, S. R., Waxman, S. G., & Sestan, N.
Affiliations
  • Yale University (US)
  • University of Pavia (IT)
  • Boston University (US)
  • University of Pittsburgh (US)
Venue
Nature
Published
2019-04-17
Volume
568
Issue
7752
Pages
336-343
ISSN
  • 0028-0836 (ISSN-L)
  • 1476-4687
OpenAlex
W2939414360
Cited by
311
References
51
Citations by year
2026: 23 · 2025: 26 · 2024: 39 · 2023: 44 · 2022: 37 · 2021: 55 · 2020: 36 · 2019: 49
FWCI
41.73
Type
journal article
Language
en
Open access
Locations
  • Nature (publishedVersion)
  • Revista de Psicología (publishedVersion, cc-by-nc-sa)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Repositorio Institucional UCA (Pontificia Universidad Católica Argentina) (submittedVersion, cc-by-nc-sa)
  • RePEc: Research Papers in Economics (submittedVersion)
Funders
  • National Institutes of Health (1s10od021845-01, 2r01mh113257-06, UL1TR001863)
  • National Institute of Mental Health (#R01-MH113257, RF1MH117064)
  • National Institute of General Medical Sciences (T32GM007205)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
  • Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury and Neurovascular Disturbances
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Organ Donation and Transplantation
Keywords
cerebral microcirculation, pulsatile perfusion, ischemia-reperfusion injury, cerebral edema, brain energy metabolism, synaptic activity, glial inflammation, cell death, pig brain, normothermic perfusion
MeSH terms
Animals, Autopsy, Brain, Cell Survival, Hypoxia, Brain, Cerebral Arteries, Brain Ischemia, Cerebrovascular Circulation, Disease Models, Animal, Inflammation, Microcirculation, Neuroglia, Neurons, Perfusion, Swine, Synapses, Time Factors, Vasodilation, Reperfusion Injury, Caspase 3

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

A language model drew the claims from the paper on 2026-11-10, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).

A second model labelled each claim on 2026-11-10 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).

Cited sources are checked with a language model’s help (gpt-6-sol).

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review