Carbon Monoxide Preserves Cellular Integrity and Intestinal Mucosal Barrier Function After Intestinal Transplantation

Intestinal transplantation is a viable life-saving intervention solely reserved for patients with end-stage intestinal failure when total parenteral nutrition is no longer possible. Over the past decade, this complex therapeutic procedure has received significant clinical attention, illustrating its evolution from an experimental origin in the mid-twentieth century to an established clinical practice today. Despite several recent advances made in this field, there are several roadblocks that hamper the long-term success of intestinal transplantation. These include surgical manipulation during intestinal graft procurement, graft preservation and reperfusion damage resulting in poor graft quality, graft rejection, post-operative infectious complications, and ultimately negatively impacting long-term recipient survival. These challenges necessitate the search for new surgical techniques with potential to improve current intestinal transplantation protocol, reduce post-transplant complications and ensure long-term transplant recipient survival. Carbon monoxide (CO), a gas previously known for its toxicity and death at high concentrations, is quickly moving past its historic notoriety to a signaling molecule with biological usefulness and therapeutic potentials at low physiological concentrations that could overcome some of the challenges in current intestinal transplantation. In this chapter, the author discusses recent knowledge about CO in intestinal transplantation, its underlying molecular mechanisms of protection during intestinal graft procurement, preservation, transplantation and post-transplant periods. In addition, a section of the chapter also discusses clinical translation of CO and its challenges in transplantation of other solid organ grafts.