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Tonna JE, Pierce J, Brintz BJ, Bardsley T, Hatton N, Lewis G, Phillips JD, Skidmore CR, Selzman CH. A randomized, double-blinded, placebo-controlled clinical trial of sterile filtered human amniotic fluid for treatment of COVID-19. BMC Infect Dis 2023; 23:864. [PMID: 38066442 PMCID: PMC10704623 DOI: 10.1186/s12879-023-08856-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
IMPORTANCE Acellular human amniotic fluid (hAF) is an antimicrobial and anti-inflammatory fluid that has been used to treat various pro-inflammatory conditions. In a feasibility study, we have previously demonstrated that hAF could be safely administered to severely ill patients with coronavirus disease-19 (COVID-19). The impact of acellular hAF on markers of systemic inflammation and clinical outcomes during COVID-19 infection remain unknown. OBJECTIVE To determine the safety and efficacy of acellular, sterile processed intravenously administered hAF on markers of systemic inflammation during COVID-19. DESIGN, SETTINGS AND PARTICIPANTS This single-center Phase I/II randomized, placebo controlled clinical trial enrolled adult (age ≥ 18 years) patients hospitalized for respiratory symptoms of COVID-19, including hypoxemia, tachypnea or dyspnea. The study was powered for outcomes with an anticipated enrollment of 60 patients. From 09/28/2020 to 02/04/2022 we enrolled and randomized 47 (of an anticipated 60) patients hospitalized due to COVID-19. One patient withdrew consent after randomization but prior to treatment. Safety outcomes to 30 days were collected through hospital discharge and were complete by the end of screening on 6/30/2022. INTERVENTIONS Intravenous administration of 10 cc sterile processed acellular hAF once daily for up to 5 days vs placebo. MAIN OUTCOME AND MEASURES Blood biomarkers of inflammation, including C-Reactive protein (CRP), lactate dehydrogenase, D-dimer, and interleukin-6 (IL-6), as well as safety outcomes. RESULTS Patients who were randomized to hAF (n = 23) were no more likely to have improvements in CRP from baseline to Day 6 than patients who were randomized to placebo (n = 24) hAF: -5.9 [IQR -8.2, -0.6] vs placebo: -5.9 [-9.4, -2.05]; p = 0.6077). There were no significant differences in safety outcomes or adverse events. Secondary measures of inflammation including lactate dehydrogenase, D-dimer and IL-6 were not statistically different from baseline to day 6. CONCLUSIONS AND RELEVANCE In this randomized clinical trial involving hospitalized patients with COVID-19, the intravenous administration of 10 cc of hAF daily for 5 days did not result in statistically significant differences in either safety or markers of systemic inflammation compared to placebo, though we did not achieve our enrollment target of 60 patients. TRIAL REGISTRATION This trial was registered at ClinicalTrials.gov as #NCT04497389 on 04/08/2020.
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Affiliation(s)
- Joseph E Tonna
- Department of Surgery, Division of Cardiothoracic Surgery, University of Utah Health, Salt Lake City, UT, USA
- Department of Emergency Medicine, University of Utah Health, Salt Lake City, UT, USA
| | - Jan Pierce
- Department of Medicine, Division of Hematology, Cell Therapy and Regenerative Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Benjamin J Brintz
- Department of Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Tyler Bardsley
- Department of Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Nathan Hatton
- Department of Medicine, Division of Pulmonary Medicine, University of Utah Health, Salt Lake City, UT, USA
| | - Giavonni Lewis
- Department of Surgery, Division of General Surgery, University of Utah Health, Salt Lake City, UT, USA
| | - John D Phillips
- Department of Medicine, Division of Hematology, Cell Therapy and Regenerative Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Chloe R Skidmore
- Department of Surgery, Division of Cardiothoracic Surgery, University of Utah Health, Salt Lake City, UT, USA
| | - Craig H Selzman
- Department of Surgery, Division of Cardiothoracic Surgery, University of Utah Health, Salt Lake City, UT, USA.
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Sharma S, Mehra H, Gupta H, Agarwal R, Gangwar A, Kumar A. Comparison of the Efficacy of Amniotic Membrane Versus Buccal Fat Pad in Treatment of Oral Submucous Fibrosis. J Maxillofac Oral Surg 2023; 22:525-532. [PMID: 37534347 PMCID: PMC10390447 DOI: 10.1007/s12663-022-01709-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/08/2022] [Indexed: 10/18/2022] Open
Abstract
Background Oral and maxillofacial surgery deals with wide range of oral defects, wound closure, tissue resection, and tissue reconstruction. The purpose of our study is to use amniotic membrane for closure of post surgery defect in patient of oral submucous fibrosis to utilize its growth factor and scaffold nature for effective healing and to evaluate effectiveness of amniotic membrane in treatment outcome. The objectives are to compare post-operative mouth opening, healing of amniotic membrane and buccal fat pad. Material and Method Diagnosed patients with OSMF are divided into two surgical site Group I (n = 5patients)-Left side buccal mucosa in which resection of fibrous band with coronoidectomy followed by reconstruction of the mucosal defect with BFP. Group II-Right side buccal mucosa in which resection of fibrous band with coronoidectomy followed by reconstruction of the mucosal defect with freeze dried irradiated amniotic membrane. Result This study suggested that in comparison to buccal fat pad flap, the HAM graft is a better option for oral reconstruction in terms of infection, graft failure, MMO, inflammation, pain. Outcome indicated that the HAM is biologically ideal graft for oral wounds and could be used as clinical alternative for various repair surgery for oral defects. Conclusion The amniotic membrane was found easy to handle and easy to use with inherent hemostatic property which is observed in all patients. No patients had shown any evidence of any complications. Good pain control observed in patients throughout postoperative period.
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Affiliation(s)
- Shipra Sharma
- Department of Oral and Maxillofacial Surgery, Babu Banarsi Das College of Dental Sciences, BBD City, Faizabad Road, Lucknow, 226028 India
| | - Hemant Mehra
- Department of Oral and Maxillofacial Surgery, Babu Banarsi Das College of Dental Sciences, BBD City, Faizabad Road, Lucknow, 226028 India
| | - Hemant Gupta
- Department of Oral and Maxillofacial Surgery, Babu Banarsi Das College of Dental Sciences, BBD City, Faizabad Road, Lucknow, 226028 India
| | - Rashmi Agarwal
- Department of Oral and Maxillofacial Surgery, Babu Banarsi Das College of Dental Sciences, BBD City, Faizabad Road, Lucknow, 226028 India
| | - Ankit Gangwar
- Department of Oral and Maxillofacial Surgery, Babu Banarsi Das College of Dental Sciences, BBD City, Faizabad Road, Lucknow, 226028 India
| | - Abhigyan Kumar
- Department of Oral and Maxillofacial Surgery, Babu Banarsi Das College of Dental Sciences, BBD City, Faizabad Road, Lucknow, 226028 India
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Wang B, Wang X, Kenneth A, Drena A, Pacheco A, Kalvin L, Ibrahim ES, Rossi PJ, Thatcher K, Lincoln J. Developing small-diameter vascular grafts with human amniotic membrane: long-term evaluation of transplantation outcomes in a small animal model. Biofabrication 2023; 15. [PMID: 36626826 DOI: 10.1088/1758-5090/acb1da] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/10/2023] [Indexed: 01/11/2023]
Abstract
While current clinical utilization of large vascular grafts for vascular transplantation is encouraging, tissue engineering of small grafts still faces numerous challenges. This study aims to investigate the feasibility of constructing a small vascular graft from decellularized amniotic membranes (DAMs). DAMs were rolled around a catheter and each of the resulting grafts was crosslinked with (a) 0.1% glutaraldehyde; (b) 1-ethyl-3-(3-dimethylaminopropyl) crbodiimidehydro-chloride (20 mM)-N-hydroxy-succinimide (10 mM); (c) 0.5% genipin; and (d) no-crosslinking, respectively. Our results demonstrated the feasibility of using a rolling technique followed by lyophilization to transform DAM into a vessel-like structure. The genipin-crosslinked DAM graft showed an improved integrated structure, prolonged stability, proper mechanical property, and superior biocompatibility. After transplantation in rat abdominal aorta, the genipin-crosslinked DAM graft remained patent up to 16 months, with both endothelial and smooth muscle cell regeneration, which suggests that the genipin-crosslinked DAM graft has great potential to beimplementedas a small tissue engineered graft for futurevasculartransplantation.
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Affiliation(s)
- Bo Wang
- Joint Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI 53226, United States of America
| | - Xiaolong Wang
- Joint Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI 53226, United States of America
| | - Allen Kenneth
- Biomedical Resource Center, Medical College of Wisconsin, Milwaukee, WI 53226, United States of America
| | - Alexander Drena
- Department of Chemistry and Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, United States of America
| | - Arsenio Pacheco
- Department of Chemistry and Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, United States of America
| | - Lindsey Kalvin
- Department of Medicine, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, United States of America
| | - Ei-Sayed Ibrahim
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI 53226, United States of America
| | - Peter J Rossi
- Heart and Vascular Center, Froedtert Hospital, Milwaukee, WI 53226, United States of America
| | - Kaitlyn Thatcher
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226, United States of America
| | - Joy Lincoln
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226, United States of America
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Ansari A, Denton KM, Lim R. Strategies for immortalisation of amnion-derived mesenchymal and epithelial cells. Cell Biol Int 2022; 46:1999-2008. [PMID: 35998259 DOI: 10.1002/cbin.11892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/10/2022] [Indexed: 01/10/2023]
Abstract
Mesenchymal (human amniotic mesenchymal stem cell [HAMSC]) and epithelial cells (human amnion epithelial cell [HAEC]) derived from human amniotic membranes possess characteristics of pluripotency. However, the pluripotency of HAMSC and HAEC are sustained only for a finite period. This in vitro cell growth can be extended by cell immortalisation. Many well-defined immortalisation systems have been used for artificially overexpressing genes such as human telomerase reverse transcriptase in HAMSC and HAEC leading to controlled and prolonged cell proliferation. In recent years, much progress has been made in our understanding of the cellular machinery that regulates the cell cycle when immortalised. This review summarises the current understanding of molecular mechanisms that contribute to cell immortalisation, the strategies that have been employed to immortalise amnion-derived cell types, and their likely applications in regenerative medicine.
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Affiliation(s)
- Aneesa Ansari
- Department of Physiology, Monash University, Clayton, Australia.,Cardiovascular Disease Program, Monash Biomedicine Discovery Institute, Monash University, Clayton, Australia
| | - Kate M Denton
- Department of Physiology, Monash University, Clayton, Australia.,Cardiovascular Disease Program, Monash Biomedicine Discovery Institute, Monash University, Clayton, Australia
| | - Rebecca Lim
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
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Wang J, Chen X, Zhang L, Zheng Y, Qian J, Sun N, Ding X, Cui B. Chick early amniotic fluid component improves heart function and protects against inflammation after myocardial infarction in mice. Front Cardiovasc Med 2022; 9:1042852. [DOI: 10.3389/fcvm.2022.1042852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/31/2022] [Indexed: 11/17/2022] Open
Abstract
Myocardial infarction (MI) is the major cause of mortality around the world. We recently demonstrated that chick early amniotic fluid (ceAF) can effectively rescue ischemic heart injury, indicating that it has a therapeutic function in MI. However, its functional components and the underlying mechanisms remain to be clarified. Here, we demonstrated that a fraction of ceAF, peak 8 (P8), had a protective effect on acute MI. P8 significantly decreased cardiomyocyte cross-sectional areas and cardiomyocyte apoptosis in MI mice. Using a human embryonic stem cell-derived cardiomyocyte model, which was subjected to hypoxia and reoxygenation, mimicking MI state, we found that P8 treatment reduced apoptosis and reversed myocardial contractility. Mechanistically, P8 improved cardiac function by inhibiting NF-κB signaling and downregulating inflammatory cytokine expression. Using mass spectrometry, we identified that guanosine and deoxynucleoside were the main functional components of P8 that suppressed the inflammatory response in human embryonic stem cell-derived cardiomyocytes. Collectively, our data suggest that specific components from ceAF are promising therapeutic agents for ischemic heart injury and could be a potential supplement to current medications for MI.
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Human Placental Mesenchymal Stem Cells for the Treatment of ARDS in Rat. Stem Cells Int 2022; 2022:8418509. [PMID: 35756754 PMCID: PMC9226970 DOI: 10.1155/2022/8418509] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 04/21/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022] Open
Abstract
The acute respiratory distress syndrome (ARDS) is one of the main causes of high mortality in patients with coronavirus (COVID-19). In recent years, due to the coronavirus pandemic, the number of patients with ARDS has increased significantly. Unfortunately, until now, there are no effective treatments for ARDS caused by COVID-19. Many drugs are either ineffective or have a low effect. Currently, there have been reports of efficient use of mesenchymal stem cells (MSCs) for the treatment of ARDS caused by COVID-19. We investigated the influence of freeze-dried human placenta-derived mesenchymal stem cells (HPMSCs) in ARDS rat model. All animals have received intratracheal injection of 6 mg/kg of lipopolysaccharide (LPS). The rats were randomly divided into five groups: I: LPS, II: LPS+dexamethasone, III: LPS+HPMSCs, IV: HPMSC, and V: saline. ARDS observation time was short-term and amounted to 168 hours. The study has shown that HPMSCs are able to migrate and attach to damaged lung tissue, contributing to the resolution of pathology, restoration of function, and tissue repair in the alveolar space. Studies have also shown that the administration of HPMSCs in animals with ARDS model significantly reduced the levels of key cytokines such as IL-1β, IL-6, and TNF-α. Freeze-dried placental stem cell is a very promising biomaterial for the treatment of ARDS. The human placenta can be easily obtained because it is considered as a medical waste. At the same time, a huge number of MSCs can be obtained from the placental tissue, and there is no ethical controversy around their use. The freeze-dried MSCs from human placental tissue can be stored sterile at room temperature for a long time before use.
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Sarvari R, Keyhanvar P, Agbolaghi S, Roshangar L, Bahremani E, Keyhanvar N, Haghdoost M, Keshel SH, Taghikhani A, Firouzi N, Valizadeh A, Hamedi E, Nouri M. A comprehensive review on methods for promotion of mechanical features and biodegradation rate in amniotic membrane scaffolds. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2022; 33:32. [PMID: 35267104 PMCID: PMC8913518 DOI: 10.1007/s10856-021-06570-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 06/07/2021] [Indexed: 06/14/2023]
Abstract
Amniotic membrane (AM) is a biological tissue that surrounds the fetus in the mother's womb. It has pluripotent cells, immune modulators, collagen, cytokines with anti-fibrotic and anti-inflammatory effect, matrix proteins, and growth factors. In spite of the biological characteristics, some results have been released in preventing the adhesion on traumatized surfaces. Application of the AM as a scaffold is limited due to its low biomechanical resistance and rapid biodegradation. Therefore, for using the AM during surgery, its modification by different methods such as cross-linking of the membrane collagen is necessary, because the cross-linking is an effective way to reduce the rate of biodegradation of the biological materials. In addition, their cross-linking is likely an efficient way to increase the tensile properties of the material, so that they can be easily handled or sutured. In this regard, various methods related to cross-linking of the AM subsuming the composite materials, physical cross-linking, and chemical cross-linking with the glutraldehyde, carbodiimide, genipin, aluminum sulfate, etc. are reviewed along with its advantages and disadvantages in the current work.
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Affiliation(s)
- Raana Sarvari
- Stem Cell And Regenerative Medicine Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Peyman Keyhanvar
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
- Department of Medical Nanotechnology, School of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.
- Convergence of Knowledge, Technology and Society Network (CKTSN), Universal Scientific Education and Research Network (USERN), Tabriz, Iran.
- ARTAN1100 Startup Accelerator, Tabriz, Iran.
| | - Samira Agbolaghi
- Chemical Engineering Department, Faculty of Engineering, Azarbaijan Shahid Madani University, P.O. BOX: 5375171379, Tabriz, Iran
| | - Leila Roshangar
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Erfan Bahremani
- Alavi Ophthalmological Treatment and Educational Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Neda Keyhanvar
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- Gene Yakhteh Keyhan (Genik) Company (Ltd), Pharmaceutical Biotechnology Incubator, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehdi Haghdoost
- Department of Infectious Diseases, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saeed Heidari Keshel
- Medical Nanotechnology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Afsaneh Taghikhani
- Department of Chemistry, Tabriz Branch, Islamic Azad University, Tabriz, Iran
| | - Nima Firouzi
- Stem Cell and Tissue Engineering Research Laboratory, Chemical Engineering Faculty, Sahand University of Technology, P.O.BOX:51335-1996, Tabriz, Iran
- Phil and Penny Knight Campus for Accelerating Scientific Impact, University of Oregon Eugene, OR, 97403, USA
| | - Amir Valizadeh
- Stem Cell And Regenerative Medicine Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elham Hamedi
- Department of Tissue Engineering and Applied Cell Science, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Nouri
- Stem Cell And Regenerative Medicine Institute, Tabriz University of Medical Sciences, Tabriz, Iran.
- Department of Reproductive Biology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.
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Hitscherich PG, Chnari E, Deckwa J, Long M, Khalpey Z. Human Placental Allograft Membranes: Promising Role in Cardiac Surgery and Repair. Front Cardiovasc Med 2022; 9:809960. [PMID: 35252389 PMCID: PMC8891556 DOI: 10.3389/fcvm.2022.809960] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Despite the immense investment in research devoted to cardiovascular diseases, mechanisms of progression and potential treatments, it remains one of the leading causes of death in the world. Cellular based strategies have been explored for decades, having mixed results, while more recently inflammation and its role in healing, regeneration and disease progression has taken center stage. Placental membranes are immune privileged tissues whose native function is acting as a protective barrier during fetal development, a state which fosters regeneration and healing. Their unique properties stem from a complex composition of extracellular matrix, growth factors and cytokines involved in cellular growth, survival, and inflammation modulation. Placental allograft membranes have been used successfully in complex wound applications but their potential in cardiac wounds has only begun to be explored. Although limited, pre-clinical studies demonstrated benefits when using placental membranes compared to other standard of care options for pericardial repair or infarct wound covering, facilitating cardiomyogenesis of stem cell populations in vitro and supporting functional performance in vivo. Early clinical evidence also suggested use of placental allograft membranes as a cardiac wound covering with the potential to mitigate the predominantly inflammatory environment such as pericarditis and prevention of new onset post-operative atrial fibrillation. Together, these studies demonstrate the promising translational potential of placental allograft membranes as post-surgical cardiac wound coverings. However, the small number of publications on this topic highlights the need for further studies to better understand how to support the safe and efficient use of placenta allograft membranes in cardiac surgery.
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Affiliation(s)
| | | | - Jessa Deckwa
- Northwest Medical Center, Heart and Valve Institute, Cardiothoracic Surgery, Tucson, AZ, United States
| | - Marc Long
- MTF Biologics, Edison, NJ, United States
| | - Zain Khalpey
- Northwest Medical Center, Heart and Valve Institute, Cardiothoracic Surgery, Tucson, AZ, United States
- *Correspondence: Zain Khalpey
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Faiza Z, Prakash A, Namburi N, Johnson B, Timsina L, Lee LS. Fifteen-year experience with pericardiectomy at a tertiary referral center. J Cardiothorac Surg 2021; 16:180. [PMID: 34158104 PMCID: PMC8220762 DOI: 10.1186/s13019-021-01561-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 06/08/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose Pericardiectomy has traditionally carried relatively high perioperative mortality and morbidity, with few published reports of intermediate- and long- term outcomes. We investigated our 15-year experience performing pericardiectomy at our institution. Methods Retrospective study of all patients who underwent pericardiectomy at our institution between 2005 and 2019. Baseline demographics, intraoperative details, and postoperative outcomes including long-term survival were analyzed. Results Sixty-three patients were included in the study. 66.7% of subjects underwent isolated pericardiectomy while 33.3% underwent pericardiectomy concomitantly with another cardiac surgical procedure. The most common indications for pericardiectomy were constrictive (79.4%) and hemorrhagic (9.5%) pericarditis. Preoperatively, 76.2% of patients were New York Heart Association class II and III, while postoperatively, 71.4% were class I and II. One-, three-, five-, and ten- year overall mortality was 9.5, 14.3, 20.6, and 25.4%, respectively. Overall pericarditis recurrence rate was 4.8%. Conclusion Pericardiectomy carries relatively high overall mortality rates, which likely reflects underlying disease etiology and comorbidities. Patients with prior cardiac intervention, history of dialysis, and immunocompromised state are associated with worse outcomes.
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Affiliation(s)
- Zainab Faiza
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indiana University Health Methodist Hospital, 1801 N. Senate Blvd., Suite 3300, Indianapolis, IN, 46202, USA
| | - Anjali Prakash
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indiana University Health Methodist Hospital, 1801 N. Senate Blvd., Suite 3300, Indianapolis, IN, 46202, USA
| | - Niharika Namburi
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indiana University Health Methodist Hospital, 1801 N. Senate Blvd., Suite 3300, Indianapolis, IN, 46202, USA
| | - Bailey Johnson
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indiana University Health Methodist Hospital, 1801 N. Senate Blvd., Suite 3300, Indianapolis, IN, 46202, USA
| | - Lava Timsina
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indiana University Health Methodist Hospital, 1801 N. Senate Blvd., Suite 3300, Indianapolis, IN, 46202, USA
| | - Lawrence S Lee
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indiana University Health Methodist Hospital, 1801 N. Senate Blvd., Suite 3300, Indianapolis, IN, 46202, USA.
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Applications of Human Amniotic Membrane for Tissue Engineering. MEMBRANES 2021; 11:membranes11060387. [PMID: 34070582 PMCID: PMC8227127 DOI: 10.3390/membranes11060387] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 12/17/2022]
Abstract
An important component of tissue engineering (TE) is the supporting matrix upon which cells and tissues grow, also known as the scaffold. Scaffolds must easily integrate with host tissue and provide an excellent environment for cell growth and differentiation. Human amniotic membrane (hAM) is considered as a surgical waste without ethical issue, so it is a highly abundant, cost-effective, and readily available biomaterial. It has biocompatibility, low immunogenicity, adequate mechanical properties (permeability, stability, elasticity, flexibility, resorbability), and good cell adhesion. It exerts anti-inflammatory, antifibrotic, and antimutagenic properties and pain-relieving effects. It is also a source of growth factors, cytokines, and hAM cells with stem cell properties. This important source for scaffolding material has been widely studied and used in various areas of tissue repair: corneal repair, chronic wound treatment, genital reconstruction, tendon repair, microvascular reconstruction, nerve repair, and intraoral reconstruction. Depending on the targeted application, hAM has been used as a simple scaffold or seeded with various types of cells that are able to grow and differentiate. Thus, this natural biomaterial offers a wide range of applications in TE applications. Here, we review hAM properties as a biocompatible and degradable scaffold. Its use strategies (i.e., alone or combined with cells, cell seeding) and its degradation rate are also presented.
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Tonna JE, Pierce J, Hatton N, Lewis G, Phillips JD, Messina A, Skidmore CR, Taylor K, Selzman CH. Safety and feasibility of using acellular sterile filtered amniotic fluid as a treatment for patients with COVID-19: protocol for a randomised, double-blinded, placebo-controlled clinical trial. BMJ Open 2021; 11:e045162. [PMID: 33574155 PMCID: PMC7880092 DOI: 10.1136/bmjopen-2020-045162] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Human amniotic fluid (hAF) has been shown to reduce inflammation in multiple experimental models. hAF has previously been approved by the US Food and Drug Administration (FDA) as a human cellular and tissue product for tissue injury for human administration, and used safely in thousands of patients as a therapeutic treatment for diverse conditions. Given the profound inflammatory response observed in patients with COVID-19, and the successful completion of 10-patient pilot study of intravenous hAF, we present a trial design for a larger clinical trial of intravenous hAF for the treatment of COVID-19. METHODS AND ANALYSIS This paper describes the methodology of a phase I/II randomised, double-blinded, placebo-controlled clinical trial to determine the safety and feasibility of using acellular sterile filtered amniotic fluid as a treatment for patients with COVID-19. Primary outcome will be the change in C-reactive protein. Secondary outcomes include safety, biomarker inflammatory levels and clinically relevant outcomes at 30 days, including mortality, ventilator-free days and hospital and intensive care unit length of stay. Exploratory outcomes of health-related quality-of-life patient-reported outcomes will be collected. Hospitalised patients with laboratory-confirmed COVID-19 will be recruited. ETHICS AND DISSEMINATION This study was approved by the University of Utah Institutional Review Board (IRB_0013292), approved by the US FDA under Investigational New Drug (No 23369) and is registered on ClinicalTrials.gov. Results will be disseminated via peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER NCT04497389; Pre-results.
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Affiliation(s)
- Joseph E Tonna
- Department of Surgery, University of Utah Health, Salt Lake City, Utah, USA
| | - Jan Pierce
- CellReGen, University of Utah Health, Salt Lake City, Utah, USA
| | - Nathan Hatton
- Department of Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | - Giavonni Lewis
- Department of Surgery, University of Utah Health, Salt Lake City, Utah, USA
| | - John D Phillips
- Department of Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | - Alyssa Messina
- Department of Surgery, University of Utah Health, Salt Lake City, Utah, USA
| | - Chloe R Skidmore
- Department of Surgery, University of Utah Health, Salt Lake City, Utah, USA
| | - Kirsten Taylor
- Department of Surgery, University of Utah Health, Salt Lake City, Utah, USA
| | - Craig H Selzman
- Department of Surgery, University of Utah Health, Salt Lake City, Utah, USA
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Selzman CH, Tonna JE, Pierce J, Vargas C, Skidmore C, Lewis G, Hatton ND, Phillips JD. A pilot trial of human amniotic fluid for the treatment of COVID-19. BMC Res Notes 2021; 14:32. [PMID: 33482902 PMCID: PMC7820830 DOI: 10.1186/s13104-021-05443-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 01/07/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Vertical transmission from SARS CoV-2-infected women is uncommon and coronavirus has not been detected in amniotic fluid. Human amniotic products have a broad immune-mediating profile. Observing that many COVID-19 patients have a profound inflammatory response to the virus, we sought to determine the influence of human amniotic fluid (hAF) on hospitalized patients with COVID-19. RESULTS A 10-patient case series was IRB-approved to study the impact of hAF on hospitalized patients with documented COVID-19. Nine of the 10 patients survived to discharge, with one patient succumbing to the disease when enrolled on maximal ventilatory support and severe hypoxia. The study design was altered by the IRB such that the last 6 patients received higher dose of intravenous hAF. In this latter group, patients that had observed reductions in C-reactive protein were associated with improved clinical outcomes. No hAF-related adverse events were noted. Acknowledging some of the inherent limitations of this case series, these results inform and catalyze a larger scaled randomized prospective trial to further investigate hAF as a therapy for COVID-19. Trial Registration ClinicalTrials.gov: NCT04319731; March 23, 2020.
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Affiliation(s)
- Craig H Selzman
- Division of Cardiothoracic Surgery, University of Utah School of Medicine, 3C 127, 30 N 1900 E, Salt Lake City, UT, 84132, USA.
| | - Joseph E Tonna
- Division of Cardiothoracic Surgery, University of Utah School of Medicine, 3C 127, 30 N 1900 E, Salt Lake City, UT, 84132, USA
| | - Jan Pierce
- Cell Therapy and Regenerative Medicine Program, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Camila Vargas
- Division of Cardiothoracic Surgery, University of Utah School of Medicine, 3C 127, 30 N 1900 E, Salt Lake City, UT, 84132, USA
| | - Chloe Skidmore
- Division of Cardiothoracic Surgery, University of Utah School of Medicine, 3C 127, 30 N 1900 E, Salt Lake City, UT, 84132, USA
| | - Giavonni Lewis
- Division of General Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Nathan D Hatton
- Pulmonary and Criticial Care Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - John D Phillips
- Cell Therapy and Regenerative Medicine Program, University of Utah School of Medicine, Salt Lake City, UT, USA.,Division of Hematology, University of Utah School of Medicine, Salt Lake City, UT, USA
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Leal-Marin S, Kern T, Hofmann N, Pogozhykh O, Framme C, Börgel M, Figueiredo C, Glasmacher B, Gryshkov O. Human Amniotic Membrane: A review on tissue engineering, application, and storage. J Biomed Mater Res B Appl Biomater 2020; 109:1198-1215. [PMID: 33319484 DOI: 10.1002/jbm.b.34782] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/07/2020] [Accepted: 12/02/2020] [Indexed: 12/15/2022]
Abstract
Human amniotic membrane (hAM) has been employed as scaffolding material in a wide range of tissue engineering applications, especially as a skin dressing and as a graft for corneal treatment, due to the structure of the extracellular matrix and excellent biological properties that enhance both wound healing and tissue regeneration. This review highlights recent work and current knowledge on the application of native hAM, and/or production of hAM-based tissue-engineered products to create scaffolds mimicking the structure of the native membrane to enhance the hAM performance. Moreover, an overview is presented on the available (cryo) preservation techniques for storage of native hAM and tissue-engineered products that are necessary to maintain biological functions such as angiogenesis, anti-inflammation, antifibrotic and antibacterial activity.
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Affiliation(s)
- Sara Leal-Marin
- Institute for Multiphase Processes, Leibniz University Hannover, Garbsen, Germany
| | - Thomas Kern
- Department of Ophthalmology, University Eye Hospital, Hannover Medical School, Hannover, Germany
| | - Nicola Hofmann
- German Society for Tissue Transplantation (DGFG), Hannover, Germany
| | - Olena Pogozhykh
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Hannover, Germany
| | - Carsten Framme
- Department of Ophthalmology, University Eye Hospital, Hannover Medical School, Hannover, Germany
| | - Martin Börgel
- German Society for Tissue Transplantation (DGFG), Hannover, Germany
| | - Constanca Figueiredo
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Hannover, Germany
| | - Birgit Glasmacher
- Institute for Multiphase Processes, Leibniz University Hannover, Garbsen, Germany
| | - Oleksandr Gryshkov
- Institute for Multiphase Processes, Leibniz University Hannover, Garbsen, Germany
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Amniotic membrane as novel scaffold for human iPSC-derived cardiomyogenesis. In Vitro Cell Dev Biol Anim 2019; 55:272-284. [PMID: 30798515 DOI: 10.1007/s11626-019-00321-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 01/08/2019] [Indexed: 12/17/2022]
Abstract
Recent approaches of using decellularized organ matrices for cardiac tissue engineering prompted us to culture human-induced pluripotent stem cell (hiPSC)-derived cardiomyocytes (CMs) on the human amniotic membrane (hAM). Since hAM has been used lately to patch diseased hearts in patients and has shown anti-inflammatory and anti-fibrotic benefits, it qualifies as a cardiac compatible and clinically relevant heart tissue scaffold. The aim of this study was to test the ability of the hAM to support attachment, differentiation, and maturation of hiPSC-derived CMs in vitro. hAMs were prepared from term placenta. An in-house generated hiPSC line was used for CM derivation. hiPSC-derived cardiac progenitors were cultured on the surface of cryopreserved hAMs and in the presence of cytokines promoting cardiac differentiation. CMs grown on hAM and popular basement membrane matrix (BMM) Matrigel™ were compared for the following aspects of cardiac development: the morphology of cardiomyocytes with respect to shape and cellular alignments, levels of cardiac-related gene transcript expression, functionality in terms of spontaneous calcium fluxes and mitochondrial densities and distributions. hAM is biocompatible with hiPSC-derived CMs. hAM increased cardiac transcription regulator and myofibril protein transcript expression, accelerated intracellular calcium transients, and enhanced cellular mitochondrial complexity of its cardiomyocytes in comparison to cardiomyocytes differentiated on Matrigel™. Our data suggests that hAM supports differentiation and improves cardiomyogenesis in comparison to Matrigel™. hAMs are natural, easily and largely available. The method of preparing hAM cardiac sheets described here is simple with potential for clinical transplantation. Graphical abstract A An outline of the differentiation protocol with stage-specific growth factors and culture media used. B Cell fates from pluripotent stem cells to cardiomyocytes during differentiation on the amniotic membrane. C-FPhotomicrographs of cells at various stages of differentiation. Scale bars represent 100 μm.
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