1
|
Song H, Hao D, Zhou J, Farmer D, Wang A. Development of pro-angiogenic skin substitutes for wound healing. Wound Repair Regen 2024. [PMID: 38308588 DOI: 10.1111/wrr.13154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/13/2023] [Accepted: 12/12/2023] [Indexed: 02/05/2024]
Abstract
Wounds pose significant challenges to public health, primarily due to the loss of the mechanical integrity and barrier function of the skin and impaired angiogenesis, causing physical morbidities and psychological trauma to affect patients. Reconstructing the vasculature of the wound bed is crucial for promoting wound healing, reducing scar formation and enhancing the quality of life for patients. The development of pro-angiogenic skin substitutes has emerged as a promising strategy to facilitate vascularization and expedite the healing process of burn wounds. This review provides an overview of the various types of skin substitutes employed in wound healing, explicitly emphasising those designed to enhance angiogenesis. Synthetic scaffolds, biological matrices and tissue-engineered constructs incorporating stem cells and primary cells, cell-derived extracellular vesicles (EVs), pro-angiogenic growth factors and peptides, as well as gene therapy-based skin substitutes are thoroughly examined. The review summarises the existing challenges, future directions and potential innovations in pro-angiogenic dressing for skin substitutes. It highlights the need for continued research to develop new technologies and combine multiple strategies and factors, and to overcome obstacles and advance the field, ultimately leading to improved outcomes for wound patients.
Collapse
Affiliation(s)
- Hengyue Song
- Center for Surgical Bioengineering, Department of Surgery, UC Davis Health, Sacramento, California, USA
- Department of Burns and Plastic Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
- Institute for Pediatric Regenerative Medicine, Shriners Hospitals for Children, Sacramento, California, USA
| | - Dake Hao
- Center for Surgical Bioengineering, Department of Surgery, UC Davis Health, Sacramento, California, USA
- Institute for Pediatric Regenerative Medicine, Shriners Hospitals for Children, Sacramento, California, USA
| | - Jianda Zhou
- Department of Burns and Plastic Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
| | - Diana Farmer
- Center for Surgical Bioengineering, Department of Surgery, UC Davis Health, Sacramento, California, USA
- Institute for Pediatric Regenerative Medicine, Shriners Hospitals for Children, Sacramento, California, USA
| | - Aijun Wang
- Center for Surgical Bioengineering, Department of Surgery, UC Davis Health, Sacramento, California, USA
- Institute for Pediatric Regenerative Medicine, Shriners Hospitals for Children, Sacramento, California, USA
- Department of Biomedical Engineering, UC Davis, Davis, California, USA
| |
Collapse
|
2
|
Fusco J, Williams R, Malek M, Avansino JR, Hirose S, Perkins JA, Farmer D, Gow KW. Centers of Excellence: If We Build It, Will They Come? J Pediatr Surg 2023; 58:1048-1052. [PMID: 36925401 DOI: 10.1016/j.jpedsurg.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 02/03/2023] [Indexed: 02/19/2023]
Abstract
Pediatric surgeons have been pursuing high quality, affordable care or value-based care for over 50 years. One approach to streamlining the clinical care for a complex problem was the development of a center of excellence (COE). The concept of COE focuses on a shared vision of providing high quality care through a multidisciplinary approach. The goal is to improve diagnostic accuracy as well as therapeutic outcomes using focused expertise within a group. COEs are often resource intensive before becoming fiscally viable and therefore require initial support from hospital leadership. This review discusses the key steps to consider before building a COE, strategies to help build one, and how to keep one successful as defined by quality, accessibility, equity, training, and maintaining teams within the group.
Collapse
Affiliation(s)
- Joseph Fusco
- Monroe Carrel Jr Children's Hospital at Vanderbilt, Nashville, TN, 37232, USA
| | | | - Marcus Malek
- University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Jeffery R Avansino
- Seattle Children's Hospital and the University of Washington, Seattle, WA, 98105, USA
| | | | - Jonathan A Perkins
- Seattle Children's Hospital and the University of Washington, Seattle, WA, 98105, USA
| | | | - Kenneth W Gow
- Seattle Children's Hospital and the University of Washington, Seattle, WA, 98105, USA.
| |
Collapse
|
3
|
Lee SY, Papanna R, Farmer D, Tsao K. Fetal Repair of Neural Tube Defects. Clin Perinatol 2022; 49:835-848. [PMID: 36328602 DOI: 10.1016/j.clp.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Myelomeningocele is the most common congenital neurologic defect, and the only nonlethal disease addressed by fetal surgery. A randomized control trial has established amelioration of the Arnold-Chiari II malformation, reduced ventriculoperitoneal shunt rate, and improvement in distal neurologic function in patients that receive in utero repair. Long-term follow-up of these school-age children demonstrates the persistence of these effects. The use of stem cells in fetal repair is being investigated to further improve distal motor function.
Collapse
Affiliation(s)
- Su Yeon Lee
- Department of Surgery, Division of Pediatric, Thoracic and Fetal Surgery, University of California Davis Medical Center, 2335 Stockton Boulevard, Room 5107, Sacramento, CA 95817, USA.
| | - Ramesha Papanna
- Department of Obstetrics, Gynecology and Reproductive Sciences, UT Health Science Center at Houston, 6410 Fannin Street, Suite 210, Houston, TX 77030, USA
| | - Diana Farmer
- Department of Surgery, University of California Davis Medical Center, 2335 Stockton Boulevard, Sacramento, CA 95817, USA
| | - KuoJen Tsao
- Department of Pediatric Surgery, UT Health Science Center at Houston, 6410 Fannin Street, Suite 950, Houston, TX 77030, USA
| |
Collapse
|
4
|
Ramasubramanian L, Jyothi H, Goldbloom-Helzner L, Light B, Kumar P, Farmer D, Wang A. Exosomes/EVs: PLACENTAL MESENCHYMAL STEM/STROMAL CELL-DERIVED LIPID RAFT NANOVESICLES: A BIOINSPIRED THERAPEUTIC FOR REGENERATIVE MEDICINE. Cytotherapy 2022. [DOI: 10.1016/s1465-3249(22)00277-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
5
|
Kulubya E, Jackson J, Bhaskara M, Kumar P, Pivetti C, Avallone S, Paxton Z, Reed C, Mor S, Wang A, Farmer D. 184 Placental Mesenchymal Stromal Cells Seeded on an Extracellular Matrix Scaffold Improve Motor Function Recovery After Acute Spinal Cord Injury. Neurosurgery 2022. [DOI: 10.1227/neu.0000000000001880_184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
6
|
Norton ME, Cassidy A, Ralston SJ, Chatterjee D, Farmer D, Beasley AD, Dragoman M. Society for Maternal-Fetal Medicine Consult Series #59: The use of analgesia and anesthesia for maternal-fetal procedures. Am J Obstet Gynecol 2021; 225:B2-B8. [PMID: 34461076 DOI: 10.1016/j.ajog.2021.08.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Pain is a complex phenomenon that involves more than a simple physical response to external stimuli. In maternal-fetal surgical procedures, fetal analgesia is used primarily to blunt fetal autonomic responses and minimize fetal movement. The purpose of this Consult is to review the literature on what is known about the potential for fetal awareness of pain and to discuss the indications for and the risk-benefit calculus involved in the use of fetal anesthesia and analgesia. The recommendations by the Society for Maternal-Fetal Medicine are as follows: (1) we suggest that fetal paralytic agents be considered in the setting of intrauterine transfusion, if needed, for the purpose of decreasing fetal movement (GRADE 2C); (2) although the fetus is unable to experience pain at the gestational age when procedures are typically performed, we suggest that opioid analgesia should be administered to the fetus during invasive fetal surgical procedures to attenuate acute autonomic responses that may be deleterious, avoid long-term consequences of nociception and physiological stress on the fetus, and decrease fetal movement to enable the safe execution of procedures (GRADE 2C); and (3) due to maternal risk and a lack of evidence supporting benefit to the fetus, we recommend against the administration of fetal analgesia at the time of pregnancy termination (GRADE 1C).
Collapse
Affiliation(s)
- Mary E Norton
- Society for Maternal-Fetal Medicine, 409 12 St. SW, Washington, DC 20024, USA.
| | - Arianna Cassidy
- Society for Maternal-Fetal Medicine, 409 12 St. SW, Washington, DC 20024, USA.
| | - Steven J Ralston
- Society for Maternal-Fetal Medicine, 409 12 St. SW, Washington, DC 20024, USA.
| | - Debnath Chatterjee
- Society for Maternal-Fetal Medicine, 409 12 St. SW, Washington, DC 20024, USA.
| | - Diana Farmer
- Society for Maternal-Fetal Medicine, 409 12 St. SW, Washington, DC 20024, USA.
| | - Anitra D Beasley
- Society for Maternal-Fetal Medicine, 409 12 St. SW, Washington, DC 20024, USA.
| | - Monica Dragoman
- Society for Maternal-Fetal Medicine, 409 12 St. SW, Washington, DC 20024, USA.
| |
Collapse
|
7
|
Medicine SFMF, Planning SOF, Norton ME, Cassidy A, Ralston SJ, Chatterjee D, Farmer D, Beasley AD, Dragoman M. Society for Maternal-Fetal Medicine Consult Series #59: The use of analgesia and anesthesia for maternal-fetal procedures. Contraception 2021; 106:10-15. [PMID: 34740602 DOI: 10.1016/j.contraception.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Pain is a complex phenomenon that involves more than a simple physical response to external stimuli. In maternal-fetal surgical procedures, fetal analgesia is used primarily to blunt fetal autonomic responses and minimize fetal movement. The purpose of this Consult is to review the literature on what is known about the potential for fetal awareness of pain and to discuss the indications for and the risk-benefit calculus involved in the use of fetal anesthesia and analgesia. The recommendations by the Society for Maternal-Fetal Medicine are as follows: (1) we suggest that fetal paralytic agents be considered in the setting of intrauterine transfusion, if needed, for the purpose of decreasing fetal movement (GRADE 2C); (2) although the fetus is unable to experience pain at the gestational age when procedures are typically performed, we suggest that opioid analgesia should be administered to the fetus during invasive fetal surgical procedures to attenuate acute autonomic responses that may be deleterious, avoid long-term consequences of nociception and physiological stress on the fetus, and decrease fetal movement to enable the safe execution of procedures (GRADE 2C); and (3) due to maternal risk and a lack of evidence supporting benefit to the fetus, we recommend against the administration of fetal analgesia at the time of pregnancy termination (GRADE 1C).
Collapse
Affiliation(s)
| | | | - Mary E Norton
- The Society for Maternal-Fetal Medicine: Publications Committee.
| | - Arianna Cassidy
- The Society for Maternal-Fetal Medicine: Publications Committee.
| | - Steven J Ralston
- The Society for Maternal-Fetal Medicine: Publications Committee.
| | | | - Diana Farmer
- The Society for Maternal-Fetal Medicine: Publications Committee.
| | - Anitra D Beasley
- The Society for Maternal-Fetal Medicine: Publications Committee.
| | - Monica Dragoman
- The Society for Maternal-Fetal Medicine: Publications Committee.
| |
Collapse
|
8
|
Farmer D, Young L. Disparity in Sex of Surgical Journal Author Contributions. J Am Coll Surg 2021; 233:175-176. [PMID: 34304814 DOI: 10.1016/j.jamcollsurg.2021.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 10/20/2022]
|
9
|
Clark K, Zhang S, Barthe S, Kumar P, Pivetti C, Kreutzberg N, Reed C, Wang Y, Paxton Z, Farmer D, Guo F, Wang A. Placenta-derived mesenchymal stem/stromal cells and secreted extracellular vesicles as novel treatments for multiple sclerosis. Cytotherapy 2021. [DOI: 10.1016/s146532492100445x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
10
|
Yamashiro K, Galganski LA, Peyton J, Haynes K, Vicuna V, Kumar P, Keller B, Becker J, Pivetti C, Stokes S, Theodorou C, Jackson J, Wang A, Farmer D. Surviving Lambs with Myelomeningocele Repaired in utero with Placental Mesenchymal Stromal Cells for 6 Months: A Pilot Study. Fetal Diagn Ther 2020; 47:912-917. [PMID: 33166951 DOI: 10.1159/000510813] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 08/11/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Fetal repair of myelomeningocele (MMC) with placental mesenchymal stromal cells (PMSCs) rescues ambulation in the ovine model up to 48 h postnatally. Outcomes past 48 h are unknown as MMC lambs have not been survived past this timepoint. OBJECTIVE We aimed to survive lambs for 6 months following the fetal repair of MMC with PMSCs. METHODS Fetal MMC lambs were repaired with PMSCs. Lambs received either no additional treatment or postnatal bracing and physical therapy (B/PT). Motor function was assessed with the sheep locomotor rating (SLR). Lambs with an SLR of 15 at birth were survived for 6 months or until a decline in SLR less than 15, whichever came first. All lambs underwent a perimortem MRI. RESULTS The lambs with no postnatal treatment (n = 2) had SLR declines to 7 and 13 at 29 and 65 days, respectively, and were euthanized. These lambs had a spinal angulation of 57° and 47°, respectively. The B/PT lamb (n = 1) survived for 6 months with a sustained SLR of 15 and a lumbar angulation of 42°. CONCLUSION Postnatal physical therapy and bracing counteracted the inherent morbidity of the absent paraspinal muscles in the ovine MMC model allowing for survival and maintenance of rescued motor function of the prenatally treated lamb up to 6 months.
Collapse
Affiliation(s)
- Kaeli Yamashiro
- Department of Surgery, University of California-Davis, Sacramento, California, USA,
| | - Laura A Galganski
- Department of Surgery, University of California-Davis, Sacramento, California, USA
| | - Jamie Peyton
- Department of Veterinary Medicine, University of California-Davis, Sacramento, California, USA
| | - Kalie Haynes
- Department of Veterinary Medicine, University of California-Davis, Sacramento, California, USA
| | - Victoria Vicuna
- Department of Veterinary Medicine, University of California-Davis, Sacramento, California, USA
| | - Priyadarsini Kumar
- Department of Surgery, University of California-Davis, Sacramento, California, USA.,Shriner's Hospitals for Children Northern California, Sacramento, California, USA
| | - Benjamin Keller
- Department of Surgery, University of California-Davis, Sacramento, California, USA
| | - James Becker
- Department of Surgery, University of California-Davis, Sacramento, California, USA
| | - Christopher Pivetti
- Department of Surgery, University of California-Davis, Sacramento, California, USA.,Shriner's Hospitals for Children Northern California, Sacramento, California, USA
| | - Sarah Stokes
- Department of Surgery, University of California-Davis, Sacramento, California, USA
| | - Christina Theodorou
- Department of Surgery, University of California-Davis, Sacramento, California, USA
| | - Jordan Jackson
- Department of Surgery, University of California-Davis, Sacramento, California, USA
| | - Aijun Wang
- Department of Surgery, University of California-Davis, Sacramento, California, USA.,Shriner's Hospitals for Children Northern California, Sacramento, California, USA.,Department of Biomedical Engineering, University of California-Davis, Davis, California, USA
| | - Diana Farmer
- Department of Surgery, University of California-Davis, Sacramento, California, USA.,Shriner's Hospitals for Children Northern California, Sacramento, California, USA
| |
Collapse
|
11
|
Seyi-Olajide JO, Anderson J, Enivwaene AO, Ibrahim SH, Farmer D, Ameh EA. Catastrophic Healthcare Expenditure from Typhoid Perforation in Children in Nigeria. Surg Infect (Larchmt) 2020; 21:586-591. [PMID: 32423308 DOI: 10.1089/sur.2020.134] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: Out-of-pocket payments and catastrophic healthcare expenditures (CHE) are important barriers to achieving equity and access to emergency and essential surgical care in low- and middle-income countries (LMICs), with important implications for universal health coverage (UHC). However, data on CHE for surgical care in these settings are limited, especially with regard to infections. Methods: We performed a retrospective review of 32 children receiving laparotomy for typhoid intestinal perforation in a four-year period. Data on medical costs were reviewed. Because of the lack of reliable data on household incomes and average national incomes for Nigeria, gross domestic product per capita was used to calculate CHE. The GDP per capita for the country during the study period was $2,028.182. Expenditure >10% GDP per capita (or > $202.82) was considered CHE. Results: There were 15 boys and 17 girls aged 2-15 years (mean 7.72 years). Seventeen patients (53%) were referred from district/general hospitals or mission hospitals. After surgical treatment, 16 patients (50%) developed complications (intra-abdominal abscesses and incision complications), and nine (28.1%) required re-operation. Seven patients (21.9%) required intensive care (ICU) treatment and three (9.4%) died from overwhelming infection. The hospital stay was 3-93 days (mean 23 days). The average total medical cost was $452 (range $236-$1,700). The total medical costs exceeded 10% of GDP ($202.82) for all patients. Total expenditure for four patients requiring intensive care exceeded $202.82 for the ICU care alone. Conclusion: Surgical treatment of typhoid intestinal perforation in children is associated with a high rate of CHE if care is provided at tertiary hospitals. Investments in prevention and control of this and other surgical infections as well as scale up of capacity at district hospitals to provide such care are important in preventing CHE.
Collapse
Affiliation(s)
- Justina O Seyi-Olajide
- Paediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Jamie Anderson
- Department of Surgery, University of California, Davis Medical Center, Sacramento, California, USA
| | - Augustine O Enivwaene
- Division of Paediatric Surgery, Department of Surgery, National Hospital, Abuja, Nigeria
| | - Salamatu Halid Ibrahim
- Division of Paediatric Surgery, Department of Surgery, National Hospital, Abuja, Nigeria
| | - Diana Farmer
- Department of Surgery, University of California, Davis Medical Center, Sacramento, California, USA
| | - Emmanuel A Ameh
- Division of Paediatric Surgery, Department of Surgery, National Hospital, Abuja, Nigeria
| |
Collapse
|
12
|
Deprest J, Choolani M, Chervenak F, Farmer D, Lagrou K, Lopriore E, McCullough L, Olutoye O, Simpson L, Van Mieghem T, Ryan G. Fetal Diagnosis and Therapy during the COVID-19 Pandemic: Guidance on Behalf of the International Fetal Medicine and Surgery Society. Fetal Diagn Ther 2020; 47:689-698. [PMID: 32375144 PMCID: PMC7251580 DOI: 10.1159/000508254] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/25/2020] [Indexed: 12/21/2022]
Abstract
The COVID-19 pandemic has stressed patients and healthcare givers alike and challenged our practice of antenatal care, including fetal diagnosis and therapy. This document aims to review relevant recent information to allow us to optimize prenatal care delivery. We discuss potential modifications to obstetric management and fetal procedures in SARS-CoV2-negative and SARS-CoV2-positive patients with fetal anomalies or disorders. Most fetal therapies are time sensitive and cannot be delayed. If personnel and resources are available, we should continue to offer procedures of proven benefit, acknowledging any fetal and maternal risks, including those to health care workers. There is, to date, minimal, unconfirmed evidence of spontaneous vertical transmission, though it may theoretically be increased with some procedures. Knowing a mother's preoperative SARS-CoV-2 status would enable us to avoid or defer certain procedures while she is contagious and to protect health care workers appropriately. Some fetal conditions may alternatively be managed neonatally. Counseling regarding fetal interventions which have a possibility of additional intra- or postoperative morbidity must be performed in the context of local resource availability. Procedures of unproven benefit should not be offered. We encourage participation in registries and trials that may help us to understand the impact of COVID-19 on pregnant women, their fetuses, and neonates.
Collapse
Affiliation(s)
- Jan Deprest
- Department of Obstetrics and Gynecology, UZ Leuven, Leuven, Belgium,
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium,
- Institute for Women's Health, University College London, London, United Kingdom,
| | - Mahesh Choolani
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Frank Chervenak
- Zucker School of Medicine at Hofstra/Northwell - Lenox Hill Hospital, New York, New York, USA
| | - Diana Farmer
- Department of Surgery, UC Davis School of Medicine, Sacramento, California, USA
- UC Davis Children's Hospital, Sacramento, California, USA
| | - Katrien Lagrou
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Clinical Department of Laboratory Medicine and National Reference Center for Respiratory Pathogens, UZ Leuven, Leuven, Belgium
| | - Enrico Lopriore
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Laurence McCullough
- Zucker School of Medicine at Hofstra/Northwell - Lenox Hill Hospital, New York, New York, USA
| | - Olutoyin Olutoye
- Department of Anesthesiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Lynn Simpson
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine, Columbia University, New York, New York, USA
| | - Tim Van Mieghem
- Fetal Medicine Unit, Ontario Fetal Centre, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Greg Ryan
- Fetal Medicine Unit, Ontario Fetal Centre, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
13
|
Gao K, He S, Kumar P, Farmer D, Zhou J, Wang A. Clonal isolation of endothelial colony-forming cells from early gestation chorionic villi of human placenta for fetal tissue regeneration. World J Stem Cells 2020; 12:123-138. [PMID: 32184937 PMCID: PMC7062038 DOI: 10.4252/wjsc.v12.i2.123] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 12/03/2019] [Accepted: 12/23/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endothelial colony-forming cells (ECFCs) have been implicated in the process of vascularization, which includes vasculogenesis and angiogenesis. Vasculogenesis is a de novo formation of blood vessels, and is an essential physiological process that occurs during embryonic development and tissue regeneration. Angiogenesis is the growth of new capillaries from pre-existing blood vessels, which is observed both prenatally and postnatally. The placenta is an organ composed of a variety of fetal-derived cells, including ECFCs, and therefore has significant potential as a source of fetal ECFCs for tissue engineering.
AIM To investigate the possibility of isolating clonal ECFCs from human early gestation chorionic villi (CV-ECFCs) of the placenta, and assess their potential for tissue engineering.
METHODS The early gestation chorionic villus tissue was dissociated by enzyme digestion. Cells expressing CD31 were selected using magnetic-activated cell sorting, and plated in endothelial-specific growth medium. After 2-3 wks in culture, colonies displaying cobblestone-like morphology were manually picked using cloning cylinders. We characterized CV-ECFCs by flow cytometry, immunophenotyping, tube formation assay, and Dil-Ac-LDL uptake assay. Viral transduction of CV-ECFCs was performed using a Luciferase/tdTomato-containing lentiviral vector, and transduction efficiency was tested by fluorescent microscopy and flow cytometry. Compatibility of CV-ECFCs with a delivery vehicle was determined using an FDA approved, small intestinal submucosa extracellular matrix scaffold.
RESULTS After four passages in 6-8 wks of culture, we obtained a total number of 1.8 × 107 CV-ECFCs using 100 mg of early gestational chorionic villus tissue. Immunophenotypic analyses by flow cytometry demonstrated that CV-ECFCs highly expressed the endothelial markers CD31, CD144, CD146, CD105, CD309, only partially expressed CD34, and did not express CD45 and CD90. CV-ECFCs were capable of acetylated low-density lipoprotein uptake and tube formation, similar to cord blood-derived ECFCs (CB-ECFCs). CV-ECFCs can be transduced with a Luciferase/tdTomato-containing lentiviral vector at a transduction efficiency of 85.1%. Seeding CV-ECFCs on a small intestinal submucosa extracellular matrix scaffold confirmed that CV-ECFCs were compatible with the biomaterial scaffold.
CONCLUSION In summary, we established a magnetic sorting-assisted clonal isolation approach to derive CV-ECFCs. A substantial number of CV-ECFCs can be obtained within a short time frame, representing a promising novel source of ECFCs for fetal treatments.
Collapse
Affiliation(s)
- Kewa Gao
- Department of Burns and Plastic Surgery, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
- Surgical Bioengineering Laboratory, Department of Surgery, University of California Davis, Sacramento, CA 95817, United States
- Institute for Pediatric Regenerative Medicine, Shriners Hospitals for Children, Sacramento, CA 95817, United States
| | - Siqi He
- Department of Burns and Plastic Surgery, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
- Surgical Bioengineering Laboratory, Department of Surgery, University of California Davis, Sacramento, CA 95817, United States
- Institute for Pediatric Regenerative Medicine, Shriners Hospitals for Children, Sacramento, CA 95817, United States
| | - Priyadarsini Kumar
- Surgical Bioengineering Laboratory, Department of Surgery, University of California Davis, Sacramento, CA 95817, United States
- Institute for Pediatric Regenerative Medicine, Shriners Hospitals for Children, Sacramento, CA 95817, United States
| | - Diana Farmer
- Surgical Bioengineering Laboratory, Department of Surgery, University of California Davis, Sacramento, CA 95817, United States
- Institute for Pediatric Regenerative Medicine, Shriners Hospitals for Children, Sacramento, CA 95817, United States
| | - Jianda Zhou
- Department of Burns and Plastic Surgery, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
| | - Aijun Wang
- Surgical Bioengineering Laboratory, Department of Surgery, University of California Davis, Sacramento, CA 95817, United States
- Institute for Pediatric Regenerative Medicine, Shriners Hospitals for Children, Sacramento, CA 95817, United States
- Department of Biomedical Engineering, University of California Davis, Davis, CA 95817, United States
| |
Collapse
|
14
|
Henry JJD, Delrosario L, Fang J, Wong SY, Fang Q, Sievers R, Kotha S, Wang A, Farmer D, Janaswamy P, Lee RJ, Li S. Development of Injectable Amniotic Membrane Matrix for Postmyocardial Infarction Tissue Repair. Adv Healthc Mater 2020; 9:e1900544. [PMID: 31778043 PMCID: PMC6986802 DOI: 10.1002/adhm.201900544] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 10/03/2019] [Indexed: 12/16/2022]
Abstract
Ischemic heart disease represents the leading cause of death worldwide. Heart failure following myocardial infarction (MI) is associated with severe fibrosis formation and cardiac remodeling. Recently, injectable hydrogels have emerged as a promising approach to repair the infarcted heart and improve heart function through minimally invasive administration. Here, a novel injectable human amniotic membrane (hAM) matrix is developed to enhance cardiac regeneration following MI. Human amniotic membrane is isolated from human placenta and engineered to be a thermoresponsive, injectable gel around body temperature. Ultrasound-guided injection of hAM matrix into rat MI hearts significantly improves cardiac contractility, as measured by ejection fraction (EF), and decrease fibrosis. The results of this study demonstrate the feasibility of engineering as an injectable hAM matrix and its efficacy in attenuating degenerative changes in cardiac function following MI, which may have broad applications in tissue regeneration.
Collapse
Affiliation(s)
- Jeffrey J D Henry
- Department of Bioengineering, University of California, Berkeley, CA, 94720, USA
| | - Lawrence Delrosario
- Department of Medicine, Cardiovascular Research Institute and Institute for Regeneration Medicine, University of California, San Francisco, CA, 94143, USA
| | - Jun Fang
- Department of Bioengineering and Medicine, University of California, Los Angeles, CA, 90095, USA
| | - Sze Yue Wong
- Department of Bioengineering, University of California, Berkeley, CA, 94720, USA
| | - Qizhi Fang
- Department of Medicine, Cardiovascular Research Institute and Institute for Regeneration Medicine, University of California, San Francisco, CA, 94143, USA
| | - Richard Sievers
- Department of Medicine, Cardiovascular Research Institute and Institute for Regeneration Medicine, University of California, San Francisco, CA, 94143, USA
| | - Surya Kotha
- Department of Bioengineering, University of California, Berkeley, CA, 94720, USA
| | - Aijun Wang
- Department of Surgery, University of California, Davis, CA, 95817, USA
| | - Diana Farmer
- Department of Surgery, University of California, Davis, CA, 95817, USA
| | - Praneeth Janaswamy
- Department of Medicine, Cardiovascular Research Institute and Institute for Regeneration Medicine, University of California, San Francisco, CA, 94143, USA
| | - Randall J Lee
- Department of Medicine, Cardiovascular Research Institute and Institute for Regeneration Medicine, University of California, San Francisco, CA, 94143, USA
| | - Song Li
- Department of Bioengineering, University of California, Berkeley, CA, 94720, USA
- Department of Bioengineering and Medicine, University of California, Los Angeles, CA, 90095, USA
| |
Collapse
|
15
|
Clark K, Zhang S, Barthe S, Kumar P, Pivetti C, Kreutzberg N, Reed C, Wang Y, Paxton Z, Farmer D, Guo F, Wang A. Placental Mesenchymal Stem Cell-Derived Extracellular Vesicles Promote Myelin Regeneration in an Animal Model of Multiple Sclerosis. Cells 2019; 8:cells8121497. [PMID: 31771176 PMCID: PMC6952942 DOI: 10.3390/cells8121497] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/16/2019] [Accepted: 11/19/2019] [Indexed: 02/04/2023] Open
Abstract
Mesenchymal stem/stromal cells (MSCs) display potent immunomodulatory and regenerative capabilities through the secretion of bioactive factors, such as proteins, cytokines, chemokines as well as the release of extracellular vesicles (EVs). These functional properties of MSCs make them ideal candidates for the treatment of degenerative and inflammatory diseases, including multiple sclerosis (MS). MS is a heterogenous disease that is typically characterized by inflammation, demyelination, gliosis and axonal loss. In the current study, an induced experimental autoimmune encephalomyelitis (EAE) murine model of MS was utilized. At peak disease onset, animals were treated with saline, placenta-derived MSCs (PMSCs), as well as low and high doses of PMSC-EVs. Animals treated with PMSCs and high-dose PMSC-EVs displayed improved motor function outcomes as compared to animals treated with saline. Symptom improvement by PMSCs and PMSC-EVs led to reduced DNA damage in oligodendroglia populations and increased myelination within the spinal cord of treated mice. In vitro data demonstrate that PMSC-EVs promote myelin regeneration by inducing endogenous oligodendrocyte precursor cells to differentiate into mature myelinating oligodendrocytes. These findings support that PMSCs’ mechanism of action is mediated by the secretion of EVs. Therefore, PMSC-derived EVs are a feasible alternative to cellular based therapies for MS, as demonstrated in an animal model of the disease.
Collapse
Affiliation(s)
- Kaitlin Clark
- Department of Surgery, School of Medicine, University of California Davis, Sacramento, CA 95817, USA; (K.C.); (S.B.); (P.K.); (C.P.); (N.K.); (C.R.); (Z.P.); (D.F.)
- Shriner’s Hospitals for Children, Northern California, Sacramento, CA 95817, USA; (S.Z.); (Y.W.); (F.G.)
| | - Sheng Zhang
- Shriner’s Hospitals for Children, Northern California, Sacramento, CA 95817, USA; (S.Z.); (Y.W.); (F.G.)
| | - Sylvain Barthe
- Department of Surgery, School of Medicine, University of California Davis, Sacramento, CA 95817, USA; (K.C.); (S.B.); (P.K.); (C.P.); (N.K.); (C.R.); (Z.P.); (D.F.)
| | - Priyadarsini Kumar
- Department of Surgery, School of Medicine, University of California Davis, Sacramento, CA 95817, USA; (K.C.); (S.B.); (P.K.); (C.P.); (N.K.); (C.R.); (Z.P.); (D.F.)
- Shriner’s Hospitals for Children, Northern California, Sacramento, CA 95817, USA; (S.Z.); (Y.W.); (F.G.)
| | - Christopher Pivetti
- Department of Surgery, School of Medicine, University of California Davis, Sacramento, CA 95817, USA; (K.C.); (S.B.); (P.K.); (C.P.); (N.K.); (C.R.); (Z.P.); (D.F.)
- Shriner’s Hospitals for Children, Northern California, Sacramento, CA 95817, USA; (S.Z.); (Y.W.); (F.G.)
| | - Nicole Kreutzberg
- Department of Surgery, School of Medicine, University of California Davis, Sacramento, CA 95817, USA; (K.C.); (S.B.); (P.K.); (C.P.); (N.K.); (C.R.); (Z.P.); (D.F.)
| | - Camille Reed
- Department of Surgery, School of Medicine, University of California Davis, Sacramento, CA 95817, USA; (K.C.); (S.B.); (P.K.); (C.P.); (N.K.); (C.R.); (Z.P.); (D.F.)
| | - Yan Wang
- Shriner’s Hospitals for Children, Northern California, Sacramento, CA 95817, USA; (S.Z.); (Y.W.); (F.G.)
| | - Zachary Paxton
- Department of Surgery, School of Medicine, University of California Davis, Sacramento, CA 95817, USA; (K.C.); (S.B.); (P.K.); (C.P.); (N.K.); (C.R.); (Z.P.); (D.F.)
| | - Diana Farmer
- Department of Surgery, School of Medicine, University of California Davis, Sacramento, CA 95817, USA; (K.C.); (S.B.); (P.K.); (C.P.); (N.K.); (C.R.); (Z.P.); (D.F.)
- Shriner’s Hospitals for Children, Northern California, Sacramento, CA 95817, USA; (S.Z.); (Y.W.); (F.G.)
| | - Fuzheng Guo
- Shriner’s Hospitals for Children, Northern California, Sacramento, CA 95817, USA; (S.Z.); (Y.W.); (F.G.)
| | - Aijun Wang
- Department of Surgery, School of Medicine, University of California Davis, Sacramento, CA 95817, USA; (K.C.); (S.B.); (P.K.); (C.P.); (N.K.); (C.R.); (Z.P.); (D.F.)
- Shriner’s Hospitals for Children, Northern California, Sacramento, CA 95817, USA; (S.Z.); (Y.W.); (F.G.)
- Department of Biomedical Engineering, University of California Davis, Davis, CA 95616, USA
- Correspondence: ; Tel.: +1-916-703-0422
| |
Collapse
|
16
|
Silbernagel KM, Carver CN, Jechorek RP, Johnson RL, Alejo W, Aleo V, Buresh J, Cagri A, Campbell S, Carson M, Chinault K, Clayborn J, Cook F, Dammann H, Dorn S, Elko B, Farmer D, Farmer R, Gasses T, Greiman L, Guzman C, Hemker M, Hintz C, Jechorek R, Jenkins J, Kexel N, Kildisg J, Knickerbocker J, Kora L, Koziczkowski J, Krieg D, Lal A, Lam L, Lau D, Loftis M, Madewell L, Matisko V, Miele A, Muzzy T, Park J, Peters C, Pickett J, Radermacher S, Romero H, Ross J, Rotten J, Rule P, Ryser E, Satterwhite LK, Schultz A, Shell D, Smith J, Storment E, Ulmer M, Walia J, Whetzel S, Woltman N. Evaluation of VIDAS Listeria monocytogenes II (LMO2) Immunoassay Method for the Detection of Listeria monocytogenes in Foods: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/87.5.1123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
A multilaboratory study was conducted to compare the VIDAS®Listeria monocytogenes II (LMO2) immunoassay and the standard cultural methods for the detection of Listeria monocytogenes in foods. Five food types—vanilla ice cream, brie cheese, cooked roast beef, frozen green beans, and frozen tilapia fish—at 3 levels were analyzed by each method. A total of 26 laboratories representing government and industry participated. In this study, 1404 test portions were analyzed of which 1152 were used in the statistical analysis. There were 448 positive by the VIDAS LMO2 assay and 457 positive by the standard culture methods. A χ2 analysis of each of the 5 food types, at the 3 inoculation levels tested, was performed. The resulting χ2 value, 0.36, indicates that overall, there are no statistical differences between the VIDAS LMO2 assay and the standard methods at the 5% level of significance.
Collapse
|
17
|
Silbernagel K, Jechorek R, Barbour WM, Mrozinski P, Alejo W, Aleo V, Andaloro B, Beacorn F, Benzinger J, Bogar S, Brayman C, Broom J, Carson M, Carver C, Cheng C, Centrella B, Clayborn J, Collins C, Deibel C, Divine M, Eliasberg S, Farmer D, Frye S, Gatesy T, Goodstein E, Halker C, Hall G, Hanson P, Hartman G, Heddaeus K, Hembree J, Hutchins J, Istafanos P, Jechorek R, Jenkins J, Kerdahi K, Kremer S, Lal A, Leighton S, Lester D, Lewis J, Lin J, Martin J, Maselli M, McCarthy P, McGovern B, Mills M, Mohnke F, Moon B, Moss D, Plaza M, Robeson S, Romero H, Rubalcaba D, Schultz A, Seehusen J, Shaw C, Siem K, Sloan E, Stanerson J, Stepanova N, Van K, Van Enkenvoort K, Vialpando M, Warren W, Watts K, Wilson K, Woodruff T. Evaluation of the BAX® System for Detection of Listeria monocytogenes in Foods: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/87.2.395] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
A multilaboratory study was conducted to compare the automated BAX® system and the standard cultural methods for detection of Listeria monocytogenes in foods. Six food types (frankfurters, soft cheese, smoked salmon, raw, ground beef, fresh radishes, and frozen peas) were analyzed by each method. For each food type, 3 inoculation levels were tested: high (average of 2 CFU/g), low (average of 0.2 CFU/g) and uninoculated controls. A total of 25 laboratories representing government and industry participated. Of the 2335 samples analyzed, 1109 were positive by the BAX system and 1115 were positive by the standard method. A Chi square analysis of each of the 6 food types, at the 3 inoculation levels tested, was performed. For all foods, except radishes, the BAX system performed as well as or better than the standard reference methods based on the Chi square results.
Collapse
Affiliation(s)
| | | | - W Mark Barbour
- DuPont Qualicon, 3531 Silverside Rd, Bedford Bldg, Wilmington, DE 19810
| | - Peter Mrozinski
- DuPont Qualicon, 3531 Silverside Rd, Bedford Bldg, Wilmington, DE 19810
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Silbernagel K, Jechorek R, Carver C, Barbour WM, Mrozinski P, Albert A, Andaloro B, Anderson G, Beacorn F, Brooks R, Carson M, Crossfield D, Eliasberg S, Farmer D, Frantzeskakis C, Gasses T, Gatesy T, Hall G, Hanson P, Heddaeus K, Hermann K, Hutchins J, Jenkins J, Johnson F, Johnson J, Kawalek M, Kelly L, Koschmann C, Lannon P, Lester D, Manner K, Martin J, Maselli M, McGovern B, Mohnke F, Moon B, Murray L, Pace R, Richards J, Robeson S, Rodgers D, Rosario G, Saunders C, Shaw C, Dana Shell J, Sloan E, Thompson S, Vialpando M, Voermans R, Watts K, Wieczorek K, Wilson K, Yeh H, Zamora D. Evaluation of the BAX® System for Detection of Salmonella in Selected Foods: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/86.6.1149] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
A multilaboratory study was conducted to compare the automated BAX® System to the standard cultural methods for detection of Salmonella in selected foods. Five food types—frankfurters, raw ground beef, mozzarella cheese, raw frozen tilapia fish, and orange juice—at 3 inoculation levels, were analyzed by each method. A sixth food type, raw ground chicken, was tested using 3 naturally contaminated lots. A total of 16 laboratories representing government and industry participated. In this study, 1386 samples were analyzed, of which 1188 were paired samples and 198 were unpaired samples. Of the 1188 paired samples, 461 were positive by both methods and 404 were negative by both methods. Thirty-seven samples were positive by the BAX System but negative by the standard reference method, and 11 samples were positive by standard cultural method and negative by the BAX System. Of the 198 unpaired samples, 106 were positive by the BAX System and 60 were positive by the standard cultural method. A Chi square analysis of each of the 6 food types, at the 3 inoculation levels tested, was performed. For all foods, the BAX System demonstrated results comparable to those of the standard reference methods based on the Chi square results.
Collapse
Affiliation(s)
| | | | - Charles Carver
- rtech laboratories, PO Box 64101, St. Paul, MN 55164-0101
| | - W Mark Barbour
- DuPont Qualicon, 3531 Silverside Rd, Bedford Building, Wilmington, DE 19810
| | - Peter Mrozinski
- DuPont Qualicon, 3531 Silverside Rd, Bedford Building, Wilmington, DE 19810
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Clark K, Vanover M, Kreutzberg N, Long C, Lankford L, Amorim RM, Farmer D, Borjesson D, Sturges B, Wang A. Translational applications of placental dervided mesenchymal stem cells for the treatment of spina bifida: a canine model. Cytotherapy 2019. [DOI: 10.1016/j.jcyt.2019.03.475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
20
|
Vanover M, Pivetti C, Galganski L, Kumar P, Lankford L, Rowland D, Paxton Z, Deal B, Wang A, Farmer D. Spinal Angulation: A Limitation of the Fetal Lamb Model of Myelomeningocele. Fetal Diagn Ther 2019; 46:376-384. [PMID: 30970373 DOI: 10.1159/000496201] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 12/13/2018] [Indexed: 01/27/2023]
Abstract
INTRODUCTION The surgically induced fetal lamb model is the most commonly used large animal model of myelomeningocele (MMC) but is subject to variation due to surgical technique during defect creation. MATERIAL AND METHODS Thirty-one fetal lambs underwent creation of the MMC defect, followed by defect repair with either an extracellular matrix (ECM) patch (n = 10) or ECM seeded with placental mesenchymal stromal cells (n = 21). Postnatal hindlimb function was assessed using the Sheep Locomotor Rating (SLR) scale. Postmortem magnetic resonance imaging of the lumbar spine was used to measure the level and degree of spinal angulation, as well as cross-sectional area of remaining vertebral bone. RESULTS Median level of angulation was between the 2nd and 3rd lumbar vertebrae, with a median angle of 24.3 degrees (interquartile range 16.2-35.3). There was a negative correlation between angulation degree and SLR (r = -0.44, p = 0.013). Degree of angulation also negatively correlated with the normalized cross-sectional area of remaining vertebral bone (r = -0.75, p < 0.0001). DISCUSSION Surgical creation of fetal MMC leads to varying severity of spinal angulation in the ovine model, which affects postnatal functional outcomes. Postnatal assessment of spinal angulation aids in standardization of the surgical model of fetal MMC repair.
Collapse
Affiliation(s)
- Melissa Vanover
- Department of Surgery, University of California Davis, Sacramento, California, USA,
| | - Christopher Pivetti
- Department of Surgery, University of California Davis, Sacramento, California, USA
| | - Laura Galganski
- Department of Surgery, University of California Davis, Sacramento, California, USA
| | - Priyadarsini Kumar
- Department of Surgery, University of California Davis, Sacramento, California, USA
| | - Lee Lankford
- Department of Surgery, University of California Davis, Sacramento, California, USA
| | - Douglas Rowland
- Center for Molecular and Genomic Imaging, University of California Davis, Davis, California, USA
| | - Zachary Paxton
- Department of Surgery, University of California Davis, Sacramento, California, USA
| | - Bailey Deal
- Department of Surgery, University of California Davis, Sacramento, California, USA
| | - Aijun Wang
- Department of Surgery, University of California Davis, Sacramento, California, USA
| | - Diana Farmer
- Department of Surgery, University of California Davis, Sacramento, California, USA
| |
Collapse
|
21
|
Kumar P, Gao K, Wang C, Pivetti C, Lankford L, Farmer D, Wang A. In Utero Transplantation of Placenta-Derived Mesenchymal Stromal Cells for Potential Fetal Treatment of Hemophilia A. Cell Transplant 2019; 27:130-139. [PMID: 29562772 PMCID: PMC6434487 DOI: 10.1177/0963689717728937] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Hemophilia A (HA) is an X-linked recessive disorder caused by mutations in the factor VIII (FVIII) gene leading to deficient blood coagulation. The current standard of care is frequent infusions of plasma-derived FVIII or recombinant B-domain-deleted FVIII (BDD-FVIII). While this treatment is effective, many patients eventually develop FVIII inhibitors that limit the effectiveness of the infused FVIII. As a monogenic disorder, HA is an ideal target for gene or cell-based therapy. Several studies have investigated allogeneic stem cell therapy targeting in utero or postnatal treatment of HA but have not been successful in completely correcting HA. Autologous in utero transplantation of mesenchymal stem cells is promising for treatment of HA due to the naive immune status of the fetal environment as well as its potential to prevent transplant rejection and long-term FVIII inhibitor formation. HA can be diagnosed by chorionic villus sampling performed during the first trimester (10 to 13 wk) of gestation. In this study, we used an established protocol and isolated placenta-derived mesenchymal stromal cells (PMSCs) from first trimester chorionic villus tissue and transduced them with lentiviral vector encoding the BDD-FVIII gene. We show that gene-modified PMSCs maintain their immunophenotype and multipotency, express, and secrete high levels of active FVIII. PMSCs were then transplanted at embryonic day 14.5 (E14.5) into wild-type fetuses from time-mated pregnant mice. Four days after birth, pups were checked for engraftment, and varying levels of expression of human green fluorescent protein were found in the organs tested. This study shows feasibility of the approach to obtain PMSCs from first trimester chorionic villus tissue, genetically modify them with the FVIII gene, and transplant them in utero for cell-mediated gene therapy of HA. Future studies will involve evaluation of long-term engraftment, phenotypic correction in HA mice, and prevention of FVIII inhibitor development by this approach.
Collapse
Affiliation(s)
- Priyadarsini Kumar
- 1 Department of Surgery, Surgical Bioengineering Laboratory, UC Davis School of Medicine, Research II, University of California, Davis, Sacramento, CA, USA
| | - Kewa Gao
- 1 Department of Surgery, Surgical Bioengineering Laboratory, UC Davis School of Medicine, Research II, University of California, Davis, Sacramento, CA, USA.,2 Department of Burns and Plastic Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
| | - Chuwang Wang
- 1 Department of Surgery, Surgical Bioengineering Laboratory, UC Davis School of Medicine, Research II, University of California, Davis, Sacramento, CA, USA.,2 Department of Burns and Plastic Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
| | - Christopher Pivetti
- 1 Department of Surgery, Surgical Bioengineering Laboratory, UC Davis School of Medicine, Research II, University of California, Davis, Sacramento, CA, USA
| | - Lee Lankford
- 1 Department of Surgery, Surgical Bioengineering Laboratory, UC Davis School of Medicine, Research II, University of California, Davis, Sacramento, CA, USA
| | - Diana Farmer
- 1 Department of Surgery, Surgical Bioengineering Laboratory, UC Davis School of Medicine, Research II, University of California, Davis, Sacramento, CA, USA
| | - Aijun Wang
- 1 Department of Surgery, Surgical Bioengineering Laboratory, UC Davis School of Medicine, Research II, University of California, Davis, Sacramento, CA, USA
| |
Collapse
|
22
|
Gao K, Kumar P, Cortez-Toledo E, Hao D, Reynaga L, Rose M, Wang C, Farmer D, Nolta J, Zhou J, Zhou P, Wang A. Potential long-term treatment of hemophilia A by neonatal co-transplantation of cord blood-derived endothelial colony-forming cells and placental mesenchymal stromal cells. Stem Cell Res Ther 2019; 10:34. [PMID: 30670078 PMCID: PMC6341603 DOI: 10.1186/s13287-019-1138-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 01/06/2019] [Accepted: 01/07/2019] [Indexed: 01/02/2023] Open
Abstract
Background Hemophilia A (HA) is an X-linked recessive disorder caused by mutations in the Factor VIII (FVIII) gene leading to deficient blood coagulation. As a monogenic disorder, HA is an ideal target for cell-based gene therapy, but successful treatment has been hampered by insufficient engraftment of potential therapeutic cells. Methods In this study, we sought to determine whether co-transplantation of endothelial colony-forming cells (ECFCs) and placenta-derived mesenchymal stromal cells (PMSCs) can achieve long-term engraftment and FVIII expression. ECFCs and PMSCs were transduced with a B domain deleted factor VIII (BDD-FVIII) expressing lentiviral vector and luciferase, green fluorescent protein or Td-Tomato containing lentiviral tracking vectors. They were transplanted intramuscularly into neonatal or adult immunodeficient mice. Results In vivo bioluminescence imaging showed that the ECFC only and the co-transplantation groups but not the PMSCs only group achieved long-term engraftment for at least 26 weeks, and the co-transplantation group showed a higher engraftment than the ECFC only group at 16 and 20 weeks post-transplantation. In addition, cell transplantation at the neonatal age achieved higher engraftment than at the adult age. Immunohistochemical analyses further showed that the engrafted ECFCs expressed FVIII, maintained endothelial phenotype, and generated functional vasculature. Next, co-transplantation of ECFCs and PMSCs into F8 knock-out HA mice reduced the blood loss volume from 562.13 ± 19.84 μl to 155.78 ± 44.93 μl in a tail-clip assay. Conclusions This work demonstrated that co-transplantation of ECFCs with PMSCs at the neonatal age is a potential strategy to achieve stable, long-term engraftment, and thus holds great promise for cell-based treatment of HA. Electronic supplementary material The online version of this article (10.1186/s13287-019-1138-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Kewa Gao
- Department of Burns and Plastic Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan, 410013, People's Republic of China.,Surgical Bioengineering Laboratory, Department of Surgery, University of California Davis, Sacramento, CA, 95817, USA
| | - Priyadarsini Kumar
- Surgical Bioengineering Laboratory, Department of Surgery, University of California Davis, Sacramento, CA, 95817, USA.,Institute for Pediatric Regenerative Medicine, Shriners Hospitals for Children, Northern California, Sacramento, CA, 95817, USA
| | - Elizabeth Cortez-Toledo
- Department of Internal Medicine, Stem Cell Program and Institute for Regenerative Cures, University of California Davis, Sacramento, CA, 95817, USA
| | - Dake Hao
- Surgical Bioengineering Laboratory, Department of Surgery, University of California Davis, Sacramento, CA, 95817, USA.,Institute for Pediatric Regenerative Medicine, Shriners Hospitals for Children, Northern California, Sacramento, CA, 95817, USA
| | - Lizette Reynaga
- Surgical Bioengineering Laboratory, Department of Surgery, University of California Davis, Sacramento, CA, 95817, USA
| | - Melanie Rose
- Department of Internal Medicine, Stem Cell Program and Institute for Regenerative Cures, University of California Davis, Sacramento, CA, 95817, USA
| | - Chuwang Wang
- Department of Burns and Plastic Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan, 410013, People's Republic of China.,Surgical Bioengineering Laboratory, Department of Surgery, University of California Davis, Sacramento, CA, 95817, USA
| | - Diana Farmer
- Surgical Bioengineering Laboratory, Department of Surgery, University of California Davis, Sacramento, CA, 95817, USA.,Institute for Pediatric Regenerative Medicine, Shriners Hospitals for Children, Northern California, Sacramento, CA, 95817, USA
| | - Jan Nolta
- Department of Internal Medicine, Stem Cell Program and Institute for Regenerative Cures, University of California Davis, Sacramento, CA, 95817, USA
| | - Jianda Zhou
- Department of Burns and Plastic Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan, 410013, People's Republic of China.
| | - Ping Zhou
- Department of Internal Medicine, Stem Cell Program and Institute for Regenerative Cures, University of California Davis, Sacramento, CA, 95817, USA.
| | - Aijun Wang
- Surgical Bioengineering Laboratory, Department of Surgery, University of California Davis, Sacramento, CA, 95817, USA. .,Institute for Pediatric Regenerative Medicine, Shriners Hospitals for Children, Northern California, Sacramento, CA, 95817, USA. .,Department of Biomedical Engineering, University of California Davis, Davis, CA, 95616, USA.
| |
Collapse
|
23
|
Vanover M, Pivetti C, Lankford L, Kumar P, Galganski L, Kabagambe S, Keller B, Becker J, Chen YJ, Chung K, Lee C, Paxton Z, Deal B, Goodman L, Anderson J, Jensen G, Wang A, Farmer D. High density placental mesenchymal stromal cells provide neuronal preservation and improve motor function following in utero treatment of ovine myelomeningocele. J Pediatr Surg 2019; 54:75-79. [PMID: 30529115 PMCID: PMC6339576 DOI: 10.1016/j.jpedsurg.2018.10.032] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 10/01/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE The purpose of this study was to determine whether seeding density of placental mesenchymal stromal cells (PMSCs) on extracellular matrix (ECM) during in utero repair of myelomeningocele (MMC) affects motor function and neuronal preservation in the ovine model. METHODS MMC defects were surgically created in 33 fetuses and repaired following randomization into four treatment groups: ECM only (n = 10), PMSC-ECM (42 K cells/cm2) (n = 8), PMSC-ECM (167 K cells/cm2) (n = 7), or PMSC-ECM (250-300 K cells/cm2) (n = 8). Motor function was evaluated using the Sheep Locomotor Rating Scale (SLR). Serial sections of the lumbar spinal cord were analyzed by measuring their cross-sectional areas which were then normalized to normal lambs. Large neurons (LN, diameter 30-70 μm) were counted manually and density calculated per mm2 gray matter. RESULTS Lambs treated with PMSCs at any density had a higher median SLR score (15 [IQR 13.5-15]) than ECM alone (6.5 [IQR 4-12.75], p = 0.036). Cross-sectional areas of spinal cord and gray matter were highest in the PMSC-ECM (167 K/cm2) group (p = 0.002 and 0.006, respectively). LN density was highest in the greatest density PMSC-ECM (250-300 K/cm2) group (p = 0.045) which positively correlated with SLR score (r = 0.807, p < 0.0001). CONCLUSIONS Fetal repair of myelomeningocele with high density PMSC-ECM resulted in increased large neuron density, which strongly correlated with improved motor function. TYPE OF STUDY Basic science. LEVEL OF EVIDENCE N/A.
Collapse
Affiliation(s)
- Melissa Vanover
- Department of Surgery, University of California Davis, Sacramento, CA, USA.
| | | | - Lee Lankford
- Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Priyadarsini Kumar
- Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Laura Galganski
- Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Sandra Kabagambe
- Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Benjamin Keller
- Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - James Becker
- Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Y. Julia Chen
- Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Karen Chung
- Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Chelsey Lee
- Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Zachary Paxton
- Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Bailey Deal
- Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Laura Goodman
- Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Jamie Anderson
- Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Guy Jensen
- Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Aijun Wang
- Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Diana Farmer
- Department of Surgery, University of California Davis, Sacramento, CA, USA
| |
Collapse
|
24
|
Farmer D. UNDERSTANDING THE RURAL LANDSCAPE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- D Farmer
- Georgia Health Policy Center, Atlanta, Georgia, United States
| |
Collapse
|
25
|
Phan J, Kumar P, Hao D, Gao K, Farmer D, Wang A. Engineering mesenchymal stem cells to improve their exosome efficacy and yield for cell-free therapy. J Extracell Vesicles 2018; 7:1522236. [PMID: 30275938 PMCID: PMC6161586 DOI: 10.1080/20013078.2018.1522236] [Citation(s) in RCA: 179] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 08/08/2018] [Accepted: 08/27/2018] [Indexed: 02/07/2023] Open
Abstract
Through traditional medicine, there were diseases and disorders that previously remained untreated or were simply thought to be incurable. Since the discovery of mesenchymal stem cells (MSCs), there has been a flurry of research to develop MSC-based therapy for diseases and disorders. It is now well-known that MSCs do not typically engraft after transplantation and exhibit their therapeutic effect via a paracrine mechanism. In addition to secretory proteins, MSCs also produce extracellular vesicles (EVs), membrane-bound nanovesicles containing proteins, DNA and RNA. The secreted vesicles then interact with target cells and deliver their contents, imparting their ultimate therapeutic effect. Unlike the widely studied cancer cells, the yield of MSC-exosomes is a limiting factor for large-scale production for cell-free therapies. Here we summarise potential approaches to increase the yield of such vesicles while maintaining or enhancing their efficacy by engineering the extracellular environment and intracellular components of MSCs.
Collapse
Affiliation(s)
- Jennifer Phan
- Surgical Bioengineering Laboratory, Department of Surgery, University of California, Davis School of Medicine, Sacramento, CA, USA.,CIRM Bridges to Stem Cell Research Program, California State University, Sacramento, CA, USA
| | - Priyadarsini Kumar
- Surgical Bioengineering Laboratory, Department of Surgery, University of California, Davis School of Medicine, Sacramento, CA, USA.,Institute for Paediatric Regenerative Medicine, Shriners Hospital for Children/UC Davis School of Medicine, Sacramento, CA, USA
| | - Dake Hao
- Surgical Bioengineering Laboratory, Department of Surgery, University of California, Davis School of Medicine, Sacramento, CA, USA.,Institute for Paediatric Regenerative Medicine, Shriners Hospital for Children/UC Davis School of Medicine, Sacramento, CA, USA
| | - Kewa Gao
- Surgical Bioengineering Laboratory, Department of Surgery, University of California, Davis School of Medicine, Sacramento, CA, USA.,Department of Burn and Plastic Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan, P.R. China
| | - Diana Farmer
- Surgical Bioengineering Laboratory, Department of Surgery, University of California, Davis School of Medicine, Sacramento, CA, USA.,Institute for Paediatric Regenerative Medicine, Shriners Hospital for Children/UC Davis School of Medicine, Sacramento, CA, USA
| | - Aijun Wang
- Surgical Bioengineering Laboratory, Department of Surgery, University of California, Davis School of Medicine, Sacramento, CA, USA.,Institute for Paediatric Regenerative Medicine, Shriners Hospital for Children/UC Davis School of Medicine, Sacramento, CA, USA
| |
Collapse
|
26
|
Kaseje N, Swanson J, Marks I, Were V, Siddiqui S, Evans F, Smith E, Poenaru D, Ameh E, Lakhoo K, Oldham K, Farmer D, Ozgediz D. Health system assessment for safe surgical care in rural Nicaragua: a retrospective survey. The Lancet Global Health 2018. [DOI: 10.1016/s2214-109x(18)30145-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
27
|
Goodman LF, St-Louis E, Yousef Y, Cheung M, Ure B, Ozgediz D, Ameh EA, Bickler S, Poenaru D, Oldham K, Farmer D, Lakhoo K. The Global Initiative for Children's Surgery: Optimal Resources for Improving Care. Eur J Pediatr Surg 2018; 28:51-59. [PMID: 28806850 DOI: 10.1055/s-0037-1604399] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The Lancet Commission on Global Surgery reported that 5 billion people lack access to safe, affordable surgical care. The majority of these people live in low-resource settings, where up to 50% of the population is children. The Disease Control Priorities (Debas HTP, Donkor A, Gawande DT, Jamison ME, Kruk, and Mock CN, editors. Essential Surgery. Disease Control Priorities. Third Edition, vol 1. Essential Surgery. Washington, DC: World Bank; 2015) on surgery included guidelines for the improvement of access to surgical care; however, these lack detail for children's surgery. AIM To produce guidance for low- and middle-income countries (LMICs) on the resources required for children's surgery at each level of hospital care. METHODS The Global Initiative for Children's Surgery (GICS) held an inaugural meeting at the Royal College of Surgeons in London in May 2016, with 52 surgical providers from 21 countries, including 27 providers from 18 LMICs. Delegates engaged in working groups over 2 days to prioritize needs and solutions for optimizing children's surgical care; these were categorized into infrastructure, service delivery, training, and research. At a second GICS meeting in Washington in October 2016, 94 surgical care providers, half from LMICs, defined the optimal resources required at primary, secondary, tertiary, and national referral level through a series of working group engagements. RESULTS Consensus solutions for optimizing children's surgical care included the following: · Establishing standards and integrating them into national surgical plans.. · Each country should have at least one children's hospital.. · Designate, facilitate, and support regional training hubs covering all. · children's surgical specialties.. · Establish regional research support centers.. An "Optimal Resources" document was produced detailing the facilities and resources required at each level of care. CONCLUSION The Optimal Resources document has been produced by surgical providers from LMICs who have the greatest insight into the needs and priorities in their population. The document will be refined further through online GICS Working Groups and the World Health Organization for broad application to ensure all children have timely access to safe surgical care.
Collapse
Affiliation(s)
- Laura F Goodman
- Department of Surgery, University of California Davis, Sacramento, California, United States
| | - Etienne St-Louis
- Department of General Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Yasmine Yousef
- Department of Surgery, Université de Montréal, Montreal, Quebec, Canada
| | - Maija Cheung
- Department of Surgery Yale University, New Haven, Connecticut, United States
| | - Benno Ure
- Department of Pediatric Surgery, Medical School Hannover, Hannover, Germany
| | - Doruk Ozgediz
- Department of Surgery Yale University, New Haven, Connecticut, United States
| | - Emmanuel Adoyi Ameh
- Division of Paediatric Surgery, Department of Surgery, National Hospital, Abuja, Nigeria
| | - Stephen Bickler
- Department of Surgery, University of California, San Diego, California, United States
| | - Dan Poenaru
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Keith Oldham
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Diana Farmer
- Department of Surgery, University of California Davis, Sacramento, California, United States
| | - Kokila Lakhoo
- Department of Paediatric Surgery, University of Oxford, Oxford, United Kingdom.,Department of Paediatric Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | |
Collapse
|
28
|
Ryzhuk V, Zeng XX, Wang X, Melnychuk V, Lankford L, Farmer D, Wang A. Human amnion extracellular matrix derived bioactive hydrogel for cell delivery and tissue engineering. Mater Sci Eng C Mater Biol Appl 2017; 85:191-202. [PMID: 29407148 DOI: 10.1016/j.msec.2017.12.026] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/29/2017] [Accepted: 12/19/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Volodymyr Ryzhuk
- Surgical Bioengineering Laboratory, Department of Surgery, University of California Davis Health System, Research II, 4625 2nd Avenue, Sacramento, CA 95817, USA
| | - Xu-Xin Zeng
- Surgical Bioengineering Laboratory, Department of Surgery, University of California Davis Health System, Research II, 4625 2nd Avenue, Sacramento, CA 95817, USA; Pharmaceutical Laboratory, School of Medicine, Foshan University, No. 5 Hebin Rd., Foshan, Guangdong, PR China
| | - Xijun Wang
- Surgical Bioengineering Laboratory, Department of Surgery, University of California Davis Health System, Research II, 4625 2nd Avenue, Sacramento, CA 95817, USA; School of Stomatology, Shandong University, 44 Wenhua Xi Road, Jinan, Shandong, PR China
| | - Veniamin Melnychuk
- Surgical Bioengineering Laboratory, Department of Surgery, University of California Davis Health System, Research II, 4625 2nd Avenue, Sacramento, CA 95817, USA
| | - Lee Lankford
- Surgical Bioengineering Laboratory, Department of Surgery, University of California Davis Health System, Research II, 4625 2nd Avenue, Sacramento, CA 95817, USA
| | - Diana Farmer
- Surgical Bioengineering Laboratory, Department of Surgery, University of California Davis Health System, Research II, 4625 2nd Avenue, Sacramento, CA 95817, USA
| | - Aijun Wang
- Surgical Bioengineering Laboratory, Department of Surgery, University of California Davis Health System, Research II, 4625 2nd Avenue, Sacramento, CA 95817, USA.
| |
Collapse
|
29
|
Kabagambe S, Keller B, Becker J, Goodman L, Pivetti C, Lankford L, Chung K, Lee C, Chen YJ, Kumar P, Vanover M, Wang A, Farmer D. Placental mesenchymal stromal cells seeded on clinical grade extracellular matrix improve ambulation in ovine myelomeningocele. J Pediatr Surg 2017; 53:S0022-3468(17)30654-1. [PMID: 29122293 DOI: 10.1016/j.jpedsurg.2017.10.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 10/05/2017] [Indexed: 01/27/2023]
Abstract
PURPOSE The purpose of this study was to investigate the effects of placental mesenchymal stromal cells (PMSCs) seeded on a clinical grade porcine small intestinal submucosa (SIS)-derived extracellular matrix (ECM) on hindlimb motor function in an ovine fetal repair model of myelomeningocele (MMC). METHODS MMC defects were surgically created in 21 fetuses at median gestational age 78 (range 76-83) days. Fetuses were randomly assigned to repair 25days later with ECM only or PMSC-ECM. Surviving fetuses were delivered at term. Motor function was evaluated using the Sheep Locomotor Rating (SLR) scale (0-15). Histologic analysis of the spinal cord (SC) was completed. RESULTS Fetal viability was 71%. 5 of 8 (63%) lambs repaired with PMSC-ECM ambulated independently versus only 1 of 6 (17%) repaired with ECM only (p=0.04, χ2 test). SLR scores and large neuron densities were higher in the PMSC-ECM group. The cross-sectional areas of the SC and the gray matter were equally preserved. CONCLUSIONS Fetal repair of MMC with PMSCs seeded on SIS-ECM improves hindlimb motor function in lambs. Using ECM helps to preserve the architecture of the SC, but adding PMSCs improves the lamb's ability to walk and increases large neuron density. Clinical studies are needed to show benefits in humans. LEVELS OF EVIDENCE/TYPE OF STUDY Basic Science.
Collapse
Affiliation(s)
| | | | - James Becker
- University of California, Davis Health, Sacramento, CA
| | - Laura Goodman
- University of California, Davis Health, Sacramento, CA
| | | | - Lee Lankford
- University of California, Davis Health, Sacramento, CA
| | - Karen Chung
- University of California, Davis Health, Sacramento, CA
| | - Chelsey Lee
- University of California, Davis Health, Sacramento, CA
| | - Y Julia Chen
- University of California, Davis Health, Sacramento, CA
| | | | | | - Aijun Wang
- University of California, Davis Health, Sacramento, CA
| | - Diana Farmer
- University of California, Davis Health, Sacramento, CA
| |
Collapse
|
30
|
Long C, Lankford L, Kumar P, Grahn R, Borjesson DL, Farmer D, Wang A. Isolation and characterization of canine placenta-derived mesenchymal stromal cells for the treatment of neurological disorders in dogs. Cytometry A 2017; 93:82-92. [DOI: 10.1002/cyto.a.23171] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/19/2017] [Accepted: 06/27/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Connor Long
- Surgical Bioengineering Laboratory, Department of Surgery; University of California, Davis School of Medicine; Sacramento California
| | - Lee Lankford
- Surgical Bioengineering Laboratory, Department of Surgery; University of California, Davis School of Medicine; Sacramento California
| | - Priyadarsini Kumar
- Surgical Bioengineering Laboratory, Department of Surgery; University of California, Davis School of Medicine; Sacramento California
| | - Robert Grahn
- Veterinary Genetics Laboratory; University of California; Davis California
| | - Dori L. Borjesson
- Veterinary Institute for Regenerative Cures and Department of Pathology, Microbiology, Immunology; University of California, Davis School of Veterinary Medicine; Davis California
| | - Diana Farmer
- Surgical Bioengineering Laboratory, Department of Surgery; University of California, Davis School of Medicine; Sacramento California
| | - Aijun Wang
- Surgical Bioengineering Laboratory, Department of Surgery; University of California, Davis School of Medicine; Sacramento California
| |
Collapse
|
31
|
Abstract
Regenerative medicine is a rapidly expanding and promising field for many diseases and injuries. Stem cells for regenerative therapies have originally been obtained from bone marrow, but are now readily extracted from a variety of adult tissues. Fetal tissue has recently garnered interest for its ease of differentiation into a variety of phenotypes and its relative abundance of pluripotent-linked transcription factors. However, much ethical concern surrounds the methods of obtaining fetal cells. The placenta has emerged as a potential source of fetal derived cells due to its favorable technical and ethical characteristics, as well as its promising therapeutic properties. This preview focuses on providing on overview on the derivation and characteristics of placental derived stem cells as well as delving into their various clinical applications and potential future directions.
Collapse
Affiliation(s)
- Diana Farmer
- Department of Surgery, University of California, Davis Health System, Sacramento, CA, United States.
| |
Collapse
|
32
|
Lankford L, Chen YJ, Saenz Z, Kumar P, Long C, Farmer D, Wang A. Manufacture and preparation of human placenta-derived mesenchymal stromal cells for local tissue delivery. Cytotherapy 2017; 19:680-688. [PMID: 28438482 DOI: 10.1016/j.jcyt.2017.03.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 03/02/2017] [Accepted: 03/03/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND In this study we describe the development of a Current Good Manufacturing Practice (CGMP)-compliant process to isolate, expand and bank placenta-derived mesenchymal stromal cells (PMSCs) for use as stem cell therapy. We characterize the viability, proliferation and neuroprotective secretory profile of PMSCs seeded on clinical-grade porcine small intestine submucosa extracellular matrix (SIS-ECM; Cook Biotech). METHODS PMSCs were isolated from early gestation placenta chorionic villus tissue via explant culture. Cells were expanded, banked and screened. Purity and expression of markers of pluripotency were determined using flow cytometry. Optimal loading density and viability of PMSCs on SIS-ECM were determined using 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium (MTS) cell proliferation and fluorescent live/dead assays, respectively. Growth factors secretion was analyzed using enzyme-linked immunosorbent assays (ELISA). RESULTS PMSCs were rapidly expanded and banked. Viable Master and Working Cell Banks were stable with minimal decrease in viability at 6 months. All PMSCs were sterile, free from Mycoplasma species, karyotypically normal and had low endotoxin levels. PMSCs were homogeneous by immunophenotyping and expressed little to no pluripotency markers. Optimal loading density on SIS-ECM was 3-5 × 105 cells/cm2, and seeded cells were >95% viable. Neurotrophic factor secretion was detectable from PMSCs seeded on plastic and SIS-ECM with variability between donor lots. DISCUSSION PMSCs from early gestation placental tissues can be rapidly expanded and banked in stable, viable cell banks that are free from contaminating agents, genetically normal and pure. PMSC delivery can be accomplished by using SIS-ECM, which maintains cell viability and protein secretion. Future work in vivo is necessary to optimize cell seeding and transplantation to maximize therapeutic capabilities.
Collapse
Affiliation(s)
- Lee Lankford
- Surgical Bioengineering Laboratory, Department of Surgery, University of California, Davis School of Medicine, Sacramento, California, USA
| | - Y Julia Chen
- Surgical Bioengineering Laboratory, Department of Surgery, University of California, Davis School of Medicine, Sacramento, California, USA
| | - Zoe Saenz
- Surgical Bioengineering Laboratory, Department of Surgery, University of California, Davis School of Medicine, Sacramento, California, USA
| | - Priyadarsini Kumar
- Surgical Bioengineering Laboratory, Department of Surgery, University of California, Davis School of Medicine, Sacramento, California, USA
| | - Connor Long
- Surgical Bioengineering Laboratory, Department of Surgery, University of California, Davis School of Medicine, Sacramento, California, USA
| | - Diana Farmer
- Surgical Bioengineering Laboratory, Department of Surgery, University of California, Davis School of Medicine, Sacramento, California, USA
| | - Aijun Wang
- Surgical Bioengineering Laboratory, Department of Surgery, University of California, Davis School of Medicine, Sacramento, California, USA.
| |
Collapse
|
33
|
Goodman L, Linden A, Jensen G, Kaseje N, Wright N, St-Louis E, Yousef Y, Wissanji H, Cheung M, Ozgediz D, Poenaru D, Lakhoo K, Greenberg S, Ameh E, Oldham K, Bickler S, Farmer D. Funding Flows for the Global Initiative for Children’s Surgery (GICS):
Lessons Learned. Ann Glob Health 2017. [DOI: 10.1016/j.aogh.2017.03.186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
34
|
Chen YJ, Lankford L, Kabagambe S, Saenz Z, Kumar P, Farmer D, Wang A. Effect of 2-octylcyanoacrylate on placenta derived mesenchymal stromal cells on extracellular matrix. Placenta 2017; 59:163-168. [PMID: 28465002 DOI: 10.1016/j.placenta.2017.03.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/07/2017] [Accepted: 03/31/2017] [Indexed: 02/08/2023]
Abstract
PURPOSE Determine the effect of 2-octylcyanoacrylate on placenta derived mesenchymal stromal cells (PMSCs) seeded onto extracellular matrix (ECM) in order to assess its biocompatibility as a potential adhesive for in-vivo fetal cell delivery. METHODS PMSCs isolated from chorionic villus tissue were seeded onto ECM. A MTS proliferation assay assessed cellular metabolic activity at various time points in PMSC-ECM with direct, indirect, and no glue contact. Conditioned media collected prior to and 24 hours after glue exposure was analyzed for secretion of human brain-derived neurotrophic factor, hepatocyte growth factor, and vascular endothelial growth factor. RESULTS Direct and indirect contact with 2-octylcyanoacrylate results in progressively decreased cellular metabolic activity over 24 hours compared to no glue controls. Cells with direct contact are less metabolically active than cells with indirect contact. 24 hours of glue exposure resulted in suppression of growth factor secretion that is near complete with direct contact. DISCUSSION Exposure to 2-octylcyanoacrylate results in decreased metabolic activity and decreased measurable secretion of growth factors by PMSCs seeded onto ECM. Thus, the application of 2-octylcyanoacrylate glue should be limited when working with cell-engineered scaffolds as its inhibitory effects on cell growth and secretory function can limit the therapeutic potential of cell-based interventions.
Collapse
Affiliation(s)
- Y Julia Chen
- Surgical Bioengineering Laboratory, Department of Surgery, University of California, Davis School of Medicine, Sacramento, CA 95817, United States
| | - Lee Lankford
- Surgical Bioengineering Laboratory, Department of Surgery, University of California, Davis School of Medicine, Sacramento, CA 95817, United States
| | - Sandra Kabagambe
- Surgical Bioengineering Laboratory, Department of Surgery, University of California, Davis School of Medicine, Sacramento, CA 95817, United States
| | - Zoe Saenz
- Surgical Bioengineering Laboratory, Department of Surgery, University of California, Davis School of Medicine, Sacramento, CA 95817, United States
| | - Priyadarsini Kumar
- Surgical Bioengineering Laboratory, Department of Surgery, University of California, Davis School of Medicine, Sacramento, CA 95817, United States
| | - Diana Farmer
- Surgical Bioengineering Laboratory, Department of Surgery, University of California, Davis School of Medicine, Sacramento, CA 95817, United States
| | - Aijun Wang
- Surgical Bioengineering Laboratory, Department of Surgery, University of California, Davis School of Medicine, Sacramento, CA 95817, United States.
| |
Collapse
|
35
|
Saxton AT, Poenaru D, Ozgediz D, Ameh EA, Farmer D, Smith ER, Rice HE. Economic Analysis of Children's Surgical Care in Low- and Middle-Income Countries: A Systematic Review and Analysis. PLoS One 2016; 11:e0165480. [PMID: 27792792 PMCID: PMC5085034 DOI: 10.1371/journal.pone.0165480] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 10/12/2016] [Indexed: 12/05/2022] Open
Abstract
Background Understanding the economic value of health interventions is essential for policy makers to make informed resource allocation decisions. The objective of this systematic review was to summarize available information on the economic impact of children’s surgical care in low- and middle-income countries (LMICs). Methods We searched MEDLINE (Pubmed), Embase, and Web of Science for relevant articles published between Jan. 1996 and Jan. 2015. We summarized reported cost information for individual interventions by country, including all costs, disability weights, health outcome measurements (most commonly disability-adjusted life years [DALYs] averted) and cost-effectiveness ratios (CERs). We calculated median CER as well as societal economic benefits (using a human capital approach) by procedure group across all studies. The methodological quality of each article was assessed using the Drummond checklist and the overall quality of evidence was summarized using a scale adapted from the Agency for Healthcare Research and Quality. Findings We identified 86 articles that met inclusion criteria, spanning 36 groups of surgical interventions. The procedure group with the lowest median CER was inguinal hernia repair ($15/DALY). The procedure group with the highest median societal economic benefit was neurosurgical procedures ($58,977). We found a wide range of study quality, with only 35% of studies having a Drummond score ≥ 7. Interpretation Our findings show that many areas of children’s surgical care are extremely cost-effective in LMICs, provide substantial societal benefits, and are an appropriate target for enhanced investment. Several areas, including inguinal hernia repair, trichiasis surgery, cleft lip and palate repair, circumcision, congenital heart surgery and orthopedic procedures, should be considered “Essential Pediatric Surgical Procedures” as they offer considerable economic value. However, there are major gaps in existing research quality and methodology which limit our current understanding of the economic value of surgical care.
Collapse
Affiliation(s)
- Anthony T. Saxton
- Duke Global Health Institute and Duke University Medical Center, Durham, NC, United States of America
| | - Dan Poenaru
- McMaster Paediatric Surgery Research Collaborative, Dept. of Surgery, McMaster University, Hamilton, Canada
| | - Doruk Ozgediz
- Yale-New Haven Hospital, New Haven, CT, United States of America
| | | | - Diana Farmer
- University of California-Davis Health System, Davis, CA, United States of America
| | - Emily R. Smith
- Duke Global Health Institute and Duke University Medical Center, Durham, NC, United States of America
| | - Henry E. Rice
- Duke Global Health Institute and Duke University Medical Center, Durham, NC, United States of America
- * E-mail:
| |
Collapse
|
36
|
Jeyarajah DR, Berman RS, Doyle MB, Geevarghese SK, Posner MC, Farmer D, Minter RM. Consensus Conference on North American Training in Hepatopancreaticobiliary Surgery: A Review of the Conference and Presentation of Consensus Statements. Am J Transplant 2016; 16:1086-93. [PMID: 26928942 DOI: 10.1111/ajt.13675] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 11/29/2015] [Accepted: 11/29/2015] [Indexed: 01/25/2023]
Abstract
The findings and recommendations of the North American consensus conference on training in hepatopancreaticobiliary (HPB) surgery held in October 2014 are presented. The conference was hosted by the Society for Surgical Oncology (SSO), the Americas Hepato-Pancreatico-Biliary Association (AHPBA), and the American Society of Transplant Surgeons (ASTS). The current state of training in HPB surgery in North America was defined through three pathways-HPB, surgical oncology, and solid organ transplant fellowships. Consensus regarding programmatic requirements included establishment of minimum case volumes and inclusion of quality metrics. Formative assessment, using milestones as a framework and inclusive of both operative and nonoperative skills, must be present. Specific core HPB cases should be defined and used for evaluation of operative skills. The conference concluded with a focus on the optimal means to perform summative assessment to evaluate the individual fellow completing a fellowship in HPB surgery. Presentations from the hospital perspective and the American Board of Surgery led to consensus that summative assessment was desired by the public and the hospital systems and should occur in a uniform but possibly modular manner for all HPB fellowship pathways. A task force composed of representatives of the SSO, AHPBA, and ASTS are charged with implementation of the consensus statements emanating from this consensus conference.
Collapse
Affiliation(s)
- D R Jeyarajah
- Department of Surgery, Methodist Dallas Medical Center, Dallas, TX
| | - R S Berman
- Department of Surgery, Division of Surgical Oncology, New York University, New York, NY
| | - M B Doyle
- Department of Abdominal Transplantation, Washington University School of Medicine, St Louis, MO
| | - S K Geevarghese
- Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, TN
| | - M C Posner
- Section of General Surgery and Surgical Oncology, University of Chicago Medicine, Chicago, IL
| | - D Farmer
- Department of Transplantation, UCLA Medical Center, Los Angeles, CA
| | - R M Minter
- Department of Surgery, Division of Hepatopancreatobiliary Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| |
Collapse
|
37
|
Tulipan N, Wellons JC, Thom EA, Gupta N, Sutton LN, Burrows PK, Farmer D, Walsh W, Johnson MP, Rand L, Tolivaisa S, D'alton ME, Adzick NS. Prenatal surgery for myelomeningocele and the need for cerebrospinal fluid shunt placement. J Neurosurg Pediatr 2015; 16:613-20. [PMID: 26369371 PMCID: PMC5206797 DOI: 10.3171/2015.7.peds15336] [Citation(s) in RCA: 133] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The Management of Myelomeningocele Study (MOMS) was a multicenter randomized trial comparing the safety and efficacy of prenatal and postnatal closure of myelomeningocele. The trial was stopped early because of the demonstrated efficacy of prenatal surgery, and outcomes on 158 of 183 pregnancies were reported. Here, the authors update the 1-year outcomes for the complete trial, analyze the primary and related outcomes, and evaluate whether specific prerandomization risk factors are associated with prenatal surgery benefit. METHODS The primary outcome was a composite of fetal loss or any of the following: infant death, CSF shunt placement, or meeting the prespecified criteria for shunt placement. Primary outcome, actual shunt placement, and shunt revision rates for prenatal versus postnatal repair were compared. The shunt criteria were reassessed to determine which were most concordant with practice, and a new composite outcome was created from the primary outcome by replacing the original criteria for CSF shunt placement with the revised criteria. The authors used logistic regression to estimate whether there were interactions between the type of surgery and known prenatal risk factors (lesion level, gestational age, degree of hindbrain herniation, and ventricle size) for shunt placement, and to determine which factors were associated with shunting among those infants who underwent prenatal surgery. RESULTS Ninety-one women were randomized to prenatal surgery and 92 to postnatal repair. The primary outcome occurred in 73% of infants in the prenatal surgery group and in 98% in the postnatal group (p < 0.0001). Actual rates of shunt placement were only 44% and 84% in the 2 groups, respectively (p < 0.0001). The authors revised the most commonly met criterion to require overt clinical signs of increased intracranial pressure, defined as split sutures, bulging fontanelle, or sunsetting eyes, in addition to increasing head circumference or hydrocephalus. Using these modified criteria, only 3 patients in each group met criteria but did not receive a shunt. For the revised composite outcome, there was a difference between the prenatal and postnatal surgery groups: 49.5% versus 87.0% (p < 0.0001). There was also a significant reduction in the number of children who had a shunt placed and then required a revision by 1 year of age in the prenatal group (15.4% vs 40.2%, relative risk 0.38 [95% CI 0.22-0.66]). In the prenatal surgery group, 20% of those with ventricle size < 10 mm at initial screening, 45.2% with ventricle size of 10 up to 15 mm, and 79.0% with ventricle size ≥ 15 mm received a shunt, whereas in the postnatal group, 79.4%, 86.0%, and 87.5%, respectively, received a shunt (p = 0.02). Lesion level and degree of hindbrain herniation appeared to have no effect on the eventual need for shunting (p = 0.19 and p = 0.13, respectively). Similar results were obtained for the revised outcome. CONCLUSIONS Larger ventricles at initial screening are associated with an increased need for shunting among those undergoing fetal surgery for myelomeningocele. During prenatal counseling, care should be exercised in recommending prenatal surgery when the ventricles are 15 mm or larger because prenatal surgery does not appear to improve outcome in this group. The revised criteria may be useful as guidelines for treating hydrocephalus in this group.
Collapse
Affiliation(s)
| | | | - Elizabeth A Thom
- The Biostatistics Center, George Washington University, Washington, DC;
| | | | | | - Pamela K Burrows
- The Biostatistics Center, George Washington University, Washington, DC;
| | | | - William Walsh
- Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mark P Johnson
- Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Pennsylvania
| | - Larry Rand
- Obstetrics and Gynecology, University of California, San Francisco, California
| | - Susan Tolivaisa
- Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; and
| | - Mary E D'alton
- Department of Obstetrics and Gynecology, Columbia University, New York, New York
| | - N Scott Adzick
- Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Pennsylvania
| | | |
Collapse
|
38
|
Lankford L, Selby T, Becker J, Ryzhuk V, Long C, Farmer D, Wang A. Early gestation chorionic villi-derived stromal cells for fetal tissue engineering. World J Stem Cells 2015; 7:195-207. [PMID: 25621120 PMCID: PMC4300931 DOI: 10.4252/wjsc.v7.i1.195] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 11/04/2014] [Accepted: 11/10/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the potential for early gestation placenta-derived mesenchymal stromal cells (PMSCs) for fetal tissue engineering.
METHODS: PMSCs were isolated from early gestation chorionic villus tissue by explant culture. Chorionic villus sampling (CVS)-size tissue samples (mean = 35.93 mg) were used to test the feasibility of obtaining large cell numbers from CVS within a clinically relevant timeframe. We characterized PMSCs isolated from 6 donor placentas by flow cytometry immunophenotyping, multipotency assays, and through immunofluorescent staining. Protein secretion from PMSCs was examined using two cytokine array assays capable of probing for over 70 factors in total. Delivery vehicle compatibility of PMSCs was determined using three common scaffold systems: fibrin glue, collagen hydrogel, and biodegradable nanofibrous scaffolds made from a combination of polylactic acid (PLA) and poly(lactic-co-glycolic acid) (PLGA). Viral transduction of PMSCs was performed using a Luciferase-GFP-containing lentiviral vector and efficiency of transduction was tested by fluorescent microscopy and flow cytometry analysis.
RESULTS: We determined that an average of 2.09 × 106 (SD ± 8.59 × 105) PMSCs could be obtained from CVS-size tissue samples within 30 d (mean = 27 d, SD ± 2.28), indicating that therapeutic numbers of cells can be rapidly expanded from very limited masses of tissue. Immunophenotyping by flow cytometry demonstrated that PMSCs were positive for MSC markers CD105, CD90, CD73, CD44, and CD29, and were negative for hematopoietic and endothelial markers CD45, CD34, and CD31. PMSCs displayed trilineage differentiation capability, and were found to express developmental transcription factors Sox10 and Sox17 as well as neural-related structural proteins NFM, Nestin, and S100β. Cytokine arrays revealed a robust and extensive profile of PMSC-secreted cytokines and growth factors, and detected 34 factors with spot density values exceeding 103. Detected factors had widely diverse functions that include modulation of angiogenesis and immune response, cell chemotaxis, cell proliferation, blood vessel maturation and homeostasis, modulation of insulin-like growth factor activity, neuroprotection, extracellular matrix degradation and even blood coagulation. Importantly, PMSCs were also determined to be compatible with both biological and synthetic material-based delivery vehicles such as collagen and fibrin hydrogels, and biodegradable nanofiber scaffolds made from a combination of PLA and PLGA. Finally, we demonstrated that PMSCs can be efficiently transduced (> 95%) with a Luciferase-GFP-containing lentiviral vector for future in vivo cell tracking after transplantation.
CONCLUSION: Our findings indicate that PMSCs represent a unique source of cells that can be effectively utilized for in utero cell therapy and tissue engineering.
Collapse
|
39
|
Farmer D, Sitkin N. The Maturation of Children With Congenital Anomalies: Who Will Be Their Providers? JAMA Surg 2014; 149:501-2. [PMID: 24695816 DOI: 10.1001/jamasurg.2013.4873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Diana Farmer
- Department of Surgery, UC Davis Health Systems, Sacramento, California
| | - Nicole Sitkin
- Department of Surgery, UC Davis Health Systems, Sacramento, California
| |
Collapse
|
40
|
Mahmoud A, Galante J, Wisner D, Farmer D, Sims D. Small community hospitals programs affiliation with university programs; "lessons learned" in 28-year successful affiliation. J Surg Educ 2013; 70:636-639. [PMID: 24016375 DOI: 10.1016/j.jsurg.2013.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Revised: 04/10/2013] [Accepted: 05/12/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Community hospitals affiliation with university hospitals in post graduate surgical education is essential for the 2 types of training programs. Many factors affect the success of the affiliation process. Additionally, various pitfalls and challenges are encountered. The goal of this work is to study the lessons learned in 28 years successful affiliation. DESIGN/SETTING small community hospital affiliation with university program for 28 years. PARTICIPANTS surgery residency programs in small community hospital and university hospital. RESULTS successful affiliation for 28 years between community hospital and university program.
Collapse
Affiliation(s)
- Ahmed Mahmoud
- University of California, Davis, California; San Joaquin General Hospital, French Camp, California.
| | | | | | | | | |
Collapse
|
41
|
|
42
|
Dancer SJ, Kirkpatrick P, Corcoran DS, Christison F, Farmer D, Robertson C. Approaching zero: temporal effects of a restrictive antibiotic policy on hospital-acquired Clostridium difficile, extended-spectrum β-lactamase-producing coliforms and meticillin-resistant Staphylococcus aureus. Int J Antimicrob Agents 2012; 41:137-42. [PMID: 23276500 DOI: 10.1016/j.ijantimicag.2012.10.013] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 10/02/2012] [Accepted: 10/26/2012] [Indexed: 11/18/2022]
Abstract
A restrictive antibiotic policy banning routine use of ceftriaxone and ciprofloxacin was implemented in a 450-bed district general hospital following an educational campaign. Monthly consumption of nine antibiotics was monitored in defined daily doses (DDDs) per 1000 patient-occupied bed-days (1000 pt-bds) 9 months before until 16 months after policy introduction. Hospital-acquired Clostridium difficile, meticillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum β-lactamase (ESBL)-producing coliform cases per month/1000 pt-bds were identified and reviewed throughout the hospital. Between the first and final 6 months of the study, average monthly consumption of ceftriaxone reduced by 95% (from 46.213 to 2.129 DDDs/1000 pt-bds) and that for ciprofloxacin by 72.5% (109.804 to 30.205 DDDs/1000 pt-bds). Over the same periods, hospital-acquisition rates for C. difficile reduced by 77% (2.398 to 0.549 cases/1000 pt-bds), for MRSA by 25% (1.187 to 0.894 cases/1000 pt-bds) and for ESBL-producing coliforms by 17% (1.480 to 1.224 cases/1000 pt-bds). Time-lag modelling confirmed significant associations between ceftriaxone and C. difficile cases at 1 month (correlation 0.83; P<0.005), and between ciprofloxacin and ESBL-producing coliform cases at 2 months (correlation 0.649; P=0.002). An audit performed 3 years after the policy showed sustained reduction in C. difficile rates (0.259 cases/1000 pt-bds), with additional decreases for MRSA (0.409 cases/1000 pt-bds) and ESBL-producing coliforms (0.809 cases/1000 pt-bds). In conclusion, banning two antibiotics resulted in an immediate and profound reduction in hospital-acquired C. difficile, with possible longer-term effects on MRSA and ESBL-producing coliform rates. Antibiotic stewardship is fundamental in the control of major hospital pathogens.
Collapse
Affiliation(s)
- S J Dancer
- Department of Microbiology, Hairmyres Hospital, East Kilbride, Lanarkshire G75 8RG, UK.
| | | | | | | | | | | |
Collapse
|
43
|
Abstract
In a recently completed randomized, prospective clinical trial, fetal repair for myelomeningocele was shown to result in reduced rates of hydrocephalus requiring placement of a ventriculoperitoneal shunt, improvement in Chiari malformation Type II, and improvement in neurological function compared with standard postnatal repair. Successful fetal surgery requires the active participation and interaction of several clinical teams. Each group has a specific role, and overlap is often required at different points of the treatment plan. Extensive multispecialty discussions with the patient and family are necessary before informed consent can be obtained. Fetal surgery carries significant risks to the mother and fetus and these must be carefully considered prior to a final treatment decision. This review will summarize the evaluation and treatment of patients undergoing fetal repair for myelomeningocele at one institution.
Collapse
Affiliation(s)
- Nalin Gupta
- Departments of Neurological Surgery, University of California, San Francisco, CA 94143-0112, USA.
| | | | | | | | | |
Collapse
|
44
|
Saab S, Desai S, Tsaoi D, Durazo F, Han S, McClune A, Holt C, Farmer D, Goldstein L, Busuttil RW. Posttransplantation hepatitis B prophylaxis with combination oral nucleoside and nucleotide analog therapy. Am J Transplant 2011; 11:511-7. [PMID: 21299826 DOI: 10.1111/j.1600-6143.2010.03416.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Liver transplant recipients are at risk of developing recurrent hepatitis B after liver transplantation for hepatitis B virus (HBV)-related liver disease. We evaluated the efficacy of a new hepatitis B prophylaxis regimen involving conversion from at least 12 months of HBIg with lamivudine to combination therapy with an oral nucleoside and nucleotide analog. Between June 2008 and May 2010, a total of 61 liver transplant recipients were converted to a combination of a nucleoside and nucleotide analog. The mean (±standard deviation) follow-up time after conversion was 15.0 (±6.1) months. Recurrent HBV occurred in two (3.3%) patients at 3.1 and 16.6 months after HBIg cessation. The overall person time incidence rate for HBV recurrence after HBIg cessation was 2.7 cases per 100 person-years. The estimate of HBV recurrence was 1.7% at 1 year after HBIg cessation. HBIg cessation a minimum of 12 months after liver transplantation with subsequent combination therapy with a nucleoside and nucleotide analog provides effective prophylaxis against recurrent HBV infection. The clinical implications of HBsAg detection without clinical, biochemical or molecular manifestations of recurrent hepatitis B require further study.
Collapse
Affiliation(s)
- S Saab
- Department of Medicine, David Geffen School of Medicine, University of California-Los Angeles, CA, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Schmidt AF, Gonçalves FLL, Nassr ACC, Pereira LAVD, Farmer D, Sbragia L. Antenatal steroid and tracheal occlusion restore vascular endothelial growth factor receptors in congenital diaphragmatic hernia rat model. Am J Obstet Gynecol 2010; 203:184.e13-20. [PMID: 20537303 DOI: 10.1016/j.ajog.2010.04.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Revised: 04/01/2010] [Accepted: 04/12/2010] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Investigate the effects of antenatal steroids and tracheal occlusion on pulmonary expression of vascular endothelial growth factor receptors in rats with nitrofen-induced congenital diaphragmatic hernia. STUDY DESIGN Fetuses were exposed to nitrofen at embryonic day 9.5. Subgroups received dexamethasone or were operated on for tracheal occlusion, or received combined treatment. Morphologic variables were recorded. To analyze vascular endothelial growth factor receptor 1 and vascular endothelial growth factor receptor 2 expression, we performed Western blotting and immunohistochemistry. Morphologic variables were analyzed by analysis of variance and immunohistochemistry by Kruskal-Wallis test. RESULTS Congenital diaphragmatic hernia decreased body weight, total lung weight, and lung-to-body weight ratio. Tracheal occlusion increased total lung weight and lung-to-body weight ratio (P < .05). Fetuses with congenital diaphragmatic hernia had reduced vascular endothelial growth factor receptor 1 and vascular endothelial growth factor receptor 2 expression, whereas steroids and tracheal occlusion increased their expression. Combined treatment increased expression of receptors, but had no additive effect. CONCLUSION Vascular endothelial growth factor signaling disruption may be associated with pulmonary hypertension in congenital diaphragmatic hernia. Tracheal occlusion and steroids provide a pathway for restoring expression of vascular endothelial growth factor receptors.
Collapse
Affiliation(s)
- Augusto F Schmidt
- Division of Pediatric Surgery, Department of Surgery, School of Medical Sciences, University of Campinas, UNICAMP, Campinas, SP, Brazil
| | | | | | | | | | | |
Collapse
|
46
|
Mazariegos GV, Steffick DE, Horslen S, Farmer D, Fryer J, Grant D, Langnas A, Magee JC. Intestine transplantation in the United States, 1999-2008. Am J Transplant 2010; 10:1020-34. [PMID: 20420650 DOI: 10.1111/j.1600-6143.2010.03044.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Improving short-term results with intestine transplantation have allowed more patients to benefit with nearly 700 patients alive in the United States with a functioning allograft at the end of 2007. This success has led to an increase in demand. Time to transplant and waiting list mortality have significantly improved over the decade, but mortality remains high, especially for infants and adults with concomitant liver failure. The approximately 200 intestines recovered annually from deceased donors represent less than 3% of donors who have at least one organ recovered. Consent practice varies widely by OPTN region. Opportunities for improving intestine recovery and utilization include improving consent rates and standardizing donor selection criteria. One-year patient and intestine graft survival is 89% and 79% for intestine-only recipients and 72% and 69% for liver-intestine recipients, respectively. By 10 years, patient and intestine survival falls to 46% and 29% for intestine-only recipients, and 42% and 39% for liver-intestine, respectively. Immunosuppression practice employs peri-operative antibody induction therapy in 60% of cases; acute rejection is reported in 30%-40% of recipients at one year. Data on long-term nutritional outcomes and morbidities are limited, while the cause and therapy for late graft loss from chronic rejection are areas of ongoing investigation.
Collapse
Affiliation(s)
- G V Mazariegos
- Children's Hospital of Pittsburgh of UPMC Hillman Center for Pediatric Transplantation, Pittsburgh, PA, USA.
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Jancelewicz T, Vu LT, Keller RL, Bratton B, Lee H, Farmer D, Harrison M, Miniati D, Mackenzie T, Hirose S, Nobuhara K. Long-term surgical outcomes in congenital diaphragmatic hernia: observations from a single institution. J Pediatr Surg 2010; 45:155-60; discussion 160. [PMID: 20105597 DOI: 10.1016/j.jpedsurg.2009.10.028] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2009] [Accepted: 10/06/2009] [Indexed: 01/18/2023]
Abstract
BACKGROUND/PURPOSE Surgical complications are common in survivors of congenital diaphragmatic hernia (CDH), but little is known about long-term incidence patterns and associated predictors. METHODS A cohort of 99 CDH survivors was prospectively followed at a single-institution multidisciplinary clinic. Data were gathered regarding the adverse surgical outcomes of hernia recurrence, chest and spinal deformity, and operative small bowel obstruction (SBO), and then were retrospectively analyzed in relation to perinatal and perioperative markers of disease severity to determine significant predictors. Statistical methods used included univariate and multivariate regression analysis, hazard modeling, and Kaplan-Meier analysis. RESULTS At a median cohort age of 4.7 (range, 0.2-10.6) years, 46% of patients with patch repairs and 10% of those with primary repairs had a hernia recurrence at a median time of 0.9 (range, 0.1-7.3) years after repair. Chest deformity was detected in 47%. Small bowel obstruction and scoliosis occurred in 13%. Recurrence and chest deformity were significantly more common with patch repair, liver herniation, age at neonatal extubation greater than 16 days, oxygen requirement at discharge, and prematurity. The strongest predictor of SBO was patch repair. Multivariate analysis showed that patch repair was independently predictive of recurrence and early chest deformity (odds ratios of 5.0 and 4.8, confidence intervals of 1-24 and 1-21, P < .05). Use of an absorbable patch was associated with the highest risk of surgical complications. CONCLUSIONS For long-term survivors of CDH, specific perinatal and operative variables, particularly patch repair, are associated with subsequent adverse surgical outcomes.
Collapse
Affiliation(s)
- Tim Jancelewicz
- Division of Pediatric Surgery, Department of Surgery, University of California, San Francisco, CA 94143, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Abstract
Many new employees naturally seek out coworkers and informal advisors as a way of learning about their new positions and organizations. However, a formalized mentoring program is a way to meet the needs of new employees and effectively impart the information and advice in a coordinated, ongoing process. This paper focuses on the process of revitalizing a formalized mentoring program in an academic library. Included are details of the process developed by one institution, an extensive bibliography, sample checklists, and assessment tools.
Collapse
|
49
|
Azzie G, Bickler S, Farmer D, Beasley S. Partnerships for developing pediatric surgical care in low-income countries. J Pediatr Surg 2008; 43:2273-4. [PMID: 19040951 DOI: 10.1016/j.jpedsurg.2008.08.062] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2008] [Accepted: 08/29/2008] [Indexed: 11/26/2022]
Affiliation(s)
- Georges Azzie
- Department of Surgery, University of Toronto, Hospital for Sick Children, Toronto, Ontario, Canada.
| | | | | | | |
Collapse
|
50
|
Ozgediz D, Wang J, Jayaraman S, Ayzengart A, Jamshidi R, Lipnick M, Mabweijano J, Kaggwa S, Knudson M, Schecter W, Farmer D. Surgical training and global health: initial results of a 5-year partnership with a surgical training program in a low-income country. ACTA ACUST UNITED AC 2008; 143:860-5; discussion 865. [PMID: 18794423 DOI: 10.1001/archsurg.143.9.860] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
HYPOTHESIS Surgical trainees in the United States have a growing interest in both clinical experiences and structured training opportunities in global health. Global health training and exposure can be integrated into a surgical residency program. DESIGN The global health activities of surgical residents and faculty in 1 department were evaluated from January 1, 1998, to June 1, 2008, using a survey and personal interviews. RESULTS From January 1, 1998, to December 31, 2002, 4 faculty members made more than 20 overseas volunteer medical expeditions, but only 1 resident participated in global health activities. In 2003, a relationship with a surgical training program in a developing country was established. Ten residents and 12 faculty members have made overseas trips during the last 5 years, and 1 international surgeon has visited the United States. During their research block, 4 residents completed 1- to 3-month clinical rotations and contributed to mentored research projects. Three residents completed a university-based Global Health Clinical Scholars Program, and 3 obtained master's degrees in public health. A joint conference in injury-trauma research was also conducted. A faculty member is based overseas with clinical and research responsibilities, and another is completing a master's degree in public health. CONCLUSIONS Global health training and exposure for residents can be effectively integrated into an academic surgical residency program through relationships with training programs in low-income countries. Legitimate academic experiences improve the success of these programs. Reciprocity with collaborative partners must be ensured, and sustained commitment and funding remain a great challenge to such programs. The long-term effect on the development of global health careers is yet to be determined.
Collapse
Affiliation(s)
- Doruk Ozgediz
- Department of Surgery, University of California, San Francisco, CA 94143-0570, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|