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Bergh E, Baschat AA, Cortes MS, Hedrick HL, Ryan G, Lim FY, Zaretsky MV, Schenone MH, Crombleholme TM, Ruano R, Gosnell KA, Johnson A. Fetoscopic Endoluminal Tracheal Occlusion for Severe, Left-Sided Congenital Diaphragmatic Hernia: The North American Fetal Therapy Network Fetoscopic Endoluminal Tracheal Occlusion Consortium Experience. Obstet Gynecol 2024; 143:440-448. [PMID: 38128107 PMCID: PMC10863657 DOI: 10.1097/aog.0000000000005491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/14/2023] [Revised: 11/01/2023] [Accepted: 11/09/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To report the outcomes of fetoscopic endoluminal tracheal occlusion in a multicenter North American cohort of patients with isolated, left-sided congenital diaphragmatic hernia (CDH) and to compare neonatal mortality and morbidity in patients with severe left-sided congenital diaphragmatic hernia who underwent fetoscopic endoluminal tracheal occlusion with those expectantly managed. METHODS We analyzed data from 10 centers in the NAFTNet (North American Fetal Therapy Network) FETO (Fetoscopic Endoluminal Tracheal Occlusion) Consortium registry, collected between November 1, 2008, and December 31, 2020. In addition to reporting procedure-related surgical outcomes of fetoscopic endoluminal tracheal occlusion, we performed a comparative analysis of fetoscopic endoluminal tracheal occlusion compared with contemporaneous expectantly managed patients. RESULTS Fetoscopic endoluminal tracheal occlusion was successfully performed in 87 of 89 patients (97.8%). Six-month survival in patients with severe left-sided congenital diaphragmatic hernia did not differ significantly between patients who underwent fetoscopic endoluminal tracheal occlusion and those managed expectantly (69.8% vs 58.1%, P =.30). Patients who underwent fetoscopic endoluminal tracheal occlusion had higher rates of preterm prelabor rupture of membranes (54.0% vs 14.3%, P <.001), earlier gestational age at delivery (median 35.0 weeks vs 38.3 weeks, P <.001), and lower birth weights (mean 2,487 g vs 2,857 g, P =.001). On subanalysis, in patients for whom all recorded observed-to-expected lung/head ratio measurements were below 25%, patients with fetoscopic endoluminal tracheal occlusion required fewer days of extracorporeal membrane oxygenation (ECMO) (median 9.0 days vs 17.0 days, P =.014). CONCLUSION In this cohort, fetoscopic endoluminal tracheal occlusion was successfully implemented across several North American fetal therapy centers. Although survival was similar among patients undergoing fetoscopic endoluminal tracheal occlusion and those expectantly managed, fetoscopic endoluminal tracheal occlusion in North American centers may reduce morbidity, as suggested by fewer days of ECMO in those patients with persistently reduced lung volumes (observed-to-expected lung/head ratio below 25%).
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Affiliation(s)
- Eric Bergh
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Medicine, UTHealth Houston, the University of Texas McGovern Medical School, and the Fetal Center at Children's Memorial Hermann Hospital, and the Division of Fetal Therapy and Surgery, Department of Obstetrics and Gynecology, Texas Children's Hospital Fetal Center, Baylor College of Medicine, Houston, Texas; the Center for Fetal Therapy, Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland; The Richard Wood Jr. Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; the Ontario Fetal Centre, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; the Center for Fetal, Cellular & Molecular Therapy, Cincinnati Fetal Center, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; the Fetal Care Center, Children's Hospital Colorado, Aurora, Colorado; the Division of Maternal and Fetal Medicine, Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, Minnesota; the Fetal Care Center Dallas, Dallas, Texas; and the Fetal Treatment Center, University of California, San Francisco, San Francisco, California
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Short WD, Steen E, Kaul A, Wang X, Olutoye OO, Vangapandu HV, Templeman N, Blum AJ, Moles CM, Narmoneva DA, Crombleholme TM, Butte MJ, Bollyky PL, Keswani SG, Balaji S. IL-10 promotes endothelial progenitor cell infiltration and wound healing via STAT3. FASEB J 2022; 36:e22298. [PMID: 35670763 PMCID: PMC9796147 DOI: 10.1096/fj.201901024rr] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 03/08/2022] [Accepted: 03/23/2022] [Indexed: 01/02/2023]
Abstract
Endothelial progenitor cells (EPCs) contribute to de novo angiogenesis, tissue regeneration, and remodeling. Interleukin 10 (IL-10), an anti-inflammatory cytokine that primarily signals via STAT3, has been shown to drive EPC recruitment to injured tissues. Our previous work demonstrated that overexpression of IL-10 in dermal wounds promotes regenerative tissue repair via STAT3-dependent regulation of fibroblast-specific hyaluronan synthesis. However, IL-10's role and specific mode of action on EPC recruitment, particularly in dermal wound healing and neovascularization in both normal and diabetic wounds, remain to be defined. Therefore, inducible skin-specific STAT3 knockdown mice were studied to determine IL-10's impact on EPCs, dermal wound neovascularization and healing, and whether it is STAT3-dependent. We show that IL-10 overexpression significantly elevated EPC counts in the granulating wound bed, which was associated with robust capillary lumen density and enhanced re-epithelialization of both control and diabetic (db/db) wounds at day 7. We noted increased VEGF and high C-X-C motif chemokine 12 (CXCL12) levels in wounds and a favorable CXCL12 gradient at day 3 that may support EPC mobilization and infiltration from bone marrow to wounds, an effect that was abrogated in STAT3 knockdown wounds. These findings were supported in vitro. IL-10 promoted VEGF and CXCL12 synthesis in primary murine dermal fibroblasts, with blunted VEGF expression upon blocking CXCL12 in the media by antibody binding. IL-10-conditioned fibroblast media also significantly promoted endothelial sprouting and network formation. In conclusion, these studies demonstrate that overexpression of IL-10 in dermal wounds recruits EPCs and leads to increased vascular structures and faster re-epithelialization.
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Affiliation(s)
- Walker D. Short
- Division of Pediatric SurgeryDepartment of SurgeryTexas Children's Hospital and Baylor College of MedicineHoustonTexasUSA
| | - Emily Steen
- Division of Pediatric SurgeryDepartment of SurgeryTexas Children's Hospital and Baylor College of MedicineHoustonTexasUSA
| | - Aditya Kaul
- Division of Pediatric SurgeryDepartment of SurgeryTexas Children's Hospital and Baylor College of MedicineHoustonTexasUSA
| | - Xinyi Wang
- Division of Pediatric SurgeryDepartment of SurgeryTexas Children's Hospital and Baylor College of MedicineHoustonTexasUSA
| | - Oluyinka O. Olutoye
- Division of Pediatric SurgeryDepartment of SurgeryTexas Children's Hospital and Baylor College of MedicineHoustonTexasUSA
| | - Hima V. Vangapandu
- Division of Pediatric SurgeryDepartment of SurgeryTexas Children's Hospital and Baylor College of MedicineHoustonTexasUSA
| | - Natalie Templeman
- Division of Pediatric SurgeryDepartment of SurgeryTexas Children's Hospital and Baylor College of MedicineHoustonTexasUSA
| | - Alexander J. Blum
- Division of Pediatric SurgeryDepartment of SurgeryTexas Children's Hospital and Baylor College of MedicineHoustonTexasUSA
| | - Chad M. Moles
- Division of Pediatric SurgeryDepartment of SurgeryTexas Children's Hospital and Baylor College of MedicineHoustonTexasUSA
| | - Daria A. Narmoneva
- Biomedical EngineeringDepartment of Biomedical, Chemical and Environmental EngineeringCollege of Engineering and Applied SciencesUniversity of CincinnatiCincinnatiOhioUSA
| | - Timothy M. Crombleholme
- Division of Pediatric General Thoracic and Fetal SurgeryConnecticut Children’s HospitalUniversity of Connecticut School of MedicineFarmingtonConnecticutUSA,Fetal Care Center DallasDallasTexasUSA
| | - Manish J. Butte
- Division of ImmunologyAllergy, and RheumatologyDepartments of Pediatrics and Microbiology, Immunology, and Molecular GeneticsUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Paul L. Bollyky
- Division of Infectious DiseasesDepartment of MedicineStanford University School of MedicineStanfordCaliforniaUSA
| | - Sundeep G. Keswani
- Division of Pediatric SurgeryDepartment of SurgeryTexas Children's Hospital and Baylor College of MedicineHoustonTexasUSA
| | - Swathi Balaji
- Division of Pediatric SurgeryDepartment of SurgeryTexas Children's Hospital and Baylor College of MedicineHoustonTexasUSA
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Fleming JM, Ross S, Hoffman LM, Coughlin R, Crombleholme TM, Mong DA, Hilden J, Maloney K, Tan GM. Pediatric mediastinal mass algorithm: A quality improvement initiative to reduce time from presentation to biopsy. Paediatr Anaesth 2021; 31:885-893. [PMID: 34002917 DOI: 10.1111/pan.14210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 01/31/2020] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mediastinal masses in children may present with compression of the great vessels and airway. An interdisciplinary plan for rapid diagnosis, acute management, and treatment prevents devastating outcomes and optimizes care. Emergency pretreatment with steroids or radiation is more likely to be administered when care is variable, which may delay and complicate diagnosis and treatment. Strategies to standardize care and expedite diagnosis may improve acute patient safety and long-term outcomes. AIMS The aim of this quality improvement project was to decrease time from presentation to diagnostic biopsy for children with an anterior mediastinal mass by 50% over 3 years within a tertiary healthcare system. METHODS This quality improvement project involved a single center with data collected and analyzed retrospectively and prospectively for 71 patients presenting with anterior mediastinal mass between February 2008 and January 2018. The Model for Improvement was utilized for project design and development of a driver diagram and smart aim. An algorithm was implemented to facilitate communication between teams and standardize initial care of patients with mediastinal masses. The algorithm underwent multiple Plan-Do-Study-Act (PDSA) cycles. Data were collected before and after algorithm implementation and between each PDSA cycle. The primary outcome measure included time from presentation to biopsy, which was monitored with a statistical process control chart. Several process measures were evaluated with Student's t-tests including administration of emergency pretreatment. RESULTS Nineteen patients preintervention and 52 patients postintervention were included in the analysis. Time from presentation to biopsy significantly decreased from 48 h at baseline to 24 h postimplementation. Although not statistically significant, emergency pretreatment decreased from a baseline of 26.3% to 6.7% postimplementation. CONCLUSION Implementation of a diagnostic and management algorithm coordinating care among multidisciplinary teams significantly reduced time to biopsy for children presenting with mediastinal mass and may result in decreased use of emergent pretreatment.
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Affiliation(s)
- Jamie M Fleming
- Anschutz Medical Center, University of Colorado Denver, Aurora, CO, USA
| | - Savannah Ross
- Anschutz Medical Center, University of Colorado Denver, Aurora, CO, USA
| | | | - Rebecca Coughlin
- Anschutz Medical Center, University of Colorado Denver, Aurora, CO, USA
| | | | - David A Mong
- Anschutz Medical Center, University of Colorado Denver, Aurora, CO, USA
| | - Joanne Hilden
- Anschutz Medical Center, University of Colorado Denver, Aurora, CO, USA
| | - Kelly Maloney
- Anschutz Medical Center, University of Colorado Denver, Aurora, CO, USA
| | - Gee Mei Tan
- Anschutz Medical Center, University of Colorado Denver, Aurora, CO, USA
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Crombleholme TM, Moise KJ. Maternal-fetal surgery during the coronavirus disease 2019 pandemic. Am J Obstet Gynecol MFM 2020; 2:100144. [PMID: 32427199 PMCID: PMC7232066 DOI: 10.1016/j.ajogmf.2020.100144] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/12/2020] [Accepted: 05/12/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Timothy M Crombleholme
- Fetal Care Center Dallas, Medical City Dallas Children's Hospital, Dallas, TX.,Fetal Think Tank Consortium
| | - Kenneth J Moise
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at UTHealth and the Fetal Center, Children's Memorial Hermann Hospital, Houston, TX.,Fetal Think Tank Consortium
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Abstract
The growth of the field of fetal surgery over the last two decades driven by new indications and data from prospective randomized trials supporting prenatal intervention has resulted in techniques protocols and methodologies that have gained confidence by insuring good outcomes. Error traps are methods or techniques that usually work well in most of the cases, but which are apt to fail under certain specific circumstances. The very confidence the surgeon develops in these techniques or methodologies makes them a trap for the unwary surgeon. The purpose of this article is to discuss common error traps in fetal interventions, including ultrasound guided procedures, fetoscopic surgery, open fetal surgery and EXIT procedures. Awareness of these error traps and approaches to avoid them may enhance fetal surgical outcomes and reduce complications rates.
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Affiliation(s)
- Jose L Peiro
- Cincinnati Fetal Center, Division of Pediatric General and Thoracic Surgery, College of Medicine at University of Cincinnati, and the Cincinnati Children's Hospital Medical Center (CCHMC). Cincinnati, OH, USA
| | - Timothy M Crombleholme
- Fetal Care Center Dallas, Division of Pediatric Surgery, Department of Surgery, and the Medical City Children's Hospital, Suite C 742, 7777 Forrest Lane, Dallas, TX 75230, USA.
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Howley LW, Chatterjee D, Patel SS, Cuneo BF, Crombleholme TM, Behrendt N, Zaretsky MV, Marwan AI, Zuk J, Galan HL, Wood C. Indomethacin Dosing and Constriction of the Ductus Arteriosus During Open Fetal Surgery for Myelomeningocele Repair. Fetal Diagn Ther 2018; 45:339-344. [PMID: 30157479 DOI: 10.1159/000491748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/01/2017] [Accepted: 07/02/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The use of perioperative tocolytic agents in fetal surgery is imperative to prevent preterm labor. Indomethacin, a well-known tocolytic agent, can cause ductus arteriosus (DA) constriction. We sought to determine whether a relationship exists between preoperative indomethacin dosing and fetal DA constriction. MATERIALS AND METHODS This is an IRB-approved, single-center retrospective observational case series of 42 pregnant mothers who underwent open fetal myelomeningocele repair. Preoperatively, mothers received either 1 (QD) or 2 (BID) indomethacin doses. Maternal anesthetic drug exposures and fetal cardiac dysfunction measures were collected from surgical and anesthesia records and intraoperative fetal echocardiography. Pulsatility Index was used to calculate DA constriction severity. Comparative testing between groups was performed using t- and chi-square testing. RESULTS DA constriction was observed in all fetuses receiving BID indomethacin and in 71.4% of those receiving QD dosing (p = 0.0002). Severe DA constriction was observed only in the BID group (35.7%). QD indomethacin group received more intraoperative magnesium sulfate (p < 0.0001). Minimal fetal cardiac dysfunction (9.5%) and bradycardia (9.5%) were observed in all groups independent of indomethacin dosing. CONCLUSIONS DA constriction was the most frequent and severe in the BID indomethacin group. QD indomethacin and greater magnesium sulfate dosing was associated with reduced DA constriction.
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Affiliation(s)
- Lisa W Howley
- University of Colorado School of Medicine, Aurora, Colorado, USA, .,Colorado Fetal Care Center, Aurora, Colorado, USA, .,Department of Pediatrics, Section of Cardiology, Aurora, Colorado, USA,
| | - Debnath Chatterjee
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Colorado Fetal Care Center, Aurora, Colorado, USA.,Department of Anesthesiology, Aurora, Colorado, USA
| | - Sonali S Patel
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Department of Pediatrics, Section of Cardiology, Aurora, Colorado, USA
| | - Bettina F Cuneo
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Colorado Fetal Care Center, Aurora, Colorado, USA.,Department of Pediatrics, Section of Cardiology, Aurora, Colorado, USA
| | - Timothy M Crombleholme
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Colorado Fetal Care Center, Aurora, Colorado, USA.,Department of Fetal and Pediatric Surgery, Aurora, Colorado, USA
| | - Nicholas Behrendt
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Colorado Fetal Care Center, Aurora, Colorado, USA.,Department of Maternal-Fetal Medicine, Aurora, Colorado, USA
| | - Michael V Zaretsky
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Colorado Fetal Care Center, Aurora, Colorado, USA.,Department of Maternal-Fetal Medicine, Aurora, Colorado, USA
| | - Ahmed I Marwan
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Colorado Fetal Care Center, Aurora, Colorado, USA.,Department of Fetal and Pediatric Surgery, Aurora, Colorado, USA
| | - Jeannie Zuk
- Colorado Fetal Care Center, Aurora, Colorado, USA.,Department of Fetal and Pediatric Surgery, Aurora, Colorado, USA
| | - Henry L Galan
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Colorado Fetal Care Center, Aurora, Colorado, USA.,Department of Maternal-Fetal Medicine, Aurora, Colorado, USA
| | - Cristina Wood
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Colorado Fetal Care Center, Aurora, Colorado, USA.,Department of Anesthesiology, Aurora, Colorado, USA
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Dodson RB, Powers KN, Gien J, Rozance PJ, Seedorf G, Astling D, Jones K, Crombleholme TM, Abman SH, Alvira CM. Intrauterine growth restriction decreases NF-κB signaling in fetal pulmonary artery endothelial cells of fetal sheep. Am J Physiol Lung Cell Mol Physiol 2018; 315:L348-L359. [PMID: 29722560 DOI: 10.1152/ajplung.00052.2018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 12/26/2022] Open
Abstract
Intrauterine growth restriction (IUGR) in premature newborns increases the risk for bronchopulmonary dysplasia, a chronic lung disease characterized by disrupted pulmonary angiogenesis and alveolarization. We previously showed that experimental IUGR impairs angiogenesis; however, mechanisms that impair pulmonary artery endothelial cell (PAEC) function are uncertain. The NF-κB pathway promotes vascular growth in the developing mouse lung, and we hypothesized that IUGR disrupts NF-κB-regulated proangiogenic targets in fetal PAEC. PAECs were isolated from the lungs of control fetal sheep and sheep with experimental IUGR from an established model of chronic placental insufficiency. Microarray analysis identified suppression of NF-κB signaling and significant alterations in extracellular matrix (ECM) pathways in IUGR PAEC, including decreases in collagen 4α1 and laminin α4, components of the basement membrane and putative NF-κB targets. In comparison with controls, immunostaining of active NF-κB complexes, NF-κB-DNA binding, baseline expression of NF-κB subunits p65 and p50, and LPS-mediated inducible activation of NF-κB signaling were decreased in IUGR PAEC. Although pharmacological NF-κB inhibition did not affect angiogenic function in IUGR PAEC, angiogenic function of control PAEC was reduced to a similar degree as that observed in IUGR PAEC. These data identify reductions in endothelial NF-κB signaling as central to the disrupted angiogenesis observed in IUGR, likely by impairing both intrinsic PAEC angiogenic function and NF-κB-mediated regulation of ECM components necessary for vascular development. These data further suggest that strategies that preserve endothelial NF-κB activation may be useful in lung diseases marked by disrupted angiogenesis such as IUGR.
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Affiliation(s)
- R Blair Dodson
- Laboratory for Fetal and Regenerative Biology, University of Colorado Denver Anschutz Medical Campus , Aurora, Colorado.,Pediatric Heart Lung Center, University of Colorado Denver Anschutz Medical Campus , Aurora, Colorado.,Department of Surgery, University of Colorado Denver Anschutz Medical Campus , Aurora, Colorado.,Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus , Aurora, Colorado.,United Therapeutics, Regenerative Medicine Laboratory, Research Triangle Park, Durham, North Carolina
| | - Kyle N Powers
- Laboratory for Fetal and Regenerative Biology, University of Colorado Denver Anschutz Medical Campus , Aurora, Colorado.,Pediatric Heart Lung Center, University of Colorado Denver Anschutz Medical Campus , Aurora, Colorado.,Department of Surgery, University of Colorado Denver Anschutz Medical Campus , Aurora, Colorado
| | - Jason Gien
- Pediatric Heart Lung Center, University of Colorado Denver Anschutz Medical Campus , Aurora, Colorado.,Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus , Aurora, Colorado
| | - Paul J Rozance
- Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus , Aurora, Colorado
| | - Gregory Seedorf
- Pediatric Heart Lung Center, University of Colorado Denver Anschutz Medical Campus , Aurora, Colorado.,Department of Biochemistry and Molecular Genetics, University of Colorado Denver Anschutz Medical Campus , Aurora, Colorado
| | - David Astling
- United Therapeutics, Regenerative Medicine Laboratory, Research Triangle Park, Durham, North Carolina
| | - Kenneth Jones
- United Therapeutics, Regenerative Medicine Laboratory, Research Triangle Park, Durham, North Carolina
| | - Timothy M Crombleholme
- Laboratory for Fetal and Regenerative Biology, University of Colorado Denver Anschutz Medical Campus , Aurora, Colorado.,Department of Surgery, University of Colorado Denver Anschutz Medical Campus , Aurora, Colorado
| | - Steven H Abman
- Pediatric Heart Lung Center, University of Colorado Denver Anschutz Medical Campus , Aurora, Colorado.,Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus , Aurora, Colorado
| | - Cristina M Alvira
- Department of Pediatrics, Stanford University School of Medicine , Palo Alto, California
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Deeney S, Howley LW, Hodges M, Liechty KW, Marwan AI, Gien J, Kinsella JP, Crombleholme TM. Impact of Objective Echocardiographic Criteria for Timing of Congenital Diaphragmatic Hernia Repair. J Pediatr 2018; 192:99-104.e4. [PMID: 29106923 DOI: 10.1016/j.jpeds.2017.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 07/27/2017] [Accepted: 09/06/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess the impact of specific echocardiographic criteria for timing of congenital diaphragmatic hernia repair on the incidence of acute postoperative clinical decompensation from pulmonary hypertensive crisis and/or acute respiratory decompensation, with secondary outcomes including survival to discharge, duration of ventilator support, and length of hospitalization. STUDY DESIGN The multidisciplinary congenital diaphragmatic hernia management team instituted a protocol in 2012 requiring the specific criterion of echocardiogram-estimated pulmonary artery pressure ≤80% systemic blood pressure before repairing congenital diaphragmatic hernias. A retrospective review of 77 neonatal patients with Bochdalek hernias repaired between 2008 and 2015 were reviewed: group 1 included patients repaired before protocol implementation (n = 25) and group 2 included patients repaired after implementation (n = 52). RESULTS The groups had similar baseline characteristics. Postoperative decompensation occurred less often in group 2 compared with group 1 (17% vs 48%, P = .01). Adjusted analysis accounting for repair type, liver herniation, and prematurity yielded similar results (15% vs 37%, P = .04). Group 2 displayed a trend toward improved survival to 30 days postoperatively, though this did not reach statistical significance (94% vs 80%, P = .06). Patient survival to discharge, duration of ventilator support, and length of hospitalization were not different between groups. CONCLUSIONS The implementation of a protocol requiring echocardiogram-estimated pulmonary arterial pressure ≤80% of systemic pressure before congenital diaphragmatic hernia repair may reduce the incidence of acute postoperative decompensation, although there was no difference in longer-term secondary outcomes, including survival to discharge.
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Affiliation(s)
- Scott Deeney
- The Colorado Fetal Care Center, Divisions of Pediatric General, Thoracic and Fetal Surgery, Pediatric Cardiology, Neonatology, and Multidisciplinary Congenital Diaphragmatic Hernia Management Team, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Lisa W Howley
- The Colorado Fetal Care Center, Divisions of Pediatric General, Thoracic and Fetal Surgery, Pediatric Cardiology, Neonatology, and Multidisciplinary Congenital Diaphragmatic Hernia Management Team, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Maggie Hodges
- The Colorado Fetal Care Center, Divisions of Pediatric General, Thoracic and Fetal Surgery, Pediatric Cardiology, Neonatology, and Multidisciplinary Congenital Diaphragmatic Hernia Management Team, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Kenneth W Liechty
- The Colorado Fetal Care Center, Divisions of Pediatric General, Thoracic and Fetal Surgery, Pediatric Cardiology, Neonatology, and Multidisciplinary Congenital Diaphragmatic Hernia Management Team, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Ahmed I Marwan
- The Colorado Fetal Care Center, Divisions of Pediatric General, Thoracic and Fetal Surgery, Pediatric Cardiology, Neonatology, and Multidisciplinary Congenital Diaphragmatic Hernia Management Team, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Jason Gien
- The Colorado Fetal Care Center, Divisions of Pediatric General, Thoracic and Fetal Surgery, Pediatric Cardiology, Neonatology, and Multidisciplinary Congenital Diaphragmatic Hernia Management Team, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - John P Kinsella
- The Colorado Fetal Care Center, Divisions of Pediatric General, Thoracic and Fetal Surgery, Pediatric Cardiology, Neonatology, and Multidisciplinary Congenital Diaphragmatic Hernia Management Team, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Timothy M Crombleholme
- The Colorado Fetal Care Center, Divisions of Pediatric General, Thoracic and Fetal Surgery, Pediatric Cardiology, Neonatology, and Multidisciplinary Congenital Diaphragmatic Hernia Management Team, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
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Zaretsky MV, Liechty KW, Galan HL, Behrendt NJ, Reeves S, Marwan AI, Wilkinson C, Handler M, Lagueux M, Crombleholme TM. Modified Hysterotomy Closure Technique for Open Fetal Surgery. Fetal Diagn Ther 2017; 44:105-111. [DOI: 10.1159/000479683] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 07/19/2017] [Indexed: 11/19/2022]
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10
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Zaretsky MV, Manchester DK, Galan HL, Behrendt NJ, Marwan AI, Liechty KW, Crombleholme TM. Case report of myometrial window following fetoscopic treatment of twin-twin transfusion syndrome: indications of underlying collagen vascular disease? Clin Case Rep 2017; 5:975-979. [PMID: 28588850 PMCID: PMC5457978 DOI: 10.1002/ccr3.885] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 01/31/2017] [Accepted: 02/04/2017] [Indexed: 11/21/2022] Open
Abstract
Intraperitoneal amniotic fluid leak is a known complication of fetoscopic procedures that usually resolves spontaneously with expectant management. Intraperitoneal amniotic fluid leak may persist after fetoscopic procedures due to a myometrial window as well as to persistent chorioamniotic membrane disruption, which may be amenable to surgical repair.
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Affiliation(s)
- Michael V Zaretsky
- Colorado Fetal Center Colorado Institute for Maternal and Fetal Health Aurora Colorado USA.,Division of Maternal Fetal Medicine Children's Hospital Colorado University of Colorado School of Medicine Aurora Colorado USA
| | - David K Manchester
- Colorado Fetal Center Colorado Institute for Maternal and Fetal Health Aurora Colorado USA.,Division of Genetics Children's Hospital Colorado University of Colorado School of Medicine Aurora Colorado USA
| | - Henry L Galan
- Colorado Fetal Center Colorado Institute for Maternal and Fetal Health Aurora Colorado USA.,Division of Maternal Fetal Medicine Children's Hospital Colorado University of Colorado School of Medicine Aurora Colorado USA
| | - Nicholas J Behrendt
- Colorado Fetal Center Colorado Institute for Maternal and Fetal Health Aurora Colorado USA.,Division of Maternal Fetal Medicine Children's Hospital Colorado University of Colorado School of Medicine Aurora Colorado USA
| | - Ahmed I Marwan
- Colorado Fetal Center Colorado Institute for Maternal and Fetal Health Aurora Colorado USA.,Division of Pediatric General, Thoracic and Fetal Surgery Children's Hospital Colorado University of Colorado School of Medicine Aurora Colorado USA
| | - Kenneth W Liechty
- Colorado Fetal Center Colorado Institute for Maternal and Fetal Health Aurora Colorado USA.,Division of Pediatric General, Thoracic and Fetal Surgery Children's Hospital Colorado University of Colorado School of Medicine Aurora Colorado USA
| | - Timothy M Crombleholme
- Colorado Fetal Center Colorado Institute for Maternal and Fetal Health Aurora Colorado USA.,Division of Pediatric General, Thoracic and Fetal Surgery Children's Hospital Colorado University of Colorado School of Medicine Aurora Colorado USA
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11
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Cuneo BF, Mitchell MB, Marwan AI, Green M, von Alvensleben JC, Reynolds R, Crombleholme TM, Galan HL. Ex utero Intrapartum Treatment to Ventricular Pacing: A Novel Delivery Strategy for Complete Atrioventricular Block with Severe Bradycardia. Fetal Diagn Ther 2017; 42:311-314. [DOI: 10.1159/000475815] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 04/04/2017] [Indexed: 11/19/2022]
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12
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Alsaied T, Omar K, James JF, Hinton RB, Crombleholme TM, Habli M. Fetal origins of adult cardiac disease: a novel approach to prevent fetal growth restriction induced cardiac dysfunction using insulin like growth factor. Pediatr Res 2017; 81:919-925. [PMID: 28099426 DOI: 10.1038/pr.2017.18] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 06/03/2016] [Accepted: 12/30/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND Fetal growth restriction (FGR) is a risk factor for adult cardiovascular disease. Intraplacental gene transfer of human insulin-like growth factor-1 (IGF-1) corrects birth weight in our mouse model of FGR. This study addresses long term effects of FGR on cardiac function and the potential preventive effect of IGF-1. STUDY DESIGN Laparotomy was performed on pregnant C57BL/6J mice at embryonic day 18 and pups were divided into three groups: Sham operated; FGR (induced by mesenteric uterine artery ligation); treatment (intraplacental injection of IGF-1 after uterine artery ligation). Pups were followed until 32 wk of life. Transthoracic echocardiography was performed starting at 12 wk. RESULTS Systolic cardiac function was significantly impaired in the FGR group with reduced fractional shortening compared with sham and treatment group starting at week 12 of life (20 ± 4 vs. 31 ± 5 vs. 32 ± 5, respectively, n = 12 for each group; P < 0.001) with no difference between the sham and treatment groups. CONCLUSION Intraplacental gene transfer of IGF-1 prevents FGR induced cardiac dysfunction. This suggests that in utero therapy may positively impact cardiac remodeling and prevent adult cardiovascular disease.
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Affiliation(s)
- Tarek Alsaied
- Cincinnati Children's Hospital Heart Institute, Cincinnati, Ohio
| | - Khaled Omar
- Colorado Fetal Care Center, Division of Pediatric General Thoracic and Fetal Surgery, Children's Hospital of Colorado, Denver, Colorado
| | - Jeanne F James
- Cincinnati Children's Hospital Heart Institute, Cincinnati, Ohio
| | - Robert B Hinton
- Cincinnati Children's Hospital Heart Institute, Cincinnati, Ohio
| | - Timothy M Crombleholme
- Colorado Fetal Care Center, Division of Pediatric General Thoracic and Fetal Surgery, Children's Hospital of Colorado, Denver, Colorado
| | - Mounira Habli
- Center for Molecular Fetal Therapy, Cincinnati Children's Hospital, Cincinnati, Ohio.,Department of General and Thoracic Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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13
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Zhelnin KE, Gebhard GM, Mirsky DM, Oliver SC, Lovell MA, Galambos C, Crombleholme TM, McCourt EA. Pediatric Intraocular Immature Teratoma Associated With Sacrococcygeal Teratoma. Pediatr Dev Pathol 2017; 20:240-244. [PMID: 28521629 DOI: 10.1177/1093526616686233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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] [Indexed: 11/16/2022]
Abstract
Intraocular teratomas are rare neoplasms with only three previously reported cases. We present the fourth case of intraocular teratoma and the second associated with sacrococcygeal teratoma. While the nature of the association between intraocular teratomas and sacrococcygeal teratomas is unclear, it suggests a need for careful ophthalmologic follow-up of infants with congenital sacrococcygeal teratomas.
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14
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Moon-Grady AJ, Baschat A, Cass D, Choolani M, Copel JA, Crombleholme TM, Deprest J, Emery SP, Evans MI, Luks FI, Norton ME, Ryan G, Tsao K, Welch R, Harrison M. Fetal Treatment 2017: The Evolution of Fetal Therapy Centers - A Joint Opinion from the International Fetal Medicine and Surgical Society (IFMSS) and the North American Fetal Therapy Network (NAFTNet). Fetal Diagn Ther 2017; 42:241-248. [PMID: 28531885 DOI: 10.1159/000475929] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 04/18/2017] [Indexed: 01/23/2023]
Abstract
More than 3 decades ago, a small group of physicians and other practitioners active in what they called "fetal treatment" authored an opinion piece outlining the current status and future challenges anticipated in the field. Many advances in maternal, neonatal, and perinatal care and diagnostic and therapeutic modalities have been made in the intervening years, yet a thoughtful reassessment of the basic tenets put forth in 1982 has not been published. The present effort will aim to provide a framework for contemporary redefinition of the field of fetal treatment, with a brief discussion of the necessary minimum expertise and systems base for the provision of different types of interventions for both the mother and fetus. Our goal will be to present an opinion that encourages the advancement of thoughtful practice, ensuring that current and future patients have realistic access to centers with a range of fetal therapies with appropriate expertise, experience, and subspecialty and institutional support while remaining focused on excellence in care, collaborative scientific discovery, and maternal autonomy and safety.
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Affiliation(s)
- Anita J Moon-Grady
- The Fetal Treatment Center, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA
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15
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Deeney S, Miyasaka E, Landman M, Crombleholme TM. Resection of bilateral bronchopulmonary sequestrations via a single left-sided muscle-sparing thoracotomy. Journal of Pediatric Surgery Case Reports 2017. [DOI: 10.1016/j.epsc.2016.03.010] [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: 11/24/2022] Open
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16
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Abou Chaar MK, Meyers ML, Tucker BD, Galan HL, Liechty KW, Crombleholme TM, Marwan AI. Twin pregnancy complicated by esophageal atresia, duodenal atresia, gastric perforation, and hypoplastic left heart structures in one twin: a case report and review of the literature. J Med Case Rep 2017; 11:64. [PMID: 28314387 PMCID: PMC5357333 DOI: 10.1186/s13256-016-1195-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 08/10/2016] [Accepted: 12/28/2016] [Indexed: 12/12/2022] Open
Abstract
Background The antenatal diagnosis of a combined esophageal atresia without tracheoesophageal fistula and duodenal atresia with or without gastric perforation is a rare occurrence. These diagnoses are difficult and can be suspected on ultrasound by nonspecific findings including a small stomach and polyhydramnios. Fetal magnetic resonance imaging adds significant anatomical detail and can aid in the diagnosis of these complicated cases. Upon an extensive literature review, there are no reports documenting these combined findings in a twin pregnancy. Therefore we believe this is the first case report of an antenatal diagnosis of combined pure esophageal and duodenal atresia in a twin gestation. Case presentation We present a case of a 30-year-old G1P0 white woman at 22-week gestation with a monochorionic-diamniotic twin pregnancy discordant for esophageal atresia, duodenal atresia with gastric perforation, hypoplastic left heart structures, and significant early gestation maternal polyhydramnios. In this case, fetal magnetic resonance imaging was able to depict additional findings including area of gastric wall rupture, hiatal hernia, dilation of the distal esophagus, and area of duodenal obstruction and thus facilitated the proper diagnosis. After extensive counseling at our multidisciplinary team meeting, the parents elected to proceed with radiofrequency ablation of the anomalous twin to maximize the survival of the normal co-twin. The procedure was performed successfully with complete cessation of flow in the umbilical artery and complete cardiac standstill in the anomalous twin with no detrimental effects on the healthy co-twin. Conclusions Prenatal diagnosis of complex anomalies in twin pregnancies constitutes a multitude of ethical, religious, and cultural factors that come into play in the management of these cases. Fetal magnetic resonance imaging provides detailed valuable information that can assist in management options including possible prenatal intervention. The combination of a cystic structure with peristalsis-like movement above the diaphragm (for example, “the upper thoracic pouch sign”), polyhydramnios, and progressive distention of the stomach and duodenum should increase suspicion for a combined pure esophageal and duodenal atresia.
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Affiliation(s)
- Mohamad K Abou Chaar
- Colorado Fetal Care Center, Colorado Institute of Maternal and Fetal Health, University of Colorado Denver, Anschutz Medical Center, Denver, USA
| | - Mariana L Meyers
- Colorado Fetal Care Center, Colorado Institute of Maternal and Fetal Health, University of Colorado Denver, Anschutz Medical Center, Denver, USA.,Department of Pediatric Radiology, University of Colorado Denver, Anschutz Medical Center, Denver, USA
| | - Bethany D Tucker
- Colorado Fetal Care Center, Colorado Institute of Maternal and Fetal Health, University of Colorado Denver, Anschutz Medical Center, Denver, USA.,Department of Pediatrics, University of Colorado Denver, Anschutz Medical Center, Denver, USA
| | - Henry L Galan
- Colorado Fetal Care Center, Colorado Institute of Maternal and Fetal Health, University of Colorado Denver, Anschutz Medical Center, Denver, USA.,Department of Obstetrics and Gynecology - Maternal Fetal Medicine, University of Colorado Denver, Anschutz Medical Center, Denver, USA
| | - Kenneth W Liechty
- Colorado Fetal Care Center, Colorado Institute of Maternal and Fetal Health, University of Colorado Denver, Anschutz Medical Center, Denver, USA.,Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Center, Denver, USA
| | - Timothy M Crombleholme
- Colorado Fetal Care Center, Colorado Institute of Maternal and Fetal Health, University of Colorado Denver, Anschutz Medical Center, Denver, USA.,Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Center, Denver, USA
| | - Ahmed I Marwan
- Colorado Fetal Care Center, Colorado Institute of Maternal and Fetal Health, University of Colorado Denver, Anschutz Medical Center, Denver, USA. .,Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Center, Denver, USA. .,Surgery and Pediatrics, Colorado Fetal Care Center - Children's Hospital Colorado, 13123 East 16th Avenue, 328, Aurora, Colorado, 80045, USA.
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17
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Balaji S, Wang X, King A, Le LD, Bhattacharya SS, Moles CM, Butte MJ, de Jesus Perez VA, Liechty KW, Wight TN, Crombleholme TM, Bollyky PL, Keswani SG. Interleukin-10-mediated regenerative postnatal tissue repair is dependent on regulation of hyaluronan metabolism via fibroblast-specific STAT3 signaling. FASEB J 2016; 31:868-881. [PMID: 27903619 PMCID: PMC5295728 DOI: 10.1096/fj.201600856r] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 11/07/2016] [Indexed: 01/05/2023]
Abstract
The cytokine IL-10 has potent antifibrotic effects in models of adult fibrosis, but the mechanisms of action are unclear. Here, we report a novel finding that IL-10 triggers a signal transducer and activator of transcription 3 (STAT3)–dependent signaling pathway that regulates hyaluronan (HA) metabolism and drives adult fibroblasts to synthesize an HA-rich pericellular matrix, which mimics the fetal regenerative wound healing phenotype with reduced fibrosis. By using cre-lox–mediated novel, inducible, fibroblast-, keratinocyte-, and wound-specific STAT3-knockdown postnatal mice—plus syngeneic fibroblast cell-transplant models—we demonstrate that the regenerative effects of IL-10 in postnatal wounds are dependent on HA synthesis and fibroblast-specific STAT3-dependent signaling. The importance of IL-10–induced HA synthesis for regenerative wound healing is demonstrated by inhibition of HA synthesis in a murine wound model by administering 4-methylumbelliferone. Although IL-10 and STAT3 signaling were intact, the antifibrotic repair phenotype that is induced by IL-10 overexpression was abrogated in this model. Our data show a novel role for IL-10 beyond its accepted immune-regulatory mechanism. The opportunity for IL-10 to regulate a fibroblast-specific formation of a regenerative, HA-rich wound extracellular matrix may lead to the development of innovative therapies to attenuate postnatal fibrosis in organ systems or diseases in which dysregulated inflammation and HA intersect.—Balaji, S., Wang, X., King, A., Le, L. D., Bhattacharya, S. S., Moles, C. M., Butte, M. J., de Jesus Perez, V. A., Liechty, K. W., Wight, T. N., Crombleholme, T. M., Bollyky, P. L., Keswani, S. G. Interleukin-10–mediated regenerative postnatal tissue repair is dependent on regulation of hyaluronan metabolism via fibroblast-specific STAT3 signaling.
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Affiliation(s)
- Swathi Balaji
- Laboratory for Regenerative Tissue Repair, Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Xinyi Wang
- Laboratory for Regenerative Tissue Repair, Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Alice King
- Laboratory for Regenerative Tissue Repair, Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Louis D Le
- Laboratory for Regenerative Tissue Repair, Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Sukanta S Bhattacharya
- Laboratory for Regenerative Tissue Repair, Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Chad M Moles
- Laboratory for Regenerative Tissue Repair, Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Manish J Butte
- Division of Immunology, Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Vinicio A de Jesus Perez
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | - Kenneth W Liechty
- Center for Children's Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Thomas N Wight
- Matrix Biology Program, Benaroya Research Institute, Seattle, Washington, USA; and
| | - Timothy M Crombleholme
- Center for Children's Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Paul L Bollyky
- Division of Infectious Diseases, Department of Medicine, Stanford University, Stanford, California, USA
| | - Sundeep G Keswani
- Laboratory for Regenerative Tissue Repair, Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA;
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18
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Meyers ML, Mirsky DM, Dannull KA, Tong S, Crombleholme TM. Effects of Maternal Valium Administration on Fetal MRI Motion Artifact: A Comparison Study at High Altitude. Fetal Diagn Ther 2016; 42:124-129. [DOI: 10.1159/000450978] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 09/16/2016] [Indexed: 11/19/2022]
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19
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Deeney S, Powers KN, Crombleholme TM. A comparison of sexing methods in fetal mice. Lab Anim (NY) 2016; 45:380-4. [DOI: 10.1038/laban.1105] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 08/10/2016] [Indexed: 11/09/2022]
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20
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Funk T, Lim Y, Kulungowski AM, Prok L, Crombleholme TM, Choate K, Bruckner AL. Symptomatic Congenital Hemangioma and Congenital Hemangiomatosis Associated With a Somatic Activating Mutation in GNA11. JAMA Dermatol 2016; 152:1015-20. [DOI: 10.1001/jamadermatol.2016.2365] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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)
- Tracy Funk
- Department of Dermatology, Oregon Health & Science University, Portland
| | - Young Lim
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut3Department of Genetics, Yale University School of Medicine, New Haven, Connecticut4Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Ann M. Kulungowski
- Division of Pediatric General, Thoracic, and Fetal Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora
| | - Lori Prok
- Department of Dermatology, University of Colorado School of Medicine, Aurora7Department of Pathology, University of Colorado School of Medicine, Aurora
| | - Timothy M. Crombleholme
- Division of Pediatric General, Thoracic, and Fetal Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora
| | - Keith Choate
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut3Department of Genetics, Yale University School of Medicine, New Haven, Connecticut4Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Anna L. Bruckner
- Department of Dermatology, University of Colorado School of Medicine, Aurora8Department of Pediatrics, University of Colorado School of Medicine, Aurora
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21
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Cho H, Balaji S, Hone NL, Moles CM, Sheikh AQ, Crombleholme TM, Keswani SG, Narmoneva DA. Diabetic wound healing in a MMP9-/- mouse model. Wound Repair Regen 2016; 24:829-840. [PMID: 27292154 DOI: 10.1111/wrr.12453] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 05/12/2016] [Indexed: 12/12/2022]
Abstract
Reduced mobilization of endothelial progenitor cells (EPCs) from the bone marrow (BM) and impaired EPC recruitment into the wound represent a fundamental deficiency in the chronic ulcers. However, mechanistic understanding of the role of BM-derived EPCs in cutaneous wound neovascularization and healing remains incomplete, which impedes development of EPC-based wound healing therapies. The objective of this study was to determine the role of EPCs in wound neovascularization and healing both under normal conditions and using single deficiency (EPC) or double-deficiency (EPC + diabetes) models of wound healing. MMP9 knockout (MMP9 KO) mouse model was utilized, where impaired EPC mobilization can be rescued by stem cell factor (SCF). The hypotheses were: (1) MMP9 KO mice exhibit impaired wound neovascularization and healing, which are further exacerbated with diabetes; (2) these impairments can be rescued by SCF administration. Full-thickness excisional wounds with silicone splints to minimize contraction were created on MMP9 KO mice with/without streptozotocin-induced diabetes in the presence or absence of tail-vein injected SCF. Wound morphology, vascularization, inflammation, and EPC mobilization and recruitment were quantified at day 7 postwounding. Results demonstrate no difference in wound closure and granulation tissue area between any groups. MMP9 deficiency significantly impairs wound neovascularization, increases inflammation, decreases collagen deposition, and decreases peripheral blood EPC (pb-EPC) counts when compared with wild-type (WT). Diabetes further increases inflammation, but does not cause further impairment in vascularization, as compared with MMP9 KO group. SCF improves neovascularization and increases EPCs to WT levels (both nondiabetic and diabetic MMP9 KO groups), while exacerbating inflammation in all groups. SCF rescues EPC-deficiency and impaired wound neovascularization in both diabetic and nondiabetic MMP9 KO mice. Overall, the results demonstrate that BM-derived EPCs play a significant role during wound neovascularization and that the SCF-based therapy with controlled inflammation could be a viable approach to enhance healing in chronic diabetic wounds.
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Affiliation(s)
- Hongkwan Cho
- Department of Biomedical, Chemical and Environmental Engineering, College of Engineering and Applied Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Swathi Balaji
- Department of Biomedical, Chemical and Environmental Engineering, College of Engineering and Applied Sciences, University of Cincinnati, Cincinnati, Ohio.,Division of Pediatric Surgery, Baylor College of Medicine, Houston, Texas
| | - Natalie L Hone
- Department of Biomedical, Chemical and Environmental Engineering, College of Engineering and Applied Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Chad M Moles
- Division of Pediatric Surgery, Baylor College of Medicine, Houston, Texas
| | - Abdul Q Sheikh
- Department of Biomedical, Chemical and Environmental Engineering, College of Engineering and Applied Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Timothy M Crombleholme
- Children's Hospital Colorado and the University of Colorado School of Medicine, Aurora, Colorado
| | - Sundeep G Keswani
- Division of Pediatric Surgery, Baylor College of Medicine, Houston, Texas
| | - Daria A Narmoneva
- Department of Biomedical, Chemical and Environmental Engineering, College of Engineering and Applied Sciences, University of Cincinnati, Cincinnati, Ohio.
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22
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Polzin WJ, Lim FY, Habli M, Van Hook J, Minges M, Jaekle R, Crombleholme TM. Use of an Amnioport to Maintain Amniotic Fluid Volume in Fetuses with Oligohydramnios Secondary to Lower Urinary Tract Obstruction or Fetal Renal Anomalies. Fetal Diagn Ther 2016; 41:51-57. [PMID: 27287190 DOI: 10.1159/000445946] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 04/04/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We describe a technique to maintain amniotic fluid in fetuses with severe oligo-/anhydramnios secondary to lower urinary tract obstruction or fetal renal disease when urine production is inadequate to maintain a normal amniotic fluid volume (AFV). METHODS An amnioport was inserted into the amniotic space. The catheter was secured to prevent dislodgment and tunneled to a subcutaneous reservoir. The reservoir was accessed as necessary, infusing normal saline to maintain AFV. Pregnancy continued until term or indicated delivery. RESULTS Since 2010, 15 patients in this category were considered for an amnioport. Six chose comfort care and one elected percutaneous amnioinfusions. Nine amnioport procedures were performed in eight patients. There were no fetal deaths. All eight had successful restoration and maintenance of amniotic fluid. Delivery ranged from 9 to 96 days after placement (mean 63.7 days). One died due to unrecognized laryngeal web and another one died of pulmonary hypoplasia after preterm premature rupture of membranes. None of the remaining six had pulmonary hypoplasia. Three remain alive. DISCUSSION Severe oligo-/anhydramnios in the second trimester secondary to fetal anomalies is almost uniformly lethal due to pulmonary hypoplasia without restoration of amniotic fluid. The amnioport procedure may allow pulmonary survival but commits families to postnatal care decisions regarding pulmonary and renal complications.
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23
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Hodges MM, Crombleholme TM, Meyers M, Kulungowski A, Marwan AI, Nakano T, Behrendt N, Liechty KW. Massive fetal chylothorax successfully treated with postnatal talc pleurodesis: A case report and review of the literature. Journal of Pediatric Surgery Case Reports 2016. [DOI: 10.1016/j.epsc.2016.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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24
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Behrendt N, Zaretsky MV, West NA, Galan HL, Crombleholme TM, Meyers ML. Ultrasound versus MRI: is there a difference in measurements of the fetal lateral ventricles? J Matern Fetal Neonatal Med 2016; 30:298-301. [DOI: 10.3109/14767058.2016.1171310] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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]
Affiliation(s)
- Nicholas Behrendt
- Department of Obstetrics and Gynecology, University Colorado Denver, Aurora, CO, USA,
- Colorado Institute for Maternal and Fetal Health, Aurora, CO, USA,
| | - Michael V. Zaretsky
- Department of Obstetrics and Gynecology, University Colorado Denver, Aurora, CO, USA,
- Colorado Institute for Maternal and Fetal Health, Aurora, CO, USA,
| | - Nancy A. West
- Department of Epidemiology, Colorado School of Public Health, CO, USA,
- Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA,
| | - Henry L. Galan
- Department of Obstetrics and Gynecology, University Colorado Denver, Aurora, CO, USA,
- Colorado Institute for Maternal and Fetal Health, Aurora, CO, USA,
| | - Timothy M. Crombleholme
- Colorado Institute for Maternal and Fetal Health, Aurora, CO, USA,
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA,
- Department of Pediatric Surgery, Children’s Hospital Colorado, Aurora, CO, USA,
| | - Mariana L. Meyers
- Colorado Institute for Maternal and Fetal Health, Aurora, CO, USA,
- Department of Pediatric Radiology, Children’s Hospital Colorado, Aurora, CO, USA, and
- Department of Radiology, University of Colorado Denver School of Medicine, Aurora, CO, USA
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25
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Euser AG, Meyers ML, Zaretsky MV, Crombleholme TM. Comparison of congenital pulmonary airway malformation volume ratios calculated by ultrasound and magnetic resonance imaging. J Matern Fetal Neonatal Med 2015; 29:3172-7. [DOI: 10.3109/14767058.2015.1118038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Anna G. Euser
- Colorado Institute for Maternal and Fetal Health, Children’s Hospital of Colorado, Aurora, CO, USA,
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO, USA,
| | - Mariana L. Meyers
- Colorado Institute for Maternal and Fetal Health, Children’s Hospital of Colorado, Aurora, CO, USA,
- Department of Radiology, University of Colorado Denver, Aurora, CO, USA, and
| | - Michael V. Zaretsky
- Colorado Institute for Maternal and Fetal Health, Children’s Hospital of Colorado, Aurora, CO, USA,
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO, USA,
| | - Timothy M. Crombleholme
- Colorado Institute for Maternal and Fetal Health, Children’s Hospital of Colorado, Aurora, CO, USA,
- Department of Surgery, Children’s Hospital of Colorado, Aurora, CO, USA
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26
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Keswani SG, Balaji S, Katz AB, King A, Omar K, Habli M, Klanke C, Crombleholme TM. Intraplacental gene therapy with Ad-IGF-1 corrects naturally occurring rabbit model of intrauterine growth restriction. Hum Gene Ther 2015; 26:172-82. [PMID: 25738403 DOI: 10.1089/hum.2014.065] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Intrauterine growth restriction (IUGR) due to placental insufficiency is a leading cause of perinatal complications for which there is no effective prenatal therapy. We have previously demonstrated that intraplacental injection of adenovirus-mediated insulin-like growth factor-1 (Ad-IGF-1) corrects fetal weight in a murine IUGR model induced by mesenteric uterine artery branch ligation. This study investigated the effect of intraplacental Ad-IGF-1 gene therapy in a rabbit model of naturally occurring IUGR (runt) due to placental insufficiency, which is similar to the human IUGR condition with onset in the early third trimester, brain sparing, and a reduction in liver weight. Laparotomy was performed on New Zealand White rabbits on day 21 of 30 days of gestation and litters were divided into five groups: Control (first position)+phosphate-buffered saline (PBS), control+Ad-IGF-1, runt (third position)+PBS, runt+Ad-IGF-1, and runt+Ad-LacZ. The effect of IGF-1 gene therapy on fetal, placental, liver, heart, lung, and musculoskeletal weights of the growth-restricted pups was examined. Protein expression after gene transfer was seen along the maternal-fetal placenta interface (n=12) 48 hr after gene therapy. There was minimal gene transfer detected in the pups or maternal organs. At term, compared with the normally grown first-position control, the runted third-position pups demonstrated significantly lower fetal, placental, liver, lung, and musculoskeletal weights. The fetal, liver, and musculoskeletal weights were restored to normal by intraplacental Ad-IGF-1 gene therapy (p<0.01), with no change in the placental weight. Intraplacental gene therapy is a novel strategy for the treatment of IUGR caused by placental insufficiency that takes advantage of an organ that will be discarded at birth. Development of nonviral IGF-1 gene delivery using placenta-specific promoters can potentially minimize toxicity to the mother and fetus and facilitate clinical translation of this novel therapy.
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Affiliation(s)
- Sundeep G Keswani
- 1 Center for Molecular Fetal Therapy, Division of Pediatric, General, Thoracic, and Fetal Surgery, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine , Cincinnati, OH 45229-3039
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Balaji S, Han N, Moles C, Shaaban AF, Bollyky PL, Crombleholme TM, Keswani SG. Angiopoietin-1 improves endothelial progenitor cell-dependent neovascularization in diabetic wounds. Surgery 2015; 158:846-56. [PMID: 26266763 DOI: 10.1016/j.surg.2015.06.034] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 06/22/2015] [Accepted: 06/27/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The diabetic phenotype of wound healing is in part characterized by impaired neovascularization and deficient endothelial progenitor cell (EPC) recruitment. Angiopoietin-1 (Ang-1) is a potent mobilizer of EPCs from the bone marrow (BM). A suggested mechanism for EPC mobilization from the BM is mediated by matrix metalloproteinase 9 (MMP-9) and stem cell factor (SCF). Taken together, we hypothesized that overexpression of Ang-1 in diabetic wounds will recruit EPCs and improve neovascularization and wound healing. METHODS An endothelial lineage BM-labeled murine model of diabetes was developed to track BM-derived EPCs. FVBN mice were lethally irradiated and then reconstituted with BM from syngeneic Tie2/LacZ donor mice. Diabetes was induced with streptozotocin. Dorsal wounds in BM-transplanted mice were treated with Ad-Ang-1, Ad-GFP, or phosphate-buffered saline. At day 7 after injury, wounds were harvested and analyzed. A similar experiment was conducted in EPC mobilization deficient MMP-9 -/- mice to determine whether the effects of Ang-1 were EPC-dependent. RESULTS Overexpression of Ang-1 resulted in greatly improved re-epithelialization, neovascularization, and EPC recruitment in diabetic BM-transplanted wounds at day 7. Ang-1 treatment resulted in increased serum levels of proMMP-9 and SCF but had no effect on vascular endothelial growth factor levels. According to our FACS results, peripheral blood EPC (CD34(+)/Cd133(+)/Flk1(+)) counts at day 3 after wounding showed impaired EPC mobilization in MMP-9 -/- mice compared with those of wild-type controls. EPC mobilization was rescued by SCF administration, validating this model for EPC-mobilization-deficient mechanistic studies. In MMP-9 -/- mice, Ad-Ang-1 accelerated re-epithelialization in a similar manner, but had no effect on neovascularization. CONCLUSION Our results show that Ang-1 administration results in improved neovascularization which is dependent on EPC recruitment and has direct effects on wound re-epithelialization. These data may represent a novel strategy to correct the phenotype of impaired diabetic neovascularization and may improve diabetic wound healing.
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Affiliation(s)
- Swathi Balaji
- Laboratory for Regenerative Wound Healing, Division of Pediatric, General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Nate Han
- Laboratory for Regenerative Wound Healing, Division of Pediatric, General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Chad Moles
- Laboratory for Regenerative Wound Healing, Division of Pediatric, General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Aimen F Shaaban
- Laboratory for Regenerative Wound Healing, Division of Pediatric, General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Paul L Bollyky
- Division of Infectious Diseases, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Timothy M Crombleholme
- Laboratory for Regenerative Wound Healing, Division of Pediatric, General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Center for Children's Surgery, Children's Hospital Colorado and the University of Colorado School of Medicine, Aurora, CO
| | - Sundeep G Keswani
- Laboratory for Regenerative Wound Healing, Division of Pediatric, General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
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Deeney S, Powers K, Dodson B, Marwan A, Liechty KW, Crombleholme TM. Reciprocal Serum Levels of Insulin-Like Growth Factor-1 and IGF-Binding Protein-3 in a Murine Surgical Model of Intrauterine Growth Restriction. J Am Coll Surg 2015. [DOI: 10.1016/j.jamcollsurg.2015.07.228] [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: 10/23/2022]
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Vemulakonda VM, Wilcox DT, Crombleholme TM, Bronsert M, Kempe A. Factors associated with age at pyeloplasty in children with ureteropelvic junction obstruction. Pediatr Surg Int 2015; 31:871-7. [PMID: 26143412 DOI: 10.1007/s00383-015-3748-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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] [Accepted: 06/24/2015] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Our objectives were to: (1) delineate factors associated with surgery at <1 year and (2) determine if early intervention was associated with increased risk of readmission. METHODS We conducted a retrospective review of children age 0-18 years with a diagnosis of UPJ obstruction who underwent pyeloplasty from 1/1/1999 to 9/1/2009 using the PHIS database. Data collected included patient factors (race, gender, insurance type, APR-DRG severity of illness) and hospital factors (annual case volume, census region, academic status). Outcomes assessed were: age at surgery and hospital readmission within 1 year of surgery. Data were analyzed using logistic regression and Cox PH for multivariate analyses. RESULTS 4499 children met study criteria. Minority race (OR 1.55), male gender (OR 1.49), public insurance (OR 1.37), high severity of illness (OR 3.60), Southern region (OR 1.44), and low hospital volume (OR 1.37) were significant predictors of early surgery (p < 0.05). Only early surgery (HR 2.42; 95% CI 1.67-3.49 2.42) was associated with increased risk of readmission. CONCLUSIONS In children with UPJ obstruction, age at surgery is associated with patient demographic and hospital factors. Early surgery is associated with higher rates of readmission, suggesting that variations in age at surgery may be associated with significant differences in outcomes.
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Affiliation(s)
- Vijaya M Vemulakonda
- Department of Pediatric Urology, Children's Hospital Colorado, 13123 E. 16th Ave, Campus Box B-463, Aurora, CO, USA,
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30
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Scott-Finley M, Woo JG, Habli M, Ramos-Gonzales O, Cnota JF, Wang Y, Kamath-Rayne BD, Hinton AC, Polzin WJ, Crombleholme TM, Hinton RB. Standardization of amniotic fluid leptin levels and utility in maternal overweight and fetal undergrowth. J Perinatol 2015; 35:547-52. [PMID: 25927274 DOI: 10.1038/jp.2015.39] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 12/03/2014] [Revised: 03/23/2015] [Accepted: 03/24/2015] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Leptin is an adipokine that regulates energy homeostasis. The objective of this study was to establish a gestational age-specific standard for amniotic fluid leptin (AFL) levels and examine the relationship between AFL, maternal overweight and fetal growth restriction. STUDY DESIGN Amniotic fluid was obtained at mid-gestation from singleton gravidas, and leptin was quantified using enzyme-linked immunosorbent assay. Amniotic fluid samples from 321 term pregnancies were analyzed. Clinical data, including fetal ultrasound measurements and maternal and infant characteristics, were available for a subset of patients (n=45). RESULTS The median interquartile range AFL level was significantly higher at 14 weeks' gestation (2133 pg ml(-1) (1703 to 4347)) than after 33 weeks' gestation (519 pg ml(-1) (380 to 761), P trend<0.0001), an average difference of 102 pg ml(-1) per week. AFL levels were positively correlated with maternal pre-pregnancy body mass index (BMI) (r=0.36, P=0.03) adjusting for gestational age at measurement, but were not associated with fetal growth. CONCLUSIONS AFL levels are higher at mid-gestation than at late gestation, and are associated with maternal pre-pregnancy BMI.
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Affiliation(s)
- M Scott-Finley
- Division of Maternal Fetal Medicine, Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, OH, USA
| | - J G Woo
- 1] Division of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA [2] Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - M Habli
- 1] Division of Maternal Fetal Medicine, Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, OH, USA [2] Division of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - O Ramos-Gonzales
- Division of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - J F Cnota
- Division of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Y Wang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - B D Kamath-Rayne
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - A C Hinton
- Division of Maternal Fetal Medicine, Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, OH, USA
| | - W J Polzin
- 1] Division of Maternal Fetal Medicine, Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, OH, USA [2] Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - T M Crombleholme
- Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - R B Hinton
- Division of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Bui YK, Howley LW, Ambrose SE, Galan HL, Crombleholme TM, Drose J, Bokowski J, Cuneo BF. Prominent coronary artery flow with normal coronary artery anatomy is a rare but ominous harbinger of poor outcome in the fetus. J Matern Fetal Neonatal Med 2015; 29:1536-40. [PMID: 26153118 DOI: 10.3109/14767058.2015.1057492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/13/2022]
Abstract
OBJECTIVES "Heart sparing" refers to prominent antegrade fetal coronary artery (CA) blood flow readily visualized by color Doppler and is a harbinger of poor outcome in growth restricted fetus, but little is known of the features and presentation of heart sparing in normally grown fetuses. Our objective was to describe heart sparing effects in normally grown fetuses, and compare the presentation and outcome of heart sparing between fetuses with growth restriction and those who were normally grown. METHODS In a series of fetuses with prominent antegrade CA flow, we assessed Doppler flow profiles in the aortic isthmus, ductus venosus (DV), umbilical vein (UV), umbilical artery (UA) and middle cerebral artery (MCA). We calculated MCA and UA systolic/diastolic ratios and the cerebral placental ratio, and measured fetal biometry. We evaluated cardiac function using the myocardial performance index (MPI) and the cardiovascular profile score (CVPS). RESULTS Ten fetuses with heart sparing had normal DV flow at 24-36.6 (mean 30.9) weeks of gestation. Five had growth restriction (Group 1); 4/5 had normal MPI and CVPS, and one died. Five were normally grown (Group 2); 5/5 had elevated MPI and decreased CVPS, of these 2 died in utero and one died immediately after birth despite urgent delivery. Coronary arteries were normal after birth or autopsy. CONCLUSIONS Heart sparing confers a poor prognosis in fetal growth restriction and in normally grown fetuses with cardiac dysfunction. We suggest CA flow be assessed in all high-risk fetuses.
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Affiliation(s)
- Yen K Bui
- a Children's Hospital Colorado Heart Institute , Aurora , CO , USA
| | - Lisa W Howley
- a Children's Hospital Colorado Heart Institute , Aurora , CO , USA .,b Colorado Institute for Maternal and Fetal Health, The University of Colorado School of Medicine , Aurora , CO , USA
| | - Steven E Ambrose
- c The Department of Obstetrics , University of Illinois at Chicago School of Medicine , Chicago , IL , USA
| | - Henry L Galan
- b Colorado Institute for Maternal and Fetal Health, The University of Colorado School of Medicine , Aurora , CO , USA
| | - Timothy M Crombleholme
- b Colorado Institute for Maternal and Fetal Health, The University of Colorado School of Medicine , Aurora , CO , USA .,d Department of Surgery , Children's Hospital Colorado , Aurora , CO , USA
| | - Julia Drose
- e Department of Radiology , University of Colorado Hospital Anschutz Medical Campus , Aurora , CO , USA , and
| | - John Bokowski
- f Rush Presbyterian St. Luke's Medical Center , Chicago , IL , USA
| | - Bettina F Cuneo
- a Children's Hospital Colorado Heart Institute , Aurora , CO , USA .,b Colorado Institute for Maternal and Fetal Health, The University of Colorado School of Medicine , Aurora , CO , USA
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Watson C, King A, Mitra S, Shaaban AF, Goldstein AM, Morowitz MJ, Warner BW, Crombleholme TM, Keswani SG. What does it take to be a successful pediatric surgeon-scientist? J Pediatr Surg 2015; 50:1049-52. [PMID: 25840603 DOI: 10.1016/j.jpedsurg.2015.03.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 02/20/2015] [Accepted: 03/10/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The factors that contribute to success as a pediatric surgeon-scientist are not well defined. The purpose of this study is to define a group of NIH-funded pediatric surgeons, assess their academic productivity, and elucidate factors that have contributed to their success. METHODS Pediatric surgeons were queried in the NIH report database to determine NIH funding awarded. Academic productivity was then assessed. An online survey was then targeted to NIH-funded pediatric surgeons. RESULTS Since 1988, 83 pediatric surgeon-investigators have received major NIH funding. Currently, there are 37 pediatric surgeons with 43 NIH-sponsored awards. The mean h-index of this group of pediatric surgeons was 18 ± 1.1, mean number of publications (since 2001) was 21 ± 2.1, and both increase commensurate with academic rank. In response to the survey, 81% engaged in research during their surgical residency, and 48% were mentored by a pediatric surgeon-scientist. More than 60% of respondents had significant protected time and financial support. Factors felt to be most significant for academic success included mentorship, perseverance, and protected time. CONCLUSIONS Mentorship, perseverance, institutional commitment to protected research time, and financial support are considered to be important to facilitate the successes of pediatric surgeon-scientists. These results will be useful to aspiring pediatric surgeon-scientists and departments wishing to develop a robust research program.
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Affiliation(s)
- Carey Watson
- Division of Pediatric, Thoracic and General Surgery, Cincinnati Children's Hospital and the University of Cincinnati College of Medicine, Cincinnati, OH
| | - Alice King
- Division of Pediatric, Thoracic and General Surgery, Cincinnati Children's Hospital and the University of Cincinnati College of Medicine, Cincinnati, OH
| | - Shaheel Mitra
- Division of Pediatric, Thoracic and General Surgery, Cincinnati Children's Hospital and the University of Cincinnati College of Medicine, Cincinnati, OH
| | - Aimen F Shaaban
- Division of Pediatric, Thoracic and General Surgery, Cincinnati Children's Hospital and the University of Cincinnati College of Medicine, Cincinnati, OH
| | - Allan M Goldstein
- Division of Pediatric Surgery, Massachusetts General Hospital, Boston, MA
| | - Michael J Morowitz
- Division of Pediatric General and Thoracic Surgery, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Brad W Warner
- Division of Pediatric, Thoracic and General Surgery, St. Louis Children's Hospital, St. Louis, MO
| | | | - Sundeep G Keswani
- Division of Pediatric, Thoracic and General Surgery, Cincinnati Children's Hospital and the University of Cincinnati College of Medicine, Cincinnati, OH.
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Balaji S, King A, Marsh E, LeSaint M, Bhattacharya SS, Han N, Dhamija Y, Ranjan R, Le LD, Bollyky PL, Crombleholme TM, Keswani SG. The role of interleukin-10 and hyaluronan in murine fetal fibroblast function in vitro: implications for recapitulating fetal regenerative wound healing. PLoS One 2015; 10:e0124302. [PMID: 25951109 PMCID: PMC4423847 DOI: 10.1371/journal.pone.0124302] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 03/12/2015] [Indexed: 12/14/2022] Open
Abstract
Background Mid-gestation fetal cutaneous wounds heal scarlessly and this has been attributed in part to abundant hyaluronan (HA) in the extracellular matrix (ECM) and a unique fibroblast phenotype. We recently reported a novel role for interleukin 10 (IL-10) as a regulator of HA synthesis in the fetal ECM, as well as the ability of the fetal fibroblast to produce an HA-rich pericellular matrix (PCM). We hypothesized that IL-10-mediated HA synthesis was essential to the fetal fibroblast functional phenotype and, moreover, that this phenotype could be recapitulated in adult fibroblasts via supplementation with IL-10 via an HA dependent process. Methodology/Principal Findings To evaluate the differences in functional profile, we compared metabolism (MTS assay), apoptosis (caspase-3 staining), migration (scratch wound assay) and invasion (transwell assay) between C57Bl/6J murine fetal (E14.5) and adult (8 weeks) fibroblasts. We found that fetal fibroblasts have lower rates of metabolism and apoptosis, and an increased ability to migrate and invade compared to adult fibroblasts, and that these effects were dependent on IL-10 and HA synthase activity. Further, addition of IL-10 to adult fibroblasts resulted in increased fibroblast migration and invasion and recapitulated the fetal phenotype in an HA-dependent manner. Conclusions/Significance Our data demonstrates the functional differences between fetal and adult fibroblasts, and that IL-10 mediated HA synthesis is essential for the fetal fibroblasts' enhanced invasion and migration properties. Moreover, IL-10 via an HA-dependent mechanism can recapitulate this aspect of the fetal phenotype in adult fibroblasts, suggesting a novel mechanism of IL-10 in regenerative wound healing.
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Affiliation(s)
- Swathi Balaji
- Laboratory for Regenerative Wound Healing, Division of Pediatric, General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Alice King
- Laboratory for Regenerative Wound Healing, Division of Pediatric, General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Emily Marsh
- Laboratory for Regenerative Wound Healing, Division of Pediatric, General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Maria LeSaint
- Laboratory for Regenerative Wound Healing, Division of Pediatric, General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Sukanta S. Bhattacharya
- Laboratory for Regenerative Wound Healing, Division of Pediatric, General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Nathaniel Han
- Laboratory for Regenerative Wound Healing, Division of Pediatric, General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Yashu Dhamija
- Laboratory for Regenerative Wound Healing, Division of Pediatric, General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Rajeev Ranjan
- Laboratory for Regenerative Wound Healing, Division of Pediatric, General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Louis D. Le
- Laboratory for Regenerative Wound Healing, Division of Pediatric, General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Paul L. Bollyky
- Division of Infectious Diseases, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, United States of America
| | - Timothy M. Crombleholme
- Laboratory for Regenerative Wound Healing, Division of Pediatric, General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
- Center for Children's Surgery, Children’s Hospital Colorado and The University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Sundeep G. Keswani
- Laboratory for Regenerative Wound Healing, Division of Pediatric, General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
- Division of Pediatric General and Thoracic Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, United States of America
- * E-mail:
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Coleman AM, Merrow AC, Crombleholme TM, Jaekle R, Lim FY. Fetal MRI of Torsed Bronchopulmonary Sequestration with Tension Hydrothorax and Hydrops in a Twin Gestation. Fetal Diagn Ther 2015; 40:156-60. [PMID: 25659425 DOI: 10.1159/000371513] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 12/08/2014] [Indexed: 11/19/2022]
Abstract
While bronchopulmonary sequestration typically has a benign course, this congenital lung malformation has a high mortality rate when associated with untreated in utero tension hydrothorax and hydrops. Hydrops related to bronchopulmonary sequestration is believed to result from torsion of the mass with compromise of the associated blood supply. The impaired venous return of the mass then leads to tension hydrothorax with compression of the heart and mediastinal vessels, impairing global venous return. To our knowledge, this scenario has only been described prenatally by ultrasound. We present the imaging findings of a dichorionic, diamniotic twin gestation with one fetus developing tension hydrothorax and hydrops from presumed intermittent torsion of a bronchopulmonary sequestration. This diagnosis was only able to be confirmed by MRI prior to the use of ultrasound-guided interstitial laser photocoagulation for the treatment of this anomaly.
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Affiliation(s)
- Alan M Coleman
- Cincinnati Fetal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Hurley JR, Cho H, Sheikh AQ, Balaji S, Keswani SG, Crombleholme TM, Narmoneva DA. Nanofiber Microenvironment Effectively Restores Angiogenic Potential of Diabetic Endothelial Cells. Adv Wound Care (New Rochelle) 2014; 3:717-728. [PMID: 25371854 DOI: 10.1089/wound.2013.0511] [Citation(s) in RCA: 11] [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: 10/11/2013] [Accepted: 01/21/2014] [Indexed: 01/03/2023] Open
Abstract
Objective: The effect of chronic hyperglycemic exposure on endothelial cell (EC) phenotype, impaired wound neovascularization, and healing is not completely understood. The hypotheses are: 1) chronic exposure to diabetic conditions in vivo impairs the angiogenic potential of ECs and 2) this deficiency can be improved by an extracellular microenvironment of angiogenic peptide nanofibers. Approach: Angiogenic potential of microvascular ECs isolated from diabetic (db/db) and wild type (wt) mice was assessed by quantifying migration, proliferation, apoptosis, capillary morphogenesis, and vascular endothelial growth factor (VEGF) expression for cell cultures on Matrigel (Millipore, Billerica, MA) or nanofibers under normoglycemic conditions. The in vivo effects of nanofiber treatment on wound vascularization were determined using two mouse models of diabetic wound healing. Results: Diabetic ECs showed significant impairments in migration, VEGF expression, and capillary morphogenesis. The nanofiber microenvironment restored capillary morphogenesis and VEGF expression and significantly increased proliferation and decreased cell apoptosis of diabetic cells versus wt controls. In diabetic wounds, nanofibers significantly enhanced EC infiltration, neovascularization, and VEGF protein levels, as compared to saline treatment; this effect was observed even in MMP9 knockout mice with endothelial progenitor cell (EPC) deficiency. Innovation: The results suggest a novel approach for correcting diabetes-induced endothelial deficiencies via cell interactions with a nanofiber-based provisional matrix in the absence of external angiogenic stimuli. Conclusion: Impaired endothelial angiogenic potential can be restored by angiogenic cell stimulation in the nanofiber microenvironment; this suggests that nanofiber technology for diabetic wound healing and treatment of other diabetes-induced vascular deficiencies is promising.
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Affiliation(s)
- Jennifer R. Hurley
- Department of Biomedical, Chemical, and Environmental Engineering, University of Cincinnati, Cincinnati, Ohio
| | - Hongkwan Cho
- Department of Biomedical, Chemical, and Environmental Engineering, University of Cincinnati, Cincinnati, Ohio
| | - Abdul Q. Sheikh
- Department of Biomedical, Chemical, and Environmental Engineering, University of Cincinnati, Cincinnati, Ohio
| | - Swathi Balaji
- Department of Biomedical, Chemical, and Environmental Engineering, University of Cincinnati, Cincinnati, Ohio
- Laboratory for Regenerative Wound Healing, Division of Pediatric, General, Thoracic, and Fetal Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Sundeep G. Keswani
- Laboratory for Regenerative Wound Healing, Division of Pediatric, General, Thoracic, and Fetal Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Timothy M. Crombleholme
- Center for Children's Surgery, Children's Hospital Colorado and the University of Colorado, School of Medicine, Aurora, Colorado
| | - Daria A. Narmoneva
- Department of Biomedical, Chemical, and Environmental Engineering, University of Cincinnati, Cincinnati, Ohio
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King A, Balaji S, Keswani SG, Crombleholme TM. The Role of Stem Cells in Wound Angiogenesis. Adv Wound Care (New Rochelle) 2014; 3:614-625. [PMID: 25300298 DOI: 10.1089/wound.2013.0497] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 03/19/2014] [Indexed: 12/18/2022] Open
Abstract
Significance: Revascularization plays a critical role in wound healing and is regulated by a complex milieu of growth factors and cytokines. Deficiencies in revascularization contribute to the development of chronic nonhealing wounds. Recent Advances: Stem-cell-based therapy provides a novel strategy to enhance angiogenesis and improve wound healing. With bioethical concerns associated with embryonic stem cells, focus has shifted to different populations of vascular precursors, isolated from adult somatic tissue. Three main populations have been identified: endothelial progenitor cells, mesenchymal stem cells, and induced-pluripotent stem cells. These populations demonstrate great promise to positively influence neovascularization and wound repair. Critical Issues: Further studies to more definitively define each population are necessary to efficiently translate stem-cell-based therapeutic angiogenesis to the bedside. Better understanding of the physiologic pathways of how stem cells contribute to angiogenesis in normal tissue repair will help identify targets for successful therapeutic angiogenesis. Future Directions: Active studies in both animal models and clinical trials are being conducted to develop effective delivery routes, including dosing, route, and timing. Stem-cell-based therapy holds significant potential as a strategy for therapeutic angiogenesis in the care of patients with chronic nonhealing wounds.
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Affiliation(s)
- Alice King
- Laboratory for Regenerative Wound Healing, Division of Pediatric, General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Swathi Balaji
- Laboratory for Regenerative Wound Healing, Division of Pediatric, General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Sundeep G. Keswani
- Laboratory for Regenerative Wound Healing, Division of Pediatric, General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Timothy M. Crombleholme
- Center for Children's Surgery, Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital Colorado, School of Medicine, University of Colorado, Aurora, Colorado
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Zaretsky MV, Somme S, Crombleholme TM. Role of adjunctive medical therapy in the fetoscopic surgical treatment of twin-twin transfusion syndrome. Am J Perinatol 2014; 31 Suppl 1:S39-46. [PMID: 25077476 DOI: 10.1055/s-0034-1384641] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 10/25/2022]
Abstract
The underlying etiology of twin-twin transfusion syndrome (TTTS) is unknown, but our growing understanding of the cardiovascular features of TTTS suggests this may be a disease that could respond to transplacental medical therapy. Adjunctive medical therapy in TTTS with the calcium channel blocker nifedipine has been shown to improve recipient survival while having no effect on the donor. There is no significant difference in recipient survival from postoperative day 5 to birth suggesting that the survival benefit is confined to the effects of nifedipine in the perioperative period. Also, there is no significant effect of nifedipine on gestational age at delivery suggesting the survival benefit was unrelated to the tocolytic effects of nifedipine and more likely a result of hemodynamic effects in the recipient twins' cardiovascular system during the perioperative period. TTTS remains poorly understood but there appears to be good evidence suggesting twin-twin hypertensive cardiomyopathy is a large component of the pathophysiology in recipient twins. The initial findings of nifedipine's effectiveness as a targeted medical therapy to address TTTS cardiomyopathy and improve survival of recipient twins opens the door for further research for adjunctive medical therapies in TTTS.
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Affiliation(s)
- Michael V Zaretsky
- Division of Maternal Fetal-Medicine, Colorado Institute of Maternal Fetal Health, The University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Stig Somme
- Department of Pediatric General Thoracic and Fetal Surgery, Colorado Institute of Maternal Fetal Health, The University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Timothy M Crombleholme
- Department of Pediatric General Thoracic and Fetal Surgery, Colorado Institute of Maternal Fetal Health, The University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
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King A, Balaji S, Le LD, Crombleholme TM, Keswani SG. Regenerative Wound Healing: The Role of Interleukin-10. Adv Wound Care (New Rochelle) 2014; 3:315-323. [PMID: 24757588 DOI: 10.1089/wound.2013.0461] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 06/21/2013] [Indexed: 11/12/2022] Open
Abstract
Significance: Postnatal wounds heal with characteristic scar formation. In contrast, the mid-gestational fetus is capable of regenerative healing, which results in wound repair that is indistinguishable from uninjured skin. However, the underlying mechanisms of fetal regenerative phenotype are unknown. Recent Advances: The potent anti-inflammatory cytokine, interleukin-10 (IL-10), plays an essential role in the ability of the fetus to heal regeneratively and has been shown to recapitulate scarless healing in postnatal tissue. IL-10's ability to facilitate regenerative healing is likely a result of pleiotropic effects, through regulation of the inflammatory response, as well as novel roles as a regulator of the extracellular matrix, fibroblast cellular function, and endothelial progenitor cells. Overexpression of IL-10 using a variety of methods has been demonstrated to recapitulate the fetal regenerative phenotype in post-natal tissue, in conjunction with promising results of Phase II clinical trials using recombinant IL-10. Critical Issues: Successful wound healing is a complex process that requires coordination of multiple growth factors, cell types, and extracellular cellular matrix components. IL-10 has been demonstrated to be critical in the fetus' intrinsic ability to heal without scars, and, further, can induce scarless healing in postnatal tissue. The mechanisms through which IL-10 facilitates this regeneration are likely the result of IL-10's pleiotropic effects. Efforts to develop IL-10 as an anti-scarring agent have demonstrated promising results. Future Directions: Further studies on the delivery, including dose, route, and timing, are required in order to successfully translate these promising findings from in vitro studies and animal models into clinical practice. IL-10 holds significant potential as an anti-scarring therapeutic.
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Affiliation(s)
- Alice King
- Laboratory for Regenerative Wound Healing, Division of Pediatric, General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Swathi Balaji
- Laboratory for Regenerative Wound Healing, Division of Pediatric, General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Louis D. Le
- Laboratory for Regenerative Wound Healing, Division of Pediatric, General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Timothy M. Crombleholme
- Center for Children's Surgery, Children's Hospital Colorado and the University of Colorado School of Medicine, Aurora, Colorado
| | - Sundeep G. Keswani
- Laboratory for Regenerative Wound Healing, Division of Pediatric, General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Balaji S, LeSaint M, Bhattacharya SS, Moles C, Dhamija Y, Kidd M, Le LD, King A, Shaaban A, Crombleholme TM, Bollyky P, Keswani SG. Adenoviral-mediated gene transfer of insulin-like growth factor 1 enhances wound healing and induces angiogenesis. J Surg Res 2014. [PMID: 24725678 DOI: 10.1016/j.jss.2014.0.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Chronic wounds are characterized by a wound healing and neovascularization deficit. Strategies to increase neovascularization can significantly improve chronic wound healing. Insulin-like growth factor (IGF)-1 is reported to be a keratinocyte mitogen and is believed to induce angiogenesis via a vascular endothelial growth factor (VEGF)-dependent pathway. Using a novel ex vivo human dermal wound model and a diabetic-impaired wound healing murine model, we hypothesized that adenoviral overexpression of IGF-1 (Ad-IGF-1) will enhance wound healing and induce angiogenesis through a VEGF-dependent pathway. METHODS Ex vivo: 6-mm full-thickness punch biopsies were obtained from normal human skin, and 3-mm full-thickness wounds were created at the center. Skin explants were maintained at air liquid interface. Db/db murine model: 8-mm full-thickness dorsal wounds in diabetic (db/db) mice were created. Treatment groups in both human ex vivo and in vivo db/db wound models include 1×10(8) particle forming units of Ad-IGF-1 or Ad-LacZ, and phosphate buffered saline (n=4-5/group). Cytotoxicity (lactate dehydrogenase) was quantified at days 3, 5, and 7 for the human ex vivo wound model. Epithelial gap closure (hematoxylin and eosin; Trichrome), VEGF expression (enzyme-linked immunosorbent assay), and capillary density (CD 31+CAPS/HPF) were analyzed at day 7. RESULTS In the human ex vivo organ culture, the adenoviral vectors did not demonstrate any significant difference in cytotoxicity compared with phosphate buffered saline. Ad-IGF-1 overexpression significantly increases basal keratinocyte migration, with no significant effect on epithelial gap closure. There was a significant increase in capillary density in the Ad-IGF-1 wounds. However, there was no effect on VEGF levels in Ad-IGF-1 samples compared with controls. In db/db wounds, Ad-IGF-1 overexpression significantly improves epithelial gap closure and granulation tissue with a dense cellular infiltrate compared with controls. Ad-IGF-1 also increases capillary density, again with no significant difference in VEGF levels in the wounds compared with control treatments. CONCLUSIONS In two different models, our data demonstrate that adenoviral-mediated gene transfer of IGF-1 results in enhanced wound healing and induces angiogenesis via a VEGF-independent pathway. Understanding the underlying mechanisms of IGF-1 effects on angiogenesis may help produce novel therapeutics for chronic wounds or diseases characterized by a deficit in neovascularization.
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Affiliation(s)
- Swathi Balaji
- Division of Pediatric, General, Thoracic and Fetal Surgery, Laboratory for Regenerative Wound Healing, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Maria LeSaint
- Division of Pediatric, General, Thoracic and Fetal Surgery, Laboratory for Regenerative Wound Healing, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Sukanta S Bhattacharya
- Division of Pediatric, General, Thoracic and Fetal Surgery, Laboratory for Regenerative Wound Healing, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Chad Moles
- Division of Pediatric, General, Thoracic and Fetal Surgery, Laboratory for Regenerative Wound Healing, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Yashu Dhamija
- Division of Pediatric, General, Thoracic and Fetal Surgery, Laboratory for Regenerative Wound Healing, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Mykia Kidd
- Division of Pediatric, General, Thoracic and Fetal Surgery, Laboratory for Regenerative Wound Healing, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Louis D Le
- Division of Pediatric, General, Thoracic and Fetal Surgery, Laboratory for Regenerative Wound Healing, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Alice King
- Division of Pediatric, General, Thoracic and Fetal Surgery, Laboratory for Regenerative Wound Healing, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Aimen Shaaban
- Division of Pediatric, General, Thoracic and Fetal Surgery, Laboratory for Regenerative Wound Healing, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Timothy M Crombleholme
- Center for Children's Surgery, Children's Hospital Colorado and the University of Colorado, School of Medicine, Aurora, Colorado
| | - Paul Bollyky
- Department of Medicine, Stanford University, Palo Alto, California
| | - Sundeep G Keswani
- Division of Pediatric, General, Thoracic and Fetal Surgery, Laboratory for Regenerative Wound Healing, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
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Yu L, Bennett JT, Wynn J, Carvill GL, Cheung YH, Shen Y, Mychaliska GB, Azarow KS, Crombleholme TM, Chung DH, Potoka D, Warner BW, Bucher B, Lim FY, Pietsch J, Stolar C, Aspelund G, Arkovitz MS, Mefford H, Chung WK. Whole exome sequencing identifies de novo mutations in GATA6 associated with congenital diaphragmatic hernia. J Med Genet 2014; 51:197-202. [PMID: 24385578 DOI: 10.1136/jmedgenet-2013-101989] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Congenital diaphragmatic hernia (CDH) is a common birth defect affecting 1 in 3000 births. It is characterised by herniation of abdominal viscera through an incompletely formed diaphragm. Although chromosomal anomalies and mutations in several genes have been implicated, the cause for most patients is unknown. METHODS We used whole exome sequencing in two families with CDH and congenital heart disease, and identified mutations in GATA6 in both. RESULTS In the first family, we identified a de novo missense mutation (c.1366C>T, p.R456C) in a sporadic CDH patient with tetralogy of Fallot. In the second, a nonsense mutation (c.712G>T, p.G238*) was identified in two siblings with CDH and a large ventricular septal defect. The G238* mutation was inherited from their mother, who was clinically affected with congenital absence of the pericardium, patent ductus arteriosus and intestinal malrotation. Deep sequencing of blood and saliva-derived DNA from the mother suggested somatic mosaicism as an explanation for her milder phenotype, with only approximately 15% mutant alleles. To determine the frequency of GATA6 mutations in CDH, we sequenced the gene in 378 patients with CDH. We identified one additional de novo mutation (c.1071delG, p.V358Cfs34*). CONCLUSIONS Mutations in GATA6 have been previously associated with pancreatic agenesis and congenital heart disease. We conclude that, in addition to the heart and the pancreas, GATA6 is involved in development of two additional organs, the diaphragm and the pericardium. In addition, we have shown that de novo mutations can contribute to the development of CDH, a common birth defect.
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Affiliation(s)
- Lan Yu
- Division of Molecular Genetics, Department of Pediatrics, Columbia University Medical Center, New York, New York, USA
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Chatterjee D, Hawkins JL, Somme S, Galan HL, Prager JD, Crombleholme TM. Ex utero intrapartum treatment to resection of a bronchogenic cyst causing airway compression. Fetal Diagn Ther 2013; 35:137-40. [PMID: 24281263 DOI: 10.1159/000355661] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 09/16/2013] [Indexed: 11/19/2022]
Abstract
We present a case report of a 28-year-old primigravida with a singleton pregnancy complicated by a fetal bronchogenic cyst compressing the left mainstem bronchus with resultant hyperinflation of the entire left lung and rightward mediastinal shift. An ex utero intrapartum treatment to resection of the fetal bronchogenic cyst via a fetal thoracotomy was performed at 36 weeks' gestational age, circumventing a potentially complicated neonatal airway emergency at birth.
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Affiliation(s)
- Debnath Chatterjee
- Department of Anesthesiology, Colorado Institute for Maternal and Fetal Health, University of Colorado School of Medicine, Aurora, Colo., USA
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Cost NG, Geller JI, Le LD, Crombleholme TM, Keswani SG, Lim FY, Alam S. Urologic co-morbidities associated with sacrococcygeal teratoma and a rational plan for urologic surveillance. Pediatr Blood Cancer 2013; 60:1626-9. [PMID: 23776168 DOI: 10.1002/pbc.24627] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [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: 03/02/2013] [Accepted: 05/14/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Sacrococcygeal teratoma (SCT) is one of the most common neonatal and fetal tumors. SCT pelvic mass effect and the need for aggressive surgical resection, create potential for urologic co-morbidity. We reviewed our experience with SCTs and propose a rational plan for urologic surveillance. METHODS We retrospectively reviewed all patients with SCT evaluated at our institution from 2004 to 2011. We collected data on the need for reconstructive surgery related to the urologic co-morbidity, the time to detection of urologic co-morbidity, and length of follow-up. RESULTS We identified 28 patients evaluated during the study period with a median follow-up of 3.1 year (range 0.14-13.4). The Altman classifications were--type I: 7 (25%), II: 15 (53.6%), and III: 6 (21.4%). Eighteen (64.3%) patients had an associated urologic co-morbidity: 12 (42.9%) patients had hydronephrosis, VUR--10 (35.7%), NGB--13 (46.4%), and 4 (14.3%) developed ≥CKD2. When comparing the patients according to Altman classification, there was a trend towards more urologic co-morbidity in patients with increasing pelvic involvement, P = 0.06. Eleven patients (39.3%) had delayed urologic evaluation and five (17.9%) required reconstructive urologic surgery. In comparing these groups, 4 of 11 (36.4%) undergoing delayed urologic evaluation progressed to reconstruction, as opposed to only one of 17 (5.7%) with urologic evaluation within first year of life (P-value = 0.06). CONCLUSION Urologic co-morbidities are common in children with SCT and appear most common in patients with more pelvic tumor involvement (≥Altman II). A risk-adapted approach to urologic surveillance is proposed.
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Affiliation(s)
- Nicholas G Cost
- Division of Urology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Balaji S, King A, Crombleholme TM, Keswani SG. The Role of Endothelial Progenitor Cells in Postnatal Vasculogenesis: Implications for Therapeutic Neovascularization and Wound Healing. Adv Wound Care (New Rochelle) 2013; 2:283-295. [PMID: 24527350 DOI: 10.1089/wound.2012.0398] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Indexed: 01/16/2023] Open
Abstract
SIGNIFICANCE Postnatal vasculogenesis mediated via endothelial progenitor cells (EPCs) contributes to re-endothelialization and augments neovascularization after ischemia and tissue injury, providing a novel therapeutic application. However, controversy exists with respect to the origin, identification, and contributions of the EPCs to neovascularization, necessitating further study. RECENT ADVANCES Bone marrow (BM) or circulating cells expressing cd133/vascular endothelial growth factor receptor 2 include those with endothelial progenitor capacity. Increasing evidence suggests that there are additional BM-derived (myeloid; mesenchymal cells) and non-BM-derived (peripheral and cord-blood; tissue-resident) cell populations which also give rise to endothelial cells (ECs) and contribute to re-endothelialization and growth factor release after ischemia and tissue injury. Currently, EPCs are being used as diagnostic markers for the assessment of cardiovascular and tumor risk/progression. Techniques aimed at enhancing ex vivo expansion and the therapeutic potential of these cells are being optimized. CRITICAL ISSUES Mobilization and EPC-mediated neovascularization are critically regulated. Stimulatory (growth factors, statins, and exercise) or inhibitory factors (obesity, diabetes, and other cardiovascular diseases) modulate EPC numbers and function. Recruitment and incorporation of EPCs require a coordinated sequence of signaling events, including adhesion, migration (by integrins), and chemoattraction. Finally, EPCs differentiate into ECs and/or secrete angiogenic growth factors. These cells are highly plastic, and depending on the microenvironment and presence of other cells, EPCs transdifferentiate and/or undergo cell fusion and become cells of a different lineage. Therefore, in vitro culture conditions should be optimized to mimic the in vivo milieu to fully characterize the biological function and contribution of EPCs to postnatal vasculogenesis. FUTURE DIRECTIONS Advances in characterization of the EPC biology and enhancement of EPC functions are required. In addition, innovative tissue-engineered carrier matrices that permit embedding of EPCs and provide optimal conditions for EPC survival and endothelial outgrowth will further contribute to EPC-mediated therapeutic applications in wound healing and ischemia repair.
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Affiliation(s)
- Swathi Balaji
- Center for Molecular Fetal Therapy, Division of Pediatric, General, Thoracic, and Fetal Surgery, Cincinnati Children's Hospital and the University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Alice King
- Center for Molecular Fetal Therapy, Division of Pediatric, General, Thoracic, and Fetal Surgery, Cincinnati Children's Hospital and the University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Timothy M. Crombleholme
- Center for Molecular Fetal Therapy, Division of Pediatric, General, Thoracic, and Fetal Surgery, Cincinnati Children's Hospital and the University of Cincinnati College of Medicine, Cincinnati, Ohio
- Center for Children's Surgery, Children's Hospital Colorado and the University of Colorado School of Medicine, Aurora, Colorado
| | - Sundeep G. Keswani
- Center for Molecular Fetal Therapy, Division of Pediatric, General, Thoracic, and Fetal Surgery, Cincinnati Children's Hospital and the University of Cincinnati College of Medicine, Cincinnati, Ohio
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Keswani SG, Balaji S, Le LD, Leung A, Parvadia JK, Frischer J, Yamano S, Taichman N, Crombleholme TM. Role of salivary vascular endothelial growth factor (VEGF) in palatal mucosal wound healing. Wound Repair Regen 2013; 21:554-62. [PMID: 23758212 DOI: 10.1111/wrr.12065] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 04/30/2013] [Indexed: 12/27/2022]
Abstract
The mucosa of alimentary tract heals more rapidly than cutaneous wounds. The underlying mechanisms of this enhanced healing have not been completely elucidated. Constant exposure to salivary growth factors has been shown to play a critical role in mucosal homeostasis and tissue repair. Angiogenesis also has an essential role in successful wound repair. One of the main angiogenic growth factors, vascular endothelial growth factor (VEGF), has a pleiotropic role in tissue repair via neovascularization, reepithelialization, and regulation of extracellular matrix. We have previously reported a critical role for salivary VEGF in bowel adaptation after small bowel resection. We hypothesize that salivary VEGF is an essential stimulus for oral mucosal tissue repair, and use the murine palatal wound model to test our hypothesis. In a loss-of-function experiment, we removed the primary source of VEGF production through selective submandibular gland (SMG) sialoadenectomy in a murine model and observed the effects on wound closure and neovascularization. We then performed a selective loss-of-function experiment using the protein VEGF-Trap to inhibit salivary VEGF. In a gain-of-function experiment, we supplemented oral VEGF following SMG sialoadenectomy. After SMG sialoadenectomy, there was significant reduction in salivary VEGF level, wound closure, and vessel density. Lower levels of salivary VEGF were correlated with impaired neovascularization and reepithelialization. The selective blockade of VEGF using VEGF-Trap resulted in a similar impairment in wound healing and neovascularization. The sole supplementation of oral VEGF after SMG sialoadenectomy rescued the impaired wound healing phenotype and restored neovascularization to normal levels. These data show a novel role for salivary-VEGF in mucosal wound healing, and provide a basis for the development of novel therapeutics aimed at augmenting wound repair of the oral mucosa, as well as wounds at other sites in the alimentary tract.
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Affiliation(s)
- Sundeep G Keswani
- Center for Molecular Fetal Therapy, Division of Pediatric General, Thoracic, and Fetal Surgery, Cincinnati Children's Hospital Medical Center and The University of Cincinnati College of Medicine, Cincinnati, Ohio 45229-3039, USA.
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King A, Balaji S, Le LD, Marsh E, Crombleholme TM, Keswani SG. Interleukin-10 regulates fetal extracellular matrix hyaluronan production. J Pediatr Surg 2013; 48:1211-1217. [PMID: 23845609 PMCID: PMC3959980 DOI: 10.1016/j.jpedsurg.2013.03.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [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] [Received: 02/22/2013] [Accepted: 03/08/2013] [Indexed: 01/18/2023]
Abstract
BACKGROUND/PURPOSE Mid-gestational (E14.5) fetal wounds heal regeneratively with attenuated inflammation and high levels of hyaluronan (HA) in their extracellular matrix (ECM), whereas late-gestational (E18.5) fetal wounds heal with scarring. IL-10 plays an essential role in the fetal regenerative phenotype and is shown to recapitulate scarless wound healing postnatally. We hypothesize a novel role of IL-10 as a regulator of HA in the ECM. METHODS Murine fetal fibroblasts (FFb) from C57Bl/6 and IL-10-/- mice were evaluated in vitro. Pericellular matrix (PCM) and HA synthesis were quantified using a particle exclusion assay and ELISA. The effects of hyaluronidase and hyaluronan synthase (HAS) inhibitor (4-methylumbelliferone[4-MU]) were evaluated. An ex vivo fetal forearm culture incisional wound model comparing mid-gestation and late-gestation fetuses was used to evaluate IL-10's effect on HA-rich ECM production with pentachrome and immunohistochemistry. RESULTS FFb produce a robust HA-rich PCM which is IL-10 dependent and attenuated with hyaluronidase and HAS inhibition. Mid-gestation fetal wounds produce more ground substance and HA than late-gestation fetal wounds. IL-10 in late-gestation fetal wounds results in elevated ground substance levels and HA staining. CONCLUSIONS Our data demonstrate that IL-10 regulates an HA-rich ECM deposition, suggesting a novel non-immunoregulatory mechanism of IL-10 in mediating regenerative wound healing.
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Affiliation(s)
- Alice King
- Division of Pediatric, Thoracic and General Surgery, The Center for Molecular Fetal Therapy, Cincinnati Children’s Hospital and the University of Cincinnati College of Medicine, Cincinnati, OH
| | - Swathi Balaji
- Division of Pediatric, Thoracic and General Surgery, The Center for Molecular Fetal Therapy, Cincinnati Children’s Hospital and the University of Cincinnati College of Medicine, Cincinnati, OH
| | - Louis D. Le
- Division of Pediatric, Thoracic and General Surgery, The Center for Molecular Fetal Therapy, Cincinnati Children’s Hospital and the University of Cincinnati College of Medicine, Cincinnati, OH
| | - Emily Marsh
- Division of Pediatric, Thoracic and General Surgery, The Center for Molecular Fetal Therapy, Cincinnati Children’s Hospital and the University of Cincinnati College of Medicine, Cincinnati, OH
| | | | - Sundeep G. Keswani
- Division of Pediatric, Thoracic and General Surgery, The Center for Molecular Fetal Therapy, Cincinnati Children’s Hospital and the University of Cincinnati College of Medicine, Cincinnati, OH
- Corresponding author. Division of General, Thoracic, and Fetal Surgery, The Center for Molecular Fetal Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229–3039.
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King A, Balaji S, Marsh E, Le LD, Shaaban AF, Crombleholme TM, Keswani SG. Interleukin-10 regulates the fetal hyaluronan-rich extracellular matrix via a STAT3-dependent mechanism. J Surg Res 2013; 184:671-7. [PMID: 23684616 DOI: 10.1016/j.jss.2013.04.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [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: 01/04/2013] [Revised: 03/08/2013] [Accepted: 04/04/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND The midgestational fetus is capable of regenerative healing. We have recently demonstrated a novel role for the anti-inflammatory cytokine interleukin 10 (IL-10) as a regulator of hyaluronan (HA) in the extracellular matrix. The signaling pathway of IL-10 has been studied in monocytes but is unknown in dermal fibroblasts. We hypothesized IL-10 signals through its primary receptor, IL-10R1, to activate STAT3, resulting in HA synthesis. METHODS Murine midgestational (E14.5) fetal fibroblasts were evaluated in vitro. Pericellular matrix was quantified using a particle exclusion assay. STAT3 levels and cellular localization were evaluated by Western blot/band densitometry and immunocytochemistry/confocal microscopy. HA levels were quantified by enzyme-linked immunosorbent assay. The effects of IL-10R1 signal blockade by a neutralizing antibody and STAT3 inhibition were evaluated. An ex vivo midgestation fetal forearm culture incisional wound model in control and transgenic IL-10-/- mice was used to evaluate the role of STAT3 on the extracellular matrix. RESULTS Fetal fibroblasts produce a robust hyaluronan-rich pericellular matrix that is IL-10R1 and STAT3 dependent. Inhibition of IL-10R1 signaling results in decreased phosphorylated STAT3 levels and inhibition of nuclear localization. Inhibition of STAT3 results in decreased HA production. At day 3, midgestation fetal wounds have efficient re-epithelialization, which is significantly slowed in IL-10-/- wounds at the same gestation and with inhibition of STAT3. CONCLUSIONS Our data demonstrate that IL-10 regulates HA synthesis through its primary receptor IL-10R1 and STAT3 activation. This supports a novel nonimmunoregulatory mechanism of IL-10 in its role in fetal regenerative wound healing.
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Affiliation(s)
- Alice King
- The Center for Molecular Fetal Therapy, Division of Pediatric, Thoracic and General Surgery, Cincinnati Children's Hospital and the University of Cincinnati College of Medicine, Cincinnati, Ohio 45229-3039, USA
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Balaji S, King A, Dhamija Y, Le LD, Shaaban AF, Crombleholme TM, Keswani SG. Pseudotyped adeno-associated viral vectors for gene transfer in dermal fibroblasts: implications for wound-healing applications. J Surg Res 2013; 184:691-8. [PMID: 23590866 DOI: 10.1016/j.jss.2013.03.051] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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: 01/05/2013] [Revised: 03/11/2013] [Accepted: 03/14/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Cell-specific gene transfer and sustained transgene expression are goals of cutaneous gene therapy. Pseudotyping strategy with adeno-associated viral (AAV) vectors has the potential to confer unique cellular tropism and transduction efficiency. We hypothesize that pseudotyped AAV vectors have differential tropism and transduction efficiency under normal and wound conditions in dermal fibroblasts. MATERIALS AND METHODS We packaged AAV2 genome with green fluorescent protein reporter in capsids of other serotypes, AAV5, AAV7, and AAV8, producing pseudotyped vectors AAV2/5, AAV2/7, and AAV2/8, respectively. Murine and human dermal fibroblasts were transduced by the different pseudotypes for 24 h at multiplicities of infection 10(2), 10(3), 10(4), and 10(5). We assessed transduction efficiency at days 3 and 7. Experiments were repeated in a simulated wound environment by adding 10 ng/mL platelet-derived growth factor-B to culture media. RESULTS Transduction efficiency of the pseudotyped AAV vectors was dose dependent. Multiplicity of infection 10(5) resulted in significantly higher gene transfer. Under normal culture conditions, the pseudotyping strategy conferred differential transduction of dermal fibroblasts, with significantly enhanced transduction of murine cells by AAV2/5 and AAV2/8 compared with AAV2/2. Adeno-associated virus 2/8 was more efficacious in transducing human cells. Under wound conditions, transduction efficiency of AAV2/2, 2/5, and 2/8 was significantly lower in murine fibroblasts. At day 3 under wound conditions, all vectors demonstrated similar transduction efficiency, but by day 7, the three pseudotyped vectors transduced significantly more murine cells compared with AAV2/2. However, in human cells, there was no significant difference in the transduction efficiency of each pseudotype between normal and wound conditions at both 3 and 7 d. CONCLUSIONS The AAV pseudotyping strategy represents a gene transfer technology that can result in differential transduction of dermal fibroblasts. The differences in transduction efficiency in murine and human dermal fibroblasts in both the normal and wound environment highlight issues with translatability of gene transfer techniques. These data provide a template for using pseudotyped AAV vectors in cutaneous applications.
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Affiliation(s)
- Swathi Balaji
- Division of Pediatric, General, Thoracic, and Fetal Surgery, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio 45229-3039, USA
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Yu L, Wynn J, Ma L, Guha S, Mychaliska GB, Crombleholme TM, Azarow KS, Lim FY, Chung DH, Potoka D, Warner BW, Bucher B, LeDuc CA, Costa K, Stolar C, Aspelund G, Arkovitz MS, Chung WK. De novo copy number variants are associated with congenital diaphragmatic hernia. J Med Genet 2013; 49:650-9. [PMID: 23054247 DOI: 10.1136/jmedgenet-2012-101135] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Congenital diaphragmatic hernia (CDH) is a common birth defect with significant morbidity and mortality. Although the aetiology of CDH remains poorly understood, studies from animal models and patients with CDH suggest that genetic factors play an important role in the development of CDH. Chromosomal anomalies have been reported in CDH. METHODS In this study, the authors investigated the frequency of chromosomal anomalies and copy number variants (CNVs) in 256 parent-child trios of CDH using clinical conventional cytogenetic and microarray analysis. The authors also selected a set of CDH related training genes to prioritise the genes in those segmental aneuploidies and identified the genes and gene sets that may contribute to the aetiology of CDH. RESULTS The authors identified chromosomal anomalies in 16 patients (6.3%) of the series including three aneuploidies, two unbalanced translocation, and 11 patients with de novo CNVs ranging in size from 95 kb to 104.6 Mb. The authors prioritised the genes in the CNV segments and identified KCNA2, LMNA, CACNA1S, MYOG, HLX, LBR, AGT, GATA4, SOX7, HYLS1, FOXC1, FOXF2, PDGFA, FGF6, COL4A1, COL4A2, HOMER2, BNC1, BID, and TBX1 as genes that may be involved in diaphragm development. Gene enrichment analysis identified the most relevant gene ontology categories as those involved in tissue development (p=4.4×10(-11)) or regulation of multicellular organismal processes (p=2.8×10(-10)) and 'receptor binding' (p=8.7×10(-14)) and 'DNA binding transcription factor activity' (p=4.4×10(-10)). CONCLUSIONS The present findings support the role of chromosomal anomalies in CDH and provide a set of candidate genes including FOXC1, FOXF2, PDGFA, FGF6, COL4A1, COL4A2, SOX7, BNC1, BID, and TBX1 for further analysis in CDH.
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Affiliation(s)
- Lan Yu
- Department of Pediatrics, Columbia University Medical Center, New York, New York 10032, USA
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Lee H, Bebbington M, Crombleholme TM. The North American Fetal Therapy Network Registry Data on Outcomes of Radiofrequency Ablation for Twin-Reversed Arterial Perfusion Sequence. Fetal Diagn Ther 2013; 33:224-9. [DOI: 10.1159/000343223] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 08/15/2012] [Indexed: 11/19/2022]
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Yu L, Wynn J, Cheung YH, Shen Y, Mychaliska GB, Crombleholme TM, Azarow KS, Lim FY, Chung DH, Potoka D, Warner BW, Bucher B, Stolar C, Aspelund G, Arkovitz MS, Chung WK. Variants in GATA4 are a rare cause of familial and sporadic congenital diaphragmatic hernia. Hum Genet 2012; 132:285-92. [PMID: 23138528 DOI: 10.1007/s00439-012-1249-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 10/30/2012] [Indexed: 01/16/2023]
Abstract
Congenital diaphragmatic hernia (CDH) is characterized by incomplete formation of the diaphragm occurring as either an isolated defect or in association with other anomalies. Genetic factors including aneuploidies and copy number variants are important in the pathogenesis of many cases of CDH, but few single genes have been definitively implicated in human CDH. In this study, we used whole exome sequencing (WES) to identify a paternally inherited novel missense GATA4 variant (c.754C>T; p.R252W) in a familial case of CDH with incomplete penetrance. Phenotypic characterization of the family included magnetic resonance imaging of the chest and abdomen demonstrating asymptomatic defects in the diaphragm in the two "unaffected" missense variant carriers. Screening 96 additional CDH patients identified a de novo heterozygous GATA4 variant (c.848G>A; p.R283H) in a non-isolated CDH patient. In summary, GATA4 is implicated in both familial and sporadic CDH, and our data suggests that WES may be a powerful tool to discover rare variants for CDH.
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Affiliation(s)
- Lan Yu
- Division of Molecular Genetics, Department of Pediatrics, Columbia University Medical Center, 1150 St. Nicholas Avenue, Room 620, New York, NY 10032, USA.
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