Evaluation of Autophagy Process in Differentiation of Human Induced Pluripotent Stem Cells toward Insulin Producing Cells

Background

Autophagy is an intracellular self-degradative homeostasis process which eliminates undesirable and harmful macromolecules and organelles. Autophagy is also involved in self-renewal and differentiation of induced pluripotent stem cell (iPSCs).

Objective

In this study, we investigated the expression profile of autophagy marker genes in human iPSCs during their differentiation induction toward insulin producing β-like cells.

Methods

Human iPSC line, R1-hiPSC1, was used for differentiation induction toward β-like cells. The mRNA expression of Nanog, OCT4 (pluripotency markers), SOX17, FOXA2 (endodermic markers), PTF1A, NKX6.1 (exocrine/endocrine determinants), and PDX1 were measured during differentiation stages. Autophagy was monitored by genes expression study of four autophagy markers, MAP1LC3B, BECN1, SQSTM1/P62 and ATG5, along with protein expression profile of LC3b-II during differentiation stages.

Results

The mRNA expression measurement of pluripotency, endoderm and exocrine/endocrine marker genes confirmed that hiPSCs skipped pluripotency, differentiated into endoderm, passed through the pancreatic lineage commitment stage and successfully generated insulin producing β-like cells. Expression profile of autophagy genes during differentiation stages indicated the decreased expression levels at the early stages (EB and MEI) and then increased at the definitive endoderm stages (DEI 1, DEI 2 and DE) followed by a subtractive pattern toward the end of differentiation. The results of protein expression of LC3b-II were consistent with gene expression data.

Conclusion

This study demonstrated the high contribution of key autophagy genes/proteins during the differentiation of hiPSC toward β-like cells. The enhanced autophagy levels were a prominent feature of early stages of differentiation and DE rather than the later stages.

Effectiveness of mesenchymal stem cell-seeded onto the 3D polylactic acid/polycaprolactone/hydroxyapatite scaffold on the radius bone defect in rat

PURPOSE

The importance of regeneration in large bone defects forces the orthopedic surgeons to search for a proper methodology. The present experiment evaluated the capability of polylactic acid/polycaprolactone/hydroxyapatite (PLA/PCL/HA) scaffold loaded with and without mesenchymal stem cells (MSCs) on bone regeneration.

METHODS

Fourier transform infrared spectrometry, X-ray diffraction, scanning electron microscopy, and rheology methodologies were used to characterize the scaffold. Forty Wistar rats were randomly divided into the four groups including the untreated defects as the control group and three other groups in which the bone defects were treated with autologous bones (autograft group), the PLA/PCL/HA scaffolds (PLA/PCL/HA group), and the MSCs-seeded scaffolds (MSCs-seeded PLA/PCL/HA group).

RESULTS

Based on the qRT-PCR results, significantly higher expression levels of osteocalcin, osteopontin, and CD31 were seen in the cell-seeded scaffold group compared to the control group (P < 0.05). The CT scanning and radiographic images depicted significantly more newly formed bonny tissue in the MSCs-loaded scaffold and autograft groups than the untreated group (P < 0.001). The immunohistochemistry, biomechanical, histopathologic, and histomorphometric evaluations demonstrated significantly improved regeneration in the autograft and MSCs-loaded scaffold groups compared to the non-treated group (P < 0.05). There were significant differences between the scaffold and untreated groups in all in vivo evaluations (P < 0.05).

CONCLUSION

The MSCs enhanced bone healing potential of the PLA/PCL/HA scaffold and the MSCs-seeded scaffold was comparable to the autograft as the golden treatment regimen (P > 0.05).

Effects of Different Cold Preservation Solutions on the Functions of Cultured Isolated Human Hepatocytes

BACKGROUND

Hepatocyte transplantation using isolated human hepatocytes is an alternative source that can be used for the treatment of metabolic diseases and acute liver failure as a time bridge to liver transplantation. These cells can also be used for bioartificial liver systems and in vitro study of drug toxicity.

OBJECTIVE

To determine which cold preservation solution is better maintain the liver function.

METHODS

We prepared 4 cold preservation solutions made of different combination of antioxidants, chelating, membrane protective, and anti-apoptotic agents as well as inhibitor of cyclophilin D. For hepatocyte isolation, we used livers obtained from unused deceased donor livers and the liver of patients with Crigler-Najjar syndrome who were candidates of partial liver transplantation. After culture and cold preservation, the level of albumin, and urea production were measured as indices of liver functionality.

RESULTS

We found that albumin production significantly decreased after cold preservation in solution 1. There was no significant difference in urea production after cold preservation in solution 1 compared with control 24 h. No significant differences in albumin production were found after cold storage in solution 2 and solution 4 compared with control 24 h. Urea production significantly decreased after cold storage in solutions 2 and 4 compared with control 24 h. As a whole albumin and urea production were significantly decreased after cold preservation. Although albumin and urea production were decreased after cold preservation, but the results of albumin production of two solutions were not significantly different from that of the control group (p=0.109 and 0.951).

CONCLUSION

Cold preservation of cultured human hepatocytes in solution 2 and solution 4 could maintain the function of albumin production better than other cold preservation solutions in our experiments; solution 1 was more effective on urea production of cultured human hepatocytes at 4 °C for 24 h. To determine if these hepatocytes are suitable candidates for transplantation, further studies should be performed.

Association between Interleukin-21, 23 and 27 Expression and Protein Level with Cytomegalovirus Infection in Liver Transplant Recipients

BACKGROUND

Cytokines have regulatory crosstalk with CMV infection leading to manage of post-liver transplantation virus-related outcomes.

OBJECTIVE

To investigate the link between IL-21, IL-23 and IL-27 mRNA and protein level with active CMV infection, which was evaluated in reactivated and non-reactivated liver transplant recipients.

METHODS

Two groups of liver transplant recipients were enrolled in this study-54 without and 15 with active CMV infection. 3 EDTA-treated blood samples were taken on day 1, 4, and 7 post-liver transplantation. Plasma and buffy coats of all samples were separated. All samples were analyzed for CMV reactivation using antigenemia technique. The separated plasma of positive samples was used for viral DNA extraction and protein evaluation. For evaluating the mRNA expression level by real-time PCR, RNA extraction and cDNA synthesis were done for all samples. Also, the protein level of studied genes was estimated by ELISA.

RESULTS

The expression level of IL-21, IL-23A and IL-27A cytokine genes was increased in CMV reactivated liver transplant recipients in comparison with CMV non-reactivated ones; IL-27A expression pattern was significant (p=0.001) at all sampling times. IL-21 significantly increased on the 2^nd and 3^rd (p=0.028 and 0.01, respectively) sampling days in CMV reactivated compared with non-reactivated patients. The expression level of IL-23A cytokine significantly increased on the 3^rd (p=0.017) sampling day in CMV reactivated compared with non-reactivated liver transplant recipients.

CONCLUSION

Elevation in the expression level of IL-21, IL-23A and IL-27A mRNA and protein level in CMV reactivated patients emphasized on the antiviral role of these cytokines in CMV reactivated liver transplant recipients.

Comparison of Human Mesenchymal Stem Cells Derived from Various Compartments of Human Adipose Tissue and Tunica Adventitia Layer of the Arteries Subsequent to Organ Donation

BACKGROUND

Mesenchymal stem cells are one of the most interesting cell sources used in regenerative medicine.

OBJECTIVE

In the present study, we isolated and characterized the mesenchymal stem cells from various compartments of human adipose tissue and tunica adventitia layer of the arteries.

METHODS

Tissue explant culture was done from various compartments of the human adipose tissue and tunica adventitia layer of the arteries, including adipose tissue far from the vessels, perivascular tissues that are completely attached to the vessels, and tunica adventitia layer of the arteries. After the cell culture, characterization of the cells was determined at 3^rd-5^th passages. Flow cytometry was performed for antigen expression analysis of CD34, CD45, CD44, CD90, CD29, CD73, and CD105. For the evaluation of cell differentiation potential, adipogenic and osteogenic differentiation was conducted under appropriate protocols.

RESULTS

The cells were positive for CD44, CD90, CD29, and CD73 and negative for CD34, CD45, and CD105. Adipogenic and osteogenic differentiation potentials were different among the cells from various compartments. The cells derived from perivascular tissue demonstrated better adipogenic and osteogenic differentiation.

CONCLUSION

It is essential to characterize the cells from different tissues and compartments for different purposes in regenerative medicine.

Repression of melanoma tumor in vitro and in vivo by photothermal effect of carbon xerogel nanoparticles

Nanosized carbonaceous materials are favorable in biomedicine applications including photothermal therapy (PTT) of cancer. Since conventional strategies of cancer treatment have not responded to this serious disease, development of efficient alternative and promising strategies is highly desirable. In this study, carbon xerogel nanoparticles (CX-NPs) were synthesized as a novel photothermal nanomaterial and activated upon laser light of 808-nm wavelength for cancer phototherapy application. The synthesized CX-NPs had a spherical shape with a size of about 16 nm that showed nice photothermal conversion ability. Upon light irradiation with a power density of 1.0 W cm^-2 for 15 min, a temperature increment occurred. A concentration-dependent cytotoxicity was also obtained for CX-NPs toward the C540 (B16/F10) cell line upon light irradiation, while CX-NPs presented biocompatibility in the mice model in dark. Photothermal property of CX-NPs efficiently led to reduction in the cell viability. A low-dose of CX-NPs was also applied in PTT of a melanoma tumor-bearing animal model. Based on tumor histopathological evaluations and volume change measurements in mice, a very good control of tumor situations after PTT by CX-NPs was attained. The findings revealed that CX-NPs is a good and novel photoabsorber for PTT of cancer.

Evaluation of Angiotensinogen M235T and T174M Polymorphisms, Demographic and Clinical Factors in New-Onset Diabetes after Liver Transplantation in Iranian Patients

BACKGROUND

New-onset diabetes after transplantation (NODAT) is a serious complication which runs the risk of infections, morbidity and mortality.

OBJECTIVE

To evaluate M235T and T174M polymorphisms of angiotensinogen gene along with some demographic and clinical factors including age; sex; body mass index (BMI); model for end-stage liver disease (MELD) score; prednisolone, mycophenolate mofetil and tacrolimus dose; and serum level in NODAT among liver recipients.

METHODS

In this study 115 patients (53 with and 62 without NODAT) who had no history of diabetes before the transplantation were investigated. Furthermore, 80 randomly selected apparently healthy people (no transplantation) were used as the control group. Two angiotensinogen polymorphisms (M235T and T174M) were studied using polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP).

RESULTS

Patients included 68 (59.1%) females and 47 (40.9%) males; they had a mean±SD age of 37.4±16.9 years. The M allele frequency was 55.7% (n=128) in M235T and 20.0% (n=46) in T174M polymorphisms. Binary logistic regression analysis confirmed that age (p=0.005), prednisolone dose (p<0.001) and mutated M235T polymorphism (p=0.003) were independent risk factors.

CONCLUSION

Presence of M235T T allele may significantly (p<0.001) increase the NODAT risk, and increase the likelihood of developing end-stage liver disease (p=0.003). T174M T allele had a significantly (p=0.007) higher frequency in NODAT group.

The Effects of Cold Preservation Solutions Supplemented with UDCA and α-Lipoic Acid on the Viability and Function of Isolated Human Hepatocytes

BACKGROUND

Liver transplantation is the only treatment for end-stage and genetic liver diseases. The main burden of this treatment is the shortage of both living and cadaveric liver donors. An alternative treatment is using liver cell transplantation, which can be obtained from unused livers for transplantation. These hepatocytes should be kept ready in viable and functional situation in a frozen state to be instantly used when they would be needed. In our previous experience, we had isolated hepatocytes from unused livers.

OBJECTIVE

To find a preserving solution for increasing viability and function of the isolated hepatocytes that are stored to be transplanted.

METHODS

9 cadaveric donor livers, which were not used for transplantation due to various causes such as severe steatosis, were selected to isolate hepatocytes. Various cold storage solutions were tried to find the best temperature for more viability and functionality for preservation of hepatocytes. University of Wisconsin (UW) solution and Williams E media were used as control media. 2 anti-apoptotic and anti-oxidative solutions, i.e., α-lipoic acid and ursodeoxycholic acid (UDCA), were used as cold preservatives solutions. The numbers of viable hepatocytes were estimated by trypan blue method; the functionality was assessed by the cells ability to produce urea.

RESULTS

The highest number of viable and functional hepatocytes was obtained from freshly isolated cells. However, after preservation, the number of these viable hepatocytes and their functionality were not significantly different in cold storage solutions comparing to the control media used. Functionality of the isolated hepatocytes stored in UW with and without UCDA solution was similar to freshly isolated hepatocytes.

CONCLUSION

Preservatives with anti-apoptotic and antioxidant activity could not increase the number of viable hepatocytes. Functionality of cold storing hepatocytes could be preserved similar to freshly isolated hepatocytes by UW solution with and without UCDA.

Evaluation of a self-nanoemulsifying docetaxel delivery system

A self-nanoemulsifying drug delivery system (SNEDDS) was developed as a novel route to enhance the efficacy of docetaxel lipophilic drug. SNEDDS comprised ethyl oleate, Tween 80 and poly(ethylene glycol) 600, as oil, surfactant and co-surfactant, and formed stabilized monodispersed oil nanodroplets upon dilution in water. SNEDDS represented encapsulation efficiency and loading capacity of 21.4 and 52.7%, respectively. The docetaxel release profile from the drug-loaded SNEDDS was recorded, its effectiveness against MCF-7 cell line was investigated, and an IC₅₀ value of 0.98 ± 0.05 μg mL^-1 was attained. The drug-loaded SNEDDS was administrated in rats, and the pharmacokinetic parameters of maximum concentration of 22.2 ± 0.8 μg mL^-1, time to attain this maximum concentration of 230 min, and area under the curve of 1.71 ± 0.18 μg min mL^-1 were obtained. The developed SNEDDS formulation can be represented as an alternative to docetaxel administration.

Stem Cell-Based Therapies and Tissue Engineering of Trachea as Promising Therapeutic Methods in Mustard Gas Exposed Patients

Tissue engineering and cell-based therapies are promising therapeutic approaches in structural and functional defects of the trachea. Researchers have focused on these approaches to overcome the complications related to such diseases. Patients exposed to mustard gas suffer from massive damage to the respiratory system. Current treatment plans are only palliative and include anti-inflammatory drugs, broncholytics, long-acting β2-agonists, and inhaled corticosteroids. As mustard gas exposure leads to chronic airway inflammation, it seems that tracheobronchomalacia, because of chronic inflammation and weakness of the supporting cartilage, is an important factor in the development of chronic and refractory respiratory symptoms. The previous studies show that regenerative medicine approaches have promising potential to improve the life quality of patients suffering from tracheal defects. It seems that the engineered tracheal graft may improve the respiratory function and decrease symptoms in patients who suffer from asthma-like attacks due to mustard gas exposure. There are several successful case reports on the transplantation of stem cell-based bioartificial grafts in structural airway diseases. Therefore, we hope that the reconstruction of tracheobronchial structure can lead to a decrease in respiratory difficulties in mustard gas-exposed patients who suffer from tracheomalacia. In the present review, we summarize the main aspects of tracheal tissue engineering and cell-based therapies and the possibilities of the application of these approaches in mustard gas-exposed patients.

The Immunomodulatory Effect of Bone-Marrow Mesenchymal Stem Cells on Expression of TLR3 and TLR9 in Mice Dendritic Cells

BACKGROUND

Mesenchymal stem cells (MSCs) are multipotent cells with immunomodulatory effect on immune cells including dendritic cells (DCs). DCs are the most potent antigen-presenting cells (APC). MSCs have been found to modulate both differentiation and function of DCs. DCs express a broad range of Toll-like receptors (TLR), which play a critical role in DCs maturation and function.

OBJECTIVE

To evaluate expression level of TLR3 and TLR9 transcripts in DCs following treatment with MSCs supernatant.

METHODS

MSCs and DCs were derived from adult BALB/c mice bone marrow and spleen, respectively. MSCs supernatant was harvested following 24, 48, and 72 hours. Isolated DCs were treated with MSCs supernatant and incubated for 24 and 48 hours. TLR3 and TLR9 transcript levels were evaluated using real-time PCR.

RESULTS

The results showed that 48 and 72 hours MSCs supernatant significantly decreased the expression of TLR3 in DCs following 24 and 48 hours incubation in comparison with untreated cells (p<0.01). Moreover, 48 hours of treatment with 24, 48 and 72 hours MSCs supernatant significantly decreased TLR9 transcript level (p<0.05).

CONCLUSION

TLR3 and TLR9 mRNA expression decreases in DCs after incubation with MSCs culture supernatant. This confirms the immunomodulatory role of MSCs in cell-base therapy.

Interleukin-28B rs12979860 C/T Polymorphism and Acute Cellular Rejection after Liver Transplantation

BACKGROUND

Interleukin-28 (IL-28B) rs12979860 C/T polymorphism is a known predictor of sustained virological response after antiviral treatment in hepatitis C. IL-28B affects the innate immune system as well as intrahepatic expression level of interferon-stimulated genes.

OBJECTIVE

To investigate the effect of recipient IL-28B polymorphism on occurrence of acute rejection after liver transplantation.

METHODS

140 liver allograft recipients were selected. Acute rejection episodes were recorded in 39 patients (AR group); the remaining had normal graft function (non-AR group). 70 normal subjects were also studied as the control group. The IL-28B rs12979860 was genotyped through PCR-RFLP method.

RESULTS

No significant difference was found between AR and non-AR groups in terms of genotype and allele frequency. However, the CC genotype was significantly (p<0.001) more frequent in patients than in the control group; the C allele variants increased the risk of end-stage liver disease (OR: 2.60).

CONCLUSION

Liver damage in association with the carriage of IL-28B C allele is associated with a higher likelihood of developing cirrhosis.

Dextrin-coated zinc substituted cobalt-ferrite nanoparticles as an MRI contrast agent: In vitro and in vivo imaging studies

Application of superparamagnetic iron oxide nanoparticles (NPs) as a negative contrast agent in magnetic resonance imaging (MRI) has been of widespread interest. These particles can enhance contrast of images by altering the relaxation times of the water protons. In this study, dextrin-coated zinc substituted cobalt-ferrite (Zn0.5Co0.5Fe2O4) NPs were synthesized by a co-precipitation method, and the morphology, size, structure and magnetic properties of the NPs were investigated. These NPs had superparamagnetic behavior with an average size of 3.9 (±0.9, n=200)nm measured by transmission electron microscopy. Measurements on the relaxivities (r2 and r2(*)) of the NPs were performed in vitro by agarose phantom. In addition, after subcutaneous injection of the NPs into C540 cell line in C-57 inbred mice, the relaxivities were measured in vivo by a 1.5T MRI system. These NPs could effectively increase the image contrast in both T2-and T2(*)-weighted samples.

Polymorphism of Transcription Factor-7-Like 2 (TCF7L2) Gene and New-Onset Diabetes after Liver Transplantation

BACKGROUND

New-onset diabetes after transplantation (NODAT) is a serious complication in transplant recipients. Transcription factor-7-like 2 (TCF7L2) is a Wnt signaling-associated transcription factor that plays an important role in β-cell proliferation and insulin secretion. The association between TCF7L2 SNP rs7903146 and NODAT was documented in renal transplant patients.

OBJECTIVE

To determine the association between TCF7L2 rs7903146 variants and the risk of NODAT after liver transplantation.

METHODS

This study was conducted on 140 liver transplant recipients who had received tacrolimus-based immunosuppressive drugs. The patients were divided into NODAT (n=70) and non-NODAT (n=70) groups and were genotyped using PCR-RFLP. In addition, 100 normal subjects were considered as the comparison group.

RESULTS

There was a significant difference (p<0.05) between the two study groups regarding donor and recipient age, recipient body mass index, and recipient fasting plasma glucose before the transplantation. No significant relationship was observed between TCF7L2 rs7903146 genotypes and development of NODAT. No significant difference was also found between the two groups in terms of the tacrolimus and mycophenolate mofetil daily dosage as well as tacrolimus blood level. However, the prednisolone daily dosage was significantly (p=0.01) higher in the NODAT group compared to those without NODAT. The majority of the patients in the NODAT group also had an episode of acute rejection. Furthermore, a significant difference was found between the transplant recipients and the comparison subjects regarding T allele (p<0.001, OR=1.96) and TT genotype (p<0.001, OR=3.47) frequencies.

CONCLUSION

No correlation was found between TCF7L2 genotypes and development of NODAT. Acute rejection and prednisolone pulse therapy predisposed the susceptible patients to NODAT.

Association of Increased Plasma Interleukin-6 and TNF-α Levels in Donors with the Complication Rates in Liver Transplant Recipients

BACKGROUND

Solid organ transplantation is the only definitive treatment available for patients with end-stage organ failure. Organs procured from brain-death donors are the main source of transplants. Following brain death, a burst of inflammatory reaction develops; it is characterized by increased plasma levels of cytokines. This inflammatory reaction has been associated with increased early allograft dysfunction.

OBJECTIVE

In this study, we test if the increased inflammatory response in brain-death donors is associated with more recipient complications.

METHODS

We prospectively recruited 38 consecutive brain-death donors admitted to the intensive care units (ICUs) of Shiraz University of Medical Sciences. Following the declaration of brain death, the demographics data on donor and recipient characteristics and cause of brain death were recorded. The post-liver transplant complications in recipients were stratified according to the Clavien classification. Plasma levels of cytokines IL-6, IL-2, and TNF-α were measured using enzyme linked immunosorbent assay (ELISA) kits, in all donors before organ procurement.

RESULTS

The mean (range) age of donors was 44 (16-74) years. Trauma due to car accident was the most common cause of brain death (79%). The post-liver transplant complications occurred in 19 (50%) recipients. The mean±SD plasma TNF-α concentration was significantly (p<0.001) higher in recipients with grade 1-3 post-transplant complications (68.33±27.74 pg/mL) than those without complication (22.09±4.14 pg/mL). Recipients with complications had also a significantly (p=0.001) higher mean±SD donor plasma concentration of IL-6 (1009±375.5 pg/mL) compared to those without complications (779±202 pg/mL). No significant differences was observed between the two groups in respect to IL-2 concentration (0.295±0.333 vs 0.285±0.342 U/mL, p=0.207). Six recipients died of complications (grade5), in whom no correlation could be found with donor plasma cytokine concentrations.

CONCLUSION

Higher plasma concentrations of IL-6 and TNF-α in donors before organ procurement, are associated with more post-operative complications in liver transplant recipients.

Prevention of arthrofibrosis by monoclonal antibody against vascular endothelial growth factor: a novel use of bevacizumab in rabbits

BACKGROUND

Prevention of arthrofibrosis by different drugs and surgical techniques is an essential issue in modern orthopedics.

HYPOTHESIS

Intra-articular injection of bevacizumab can reduce arthrofibrosis on the rabbit's stifle joint model.

MATERIALS AND METHODS

Arthrofibrosis was induced in the right stifle joint of thirty male New Zealand white rabbits by removing the cortical bone of the medial femoral condyle under general anesthesia. The rabbits were randomly divided into three equal groups. The control group received intra-articular injection of saline; the one-injection group received a single dose of bevacizumab (2.5mg/kg), and the two-injection group received two intra-articular injections; the operation day and 14 days later. Forty-five days after surgery, animals were sacrificed. The severity of fibrosis was assessed based on the range of motion of the joint, a macroscopic adhesion score, and histopathologic variables such as the number of fibroblasts and of inflammatory cells, collagenous matrix deposition, synovial hyperplasia, granulation tissue formation, vascular proliferation, and presence of giant cells.

RESULTS

Although no statistically significant differences were found between the range of motion (P=0.222) and the macroscopic evaluation (P=0.067) of the control group and the one-injection group, all microscopic variables regarding the prevention of arthrofibrosis were significantly superior in the one-injection group except granulation tissue (P=0.347). Compared to the one-injection group, the two-injection group had better results not only in terms of macroscopic evaluation (P=0.001 for range of motion and 0.012 for visual adhesion score) but also in most of the histopathologic variables especially the number of fibroblasts (P=0.002), vascularity (P=0.028) and collagenous matrix deposition (P=0.039).

CONCLUSION

A single intra-articular injection of bevacizumab was effective for prevention of microscopically detected arthrofibrosis in the rabbit. Compared to single injection, two injections of bevacizumab improved the clinical outcome.

LEVEL OF EVIDENCE

Level II.

Human Bone Marrow-derived Mesenchymal Stem Cell: A Source for Cell-Based Therapy

BACKGROUND

The ability of mesenchymal stem cells (MSCs) to differentiate into many cell types, and modulate immune responses, makes them an attractive therapeutic tool for cell transplantation and tissue engineering.

OBJECTIVE

This project was designed for isolation, culture, and characterization of human marrow-derived MSCs based on the immunophenotypic markers and the differentiation potential.

METHODS

Bone marrow of healthy donors was aspirated from the iliac crest. Mononuclear cells were layered over the Ficoll-Paque density-gradient and plated in tissue cultures dish. The adherent cells expanded rapidly and maintained with periodic passages until a relatively homogeneous population was established. The identification of adherent cells and the immune-surface markers was performed by flow cytometric analysis at the third passage. The in vitro differentiation of MSCs into osteoblast and adipocytes was also achieved.

RESULTS

The MSCs were CD11b (CR3), CD45, CD34, CD31 (PCAM-1), CD40, CD80 (B7-1), and HLA-class II negative because antigen expression was less than 5%, while they showed a high expression of CD90, and CD73. The differentiation of osteoblasts, is determined by deposition of a mineralized extracellular matrix in the culture plates that can be detected with Alizarin Red. Adipocytes were easily identified by their morphology and staining with Oil Red.

CONCLUSION

MSCs can be isolated and expanded from most healthy donors, providing for a source of cell-based therapy.

The effect of egg yolk oil in the healing of third degree burn wound in rats

BACKGROUND

Burn injury is a major cause of death and disability worldwide. A domestic medication in wound healing, preventing infection and reduction of scar tissue as well as availability is still an important challenge. This study aims to evaluate the efficacy of yolk egg oil in treatment of burn wounds in rats.

METHODS

A standard 3rd degree burn wound was produced and the animals were divided into three groups according to topical treatment including yolk oil, 1% silver sulfadiazine (SSD) and control. In days 7, 14 and 30,animal's weight, wound size, as well as histopathological findings of skin were evaluated in different groups.

RESULTS

Average size of wound after 7 days was 3.4, 5.3, and 6.7 cm in yolk oil, SSD and control groups. There were significant differences between yolk oil and the other groups in this aspect. The wound size of yolk egg group was also significantly smaller than other groups in 14th and 30th days. Results of the histological studies indicated significant differences between yolk oil, SSD and control groups on day 30, with mean score of 3.75, 3.5 and 2.8 respectively. The difference between yolk oil and the other groups was significant.

CONCLUSION

Yolk oil-treated burned animals showed abundant re-epithelialization without tissue scar in comparison with SSD group. Although the egg yolk has many vital nutrients, but its exact mechanism in healing process is unknown. Therefore, further studies evaluating the influence of individual components on burn-healing process is advised.

Relation between Actinomycosis and Histopathological and Clinical Features of the Palatine Tonsils: An Iranian Experience

BACKGROUND

Actinomycosis of the tonsils has been reported in a variable percentage of tonsil specimens by other authors. This study determines the incidence of actinomyces in the palatine tonsil and evaluates the clinical diagnoses and histopathological features of tonsillectomy specimens.

METHODS

In a retrospective study, 204 patients who had undergone tonsillectomy for recurrent tonsillitis (group A) and for sleep apnea without a history of recurrent tonsillitis (group B) were enrolled.

RESULTS

The prevalence rate was significantly higher in the adult compared with the pediatric population. The prevalence of tonsillar actinomycetes colonization was higher in patients who had undergone tonsillectomy for recurrent tonsillitis (43.9%) than in patients who had undergone tonsillectomy for obstructive sleep apnea (26.3%). The prevalence did not differ by sex of patient. Histopathological analysis of resected tonsils did not show active tissue infection. There was a statistically significant relationship between the presence of actinomycosis and age, with a greater occurrence of actinomycosis in adult patients.

CONCLUSION

Although actinomyces colonization is more prevalent in patients with recurrent tonsillitis than sleepdisordered breathing, but the presence of actinomyces does not indicate any active disease.

Distant metastases to nasal cavities and paranasal sinuses case series

Metastatic tumors to the nasal cavity and paranasal sinuses are far less common than primary cancer in this location. Review of the 2004-2010 pathology records of patients with sinonasal malignancy, revealed three cases with distant metastases to this region from primary sites in kidney, prostate and breast. The clinical presentation, histopathological findings and clinical outcome is presented for each patient. Metastases to the nose and paranasal sinuses usually respond poorly to treatment and have a poor prognosis. This report highlights the importance of suspecting metastases in patients with a previous history of malignancy. Therefore, thorough history and clinical evaluation is mandatory in any known/treated case of cancer.

Endothelial Nitric Oxide Synthase Gene T-786C Polymorphism in Renal Transplant Recipients

BACKGROUND

Nitric oxide (NO) is a major mediator in vascular biology, regulating regional blood flow. NO and the enzymes required for its production contribute to ischemia-reperfusion injury. The T-786C functional polymorphism in the promoter region substantially reduces promoter activity of the endothelial nitric oxide synthase (eNOS) gene and compromises endothelial NO synthesis.

OBJECTIVE

To examine the association between T-786C (rs 2070744) single nucleotide polymorphism (SNP) in eNOS gene and the development of acute rejection in renal transplant patients.

METHODS

60 renal transplant recipients (30 with episodes of acute rejection (ARs) and 30 without rejection (non-ARs)), between June 2008 and March 2010, were included in this study. The polymorphism was determined by PCR-restriction fragment-length polymorphism analysis.

RESULTS

The distribution of the genotypes were TT/TC/CC 60%, 33.4%, 6.6%, and 43%, 46.7%, 13.3% in ARs and non-ARs, respectively (p=0.28). The frequency of T-allele was 76.7% and 66.3%; and for C-allele was 66.6% and 33.3% in ARs and non-ARs, respectively (p=0.09). There were no significant associations between these polymorphisms and acute and chronic kidney allograft rejection.

CONCLUSION

We could not detect any significant association between polymorphism in T-786C of eNOS gene and the development of acute rejection.

The molecular and antigenic tissue impact of viral infections on liver transplant patients with neonatal hepatitis

BACKGROUND

Pathogenesis of neonatal hepatitis relates to various underlying causes including viral infections. Both hepatotropic and non-hepatotropic viruses may induce liver failures in infants before birth, during delivery, or shortly after birth.

OBJECTIVES

The tissue impact of HCMV, HSV, HBV, HCV, and rotavirus and adenovirus infections was evaluated in studied infants with neonatal hepatitis.

METHODS

The history of viral infections was analyzed in paraffin-embedded biopsy and autopsy tissues of 22 infants with neonatal hepatitis between years 1996 and 2007, retrospectively. The tissue molecular presentation of HBV, HCV, HCMV, HSV, adenovirus, and rotavirus was evaluated by different qualitative simple and nested PCR and RT-PCR protocols. Immunohistochemistry (IHC) method was used for studying the antigenic prevalence of HSV-1, 2; HBV, HCMV and adenovirus infections. Also the laboratory liver indices of all patients with neonatal hepatitis were analyzed.

RESULTS

The HBV and HSV genomes were detected in 3 (14%) of 22 infants. The rotavirus and HCV-RNA and also the HCMV-DNA were detected separately in 1 (4%) of 26 paraffin-embedded autopsy and biopsy tissues. The HBV and HSV-1 specific antigens were separately diagnosed in 1 (4%) of 26 neonatal samples by IHC protocols. Also the HSV-2 antigen was seen in 5 (23%) of 22 liver autopsy and biopsy specimens. Co-infections with HCMV, HSV, HBV, HCV, and rotavirus were detected in these infants with hepatitis.

CONCLUSION

Diagnosis of single and mixed molecular and antigenic traces of HCMV, HSV, HBV, HCV and rotavirus underlines the etiologic role of these viruses in clinical pathogenesis of neonatal hepatitis.

Association of the Co-stimulatory Molecules Polymorphisms with CMV Infection in Liver Transplant Recipients

BACKGROUND

Co-stimulatory molecules play a critical role in regulating T-cell function during CMV infection after liver transplantation.

OBJECTIVE

To investigate the relationship between the polymorphisms of the co-stimulatory genes and the susceptibility to CMV infection after liver transplantation.

METHODS

Single nucleotide polymorphisms (SNPs) in PD-1 gene (PD1.1 A/G, PD1.3 A/G, PD1.9 C/T) ICOS (-693 A/G, 1720 C/T), CTLA-4 gene (318 C/T, 1722 T/C, 1661 A/G, 49 A/G) and CD28 (+17 C/T) were analyzed by PCR-RFLP in 70 liver transplant patients. CMV infection was determined in these patients by antigenemia test.

RESULTS

CTLA-4 49G showed significant association with CMV infection (p=0.03, OR=3.82, 95% CI: 0-3.5; p=0.01, OR=004, 95% CI: 0-1.3). G and T alleles in CTLA-4 gene (318 C/T and 1661 A/G) (p=0.03, OR=0, 95% CI: 0-3.5; p=0.01, OR=0.04, 95% CI: 0-1.3) were significantly higher in CMV-infected rejector group.

CONCLUSION

CTLA-4 have significant role in CMV pathogenesis and rejection among CMV-positive liver transplant patients.

Squamous cell carcinoma associated with tall cell variant of papillary carcinoma of the thyroid

We report the simultaneous occurrence of the tall cell variant of papillary carcinoma and squamous cell carcinoma in the thyroid gland. Histology and immunohistochemical findings are discussed and it seems that the malignant squamous component was transformed from the tall cell variant of papillary carcinoma. Metastasis from the squamous cell carcinoma is diagnosed in the regional lymph node.

Histopathological screening of tonsillectomy and/or adenoidectomy specimens: a report from southern Iran

BACKGROUND

The need for pathologic examination of all tonsillectomy and/or adenoidectomy (T&A) specimens is controversial. Microscopic pathologic examination of these specimens is costly, but neglecting this step may miss diagnoses of significant diseases, especially malignancies. This study was designed to determine the rate of unexpected malignancies among patients who underwent T&A.

METHODS

All patients who underwent T&A at Shiraz University of Medical Sciences between February 2004 and February 2008 were included in a prospective study. Gross and microscopic pathologic examinations were done on all the specimens. The charts of the patients with significant pathological finding were reviewed. Information about pre-operative signs, symptoms, and risk factors were used to verify unexpected pathologic findings.

RESULTS

A total of 5058 patients were included. The age distribution was 10 months to 92 years (mean 14.0 years). There were 2498 males (49.4) and 2560 females (50.6%). Significant pathological findings were detected in 54 patients (1%). One unexpected malignancy (0.019%) was found in an adult patient. No unexpected malignancies were found in pediatric patients.

CONCLUSIONS

All T&A specimens in the adult population should be sent for microscopic pathological examination. Also specimens of nonroutine T&A in children (with positive findings in the medical history or on physical examination) should be sent for microscopic pathological examination. In children without positive findings in their history or on physical examination, gross pathological evaluation of routine T&A specimens by a pathologist is sufficient.

Cytotoxic T lymphocyte associated antigen-4 exon 1 A/G polymorphism in Iranian patients with multiple sclerosis

BACKGROUND

Cytotoxic T lymphocyte antigen-4 (CTLA-4) is a T-cell surface receptor of activated T cells.

MATERIAL AND METHODS

We studied 100 Iranian patients with clinically definite multiple sclerosis (MS) and 100 ethnic, sex- and age-matched controls. CTLA-4 exon 1 A/G polymorphism was compared amongst patients and controls.

RESULTS

There was no statistically significant difference in the allelic [odds ratio (OR): 1.19, confidence interval (CI) 95%: 0.76-1.85, P = 0.4] and genotypes (OR: 1.60, CI 95%: 0.911-2.824, P = 0.102) distribution amongst patients and controls. Also gender, course and progression index did not reveal any statistically significant differences in allele and genotype distribution of A/G polymorphism.

CONCLUSION

As a non-European patient population, our results are consistent with the major previous studies showing no significant associations between CTLA4 exon 1 polymorphism and neither MS nor any of its subtypes.

Effect of the Immunoregulatory Cytokines on Successful Pregnancy Depends Upon the Control of Graft Rejection Mechanisms

Successful outcomes in allopregnant women depend upon control of graft rejection mechanisms. An understanding of how the fetus escapes the maternal immune system may be relevant for the prevention of transplant rejection. It has been suggested that the same immunosuppressive cytokines contribute to successful pregnancy and transplantation. Recent reports suggest a role for transforming growth factor beta (TGF-beta) in the generation of T-regulatory lymphocytes. In contrast, production of proinflammatory cytokines accompanying intrauterine infection has been associated with fetal rejection or preterm labor. Interleukin-12 (IL-12) is the unique stimulator for differentiation of T-helper lymphocytes (Th) to Th1 cells. It rapidly induces transcription of Th1 cytokines such as interferon-gamma. This study was performed in 70 pregnant women at 21 to 36 weeks gestation, and in 32 healthy nonpregnant controls. An indirect enzyme-linked immunosorbent assay was used to estimate TGF-beta1, and IL-12 in serum. The results showed that TGF-beta1 levels were higher in all pregnant women compared with the nonpregnant controls. No significant changes in serum levels of IL-12 were observed in pregnant compared with the normal control women. The results suggested that the cytokine milieu of the placenta appeared to play a critical role in the maternal acceptance of the fetus, and that TGF-beta1 may function as a regulatory factor in fetal allograft survival during pregnancy.

Cytokine gene polymorphisms in renal transplant recipients

OBJECTIVE

Acute rejection remains an important cause of graft loss after renal transplantation, and cytokines are key mediators in the induction and effector phases of all immune and inflammatory responses. However, the influence of gene polymorphisms on the functional immune response of transplant recipient outcomes remains controversial.

MATERIALS AND METHODS

The amplification refractory mutation system polymerase chain reaction was used to detect the interleukin-10 (IL-10) (-1082 G/A), tumor necrosis factor-alpha (TNF-alpha) (-308 G/A), and interferon-gamma (IFN-gamma) (+874 T/A) single nucleotide polymorphisms in 100 of the first adult kidney recipients at our institution who were receiving cyclosporine-based immunosuppressive therapy. The diagnosis of acute rejection was based on clinical and histologic findings according to the Banff criteria.

RESULTS

The results of multivariate analyses showed no significant association between episodes of acute rejection and single nucleotide polymorphisms in IL- 10, TNF-alpha genes, or dinucleotide repeat polymorphisms in the IFN-gamma gene.

CONCLUSIONS

Our results demonstrate that cytokine gene polymorphisms did not influence the early outcome of kidney transplantation.

Urine Cytology as a Useful Screening Method for Polyoma Virus Nephropathy in Renal Transplant Patients: A Single-Center Experience

Polyoma virus nephropathy occurs in 3% to 4% of renal transplant recipients, causing graft loss in 50% of cases. In this study we sought to identify the incidence of polyoma virus infection among our transplanted patients on the basis of age, sex, creatinine level, and postoperative period. During this study the 1086 urine samples collected from 362 patients were centrifuged and stained with the Papaniclaou method. All slides were classified as negative or positive (>1 decoy cell/sample). Among 1086 urine cytologies from 241 men and 121 women, decoy cells were identified in 26.6% (96) of patients, including 29.9% (n = 72) men and 20% (n = 24) women. The incidence of decoy cells (26.6%) was increased among men and associated with a longer transplantation period (P < .05). A significant relation was detected between older age and positive urine cytology. The patients with positive urine cytology for decoy cells showed a greater incidence of abnormal plasma creatinine values (26%) compared with patients showing a negative urine cytology (13.5%). In conclusion, identification of cells with viral inclusions (decoy cells) may help with the diagnosis of viral replication or active infection, therefore, routine urine cytology may be used as screening method for the detection of polyoma virus infection.

Association between cyclosporine concentration and genetic polymorphisms of CYP3A5 and MDR1 during the early stage after renal transplantation

OBJECTIVES

Cyclosporine (CsA) has a narrow therapeutic range, and its pharmacokinetic characteristics vary among individuals. It also is a substrate for cytochrome P450 (CYP) 3A and P-glycoprotein, the product of the multidrug resistance 1 (MDR1) and CYP3A5 genes. Some of the single nucleotide polymorphisms (SNPs) in these genes are associated with deficient protein expression and reduced in vivo activity. We postulated that in renal transplant recipients, these SNPs should be associated with interindividual variations in CsA pharmacokinetics.

MATERIALS AND METHODS

In 88 Iranian renal transplant patients receiving CsA, CYP3A5 and MDR1 genotypes were determined by polymerase chain reaction, followed by restriction fragment length polymorphism analysis. Whole blood trough CsA concentrations were measured by radioactive immunosorbent assay. The dose-adjusted concentration (ng/mL per mg/kg/d) was calculated at 1 day (+/-2 days), 7 days, and 1 month after transplantation.

RESULTS

The MDR-1 wild-type genotype (3435CC) was observed in 17 patients (19%), whereas 45 patients (51%) were heterozygous (3435CT), and 26 patients (30%) were homozygous (3435 TT) for the mutation. In the days immediately after transplantation, we found a correlation between the concentration/dose ratio and the exon 26 MDR single nucleotide polymorphisms (33.3+/-15.24 microg mg/L/kg in the CT group vs 44.1+/-28.4 microg mg/L/kg in the TT group, P=.019). This ratio was significantly higher in subjects homozygous for the mutation (3435TT). This significant difference was not seen 1 week or 1 month after transplantation. All patients had the CYP3A5*3/*3 genotype, so no differences among the CYP3A5*1/*3 genotypes were found.

CONCLUSIONS

MDR-1 (3435CC) polymorphisms are associated with CsA pharmacokinetics and dose requirements in the first few days after renal transplantation. Pharmacogenetic methods could be used to help select the initial dosage and individualize immunosuppressive therapy. According to our results, the major genotype of our recipients is CYP3A5*3/*3. According to the literature, the recommended starting dosage of CsA is 9-14 mg/kg/day; however, the Iranian population has a good response with lower dosages (3-5 mg/kg/day), which may be explained by genetic differences.

Incidence of Reactive Antibodies Against Epstein-Barr in a Group of Renal Transplant Patients

Epstein-Barr virus (EBV) infection which is common among immunocompromised patients, may lead to life threatening lymphoproliferative diseases. In this study we examined the incidence and serologic status of EBV infection in 116 renal transplant patients including 84 males and 32 females as well as 72 normal volunteers. The time interval between transplantation and sampling was 1 month to 10 years. Twenty-two patients had a history of rejection. All cases were first transplants except for 3 second transplants. Four patients and no normals showed a positive PCR by a qualitative method. VCA IgM was positive in 11/116 patients (0.09%) and 3 of 72 (0.04%) normal volunteers. 99% (115/116) and 98% (65/72) of patients and normal controls were positive for VCA IgG. EA IgG was positive in 36/116 (31%) and 13/72(18%) of patients and normals, respectively. EBNA IgG was positive in 113/116 (97%) and 100% of patients versus normal controls, respectively. In all except one case with a positive VCA IgM there was a history of infectious mononucleosis-like syndrome. According to our previous data in more than 1000 renal transplant patients during more than 10 years, only one case of PTLD has been diagnosed (0.1%) which is lower than that reported. The high incidence of EBV seropositivity may contribute to this low incidence. The rate of EBV seropositivity in renal transplant patients was greater than in the normal population (P = .05). No association was observed between PCR and seropositivity and rejection or the type of treatment. After this study we began routine PCR and antibody testing in all renal transplant patients both pre- and posttransplant to determine the exact rate of reactivation versus primary infection which we plan to evaluate after 2 to 3 years. In conclusion we believe that the best easiest method to detect EBV infection in immunocompromised patients is VCA IgM ELISA; a qualitative PCR alone is not sufficient for this evaluation.