Cardioprotective Effects of Wharton Jelly Derived Mesenchymal Stem Cell Transplantation in a Rodent Model of Myocardial Injury

BACKGROUND: Whartons jelly-derived mesenchymal stem cells are a valuable alternative source that possess multipotent properties, easy to obtain and available in large scale compared to BMMSCs. We investigated the possibility of cardiac function improvement post isoproterenol induced cardiac injury in a rat model following human WJMSCs transplantation. MATERIALS AND METHODS: MSCs were extracted and cultured from cord WJ, characterized by morphology, Immunophenotyping and differentiation to osteoblast and adipocytes. WJMSCs were labeled with PKH2 linker dye. Wistar rats were divided into control group, ISO group (injected with 2 doses of isoproterenol) to induce myocardial injury and ISO group transplanted with labelled WJMSCs. ECG, electrocardiographic patterns, cardiac marker enzymes, tracing of labeled MSCs and immunohistochemical analysis of myocardial cryosections were studied. RESULTS AND CONCLUSIONS: WJ derived MSCs were expanded for more than 14 passages while maintaining their un-differentiated state, were positive for MSC markers and were able to differentiate into adipocyte and osteoblast. We demonstrated that intravenously administered WJMSCs were capable of homing predominently in the ischemic myocardium. Cardiac markers were positively altered in stem cell treated group compared to ISO group. ECG and ECHO changes were improved with higher survival rate. WJMSCs could differentiate into cardiac-like cells (positive for cardiac specific proteins) in vivo. WJMSCs infusion promoted cardiac protection and reduced mortality, emphasizing a promising therapeutic role for myocardial insufficiency.

1[st] line antimicrobial therapy for febrile neutropenic cancer patients

Empiric antibiotic regimens used in febrile neutropenic patients often include an extended spectrum cephalosporin, but the response of therapy in Gram positive coccal bacteremia has been unsatisfactory, thus new antibiotic with better activity against Gram positive bacteria should be tested. Antipseudomonal penicillins including piperacillin are effective against many Gram positive and Gram negative organisms. The aim of this work is to compare combination therapy with piperacillin-tazobactam plus amikacin versus ceftazidime plus amikacin as first line in treatment of febrile neutropenic cancer patients. This study is a single center, prospective and randomized trial performed in pediatric branch wards, of the National Cancer Institute, Cairo University. All patients were subjected to full clinical and laboratory evaluation including microbiological study. Doses were given according to the International Antimicrobial Therapy Cooperative Group [IATCG] of the European Organization for the Research and Treatment of Cancer [EORTC]. 164 febrile neutropenic episodes were enrolled on this study. 82 patients with 105 [64%] high risk febrile granulocytopenic episodes were considered eligible. 53 were treated with piperacillin-tazobactam plus amikacin [group A], and 52 were treated with ceftazidime plus amikacin [group B]. The overall success in group A was higher than group B, yet, the difference was statistically insignificant with a p value=0.2. Time of defervecence was significantly shorter in piperacillin-tazobactam group [p=0.001]. There was no infection related mortality in this study. Side effects were encountered in 3 [5.6%] cases receiving piperacillin-tazobactam in the form of mild skin reaction. 55.7% of positive cultures yielded Gram positive organisms. Staphylococcus species were the most common organism in both groups. Both Gram positive and negative organisms showed higher sensitivity to pipercillin-tazobactam compared to ceftazidime with a significant p value=0.05. Piperacillin-tazobactam is safe and more effective than ceftazidime in febrile neutropenia in pediatric cancer patients

Non-invasive versus invasive assessment of pulmonary artery branches in pediatric patients with tetralogy of fallot

This study was based on two issues, the 1[st] one was that the pulmonary artery anatomy is the key factor that determines the type of surgical treatment required in tetralogy of Fallot [TOF]. The 2[nd] one was that many studies showed a good correlation of the echocardiographic measurements of cardiac structures with the angiographic and pathological findings. So, the aim of this work was to evaluate the reliability of echocardiography in assessment of the pulmonary blood flow status in pediatric patients with TOF. Only patients with the usual anatomy of TOF were included in this study. It included 68 patients distributed into two groups; group I included 18 patients [26.5%], their mean age was 29.1 +/- 21.4 months and their mean weight was 11.2 +/- 2.1 kg. Group II included 50 patients [73.5%], their mean age was 34 +/- 23 months, their mean weight was 12.6 +/- 4.1 kg. We tested the accuracy of the 2-D echocardiography in measuring the right and the left pulmonary arteries [RPA and LPA] and compared them to the measurements taken by angiography [group I] as well as to the measurements taken at surgery [group II]. The standard deviation unit [Z value] for the RPA and LPA was calculated as well as the pulmonary artery index [PAI] from echocardiographic and angiographic measurements for group I and from echocardiographic and surgical measurements for group II. The results showed that For group I patients, there was statistically significant difference in the measurements of RPA and LPA and consequently the calculated Z value and the PAI between echocardiographic and angiographic modalities. Similarly, group II patients demonstrated a statistically significant difference in the measurements of RPA and LPA and consequently the calculated Z value and the PAI between the echocardiographic and surgical methods. Despite these significant differences found in both groups, the echocardiographic measurements correlated well with the angiographic measurements in group I as well as with the surgical measurements in group II. The differences detected between the echocardiographic and the surgical measurements were less than the differences detected between the echocardiographic and angiographic measurements. This mostly related to our earlier experience in measurement of the pulmonary artery branches using 2-D echocardiography in group I, but with time, we got more experienced in this issue, thus the differences in measurements were minimized in group II. The maximum difference between the echocardiography and surgery for the RPA and LPA was 2.1 mm and 2.0 mm and the mean difference was 0.71 +/- 0.45 and 0.63 +/- 0.46 mm respectively. Our results reflect a clinically acceptable accuracy of 2-D echocardiography in estimation of the pulmonary artery branches and thus surgical management of TOF, guided by echocardiography alone, can be confidently performed in selected infants and children. Cardiac catheterization should be reserved for patients in whom the echocardiographic measurements are not fully certain or suggest association of cardiovascular malformation