On the existence of cardiomesenchymal stem cells.

The most efficient cells for cardiac regeneration are myocardium-resident cardiac stem cells. However, the limited availability of these cells restricts their utility for cardiac cellular therapy. Mesenchymal stem cells can differentiate into a wide variety of tissues, but it is not simple to accurately direct cell differentiation into a specific lineage, such as cardiac tissue; this renders a low efficiency for cardiac regeneration therapy. Given the heterogeneity of mesenchymal stem cells, it may be possible to find specific stem cell subpopulations with a definite differentiation capacity toward cardiac lineage. A parameter to assess cardiac differentiation specificity could be surface marker expression; a population with an immunophenotype similar to cardiac stem cells may have a superior therapeutic value than unsorted mesenchymal stem cells. We hypothesize the existence of a cell line that combines the expression of cardiac stem cell surface markers with those of mesenchymal stem cells, a suitable name for this population is cardiomesenchymal stem cells (CMSC); such cells would be ideal for cardiac regeneration.

Pre-conditioning with CDP-choline attenuates oxidative stress-induced cardiac myocyte death in a hypoxia/reperfusion model.

BACKGROUND: CDP-choline is a key intermediate in the biosynthesis of phosphatidylcholine, which is an essential component of cellular membranes, and a cell signalling mediator. CDP-choline has been used for the treatment of cerebral ischaemia, showing beneficial effects. However, its potential benefit for the treatment of myocardial ischaemia has not been explored yet. AIM: In the present work, we aimed to evaluate the potential use of CDP-choline as a cardioprotector in an in vitro model of ischaemia/reperfusion injury. METHODS: Neonatal rat cardiac myocytes were isolated and subjected to hypoxia/reperfusion using the coverslip hypoxia model. To evaluate the effect of CDP-choline on oxidative stress-induced reperfusion injury, the cells were incubated with H2O2 during reperfusion. The effect of CDP-choline pre- and postconditioning was evaluated using the cell viability MTT assay, and the proportion of apoptotic and necrotic cells was analyzed using the Annexin V determination by flow cytometry. RESULTS: Pre- and postconditioning with 50 mg/mL of CDP-choline induced a significant reduction of cells undergoing apoptosis after hypoxia/reperfusion. Preconditioning with CDP-choline attenuated postreperfusion cell death induced by oxidative stress. CONCLUSION: CDP-choline administration reduces cell apoptosis induced by oxidative stress after hypoxia/reperfusion of cardiac myocytes. Thus, it has a potential as cardioprotector in ischaemia/reperfusion-injured cardiomyocytes.

Treatment of reperfused ischemia with adipose-derived stem cells in a preclinical Swine model of myocardial infarction.

The aim of the study was to determine the long-term effect of transplantation of adipose-derived stromal cells (ADSCs) in a preclinical model of ischemia/reperfusion (I/R). I/R was induced in 28 Goettingen minipigs by 120 min of coronary artery occlusion followed by reperfusion. Nine days later, surviving animals were allocated to receive transendocardial injection of a mean of 213.6 ± 41.78 million green fluorescent protein (GFP)-expressing ADSCs (n = 7) or culture medium as control (n = 9). Heart function, cell engraftment, and histological analysis were performed 3 months after transplantation. Transplantation of ADSCs induced a statistically significant long-lasting (3 months) improvement in cardiac function and geometry in comparison with control animals. Functional improvement was associated with an increase in angiogenesis and vasculogenesis and a positive effect on heart remodeling with a decrease in fibrosis and cardiac hypertrophy in animals treated with ADSCs. Despite the lack of cell engraftment after 3 months, ADSC transplantation induced changes in the ratio between MMP/TIMP. Our results indicate that transplantation of ADSCs, despite the lack of long-term significant cell engraftment, increases vessel density and prevents adverse remodeling in a clinically relevant model of myocardial infarction, strongly suggesting a paracrine-mediated effect. ADSCs thus constitute an attractive candidate for the treatment of myocardial infarction.

Adipose stromal vascular fraction improves cardiac function in chronic myocardial infarction through differentiation and paracrine activity.

Fresh adipose-derived cells have been shown to be effective in the treatment of acute myocardial infarction (MI), but their role in the chronic setting is unknown. We sought to determine the long-term effect of the adipose derived-stromal vascular fraction (SVF) cell transplantation in a rat model of chronic MI. MI was induced in 82 rats by permanent coronary artery ligation and 5 weeks later rats were allocated to receive an intramyocardial injection of 10(7) GFP-expressing fresh SVF cells or culture media as control. Heart function and tissue metabolism were determined by echocardiography and (18)F-FDG-microPET, respectively, and histological studies were performed for up to 3 months after transplantation. SVF induced a statistically significant long-lasting (3 months) improvement in cardiac function and tissue metabolism that was associated with increased revascularization and positive heart remodeling, with a significantly smaller infarct size, thicker infarct wall, lower scar fibrosis, and lower cardiac hypertrophy. Importantly, injected cells engrafted and were detected in the treated hearts for at least 3 months, directly contributing to the vasculature and myofibroblasts and at negligible levels to cardiomyocytes. Furthermore, SVF release of angiogenic (VEGF and HGF) and proinflammatory (MCP-1) cytokines, as well as TIMP1 and TIMP4, was demonstrated in vitro and in vivo, strongly suggesting that they have a trophic effect. These results show the potential of SVF to contribute to the regeneration of ischemic tissue and to provide a long-term functional benefit in a rat model of chronic MI, by both direct and indirect mechanisms.

Comunicación de un caso de malformación arteriovenosa pulmonar en la adolescencia / Arteriovenous malformation of the lung in a fourteen year old girl

Las malformaciones arteriovenosas pulmonares (MA VP) son comunicaciones anormales entre las arterias y las venas pulmonares. Las MAVP, están caracterizadas por cortocircuitos de derecha a izquierda de grado variable y el efecto de estas comunicaciones depende del tamaño de los vasos involucrados. Puede presentarse hipoxemia, hipocratismo digital y poliglobulia secundario al cortocircuito intrapulmonar. Presentamos el caso de un paciente femenino de 14 años de edad con MA VP pulmonar, cuyos hallazgos a la exploración física fueron hipocratismo digital y cianosis.

Pulmonary arteriovenous malformations (PVAM) are abnormal communications between pulmonary arteries and pulmonary veins, which are more commonly congenital in nature. Pulmonary arteriovenous fistulae are characterized by right-to-left shunts of variable magnitude; the effect of these communications depends on the size of the vessels involved. Arterial oxygen desaturation, cyanosis, clubbing of the fingers, and polycythemia may occur, secondary to the intrapulmonary shunt. We report the case of a 14-year-old female patient with PA VM; the findings on physical examination were clubbing of her fingers and cyanosis.

[Early diagnosis of a newborn with a mediastinal mass]. / Recién nacido con masa mediastinal: diagnóstico temprano.

Neuroblastoma is an embryonal tumour that evolves from the neural crest cell. This neoplasm may arise at any site in the sympathetic nervous system, including the brain, the cervical region, the posterior mediastinum, the para-aortic sympathetic ganglia, the pelvis, and the adrenal medulla. The clinical presentation in neonatal age is rare and the differential diagnosis includes congenital lung malformations, pneumoniae, atelectasia, etc. The case of a newborn with a mediastinal neuroblastoma is presented. This case illustrates how a patient with an X-ray image compatible with a thoracic tumor should be studied.

Recién nacido con masa mediastinal: diagnóstico temprano / Early diagnosis of a newborn with a mediastinal mass

El neuroblastoma es un tumor embrionario que evoluciona a partir de las células de la cresta neural. Esta neoplasia puede originarse en cualquier sitio del sistema nervioso simpático, incluyendo el cerebro, la región cervical, el mediastino posterior, los ganglios simpáticos paraaórticos, la pelvis y la médula de las glándulas suprarrenales. La presentación en la etapa neonatal es rara y en el diagnóstico diferencial deben incluirse las malformaciones congénitas broncopulmonares, neumonías, atelectasias, etc. Se presenta el caso de un recién nacido con neuroblastoma mediastinal, que ejemplifica cómo hacer el abordaje clínico de un paciente con imagen radiológica de masa torácica.

Neuroblastoma is an embryonal tumour that evolves from the neural crest cell. This neoplasm may arise at any site in the sympathetic nervous system, including the brain, the cervical region, the posterior mediastinum, the para aortic sympathetic ganglia, the pelvis, and the adrenal medulla. The clinical presentation in neonatal age is rare and the differential diagnosis includes congenital lung malformations, pneumoniae, atelectasia, etc. The case of a newborn with a mediastinal neuroblastoma is presented. This case illustrates how a patient with an X ray image compatible with a thoracic tumor should be studied.

Extracción de cuerpos extraños de la vía aérea en niños mediante broncoscopía flexible / Removal of tracheobronchial foreign bodies in infants and children by flexible bronchoscopy

Objetivo: Informar los resultados iniciales en la extracción de cuerpos extraños de la vía aérea de pacientes pediátricos mediante broncoscopía flexible. Material y métodos: Todos los pacientes menores de 18 años de edad referidos al Servicio de Broncoscopía del Instituto Nacional de Enfermedades Respiratorias con diagnóstico de aspiración de cuerpo extraño durante el periodo de marzo a diciembre de 2004. Resultados: Ocho pacientes entre 18 meses y 12 años (promedio 3 años, 5 meses), 5 del género masculino y 3 del femenino. En 4, el cuerpo extraño estaba en tráquea, 1 en bronquio intermediario, 1 en bronquio para el lóbulo inferior izquierdo y 2 en bronquio principal derecho. En 6 se logró extraer el cuerpo extraño en el primer intento con un broncoscopio flexible de 6.3 mm de diámetro, no se presentaron complicaciones mayores. En 2 pacientes, la extracción fue imposible con instrumental flexible y se realizó con broncoscopio rígido; en ambos, el cuerpo extraño estaba firmemente impactado en el bronquio después de tres meses y un año, respectivamente, de haber sido aspirado. No se presentaron complicaciones mayores. Conclusiones: Este estudio aporta evidencia útil para apoyar la broncoscopía flexible en la extracción de cuerpos extraños de las vías aéreas de pacientes pediátricos.

Objective: Report our experience in the removal of tracheobronchial foreign bodies in infants and children by flexible bronchoscopy. Patients and methods: All infants and children referred to the Department of Bronchoscopy from March to December 2004. Results: Eight patients from 18 months to 12 years, average 3 years and 5 months; 5 male, 3 female. Localization: 4 in the trachea, 1 in the intermediary bronchus, 1 in the left lower lobe bronchus and 2 in the main right bronchus. The foreign body was removed at the first attempt in 6 cases with a 6.3 mm dm flexible bronchoscope. Rigid bronchoscopy was successfully used in the other 2 after failure with the flexible instrument because the foreign bodies were heavily impacted; they had been aspirated 3 and 12 months before. There were no major complications. Conclusions: This study provides support for the removal of tracheobronchial foreign bodies in infants and children by flexible bronchoscopy.