Effect of Cell Derived Matrices on growth and differentiation of human Wharton's jelly derived Mesenchymal Stem Cells.

Cell derived matrices (CDMs) are scaffolds constructed by decellularization of cellular matrices from different tissues and organs. Since cell derived matrices mimic the ECM of native tissues, CDM plays an essential role in the preparation of bioscaffolds. CDM scaffolds from Mesenchymal Stem Cells (MSCs) have been reported to support cell adhesion and proliferation of its own cells. Therefore, in this study we aimed to test if growth of human Wharton's jelly derived MSCs (hWJ-MSCs) may be enhanced when cultured on their own cell derived matrices. To do this, MSCs were induced to generate ECM using ascorbic acid. Thus, obtained matrices were decellularized and characterized quantitatively for changes in their biochemical components (total protein, collagen, glycosaminoglycans) and qualitatively for fibronectin, laminin and collagen (I & IV) by immunostaining. Our results show the retention of essential ECM components in the decellularized WJ-CDM. The influence of WJ-MSC-derived CDM on proliferation and differentiation of WJ-MSCs were evaluated by comparing their growth on collagen and fibronectin only coated plates. A non-coated tissue culture polystyrene plate (TCPS/WC) served as control. Our cell proliferation results show that no significant changes were observed in the proliferation of MSCs when cultured on WJ-MSC derived CDM as compared to the bio-coated and non-coated cultures. However, gene expression analysis of the differentiation process showed that osteogenic and adipogenic differentiation potential of the WJ-MSCs was significantly increased upon culturing them on WJ-MSC-CDM. In conclusion, the present study reveals that the WJ-MSCs cultured on WJ-MSC-CDM may augment osteogenic and adipogenic differentiation.

Central Pancreatectomy for Central Pancreatic Lesions: A Single-Institution Experience.

Background Pancreaticoduodenectomy and distal pancreatectomy are radical procedures for pancreatic lesions with high postoperative morbidity and mortality even in experienced hands. Central pancreatectomy is an alternative less radical procedure for centrally located pancreatic lesions that are benign or have a low malignant potential. It involves removing the central portion of the pancreas and has the advantage of preserving the pancreatic parenchyma, thereby decreasing the postoperative endocrine and exocrine insufficiencies. Methods We conducted a prospective study of six cases of central pancreatectomy in the Department of Surgical Gastroenterology and Liver Transplant, Government Stanley Medical College, India, between the years 2015 and 2019. All patients with lesions in the neck and proximal body of the pancreas were clinically and radiologically evaluated, and those with benign or borderline malignant lesions underwent central pancreatectomy by a standardized technique. Results The mean age of the patients was 27.8 years (range: 14 years - 37 years). Most of the patients were females (66.6%). The most common presenting symptom was abdominal pain, and the most common diagnosis was solid pseudopapillary neoplasm (83.3%). The mean diameter of the lesion was 6.1 cm. All patients underwent pancreaticojejunostomy of the distal stump. The median operative time and the blood loss were 310 minutes and 85 ml, respectively. Two patients developed biochemical postoperative pancreatic fistula, and in the long-term follow-up, none of them developed endocrine or exocrine insufficiency. Conclusion Central pancreatectomy is a safe and effective alternative for benign and low-grade lesions in the neck and body of the pancreas in which the head of the pancreas and a significant portion of the distal body and tail of the pancreas is uninvolved. Standardization of this pancreas-preserving procedure will result in better outcomes.

Role of Human Wharton's Jelly Derived Mesenchymal Stem Cells (WJ-MSCs) for Rescue of d-Galactosamine Induced Acute Liver Injury in Mice.

BACKGROUND/AIM: Mesenchymal stem cells (MSCs) are multipotent precursor cells having self-renewal ability making them a candidate for use in regenerative medicine. Acute liver injury results in sudden loss of hepatic function leading to organ failure. Liver transplantation is often required to salvage patients with acute liver failure. Due to shortage of organs, identification of alternate method is the need of the hour. In view of this, an attempt has been made to check the regenerative ability of WJ-MSCs (wharton's jelly derived MSC) in mice models for acute liver injury. METHODS: Swiss albino mice weighing 25 ± 5 g were used in this study. The control mice (Group I), was given saline. Group II mice received d-Galactosamine (d-GalN-800 mg/kg; i.p). Group III mice similar with Group II, received WJ-MSCs (5 × 105 cells/0.5 ml DMEM) through tail vein, 24 h after d-GalN administration and Group IV mice received MSC alone. RESULTS: Parameters, indicative of hepatotoxicity and oxidative stress were analyzed. A two-fold elevation in the marker enzymes of liver toxicity such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (SAP), and total serum bilirubin (TBIL) confirms hepatocellular injury, while a greater than four-fold increase in malondialdehyde (MDA) formation, along with around 40% fall in superoxide-dis-mutase (SOD) activity was indicative of oxidative stress and loss of hepatocellular membrane integrity induced by d-GalN. The above biochemical and pathological changes were significantly restored in mice that received WJ-MSCs indicating hepatoprotective and probable regenerative property. CONCLUSION: The present study showed that WJ-MSC treatment is able to rescue/ameliorate the hepatotoxicity induced by d-GalN in mice.

Endoscopic Management of Postoperative Stapled Anastomosis Bleeding.

To the Editor: Knowledge has evolved and the use of staplers in gastrointestinal surgery is now widespread. They are associated with low rates of postoperative complications. Postoperative anastomotic complications with stapling devices are relatively rare, with a reported incidence between 0 and 2.5%.1 How to cite this article: Krishnan A, Velayutham V, Satyanesan J. Endoscopic Management of Postoperative Stapled Anastomosis Bleeding. Euroasian J Hepato-Gastroenterol 2014;4(1):62-63.

Role of endoscopic band ligation in management of non-variceal upper gastrointestinal bleeding.

BACKGROUND: Acute non-variceal upper GI bleeding (NVUGIB) is a challenging emergency condition. Early endoscopic therapy has been recommended as the first-line of treatment for upper GI bleeding (UGIB) as it has been shown to reduce recurrent bleeding. We aimed to determine the various causes of NVUGIB and discuss the role of band ligation. PATIENTS AND METHODS: A total of 74 patients with NVUGIB who had been treated with endoscopic band ligation (EBL), between November 2006 and December 2011, were included in the study. Bleeding lesions included Dieulafoy lesion (DL), Mallory-Weiss tears (MWTs), duodenal ulcer, post-surgical anastomosis bleed and gastric ulcer after polypectomy. After the basic life support was provided, all patients underwent emergent and elective endoscopy. RESULTS: The study comprised 49 (66.2%) men and 25 (33.8%) women. The mean age was 48.2 +/- 6.4 years for men and 40.6 +/- 2.2 years for women. MWTs and DL constituted the majority of bleeding lesions, of these 26 and 17, respectively required EBL. Other causes were: prepyloric ulcer 11; duodenal ulcer 9; ulcers in antrum 5; post-polypectomy bleed 3; anastomosis bleed 1; and malignant lesions 2. Bleeding stopped after endoscopic therapy in 96.5% of patients. The single failure was in bleeding from a pre-pyloric lesion which was treated by using injection sclerotherapy with 1:10,000 adrenaline solution where EBL was not successful. CONCLUSION: EBL provides safe and effective modality for haemostasis in patients with NVUGIB. EBL could be considered as an alternative method of choice for treatment of endoscopic haemostasis in patients with NVGIB.