Closure of a Recurrent Bronchopleural Fistula Using a Matrix Seeded With Patient-Derived Mesenchymal Stem Cells
نویسندگان
چکیده
: Management of recurrent bronchopleural fistula (BPF) after pneumonectomy remains a challenge. Although a variety of devices and techniques have been described, definitive management usually involves closure of the fistula tract through surgical intervention. Standard surgical approaches for BPF incur significant morbidity and mortality and are not reliably or uniformly successful. We describe the first-in-human application of an autologous mesenchymal stem cell (MSC)-seeded matrix graft to repair a multiply recurrent postpneumonectomy BPF. Adipose-derived MSCs were isolated from patient abdominal adipose tissue, expanded, and seeded onto bio-absorbable mesh, which was surgically implanted at the site of BPF. Clinical follow-up and postprocedural radiological and bronchoscopic imaging were performed to ensure BPF closure, and in vitro stemness characterization of patient-specific MSCs was performed. The patient remained clinically asymptomatic without evidence of recurrence on bronchoscopy at 3 months, computed tomographic imaging at 16 months, and clinical follow-up of 1.5 years. There is no evidence of malignant degeneration of MSC populations in situ, and the patient-derived MSCs were capable of differentiating into adipocytes, chondrocytes, and osteocytes using established protocols. Isolation and expansion of autologous MSCs derived from patients in a malnourished, deconditioned state is possible. Successful closure and safety data for this approach suggest the potential for an expanded study of the role of autologous MSCs in regenerative surgical applications for BPF. SIGNIFICANCE Bronchopleural fistula is a severe complication of pulmonary resection. Current management is not reliably successful. This work describes the first-in-human application of an autologous mesenchymal stem cell (MSC)-seeded matrix graft to the repair of a large, multiply recurrent postpneumonectomy BPF. Clinical follow-up of 1.5 years without recurrence suggests initial safety and feasibility of this approach. Further assessment of MSC grafts in these difficult clinical scenarios requires expanded study.
منابع مشابه
Mesenchymal stem cells can survive on the extracellular matrix-derived decellularized bovine articular cartilage scaffold
Objective (s): The scarcity of articular cartilage defect to repair due to absence of blood vessels and tissue engineering is one of the promising approaches for cartilage regeneration. The objective of this study was to prepare an extracellular matrix derived decellularized bovine articular cartilage scaffold and investigate its interactions with seeded rat bone marrow mesenchymal stem cells (...
متن کاملMatrigel Enhances in vitro Bone Differentiation of Human Marrow-derived Mesenchymal Stem Cells
Objective(s) The use of co-culture cells as well as extra cellular matrix are among those strategies that have been employed to direct mesenchymal stem cell (MSC) bone differentiation in culture. In this regard, there is no study considering the effects of Matrigel on mesenchymal stem cell (MSC) in vitro bone differentiation. This was the subject of the present study. Materials and Methods ...
متن کاملCo-culture of Umbilical Cord-derived Hematopoietic and Mesenchymal Stem Cells on Protein-Coated poly-L-Lactic Acid Nanoscaffolds
Background and purpose: Umbilical cord blood (UCB) is a source of Hematopoietic stem cells (HSCs) and has received a lot of attention due to its availability, renewal capacity, proliferation rate, and differentiation potential. The main limitation of using these cells is their low quantity in one unite of UCB. To overcome this, HSCs co-culturing with UCB derived mesenchymal cells (MSCs) is a pr...
متن کاملOsteogenic Differentiation of Mesenchymal Stem Cells Via Osteoblast- Imprinted Substrate: In Vitro and In Vivo Evaluation in Rat Model
BACKGROUND: Stem cells have great effects in clinical cell-based therapy. Accordingly, controlling the behavior and directing the fate of stem cells cultured in the laboratory is an important issue. OBJECTIVES: The aim of this study was to evaluate osteogenic properties of adipose derived mesenchymal stem cells (ADSCs) which differentiated toward osteogenic linage by osteoblast-imprinted substr...
متن کاملLaminin matrix promotes hepatogenic terminal differentiation of human bone marrow mesenchymal stem cells
Objective(s):The application of stem cells holds great promises in cell transplants. Considering the lack of optimal in vitro model for hepatogenic differentiation, this study was designed to examine the effects of laminin matrix on the improvement of in vitro differentiation of human bone marrow mesenchymal stem cells (hBM-MSC) into the more functional hepatocyte-like cells. Materials and Met...
متن کامل