Pathological and MR-DWI study of the acute hepatic injury model after stem cell transplantation

AIM:To investigate apparent diffusion coefficient (ADC) values as an indication of reconditioning of acute hepatic injury (AHI) after allogeneic mononuclear bone marrow cell (MBMC) transplantation.METHODS:Three groups were used in our study:a cell transplantation group (n=21),transplantation control group (n=21) and normal control group (n=10).AHI model rabbits in the cell transplantation group were injected with 5 mL of MBMC suspension at multiple sites in the liver and the transplantation controls were injected with 5 mL D-Hanks solution.At the end of the 1st,2nd and 4th wk,7 rabbits were randomly selected from the cell transplantation group and transplantation control group for magnetic resonance diffusion-weighted imaging (MR-DWI) and measurement of the mean ADC values of injured livers.After MR-DWI examination,the rabbits were sacrificed and the livers subjected to pathological examination.Ten healthy rabbits from the normal control group were used for MRDWI examination and measurement of the mean ADC value of normal liver.RESULTS:At all time points,the liver pathological scores from the cell transplantation group were significantly lower than those in the transplantation control group (27.14±1.46 vs 69.29±6.16,22.29±2.29 vs 57.00±1.53,19.00±2.31vs 51.86±6.04,P=0.000).The mean ADC values of the cell transplantation group were significantly higher than the transplantation control group ((1.07±0.07)×10-3 mm2/svs (0.69±0.05)×10-3 mm2/s,(1.41±0.04)×10-3 mm2/s vs (0.84±0.06)×10-3 mm2/s,(1.68±0.04)×10-3 mm2/svs (0.86±0.04)×10-3 mm2/s,P=0.000).The pathological scores of the cell transplantation group and transplantation control group gradually decreased.However,their mean ADC values gradually increased to near that of the normal control.At the end of the 1st wk,the mean ADC values of the cell transplantation group and transplantation control group were significantly lower than those of the normal control group [(1.07±0.07)×10-3 mm2/s vs (1.76±0.03)×10-3 mm2/s,(0.69±0.05)×10-3 mm2/s vs (1.76±0.03)×10-3 mm2/s,P=0.000].At any 2 time points,the pathological scores and the mean ADC values of the cell transplantation group were significantly different (P=0.000).At the end of the 1st wk,the pathological scores and the mean ADC values of the transplantation control group were significantly different from those at the end of the 2nd and 4th wk (P=0.000).However,there was no significant difference between the 2nd and 4th wk (P=0.073 and 0.473,respectively).The coefficient of correlation between the pathological score and the mean ADC value in the cell transplantation group was-0.883 (P=0.000) and-0.762 (P=0.000) in the transplantation control group.CONCLUSION:Tracking the longitudinally dynamic change in the mean ADC value of the AHI liver may reflect hepatic injury reconditioning after allogeneic MBMC transplantation.

Fetal lung surfactant and development alterations in intrahepatic cholestasis of pregnancy

AIM: To investigate the association between total bile acid(TBA) level during intrahepatic cholestasis of pregnancy(ICP) and fetal lung surfactant alteration. METHODS: We recruited 42 ICP and 32 normal pregnancy women in this study. The maternal blood, fetal blood and amniotic fluid TBA level were detected using a circulating enzymatic method. Umbilical blood pulmonary surfactant protein A(SP-A) was evaluated with enzyme-linked immunosorbent assay. High performance liquid chromatography was used for the determination of phosphatidyl choline(PC), phosphatidyl inositol(PI), lysolecithin(LPC) and sphingomyelin(SM). Amniotic fluid lamellar body was counted with a fully automatic blood cell counter. Fetal lung area and fetal body weight were calculated from data obtained with an iu22 color supersonic diagnostic set. Clinical information of a nonstress test, amniotic fluid properties and neonatal Apgar score, and birth weight were recorded for review. RESULTS: The TBA level in maternal blood, fetal blood and amniotic fluid in the ICP group were significantly higher than that in the control group(maternal blood: 34.11 ± 6.75 mmol/L vs 4.55 ± 1.72 mmol/L, P < 0.05; fetal blood: 11.9 ± 2.23 mmol/L vs 3.52 ± 1.56 mmol/L, P < 0.05; amniotic fluid: 3.89 ± 1.99 mmol/L vs 1.43 ± 1.14 mmol/L, P < 0.05). Amniotic fluid PC and PI in the ICP group were significantly lower than that in the control group(PC: 65.71 ± 7.23 μg/m L vs 69.70 ± 6.68 μg/m L, P < 0.05; PI: 3.87 ± 0.65 μg/m L vs 4.28 ± 0.74 μg/m L, P < 0.05). PC/LPC ratio of the ICP group was lower than that of the control group(14.40 ± 3.14 vs 16.90 ± 2.52, P < 0.05). Amniotic LB in the ICP group was significantly lower than that of the control group((74.13 ± 4.37) × 109/L vs(103.0 ± 26.82) × 109/L, P < 0.05). Fetal umbilical blood SP-A level in the ICP group was significantly higher than that of the control group(30.26 ± 7.01 ng/m L vs 22.63 ± 7.42 ng/m L, P < 0.05). Fetal lung area/body weight ratio of the ICP group was significantly lower than that of the control group(5.76 ± 0.63 cm2/kg vs 6.89 ± 0.48 cm2/kg, P < 0.05). In the ICP group, umbilical cord blood TBA concentration was positively correlated to the maternal blood TBA concentration(r = 0.746, P < 0.05) and umbilical blood SP-A(r = 0.422, P < 0.05), but it was negatively correlated to the amniotic fluid lamellar corpuscle(r = 0.810, P < 0.05) and fetal lung area/body weight ratio(r = 0.769, P < 0.05). Furthermore, umbilical blood TBA showed a negative correlation to PC, SM and PI(r pc = 0.536, r sm = 0.438, r pi = 0.387 respectively, P < 0.05). The neonatal asphyxia, neonatal respiratory distress syndrome, fetal distress and perinatal death rates in the ICP group are higher than that of theCONCLUSION: ICP has higher TBA in maternal and fetal blood and amniotic fluid. The high concentration of TBA may affect fetal pulmonary surfactant production and fetal lung maturation.