K.M. Cherian

“Humanized” Stem Cell Culture Techniques: The Animal Serum Controversy

Cellular therapy is reaching a pinnacle with an understanding of the potential of human mesenchymal stem cells (hMSCs) to regenerate damaged tissue in the body. The limited numbers of these hMSCs in currently identified sources, like bone marrow, adipose tissue, and so forth, bring forth the need for their in vitro culture/expansion. However, the extensive usage of supplements containing xenogeneic components in the expansion-media might pose a risk to the post-transplantation safety of patients. This warrants the necessity to identify and develop chemically defined or “humanized” supplements which would make in vitro cultured/processed cells relatively safer for transplantation in regenerative medicine. In this paper, we outline the various caveats associated with conventionally used supplements of xenogenic origin and also portray the possible alternatives/additives which could one day herald the dawn of a new era in the translation of in vitro cultured cells to therapeutic interventions.

Pregnancy associated plasma protein-A (PAPP-A) as an early marker for the diagnosis of acute coronary syndrome.

AIMS AND OBJECTIVES Pregnancy associated plasma protein-A (PAPP-A), a metalloproteinase plays a pivotal role in the pathogenesis of atherosclerosis. Recent studies have reported that elevated levels of PAPP-A, signal the onset of acute coronary syndrome (ACS). We, therefore, proposed to study the analytical competence of PAPP-A in patients admitted to the emergency department with chest pain and finally diagnosed as ACS. METHODS AND RESULTS Pregnancy associated plasma protein-A was measured using enzyme-linked immunosorbent assay (ELISA) in 485 patients admitted to emergency care unit, of which 89 patients were diagnosed as Non-cardiac chest pain (NCCP). Elevated levels of PAPP-A were observed in patients diagnosed as ACS on comparison with the controls. Receiver operator characteristic (ROC) curve analysis showed PAPP-A to be a good discriminator between ischaemic and non-ischaemic patients. The area under the curve was found to be 0.904, 95% CI (0.874-0.929) with 90% sensitivity and 85% specificity (P< 0.0001). The cut-off value from the ROC curve was 0.55 μg/mL above which PAPP-A was considered to be positive. CONCLUSION Pregnancy associated plasma protein-A seems to be a promising biomarker for identification and risk stratification for patients with ACS.

Hybrid intraoperative pulmonary artery stenting in redo congenital cardiac surgeries

OBJECTIVE Reconstruction of branch pulmonary arteries (PAs) can be challenging in redo congenital heart surgeries. Treatment options like percutaneous stent implantation and surgical patch angioplasty may yield suboptimal results. We present our experience with hybrid intraoperative stenting which may be an effective alternative option. METHODS We retrospectively analyzed data of all patients with PA stenosis who underwent intraoperative PA branch stenting in our institution between January 2011 and December 2012. RESULTS Ten patients [6 females, median age 10 (1.4 to 37) years], underwent hybrid stenting of the PA. Primary cardiac diagnoses were pulmonary atresia with ventricular septal defect (VSD) in three patients, pulmonary atresia with intact ventricular septum in two, Tetralogy of Fallot (TOF) in one, Double outlet right ventricle (DORV) with pulmonary stenosis (PS) in one, complex single ventricle in two and VSD with bilateral branch PA stenosis in one patient. Concomitant surgeries were revision/reconstruction of RV-PA conduit in 4, Fontan completion in 4, repair of TOF with conduit placement in 1 and VSD closure in 1 patient. The left PA was stented in 7, the right in 2 and both in 1, with a total of 11 stents. There were no complications related to stent implantation. Two early postoperative deaths were unrelated to stent implantation. At mean follow-up period of 14.8 (12-26) months, stent position and patency were satisfactory in all survivors. None of them needed repeat dilatation or surgical reintervention. CONCLUSION Hybrid stenting of branch PA is a safe and effective option for PA reconstruction in redo cardiac surgeries. With meticulous planning, it can be safely performed without fluoroscopy.

Viability of cancerous cell lines as a function of energy delivered

Electroporation is an elegant technique used for proliferation control in Cancer cells. This budding mode of therapy called electrochemotherapy uses electrical pulses and chemodrugs to trigger cell death in cancerous cells. The efficacy of this technique depends on a variety of factors including electric field intensity, pulse duration and the number of pulses. In this study, Human cervical (ME180), Human Acute Myeloid Leukemia (KG1) and Human Promyelocytic leukemia (HL60) cancerous cell lines were subjected to electroporation in the presence of 1µM Bleomycin at 1200 V/cm, 100µs; 450 V/cm, 25ms; and 200 V/cm, 40ms. The energy applied and charge delivered with each pulse are also calculated. The results indicate that with increase in energy delivered, there in increase in cell death. This promises to be a very useful tool in for the treatment of patients suffering from chemo-refractive tumors.

The curious case of a button which led to the needle.

Foreign bodies in the heart are uncommon in children. These are often removed even if asymptomatic to prevent complications like erosion, embolization, bleeding, thrombosis, and endocarditis. We report the case of a one-and-a-half-year-old child with a hypodermic needle in the heart which was found incidentally and removed successfully by surgery.

Transcatheter closure of a residual aortopulmonary window through internal jugular vein access

The use of Amplatzer septal occluder for closing a residual aortopulmonary defect has been described. This is usually performed by femoral access. We report closure of a residual aortopulmonary defect using right internal jugular vein access in a patient who had no femoral access as a result of previous cannulation for surgical repair. The 1 cm defect was closed successfully using a 10 mm Amplatzer septal occluder. Technical difficulty anticipated was unfounded although it was more cumbersome than femoral access. Left to right cardiac defects including PDA and AP window are amenable to transcatheter closure through internal jugular vein access.

Hybrid stage I palliation for hypo-plastic left heart condition without a hybrid suite: suggestions for developing nations.

Cardiac hybrid procedures are performed in modern, spacious, and highly equipped hybrid suites in developed countries. Organizing such expensive suites in countries with an emerging economy is difficult from both a financial and logistics point of view. We share our experience of safely performing a Hybrid stage I palliation procedure for Aortic atresia with ventricular septal defect on a 2-month-old infant weighing 3.35 kg using minimal resources in a conventional catheterization laboratory.

Efficient and economical electro-drug delivery

Presented in this paper are our investigations on the application of short duration (milli and micro seconds) electrical voltage pulses for the treatment of breast carcinoma cells and also for delivering molecules into adult mesenchymal stem cells. Since current therapies do not work effectively for many patients, there is a need for alternative, affordable, yet effective treatments for various cancers and other diseases. For this purpose, electroporation, a pulse power technology was used as a tool to investigate its effect on viability and proliferation on human breast cancer cell lines and adult stem cells using various voltages and pulse durations. The results indicate that electrical pulses could be used effectively and economically to enhance drug transport across the normally impermeable plasma cell membranes as well as to reduce proliferation.

Indigenous decellularised jugular venous valved conduit in truncus arteriosus repair.

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Myocardial ischemia following arterial switch operation: An uncommon etiology

Myocardial ischemia following arterial switch operation (ASO) usually occurs due to coronary ostial narrowing that might result from technical failure in translocation of the coronary arteries to the neoaorta. We present an unusual case report of neonatal myocardial ischemia caused by coronary steal secondary to aortopulmonary collaterals, following ASO in transposition of great arteries.