M Barsotti

Fibrin acts as biomimetic niche inducing both differentiation and stem cell marker expression of early human endothelial progenitor cells

Objectives:  Transplantation of endothelial progenitor cells (EPCs) is a promising approach for revascularization of tissue. We have used a natural and biocompatible biopolymer, fibrin, to induce cell population growth, differentiation and functional activity of EPCs.

Circulating Endothelial Progenitor Cells Characterization, Function and Relationship with Cardiovascular Risk Factors

Since the first description of putative progenitor endothelial cells mobilized from bone marrow by stimuli like ischemia and cytokines, several studies in animals have confirmed their role in neovascularization of ischemic organs. In ischemic myocardium endothelial progenitor cells can prevent cardiomyocyte apoptosis, reduce remodeling and improve cardiac function. These observations led to the hypothesis of endothelial progenitor cells as possible cell-based therapy in patients by autologous transplantation in ischemic tissue or by improving peripheral circulating numbers with mobilization by cytokines. Early trials, including a randomized one, suggest that the intracoronary autologous bone marrow cell transfer after myocardial infarction exerts at least short term functional benefits. Since endothelial damage and dysfunction play a critical role in atherosclerosis disease, research interest was addressed to evaluate the role of progenitor endothelial cells in vascular endothelial layer maintenance. Opposing to local resident endothelial cells poor proliferation rate, progenitor endothelial cells regenerative capacity, homing and integration into blood vessels have been interpreted as a protective role of these cells in vascular homeostasis. Indeed, the number and function of endothelial progenitor cells relate with the progression of atherosclerosis; the accumulation of cardiovascular risk factors or an increased overall risk are inversely associated with endothelial progenitor cells number and function. Finally, recent studies have shown a role of progenitor cells numbers to predict cardiovascular events, raising endothelial progenitor cells to the podium of novel prognostic biomarker.

Role of Endothelial Progenitor Cell Mobilization After Percutaneous Angioplasty Procedure

Circulating endothelial progenitor cells (EPCs) are bone marrow-derived cells, contributing to endothelial cell regeneration of injured vessels as well as neovascularization of ischemic lesions. EPC levels and function are inversely correlated with cardiovascular risk factors, can predict the occurrence of adverse events and atherosclerotic disease progression. Ischemia and inflammation are the primary triggers for EPC mobilization and homing, however, vascular trauma, as it occurs during surgical procedures, has been demonstrated to stimulate EPC mobilization even in absence of tissue ischemia. The effect of angioplasty on EPCs is not well defined, mainly because of the different and sometimes contrasting clinical results, due to low numbers of patients enrolled and to lack of standardization in evaluating EPCs. Aim of this review is to report recent results on the effect of EPC mobilization and homing after angioplasty, attempting to summarize them in a comprehensive model. The effect on EPCs of different kind of stents and the potential use of new stents able to attract EPCs will be also described. Results obtained in patients undergoing angioplasty in different vascular districts (coronary, peripheral and carotid) will be shown, together with the correlation between circulating progenitor cells and restenosis.

Living Kidney Transplantation: Evaluation of Renal Function and Morphology of Potential Donors

The evaluation of potential living kidney donors requires an accurate study of renal function and morphology. The gold standard to assess renal function is the measurement of glomerular filtration rate (GFR). However, GFR is often estimated from serum creatinine (SCr), cystatin C (SCys), or creatinine clearance (CCr). Otherwise, GFR is predicted using formulas based on SCr or SCys. Ultrasound scanning evaluates morphology and dimensions, while scintigraphy provides information on morphofunctional symmetry of kidneys. The aim of this study in 79 potential donors was to assess the accuracy of the tests employed to estimate GFR and the utility of renal ultrasound and scintigraphy for morphofunctional evaluation of potential donors. GFR (clearance of (99m)Tc-DTPA) was compared with estimates obtained with Cockcroft and Gault (CG-CCr) and Modification of Diet in Renal Disease (MDRD-GFR) formulas, and from SCys (Cys-GFR). The correlation with GFR was statistically significant for SCys and for all estimates, but not for SCr. CCr showed a poor agreement with GFR, with a large range of agreement and a marked and significant overestimation of GFR (33.8 mL/min). The accuracy of CG-CCr and MDRD-GFR as indicators of a GFR < 80 mL/min was better than that of Cys-GFR and CCr. However, their mean prediction errors versus GFR were relevant. Renal dimensions, particularly renal volume, showed a good correlation with GFR. The correlation was higher than that of all prediction equations. The direct measurement of GFR remains the reference method to assess renal function in potential kidney donors. The measurement of renal dimensions can provide useful information also on renal function.

Endothelial progenitor cell homing in human myocardium in patients with coronary artery disease

Endothelialprogenitorcells(EPCs)aremobilizedfrombonemarrowinto peripheral blood, contributing to the revascularization of ischemicareas, to endothelial repair and to the physiological maintenance ofvascularization. EPC mobilization and homing have been primarilylinked to ischemia and inflammation presence [1]. EPCs are directlycorrelated with endothelial function and inversely correlated withcardiovascular risk factors and atherosclerosis progression [2].EPClevelshavealsobeencorrelatedtoprognosisevaluationincardiovascu-lar disease [3].Regarding EPC correlation with coronary artery disease (CAD)presence and severity, an inverse relationship with CAD severity, inde-pendent of traditional risk factors, was demonstrated by EPC colonycounting [4],whileahighnumberofEPCsassociatedwithCADandcorre-latedwithstenosisseveritywereshownby flowcytometry [5].Recentlyanew protocol, adapted from the standardized ISHAGE protocol for hema-topoieticstemcells,hasbeendevelopedforEPClevelevaluationtoenablecomparison of clinical and laboratory data [6].While thepresence of circulatingEPCshasbeenwidely evaluated indifferent diseases, few studies tried to evaluate the presence of EPCs inhuman vital myocardium.TheaimofourstudywastoinvestigateEPClevelsbothinperipheralbloodand inmyocardium in thesame patients atthesame time, evalu-atingthecorrelationwith CADpresence. In bothsampleswequantifiedCD34

New-onset diabetes after kidney transplantation

Introduction. The occurrence of the new-onset diabetes after kidney transplantation is common and represents a risk factor for decreased survival of the graft and the patient. Case presentations. We report 6 cases of diabetes appeared in post renal transplantation. Treatment after kidney transplantation was based on corticosteroids associated with immunosuppressive therapy in all cases. Diabetes appeared after renal transplantation in 30% of cases, it was discovered during a systematic examination. The treatment consisted of insulin therapy for 3 patients, oral anti-diabetic for a patient and 2 patients had normalized their blood glucose levels after discontinuation of corticosteroids and immunosuppressive therapy adjustment. Conclusion. Immunosuppressive therapy associated with multiple risk factors presented by patients favor the occurrence of this diabetes.

PANCREAS TRANSPLANT ALONE IN TYPE 1 DIABETIC RECIPIENTS WITH OVERT DIABETIC NEPHROPATHY: RENAL FUNCTION OUTCOME: 2378

U. Boggi1, F. Vistoli1, C. Croce1, S. Signori1, C. Moretto1, M. Del Chiaro1, G. Amorese2, M. Barsotti3, P. Marchetti4 1Azienda Ospedaliero-universitaria Pisana, U.O. Chirurgia Generale e Trapianti, Pisa/ITALY, 2Azienda Ospedaliero-universitaria Pisana, U.O. Anestesia e Terapia Intensiva, Pisa/ITALY, 3Azienda Ospedalierouniversitaria Pisana, U.O. Nefrologia e Dialisi con Trapianti, Pisa/ITALY, 4Azienda Ospedaliero-universitaria Pisana, S.V.D. Endocrinologia e Metabolismo dei Trapianti d’Organo e Cellulari, Pisa/ ITALY

OUTCOME OF PANCREAS TRANSPLANTATION WITH 5 YEARS FOLLOW-UP OR MORE: 2312

F. Vistoli1, C. Croce1, S. Signori1, C. Moretto1, M. Del Chiaro1, G. Amorese2, M. Barsotti3, P. Marchetti4, U. Boggi1 1Azienda Ospedaliero-universitaria Pisana, U.O. Chirurgia Generale e Trapianti, Pisa/ITALY, 2Azienda Ospedaliero-universitaria Pisana, U.O. Anestesia e Terapia Intensiva, Pisa/ITALY, 3Azienda Ospedalierouniversitaria Pisana, U.O. Nefrologia e Dialisi con Trapianti, Pisa/ITALY, 4Azienda Ospedaliero-universitaria Pisana, S.V.D. Endocrinologia e Metabolismo dei Trapianti d’Organo e Cellulari, Pisa/ ITALY