Yieh-Loong Tsai

Clonal Amniotic Fluid-Derived Stem Cells Express Characteristics of Both Mesenchymal and Neural Stem Cells

Abstract Recent evidence has shown that amniotic fluid may be a novel source of fetal stem cells for therapeutic transplantation. We previously developed a two-stage culture protocol to isolate a population of amniotic fluid-derived mesenchymal stem cells (AFMSCs) from second-trimester amniocentesis. AFMSCs maintain the capacity to differentiate into multiple mesenchymal lineages and neuron-like cells. It is unclear whether amniotic fluid contains heterogeneous populations of stem cells or a subpopulation of primitive stem cells that are similar to marrow stromal cells showing the behavior of neural progenitors. In this study, we showed a subpopulation of amniotic fluid-derived stem cells (AF-SCs) at the single-cell level by limiting dilution. We found that NANOG- and POU5F1 (also known as OCT4)-expressing cells still existed in the expanded single cell-derived AF-SCs. Aside from the common mesenchymal characteristics, these clonal AF-SCs also exhibit multiple phenotypes of neural-derived cells such as NES, TUBB3, NEFH, NEUNA60, GALC, and GFAP expressions both before and after neural induction. Most importantly, HPLC analysis showed the evidence of dopamine release in the extract of dopaminergic-induced clonal AF-SCs. The results of this study suggest that besides being an easily accessible and expandable source of fetal stem cells, amniotic fluid will provide a promising source of neural progenitor cells that may be used in future cellular therapies for neurodegenerative diseases and nervous system injuries.

The recommendations of the American Institute of Medicine (IOM) for normal and underweight women to reduce the risk of low birth weight.

OBJECTIVE The recommendations of the American Institute of Medicine (IOM) were revised recently in order to enhance maternal and neonatal health. The aim of our study was to investigate the risk of low birth weight (LBW) among women who follow the IOM recommendations. MATERIALS AND METHODS Gestational weight gain (GWG) and rate of weight gain (RWG) across the different periods of pregnancy among women who delivered LBW fetuses were analyzed retrospectively. The logistic regression was used to analyze the risk of LBW and to identify recommendations. RESULTS From January 2008 to December 2009, 117 out of 4924 (2.4%) women delivered term LBW fetuses. After exclusions, 88 LBW and 91 control subjects were enrolled into the study. There was increased risk of cesarean delivery [odds ratio (OR) with 95% confidence interval (CI): 2.53 (1.33-4.83)] and neonatal asphyxia within 7 days of birth [OR 95% CI: 5.71 (1.21-26.83)] for the LBW group compared with the control group. Normal weight women [body mass index (BMI): 18.5-24.9 kg/m(2)] who followed the GWG and RWG recommendations of the IOM had no increased risk of LBW. However, there was a two-to three-fold increased LBW risk among normal weight women who followed the IOM guidelines when, during the 2(nd) trimester, their GWG was ≤7 kg [OR 95% CI: 2.21 (1.28-6.49)] or their RWG was ≤0.45 kg/week [OR 95% CI: 3.14 (1.32-7.47)]. Among underweight women (BMI < 18.5 kg/m(2)), if, during the 2(nd) and 3(rd) trimesters, they followed the lower range of the GWG and RWG recommendations of the IOM there was a five-fold increased risk of LBW if the GWG was ≤13 kg [OR 95% CI: 5.29 (1.61-25.51)]; or the RWG was ≤0.45 kg/week [OR 95% CI: 5.35 (1.61-24.66)]. CONCLUSION For underweight women, it is suggested that they follow the upper range of the IOM recommendation in order to avoid LBW. For normal weight women, although the IOM guidelines provide a good basis, it is suggested that they carefully follow the recommended GWG and the RWG values during the 2(nd) trimester, which is a very important period for fetal growth.

Following the 2009 American Institute of Medicine recommendations for normal body mass index and overweight women led to an increased risk of fetal macrosomia among Taiwanese women

OBJECTIVE This study aimed to investigate the risk of birth weights over 4000 g (macrosomia) in association with following the 2009 American Institute of Medicine (AIOM) recommendations. MATERIALS AND METHODS Seventy-six nondiabetic women who delivered a singleton, term macrosomic fetus and 82 women who delivered a singleton, term fetus weighing <4000 g were analyzed retrospectively. The relationship between the risk of macrosomia and gestational weight gain in different periods of pregnancy was investigated using logistic regression. RESULTS The incidence of macrosomia from January 2008 to December 2009 was 1.8% among the Taiwanese women. The incidences of cesarean delivery (54.5% vs. 18.2%, p < 0.001) and blood loss >1000 mL at delivery (35.5% vs. 6.1%, p < 0.0001) were associated with macrosomia. The risk of macrosomia among normal weight women with gestational weight gain greater than 13 kg increased four-fold [odds ratio (OR) = 4.88; 95% confidence interval (CI) 1.84-12.90]. For overweight women with total gestational weight gain >11.5 kg, the risk of macrosomia increased nine-fold (OR = 9.63; 95% CI 1.76-52.74). CONCLUSION Macrosomia resulted in more cesarean deliveries and greater maternal blood loss at birth. In Taiwan, to prevent macrosomia, we suggest that the total gestational weight gain should be <11.5 kg among normal weight women and within 10 kg for overweight women.

EXPRESSION OF A HOECHST 33342 EFFLUX PHENOMENON AND COMMON CHARACTERISTICS OF PLURIPOTENT STEM CELLS IN A SIDE POPULATION OF AMNIOTIC FLUID CELLS

OBJECTIVE The aim of this study was to verify the existence of a side population (SP) of cells in second-trimester amniotic fluid. MATERIALS AND METHODS Amniotic fluid samples (n = 35) were obtained, and the number and size of viable amniotic fluid cells (AFCs) were analyzed. Small AFCs (SAFCs) and large AFCs (LAFCs) were isolated using a sterile 10-microm pore size strainer. Hoechst 33342 dye exclusion assay, flow cytometry analysis, reverse transcriptase polymerase chain reaction and immunocytochemistry were used to analyze the characteristics of SAFCs and LAFCs. RESULTS The mean concentration of viable AFCs from 16 to 21 weeks of gestation was 0.3 x 10(5), 0.8 x 10(5), 1.1 x 10(5), 1.3 x 10(5), 1.0 x 10(5) and 1.0 x 10(5) cells/mL respectively. The mean percentage of SAFCs from 16 to 21 weeks of gestation was 27.3%, 40.5%, 49.7%, 60.2%, 41.0% and 58.2%, respectively. The Hoechst 33342 efflux phenomenon was obvious among SAFCs but was rare in the LAFC population. Flow cytometry analyses showed that cell surface antigen expression on LAFCs and SAFCs were positive for CD29, CD44, CD73, CD90, CD166 and HLA-I, but negative for CD31, CD34, CD45, CD117 and HLA-II. Importantly, Nanog, Oct-4, ABCG2 and SOX2 expression in cells was easily detectable among the SAFC population. Expression of Nanog and ABCG2 was not observed among LAFCs. CONCLUSION Amniotic fluid contains a SP that was found mostly among the SAFCs. Enriched SP cells isolated by the efflux of Hoechst 33342 could be a novel and promising source of pluripotent-like amniotic derived stem cells for cellular therapy in the near future.

Fertility outcomes following pelvic embolization in women with acquired uterine arteriovenous malformation.

OBJECTIVE Acquired uterine arteriovenous malformation (UAVM) is a rare, life-threatening disease. Angiography with uterine arterial embolization (UAE) is the diagnostic tool and a choice of fertility-sparing treatment. Here, we present a series of five successful pregnancies after embolization of UAVM. CASE REPORTS Three reproductive aged women were treated for UAVM, resulting in five successful pregnancies. Their past history suggested that three cases had had previous uterine procedures, including second trimester abortion and elective dilatation and curettage. Intermittent heavy vaginal bleeding was the primary symptom of UAVM. One patient with anemia had two ineffective embolizations and achieved a singleton pregnancy after the third embolization. However, intrauterine fetal demise with severe fetal growth retardation was noted on the 28th gestation week. The other two women had temporary ovulation disorder after UAE. After Clomiphene Citrate (CC) treatment, successful pregnancies were achieved and carried to term uneventfully. CONCLUSION UAE is an acceptable method for preserving fertility and treatment in women with symptomatic UAVMs.