Exploring Anti-Fibrotic Effects of Adipose-Derived Stem Cells: Transcriptome Analysis upon Fibrotic, Inflammatory, and Hypoxic Conditioning

Autologous fat transfers show promise in treating fibrotic skin diseases, reversing scarring and stiffness, and improving quality of life. Adipose-derived stem cells (ADSCs) within these grafts are believed to be crucial for this effect, particularly their secreted factors, though the specific mechanisms remain unclear. This study investigates transcriptomic changes in ADSCs after in vitro fibrotic, inflammatory, and hypoxic conditioning. High-throughput gene expression assays were conducted on ADSCs exposed to IL1-β, TGF-β1, and hypoxia and in media with fetal bovine serum (FBS). Flow cytometry characterized the ADSCs. RNA-Seq analysis revealed distinct gene expression patterns between the conditions. FBS upregulated pathways were related to the cell cycle, replication, wound healing, and ossification. IL1-β induced immunomodulatory pathways, including granulocyte chemotaxis and cytokine production. TGF-β1 treatment upregulated wound healing and muscle tissue development pathways. Hypoxia led to the downregulation of mitochondria and cellular activity.

Assessment of Small Paediatric Burns: A Coin-Based System

A review of paediatric burns in our burns facility in the United Kingdom demonstrated variable accuracy of size, and a majority documented as <1% total body surface area (TBSA). Accurate assessment is important for medical records, clinical management and non-accidental injuries. We propose to assess burn size with a coin-based system, where small burns are described by single/multiple sterling coins. Participants were asked about their confidence in evaluating small paediatric burns. Participants were given ten scenarios which included photographs of paediatric patients with small burns. They were asked to assess burn size in their normal manner (TBSA, measurement) and with a coin-based system. The 'burns' were drawn on children based on a given coin size and percentage so that the accuracy of the participant's answer was quantifiable. Participants provided qualitative feedback in a questionnaire on the coin-based system. Thirty nurses and medical staff of varying seniority actively involved in referral/management of paediatric burns took part, creating over 300 responses. In preliminary questions, 66% of participants did not feel confident in estimating paediatric burns and 83% needed to refer to a paediatric burns chart. Accuracy of burn size using TBSA and the coin-based system was 45% and 67%, respectively. The majority (97%) stated estimating size was easier, and 93% found it more accurate. A total of 87% found communication between colleagues easier. Results highlight the improved assessment of small burns in our hospital using a coin-based approach in comparison to TBSA, and could facilitate accurate communication between health care professionals.

A comparison of commercially available synthetic skin substitutes for surgical simulation training

Objective

Simulation training provides an important opportunity to accelerate surgical skills acquisition whilst safeguarding patients. This study compares the suitability of different synthetic skin substitutes for use in surgical simulation training.

Design

Data was collected for eight commercially available synthetic skin substitutes and included cost, delivery time, subjective assessment of fidelity by surgeons and trainees, and objective comparison with the biomechanics of human skin was made through cutometry and durometry measurements. Cutometry and durometry data was collected from three healthy adults from the forearm, forehead and back, with measurements being repeated in triplicate. Subjective assessment of skin pad quality was collected using an 8-criteria questionnaire, graded using a 5-point Likert scale for fidelity to normal skin.

Results

The questionnaire assessment was completed by 30 trainees and practitioners. Overall, felt pads received the poorest outcomes in all criteria; cutometry and durometry results demonstrate poor similarity to skin, and felt received the lowest scores in the questionnaire, although the cheapest. Foam dressings were similar in both cutometric and durometric properties to skin of the face, back and arm. Clinical outcomes of foam dressings were similar to the most expensive commercial skin pad.

Conclusions

Bilaminar foam-based dressings provide a low cost, high fidelity non-biological simulation of skin for surgical training, which is non-inferior to more expensive specifically designed products. Many products designed to act as skin substitutes for surgical simulation fail to adequately replicate the anatomical and mechanical properties of skin.

Single-Cell Analysis of ADSC Interactions with Fibroblasts and Endothelial Cells in Scleroderma Skin

Adipose-derived stem cells (ADSCs) as part of autologous fat grafting have anti-fibrotic and anti-inflammatory effects, but the exact mechanisms of action remain unknown. By simulating the interaction of ADSCs with fibroblasts and endothelial cells (EC) from scleroderma (SSc) skin in silico, we aim to unravel these mechanisms. Publicly available single-cell RNA sequencing data from the stromal vascular fraction of 3 lean patients and biopsies from the skin of 10 control and 12 patients with SSc were obtained from the GEO and analysed using R and Seurat. Differentially expressed genes were used to compare the fibroblast and EC transcriptome between controls and SSc. GO and KEGG functional enrichment was performed. Ligand-receptor interactions of ADSCs with fibroblasts and ECs were explored with LIANA. Pro-inflammatory and extracellular matrix (ECM) interacting fibroblasts were identified in SSc. Arterial, capillary, venous and lymphatic ECs showed a pro-fibrotic and pro-inflammatory transcriptome. Most interactions with both cell types were based on ECM proteins. Differential interactions identified included NTN1, VEGFD, MMP2, FGF2, and FNDC5. The ADSC secretome may disrupt vascular and perivascular inflammation hubs in scleroderma by promoting angiogenesis and especially lymphangiogenesis. Key phenomena observed after fat grafting remain unexplained, including modulation of fibroblast behaviour.

“Achieving Optimal Clinical Outcomes in Autologous Fat Grafting: A Systematic Review of Processing Techniques”

BACKGROUND

Autologous fat grafting (AFG) is a versatile technique in reconstructive and cosmetic surgery. Graft processing is a key source of variability resulting in unreliable clinical outcomes, with no consensus on the optimal methodology. This systematic review identifies the evidence base supporting different processing paradigms.

METHODS

A systematic literature search was conducted using the PubMed, Scopus and The Cochrane Foundation databases. Studies comparing AFG processing methods and reporting long-term patient outcomes were identified.

RESULTS

Twenty-four studies (2413 patients) were identified. Processing techniques evaluated included centrifugation, decantation, washing, filtration, gauze rolling, as well as commercial devices and adipose-derived stem/stromal cell (ASC) enrichment methods. Objective volumetric and subjective patient-reported outcomes were discussed. There was a variable reporting of complications and volume retention rates. Complications were infrequent; palpable cysts (0-20%), surgical-site infections (0-8%) and fat necrosis (0-58.4%) were the most reported. No significant differences in long-term volume retention between techniques were found in AFG in the breast. In head and neck patients, greater volume retention was documented in ASC enrichment (64.8-95%) and commercial devices (41.2%) compared to centrifugation (31.8-76%).

CONCLUSIONS

Graft processing through washing and filtration, including when incorporated into commercial devices, results in superior long-term outcomes compared to centrifugation and decantation methods. ASC enrichment methods and commercial devices seem to have superior long-term volume retention in facial fat grafting.

Burns incident responses worldwide and the role of burn speciality teams: a review

INTRODUCTION

Mass casualty incidents (MCIs) have a profound impact on health care systems worldwide. Following recent incidents within the United Kingdom (UK), notably terrorist attacks in Manchester and the Grenfell Tower fire in London, there has been a renewed interest in how the UK would cope with a burn MCI. A Burns Incidence Response Team (BIRT) is a new development incorporated into the Burn Annex of the NHS England National Concept of Operation for Managing Mass Casualties. It is a mobile advice team of healthcare professionals with burns expertise who can support the subsequent management of an MCI, and triage effectively. This review assesses the response to disasters worldwide, detailing national structure, and in particular the involvement of burn specialist teams. This review aims to highlight the roles of burns specialists, and their role within the UK.

METHOD

A review of Web of Science, PubMed, Embase, UK government reports, annexes and textbooks was conducted.

RESULTS

A search resulted in 826 sources; 42 articles were included in this review, with 9 additional sources. BIRTs are described in the NHS Guideline Concept of Operations for the Management of Mass Casualties: Burns Annex, published September 2020.

CONCLUSIONS

The implementation of a national burn response plan is a necessary step forward for effective management of these continuing MCIs. The available literature supports the need for preparation and organized response with a centralized control. Increased awareness and understanding of the role of BIRTs is important and highlights the need for specialist input in the long and short term. Factors which may affect the implementation of BIRT's need to be explored in further detail.

O096 Does boron bioactive glass have a role in bone regeneration?

Introduction

Bioactive glasses (BGs) provide an alternative to allogenic bone grafts. Various ions can be incorporated into the BGs structure to further influence regenerative or antimicrobial properties. Boron has recently been purposed as element that can be incorporated into BGs to promote desirable cellular regenerative response. This study aims to systematically review literature to determine the level of evidence that boron bioactive glasses (BBGs) and boron can promote desirable bone regenerative responses both in vitro and in vivo.

Methods

A systematic review of Web of Science was conducted in accordance with PRISMA guidelines. Data collected included bone cell behavioural analysis in response to boron or BBG compared to controls. Material properties of BBG (mechanical properties, degradation rate) compared to BG were compared.

Results

A total of 105 articles were included; 98 regarding BBG, and 12 articles studying the effect of boron. A higher biodegradation rate was observed in BBG compared with silicate-based BGs. BBGs have a lower compressive strength and increased fragility, as the percentage of B203 increases. 16 articles demonstrated a positive correlation with BBG and expression of OCN, VEGF, osteopontin, and RUNX2. Overall, metabolic activity of cells up to 14 days was lower in comparison to media and silicate BG.

Conclusion

BBGs have gained increased attention in the literature but the lack of heterogeneity and paucity of data does not provide convincing evidence of the effect of boron on bone regeneration and indicates the need for further quantitative research with a standardised approach to assessment.

Take-home message

Bioactive glasses can promote regeneration of bone, however the lack of heterogeneity and paucity of data regarding boron bioactive glass indicate the need for further quantitative research and standardised approach to assessment.

O 089 - A soft robotic exosuit assisting the paretic ankle in patients post-stroke: Effect on muscle activation during overground walking

This study compared overground walking with and without exosuit assistance in post-stroke patients. Exosuit-assisted walking was found to improve paretic propulsion and ground clearance during swing, two common gait deviations in stroke patients. No changes in leg muscle activity was found, motivating further study of the exosuit as a tool for gait training during stroke rehabilitation.

How Well Do We Achieve SAFER Referrals?

Aims: Assess the completion of Situation, Assessment, Family, Expected Response, and Recording (SAFER) referrals for paediatric dog bites under 5yrs, and burns with clinical suspicion at a trauma centre. It is a document used to communicate concern with the LSCB (Local Safeguarding Children’s Board). Method: Data was collated from e-records and case notes during 1/1/18-30/10/2018. The LSCB and hospital safeguarding team do not hold databases with information regarding these referrals. Results: 81 were seen by Plastic Surgery with dog bites. 33 were children (40.74%). 18/81 were 5yrs or less at presentation (22.2%); 8/18 referrals were completed (44.4%). For one a referral was deemed inappropriate because the bite was sustained from a stranger's dog. 164 paediatric burns were reviewed. 7/164 (4.3%) raised suspicion and 6/7 had referrals (85.7%). Discussion: Fewer referrals were made for dog bites. Possibly due to lack of awareness of guidelines, poor availability of forms or ambiguity regarding responsibility. Referrals sent for burns were better perhaps because of a perceived greater risk assigned to this injury or because the workload was monitored by a single clinical lead with knowledge of the pathway. Data collection was difficult due to multiple recording methods, which may cause clinical errors. Solutions could include staff education, clear guidelines within departments with easy access to forms, or added checklists. Conclusion: Referrals were not completed often enough with several areas of improvement. There are easy steps that can be implemented which could lead to increased effectiveness of our communication and standard of care.

Predictive factors of survival in patients with advanced colorectal cancer: an individual data analysis of 602 patients included in irinotecan phase III trials

BACKGROUND

The infusional LV5FU2 and Arbeitsgemeinschaft Internische Onkologie (AIO) regimens are used widely in the treatment of advanced colorectal cancer. Irinotecan combined with these regimens increases survival in front-line treatment. Irinotecan also improves survival in second-line treatment.

PATIENTS AND METHODS

Univariate and multivariate analyses based on the individual data of 602 patients included in two phase III trials were performed to determine predictive factors of survival in advanced colorectal cancer.

RESULTS

Three factors were independently associated with a better progression-free survival: weight loss <5% [hazard ratio (HR) 1.25; 95% confidence interval (CI) 1.00-1.58], World Health Organization performance status (WHO PS) 0-1 (HR 1.29; 95% CI 1.08-1.54) and irinotecan (CPT-11)-containing regimens (HR 1.48; 95% CI 1.03-2.13). Five factors were independently associated with a better overall survival: weight loss <5% (HR 1.67; 95% CI 1.29-2.14), WHO PS 0-1 (HR 1.88; 95% CI 1.27-2.75), one or two metastatic sites (HR 1.24; 95% CI 1.01-1.53), alkaline phosphatase values not over twice the normal range (HR 1.71; 95% CI 1.30-2.24) and CPT-11-containing regimens (HR 1.31; 95% CI 1.07-1.61).

CONCLUSIONS

The present analysis confirms that CPT-11-based chemotherapy regimens are independently associated with a better survival in patients with advanced colorectal cancer. Age was not identified as a prognostic factor in this analysis.

Irinotecan plus fluorouracil/leucovorin for metastatic colorectal cancer: a new survival standard

BACKGROUND

Irinotecan is a topoisomerase I inhibitor that prolongs survival in patients with colorectal cancer refractory to fluorouracil (5-FU) and leucovorin (LV). This demonstrated activity of irinotecan as effective second-line therapy for colorectal cancer led to evaluation of combination irinotecan/5-FU/LV as first-line therapy for patients with metastatic disease. The results of two prospective phase III randomized, controlled, multicenter, multinational clinical trials in patients with previously untreated metastatic colorectal cancer served as the basis for U.S. and European approval of irinotecan/5-FU/LV for this indication. An overview of the findings of these two pivotal studies provides insights regarding the application of this new combination in clinical practice.

METHODS

Patients were randomly assigned to receive 5-FU/LV, either alone, or with concurrent irinotecan. The study conducted primarily in North America (study 1), employed bolus 5-FU/LV schedules, while the study performed primarily in Europe (study 2), employed infusional 5-FU/LV regimens. Major endpoints included tumor response rate, time to tumor progression (TTP), overall survival, quality of life, and safety.

RESULTS

In study 1, the respective confirmed response rates for irinotecan/5-FU/LV versus 5-FU/LV were 39% and 21% (p <.001); median TTPs were 7.0 months and 4.3 months, respectively (p =.004). In study 2, response rates for irinotecan/5-FU/LV versus 5-FU/LV alone were 35% and 22% (p =.005); median TTPs were 6.7 months and 4.4 months, respectively (p <.001). Survival time increased significantly with irinotecan/5-FU/LV versus 5-FU/LV alone in both studies (study 1: median 14.8 months versus 12.6 months, p =.042; study 2: median 17.4 months versus 14.1 months, p =.032). The combined analysis of the data from the two studies showed median survivals of 15.9 months versus 13.3 months, favoring the irinotecan-containing combinations (stratified-by-study p =.003). Patients in study 1 had a 36% lower risk of tumor progression and a 20% lower risk of death with the irinotecan combination than with 5-FU/LV alone; comparable risk reduction values in study 2 were 42% and 23%. While grade 3 diarrhea and vomiting were more common with irinotecan/5-FU/LV, grade 4 neutropenia, neutropenic fever, and mucositis were less common with irinotecan/5-FU/LV than with the Mayo Clinic 5-FU/LV regimen.

CONCLUSION

The combination of irinotecan/5-FU/LV is superior to 5-FU/LV alone as first-line therapy for patients with metastatic colorectal cancer, offering consistently improved tumor control and prolonged survival. Irinotecan-based combination therapy sets a new survival standard for the treatment of this life-threatening disease.

Prognostic factors for tumour response, progression-free survival and toxicity in metastatic colorectal cancer patients given irinotecan (CPT-11) as second-line chemotherapy after 5FU failure. CPT-11 F205, F220, F221 and V222 study groups

Our purpose was to determine, in patients with metastatic colorectal carcinoma treated with irinotecan single-agent after 5-FU failure, the most significant predictive parameters for tumour response, progression-free survival and toxicity. Between October 1992 and April 1995, 455 patients with 5-FU resistant metastatic colorectal carcinoma entered four consecutive phase II trials. The first two studies assessed tumour response, the other two were randomized studies which assessed the efficacy of racecadotril to prevent irinotecan-induced diarrhoea. Due to homogeneous main eligibility criterias, data from those studies could be pooled for statistical analysis. Potential clinical and biological predictive factors (PF) for toxicity, tumour growth control, e.g. response or stabilization and progression-free survival (PFS), were studied in multivariate analysis. 363 patients were evaluable for response, 432 were evaluable for PFS, 368 for neutropenia and 416 for delayed diarrhoea, respectively. Normal baseline haemoglobin level (Hb), time since diagnosis of colorectal carcinoma, grade 3 or 4 neutropenia or diarrhoea at first cycle and a low number of organs involved were the most PF for tumour growth control (P<0.05). Significant prognostic variables for PFS were WHO Performance Status, liver and lymph-node involvement, time since diagnosis, age and CEA value (P < or =0.02). Six groups of patients based on the number of unfavourable prognostic factors are presented. Baseline bilirubin, haemoglobin level, number of organs involved and time from diagnosis were PF for neutropenia; PS, serum creatinine, leukocyte count, time from 5-FU progression and prior abdominopelvic irradiation were PF for delayed diarrhoea (P< or =0.05). These PF should help clinicians to anticipate for a given patient the probability to observe a response/stabilization or a toxicity. These results should also be prospectively confirmed in ongoing or future trials using irinotecan, both as a single agent and in combination with other drugs.

Irinotecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer: a multicentre randomised trial

BACKGROUND

Irinotecan is active against colorectal cancer in patients whose disease is refractory to fluorouracil. We investigated the efficacy of these two agents combined for first-line treatment of metastatic colorectal cancer.

METHODS

387 patients previously untreated with chemotherapy (other than adjuvant) for advanced colorectal cancer were randomly assigned open-label irinotecan plus fluorouracil and calcium folinate (irinotecan group, n=199) or fluorouracil and calcium folinate alone (no-irinotecan group, n=188). Infusion schedules were once weekly or every 2 weeks, and were chosen by each centre. We assessed response rates and time to progression, and also response duration, survival, and quality of life. Analyses were done on the intention-to-treat population and on evaluable patients.

FINDINGS

The response rate was significantly higher in patients in the irinotecan group than in those in the no-irinotecan group (49 vs 31%, p<0.001 for evaluable patients, 35 vs 22%, p<0.005 by intention to treat). Time to progression was significantly longer in the irinotecan group than in the no-irinotecan group (median 6.7 vs 4.4 months, p<0.001), and overall survival was higher (median 17.4 vs 14.1 months, p=0.031). Some grade 3 and 4 toxic effects were significantly more frequent in the irinotecan group than in the no-irinotecan group, but effects were predictible, reversible, non-cumulative, and manageable.

INTERPRETATION

Irinotecan combined with fluorouracil and calcium folinate was well-tolerated and increased response rate, time to progression, and survival, with a later deterioration in quality of life. This combination should be considered as a reference first-line treatment for metastatic colorectal cancer.

Inhibition of some hepatic lysosomal glycosidases by ethanolamines and phenyl 6-deoxy-6-(morpholin-4-yl)-beta-D-glucopyranoside

The hepatic lysosomal glycosidases alpha-glucosidase and beta-glucuronidase were inhibited in vitro and in vivo by mono- and diethanolamines. The in vivo inhibition is dose dependent and occurs at a value less than LD50. Phenyl 6-deoxy-6-(morpholin-4-yl)-beta-D-glucopyranoside inhibited alpha-glucosidase both in vitro and in vivo. The treatment of the enzymes in vitro by ethanolamine exhibited a reversible inhibition of the mixed and competitive types for alpha-glucosidase and beta-glucuronidase, respectively. Diethanolamine showed a reversible inhibition of the competitive type for both enzymes. It is a potent inhibitor for beta-glucuronidase, in vitro, whose inhibition constant (Ki) is 5 x 10(-5) M. Phenyl 6-deoxy-6-(morpholin-4-yl)-beta-D-glucopyranoside is a potent inhibitor only for hepatic alpha-glucosidase with a Ki value of 1.6 x 10(-5) M. The pattern of the pH dependence of enzymic activity was not affected by ethanolamine inhibition. The magnitude of the inhibition of enzymes is dependent on the structure of the inhibitor.

Randomised trial of irinotecan plus supportive care versus supportive care alone after fluorouracil failure for patients with metastatic colorectal cancer

BACKGROUND

In phase II studies, irinotecan is active in metastatic colorectal cancer, but the overall benefit has not been assessed in a randomised clinical trial.

METHODS

Patients with proven metastatic colorectal cancer, which had progressed within 6 months of treatment with fluorouracil, were randomly assigned either 300-350 mg/m2 irinotecan every 3 weeks with supportive care or supportive care alone, in a 2:1 ratio.

FINDINGS

189 patients were allocated irinotecan and supportive care and 90 supportive care alone. The mean age of the participants was 58.8 years; 181 (65%) were men and 98 (35%) were women. WHO performance status was 0 in 79 (42%) patients, 1 in 77 (41%) patients, and 2 in 32 (17%) patients. Tumour-related symptoms were present in 134 (71%) patients and weight loss of more than 5% was seen in 15 (8%) patients. With a median follow-up of 13 months, the overall survival was significantly better in the irinotecan group (p=0.0001), with 36.2% 1-year survival in the irinotecan group versus 13.8% in the supportive-care group. The survival benefit, adjusted for prognostic factors in a multivariate analysis, remained significant (p=0.001). Survival without performance-status deterioration (p=0.0001), without weight loss of more than 5% (p=0.018), and pain-free survival (p=0.003) were significantly better in the patients given irinotecan. In a quality-of-life analysis, all significant differences, except on diarrhoea score, were in favour of the irinotecan group.

INTERPRETATION

Our study shows that despite the side-effects of treatment, patients who have metastatic colorectal cancer, and for whom fluorouracil has failed, have a longer survival, fewer tumour-related symptoms, and a better quality of life when treated with irinotecan than with supportive care alone.

Randomised trial of irinotecan versus fluorouracil by continuous infusion after fluorouracil failure in patients with metastatic colorectal cancer

BACKGROUND

In phase II trials, irinotecan is active in patients with advanced colorectal cancer, but the survival and clinical benefit of irinotecan compared with second-line fluorouracil by continuous infusion is not known.

METHODS

267 patients who had failed to respond to first-line fluorouracil, or whose disease had progressed after treatment with first-line fluorouracil were randomly allocated irinotecan 300-350 mg/m2 infused once every 3 weeks or fluorouracil by continuous infusion. Treatment was given until disease progression, unacceptable toxic effects, or the patient refused to continue treatment. The primary endpoint was survival, while progression-free survival, response rate, symptom-free survival, adverse events, and quality of life (QoL) were secondary endpoints.

FINDINGS

133 patients were randomly allocated irinotecan and 134 were allocated fluorouracil by continuous infusion. Patients treated with irinotecan lived for significantly longer than patients on fluorouracil (p=0.035). Survival at 1 year was increased from 32% in the fluorouracil group to 45% in the irinotecan group. Median survival was 10.8 months in the irinotecan group and 8.5 months in the fluorouracil group. Median progression-free survival was longer with irinotecan (4.2 vs 2.9 months for irinotecan vs fluorouracil, respectively; p=0.030). The median pain-free survival was 10.3 months and 8.5 months (p=0.06) for irinotecan and fluorouracil, respectively. Both treatments were equally well tolerated. QoL was similar in both groups.

INTERPRETATION

Compared with fluorouracil by continuous infusion second-line irinotecan significantly improved survival in patients with advanced colorectal cancer.

Ferruginous bodies in sputum as an indication of exposure to airborne mineral fibers in the mesothelioma villages of Cappadocia

The counts of ferruginous bodies (pulmonary-coated mineral fibers) in sputum samples from inhabitants in each of the two agricultural villages of Karain and Tusköy (Cappadocia, central Turkey) increased with subjects' age, whereas 94% of samples collected in the neighboring villages were free of ferruginous body. These findings are consistent with the previous hypothesis that the very high frequency of mesothelioma in Karain and Tusköy was related to exposure to airborne mineral fibers of natural origin.