World Congress of Gastroenterology

WCOG 2019


 
ENDOSCOPIC, MUSCLE CELL-DERIVED PROGENITOR CELL IMPLANTATION INTO LOWER ESOPHAGUS SPHINCTER. A NEW EXPERIMENTAL INVASIVE MODEL IN THE TREATMENT OF GASTRO-ESOPHAGEAL REFLUX DISEASE
MURAT KANTARCIOĞLU 1 HAKAN SARLAK 4 HAKAN DEMIRCI 5 ERDAL KARAOZ 2 AYSE GULDEM KILCILER 3 SAIT BAGCI 6

1- LÖSANTE HOSPITAL ANKARA
2- LIV HOSPITAL İSTANBUL
3- USAK UNIVERSITY HOSPITAL DEP. OF GASTROENTEROLOGY
4- GULHANE HOSPITAL DEP. OF GASTROENTEROLOGY ANKARA
5- MEDICAL PARK HOSPITAL PENDIK ISTANBUL
6- ANKARA SURGERY CENTER
 
Background/Aims:

 Gastroesophageal reflux disease (GERD) is a worldwide common and chronic health problem. In addition to drugs, surgical or endoluminal antireflux procedures are treatment options for selected patients. The 2 main endoluminal GERD therapies are the Stretta procedure and transoral incisionless fundoplication. Progenitor stromal cells provide tissue regeneration and viability in many human organs. Human endometrial tissue progenitor stem cells (HEPSCs) have high ability to differentiate into functional muscle tissue cells. In this study, we aimed to implant HEPSCs into the lower esophageal sphincter (LES) of the rabbits, observe their ability to differentiate to functional muscle cells and evaluate sphincter pressure values.

Materials and Methods:

 Green fluorescent protein (GFP) transfected HEPSCs were obtained from Kocaeli University Stem Cell Laboratory. Eight months old, 1500 gm. weighing, twenty New Zealand rabbits were used. Invasive procedures were performed using the Olympus BF-P30 bronchoscope 21 G TBNA sclerotherapy catheter. Ten rabbits have implanted 1 x 106 stem cells each (Group 1), and serum physiological injection was performed to the other ten (Group 2). LES pressures were measured using MMS Ver 8.11 (BV. Netherlands) device and 12 fr (3.9 mm) radial water perfusion manometry catheter with 8 channels before and 3 weeks after implantation. Animals were sacrificed in the third week of the study. LES were dissected. Histopathological examination was performed. Muscle differentiation markers on transplanted GFP-labeled cells were investigated.

Results:

 Three rabbits died due to complications. Histopathological examination revealed GFP expressing implanted cells in the LES tissues of group 1. These cells expressed MYO D protein and MYH2 factor which indicates mature muscle cell differentiation. In the stem cell implanted group, lower esophageal sphincter pressure values were significantly increased compared to the controls. 

Conclusion:

 Endoluminal implantation of HEPSCs result in differentiation into mature muscle cells and leads to an increase in sphincter pressure. In the light of our findings, endoluminal autologous, muscle-derived progenitor-stem cell implantation seems to be a new endoscopic invasive model for the treatment of GERD. 

Keywords:

 gerd, stem cell implantation, endoluminal