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Human Umbilical Cord (HUC) Vessels: a Novel Substitute for Arterial Bypass Grafting

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Human Umbilical Cord (HUC) Vessels: a Novel Substitute for Arterial Bypass Grafting Cell Rese a m rc te h S & f T o h l e a r n a r Journal of Stem Cell Research & p u y o J ISSN: 2157-7633 Therapy Hypothesis Human Umbilical Cord (HUC) Vessels: A Novel Substitute for Arterial Bypass Grafting Biplabendu Talukdar1,2*, Swarnendu Datta3, Priyodarshi Sengupta4, Plaban Mukherjee5, Ushnish Chakravarty3 1Department of Immunohaematology and Blood Transfusion, Medical College Hospital, Kolkata, West Bengal, India; 2Department of Biochemistry and Biophysics, Kalyani University, Kalyani, West Bengal, India; 3Department of Cardio Thoracic and Vascular Surgery, MCH, Kolkata, India; 4Department of Regenerative Medicine and Translational Science, STM, Kolkata, India; 5Department of CTVS, MCH, Kolkata,West Bengal, India ABSTRACT Human Umbilical Cord (HUC) vessels and Wharton's jelly containing Mesenchymal Stem Cells may novel substitute for coronary vessels in reconstructive Coronary Artery Bypass Grafting (CABG) surgery. In developing countries, ischemic cardiac tissue injury-related mortality is higher than in developed countries. Organ and tissue transplants may amend the disease but the availability of donor tissue, tissue matching, and procurement of organs are important parameters for successful grafting. Allogenic or autologous preserved HUC vessels along with Wharton’s jelly containing MSCs having human Cord Lining Epithelial Cells (CLECs) which did not express the MHC class II antigen HLA-DR but the non-classical MHC class I antigen HLA-G and HLA-E lacked. HUC-MSC also expresses exosome, Smad protein, TGF beta, BMP also helps in cardiomyocytes regeneration and neo-vascularisation. So the chances of graft rejection is lower and long term survival of graft also initiated. Therefore, human umbilical cord may be used as a substitute for artery or venous graft of vascular and reconstructing surgery. Moreover, chances of recurrent surgical or interventional is diminished for maintaining the patency of coronary vessels. Keywords: Fetal stem cell; Immune tolerance; Coronary artery bypass grafting; Transfusion transmitted infection Abbreviations: HUC: Human Umbilical Cord; MSC: Mesenchymal Stem Cells; HLA: Human Leukocyte Antigen; HUV: Human Umbilical Vein; PCI: Percutaneous Coronary Intervention; CABG: Coronary Artery Bypass grafting; TTI: Transfusion Transmitted Infection; CAD: Coronary Artery Disease INTRODUCTION Bypass Grafting (CABG) is the gold standard treatment for ischemic heart disease patients. Organ and tissue transplants Coronary Artery Disease (CAD) is a most common cause of may amend the disease but availability of donor tissue, tissue death and disability in developed and developing countries. matching and procurement of organ are important parameters Globally 17.5 million deaths have been noted in 2012 [1] due to for successful graft. this disease. More than 75% of deaths, observed in developing countries. Mortality related to cardiovascular disease is Recently Human Umbilical Cord (HUC) has been broadly decreasing rapidly in developed countries. Whereas death or studied and current studies have revealed that HUC may be the disability related to myocardial disease as been increasing in potential substitute of vessels [4-7], ligaments [8], tendon and developing countries due to industrialization, urbanization, food bone [9,10]. Human Cord Lining Epithelial Cells (CLECs) does habit changes and changes in the lifestyle of people [2,3]. not express the MHC class II antigen HLA-DR whereas the non- Percutaneous Coronary Intervention (PCI) or Coronary Artery classical MHC class Ib antigen HLA-G and HLA-E has a few immunomodulatory roles. HLA-G protein decreases CD8 and Correspondence to: Biplabendu Talukdar, Department of Immunohaematology and Blood Transfusion, Medical College Hospital, Kolkata, West Bengal, India, Tel: +919477305795; E-mail: [email protected] Received date: April 28, 2020; Accepted date: May 01, 2020; Published date: May 15, 2020 Citation: Talukdar B, Datta S, Sengupta P, Mukherjee P, Chakravarty U (2020) Human Umbilical Cord (HUC) Vessels: A Novel Substitute for Arterial Bypass Grafting. J Stem Cell Res Ther 10:458. doi: 10.35248/2157-7633/2020.10.458 Copyright: © 2020 Talukdar B, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited. J Stem Cell Res Ther, Vol.10 Iss.3 No:458 1 Talukdar B, et al. natural killer cells production. Therefore, human umbilical cord a length of 50 cm-60 cm. The diameter of umbilical artery varies may be used as a substitute for artery or venous graft of vascular from 3 mm and 4 mm, and the diameter of umbilical vein and reconstructing surgery. ranges between 6 mm to 8 mm. The normal coronary artery has a diameter of 6 mm or less, with a range of 4 mm-8 mm in HYPOTHESIS adults. After choosing the umbilical vessels with the appropriate diameter, cells and Major Histocompatibility Complex (MHC) We hypothesise that the vessels of Human Umbilical Cord antigens can be removed to reduce immunogenicity without (HUC) may be an effective novel substitute for reconstruction of performing the process of decellularisation because chemical the coronary artery for those having coronary artery diseases as treatment of HUC-MSC may lose the valuable cells and well as peripheral vascular disease. Our hypothesis can be Extracellular matrix [14]. summarised as follows: 2. Seed cells: The HUC, especially the part of Wharton’s jelly 1. Allogenic substitute: Human umbilical cord, as a natural and HUC vein, is an abundant resource of Mesenchymal Stem tissue product for reconstruction of the diseased coronary artery. Cells (HUC-MSCs) [15,16]. It is generally accepted that HUC- It is collected from Transmission Transmitted Disease (TTD) MSCs are poorly immunogenic with multilineage differentiation screened mother of neonate right after parturition in a sterile potential [15,16]. Recently, HUC-MSCs have successfully manner. Umbilical arteries/veins help in surgical reconstruction differentiated into osteocytes [17], cardiomyocytes, etc. HUC- of damage vessels to another person. HUC containing two MSCs have capacity toself renewal and regenerate arteries and one vein. It is also established that the HUC is a cardiomyocytes and other essentialepithelial cells of goodsource for Mesenchymal Stem Cells (HUC-MSCs) which myocardium. can be differentiated into multiple lineage-specific cells that form bone, cartilage, liver, cardiac tissueetc [10,11]. Moreover, it 3. Growth factors: MSCs and Wharton jelly helps in liberation is also established that the Wharton’s jelly that surrounds the of various growth factors, those are responsible for proliferation Human Umbilical Vein (HUV) is rich in growth factors [12]. and differentiation of cells. For example, Epidermal Growth Thus HUC, with such a composition of MSC, living cells and Factor (EGF) exerts a wide variety of biological effects, including growth factors, might be a promising material for restoration of the promotion of proliferation and differentiation of MSCs the function of coronary artery [18,19] Transforming Growth Factor Beta (TGF- β) plays important roles in cellular differentiation, BMP hormone 2. Autologous substitute:An individual ’ s umbilical cord of secretion and immune function [18,19]. Fibroblast Growth patients, banked right after birth can come in handy for future Factor (FGF), EGF and TGF- β have been detected in the use. It could be directly applied to directly reconstruct the extracts of Wharton’s jelly [20]. patient ’ s own coronary artery. We hypothesise that the autologous HUC may also be used to reconstruct the coronary 4. Sources: The HUC is abundant in resource without ethical artery. The autologous HUC offers the following advantages: issues. It is usually discarded after delivery. Screened collecting Firstly, the HUC-MSCs might differentiate into myocardial cells the HUC after birth in sterile waydoes not carry any risk to the in vivo after transplantation, which might promote the collaterals mother or new born. Some ofinvestigators have been suggested regeneration. Secondly, replacement of the scared myocardial the importance of banking the whole umbilical cord unit for tissues by helping regeneration of new viable cardiac tissue research or future use in therapeutic purpose [21]. without any immunologic graft rejection can also be predicted. 5. Collection, preservation and cryopreservation: Human Both allogenic and autologous substitute can be used to umbilical cords obtained from the OT and were immediately reconstruct the coronary artery without altering the normal stored at 4°C post-delivery. The whole processing of the cardio vascular anatomy. This operation does preserve the umbilical artery/vein should start within 24 hours of its myocardial contractile function. Furthermore, the HUC is long collection. Using a sharp dissection needle, the umbilical cords enough to reconstruct the coronary artery more than once, if are removed under sterile conditions [22,23]. The decellularized necessary (e.g., in case of postoperative anastomotic stricture). or de novo cord blood vessels for vascular or surgical reconstruction and tissue engineering scaffolds, the saline EVALUATION OF THE HYPOTHESIS cryopreservation medium composed of DMEM/α-MEM/EGM in presence of FBS and PenStrep can be used for storage at The feasibility of this hypothesis is based on the following four -20°С and the ratio of the volume of the cryopreservation
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