Clinical effect of stem cell transplantation via hepatic artery in the treatment of type II hyperammonemia: a report on 6 cases

DU Kan, LUAN Zuo, QU Su-Qing, YANG Hui, YANG Yin-Xiang, WANG Zhao-Yan, JIN Hui-Yu, LIU Wei-Peng

Chinese Journal of Contemporary Pediatrics ›› 2013, Vol. 15 ›› Issue (11) : 948-953.

PDF(1352 KB)
PDF(1352 KB)
Chinese Journal of Contemporary Pediatrics ›› 2013, Vol. 15 ›› Issue (11) : 948-953. DOI: 10.7499/j.issn.1008-8830.2013.11.006
TOPIC OF GENETIC DISEASE

Clinical effect of stem cell transplantation via hepatic artery in the treatment of type II hyperammonemia: a report on 6 cases

  • DU Kan, LUAN Zuo, QU Su-Qing, YANG Hui, YANG Yin-Xiang, WANG Zhao-Yan, JIN Hui-Yu, LIU Wei-Peng
Author information +
History +

Abstract

This study aimed to investigate the clinical effect of transplantation of CD133+ peripheral blood stem cells or umbilical cord mesenchymal stem cells via the hepatic artery in children with type II hyperammonemia and its possible action mechanism. Umbilical cord mesenchymal stem cells were obtained by collecting cord blood (100-150 mL) from healthy fetuses and separating stem cell suspension (5 mL) from the cord blood by hydroxyethyl starch sedimentation. CD133+ peripheral blood stem cells were obtained by mobilizing peripheral blood from the fathers of sick children using recombinant human granulocyte colony-stimulating factor for 5 days, collecting mononuclear cells (120 mL), and separating out CD133+ cells by sorting. With catheterization and percutaneous puncture, the obtained stem cells were slowly injected into the liver of sick children via the hepatic artery. The changes in clinical symptoms and laboratory indices such as blood ammonia, liver function, and arginine and citrulline concentrations were observed. After stem cell transplantation via the hepatic artery, the 6 children showed significantly decreased blood ammonia levels, and their blood ammonia levels slowly increased 1 to 2 weeks later, but remained below 100 μmol/L, and changes in glutamic-pyruvic transaminase levels were similar to blood ammonia. Plasma citrulline and arginine concentrations increased significantly after transplantation and the increase in citrulline level exceeded the increase in arginine level. An 8 months follow-up visit for one typical patient showed that the weight and height increased after transplantation and sleep was improved without night crying. The child could actively gaze at interesting objects instead of responding indifferently and started to say simple words. With regard to fine motor skills, the child could pinch things with the thumb and middle finger instead of displaying a lack of hand-eye coordination and progress was also made in gross motor skills. Gesell test showed that the child made progress for an average of 3.82 months in all areas. It was concluded that after stem cell transplantation, children with type II hyperammonemia have decreased blood ammonia levels, stable and improved liver function and steadily increased plasma citrulline and arginine concentrations. They display a progressive trend in such aspects as movement, language and environmental adaptability. It is hypothesized that stem cell transplantation via the hepatic artery partially or totally activates, or provides supplementary ornithine carbamoyl transferase, so that plasma citrulline and arginine concentrations increase and urea cycle disorder can be corrected to some extent.

Key words

Type II hyperammonemia / Ornithine carbamoyl transferase / Stem cell transplantation / Child

Cite this article

Download Citations
DU Kan, LUAN Zuo, QU Su-Qing, YANG Hui, YANG Yin-Xiang, WANG Zhao-Yan, JIN Hui-Yu, LIU Wei-Peng. Clinical effect of stem cell transplantation via hepatic artery in the treatment of type II hyperammonemia: a report on 6 cases[J]. Chinese Journal of Contemporary Pediatrics. 2013, 15(11): 948-953 https://doi.org/10.7499/j.issn.1008-8830.2013.11.006

References

[1] Nagata N, Matsuda I, Matsuura T, Oyanagi K, Tada K, Narisawa K, et al. Retrospective survey of urea cycle disorders, Part 2: Neurological outcome in forty-nine, Japanese patients with urea cycle enzymopathies[J]. Am J Met Genet, 1991, 40(4): 477-481.

[2] 杨艳玲, 张致祥, 戚豫, 顾强, 米春兰, 山口昭弘, 等.鸟氨酸氨甲酞转移酶缺陷所致高氨血症的诊断与分析[J].中国优生与遗传杂志, 1999, 7(5): 25-29.

[3] AASLD指南: 肝移植患者的评估[EB/OL]. [2013-01-30]. www.0188.com/show.asp?id=67269.

[4] 杜传书, 刘祖洞. 医学遗传学[M]. 北京: 人民卫生出版社, 1992: 468-471.

[5] Matsuda I, Nagata N, Matsuura T, Oyanagi K, Tada K, Narisawa K, et al. Retrospective survey of urea cycle disorders, Part 1: Clinical and laboratory observation of thirty-nine Japanese male patients with ornithine transcarbamylase(OTC) deficiency[J]. Am J Med Genet, 1991, 38(1): 85-89.

[6] Lee OK, Kuo TK, Chen WM, Lee KD, Hsieh SL, Chen TH. Isolation of multpotent mesenchymal stem cells from umbilical cord blood[J]. Blood, 2004, 103(5): 1669-1675.

[7] Ohgushi H, Caplan AI. Stem cell technology and bioeeramies: from cell to gene engineering[J]. J Biomed Mater Res, 1999, 48(6): 913-927.

[8] Erices A, Conget P, Minguell JJ. Mesenchymal progenitor cells in human umbilical cord blood[J]. Br J Haematol, 2008, 109(1): 235-242.

[9] 高蕾, 刘吉勇, 裴庆山, 孙欣欣. 人脐血间充质干细胞向肝细胞样细胞的分化[J]. 山东大学学报(医学版), 2008, 46(12): 1141-1144.

[10] 张彦,黄平平. 人脐带间充质干细胞的生物学特性及应用前景[J]. 国际移植与血液净化杂志, 2007, 5(4): 39-42.

[11] Horslen SP, McCowan TC, Goertzen TC, Warkentin PI, Cai HB, Strom SC, et al. Isolated hepatocyte transplantation in an infant with a severe urea cycle disorder[J]. Pediatrics, 2003, 111(6 Pt 1): 1262-1267.

[12] 王平, 王建华, 颜志平, 胡美玉, 徐鹏举, 周梅玲.超顺磁性氧化铁标记大鼠骨髓基质细胞经门静脉移植MRI活体示踪的研究[J].中华放射学杂志, 2006, 40(2): 133-138.

PDF(1352 KB)

Accesses

Citation

Detail

Sections
Recommended

/