title: Percutaneous intraportal application of adipose tissue-derived mesenchymal stem cells using a balloon occlusion catheter in a porcine model of liver fibrosis.
abstract: OBJECTIVE
  To investigate the safety and effectiveness of a novel endovascular approach for therapeutic cell delivery using a balloon occlusion catheter in a large animal model of liver fibrosis.
  
  
  METHODS
  Transcatheter arterial embolization with ethiodized oil (Ethiodol) and ethanol was used to induce liver damage in 11 pigs. Mesenchymal stem cells (MSCs) were harvested from adipose tissue and engineered to express green fluorescent protein (GFP). A balloon occlusion catheter was positioned in the bilateral first-order portal vein branches 2 weeks after embolization to allow intraportal application of MSCs in six experimental animals. MSCs were allowed to dwell for 10 minutes using prolonged balloon inflation. Five control animals received a sham injection of normal saline in a similar fashion. Hepatic venous pressure gradient (HVPG) was measured immediately before necropsy. Specimens from all accessible lobes were obtained with ultrasound-guided percutaneous 18-gauge biopsy 2 hours after cell application. All animals were euthanized within 4 weeks. Fluorescent microscopy was used to assess the presence and distribution of cells.
  
  
  RESULTS
  Liver injury and fibrosis were successfully induced in all animals. MSCs (6-10 × 10(7)) were successfully delivered into the portal vein in the six experimental animals. Cell application was not associated with vascular complications. HVPG showed no instances of portal hypertension. GFP-expressing MSCs were visualized in biopsy specimens and were distributed primarily within the sinusoidal spaces; however, 4 weeks after implantation, MSCs could not be identified in histologic specimens.
  
  
  CONCLUSIONS
  A percutaneous endovascular approach for cell delivery using a balloon occlusion catheter proved safe for intraportal MSC application in a large animal model of liver fibrosis.
authors.affiliation: Department of Diagnostic Radiology, Interventional Radiology Section, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1471 Houston, TX 77030. Electronic address: rony.avritscher@mdanderson.org.
authors.forename: Rony
authors.initials: R
authors.lastname: Avritscher
authors.forename: Mohamed E
authors.initials: ME
authors.lastname: Abdelsalam
authors.forename: Sanaz
authors.initials: S
authors.lastname: Javadi
authors.forename: Joe
authors.initials: J
authors.lastname: Ensor
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Wallace
authors.forename: Eckhard
authors.initials: E
authors.lastname: Alt
authors.forename: David C
authors.initials: DC
authors.lastname: Madoff
authors.forename: Jody V
authors.initials: JV
authors.lastname: Vykoukal
mesh_terms: D000273:Adipose Tissue / Q000166:cytology*; D000818:Animals; D021721:Balloon Occlusion / Q000295:instrumentation*; D015415:Biomarkers / Q000378:metabolism; D001706:Biopsy; D058948:Cell Tracking; D002478:Cells, Cultured; D057510:Endovascular Procedures / Q000295:instrumentation*; D004867:Equipment Design; D000431:Ethanol; D004998:Ethiodized Oil; D049452:Green Fluorescent Proteins / Q000096:biosynthesis / Q000235:genetics; D006503:Hepatic Veins / Q000503:physiopathology; D008099:Liver / Q000378:metabolism / Q000473:pathology*; D008106:Liver Cirrhosis, Experimental / Q000139:chemically induced / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D045164:Mesenchymal Stem Cell Transplantation / Q000295:instrumentation*; D059630:Mesenchymal Stem Cells / Q000378:metabolism; D034421:Sus scrofa; D013997:Time Factors; D014162:Transfection; D062666:Vascular Access Devices; D014690:Venous Pressure
chemical_list: D015415:Biomarkers; D049452:Green Fluorescent Proteins; D000431:Ethanol; D004998:Ethiodized Oil
keywords: AD-MSC; GFP; HVPG; MSC; adipose-derived mesenchymal stem cell; green fluorescent protein; hepatic venous pressure gradient; mesenchymal stem cell