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    Latin American association for the study of the liver (ALEH) guidance on postoperative care after liver transplantation
    (Elsevier BV, 2025-07)
    Liana Codes
    ;
    ZAPATA LARRAIN, RODRIGO  
    ;
    Manuel Mendizabal
    ;
    Alfeu de Medeiros Fleck Junior
    ;
    Juan Carlos Restrepo
      7Scopus© Citations 1
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    Time-dependent LPS exposure commands MSC immunoplasticity through TLR4 activation leading to opposite therapeutic outcome in EAE
    (2020)
    Mónica Kurte
    ;
    Ana María Vega-Letter
    ;
    Patricia Luz-Crawford
    ;
    Farida Djouad
    ;
    Danièle Noël
    <jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>Mesenchymal stem cells (MSCs) have been recognized for their regenerative and anti-inflammatory capacity which makes them very attractive to cell therapy, especially those ones to treat inflammatory and autoimmune disease. Two different immune-phenotypes have been described for MSCs depending on which Toll-like receptor (TLR) is activated. MSC1 is endowed with a pro-inflammatory phenotype following TLR4 activation with LPS. On the other hand, anti-inflammatory MSC2 is induced by the activation of TLR3 with Poly(I:C). High immunoplasticity of MSCs is a matter of concern in cell-based therapies. In this study, we investigated whether a single stimulus can induce both types of MSCs through a differential activation of TLR4 with LPS.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>MSCs were activated with LPS following a short exposure of 1-h (MSCs-LPS1h) or long-time exposure for 48 h (MSCs-LPS48h), and then, we evaluated the biological response in vitro, the immunosuppressive capacity of MSCs in vitro, and the therapeutic potential of MSCs in an experimental autoimmune encephalomyelitis (EAE) mouse model.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>Our results showed that 1-h LPS exposure induced a MSC1 phenotype. Indeed, MSCs-LPS1h expressed low levels of NO/iNOS and decreased immunosuppressive capacity in vitro without therapeutic effect in the EAE model. In contrast, MSCs-LPS48h achieved a MSC2-like phenotype with significant increase in the immunosuppressive capacity on T cell proliferation in vitro, together with an improved in the therapeutic effect and higher Treg, compared to unstimulated MSCs. Furthermore, we determine through the MSCs-TLR4KO that the expression of TLR4 receptor is essential for MSCs’ suppressive activity since TLR4 deletion was associated with a diminished suppressive effect in vitro and a loss of therapeutic effect in vivo.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>We demonstrate that MSCs display a high immunoplasticity commanded by a single stimulus, where LPS exposure time regulated the MSC suppressive effect leading into either an enhanced or an impairment therapeutic activity. Our results underscore the importance of phenotype conversion probably related to the TLR4 expression and activation, in the design of future clinical protocols to treat patients with inflammatory and autoimmune diseases.</jats:p> </jats:sec>
      7Scopus© Citations 60
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    Scopus© Citations 18  5
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    High Flow Nasal Cannula as Support in Immunocompromised Patients with Acute Respiratory Failure: A Retrospective Study
    (2021)
    Claudia Giugliano-Jaramillo
    ;
    Josefina León
    ;
    Cristobal Enriquez
    ;
    Juan E. Keymer
    ;
    Rodrigo Pérez-Araos
    <jats:sec> <jats:title>Introduction:</jats:title> <jats:p>High Flow Nasal Cannula (HFNC) is a novel technique for respiratory support that improves oxygenation. In some patients, it may reduce the work of breathing. In immunocompromised patients with Acute Respiratory Failure (ARF), Non-Invasive Ventilation (NIV) is the main support recommended strategy, since invasive mechanical ventilation could increase mortality rates. NIV used for more than 48 hours may be associated with increased in-hospital mortality and hospital length of stay. Therefore HFNC seems like a respiratory support alternative.</jats:p> </jats:sec> <jats:sec> <jats:title>Objective:</jats:title> <jats:p>To describe clinical outcomes of immunocompromised patients with ARF HFNC-supported.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>Retrospective study in patients admitted with ARF and HFNC-supported. 25 adult patients were included, 21 pharmacologically and 4 non- pharmacologically immunosuppressed. Median age of the patients was 64 [60-76] years, APACHE II 15 [11-19], and PaO2:FiO2 218 [165-248]. Demographic information, origin of immunosuppression, Respiratory Rate (RR), Heart Rate (HR), Mean Arterial Pressure (MAP), oxygen saturation (SpO<jats:sub>2</jats:sub>) and PaO<jats:sub>2</jats:sub>:FiO<jats:sub>2</jats:sub> ratio were extracted from clinical records of our HFNC local protocol. Data acquisition was performed before and after the first 24 hours of connection. In addition, the need for greater ventilatory support after HFNC, orotracheal intubation, in-hospital mortality and 90 days out-patients’ mortality was recorded.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p>Mean RR before the connection was 25±22 breaths/min and 22±4 breaths/min after the first 24 hours of HFNC use (95% CI; p=0.02). HR mean before connection to HFNC was 96±22 beats/min, and after, it was 86±15 beats/min (95%CI; p=0.008). Previous mean MAP was 86±15 mmHg, and after HFNC, it was 80±12 mmHg (95%CI; p=0.09); mean SpO<jats:sub>2</jats:sub> after was 93±5% and before it was 95±4% (95% CI; p=0.13); and previous PaO<jats:sub>2</jats:sub>:FiO<jats:sub>2</jats:sub> mean was 219±66, and after it was 324±110 (95%CI; p=0.52). In-hospital mortality was 28% and 90 days out-patients’ mortality was 32%.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion:</jats:title> <jats:p>HFNC in immunosuppressed ARF subjects significantly decreases HR and RR, being apparently an effective alternative to decrease work of breathing. In-hospital mortality in ARF immunosuppressed patients was high even though respiratory support was used. Better studies are needed to define the role of HFNC-support in ARF.</jats:p> </jats:sec>
      11
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    Scopus© Citations 1  1
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    Switching Stable Kidney Transplant Recipients to a Generic Tacrolimus Is Feasible and Safe, but It Must Be Monitored
    (2017)
    Fernando González  
    ;
    Elizabeth Arriagada
    ;
    René López  
    ;
    René Carrasco
    ;
    NATALIA BERNARDITA GALLARDO CHAPARRO
    <jats:p><jats:italic>Background</jats:italic>. Tacrolimus is the primary immunosuppressive drug used in kidney transplant patients. Replacing brand name products with generics is a controversial issue that we studied after a Chilean Ministry of Health mandate to implement such a switch.<jats:italic>Methods</jats:italic>. Forty-one stable Prograf (Astellas) receiving kidney transplant patients were switched to a generic tacrolimus (Sandoz) in a 1 : 1 dose ratio and were followed up for up to 8 months. All other drugs were maintained as per normal practice.<jats:italic>Results</jats:italic>. Neither tacrolimus doses nor their trough blood levels changed significantly after the switch, but serum creatinine did:<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M1"><mml:mn fontstyle="italic">1.62</mml:mn><mml:mo>±</mml:mo><mml:mn fontstyle="italic">0.90</mml:mn></mml:math>versus<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"><mml:mn fontstyle="italic">1.75</mml:mn><mml:mo>±</mml:mo><mml:mn fontstyle="italic">0.92</mml:mn></mml:math> mg/dL (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M3"><mml:mi>p</mml:mi><mml:mo>&lt;</mml:mo><mml:mn fontstyle="italic">0.001</mml:mn></mml:math>). At the same time, five graft biopsies were performed, and two of them showed cellular acute rejection. There were nine infectious episodes treated satisfactorily with proper therapies. No patient or graft was lost during the follow-up time period.<jats:italic>Conclusion</jats:italic>. Switching from brand name tacrolimus to a generic tacrolimus (Sandoz) is feasible and appears to be safe, but it must be monitored carefully by treating physicians.</jats:p>
      3
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    Gilz-Activin A as a Novel Signaling Axis Orchestrating Mesenchymal Stem Cell and Th17 Cell Interplay
    (2018)
    Patricia Luz-Crawford
    ;
    Gabriel Espinosa-Carrasco
    ;
    Natacha Ipseiz
    ;
    Rafael Contreras
    ;
    Gautier Tejedor
      27Scopus© Citations 15