Bronchoscopic Transplant of Stem Cells May Close Fistula
(HealthDay News) — Bronchoscopic transplantation of bone marrow-derived mesenchymal stem cells can close a post-resectional bronchopleural fistula, according to a letter to the editor published in the January 1 issue of the New England Journal of Medicine.
Noting that the presence or absence of bronchopleural fistula can make the difference between recovery, chronic illness, and death after lung resection, Francesco Petrella, MD, from the European Institute of Oncology in Milan, and colleagues describe a method for closing a fistula. Earlier experiments have shown that bronchoscopic transplantation of mesenchymal stem cells derived from bone marrow could close bronchopleural fistula with the extraluminal proliferation of fibroblasts and development of collagenous matrix. This approach was employed for a 42-year-old male patient in whom bronchopleural fistula had developed after right extrapleural pneumonectomy for early-stage malignant mesothelioma.
The researchers found that bronchoscopy at 60 days showed a complete healing of the resection line, and the orifice that was seen prior to stem cell implantation was no longer visible. A hyperplastic respiratory epithelium lying on a fibrotic lamina propria was seen on analysis of biopsy samples, and bands of smooth muscle fibers were reduced and replaced with fibroblasts. A well-differentiated layer of basal cells and basal-cell hyperplasia were seen with immunocytochemical staining. Interruption of the fistula was seen on computed tomography at its orifice from the right bronchus where the cells were injected.
"Further work is required to determine whether this approach can be replicated," the authors write.