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4 . 2021

The results of experimental and clinical application of extracellular microvesicles of mesenchymal stromal cells after caesarean section

Abstract

The aim - to assess the tolerance after introduction of extracellular microvesicles (EMV) of mesenchymal stromal cells of placental origin (MSC), first to experimental animals (rats of the WAG line) after creating them a model of cesarean section to improve a scar repair, and the next stage - to women, during the abdominal delivery to analyse their postoperative period.

Material and methods. The study included two groups of laboratory animals (144 rats - the main group and 189 - the control group), which were injected with extracellular microvesicles into the intact uterus and into the suture area after modeling the Caesarean section, and 2 groups of women after cesarean section: the main group consisted of 59 patients, who, during abdominal delivery were injected with 500 μl of EMV MSC after suturing the lower segment with a single-row continuous vicryl suture. The comparison group (control) included 60 patients with suturing of the uterus with a single-row continuous vicryl suture without the introduction of microvesicles.

Results. In the group with introduction of exosomes, no postoperative deaths were recorded, while in the control group died 9 rats. After the application of microvesicles, a 1.3 times greater number of animals gave birth - 62.5%, compared to 47.6% whithout exosomes. It indicated not only the absence of an adverse intraoperative effect of microvesicles, but also improved a great microcirculation in the surgical wound area. The results of the experimental study allowed the local ethics committee from the Novosibirsk State Clinical Perinatal Center to approve the application of extracellular microvesicles of mesenchymal stromal cells to pregnant women after signing an informed voluntary consent during the Caesarean section. All women of the main group had an uneventful postoperative period without complications. Their postoperative bed-day was 4.26±0.09, which is significantly less than in the control group, in which patients were discharged mainly after 5.33±0.38 (p<0.05). After exosome injection, all patients were included into the group of spontaneous childbirth after Cesarean section after 2-3 years. They did not have any purulent-septic complications, while in the control group without the introduction of EMV MSCs there were 4 endometritis (6%) and 2 lochiometers (3.3%).

Conclusion. The obtained successful experimental data made it possible to inject EMW ISS into patients and to demonstrate their good tolerance and higher efficiency with intraoperative use in compare to traditional surgical treatment. The first results of the clinical use of exosomes allow us to hope for an improvement in myometrial repair and predict spontaneous childbirth with a scar on the uterus after cesarean section.

Keywords:extracellular microvsicles, exosomes, caesarean section

Funding. The author received no financial support.

Conflict of interest. The author declares no conflict of interest.

For citation: Pekareva E.O. The results of experimental and clinical application of extracellular microvesicles of mesenchymal stromal cells after caesarean section. Akusherstvo i ginekologiya: novosti, mneniya, obuchenie [Obstetrics and Gynecology: News, Opinions, Training]. 2021; 9 (4): 36-43. DOI: https://doi.org/10.33029/2303-9698-2021-9-4-36-43 (in Russian)

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CHIEF EDITORS
CHIEF EDITOR
Sukhikh Gennadii Tikhonovich
Academician of the Russian Academy of Medical Sciences, V.I. Kulakov Obstetrics, Gynecology and Perinatology National Medical Research Center of Ministry of Healthсаre of the Russian Federation, Moscow
CHIEF EDITOR
Kurtser Mark Arkadievich
Academician of the Russian Academy of Sciences, MD, Professor, Head of the Obstetrics and Gynecology Subdepartment of the Pediatric Department, N.I. Pirogov Russian National Scientific Research Medical University, Ministry of Health of the Russian Federation
CHIEF EDITOR
Radzinsky Viktor Evseevich
Corresponding Member of the Russian Academy of Sciences, MD, Professor, Head of the Subdepartment of Obstetrics and Gynecology with a Course of Perinatology of the Medical Department in the Russian People?s Friendship University

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