Hwang Gyun Jeon

Sungkyunkwan University, Sŏul, Seoul, South Korea

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Publications (60)116.34 Total impact

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    ABSTRACT: Traditionally, urologists recommend an interval of at least 4 weeks after prostate biopsy before radical prostatectomy. The aim of our study was to evaluate whether the interval from prostate biopsy to radical prostatectomy affects immediate operative outcomes, with a focus on differences in surgical approach. The study population of 1,848 radical prostatectomy patients was divided into two groups according to the surgical approach: open or minimally invasive. Open group included perineal and retropubic approach, and minimally invasive group included laparoscopic and robotic approach. The cut-off of the biopsy-to-surgery interval was 4 weeks. Positive surgical margin status, operative time and estimated blood loss were evaluated as endpoint parameters. In the open group, there were significant differences in operative time and estimated blood loss between the <4-week and ≥4-week interval subgroups, but there was no difference in positive margin rate. In the minimally invasive group, there were no differences in the three outcome parameters between the two subgroups. Multivariate analysis revealed that the biopsy-to-surgery interval was not a significant factor affecting immediate operative outcomes in both open and minimally invasive groups, with the exception of the interval ≥4 weeks as a significant factor decreasing operative time in the minimally invasive group. In conclusion, performing open or minimally invasive radical prostatectomy within 4 weeks of prostate biopsy is feasible for both approaches, and is even beneficial for minimally invasive radical prostatectomy to reduce operative time.
    Journal of Korean medical science. 12/2014; 29(12):1688-93.
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    ABSTRACT: To provide an overview of the incidence, bacteriologic characteristics, and antimicrobial resistance in acute prostatitis after transrectal ultrasonography (TRUS)-guided prostate biopsy. We reviewed the medical records of 9568 patients who underwent TRUS-guided biopsy between March 1995 and May 2013. These patients received oral quinolone and/or cephalosporin and intramuscular aminoglycoside as antibiotic prophylaxis. In patients with acute prostatitis, blood and urine cultures were obtained on hospital admission. The incidences of acute prostatitis and antimicrobial resistance were examined according to time period. A total of 11,345 cases of TRUS-guided biopsy were performed for 9568 patients. Acute prostatitis developed in 103 patients (0.91%). In 63 patients, the causative organism was isolated from blood and/or urine culture. The most frequent etiologic organism was Escherichia coli, which was present in 47 of 49 patients (95.9%) in blood and from 39 of 41 patients (95.1%) in urine. Extended-spectrum beta-lactamase (ESBL)-producing E coli were detected continuously since 2008 and found in 10 patients (21.3%) in blood and 8 patients (20.5%) in urine. Forty-four patients (93.6%) in blood and 36 patients (92.3%) in urine of the positive cultures and all cases with ESBL-producing E coli infection showed resistance to quinolone. ESBL-producing E coli were susceptible to imipenem, amikacin, and cefoxitin. In the treatment of acute prostatitis after TRUS-guided biopsy, quinolone is not an effective antimicrobial of choice. We should take into account antimicrobial-resistant patterns because of the high prevalence of quinolone resistance and emergence of an ESBL-producing strain. Copyright © 2014 Elsevier Inc. All rights reserved.
    Urology 10/2014; · 2.42 Impact Factor
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    ABSTRACT: To evaluate the clinical significance of preoperative erythrocyte sedimentation rate (ESR) and neutrophil-lymphocyte ratio (NLR) as prognostic factors in patients underwent radical nephroureterectomy for upper tract urothelial cancer (UTUC).
    BJU International 06/2014; · 3.05 Impact Factor
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    ABSTRACT: The purpose of this study was to compare perioperative outcomes of transperitoneal (TP) and retroperitoneal (RP) robot-assisted partial nephrectomy (RPN) by matched analysis using nephrometry systems. A total of 107 patients who underwent RPN by a single surgeon from December 2008 to June 2012 were analyzed; 57 patients underwent TP RPN and 50 patients underwent RP RPN. Baseline demographic characteristics, perioperative outcomes and changes in renal function were collected by retrospective review of medical records. Matched-pair comparisons were done using RENAL score and C-index. No significant difference was observed between TP and RP RPN in patient age, body mass index, gender, laterality, clinical stage, tumor size, RENAL score or ASA score. The TP RPN had more cystic renal masses (TP vs. RP = 33 vs. 12 %, p = 0.012) and RP RPN had shorter median operation times (150 vs. 120 min, p = 0.015) and shorter mean warm ischemic times (26.2 vs. 22.6 min, p = 0.040) than TP RPN. In the matched-pair analysis, RP RPN showed shorter operation times with similar warm ischemic times. Estimated blood loss and visual analog pain scales showed no significant differences between groups. A total of 12 (11.4 %) postoperative complications occurred, all Clavien class I or II with no significant difference in incidence. Retroperitoneal robot-assisted partial nephrectomy showed shorter operation time and generally equivalent perioperative results to TP RPN. RP RPN is a viable treatment option for treating posterior or lateral renal masses.
    World Journal of Urology 05/2014; · 2.89 Impact Factor
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    ABSTRACT: To evaluate the oncologic outcomes and postoperative complications of high-intensity focused ultrasound (HIFU) as a salvage therapy after external-beam radiotherapy (EBRT) failure in patients with prostate cancer. Between February 2002 and August 2010, we retrospectively reviewed the medical records of all patients who underwent salvage HIFU for transrectal ultrasound-guided, biopsy-proven locally recurred prostate cancer after EBRT failure (by ASTRO definition: prostate-specific antigen [PSA] failure after three consecutive PSA increases after a nadir, with the date of failure as the point halfway between the nadir date and the first increase or any increase great enough to provoke initiation of therapy). All patients underwent prostate magnetic resonance imaging and bone scintigraphy and had no evidence of distant metastasis. Biochemical recurrence (BCR) was defined according to the Stuttgart definition (PSA nadir plus 1.2 ng/mL). A total of 13 patients with a median age of 68 years (range, 60-76 years) were included. The median pre-EBRT PSA was 21.12 ng/mL, the pre-HIFU PSA was 4.63 ng/mL, and the period of salvage HIFU after EBRT was 32.7 months. The median follow-up after salvage HIFU was 44.5 months. The overall BCR-free rate was 53.8%. In the univariate analysis, predictive factors for BCR after salvage HIFU were higher pre-EBRT PSA (p=0.037), pre-HIFU PSA (p=0.015), and short time to nadir (p=0.036). In the multivariate analysis, there were no significant predictive factors for BCR. The complication rate requiring intervention was 38.5%. Salvage HIFU for prostate cancer provides effective oncologic outcomes for local recurrence after EBRT failure. However, salvage HIFU had a relatively high rate of complications.
    Korean journal of urology 02/2014; 55(2):91-6.
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    ABSTRACT: To assess the location of recurrent tumors and suggest the optimal target volume in adjuvant or salvage radiotherapy (RT) after a radical prostatectomy (RP). From January 2000 to December 2012, 113 patients had been diagnosed with suspected recurrent prostate cancer by MRI scan and received salvage RT in the Samsung Medical Center. This study assessed the location of the suspected tumor recurrences and used the inferior border of the pubic symphysis as a point of reference. There were 118 suspect tumor recurrences. The most common site of recurrence was the anastomotic site (78.8%), followed by the bladder neck (15.3%) and retrovesical area (5.9%). In the cranial direction, 106 (87.3%) lesions were located within 30mm of the reference point. In the caudal direction, 12 lesions (10.2%) were located below the reference point. In the transverse plane, 112 lesions (94.9%) were located within 10mm of the midline. A MRI scan acquired before salvage RT is useful for the localization of recurrent tumors and the delineation of the target volume. We suggest the optimal target volume in adjuvant or salvage RT after RP, which includes 97% of suspected tumor recurrences.
    Radiotherapy and Oncology 01/2014; · 4.52 Impact Factor
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    ABSTRACT: To evaluate the accuracy of preoperative multiparametric 3.0-T magnetic resonance imaging(MRI) for local staging of prostate cancer(PCa) and its influence on the decision to preserve neurovascular bundles(NVB) at robotic-assisted laparoscopic radical prostatectomy(RALRP). Between 2008 and 2011, 353 patients, who had confirmed PCa and underwent preoperative MRI and RALRP, were included. The extent of NVB sparing was initially determined on the basis of the clinical information and nerve sparing surgical plan was reevaluated after review of the MRI report. The value of preoperative MRI in the prediction of extracapsular extension(ECE) and in the decision of surgical plan according to D'Amico risk classification were analyzed. The MRI performed correct, over- and under- staging in 261(73.9%), 43(12.2%), and 49(13.9%) patients, respectively. After review of the MRI reports, the initial surgical plan was not changed in 260 patients(260/353, 74%) and changed in 93 patients(93/353, 26%). RALRP was changed to a more preservable NVB sparing procedure in 53 patients(53/93, 57%) and changed to a more aggressive NVB resecting procedure in 40 patients(40/93, 43%). For the patients with a change to more conservative surgery, the appropriateness was 91%. The sensitivity of MRI in predicting ECE showed a tendency to increase from low to high risk groups(33%,46%,80%, respectively; p<0.001). In intermediate and high risk groups, there was a surgical plan change in 40 patients(40/129, 31%) and 27 patients(27/67, 40%), respectively. The preoperative MRI significantly improves the decision-making to preserve or resect the NVB at RALRP which lacks haptic feedback.
    The Journal of urology 01/2014; · 3.75 Impact Factor
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    ABSTRACT: Background and purpose To assess the location of recurrent tumors and suggest the optimal target volume in adjuvant or salvage radiotherapy (RT) after a radical prostatectomy (RP). Material and methods From January 2000 to December 2012, 113 patients had been diagnosed with suspected recurrent prostate cancer by MRI scan and received salvage RT in the Samsung Medical Center. This study assessed the location of the suspected tumor recurrences and used the inferior border of the pubic symphysis as a point of reference. Results There were 118 suspect tumor recurrences. The most common site of recurrence was the anastomotic site (78.8%), followed by the bladder neck (15.3%) and retrovesical area (5.9%). In the cranial direction, 106 (87.3%) lesions were located within 30 mm of the reference point. In the caudal direction, 12 lesions (10.2%) were located below the reference point. In the transverse plane, 112 lesions (94.9%) were located within 10 mm of the midline. Conclusions A MRI scan acquired before salvage RT is useful for the localization of recurrent tumors and the delineation of the target volume. We suggest the optimal target volume in adjuvant or salvage RT after RP, which includes 97% of suspected tumor recurrences.
    Radiotherapy and Oncology. 01/2014;
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    ABSTRACT: To investigate the predictive factors of unfavorable prostate cancer in Korean men who underwent radical prostatectomy but eligible for active surveillance according to Epstein criteria.
    Prostate international. 01/2014; 2(2):70-5.
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    ABSTRACT: Purpose We evaluated the accuracy of preoperative multiparametric 3.0-T magnetic resonance imaging for local staging of prostate cancer and its influence in the decision to preserve neurovascular bundles at robotic assisted laparoscopic radical prostatectomy. Materials and Methods The study included 353 patients who had confirmed prostate cancer and underwent preoperative magnetic resonance imaging and robotic assisted laparoscopic radical prostatectomy between 2008 and 2011. The extent of neurovascular bundle sparing was initially determined on the basis of the clinical information and the nerve sparing surgical plan was reevaluated after review of the magnetic resonance imaging report. The value of preoperative magnetic resonance imaging in the prediction of extracapsular extension and in the decision of surgical plan according to D'Amico risk classification was analyzed. Results The magnetic resonance imaging performed correct staging, over staging and under staging in 261 (73.9%), 43 (12.2%), and 49 (13.9%) patients, respectively. After review of the magnetic resonance imaging reports, the initial surgical plan was not changed in 260 patients (74%) and was changed in 93 patients (26%). Robotic assisted laparoscopic radical prostatectomy was changed to a more preservable neurovascular bundle sparing procedure in 53 patients (57%) and changed to a more aggressive neurovascular bundle resecting procedure in 40 patients (43%). For the patients with a change to more conservative surgery, the appropriateness was 91%. The sensitivity of magnetic resonance imaging in predicting extracapsular extension showed a tendency to increase from low to high risk groups (33%, 46%, 80%, respectively, p <0.001). In intermediate and high risk groups, there was a surgical plan change in 40 patients (of 129, 31%) and 27 patients (of 67, 40%), respectively. Conclusions Preoperative magnetic resonance imaging significantly improves the decision making to preserve or resect the neurovascular bundle at robotic assisted laparoscopic radical prostatectomy, which lacks haptic feedback.
    The Journal of Urology. 01/2014; 192(1):82–88.
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    ABSTRACT: To investigate the ability of six contemporary active surveillance protocols to appropriately select active surveillance candidates among Korean men who underwent radical prostatectomy. Between January 2001 and December 2011, 1968 patients underwent radical prostatectomy for prostate cancer at Samsung Medical Center, Seoul, Korea. Patients met the criteria for active surveillance according to six currently used criteria, including those from the Johns Hopkins Hospital, the University of Toronto, the University of California at San Francisco, the Prospective Prostate Cancer Research International Active Surveillance, the University of Miami and the Memorial Sloan-Kettering Cancer Center. The rates of Gleason score upgrading, upstaging and misclassification at final pathology were assessed. Among 1006 assessable patients, the percentage of men eligible for active surveillance varied from 13.5% to 38.5%, depending on the criteria used. The rates of upgrading ranged from 41.6% to 50.6%. Extracapsular extension was reported in 4.1% to 8.5% of patients, whereas seminal vesicle invasion was reported in 0.5% to 1.6% of patients. The upstaging rates according to the six active surveillance criteria varied from 4.5% to 9.3%, and the rates of misclassification varied from 44.5% to 54.8%. Currently available active surveillance criteria might not be suitable in Korean patients with prostate cancer, as they have a high likelihood of underestimating cancer.
    International Journal of Urology 10/2013; · 1.73 Impact Factor
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    ABSTRACT: To investigate the impact of tumour size on postoperative glomerular filtration rate (GFR) in patients undergoing radical nephrectomy (RN) for renal cell carcinoma (RCC). We retrospectively identified 1371 patients who underwent RN between 1995 and 2010. Serum creatinine levels were measured preoperatively, within 7days of RN, at 3months, 1 and 3years. We divided patients into three groups based on tumour size: A: ⩽4cm, B: 4-7cm, C: >7cm. The changes in GFR were compared and multivariate logistic regression was used to analyse the predictive value of tumour size for new-onset chronic kidney disease (CKD, GFR<60mL/min/1.73m(2)). The preoperative GFR was significantly different among the three groups (A: 83.0, B: 82.0, C: 79.4ml/min/1.73m(2), P=0.040). The decrease in GFR from preoperative to within 7days was greater in group A than in groups B and C (28.2 versus 24.2 versus 18.5ml/min/1.73m(2), P<0.001). The GFR at 1year postoperative was lower in group A than in group C (58.4 versus 61.5ml/min/1.73m(2), P=0.009), in contrast to preoperative GFR. The incidence of GFR decrease >30% was higher in Group A than in Groups B and C at 1year (52.4% versus 41.5% versus 33.7%, P<0.001). On multivariate analysis Groups A and B had a 2.37-fold (95% confidence interval (CI) 1.56-3.60, P<0.001) and 2.24-fold (95% CI 1.49-3.38, P<0.001) higher risk of new-onset CKD compared with Group C. Small tumour size is associated with CKD after RN. Partial nephrectomy should be considered in patients with tumour size 7cm or less.
    European journal of cancer (Oxford, England: 1990) 09/2013; · 4.12 Impact Factor
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    ABSTRACT: To evaluate predictors of more aggressive disease and the role of multiparametric 3.0-T magnetic resonance imaging (MRI) in selecting prostate cancer patients for active surveillance. We retrospectively assessed 298 prostate cancer patients who met the Prostate Cancer Research International: Active Surveillance (PRIAS) criteria, defined as T1c/T2, PSA level of ≤10 ng/mL, PSA density of <0.2 ng/mL(2) , Gleason score <7, and one or two positive biopsy cores. All patients underwent preoperative MRI, including T2-weighted, diffusion-weighted, and dynamic contrast-enhanced imaging, as well as radical prostatectomy between June 2005 and December 2011. Imaging results were correlated with pathological findings to evaluate the ability of MRI to select patients for active surveillance. In 35(11.7%) patients, no discrete cancer was visible on MRI while in the remaining 263(88.3%) patients, a discrete cancer was visible. Pathologic examination of radical prostatectomy specimens resulted in upstaging (>T2) in 21(7%) patients, upgrading (Gleason score>6) in 136(45.6%), and a diagnosis of unfavorable disease in 142(47.7%) patients. The 263 patients(88.3%) with visible cancer on imaging were more likely to have their cancer status upgraded(49.8% vs. 14.3%) and be diagnosed with unfavorable disease(52.1% vs. 14.3%) than the 35 patients(11.7%) with no cancer visible upon imaging, and these differences were statistically significant(p<0.001 for all). A visible cancer lesion on MRI, PSA density, and patient age were found to be predictors of unfavorable disease in multivariate analysis. MRI can predict adverse pathologic features and be used to assess the eligibility of prostate cancer patients for active surveillance.
    BJU International 08/2013; · 3.05 Impact Factor
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    ABSTRACT: The aim of this study was to improve understanding of the characteristics of micropapillary urothelial carcinoma (MPUC) in the renal pelvis and ureter, and to compare oncological outcomes between MPUC and non-MPUC. From September 1994 to October 2010, 418 patients underwent nephroureterectomy with bladder excision due to presumed urothelial carcinoma. Pathological review of all specimens was done by one uropathologist. Perioperative data from these patients were reviewed retrospectively. Patients were divided into MPUC and non-MPUC groups. Oncological outcomes were compared between the two groups via progression-free survival (PFS) and cancer-specific survival (CSS) rates. A total of 386 patients were included in the study. Of these, seven patients (1.81%) had MPUC. The median follow-up duration was 39.0 months (IQR range 21.1-70.6). All MPUC patients were men and had lymphovascular invasion, and six patients (85.7%) had grade III and T3 disease. On univariable analysis, MPUC showed significantly worse prognosis with regard to disease progression (p<0.001). In the subgroup analysis confined to T3 or T4 disease, MPUC showed worse prognosis than non-MPUC in terms of PFS and CSS, respectively (p<0.05). In the multivariable model, MPUC still remained a statistically significant independent predictor for PFS (HR (95% CI)=3.85 (1.59-9.32), p=0.003). MPUC was associated with poorer CSS than non-MPUC (p<0.001). We have observed that upper tract MPUC is associated with poor oncological outcomes in terms of PFS and CSS. MPUC was an independent prognostic factor for PFS in multivariable analysis.
    Journal of clinical pathology 08/2013; · 2.43 Impact Factor
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    ABSTRACT: We assessed the predictive factors for renal insufficiency in patients followed for more than 5 years after radical nephrectomy. Age, gender, history of diabetes, history of hypertension, body mass index, preoperative estimated glomerular filtration rate (eGFR), serum uric acid, urine albumin, normal renal parenchymal volume, tumor size, and ratio of normal parenchymal volume of the removed kidney to that of the remaining kidney were evaluated retrospectively in 89 patients who underwent radical nephrectomy from January 2001 to December 2005. Patients were included whose renal parenchymal volume was measurable by use of perioperative imaging (computed tomography or magnetic resonance imaging), whose preoperative eGFR was greater than 60 mL/min/1.73 m(2), and who were followed for more than 5 years. To measure renal parenchymal volume from imaging, we integrated the extent of the normal renal parenchyma from axial slides of images. In univariate and multivariate binary regression analysis, the parenchymal volume of the remnant kidney (p=0.001), a history of diabetes (p=0.035), and preoperative eGFR (p=0.011) were independent factors for renal insufficiency. By use of a receiver operating characteristic curve, a volume of 170 mL was determined to be an appropriate cutoff value, with sensitivity of 58.7% and specificity of 74.4% for the parenchymal volume of the remnant kidney for predicting eGFR less than 60 mL/min/1.73 m(2) (area under the curve, 0.678). The parenchymal volume of the remnant kidney was also an independent factor for the downgrading of the chronic kidney disease category in the multivariate linear regression analysis (p=0.021). Preoperative eGFR, a history of diabetes, and the radiologic volume of the remaining kidney parenchyma could be useful factors for predicting postoperative renal function. Patients with parenchymal volumes of less than 170 mL have a higher risk of postoperative renal insufficiency, which should be considered carefully when choosing a treatment modality.
    Korean journal of urology 05/2013; 54(5):303-310.
  • Hwang Gyun Jeon
    Canadian Urological Association journal = Journal de l'Association des urologues du Canada 05/2013; 7(5-6):193-4. · 1.66 Impact Factor
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    ABSTRACT: The purpose of this article was to announce the establishment of the multicenter Korean Prostate Cancer Database (K-CaP) and to provide urologists with details about K-CaP's methodology. The initial participating K-CaP institutions include five medical centers in Korea. First, we registered prostate cancer patients who underwent radical prostatectomy as the basic background data. K-CaP is poised to combine these initial observational longitudinal studies with those of other eligible institutions as the database grows. All current prostate cancer patients in Korea are able to be registered into the Web-based database system and thereby have a role in several observational studies. The structure of the database for K-CaP was developed by matching it with the respective data from different studies. The operability of the K-CaP database system was verified by using the existing databases from three participating institutions. The analysis of clinicopathologic characteristics of patients with the use of the Web-based database was successfully conducted. We confirmed the accurate operation of the Web-based database system without any difficulties. We are announcing the establishment of K-CaP the first database of comprehensive observational longitudinal studies about prostate cancer in Korea. The database will be successfully maintained by sufficiently and continuously updating all patient data covering several treatments. Complete statistical results for registered prostate cancer patients are forthcoming for the basic background data to establish the database. Even though much trial and error are expected during the development process, we expect that K-CaP will eventually become one of the most powerful longitudinal observation databases.
    Korean journal of urology 04/2013; 54(4):229-33.
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    ABSTRACT: Human adult stem cells are a readily available multipotent cell source that can be used in regenerative medicine. Despite many advantages, including low tumorigenicity, their rapid senescence and limited plasticity have curtailed their use in cell-based therapies. In this study, we isolated CD34/CD73 double-positive (CD34+/CD73+) testicular stromal cells (HTSCs) and found that the expression of CD34 was closely related to the cells' stemness and proliferation. The CD34+/CD73+ cells grew in vitro for an extended period of time, yielding a multitude of cells (5.6 x 1016 cells) without forming tumors in vivo. They also differentiated into all 3 germ layer lineages both in vitro and in vivo, produced cartilage more efficiently compared to bone marrow stem cells and, importantly, restored erectile function in a cavernous nerve crush injury rat model. Thus, these HTSCs may represent a promising new autologous cell source for clinical use.
    Stem cells and development 03/2013; · 4.15 Impact Factor
  • Urology 01/2013; 81(1):213–214. · 2.42 Impact Factor
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    ABSTRACT: Background and Aims: Immunomodulatory properties of mesenchymal stem cells (MSCs) have been applied to reduce the incidence of graft-versus-host disease (GVHD) after hematopoietic stem cell transplantation (HSCT). Among the various sources of MSCs that have immunomodulatory effects in vitro, only placenta-derived MSCs (PD-MSCs) have not been evaluated in an in vivo model of GVHD. In this study, we investigated the immunomodulatory properties of PD-MSCs in vitro and evaluated their clinical potential for controlling GVHD in an animal model. Methods: A GVHD animal model was established by transplanting C57BL/6 donor bone marrow cells and spleen cells into lethally irradiated BALB/c recipient mice. To control GVHD, human PD-MSCs were transplanted into recipient mice (5 × 10(5) or 1 × 10(6) cells). Results: PD-MSCs suppressed mitogen-stimulated T cell proliferation in vitro in a dose-dependent manner. Moreover, PD-MSCs inhibited cytokine secretion (interleukin-12, tumor necrosis factor-α and interferon-γ) of activated T cells. In vivo, the survival rate in the PD-MSC group (transplanted with 1 × 10(6) cells) was higher than that in the control group and histological scores were low in the PD-MSC group. Conclusion: We present the first evidence that human PD-MSCs can efficiently control GVHD in an HSCT in vivo model.
    Acta Haematologica 12/2012; 129(4):197-206. · 0.89 Impact Factor

Publication Stats

391 Citations
116.34 Total Impact Points

Institutions

  • 2012–2014
    • Sungkyunkwan University
      • Department of Urology
      Sŏul, Seoul, South Korea
  • 2010–2012
    • CHA University
      Sŏul, Seoul, South Korea
    • Yonsei University
      • Department of Urology
      Seoul, Seoul, South Korea
    • Seoul National University
      • Department of Urology
      Seoul, Seoul, South Korea
  • 2011
    • Yonsei University Hospital
      • Department of Internal Medicine
      Sŏul, Seoul, South Korea
  • 2009–2011
    • Seoul National University Hospital
      • Department of Urology
      Seoul, Seoul, South Korea