Autologous Bone Marrow Cell Infusion for the Treatment of Decompensated Liver Cirrhosis Patients With Type 2 Diabetes Mellitus

This study aimed to indicate whether autologous bone marrow cell infusion (ABMI) via the right omental vein (ROV) could have a regulatory effect on decompensated liver cirrhosis (DLC) patients with type 2 diabetes mellitus (T2DM). For this purpose, 24 DLC patients with T2DM were divided into observation group (n=14) and control group (n=10). Patients in the observation group were given ABMI through the ROV and right omental artery (ROA), and cases in the control group received ABMI through the ROV. At 1, 3, 6, and 12months after ABMI, it was revealed that the prothrombin time, the total bilirubin levels, and the amount of ascites were significantly lower, while the serum albumin levels in the two groups were markedly higher compared with those before ABMI (p<0.01), and there was no significant difference between the two groups at each time point (p>0.05). The fasting blood glucose and glycosylated hemoglobin levels at 6 and 12months after ABMI in the two groups significantly decreased compared with those before ABMI (p<0.05 or p<0.01), while the decreased levels in the observation group were more obvious than those in the control group at each time point (p<0.01). The amount of insulin in the observation group at 3, 6, and 12months after ABMI was significantly less than that before ABMI in the control group (p<0.01). In summary, ABMI showed a significant therapeutic efficacy for DLC patients with T2DM through ROV and ROA.

Highly accurate differentiation of bone marrow cell morphologies using deep neural networks on a large image data set

Biomedical applications of deep learning algorithms rely on large expert annotated data sets. The classification of bone marrow (BM) cell cytomorphology, an important cornerstone of hematological diagnosis, is still done manually thousands of times every day because of a lack of data sets and trained models. We applied convolutional neural networks (CNNs) to a large data set of 171 374 microscopic cytological images taken from BM smears from 945 patients diagnosed with a variety of hematological diseases. The data set is the largest expert-annotated pool of BM cytology images available in the literature. It allows us to train high-quality classifiers of leukocyte cytomorphology that identify a wide range of diagnostically relevant cell species with high precision and recall. Our CNNs outcompete previous feature-based approaches and provide a proof-of-concept for the classification problem of single BM cells. This study is a step toward automated evaluation of BM cell morphology using state-of-the-art image-classification algorithms. The underlying data set represents an educational resource, as well as a reference for future artificial intelligence–based approaches to BM cytomorphology.

Genotoxicity Assessment and Protective Effect of Anogeissus leiocarpus Roots against Cyclophosphamide-Induced DNA Damage In Vivo

Background. Belonging to the family of Combretaceae, the roots of Anogeissus leiocarpus are traditionally used to treat diabetes, wounds, infections, pain, and gastrointestinal diseases. To our knowledge, no genotoxicity assessment of the plant was reported. Hence, this study was designed to evaluate the potential genotoxic and protective effects of extract of Anogeissus leiocarpus roots using the micronucleus test on mice bone marrow cells in vivo. Methods. Three different concentrations (250, 500, and 1000 mg·kg−1) of hydroalcoholic extract of roots of A. leiocarpus were administered daily for 7 days per os to mice, and the genotoxicity was induced by the administration ip of cyclophosphamide. Genotoxicity and cytotoxicity were evaluated by counting, respectively, the number of micronucleated polychromatic erythrocytes and polychromatic erythrocytes to total erythrocytes in the bone marrow of mice. Results. The administration of A. leiocarpus did neither increase the ratio of the polychromatic erythrocyte (PCE) nor the frequency of micronucleated PCE (MNPCE) significantly in the bone marrow cells of the mice, compared to the vehicle control animals. However, a significant increase in the incidence of MNPCE in the bone marrow cell of the cyclophosphamide-treated mice was found. Moreover, in the groups treated with the total extract of A. leiocarpus at different doses plus cyclophosphamide, there was a significant decrease p < 0.0001 in MNPCEs compared to the positive controls, in a dose-dependent manner. Conclusion. This first finding reports that the extract of A. leiocarpus was neither genotoxic nor cytotoxic. However, it shows a protective effect against the genotoxicity and cytotoxicity induced by cyclophosphamide.

A Completely Digital Workflow for Differentials in Bone Marrow Cytomorphology Supported By Machine Learning Provides Promising Results in Object Detection

Background: Cytomorphology is an essential method to assess disease phenotypes. Recently, promising results of automation, digitalization and machine learning (ML) for this gold standard have been demonstrated. We reported on successful integration of such workflows into our lab routine, including automated scanning of peripheral blood smears and ML-based classification of blood cell images (ASH 2020). Following this pilot project, we are focusing on an equivalent approach for bone marrow. Aim: To establish a multistep-approach including scan of bone marrow smears and detection/classification of all kinds of bone marrow cell types in healthy individuals and leukemia patients. Methods: The method includes a pre-scan at 10x magnification for detecting suitable "areas of interest" (AOI) for cytomorphological analysis, a high resolution capture of a predefinable number of AOI at 40x magnification (always using oil) and an automated object detection and classification. For all scanning tasks, a Metafer Scanning System (Zeiss Axio Imager.Z2 microscope, automatic slide feeder SFx80 and automated oil disperser) from MetaSystems (Altlussheim, GER) was used. To generate training data for AOI detection, 37 bone marrow smears were scanned at 10x magnification. 6 different quality classes of regions (based on number and distribution of cells) were annotated by hem experts using polygons. In total, 185,000 grid images were extracted from the annotated regions and used for training a deep neural network (DNN) to distinguish the 6 quality classes and to generate a position list for a high resolution scan (40x magnification). In addition, we scanned the labeled AOI of 68 smears at 40x magnification, acquiring colour images (2048x1496 pixels) of bone marrow cell layers. Each single cell was labeled by human investigators using rectangular bounding boxes (in total: 47,118 cells in 511 images). We set up a supervised ML model, using the labeled 40x images as an input. We fine-tuned the COCO dataset pre-trained YOLOv5 model with our dataset and evaluated using 5-fold cross valuation. To reduce overfitting, image augmentation algorithms were applied. Results: Our first DNN was able to detect (10x magnification) and capture (40x magnification) AOI in bone marrow smears, sorted by quality and in acceptable time spans. Average time for the 10x pre-scan was 6 min. From the resulting position list, the 50 positions with highest quality values were acquired at an average of 1:30 min. Our second, independent DNN was able to detect nucleated cells at 94% sensitivity and 75% precision in unlabeled bone marrow images (40x magnification). In this model, we overweighted recall over precision (5:1) to avoid missing any objects of interest, assuming that false positive labels could be corrected by human investigators when reviewing digital images. For the classification of single cells, a third independent DNN will be necessary. Actually, different approaches are being tested, including our existing blood cell classifier and a former collaborative bone marrow classification model based on a training set of 100,000 annotated bone marrow cells. Depending on these results, new training data for generation of a completely new model could be assessed. The two existing models enable a fully automated digital workflow including scan of bone marrow smears and delivery of single cell image galleries for human classification already now. Conclusion: We here present solutions for multiple-DNN-based tools for bone marrow cytomorphology. They allow working digitally and remotely in routine diagnostics. Final solutions will offer single cell classifications and galleries for human review and include real time training of respective classifier models with dynamic datasets. Figure 1 Figure 1. Disclosures Haferlach: MLL Munich Leukemia Laboratory: Other: Part ownership. Kern: MLL Munich Leukemia Laboratory: Other: Part ownership. Haferlach: MLL Munich Leukemia Laboratory: Other: Part ownership.

Tissue-resident M2 macrophages directly contact primary sensory neurons in the sensory ganglia after nerve injury

Background Macrophages in the peripheral nervous system are key players in the repair of nerve tissue and the development of neuropathic pain due to peripheral nerve injury. However, there is a lack of information on the origin and morphological features of macrophages in sensory ganglia after peripheral nerve injury, unlike those in the brain and spinal cord. We analyzed the origin and morphological features of sensory ganglionic macrophages after nerve ligation or transection using wild-type mice and mice with bone-marrow cell transplants. Methods After protecting the head of C57BL/6J mice with lead caps, they were irradiated and transplanted with bone-marrow-derived cells from GFP transgenic mice. The infraorbital nerve of a branch of the trigeminal nerve of wild-type mice was ligated or the infraorbital nerve of GFP-positive bone-marrow-cell-transplanted mice was transected. After immunostaining the trigeminal ganglion, the structures of the ganglionic macrophages, neurons, and satellite glial cells were analyzed using two-dimensional or three-dimensional images. Results The number of damaged neurons in the trigeminal ganglion increased from day 1 after infraorbital nerve ligation. Ganglionic macrophages proliferated from days 3 to 5. Furthermore, the numbers of macrophages increased from days 3 to 15. Bone-marrow-derived macrophages increased on day 7 after the infraorbital nerve was transected in the trigeminal ganglion of GFP-positive bone-marrow-cell-transplanted mice but most of the ganglionic macrophages were composed of tissue-resident cells. On day 7 after infraorbital nerve ligation, ganglionic macrophages increased in volume, extended their processes between the neurons and satellite glial cells, and contacted these neurons. Most of the ganglionic macrophages showed an M2 phenotype when contact was observed, and little neuronal cell death occurred. Conclusion Most of the macrophages that appear after a nerve injury are tissue-resident, and these make direct contact with damaged neurons that act in a tissue-protective manner in the M2 phenotype. These results imply that tissue-resident macrophages signal to neurons directly through physical contact.

Diagnostic Value of Bone Marrow Cell Morphology in Visceral Leishmaniasis-Associated Hemophagocytic Syndrome of Two Cases

Background: Visceral leishmaniasis related-hemophagocytic lymphohistiocytosis (VL-HLH) is a hemophagocytic syndrome caused by Leishmania infection. VL-HLH is rare, especially in nonendemic areas where the disease is severe, and mortality rates are high. The key to diagnosing VL-HLH is to find the pathogen; therefore, the Leishmania must be accurately identified for timely clinical treatment.Case presentationWe retrospectively analyzed the clinical data, laboratory examination results and bone marrow cell morphology of two children with VL-HLH diagnosed via bone marrow cell morphology between July 2017 and January 2021 at Kunming Children’s Hospital of Yunnan, China.Two cases suspected of having malignant tumors at other hospitals and who had undergone ineffective long-term treatment were transferred to Kunming Children’s Hospital. They had repeated fevers, pancytopenia, hepatosplenomegaly, hypertriglyceridemia, and hypofibrinogenemia over a long period and met the HLH-2004 standard. Their HLH genetic test results were negative, and primary HLH was excluded. Both children underwent chemotherapy as per the HLH-2004 chemotherapy regimen , but it was ineffective and accompanied by serious infections. We found Leishmania amastigotes in their bone marrow via morphological examination of their bone marrow cells, which showed hemophagocytic cells; thus, the children were diagnosed with VL-HLH. After being transferred to a specialty hospital for treatment, the condition was well-controlled. Conclusion: Morphological examination of the bone marrow cells played an important role in diagnosing VL-HLH. When clinically diagnosing secondary HLH, VL-HLH should be considered in addition to common pathogens, especially in patients for whom HLH-2004 chemotherapy regimens are ineffective. For infants and young children, bone marrow cytology examinations should be performed several times and as early as possible to find the pathogens to reduce potential misdiagnoses.

Reduction of Cell Proliferation by Acute C2H6O Exposure

Endogenous acetaldehyde production from the metabolism of ingested alcohol exposes hematopoietic progenitor cells to increased genotoxic risk. To develop possible therapeutic strategies to prevent or reverse alcohol abuse effects, it would be critical to determine the temporal progression of acute ethanol toxicity on progenitor cell numbers and proliferative status. We followed the variation of the cell proliferation rate in bone marrow and spleen in response to acute ethanol intoxication in the MITO-Luc mouse, in which NF-Y-dependent cell proliferation can be assessed in vivo by non-invasive bioluminescent imaging. One week after ethanol administration, bioluminescent signals in bone marrow and spleen decreased below the level corresponding to physiological proliferation, and they progressively resumed to pre-treatment values in approximately 4 weeks. Boosting acetaldehyde catabolism by administration of an aldehyde dehydrogenase activity activator or administration of polyphenols with antioxidant activity partially restored bone marrow cells’ physiological proliferation. These results indicate that in this mouse model, bioluminescent alteration reflects the reduction of the physiological proliferation rate of bone marrow progenitor cells due to the toxic effect of aldehydes generated by alcohol oxidation. In summary, this study presents a novel view of the impact of acute alcohol intake on bone marrow cell proliferation in vivo.

Transition of clinical and basic studies on liver cirrhosis treatment using cells to seek the best treatment

The liver is a highly regenerative organ; however, its regeneration potential is reduced by chronic inflammation with fibrosis accumulation, leading to cirrhosis. With an aim to tackle liver cirrhosis, a life-threatening disease, trials of autologous bone marrow cell infusion (ABMi) therapy started in 2003. Clinical studies revealed that ABMi attenuated liver fibrosis and improved liver function in some patients; however, this therapy has some limitations such as the need of general anesthesia. Following ABMi therapy, studies have focused on specific cells such as mesenchymal stromal cells (MSCs) from a variety of tissues such as bone marrow, adipose tissue, and umbilical cord tissues. Particularly, studies have focused on gaining mechanistic insights into MSC distribution and effects on immune cells, especially macrophages. Several basic studies have reported the use of MSCs for liver cirrhosis models, while a number of clinical studies have used autologous and allogeneic MSCs; however, there are only a few reports on the obvious substantial effect of MSCs in clinical studies. Since then, studies have analyzed and identified the important signals or components in MSCs that regulate immune cells, such as macrophages, under cirrhotic conditions and have revealed that MSC-derived exosomes are key regulators. Researchers are still seeking the best approach and filling the gap between basic and clinical studies to treat liver cirrhosis. This paper highlights the timeline of basic and clinical studies analyzing ABMi and MSC therapies for cirrhosis and the scope for future studies and therapy.