岩田 洋平

Background: Adipose-derived stem cells (ASCs) are a robust, multipotent cell source. They are easily obtained and hold promise in many regenerative applications. It is generally considered that the function of somatic stem cells declines with age. Although several studies have examined the effects of donor age on proliferation potential and pluripotency of ASCs, the results of these studies were not consistent. Objective: This study tested whether the donor age affects the yield of ASCs from adipose tissue, as well as the proliferation and differentiation potentials of ASCs. Methods: This study used ASCs obtained from adipose tissues of 260 donors (ages 5-97 years). ASCs were examined for individual differences in proliferation, and adipogenic, osteogenic and chondrogenic differentiation potentials in vitro. Characteristics of ASCs from each donor were evaluated by the principal component analysis (PCA) using their potential parameters. Results: Analyses on ASCs demonstrated that adipogenic potentials declined with age, but proliferation, osteogenic and chondrogenic potentials were not correlated with age. Interestingly, in all ASC potentials, including adipogenesis, individual differences were observed. Principal component analysis (PCA) revealed that individual differences became evident in the elderly, and those variations were more prominent in females than in males. Conclusions: This study demonstrated age-related changes in the potentials of ASCs and revealed that the individual differences of ASCs become significant in people over 60 years of age (for females over 60, and for males over 80). We believe that it is important to carefully observe ASC potentials in order to achieve effective regenerative medicine treatments using ASCs. (C) 2017, The Japanese Society for Regenerative Medicine. Production and hosting by Elsevier B.V.

Stem cells have recently been shown to play important roles in wound healing. The aim of this study was to investigate the role of dermal CD271(+) cells in wound healing. Full-thickness wounds were produced on the backs of 5-year-old and 24-week-old mice, and time course of wound closure, CD271(+) cell counts, and gene expression levels were compared. Delayed wound healing was observed in 24-week-old mice. The peak of CD271(+) cell increase was delayed in 24-week-old mice, and gene expression levels of growth factors in wounded tissue were significantly increased in 5-year-old mice. Dermal CD271(+) cells purified by fluorescence-activated cell sorting (FACS) expressed higher growth factors than CD271(-) cells, suggesting that CD271(+) cells play important roles by producing growth factors. This study also investigated dermal CD271(+) cells in patients with chronic skin ulcers. Dermal CD271(+) cells in patients were significantly reduced compared with in healthy controls. Thus, dermal CD271(+) cells are closely associated with wound healing.

Here, we report 3 cases of necrotizing fasciitis that were successfully treated by minimal surgical debridement. Case 1: a 73-year-old woman had bruised her right hand, and redness rapidly spread to the right upper arm. Initial debridement was performed on her right hand, and administration of an antibiotic was started. The redness and fever diminished in 10 days. Case 2: a 39-year-old man was admitted to our hospital because of purpura and necrosis accompanied by tenderness over a wide area from the right knee to the thigh. Since he also had severe diabetes, we limited initial debridement by incision only to the markedly necrotic site. The inflammatory response was improved after the administration of an antibiotic and strict general care for a few days. Case 3: a 73-year-old man was aware of a swelling of the dorsal side of the right hand since his first visit 2 days before. The swelling and redness rapidly expanded to the entire right upper arm, and he suffered from septic shock. In addition to an incision to his right hand, intensive care including the intravenous administration of antibiotics and endotoxin adsorption therapy were performed. He recovered from septic shock and was fully recovered within a month after admission. In conclusion, proper debridement is required for the treatment of necrotizing fasciitis.

62歳、男性。初診の6ヵ月前から躯幹・四肢に環状の紅斑を生じた。皮膚生検でCD8陽性異型リンパ球が血管周囲および表皮内へ密に浸潤する像を認め、CD8陽性皮膚T細胞性リンパ腫が疑われ当科へ紹介された。初診時、全身に多発する環状の紅斑と紅色腫瘤を認めた。末梢血に異型細胞はなく、PET-CTを含む画像検査では、皮膚に多発する腫瘤への集積像を認めたが、他に異常集積は認めなかった。受診後より皮疹が急速に増悪し、末梢性T細胞リンパ腫、非特定としてCHOP療法を開始した。その後、追加の精査にて浸潤細胞はCD56陽性、EBER-ISH陽性であり、Southern blot hybridization法でTCR遺伝子再構成検査も陰性であることが判明し、皮膚原発節外性NK/T細胞リンパ腫と診断した。CHOP療法は無効でSMILE療法に変更し、2コースで完全寛解を得た。CD8陽性末梢性T細胞リンパ腫との鑑別が重要と考え報告した。(著者抄録)

Herein, we describe five patients with necrotizing fasciitis (NF) who had variable outcomes and clinical manifestations. At the onset, all patients exhibited purpura with or without blister and ulceration accompanied by severe pain and tenderness in the affected skin. Out of five patients, three lacked inflammatory signs such as redness and heat, and two of the three patients showed fulminant progression and died despite intensive treatments including surgical debridement, antimicrobial therapy, close monitoring and physiological support. Tissue specimens from the patients without skin inflammatory signs showed mild neutrophil infiltration in addition to necrosis from the epidermis to subcutaneous fat, and variable amounts of thrombi. Furthermore, numerous bacteria were detected by Gram stain. By contrast, the remaining two patients with skin inflammatory signs revealed slower progression, and tissue specimens from both patients showed heavy neutrophil infiltration, but bacteria were hardly detected. Therefore, these cases suggest the possibility that the paucity of skin inflammatory signs, such as redness and heat, in NF may be a clinical clue to predict the fulminant type.