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Thorat V.,Poona Hospital and Research Center | Reddy N.,Asian Medical Institute | Bhatia S.,Seth G S Medical College | Rajkumar J.S.,Lifeline Multispeciality Hospital | And 3 more authors.
Alimentary Pharmacology and Therapeutics | Year: 2012

Background Pancreatic exocrine insufficiency (PEI) results in maldigestion, leading to abdominal pain, steatorrhoea, malnutrition and weight loss. Aim To assess the efficacy and safety of pancreatin (Creon 40000 MMS) in treating PEI due to chronic pancreatitis (CP). Methods This was a 1-week, double-blind, randomised, placebo-controlled, parallel-group, multicentre study in India. Men and women ≥18 years of age with proven CP and PEI [defined as a coefficient of fat absorption (CFA) ≤80% during run-in phase] were randomised 1:1 to pancreatin or placebo (two capsules orally per main meal, one with snacks). The primary outcome measure was change in CFA from baseline to end of double-blind treatment (analysis of covariance). Results Of 62 patients randomised (34 pancreatin, 28 placebo), 61 completed treatment; one patient in the placebo arm withdrew consent before completion. Patient characteristics were similar in both groups except for the proportion of men (pancreatin 82% vs. placebo 68%). Patients receiving pancreatin had a statistically significant greater improvement in fat absorption from baseline to the end of double-blind treatment compared with those receiving placebo, with a least squares mean change (95% CI) in CFA of 18.5% (15.8-21.2) vs. 4.1% (1.0-7.2), respectively. This resulted in a treatment difference of 14.4% (10.3-18.5); P = 0.001. Patients receiving pancreatin also had a statistically significant greater improvement in nitrogen absorption and greater reductions in mean stool fat, stool frequency and stool weight compared with those receiving placebo. Treatment-emergent adverse events occurred in 12 patients on pancreatin and in seven on placebo; none led to study discontinuation. Conclusions The results provide evidence for the efficacy of pancreatin (Creon 40000 MMS) in patients with pancreatic exocrine insufficiency due to chronic pancreatitis, and confirm that this formulation is well tolerated, with a good safety profile, at the dose administered. © 2012 Blackwell Publishing Ltd. Source

Dhanasekaran M.,Lifeline Multispeciality Hospital | Indumathi S.,Loyola College | Rajkumar J.S.,Lifeline Multispeciality Hospital | Sudarsanam D.,Loyola College
Cell Biochemistry and Function | Year: 2013

Frontline research progresses the applicability of bone marrow and adipose tissue in regenerative medicine, but fails to account for the functional improvement of the diseased. The justification for the failure in terms of stem cell survival, proliferation and regeneration is unclear. However, hyperglycemia rising during pathological conditions might be one such stumbling block. The prevailing literature accounts for both detrimental and beneficial effect of high glucose on mesenchymal stem cells (MSCs) leading to perplexity. Thus, this study focuses on the effect of high glucose on mesenchymal stem cells derived from subcutaneous fat, omentum fat and bone marrow in extensive cultures. We provide evidence for the retention of MSC characteristics of all sources with regards to surface marker profiling, proliferation, differentiation and karyotyping when cultured extensively under DMEM-HG containing glucose concentration of 25mmol.l-1. Thus, it can be concluded that hyperglycemia in vivo (11mmol.l-1) might not be a barrier for the ineffective functional improvement of transplanted stem cells. Furthermore, we elucidated subcutaneous and omentum fat as better sources of MSCs when compared with bone marrow, thereby making these sources optimal for therapies during hyperglycemic conditions. However, further research is needed to clear the path for efficient stem cell transplantation. © 2012 John Wiley & Sons, Ltd. Source

Ramesh H.,The Surgical Center | Reddy N.,Asian Medical Institute | Bhatia S.,Seth G S Medical College | Rajkumar J.S.,Lifeline Multispeciality Hospital | And 4 more authors.
Pancreatology | Year: 2013

Background/objectives: To assess the efficacy and safety of pancreatin (pancrelipase) enteric-coated minimicrospheres (MMS) over a one-year period in patients with pancreatic exocrine insufficiency (PEI) due to chronic pancreatitis (CP). Methods: This was a 51-week, open-label extension (OLE) of a one-week, multicenter, double-blind, randomized, placebo-controlled trial in India that enrolled patients ≥18 years of age with confirmed PEI due to CP. Patients received pancreatin (Creon® 40000 MMS™) at a dose of 80,000 Ph. Eur. lipase units with each of three main meals/day and 40,000 with each of up to three snacks/day. Results: Of 61 patients entering the OLE, 48 completed treatment (nine were lost to follow up, two withdrew consent, one discontinued due to adverse event [acute exacerbation of CP], one protocol violation). There were significant improvements from baseline to end of OLE in mean ± SD coefficient of fat absorption (CFA: 22.7 ± 12.2%), coefficient of nitrogen absorption (CNA: 6.5 ± 7.9%), body weight (4.9 ± 4.9 kg), BMI (1.9 ± 1.9 kg/m2), and most nutritional laboratory parameters tested (p ≤ 0.001). Mean daily stool frequency was reduced from 2.8 to 1.6 (p < 0.001). Improvements in clinical symptoms, clinical global impression of disease symptoms, and quality of life were also observed. Treatmentemergent adverse events (TEAEs) were observed in 64% of patients overall. Only 13% of patients experienced TEAEs judged treatment related. Conclusions: In patients with PEI due to CP, treatment with pancreatin for one year was associated with significant improvements in fat absorption, nitrogen absorption, and nutritional parameters, improvements in clinical symptoms, and a favorable safety and tolerability profile. Copyright © 2012, IAP and EPC. Source

Indumathi S.,Lifeline Multispeciality Hospital | Harikrishnan R.,Lifeline Multispeciality Hospital | Mishra R.,Lifeline Multispeciality Hospital | Rajkumar J.S.,Chairman | And 3 more authors.
Tissue and Cell | Year: 2013

Scientific explorations on feto-maternal organ stem cells revealed its possible applicability in treatment of various diseases. However, establishment of an ideal placental tissue stem cell source in regenerative application is inconclusive and arduous. Hence, this study aims to resolve this tribulation by comparison of mesenchymal stem cells (MSC) from fetal placenta - amniotic membrane (AM-MSC), chorionic plate (CP-MSC) tissue and the maternal placenta-Decidua (D-MSC), thereby facilitating the researchers to determine their pertinent source. The cells were expanded and scrutinized for expression profiling, proliferation and differentiation ability. Remarkable expressions of certain markers in addition to its prospective mesodermal differentiation confirmed their mesenchyme origin. Despite the specified alikeness among these sources, reliable and non-invasive procurement of AM-MSC coupled with its higher growth potency makes it the most constructive stem cell source. However, exhibited similarities demands further investigations on extensive expandability and cytogenetic stability of these sources prior to its therapeutic applicability. © 2013 Elsevier Ltd. Source

Dhanasekaran M.,Loyola College | Indumathi S.,Loyola College | Poojitha R.,Lifeline Multispeciality Hospital | Kanmani A.,Lifeline Multispeciality Hospital | And 2 more authors.
Cell and Tissue Banking | Year: 2013

The present day research on stem cells is yet not filled to the gunwales. The correlation of stem cell technology with tissue repair still has a long way to go. Since Embryonic stem cells are a kind of thorn inside when it comes to therapeutics, there emerged few potent contemporary sources of stem cells. Though bone marrow proves to be the pioneer among these, they lose themselves to adipose tissue in various aspects. The major shortcoming of bone marrow lies in lieu of its loss in potency with age. Adipose tissue puts up a tough competition among leading edge stem cell sources like cord blood and cord matrix. Adipose tissue wins over its counterparts in that it possesses astounding proliferation potency in vitro and holds a prominent stand in showcasing in vivo tissue repair efficacy. In spite of its precedence, the whole enchilada of adipose derived stem cells is still in its salad days. In our work we aim at excogitating the Mesenchymal stem cell population present in cultured adipose derived stem cells, in a wide perspective. Furthermore, the coalition of cell adhesion molecules with the proliferation potency of MSC and analysis of growth curve of ADSC was also paid accolade. The presence of robust MSC with immense differentiation and transdifferentiation potency was endorsed by lucrative differentiation of P3 cells into mesodermal and neuronal lineages. Additionally, mesenchymal stem cells exhibiting coherent expression of surface markers at P3 in all samples can be cryopreserved for therapeutic applications. © 2012 Springer Science+Business Media B.V. Source

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