Improved cardiac function in infarcted mice after treatment with pluripotent embryonic stem cells

Because pluripotent embryonic stem cells (ESCs) are able to differentiate into any tissue, they are attractive agents for tissue regeneration. Although improvement of cardiac function has been observed after transplantation of pluripotent ESCs, the extent to which these effects reflect ESC-mediated remuscularization, revascularization, or paracrine mechanisms is unknown. Moreover, because ESCs may generate teratomas, the ability to predict the outcome of cellular differentiation, especially when transplanting pluripotent ESCs, is essential; conversely, a requirement to use predifferentiated ESCs would limit their application to highly characterized subsets that are available in limited numbers. In the experiments reported here, we transplanted low numbers of two murine ESC lines, respectively engineered to express a beta-galactosidase gene from either a constitutive (elongation factor) or a cardiac-specific (alpha-myosin heavy chain) promoter, into infarcted mouse myocardium. Although ESC-derived tumors formed within the pericardial space in 21% of injected hearts, lacZ histochemistry revealed that engraftment of ESC was restricted to the ischemic myocardium. Echocardiographic monitoring of ESC-injected hearts that did not form tumors revealed functional improvements by 4 weeks postinfarction, including significant increases in ejection fraction, circumferential fiber shortening velocity, and peak mitral blood flow velocity. These experiments indicate that the infarcted myocardial environment can support engraftment and cardiomyogenic differentiation of pluripotent ESCs, concomitant with partial functional recovery.     

Cardiac cell sheet transplantation improves damaged heart function via superior cell survival in comparison with dissociated cell injection

Regenerative therapies have currently emerged as one of the most promising treatments for repair of the damaged heart. Recently, numerous researchers reported that isolated cell injection treatments can improve heart function in myocardial infarction models. However, significant cell loss due to primary hypoxia or cell wash-out and difficulty to control the location of the grafted cells remains problem. As an attempt to overcome these limitations, we have proposed cell sheet-based tissue engineering, which involves stacking confluently cultured cells (two-dimensional), cell sheets, to construct three-dimensional cell-dense tissues. Cell sheet transplantation has been able to recover damaged heart function. However, no detailed analysis for transplanted cell survival has been previously performed. The present study compared the survival of cardiac cell sheet transplantation to direct cell injection in a rat myocardial infarction model. Luciferase-expressing neonatal rat cardiac cells were harvested as cell sheets from temperature-responsive culture dishes. The transplantation of cell sheets was compared to the direct injection of isolated cells dissociated with trypsin-ethylenediaminetetraacetic acid. These grafts were transplanted to infarcted rat hearts and cardiac function was assessed by echocardiography at 2 and 4 weeks after transplantation. In vivo bioluminescence and histological analyses were performed to examine cell survival. Cell sheet transplantation consistently yielded greater cell survival than cell injection. Immunohistochemistry revealed that cardiac cell sheets existed over the infarcted area as an intact layer. In contrast, the injected cells were scattered with relatively few cardiomyocytes in the infarcted areas. Four weeks after transplantation, cardiac function was also significantly improved in the cell sheet transplantation group compared with the cell injection. Twenty-four hours after cell grafting, significantly greater numbers of mature capillaries were also observed in the cardiac cell sheet transplantation. Additionally, the numbers of apoptotic cells with deterioration of integrin-mediated attachment were significantly lower after cardiac cell sheet transplantation. In accordance with increased cell survival, cardiac function was significantly improved after cardiac cell sheet transplantation in comparison to cell injection. Cell sheet transplantation can repair damaged hearts through improved cell survival and should become a promising therapy in cardiovascular regenerative medicine.     

Transplantation of platelet gel spiked with cardiosphere-derived cells boosts structural and functional benefits relative to gel transplantation alone in rats with myocardial infarction

The emerging field of stem cell therapy and biomaterials has begun to provide promising strategies for the treatment of ischemic cardiomyopathy. Platelet gel and cardiosphere-derived cells (CDCs) are known to be beneficial when transplanted separately post-myocardial infarction (MI). We hypothesize that pre-seeding platelet gel with CDCs can enhance therapeutic efficacy. Platelet gel and CDCs were derived from venous blood and heart biopsies of syngeneic rats, respectively. In vitro, the viability, growth, and morphology of CDCs cultured in platelet gel were characterized. When delivered into infarcted rat hearts, platelet gel pre-seeded with CDCs was more efficiently populated with endogenous cardiomyocytes and endothelial cells than platelet gel alone. Recruitment of endogenous c-kit positive cells was enhanced in the hearts treated with gel with CDC. At 3 weeks, the hearts treated with CDC-seeded platelet gel exhibited the greatest attenuation of adverse left ventricular (LV) remodeling and the highest cardiac function (i.e., LV ejection fraction) as compared to hearts transplanted with Gel only or vehicle controls. Histological analysis revealed that, though some transplanted CDCs differentiated into cardiomyocytes and endothelial cells in the recipients’ hearts, most of the incremental benefit arose from CDC-mediated endogenous repair. Pre-seeding platelet gel with CDCs enhanced the functional benefit of biomaterial therapy for treating myocardial infarction.     

Patterning human stem cells and endothelial cells with laser printing for cardiac regeneration

Recent study showed that mesenchymal stem cells (MSC) could inhibit apoptosis of endothelial cells in hypoxic condition, increase their survival, and stimulate the angiogenesis process. In this project we applied Laser-Induced-Forward-Transfer (LIFT) cell printing technique and prepared a cardiac patch seeded with human umbilical vein endothelial cells (HUVEC) and human MSC (hMSC) in a defined pattern for cardiac regeneration. We seeded HUVEC and hMSC in a defined pattern on a Polyester urethane urea (PEUU) cardiac patch. On control patches an equal amount of cells was randomly seeded without LIFT. Patches were cultivated in?vitro or transplanted in?vivo to the infarcted zone of rat hearts after LAD-ligation. Cardiac performance was measured by left ventricular catheterization 8 weeks post infarction. Thereafter hearts were perfused with fluorescein tomato lectin for the assessment of functional blood vessels and stored for histology analyses. We demonstrated that LIFT-derived cell seeding pattern definitely modified growth characteristics of co-cultured HUVEC and hMSC leading to increased vessel formation and found significant functional improvement of infarcted hearts following transplantation of a LIFT-tissue engineered cardiac patch. Further, we could show enhanced capillary density and integration of human cells into the functionally connected vessels of murine vascular system. LIFT-based Tissue Engineering of cardiac patches for the treatment of myocardial infarction might improve wound healing and functional preservation.     

Repair of infarcted myocardium mediated by transplanted bone marrow-derived CD34+ stem cells in a nonhuman primate model

Rodent and human clinical studies have shown that transplantation of bone marrow stem cells to the ischemic myocardium results in improved cardiac function. In this study, cynomolgus monkey acute myocardial infarction was generated by ligating the left anterior descending artery, and autologous CD34(+) cells were transplanted to the peri-ischemic zone. To track the in vivo fate of transplanted cells, CD34(+) cells were genetically marked with green fluorescent protein (GFP) using a lentivirus vector before transplantation (marking efficiency, 41% on average). The group receiving cells (n = 4) demonstrated improved regional blood flow and cardiac function compared with the saline-treated group (n =4) at 2 weeks after transplant. However, very few transplanted cell-derived, GFP-positive cells were found incorporated into the vascular structure, and GFP-positive cardiomyocytes were not detected in the repaired tissue. On the other hand, cultured CD34(+) cells were found to secrete vascular endothelial growth factor (VEGF), and the in vivo regional VEGF levels showed a significant increase after the transplantation. These results suggest that the improvement is not the result of generation of transplanted cell-derived endothelial cells or cardiomyocytes; and raise the possibility that angiogenic cytokines secreted from transplanted cells potentiate angiogenic activity of endogenous cells.     

Transplantation of fetal cardiomyocytes into infarcted rat hearts results in long-term functional improvement

Studies have demonstrated the feasibility of transplanting cardiomyocytes after myocardial infarction (MI). However, persistence and effects on left ventricular (LV) function have not been elucidated in long-term studies. Ventricular fetal cardiomyocytes from embryos of both sexes were injected into marginal regions of MI 4 weeks after suture occlusion of the left anterior descending artery in adult female rats. Two and 6 months after transplantation (Tx), engrafted cells were traced by immunohistochemical in situ hybridization for Y chromosomes or bromodeoxyuridine (BrdU) staining, LV dimensions and function were assessed by echocardiography, and LV pressure was assessed ex vivo in a Langendorff perfusion system. Immunohistochemistry for alpha-sarcomeric actin and Y chromosomes revealed the presence of transplanted cells in infarcted host myocardium at both 2 and 6 months. End-diastolic LV diameter markedly decreased after Tx and fractional shortening gradually increased after Tx (31.3 +/- 4.5% before Tx, 45.4 +/- 4.2% at 6 months; p<0.005). Wall area fraction and MI size were unaffected by Tx. In hearts with MI, but not in normal hearts, Tx led to the development of higher pressures (87 +/- 18 versus 38 +/- 8 mmHg, 6 months post-Tx versus nontreated). After catecholamine stimulation, both infarcted and normal hearts developed higher pressures after Tx (p<0.005), ultimately associated with reduced mortality after Tx versus nontreated. Transplanted cardiomyocyte-rich graft cells persist in host myocardium and mediate continuous improvement of LV function and survival in a rat model of MI even during long-term follow-up, possibly involving a catecholamine-sensitive mechanism.     

Xenotransplantation of long-term-cultured swine bone marrow-derived mesenchymal stem cells

Swine-derived MSCs were efficiently isolated and extensively expanded using a low fetal serum content growth medium to which selected growth factors were added. After > or =96 cell population doublings (PDs), MSCs were devoid of cytogenetic abnormalities. In vitro chondrogenic and osteogenic differentiation capacity was preserved after 80 PDs. To test therapeutic efficacy, 1 x 10(6) 80-PD MSCs were injected directly into the peri-infarct zone of hearts of immunodeficient (non-obese diabetic/severe combined immunodeficient) mice at the time of acute myocardial infarction. Engrafted MSCs survived in the infarcted hearts for at least 4 weeks. Echocardiography at 2 and 4 weeks postinfarction revealed a significant preservation of the left ventricular ejection fractions of infarct hearts receiving MSCs compared with infarct hearts receiving saline. Peri-infarct zone capillarity was better preserved in MSC-treated hearts than other infarct groups of hearts, but infarct size was comparable in all groups. Only rare engrafted MSCs expressed cardiac-specific or endothelial cell-specific markers. Hence, 80-PD MSCs retained the capacity to promote functional improvement in the infarcted heart despite minimal differentiation of MSCs into cardiomyocytes or endothelial cells. These data suggest that the beneficial effects of MSC transplantation most likely result from the trophic effects of MSC-released substances on native cardiac and vascular cells. The capacity to massively expand MSC lines without loss of therapeutic efficacy may prove to be useful in the clinical setting where "off the shelf" MSCs may be required for interventions in patients with acute coronary syndromes.     

The role of the sca-1+/CD31- cardiac progenitor cell population in postinfarction left ventricular remodeling

Cardiac stem cell-like populations exist in adult hearts, and their roles in cardiac repair remain to be defined. Sca-1 is an important surface marker for cardiac and other somatic stem cells. We hypothesized that heart-derived Sca-1(+)/CD31(-) cells may play a role in myocardial infarction-induced cardiac repair/remodeling. Mouse heart-derived Sca-1(+)/CD31(-) cells cultured in vitro could be induced to express both endothelial cell and cardiomyocyte markers. Immunofluorescence staining and fluorescence-activated cell sorting analysis indicated that endogenous Sca-1(+)/CD31(-) cells were significantly increased in the mouse heart 7 days after myocardial infarction (MI). Western blotting confirmed elevated Sca-1 protein expression in myocardium 7 days after MI. Transplantation of Sca-1(+)/CD31(-) cells into the acutely infarcted mouse heart attenuated the functional decline and adverse structural remodeling initiated by MI as evidenced by an increased left ventricular (LV) ejection fraction, a decreased LV end-diastolic dimension, a decreased LV end-systolic dimension, a significant increase of myocardial neovascularization, and modest cardiomyocyte regeneration. Attenuation of LV remodeling was accompanied by remarkably improved myocardial bioenergetic characteristics. The beneficial effects of cell transplantation appear to primarily depend on paracrine effects of the transplanted cells on new vessel formation and native cardiomyocyte function. Sca-1(+)/CD31(-) cells may hold therapeutic possibilities with regard to the treatment of ischemic heart disease.     

Force measurements of human embryonic stem cell-derived cardiomyocytes in an in vitro transplantation model

Human embryonic stem cell (hESC)-derived cardiomyocytes have been suggested for cardiac cell replacement therapy. However, there are no data on loaded contractions developed by these cells and the regulation thereof. We developed a novel in vitro transplantation model in which beating cardiomyocytes derived from hESCs (line H1) were isolated and transplanted onto noncontractile, ischemically damaged ventricular slices of murine hearts. After 2-3 days, transplanted cells started to integrate mechanically into the existing matrix, resulting in spontaneous movements of the whole preparation. Preparations showed a length-dependent increase of active tension. In transplanted early beating hESC-derived cardiomyocytes, frequency modulation by field stimulation was limited to a small range around their spontaneous beating rate. Our data demonstrate that this novel in vitro transplantation model is well suited to assess the mechanical properties and functional integration of cells suggested for cardiac replacement strategies.     

Enhancement of MSC adhesion and therapeutic efficiency in ischemic heart using lentivirus delivery with periostin

Many approaches have shown beneficial effects of modified mesenchymal stem cells (MSCs) for treatment of infarcted myocardium, but have primarily focused on enhancing the survival of transplanted MSCs. Here, we show the dual benefits of periostin-overexpressing MSCs (p-MSCs) for infarcted myocardium. P-MSCs led to the marked histological and functional recovery of infarcted myocardium by enhancing survival of MSCs and directly preventing apoptosis of cardiomyocytes. Survival of p-MSCs themselves and cardiomyocytes co-cultured with p-MSCs or treated with the conditioned media from p-MSCs was significantly increased under hypoxic conditions. Decreases in adhesion-related integrins were reversed in cardiomyocytes co-cultured with p-MSCs, followed by increases in p-PI3K and Akt, indicating that periostin activates the PI3K pathway through adhesion-related integrins. When p-MSCs were injected into myocardial infarcted rats, histological pathology and cardiac function were significantly improved compared to MSC-injected controls. Thus, periostin might be a new target of therapeutic treatments using MSCs as carriers for infarcted myocardium.     

Skeletal myoblasts for cardiac repair

Stem cells provide an alternative curative intervention for the infarcted heart by compensating for the cardiomyocyte loss subsequent to myocardial injury. The presence of resident stem and progenitor cell populations in the heart, and nuclear reprogramming of somatic cells with genetic induction of pluripotency markers are the emerging new developments in stem cell-based regenerative medicine. However, until safety and feasibility of these cells are established by extensive experimentation in in vitro and in vivo experimental models, skeletal muscle-derived myoblasts, and bone marrow cells remain the most well-studied donor cell types for myocardial regeneration and repair. This article provides a critical review of skeletal myoblasts as donor cells for transplantation in the light of published experimental and clinical data, and indepth discussion of the advantages and disadvantages of skeletal myoblast-based therapeutic intervention for augmentation of myocardial function in the infarcted heart. Furthermore, strategies to overcome the problems of arrhythmogenicity and failure of the transplanted skeletal myoblasts to integrate with the host cardiomyocytes are discussed.     

人外周血单个核细胞在裸鼠缺血心肌中的分化

我们旨在探讨人外周血单个核细胞(human peripheral derived mononuclear cells,hMNCs)能否向心肌细胞、血管内皮细胞、平滑肌细胞分化.分离出hMNCs,将其经尾静脉回输到裸鼠心肌梗死模型中,2-12w后获取裸鼠心脏制备冰冻切片.用免疫双染判断移植细胞是否分别向以上三种细胞分化.免疫荧光分析的结果显示回输hMNCs后,在其心肌缺血区发现有部分细胞能同时表达人类特异的人类白细胞抗原(human leukocyte antigen,HLA)和心肌特异的TNT(troponin T)抗原、HLA和平滑肌细胞特异的平滑肌α-肌动蛋白(α-smooth muscle actin)抗原、HLA和血管内皮细胞特异的Ⅷ因子vWF(Von Willebrand factor)抗原.从而推断hMNCs通过分化参与梗死后心脏组织的再生修复过程.     

血红素氧化酶1可提高脐血间充质干细胞移植梗死心肌细胞的存活率*☆

背景：血红素氧化酶1具有较强的内源性抗氧化作用,可减轻炎症反应,发挥细胞保护作用。 目的：观察血红素氧化酶1对犬脐血间充质干细胞梗死心肌移植后细胞存活率的影响。  方法：取第4代体外培养脐血间充质干细胞,用含氯化高铁血红素的培养液培养24 h,免疫组织化学法检测细胞血红素氧化酶1的表达;将细胞经LacZ报告基因标记后经冠状动脉植入犬心肌梗死区域。 结果与结论：经含氯化高铁血红素培养液培养后的脐血间充质干细胞血红素氧化酶1表达明显上调,并持续2周以上;移植犬梗死心肌区后可长期存活,存活能力明显增强。结果表明氯化高铁血红素可诱导上调犬脐血间充质干细胞血红素氧化酶1的表达,血红素氧化酶1可明显提高脐血间质干细胞梗死心肌移植后的细胞存活率。 关键词：血红素氧化酶1;脐血;间充质干细胞;细胞移植;存活率 doi:10.3969/j.issn.1673-8225.2012.06.017     

同种异体移植骨髓间质干细胞治疗大鼠心梗后心室重构

目的： 观察骨髓间质干细胞（MSCs）移植对大鼠心梗后心室重构和心功能的影响，比较成年大鼠MSCs与乳鼠MSCs移植疗效，初步探讨同种异体移植的可行性。方法: 分别取大鼠和乳鼠的骨髓，体外分离、扩增培养MSCs，Brdu标记。在结扎冠脉后1-2 h 分别将大鼠MSCs和乳鼠MSCs分点注射到异体大鼠心脏梗死边缘区，6周后，采用超声心动图和解剖直测法获得大鼠心功能、心室重构和病理学资料。结果: 细胞移植组左室舒张末期内径和收缩末期内径短于、室壁厚于对照组，重量指数和心室腔都明显小于对照组。组织病理表现细胞移植组心梗区心肌数目多于、血管密度大于对照组，细胞外基质胶原的形成和血管周围胶原沉积均明显少于对照组，心梗区可见Brdu阳性细胞。但大鼠MSCs移植组和乳鼠MSCs移植组间无明显差异。结论: 同种异体骨髓间质干细胞可以在心梗区定植，减少胶原形成，促进心肌和血管生成，从而延缓心梗后心室重构，提高左室收缩和舒张功能。成年鼠干细胞移植与乳鼠干细胞移植具有相似的效果。     

SPIO标记骨髓间充质干细胞移植入心肌梗死大鼠的示踪研究

目的探讨超顺磁性氧化铁微粒（SPIO）体外标记骨髓间充质干细胞（BMSCs）及体内示踪移植入大鼠心肌梗死心脏的BMSCs的能力。方法使用左旋多聚赖氨酸-SPIO共培养方式标记BMSCs。采用普鲁士蓝染色观察细胞内铁颗粒,流式细胞术检测细胞活力,将经过SPIO标记的干细胞移植入心肌梗死大鼠心脏,应用1.5TMRI系统行磁标记干细胞成像。超声心动图检测各组心脏的左室射血分数（EF）,左室舒张末期内径（LVIDd）,左室收缩末期内径（LVIDs）及短轴缩短率（FS）。结果普鲁士蓝染色显示,SPIO标记的BMSCs细胞胞质内出现细小的蓝色铁颗粒,标记效率为（99.81±1.57）%;与正常未标记细胞相比较,细胞的活力差异无统计学意义（P〉0.05）。标记了SPIO的BMSCs体内MRI成像时显示,细胞移植区域信号缺失,对应区域病理切片普鲁士蓝染色可见胞浆内染色阳性的细胞。超声心动图显示,PBS组FS移植前后没有明显变化,BMSC组FS从移植前的（23.1±1.88）%上升到第1周的（31.28±4.15）%。BMSC组EF在移植前是（51.13±5.07）%,第1周时上升到（60.12±8.40）%。结论 SPIO能成功地标记BMSCs,且对BMSCs的活力无明显影响。BMSCs移植后能改善心梗大鼠的心功能。SPIO标记的BMSCs移植后在大鼠体内的分布、迁移过程可用MRI进行检测评价。     

An oxygen release system to augment cardiac progenitor cell survival and differentiation under hypoxic condition

Stem cell therapy has the potential to regenerate heart tissue damaged by myocardial infarction (MI), but it experiences extremely low efficacy. One of the major causes is the inferior cell survival under hypoxic condition of the infarcted hearts. We examined whether an oxygen-releasing system capable of sustainedly supplying oxygen to stem cells would augment cell survival and cardiac differentiation under hypoxic condition mimicking that of the infarcted hearts. The oxygen-releasing system consisted of hydrogen peroxide (H(2)O(2))-releasing microspheres, catalase and an injectable, thermosensitive hydrogel. The microspheres were based on poly(lactide-co-glycolide) (PLGA) and a complex of H(2)O(2) and poly(2-vinlypyrridione) (PVP). The oxygen was generated after the released H(2)O(2) was decomposed by catalase. The hydrogel was designed to improve the retention of microspheres and stem cells in the beating heart tissue during myocardial injection. The oxygen-releasing system was capable of sustainedly releasing oxygen for at least two weeks. The release kinetics was dependent on the ratio of H(2)O(2)/VP. The hydrogel was based on N-isopropylacrylamide (NIPAAm), acrylic acid (AAc), and a macromer hydroxyethyl methacrylate-oligo(hydroxybutyrate) (HEMA-oHB). The hydrogel had a stiffness matching that of the heart tissue and was able to stimulate the cardiosphere-derived cells (CDCs) to differentiate into cardiomyocytes. Under hypoxic condition mimicking that of the infarcted hearts (1% O(2)), CDCs encapsulated in the hydrogel experienced massive cell death. Introduction of oxygen release in the hydrogel significantly augmented cell survival; no cell death was found after seven days of culture, and cells even grew after seven days. Under hypoxic condition, cardiac differentiation of CDCs was completely silenced in the hydrogel, as confirmed at both mRNA and protein levels. However, introduction of oxygen release restored the differentiation. These results demonstrate that the developed oxygen-releasing system has great potential to improve the efficacy of cardiac stem cell therapy.     

Pluripotent stem cell-engineered cell sheets reassembled with defined cardiovascular populations ameliorate reduction in infarct heart function through cardiomyocyte-mediated neovascularization

Although stem cell therapy is a promising strategy for cardiac restoration, the heterogeneity of transplanted cells has been hampering the precise understanding of the cellular and molecular mechanisms. Previously, we established a cardiovascular cell differentiation system from mouse pluripotent stem cells, in which cardiomyocytes (CMs), endothelial cells (ECs), and mural cells (MCs) can be systematically induced and purified. Combining this with cell sheet technology, we generated cardiac tissue sheets reassembled with defined cardiovascular populations. Here, we show the potentials and mechanisms of cardiac tissue sheet transplantation in cardiac function after myocardial infarction (MI). Transplantation of the cardiac tissue sheet to a rat MI model showed significant and sustained improvement of systolic function accompanied by neovascularization. Reduction of the infarct wall thinning and fibrotic length indicated the attenuation of left ventricular remodeling. Cell tracing with species-specific fluorescent in situ hybridization after transplantation revealed a relatively early loss of transplanted cells and an increase in endogenous neovascularization in the proximity of the graft, suggesting an indirect angiogenic effect of cardiac tissue sheets rather than direct CM contributions. We prospectively dissected the functional mechanisms with cell type-controlled sheet analyses. Sheet CMs were the main source of vascular endothelial growth factor. Transplantation of sheets lacking CMs resulted in the disappearance of neovascularization and subsequent functional improvement, indicating that the beneficial effects of the sheet were achieved by sheet CMs. ECs and MCs enhanced the sheet functions and structural integration. Supplying CMs to ischemic regions with cellular interaction could be a strategic key in future cardiac cell therapy.