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Shah KS, Ziaeian B, Mody FV, Nsair A, Fonarow GC. Perceived Barriers to Sacubitril/Valsartan Use in Patients with Heart Failure. J Card Fail 2018. [DOI: 10.1016/j.cardfail.2018.07.378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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52
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Bakir M, Jackson NJ, Han SX, Bui A, Chang E, Liem DA, Ardehali A, Ardehali R, Baas AS, Press MC, Cruz D, Deng MC, DePasquale EC, Fonarow GC, Khuu T, Kwon MH, Kubak BM, Nsair A, Phung JL, Reed EF, Schaenman JM, Shemin RJ, Zhang QJ, Tseng CH, Cadeiras M. Clinical phenomapping and outcomes after heart transplantation. J Heart Lung Transplant 2018; 37:956-966. [PMID: 29802085 PMCID: PMC6064662 DOI: 10.1016/j.healun.2018.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 03/12/2018] [Accepted: 03/14/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Survival after heart transplantation (HTx) is limited by complications related to alloreactivity, immune suppression, and adverse effects of pharmacologic therapies. We hypothesize that time-dependent phenomapping of clinical and molecular data sets is a valuable approach to clinical assessments and guiding medical management to improve outcomes. METHODS We analyzed clinical, therapeutic, biomarker, and outcome data from 94 adult HTx patients and 1,557 clinical encounters performed between January 2010 and April 2013. Multivariate analyses were used to evaluate the association between immunosuppression therapy, biomarkers, and the combined clinical end point of death, allograft loss, retransplantation, and rejection. Data were analyzed by K-means clustering (K = 2) to identify patterns of similar combined immunosuppression management, and percentile slopes were computed to examine the changes in dosages over time. Findings were correlated with clinical parameters, human leucocyte antigen antibody titers, and peripheral blood mononuclear cell gene expression of the AlloMap (CareDx, Inc., Brisbane, CA) test genes. An intragraft, heart tissue gene coexpression network analysis was performed. RESULTS Unsupervised cluster analysis of immunosuppressive therapies identified 2 groups, 1 characterized by a steeper immunosuppression minimization, associated with a higher likelihood for the combined end point, and the other by a less pronounced change. A time-dependent phenomap suggested that patients in the group with higher event rates had increased human leukocyte antigen class I and II antibody titers, higher expression of the FLT3 AlloMap gene, and lower expression of the MARCH8 and WDR40A AlloMap genes. Intramyocardial biomarker-related coexpression network analysis of the FLT3 gene showed an immune system-related network underlying this biomarker. CONCLUSIONS Time-dependent precision phenotyping is a mechanistically insightful, data-driven approach to characterize patterns of clinical care and identify ways to improve clinical management and outcomes.
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Reardon LC, DePasquale EC, Tarabay J, Cruz D, Laks H, Biniwale RM, Busuttil RW, Kaldas FM, Saab S, Venick RS, Lin JP, Nsair A, Deng MC, Ardehali A, Caderias M, Iygengar A, Aboulhosn JA. Heart and heart-liver transplantation in adults with failing Fontan physiology. Clin Transplant 2018; 32:e13329. [DOI: 10.1111/ctr.13329] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 06/04/2018] [Accepted: 06/11/2018] [Indexed: 11/30/2022]
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Moore M, Fraschilla S, Chang A, Salimbangon A, Kamath M, Nsair A, Sweet L, DePasquale E. Survival Post Heart Transplant by Era in Recipients _-= 65. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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55
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Chang A, Nsair A, Kwon M, Kamath M, Salimbangon A, Vucicivec D, Cadeiras M, Deng M, Moreno E, Bellam N, Iyengar A, Shah S, Ardehali A, Depasquale E. Survival Post Heart Transplant by Listing Strategy. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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56
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Meguerdijian R, Chang A, Moreno E, Salimbangon A, Kamath M, Khuu T, Kwon M, Moore M, Nsair A, Pandya K, Vucicevic D, Ardehali A, Deng M, DePasquale E. Improving Utility of MELD-XI Prognostication in Heart Transplant. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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57
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Kamath M, Salimbangon A, Chang A, Moreno E, Cadeiras M, Deng M, Khuu T, Nsair A, Ardehali A, Kwon M, Depasquale E. LVAD Patients with CKD: Are Two Organs Better than One? J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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58
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Kamath M, Bellam N, Moore M, Salimbangon A, Chang A, Nsair A, Cadeiras M, Kwon M, Ardehali A, Depasquale E. Extracorporeal Membrane Oxygenation to Transplant Survival: Past, Present and Future. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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59
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Khuu T, DePasquale E, Salimbangon A, Chang A, Moreno E, Rourke D, Creaser J, Vandenbogaart E, Kwon M, Ardehali A, Nsair A. Reduced Readmissions with Enoxaparin Bridging for Subtherapeutic INR in MCS. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Hanna RM, Kamgar M, Hasnain H, Khorsan R, Nsair A, Kaldas F, Baas A, Bunnapradist S, Wilson JM. Case Report: First Reported Combined Heart-Liver Transplant in a Patient With a Congenital Solitary Kidney. Transplant Proc 2018; 50:943-946. [PMID: 29458999 DOI: 10.1016/j.transproceed.2017.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 11/11/2017] [Indexed: 10/18/2022]
Abstract
We report a case of successful combined heart liver transplant in a patient with a congenital solitary kidney. The patient had normal renal function before combined heart-liver transplantation and developed acute kidney injury requiring slow continuous dialysis and subsequent intermittent dialysis for almost 8 weeks post transplantation. Her renal function recovered and she remains off dialysis now 7 months post transplantation. She only currently has mild chronic renal insufficiency. We believe this is the first reported case of successful heart liver transplant in a patient with a congenital solitary kidney.
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Shkhyan R, Van Handel B, Bogdanov J, Lee S, Yu Y, Scheinberg M, Banks NW, Limfat S, Chernostrik A, Franciozi CE, Alam MP, John V, Wu L, Ferguson GB, Nsair A, Petrigliano FA, Vangsness CT, Vadivel K, Bajaj P, Wang L, Liu NQ, Evseenko D. Drug-induced modulation of gp130 signalling prevents articular cartilage degeneration and promotes repair. Ann Rheum Dis 2018; 77:760-769. [PMID: 29436471 DOI: 10.1136/annrheumdis-2017-212037] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 01/03/2018] [Accepted: 01/16/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Human adult articular cartilage (AC) has little capacity for repair, and joint surface injuries often result in osteoarthritis (OA), characterised by loss of matrix, hypertrophy and chondrocyte apoptosis. Inflammation mediated by interleukin (IL)-6 family cytokines has been identified as a critical driver of proarthritic changes in mouse and human joints, resulting in a feed-forward process driving expression of matrix degrading enzymes and IL-6 itself. Here we show that signalling through glycoprotein 130 (gp130), the common receptor for IL-6 family cytokines, can have both context-specific and cytokine-specific effects on articular chondrocytes and that a small molecule gp130 modulator can bias signalling towards anti-inflammatory and antidegenerative outputs. METHODS High throughput screening of 170 000 compounds identified a small molecule gp130 modulator termed regulator of cartilage growth and differentiation (RCGD 423) that promotes atypical homodimeric signalling in the absence of cytokine ligands, driving transient increases in MYC and pSTAT3 while suppressing oncostatin M- and IL-6-mediated activation of ERK and NF-κB via direct competition for gp130 occupancy. RESULTS This small molecule increased proliferation while reducing apoptosis and hypertrophic responses in adult chondrocytes in vitro. In a rat partial meniscectomy model, RCGD 423 greatly reduced chondrocyte hypertrophy, loss and degeneration while increasing chondrocyte proliferation beyond that observed in response to injury. Moreover, RCGD 423 improved cartilage healing in a rat full-thickness osteochondral defect model, increasing proliferation of mesenchymal cells in the defect and also inhibiting breakdown of cartilage matrix in de novo generated cartilage. CONCLUSION These results identify a novel strategy for AC remediation via small molecule-mediated modulation of gp130 signalling.
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Monaghan MG, Holeiter M, Brauchle E, Layland SL, Lu Y, Deb A, Pandit A, Nsair A, Schenke-Layland K. Exogenous miR-29B Delivery Through a Hyaluronan-Based Injectable System Yields Functional Maintenance of the Infarcted Myocardium. Tissue Eng Part A 2017; 24:57-67. [PMID: 28463641 PMCID: PMC5770094 DOI: 10.1089/ten.tea.2016.0527] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Myocardial infarction (MI) results in debilitating remodeling of the myocardial extracellular matrix (ECM). In this proof-of-principle study it was sought to modulate this aggressive remodeling by injecting a hyaluronic acid-based reservoir delivering exogenous microRNA-29B (miR-29B). This proof-of-principal study was executed whereby myocardial ischemia/reperfusion was performed on C57BL/6 mice for 45 min after which five 10 μL boluses of a hydrogel composed of thiolated hyaluronic acid cross-linked with poly (ethylene glycol) diacrylate, containing exogenous miR-29B as an active therapy, were injected into the border zone of the infarcted myocardium. Following surgery, the myocardial function of the animals was monitored up to 5 weeks. Delivering miR-29B locally using an injectable hyaluronan-based hydrogel resulted in the maintenance of myocardial function at 2 and 5 weeks following MI in this proof-of-principle study. In addition, while animals treated with the control of a nontargeting miR delivered using the hyaluronan-based hydrogel had a significant deterioration of myocardial function, those treated with miR-29B did not. Histological analysis revealed a significantly decreased presence of elastin and significantly less immature/newly deposited collagen fibers at the border zone of the infarct. Increased vascularity of the myocardial scar was also detected and Raman microspectroscopy discovered significantly altered ECM-specific biochemical signals at the border zone of the infarct. This preclinical proof-of-principle study demonstrates that an injectable hyaluronic acid hydrogel system could be capable of delivering miR-29B toward maintaining cardiac function following MI. In addition, Raman microspectroscopy revealed subtle, yet significant changes in ECM organization and maturity. These findings have great potential with regard to using injectable biomaterials as a local treatment for ischemic tissue and exogenous miRs to modulate tissue remodeling.
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Shen N, Knopf A, Westendorf C, Kraushaar U, Riedl J, Bauer H, Pöschel S, Layland SL, Holeiter M, Knolle S, Brauchle E, Nsair A, Hinderer S, Schenke-Layland K. Steps toward Maturation of Embryonic Stem Cell-Derived Cardiomyocytes by Defined Physical Signals. Stem Cell Reports 2017; 9:122-135. [PMID: 28528699 PMCID: PMC5511039 DOI: 10.1016/j.stemcr.2017.04.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 04/19/2017] [Accepted: 04/20/2017] [Indexed: 01/18/2023] Open
Abstract
Cardiovascular disease remains a leading cause of mortality and morbidity worldwide. Embryonic stem cell-derived cardiomyocytes (ESC-CMs) may offer significant advances in creating in vitro cardiac tissues for disease modeling, drug testing, and elucidating developmental processes; however, the induction of ESCs to a more adult-like CM phenotype remains challenging. In this study, we developed a bioreactor system to employ pulsatile flow (1.48 mL/min), cyclic strain (5%), and extended culture time to improve the maturation of murine and human ESC-CMs. Dynamically-cultured ESC-CMs showed an increased expression of cardiac-associated proteins and genes, cardiac ion channel genes, as well as increased SERCA activity and a Raman fingerprint with the presence of maturation-associated peaks similar to primary CMs. We present a bioreactor platform that can serve as a foundation for the development of human-based cardiac in vitro models to verify drug candidates, and facilitates the study of cardiovascular development and disease. Custom-made bioreactor exposes ESC-CMs to defined shear stress and cyclic stretch Physical signals and extended culture significantly improve maturation of ESC-CMs Biochemical fingerprint of dynamically cultured ESC-CMs is similar to primary CMs
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John R, Keebler M, Stulak J, Emani S, Klodell C, Nathan S, Brieke A, Uriel N, Chin J, Eckman P, Nsair A, Agarwal R, Thenappan T, Adamson R, Chuang J, Farrar D, Sundareswaran K, Katz J. Incidence and Risk Factors of Late Bleeding in Patients Enrolled in the PREVENT Study. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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65
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Bakir M, Jackson N, Han S, Tseng C, Chang E, Khuu T, Bui A, Zhang Q, Reed E, Liem D, Kubak B, Schaenman J, Ardehali A, Ardehali R, Baas A, Nsair A, Cruz D, Kwon M, DePasquale E, Deng M, Cadeiras M. Cluster Analysis and Dynamic Phenomapping to Guide Clinical Management After Heart Transplantation. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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66
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Tran BG, De La Cruz K, Grant S, Meltzer J, Benharash P, Dave R, Ardehali A, Shemin R, Depasquale E, Nsair A. Temporary Venoarterial Extracorporeal Membrane Oxygenation: Ten-Year Experience at a Cardiac Transplant Center. J Intensive Care Med 2016; 33:288-295. [DOI: 10.1177/0885066616654451] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Advances in extracorporeal membrane oxygenation (ECMO) have enabled rapid deployment in a wide range of clinical settings. We report our experience with venoarterial (VA) ECMO in adult patients over 10 years and aim to identify predictors of mortality. Design: This is a retrospective analysis of all adult patients undergoing VA ECMO at a tertiary care center from January 1, 2004, to December 31, 2013. Results: A total of 224 consecutive cases were reviewed. Eighty (35.7%) patients survived to discharge and 144 (64.3%) patients died. Patients requiring ECMO for heart transplant graft failure had lower mortality (51.6%) compared to all other etiologies (69.1%; P = .02). Forty-two percent (94 of the 224) of the patients required cardiopulmonary resuscitation (CPR) preceding ECMO and had higher rate of in-hospital mortality (74.5%) compared with patients without cardiac arrest (56.9%; P = .01). Patients with less than 30 minutes of CPR had a mortality rate of 40.0% compared to 91.4% for CPR > 30 minutes ( P = .001). In all, 24.1% of patients (54 of the 224) experienced ECMO-associated complications without significant increase in mortality, and 22.3% (50 of the 224) of the patients were transitioned to ventricular assist devices (VADs) or transplant. Patients bridged to a VAD including left ventricular assist devices and biventricular assist devices had a mortality rate of 56.1% versus 22.2% when bridged directly to transplant ( P = .01). Paradoxically, patients with an ejection fraction (EF) > 35% had a higher mortality compared to patients with an EF < 35% (75.3% vs 49.4%, respectively, P = .001). Conclusion: Extracorporeal membrane oxygenation in patients with heart transplant graft failure had the best outcome. In patients who had cardiac arrest, prolonged CPR > 30 minutes was associated with very high mortality. Paradoxically, patients with EF > 35% had a higher mortality than patients with EF < 35%, likely reflecting patients with diastolic heart failure or noncardiac causes necessitating ECMO. For transplant candidates, direct bridge from ECMO to transplant could achieve a very good outcome.
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Mukku RB, Fonarow GC, Watson KE, Ajijola OA, Depasquale EC, Nsair A, Baas AS, Deng MC, Yang EH. Heart Failure Therapies for End-Stage Chemotherapy-Induced Cardiomyopathy. J Card Fail 2016; 22:439-48. [PMID: 27109619 DOI: 10.1016/j.cardfail.2016.04.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 04/13/2016] [Accepted: 04/15/2016] [Indexed: 02/06/2023]
Abstract
With ongoing advancements in cancer-related treatments, the number of cancer survivors continues to grow globally, with numbers in the United States predicted to reach 18 million by 2020. As a result, it is expected that a greater number of patients will present with chemotherapy-related side effects. One entity in particular, chemotherapy-related cardiomyopathy (CCMP), is a known cardiotoxic manifestation associated with agents such as anthracyclines, trastuzumab, and tyrosine kinase inhibitors. Although such effects have been described in the medical literature for decades, concrete strategies for screening, prevention, and management of CCMP continue to be elusive owing to limited studies. Late recognition of CCMP is associated with a poorer prognosis, including a lack of clinical response to pharmacologic therapy, and end-stage heart failure. A number of advanced cardiac therapies, including cardiac resynchronization therapy, ventricular assist devices, and orthotopic cardiac transplantation, are available to for end-stage heart failure; however, the role of these therapies in CCMP is unclear. In this review, management of end-stage CCMP with the use of advanced therapies and their respective effectiveness are discussed, as well as clinical characteristics of patients undergoing these treatments. The relative paucity of data in this field highlights the importance and need for larger-scale longitudinal studies and long-term registries tracking the outcomes of cancer survivors who have received cardiotoxic cancer therapy to determine the overall incidence of end-stage CCMP, as well as prognostic factors that will ultimately guide such patients toward receiving appropriate end-stage care.
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Iyengar A, Eisenring C, Reardon L, Nsair A, Deng M, Ardehali A, DePasquale E. Influence of the MELD-XI (Model of End-Stage Liver Disease Excluding INR) on Heart Transplant Outcomes. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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69
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DePasquale E, Salimbangon A, Howell E, Chang A, Nsair A, Ardehali A. Biventricular Bridge to Transplant: Total Artificial Heart (TAH) vs Thoratec Paracorporeal VADs (PVADs) Outcomes Post Heart Transplant (HT). J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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70
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DePasquale E, Iyengar A, Nsair A, Pandya K, Deng M, Ardehali A. Outcomes of Heart Transplantation in Adults with Sarcoidosis: UNOS Registry Analysis. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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71
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Iyengar A, Eisenring C, Nsair A, Deng M, Reardon L, Ardehali A, DePasquale E. Outcomes in Patients Older than 65 Years of Age Post Heart (HT) & Heart-Kidney Transplant (HKT). J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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72
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DePasquale E, Salimbangon A, Chang A, Howell E, Howell E, Nsair A, Deng M, Ardehali A. Competing Outcomes of Heart Transplantation in Adults Bridged with Total Artificial Heart (TAH): UNOS Registry Analysis. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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73
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Brauchle E, Knopf A, Bauer H, Shen N, Linder S, Monaghan MG, Ellwanger K, Layland SL, Brucker SY, Nsair A, Schenke-Layland K. Non-invasive Chamber-Specific Identification of Cardiomyocytes in Differentiating Pluripotent Stem Cells. Stem Cell Reports 2016; 6:188-99. [PMID: 26777059 PMCID: PMC4750099 DOI: 10.1016/j.stemcr.2015.12.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 12/04/2015] [Accepted: 12/07/2015] [Indexed: 12/31/2022] Open
Abstract
One major obstacle to the application of stem cell-derived cardiomyocytes (CMs) for disease modeling and clinical therapies is the inability to identify the developmental stage of these cells without the need for genetic manipulation or utilization of exogenous markers. In this study, we demonstrate that Raman microspectroscopy can non-invasively identify embryonic stem cell (ESC)-derived chamber-specific CMs and monitor cell maturation. Using this marker-free approach, Raman peaks were identified for atrial and ventricular CMs, ESCs were successfully discriminated from their cardiac derivatives, a distinct phenotypic spectrum for ESC-derived CMs was confirmed, and unique spectral differences between fetal versus adult CMs were detected. The real-time identification and characterization of CMs, their progenitors, and subpopulations by Raman microspectroscopy strongly correlated to the phenotypical features of these cells. Due to its high molecular resolution, Raman microspectroscopy offers distinct analytical characterization for differentiating cardiovascular cell populations.
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Abstract
A 22-year-old woman with primary pulmonary hypertension presented with displacement of stents that had been implanted in the left main coronary artery and had migrated into the aorta. She had been referred to our center for evaluation for lung transplantation.
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DePasquale E, Pandya K, Lyons K, Reardon L, Nsair A, Deng M, Ardehali A. Outcomes of Heart Transplantation in Adults With Amyloidosis: UNOS Registry Analysis. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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76
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Reardon L, Alejos J, Deng M, Nsair A, Reemtsen B, Biniwale R, Depasquale E. Transition to Adulthood: Heart Transplant (HT) Recipient Outcomes By Age Group. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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77
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Tran B, Depasquale E, Meltzer J, Ardehali A, Cruz D, Deng M, Shemin R, Nsair A. Temporary Extracorporeal Membrane: Oxygenation: Ten-Year Experience at a Cardiac Transplant Center. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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78
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Pandya K, Zhang J, Hickey M, Nsair A, Baas A, Cadeiras M, Cruz D, Reardon L, Deng M, Ardehali A, Reed E, Depasquale E. Influence of HLA Mismatch on Outcomes After Heart Transplantation: UNOS Registry Data. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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79
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Pandya K, Lyons K, Nsair A, Baas A, Cadeiras M, Cruz D, Reardon L, Deng M, Ardehali A, Depasquale E. Cardiac Retransplantation: How Far Have We Come? J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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80
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Reardon LC, Alejos J, Nsair A, DePasquale E. INFLUENCE OF MELD (MODEL OF END-STAGE LIVER DISEASE)_XI (EXCLUDING INR) ON PEDIATRIC POST-HEART TRANSPLANT (HT) OUTCOMES. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60802-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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81
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Nsair A, Liem DA, Cadeiras M, Cheng RK, Allareddy M, Kwon M, Shemin R, Deng MC. Molecular basis of recovering on mechanical circulatory support. Heart Fail Clin 2014; 10:S57-62. [PMID: 24262353 DOI: 10.1016/j.hfc.2013.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Our insights into different system levels of mechanisms by left ventricular assist device support are increasing and suggest a complex regulatory system of overlapping biological processes. To develop novel decision-making strategies and patient selection criteria, heart failure and reverse cardiac remodeling should be conceptualized and explored by a multifaceted research strategy of transcriptomics, metabolomics, proteomics, molecular biology, and bioinformatics. Knowledge of the molecular mechanisms of reverse cardiac remodeling is in its early stages, and comprehensive reconstruction of the underlying networks is necessary.
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Abstract
ACC Stage C heart failure includes those patients with prior or current symptoms of heart failure in the context of an underlying structural heart problem who are primarily managed with medical therapy. Although there is guideline-based medical therapy for those with heart failure with reduced ejection fraction (HFrEF), therapies in heart failure with preserved ejection fraction (HFpEF) have thus far proven elusive. Emerging therapies such as serelaxin are currently under investigation and may prove beneficial. The role of advanced surgical therapies, such as mechanical circulatory support, in this population is not well defined. Further investigation is warranted for these therapies in patients with Stage C heart failure.
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Meng X, Knopf A, Vega-Crespo A, Byrne J, Van Handel B, Nsair A. Abstract 11: Xenogen-free In Vitro Differentiation and Expansion of Human Pluripotent Stem Cell-Derived Cardiovascular Progenitor Cells. Circ Res 2014. [DOI: 10.1161/res.115.suppl_1.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Human pluripotent stem cell-derived cardiovascular progenitor cells (hPSC-CPCs) represent a tractable option for cell-based therapy for heart disease. However, to be clinically relevant, these cells must be derived under good manufacturing practices (GMP)-compatible conditions and produced in great enough quantities to treat adult patients. Here we sought to demonstrate for the first time the generation and expansion of clinically relevant numbers of hPSC-CPCs in xenogen-free protocol.
Methods and Results:
GMP-grade human induced pluripotent stem cells (GMP-hiPSCs) and human embryonic stem cells (H1 and H9) were dissociated into single cells and cultured in low attachment dishes to differentiate into CPCs in StemPro medium including small molecules and human cytokines with high efficiency of 86%, 80% and 66% for GMP-hiPSCs, H1 and H9, respectively (Figure 1). All hPSC-CPCs possessed trilineage differentiation potentials, as shown by differentiation into endothelial and smooth muscle cells and functional cardiomyocytes (Figure 2). Moreover, sorted hPSC-CPCs expanded >5 fold in 10 days in xenogen-free conditions while still maintaining trilineage differentiation potential and an efficiency of ~70% (Figure 3).
Conclusions:
Here we demonstrate a xenogeny-free CPC derivation and expansion protocol that can generate clinically relevant numbers of GMP-grade cardiovascular progenitors that could be used in a clinical setting.
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84
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Cheng RK, Aboulhosn J, Nsair A. Percutaneous Angioplasty of Stenotic Outflow Graft Anastomosis of HeartMate II. JACC Cardiovasc Interv 2014; 7:700-3. [DOI: 10.1016/j.jcin.2013.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 09/16/2013] [Accepted: 09/26/2013] [Indexed: 11/27/2022]
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85
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Liem DA, Nsair A, Setty SP, Cadeiras M, Wang D, Maclellan R, Lotz C, Lin AJ, Tabaraki J, Li H, Ge J, Odeberg J, Ponten F, Larson E, Mulder J, Lundberg E, Weiss JN, Uhlen M, Ping P, Deng MC. Molecular- and organelle-based predictive paradigm underlying recovery by left ventricular assist device support. Circ Heart Fail 2014; 7:359-66. [PMID: 24643888 DOI: 10.1161/circheartfailure.113.000250] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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86
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Gago-Lopez N, Awaji O, Zhang Y, Ko C, Nsair A, Liem D, Stempien-Otero A, MacLellan W. THY-1 receptor expression differentiates cardiosphere-derived cells with divergent cardiogenic differentiation potential. Stem Cell Reports 2014; 2:576-91. [PMID: 24936447 PMCID: PMC4050474 DOI: 10.1016/j.stemcr.2014.03.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 03/05/2014] [Accepted: 03/07/2014] [Indexed: 01/26/2023] Open
Abstract
Despite over a decade of intense research, the identity and differentiation potential of human adult cardiac progenitor cells (aCPC) remains controversial. Cardiospheres have been proposed as a means to expand aCPCs in vitro, but the identity of the progenitor cell within these 3D structures is unknown. We show that clones derived from cardiospheres could be subdivided based on expression of thymocyte differentiation antigen 1 (THY-1/CD90) into two distinct populations that exhibit divergent cardiac differentiation potential. One population, which is CD90(+), expressed markers consistent with a mesenchymal/myofibroblast cell. The second clone type was CD90(-) and could form mature, functional myocytes with sarcomeres albeit at a very low rate. These two populations of cardiogenic clones displayed distinct cell surface markers and unique transcriptomes. Our study suggests that a rare aCPC exists in cardiospheres along with a mesenchymal/myofibroblast cell, which demonstrates incomplete cardiac myocyte differentiation.
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87
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Zhang Q, McNamara J, Cadeiras M, Khuu T, Baas A, Depasquale E, Halnon N, Perens G, Carlos J, Nsair A, Shemin R, Murray K, Ardehali A, Deng M, Reed E. Incidence and Importance of Donor-Specific HLA Antibody in Heart Transplant Recipients. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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88
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DePasquale E, Nsair A, Reardon L, Ardehali A, Deng M. Influence of MELD (Model of End-Stage Liver Disease)_XI (eXcluding INR) on Post-Heart Transplant (HT) Outcomes. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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89
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DePasquale E, Reardon L, Nsair A, Deng M, Alejos J. Influence of MELD (Model of End-Stage Liver Disease)_XI (eXcluding INR) on Pediatric Post-Heart Transplant (HT) Outcomes. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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90
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DePasquale E, Cheng R, Nsair A, Baas A, Cadeiras M, Cruz D, Khuu T, Deng M, Laks H, Ardehali A. Cardiac Retransplantation: How Far Have We Come? J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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91
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DePasquale E, Nsair A, Gayheart M, Reardon L, Deng M, Ardehali A. Outcomes of Heart vs. Heart-Liver Transplantation: UNOS Registry Analysis. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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92
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Nsair A, Reardon L, Deng M, Ardehali A, DePasquale E. Outcomes of Heart Transplant (HT) Recipients Bridged with BIVAD (BiVentricular Assist Device). J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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93
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DePasquale EC, Cheng R, Nsair A, Reardon L, Baas A, Cadeiras M, Cruz D, Halnon N, Alejos J, Deng M, Laks H, Ardehali A. CARDIAC RETRANSPLANTATION: HOW FAR HAVE WE COME? J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60807-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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94
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DePasquale E, Vivo R, Nsair A, Cadeiras M, Cruz D, Ardehali R, Baas A, Deng M, Fonarow G, Reardon L, Ardehali A. Comparison of Survival between Pediatric and Adult Patients after Biventricular Assist Device Implantation: Analysis of the UNOS Database. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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95
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Khan SN, Moghaddam AN, Kaveh R, Plotnik A, Lehrman E, Nsair A, Paul Finn J. Myocardial tagging in the polar coordinate system; early clinical experience. J Cardiovasc Magn Reson 2014. [PMCID: PMC4045827 DOI: 10.1186/1532-429x-16-s1-p387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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96
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Wu L, Bluguermann C, Kyupelyan L, Latour B, Gonzalez S, Shah S, Galic Z, Ge S, Zhu Y, Petrigliano FA, Nsair A, Miriuka SG, Li X, Lyons KM, Crooks GM, McAllister DR, Van Handel B, Adams JS, Evseenko D. Human developmental chondrogenesis as a basis for engineering chondrocytes from pluripotent stem cells. Stem Cell Reports 2013; 1:575-89. [PMID: 24371811 PMCID: PMC3871393 DOI: 10.1016/j.stemcr.2013.10.012] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 10/18/2013] [Accepted: 10/30/2013] [Indexed: 12/18/2022] Open
Abstract
Joint injury and osteoarthritis affect millions of people worldwide, but attempts to generate articular cartilage using adult stem/progenitor cells have been unsuccessful. We hypothesized that recapitulation of the human developmental chondrogenic program using pluripotent stem cells (PSCs) may represent a superior approach for cartilage restoration. Using laser-capture microdissection followed by microarray analysis, we first defined a surface phenotype (CD166low/negCD146low/negCD73+CD44lowBMPR1B+) distinguishing the earliest cartilage committed cells (prechondrocytes) at 5–6 weeks of development. Functional studies confirmed these cells are chondrocyte progenitors. From 12 weeks, only the superficial layers of articular cartilage were enriched in cells with this progenitor phenotype. Isolation of cells with a similar immunophenotype from differentiating human PSCs revealed a population of CD166low/negBMPR1B+ putative cartilage-committed progenitors. Taken as a whole, these data define a developmental approach for the generation of highly purified functional human chondrocytes from PSCs that could enable substantial progress in cartilage tissue engineering. BMPR1B and LIFR mark immature primary chondrocytes throughout ontogeny LIF is highly expressed by synovial cells LIF inhibits chondrocyte maturation and hypertrophy Human development dictates how to generate chondrocyte-enriched progenitors from PSCs
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Cheng RK, DePasquale EC, Deng MC, Nsair A, Horwich TB. Obesity in heart failure: impact on survival and treatment modalities. Expert Rev Cardiovasc Ther 2013; 11:1141-53. [PMID: 23944985 DOI: 10.1586/14779072.2013.824691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Heart failure (HF) and obesity are commonly seen in the USA. Although obesity is associated with traditional cardiovascular disease, its relationship with HF is complex. Obesity is an accepted risk factor for incident HF. However, in patients with established HF, there exists a paradoxical correlation, with escalating BMI incrementally protective against adverse outcomes. Despite this relationship, patients with HF may desire to lose weight to reduce comorbidities or to improve quality of life. Thus far, studies have shown that intentional weight loss in obese patients with HF does not increase risk, with strategies including dietary modification, physical activity, pharmacotherapy, and/or surgical intervention.
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98
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Yagishita D, Ajijola OA, Vaseghi M, Nsair A, Zhou W, Yamakawa K, Tung R, Mahajan A, Shivkumar K. Electrical homogenization of ventricular scar by application of collagenase: a novel strategy for arrhythmia therapy. Circ Arrhythm Electrophysiol 2013; 6:776-83. [PMID: 23873142 DOI: 10.1161/circep.113.000448] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Radiofrequency ablation for ventricular tachycardia is an established therapy. Use of chemical agents for scar homogenization represents an alternative approach. The purpose of this study was to characterize the efficacy of collagenase (CLG) application on epicardial ventricular scar homogenization. METHODS AND RESULTS Myocardial infarcts were created in Yorkshire pigs (n=6) by intracoronary microsphere injection. After 46.6±4.3 days, CLG type 2, type 4, and purified CLG were applied in vitro (n=1) to myocardial tissue blocks containing normal myocardium, border zone, and dense scar. Histopathologic studies were performed to identify the optimal CLG subtype. In vivo high-density electroanatomic mapping of the epicardium was also performed, and border zone and dense scar surface area and late potentials were quantified before and after CLG-4 application (n=5). Of the CLG subtypes tested in vitro, CLG-4 provided the best scar modification and least damage to normal myocardium. During in vivo testing, CLG-4 application decreased border zone area (21.3±14.3 to 17.1±11.1 mm(2), P=0.043) and increased dense scar area (9.1±10.3 to 22.0±20.6 mm(2), P=0.043). The total scar area before and after CLG application was 30.4±23.4 and 39.2±29.5 mm(2), respectively (P=0.08). Late potentials were reduced by CLG-4 application (28.8±21.8 to 13.8±13.1, P=0.043). During CLG-4 application (50.0±15.5 minutes), systolic blood pressure and heart rate were not significantly changed (68.0±7.7 versus 61.8±5.3 mmHg, P=0.08; 77.4±7.3 versus 78.8±6.0 beats per minute, P=0.50, respectively). CONCLUSIONS Ventricular epicardial scar homogenization by CLG-4 application is feasible and effective. This represents the first report on bioenzymatic ablation of arrhythmogenic tissue as an alternative strategy for lesion formation.
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99
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Votteler M, Berrio DAC, Horke A, Sabatier L, Reinhardt DP, Nsair A, Aikawa E, Schenke-Layland K. Elastogenesis at the onset of human cardiac valve development. Development 2013; 140:2345-53. [PMID: 23637335 PMCID: PMC3912871 DOI: 10.1242/dev.093500] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Semilunar valve leaflets have a well-described trilaminar histoarchitecture, with a sophisticated elastic fiber network. It was previously proposed that elastin-containing fibers play a subordinate role in early human cardiac valve development; however, this assumption was based on data obtained from mouse models and human second and third trimester tissues. Here, we systematically analyzed tissues from human fetal first (4-12 weeks) and second (13-18 weeks) trimester, adolescent (14-19 years) and adult (50-55 years) hearts to monitor the temporal and spatial distribution of elastic fibers, focusing on semilunar valves. Global expression analyses revealed that the transcription of genes essential for elastic fiber formation starts early within the first trimester. These data were confirmed by quantitative PCR and immunohistochemistry employing antibodies that recognize fibronectin, fibrillin 1, 2 and 3, EMILIN1 and fibulin 4 and 5, which were all expressed at the onset of cardiac cushion formation (~week 4 of development). Tropoelastin/elastin protein expression was first detectable in leaflets of 7-week hearts. We revealed that immature elastic fibers are organized in early human cardiovascular development and that mature elastin-containing fibers first evolve in semilunar valves when blood pressure and heartbeat accelerate. Our findings provide a conceptual framework with the potential to offer novel insights into human cardiac valve development and disease.
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100
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Khuu T, Cheng R, Cadeiras M, Allareddy M, Baas A, Cruz D, Depasquale E, Hickey A, Kubak B, Nsair A, Holt C, Fishbein M, Kwon M, Ardehali A, Shemin R, Reed E, Deng M. Comparing Bortezomib to Traditional Therapies for Antibody-Mediated Rejection (AMR): Out with the Old? J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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