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Sürder D, Manka R, Lo Cicero V, Moccetti T, Rufibach K, Soncin S, Turchetto L, Radrizzani M, Astori G, Schwitter J, Erne P, Zuber M, Auf der Maur C, Jamshidi P, Gaemperli O, Windecker S, Moschovitis A, Wahl A, Bühler I, Wyss C, Kozerke S, Landmesser U, Lüscher TF, Corti R. Intracoronary Injection of Bone Marrow–Derived Mononuclear Cells Early or Late After Acute Myocardial Infarction. Circulation 2013; 127:1968-79. [DOI: 10.1161/circulationaha.112.001035] [Citation(s) in RCA: 163] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Daniel Sürder
- From the Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich (R.M., J.S., O.G., I.B., C.W., U.L., T.F.L., R.C.); Fondazione Cardiocentro Ticino, Lugano (D.S., V.L.C., T.M., S.S., L.T., M.R., G.A.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich (R.M., S.K.); Rufibach rePROstat, Biostatistical Consulting and Training, Bern (K.R.); Department of Cardiology, Cantonal Hospital Lucerne, Lucerne (P.E., M.Z., C.A.d.M., P.J.); Department of Cardiology
| | - Robert Manka
- From the Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich (R.M., J.S., O.G., I.B., C.W., U.L., T.F.L., R.C.); Fondazione Cardiocentro Ticino, Lugano (D.S., V.L.C., T.M., S.S., L.T., M.R., G.A.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich (R.M., S.K.); Rufibach rePROstat, Biostatistical Consulting and Training, Bern (K.R.); Department of Cardiology, Cantonal Hospital Lucerne, Lucerne (P.E., M.Z., C.A.d.M., P.J.); Department of Cardiology
| | - Viviana Lo Cicero
- From the Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich (R.M., J.S., O.G., I.B., C.W., U.L., T.F.L., R.C.); Fondazione Cardiocentro Ticino, Lugano (D.S., V.L.C., T.M., S.S., L.T., M.R., G.A.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich (R.M., S.K.); Rufibach rePROstat, Biostatistical Consulting and Training, Bern (K.R.); Department of Cardiology, Cantonal Hospital Lucerne, Lucerne (P.E., M.Z., C.A.d.M., P.J.); Department of Cardiology
| | - Tiziano Moccetti
- From the Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich (R.M., J.S., O.G., I.B., C.W., U.L., T.F.L., R.C.); Fondazione Cardiocentro Ticino, Lugano (D.S., V.L.C., T.M., S.S., L.T., M.R., G.A.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich (R.M., S.K.); Rufibach rePROstat, Biostatistical Consulting and Training, Bern (K.R.); Department of Cardiology, Cantonal Hospital Lucerne, Lucerne (P.E., M.Z., C.A.d.M., P.J.); Department of Cardiology
| | - Kaspar Rufibach
- From the Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich (R.M., J.S., O.G., I.B., C.W., U.L., T.F.L., R.C.); Fondazione Cardiocentro Ticino, Lugano (D.S., V.L.C., T.M., S.S., L.T., M.R., G.A.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich (R.M., S.K.); Rufibach rePROstat, Biostatistical Consulting and Training, Bern (K.R.); Department of Cardiology, Cantonal Hospital Lucerne, Lucerne (P.E., M.Z., C.A.d.M., P.J.); Department of Cardiology
| | - Sabrina Soncin
- From the Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich (R.M., J.S., O.G., I.B., C.W., U.L., T.F.L., R.C.); Fondazione Cardiocentro Ticino, Lugano (D.S., V.L.C., T.M., S.S., L.T., M.R., G.A.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich (R.M., S.K.); Rufibach rePROstat, Biostatistical Consulting and Training, Bern (K.R.); Department of Cardiology, Cantonal Hospital Lucerne, Lucerne (P.E., M.Z., C.A.d.M., P.J.); Department of Cardiology
| | - Lucia Turchetto
- From the Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich (R.M., J.S., O.G., I.B., C.W., U.L., T.F.L., R.C.); Fondazione Cardiocentro Ticino, Lugano (D.S., V.L.C., T.M., S.S., L.T., M.R., G.A.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich (R.M., S.K.); Rufibach rePROstat, Biostatistical Consulting and Training, Bern (K.R.); Department of Cardiology, Cantonal Hospital Lucerne, Lucerne (P.E., M.Z., C.A.d.M., P.J.); Department of Cardiology
| | - Marina Radrizzani
- From the Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich (R.M., J.S., O.G., I.B., C.W., U.L., T.F.L., R.C.); Fondazione Cardiocentro Ticino, Lugano (D.S., V.L.C., T.M., S.S., L.T., M.R., G.A.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich (R.M., S.K.); Rufibach rePROstat, Biostatistical Consulting and Training, Bern (K.R.); Department of Cardiology, Cantonal Hospital Lucerne, Lucerne (P.E., M.Z., C.A.d.M., P.J.); Department of Cardiology
| | - Giuseppe Astori
- From the Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich (R.M., J.S., O.G., I.B., C.W., U.L., T.F.L., R.C.); Fondazione Cardiocentro Ticino, Lugano (D.S., V.L.C., T.M., S.S., L.T., M.R., G.A.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich (R.M., S.K.); Rufibach rePROstat, Biostatistical Consulting and Training, Bern (K.R.); Department of Cardiology, Cantonal Hospital Lucerne, Lucerne (P.E., M.Z., C.A.d.M., P.J.); Department of Cardiology
| | - Juerg Schwitter
- From the Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich (R.M., J.S., O.G., I.B., C.W., U.L., T.F.L., R.C.); Fondazione Cardiocentro Ticino, Lugano (D.S., V.L.C., T.M., S.S., L.T., M.R., G.A.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich (R.M., S.K.); Rufibach rePROstat, Biostatistical Consulting and Training, Bern (K.R.); Department of Cardiology, Cantonal Hospital Lucerne, Lucerne (P.E., M.Z., C.A.d.M., P.J.); Department of Cardiology
| | - Paul Erne
- From the Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich (R.M., J.S., O.G., I.B., C.W., U.L., T.F.L., R.C.); Fondazione Cardiocentro Ticino, Lugano (D.S., V.L.C., T.M., S.S., L.T., M.R., G.A.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich (R.M., S.K.); Rufibach rePROstat, Biostatistical Consulting and Training, Bern (K.R.); Department of Cardiology, Cantonal Hospital Lucerne, Lucerne (P.E., M.Z., C.A.d.M., P.J.); Department of Cardiology
| | - Michel Zuber
- From the Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich (R.M., J.S., O.G., I.B., C.W., U.L., T.F.L., R.C.); Fondazione Cardiocentro Ticino, Lugano (D.S., V.L.C., T.M., S.S., L.T., M.R., G.A.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich (R.M., S.K.); Rufibach rePROstat, Biostatistical Consulting and Training, Bern (K.R.); Department of Cardiology, Cantonal Hospital Lucerne, Lucerne (P.E., M.Z., C.A.d.M., P.J.); Department of Cardiology
| | - Christoph Auf der Maur
- From the Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich (R.M., J.S., O.G., I.B., C.W., U.L., T.F.L., R.C.); Fondazione Cardiocentro Ticino, Lugano (D.S., V.L.C., T.M., S.S., L.T., M.R., G.A.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich (R.M., S.K.); Rufibach rePROstat, Biostatistical Consulting and Training, Bern (K.R.); Department of Cardiology, Cantonal Hospital Lucerne, Lucerne (P.E., M.Z., C.A.d.M., P.J.); Department of Cardiology
| | - Peiman Jamshidi
- From the Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich (R.M., J.S., O.G., I.B., C.W., U.L., T.F.L., R.C.); Fondazione Cardiocentro Ticino, Lugano (D.S., V.L.C., T.M., S.S., L.T., M.R., G.A.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich (R.M., S.K.); Rufibach rePROstat, Biostatistical Consulting and Training, Bern (K.R.); Department of Cardiology, Cantonal Hospital Lucerne, Lucerne (P.E., M.Z., C.A.d.M., P.J.); Department of Cardiology
| | - Oliver Gaemperli
- From the Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich (R.M., J.S., O.G., I.B., C.W., U.L., T.F.L., R.C.); Fondazione Cardiocentro Ticino, Lugano (D.S., V.L.C., T.M., S.S., L.T., M.R., G.A.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich (R.M., S.K.); Rufibach rePROstat, Biostatistical Consulting and Training, Bern (K.R.); Department of Cardiology, Cantonal Hospital Lucerne, Lucerne (P.E., M.Z., C.A.d.M., P.J.); Department of Cardiology
| | - Stephan Windecker
- From the Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich (R.M., J.S., O.G., I.B., C.W., U.L., T.F.L., R.C.); Fondazione Cardiocentro Ticino, Lugano (D.S., V.L.C., T.M., S.S., L.T., M.R., G.A.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich (R.M., S.K.); Rufibach rePROstat, Biostatistical Consulting and Training, Bern (K.R.); Department of Cardiology, Cantonal Hospital Lucerne, Lucerne (P.E., M.Z., C.A.d.M., P.J.); Department of Cardiology
| | - Aris Moschovitis
- From the Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich (R.M., J.S., O.G., I.B., C.W., U.L., T.F.L., R.C.); Fondazione Cardiocentro Ticino, Lugano (D.S., V.L.C., T.M., S.S., L.T., M.R., G.A.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich (R.M., S.K.); Rufibach rePROstat, Biostatistical Consulting and Training, Bern (K.R.); Department of Cardiology, Cantonal Hospital Lucerne, Lucerne (P.E., M.Z., C.A.d.M., P.J.); Department of Cardiology
| | - Andreas Wahl
- From the Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich (R.M., J.S., O.G., I.B., C.W., U.L., T.F.L., R.C.); Fondazione Cardiocentro Ticino, Lugano (D.S., V.L.C., T.M., S.S., L.T., M.R., G.A.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich (R.M., S.K.); Rufibach rePROstat, Biostatistical Consulting and Training, Bern (K.R.); Department of Cardiology, Cantonal Hospital Lucerne, Lucerne (P.E., M.Z., C.A.d.M., P.J.); Department of Cardiology
| | - Ines Bühler
- From the Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich (R.M., J.S., O.G., I.B., C.W., U.L., T.F.L., R.C.); Fondazione Cardiocentro Ticino, Lugano (D.S., V.L.C., T.M., S.S., L.T., M.R., G.A.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich (R.M., S.K.); Rufibach rePROstat, Biostatistical Consulting and Training, Bern (K.R.); Department of Cardiology, Cantonal Hospital Lucerne, Lucerne (P.E., M.Z., C.A.d.M., P.J.); Department of Cardiology
| | - Christophe Wyss
- From the Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich (R.M., J.S., O.G., I.B., C.W., U.L., T.F.L., R.C.); Fondazione Cardiocentro Ticino, Lugano (D.S., V.L.C., T.M., S.S., L.T., M.R., G.A.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich (R.M., S.K.); Rufibach rePROstat, Biostatistical Consulting and Training, Bern (K.R.); Department of Cardiology, Cantonal Hospital Lucerne, Lucerne (P.E., M.Z., C.A.d.M., P.J.); Department of Cardiology
| | - Sebastian Kozerke
- From the Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich (R.M., J.S., O.G., I.B., C.W., U.L., T.F.L., R.C.); Fondazione Cardiocentro Ticino, Lugano (D.S., V.L.C., T.M., S.S., L.T., M.R., G.A.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich (R.M., S.K.); Rufibach rePROstat, Biostatistical Consulting and Training, Bern (K.R.); Department of Cardiology, Cantonal Hospital Lucerne, Lucerne (P.E., M.Z., C.A.d.M., P.J.); Department of Cardiology
| | - Ulf Landmesser
- From the Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich (R.M., J.S., O.G., I.B., C.W., U.L., T.F.L., R.C.); Fondazione Cardiocentro Ticino, Lugano (D.S., V.L.C., T.M., S.S., L.T., M.R., G.A.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich (R.M., S.K.); Rufibach rePROstat, Biostatistical Consulting and Training, Bern (K.R.); Department of Cardiology, Cantonal Hospital Lucerne, Lucerne (P.E., M.Z., C.A.d.M., P.J.); Department of Cardiology
| | - Thomas F. Lüscher
- From the Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich (R.M., J.S., O.G., I.B., C.W., U.L., T.F.L., R.C.); Fondazione Cardiocentro Ticino, Lugano (D.S., V.L.C., T.M., S.S., L.T., M.R., G.A.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich (R.M., S.K.); Rufibach rePROstat, Biostatistical Consulting and Training, Bern (K.R.); Department of Cardiology, Cantonal Hospital Lucerne, Lucerne (P.E., M.Z., C.A.d.M., P.J.); Department of Cardiology
| | - Roberto Corti
- From the Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich (R.M., J.S., O.G., I.B., C.W., U.L., T.F.L., R.C.); Fondazione Cardiocentro Ticino, Lugano (D.S., V.L.C., T.M., S.S., L.T., M.R., G.A.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich (R.M., S.K.); Rufibach rePROstat, Biostatistical Consulting and Training, Bern (K.R.); Department of Cardiology, Cantonal Hospital Lucerne, Lucerne (P.E., M.Z., C.A.d.M., P.J.); Department of Cardiology
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Human vasculogenic cells form functional blood vessels and mitigate adverse remodeling after ischemia reperfusion injury in rats. Angiogenesis 2013; 16:773-84. [PMID: 23666122 DOI: 10.1007/s10456-013-9354-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 05/03/2013] [Indexed: 01/30/2023]
Abstract
Cell-based therapies to restore heart function after infarction have been tested in pre-clinical models and clinical trials with mixed results, and will likely require both contractile cells and a vascular network to support them. We and others have shown that human endothelial colony forming cells (ECFC) combined with mesenchymal progenitor cells (MPC) can be used to "bio-engineer" functional human blood vessels. Here we investigated whether ECFC + MPC form functional vessels in ischemic myocardium and whether this affects cardiac function or remodeling. Myocardial ischemia/reperfusion injury (IRI) was induced in 12-week-old immunodeficient rats by ligation of the left anterior descending coronary artery. After 40 min, myocardium was reperfused and ECFC + MPC (2 × 10(6) cells, 2:3 ratio) or PBS was injected. Luciferase assays after injection of luciferase-labeled ECFC + MPC showed that 1,500 ECFC were present at day 14. Human ECFC-lined perfused vessels were directly visualized by femoral vein injection of a fluorescently-tagged human-specific lectin in hearts injected with ECFC + MPC but not PBS alone. While infarct size at day 1 was no different, LV dimensions and heart weight to tibia length ratios were lower in cell-treated hearts compared with PBS at 4 months, suggesting post-infarction remodeling was ameliorated by local cell injection. Fractional shortening, LV wall motion score, and fibrotic area were not different between groups at 4 months. However, pressure-volume loops demonstrated improved cardiac function and reduced volumes in cell-treated animals. These data suggest that myocardial delivery of ECFC + MPC at reperfusion may provide a therapeutic strategy to mitigate LV remodeling and cardiac dysfunction after IRI.
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Progenitor Cell Therapy to Treat Acute Myocardial Infarction: The Promise of High-Dose Autologous CD34(+) Bone Marrow Mononuclear Cells. Stem Cells Int 2013; 2013:658480. [PMID: 23737803 PMCID: PMC3655659 DOI: 10.1155/2013/658480] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 03/18/2013] [Accepted: 03/21/2013] [Indexed: 12/11/2022] Open
Abstract
ST elevation myocardial infarction (STEMI) is associated with an increased risk for congestive heart failure and long-term mortality despite the widespread use of thrombolysis and catheter-based revascularization. The need for improved post-STEMI therapies has led to a surge of novel therapeutics, especially regenerative approaches using autologous mononuclear cells. Indeed, the past decade has been marked by a number of human trials studying the safety and efficacy of progenitor cell delivery in the post-STEMI setting. While a variety of cell types and delivery techniques have been utilized, directed therapy to the infarct-related artery has been the most widely used approach. From over 1300 subjects randomized in these studies, there is sufficient evidence to conclude that cell therapy after STEMI is uniformly safe, while the efficacy of this intervention for improving outcomes is less clear. Recent meta-analyses have highlighted the importance of both timing of cell delivery, as well as the type, quantity, and mobility of delivered cells as determinants of response. Here, we show the case in which higher doses of CD34+ cells, which are more potent in terms of their migratory capacity, offer the best hope for preserving cardiac function following STEMI.
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Affiliation(s)
- Marcus-André Deutsch
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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Abstract
PURPOSE OF REVIEW Stem cell-based therapies for preventing and treating chronic end-organ dysfunction have captured the imagination of the lay public and spurred scientific and clinical development in multiple disciplines and disease states. The goal of this review is to build a framework around the different approaches being deployed to heal or treat end-organ dysfunction and discuss how within this framework future developments may occur. RECENT FINDINGS In this review, we divide the development of regenerative therapies into two broad categories. The first 'Stem Cells as the Student' focuses on the fact that we need to coax/teach the stem cells to differentiate in an efficient manner into the cells of interest, then using tissue engineering, we need to integrate them in an appropriate delivery system/matrix, and then generate a blood supply, sufficient to allow for their survival following engraftment. In the second category 'Stem Cells as the Teacher,' we learn from studies on stem cell biology, critical pathways that are dysregulated in tissue repair. By identifying these critical pathways, we can develop drug and biologics that can enhance tissue repair and end-organ function. SUMMARY Regenerative therapies have exciting potential to improve patient outcomes in a variety of acute and chronic disease states. There is significant excitement in general public, and the scientific and clinical communities. Early studies have been variably successful. As we move forward and understand the biology and engineering principles involved, significant advances with greater chances of success and efficacy will come.
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Bartunek J, Behfar A, Dolatabadi D, Vanderheyden M, Ostojic M, Dens J, El Nakadi B, Banovic M, Beleslin B, Vrolix M, Legrand V, Vrints C, Vanoverschelde JL, Crespo-Diaz R, Homsy C, Tendera M, Waldman S, Wijns W, Terzic A. Cardiopoietic stem cell therapy in heart failure: the C-CURE (Cardiopoietic stem Cell therapy in heart failURE) multicenter randomized trial with lineage-specified biologics. J Am Coll Cardiol 2013; 61:2329-38. [PMID: 23583246 DOI: 10.1016/j.jacc.2013.02.071] [Citation(s) in RCA: 364] [Impact Index Per Article: 33.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 02/05/2013] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study sought to evaluate the feasibility and safety of autologous bone marrow-derived and cardiogenically oriented mesenchymal stem cell therapy and to probe for signs of efficacy in patients with chronic heart failure. BACKGROUND In pre-clinical heart failure models, cardiopoietic stem cell therapy improves left ventricular function and blunts pathological remodeling. METHODS The C-CURE (Cardiopoietic stem Cell therapy in heart failURE) trial, a prospective, multicenter, randomized trial, was conducted in patients with heart failure of ischemic origin who received standard of care or standard of care plus lineage-specified stem cells. In the cell therapy arm, bone marrow was harvested and isolated mesenchymal stem cells were exposed to a cardiogenic cocktail. Derived cardiopoietic stem cells, meeting release criteria under Good Manufacturing Practice, were delivered by endomyocardial injections guided by left ventricular electromechanical mapping. Data acquisition and analysis were performed in blinded fashion. The primary endpoint was feasibility/safety at 2-year follow-up. Secondary endpoints included cardiac structure/function and measures of global clinical performance 6 months post-therapy. RESULTS Mesenchymal stem cell cocktail-based priming was achieved for each patient with the dose attained in 75% and delivery without complications in 100% of cases. There was no evidence of increased cardiac or systemic toxicity induced by cardiopoietic cell therapy. Left ventricular ejection fraction was improved by cell therapy (from 27.5 ± 1.0% to 34.5 ± 1.1%) versus standard of care alone (from 27.8 ± 2.0% to 28.0 ± 1.8%, p < 0.0001) and was associated with a reduction in left ventricular end-systolic volume (-24.8 ± 3.0 ml vs. -8.8 ± 3.9 ml, p < 0.001). Cell therapy also improved the 6-min walk distance (+62 ± 18 m vs. -15 ± 20 m, p < 0.01) and provided a superior composite clinical score encompassing cardiac parameters in tandem with New York Heart Association functional class, quality of life, physical performance, hospitalization, and event-free survival. CONCLUSIONS The C-CURE trial implements the paradigm of lineage guidance in cell therapy. Cardiopoietic stem cell therapy was found feasible and safe with signs of benefit in chronic heart failure, meriting definitive clinical evaluation. (C-Cure Clinical Trial; NCT00810238).
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Affiliation(s)
- Jozef Bartunek
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium.
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Kreke M, Smith RR, Marbán L, Marbán E. Cardiospheres and cardiosphere-derived cells as therapeutic agents following myocardial infarction. Expert Rev Cardiovasc Ther 2013; 10:1185-94. [PMID: 23098154 DOI: 10.1586/erc.12.102] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Heart disease is a major cause of morbidity and mortality. Cellular therapies hold significant promise for patients with heart disease. Heart-derived progenitor cells are capable of repairing a diseased heart through modulation of growth factor milieu and temporary engraftment leading to endogenous repair. The proof-of-concept CADUCEUS clinical trial using cardiosphere-derived cells has shown evidence of therapeutic cardiac tissue regeneration. Future clinical trials are now being planned to generate additional safety and efficacy data in the hopes of building toward an approved cellular therapy for heart disease.
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Hatt CR, Jain AK, Parthasarathy V, Lang A, Raval AN. MRI-3D ultrasound-X-ray image fusion with electromagnetic tracking for transendocardial therapeutic injections: in-vitro validation and in-vivo feasibility. Comput Med Imaging Graph 2013; 37:162-73. [PMID: 23561056 DOI: 10.1016/j.compmedimag.2013.03.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Revised: 03/12/2013] [Accepted: 03/14/2013] [Indexed: 11/17/2022]
Abstract
Myocardial infarction (MI) is one of the leading causes of death in the world. Small animal studies have shown that stem-cell therapy offers dramatic functional improvement post-MI. An endomyocardial catheter injection approach to therapeutic agent delivery has been proposed to improve efficacy through increased cell retention. Accurate targeting is critical for reaching areas of greatest therapeutic potential while avoiding a life-threatening myocardial perforation. Multimodal image fusion has been proposed as a way to improve these procedures by augmenting traditional intra-operative imaging modalities with high resolution pre-procedural images. Previous approaches have suffered from a lack of real-time tissue imaging and dependence on X-ray imaging to track devices, leading to increased ionizing radiation dose. In this paper, we present a new image fusion system for catheter-based targeted delivery of therapeutic agents. The system registers real-time 3D echocardiography, magnetic resonance, X-ray, and electromagnetic sensor tracking within a single flexible framework. All system calibrations and registrations were validated and found to have target registration errors less than 5 mm in the worst case. Injection accuracy was validated in a motion enabled cardiac injection phantom, where targeting accuracy ranged from 0.57 to 3.81 mm. Clinical feasibility was demonstrated with in-vivo swine experiments, where injections were successfully made into targeted regions of the heart.
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Affiliation(s)
- Charles R Hatt
- University of Wisconsin - Madison, College of Engineering, Department of Biomedical Engineering, 1415 Engineering Drive, Madison, WI 53706, USA.
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Chen IY, Wu JC. Molecular imaging: the key to advancing cardiac stem cell therapy. Trends Cardiovasc Med 2013; 23:201-10. [PMID: 23561794 DOI: 10.1016/j.tcm.2012.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 12/10/2012] [Accepted: 12/11/2012] [Indexed: 12/30/2022]
Abstract
Cardiac stem cell therapy continues to hold promise for the treatment of ischemic heart disease despite the fact that early promising pre-clinical findings have yet to be translated into consistent clinical success. The latest human studies have collectively identified a pressing need to better understand stem cell behavior in humans and called for more incorporation of noninvasive imaging techniques into the design and evaluation of human stem cell therapy trials. This review discusses the various molecular imaging techniques validated to date for studying stem cells in living subjects, with a particular emphasis on their utilities in assessing the acute retention and the long-term survival of transplanted stem cells. These imaging techniques will be essential for advancing cardiac stem cell therapy by providing the means to both guide ongoing optimization and predict treatment response in humans.
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Affiliation(s)
- Ian Y Chen
- Department of Medicine, Division of Cardiovascular Medicine, Stanford, CA, USA; Department of Radiology, Molecular Imaging Program at Stanford, Stanford, CA 94305-5454, USA
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261
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Jones DA, Choudry F, Mathur A. Almanac 2012: Cell therapy in cardiovascular disease. The national society journals present selected research that has driven recent advances in clinical cardiology. Rev Port Cardiol 2013; 32:351-8. [PMID: 23540445 DOI: 10.1016/j.repc.2013.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 01/15/2013] [Indexed: 11/24/2022] Open
Abstract
The rapid translation from bench to bedside that has been seen in the application of regenerative medicine to cardiology has led to exciting new advances in our understanding of some of the fundamental mechanisms related to human biology. The first generation of cells used in phase I-II trials (mainly bone marrow mononuclear cells) are now entering phase III clinical trials with the goal of producing a cell based therapeutic that can change the outcome of cardiac disease. First generation cell therapy appears to have addressed safety concerns as well as showing 'activity' in numerous published meta-analyses. With the knowledge gained to date, the field is moving towards the next generation of cells-the 'engineered' cell-that have been developed to display a phenotype that will further enhance the myocardial repair/salvage process. This almanac review covers the latest basic research that may soon have application to humans as well as the results of the latest clinical trials.
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Affiliation(s)
- Daniel A Jones
- Department of Cardiology, London Chest Hospital, London, UK
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262
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Jones DA, Choudry F, Mathur A. Almanac 2012: Cell therapy in cardiovascular disease. The national society journals present selected research that has driven recent advances in clinical cardiology. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.repce.2013.05.004] [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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263
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Critical path in cardiac stem cell therapy: an update on cell delivery. Cytotherapy 2013; 15:399-415. [DOI: 10.1016/j.jcyt.2012.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 09/25/2012] [Accepted: 11/02/2012] [Indexed: 01/14/2023]
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264
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Loughran JH, Elmore JB, Waqar M, Chugh AR, Bolli R. Cardiac stem cells in patients with ischemic cardiomyopathy: discovery, translation, and clinical investigation. Curr Atheroscler Rep 2013; 14:491-503. [PMID: 22847771 DOI: 10.1007/s11883-012-0273-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The increasing prevalence of heart failure, in the US and worldwide, poses a significant burden to patients, practitioners, and healthcare systems. Hence, there is a pressing need for alternative therapies to enhance the current treatment armamentarium. Accordingly, when considering heart failure of ischemic etiology, an intervention designed to regenerate the attending loss of myocardium could potentially result in improved cardiac function, functional status, and quality of life. Significant strides have been made by investigators in the study of stem cell therapy for cardiac repair; recently with cardiac-derived progenitor cells. These cells include cardiospheres, cardiosphere-derived cells, and c-kit positive cardiac stem cells. Herein, a review of both preclinical studies and phase I clinical trials of these cell types is presented. A detailed account of in vitro characterization, in vivo bioactivity, and safety and efficacy in humans is outlined. Thus far, encouraging results have been realized, although larger studies have yet to be undertaken.
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Affiliation(s)
- John H Loughran
- Division of Cardiovascular Medicine, University of Louisville, 550 S Jackson Street, ACB Bldg, 3rd Floor, Louisville, KY 40202, USA.
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265
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Takashima SI, Tempel D, Duckers HJ. Current outlook of cardiac stem cell therapy towards a clinical application. Heart 2013; 99:1772-84. [PMID: 23525708 DOI: 10.1136/heartjnl-2012-303308] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Shin-Ichiro Takashima
- University Medical Center Utrecht, Division Cardiology & Pulmonology, Interventional Cardiology Department, Utrecht, The Netherlands
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266
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Abstract
SIGNIFICANCE Proangiogenic therapy appeared a promising strategy for the treatment of patients with acute myocardial infarction (MI), as de novo formation of microvessels, has the potential to salvage ischemic myocardium at early stages after MI, and is also essential to prevent the transition to heart failure through the control of cardiomyocyte hypertrophy and contractility. RECENT ADVANCES Exciting preclinical studies evaluating proangiogenic therapies for MI have prompted the initiation of numerous clinical trials based on protein or gene transfer delivery of growth factors and administration of stem/progenitor cells, mainly from bone marrow origin. Nonetheless, these clinical trials showed mixed results in patients with acute MI. CRITICAL ISSUES Even though methodological caveats, such as way of delivery for angiogenic growth factors (e.g., protein vs. gene transfer) and stem/progenitor cells or isolation/culture procedure for regenerative cells might partially explain the failure of such trials, it appears that delivery of a single growth factor or cell type does not support angiogenesis sufficiently to promote cardiac repair. FUTURE DIRECTIONS Optimization of proangiogenic therapies might include stimulation of both angiogenesis and vessel maturation and/or the use of additional sources of stem/progenitor cells, such as cardiac progenitor cells. Experimental unraveling of the mechanisms of angiogenesis, vessel maturation, and endothelial cell/cardiomyocyte cross talk in the ischemic heart, analysis of emerging pathways, as well as a better understanding of how cardiovascular risk factors impact endogenous and therapeutically stimulated angiogenesis, would undoubtedly pave the way for the development of novel and hopefully efficient angiogenesis targeting therapeutics for the treatment of acute MI.
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Affiliation(s)
- Clement Cochain
- Paris Cardiovascular Research Center, INSERM UMR-S 970, Paris Descartes University, Paris, France
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267
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Jones DA, Choudry F, Mathura A. Almanac 2012: Cell therapy in cardiovascular disease. The national society journals present selected research that has driven recent advances in clinical cardiology. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2013; 83:130-7. [PMID: 23499245 DOI: 10.1016/j.acmx.2013.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 01/16/2013] [Indexed: 10/26/2022] Open
Affiliation(s)
- Daniel A Jones
- Department of Cardiology, London Chest Hospital, London, UK; Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, UK; NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, UK
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268
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Huu AL, Prakash S, Shum-Tim D. Cellular cardiomyoplasty: current state of the field. Regen Med 2013; 7:571-82. [PMID: 22817629 DOI: 10.2217/rme.12.28] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Cellular cardiomyoplasty employs stem cell therapy to regenerate myocardium. Characterized by their potential for proliferation, differentiation and capacity for self-renewal, stem cells are ideally suited for use in regenerative medicine. Supplementing traditional therapeutic modalities aimed at the palliation of congestive heart failure, cellular cardiomyoplasty is an innovative approach aimed at producing functional, viable myocardium following an acute infarction. The primary focus is to prevent the onset of congestive heart failure; however, potential applications aimed at reversing ischemic heart disease are concurrently in development. After decades of research, cellular cardiomyoplasty has moved beyond traditional in vitro and animal models; it is currently being implemented in clinical trials. Despite this monumental advance, certain limitations remain inherent in this process, preventing stem cell therapy from reaching its full potential. On a cellular level, stem cell retention and viability postimplantation continues to be problematic. Solutions under investigation include pioneering advances in cell delivery, in vitro pretreatment, and tissue engineering. Moreover, questions surrounding optimal cell type and cellular mechanisms concerning cellular cardiomyoplasty remain unanswered. Clarification of these issues is essential to ensure continued progression of this new technology. Stem cell therapy has been highly successful within the in vitro and in vivo environment. However, as clinical trials abound, cellular cardiomyoplasty must transition from an experimental concept to an effective therapeutic treatment. This process is hindered by discordance between scientific accrue and practical applicability. This review will provide a comprehensive summary of current innovations on cellular cardiomyoplasty, and future prospects. There will be a particular emphasis on the clinical aspects of stem cell therapy in an attempt to bridge the gap between science and medicine. Overcoming this barrier will render cellular cardiomyoplasty accessible to patients on a global basis.
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Affiliation(s)
- Alice Le Huu
- Division of Cardiac Surgery & Surgical Research, Department of Surgery, McGill University Health Center, Montreal, QC, Canada
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269
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Dey D, Han L, Bauer M, Sanada F, Oikonomopoulos A, Hosoda T, Unno K, De Almeida P, Leri A, Wu JC. Dissecting the molecular relationship among various cardiogenic progenitor cells. Circ Res 2013; 112:1253-62. [PMID: 23463815 DOI: 10.1161/circresaha.112.300779] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
RATIONALE Multiple progenitors derived from the heart and bone marrow (BM) have been used for cardiac repair. Despite this, not much is known about the molecular identity and relationship among these progenitors. To develop a robust stem cell therapy for the heart, it is critical to understand the molecular identity of the multiple cardiogenic progenitor cells. OBJECTIVE This study is the first report of high-throughput transcriptional profiling of cardiogenic progenitor cells carried out on an identical platform. METHOD AND RESULTS Microarray-based transcriptional profiling was carried out for 3 cardiac (ckit(+), Sca1(+), and side population) and 2 BM (ckit(+) and mesenchymal stem cell) progenitors, obtained from age- and sex-matched wild-type C57BL/6 mice. Analysis indicated that cardiac-derived ckit(+) population was very distinct from Sca1(+) and side population cells in the downregulation of genes encoding for cell-cell and cell-matrix adhesion proteins, and in the upregulation of developmental genes. Significant enrichment of transcripts involved in DNA replication and repair was observed in BM-derived progenitors. The BM ckit(+) cells seemed to have the least correlation with the other progenitors, with enrichment of immature neutrophil-specific molecules. CONCLUSIONS Our study indicates that cardiac ckit(+) cells represent the most primitive population in the rodent heart. Primitive cells of cardiac versus BM origin differ significantly with respect to stemness and cardiac lineage-specific genes, and molecules involved in DNA replication and repair. The detailed molecular profile of progenitors reported here will serve as a useful reference to determine the molecular identity of progenitors used in future preclinical and clinical studies.
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Affiliation(s)
- Devaveena Dey
- Division of Cardiology, Department of Medicine, Stanford Cardiovascular Institute, Institute of Stem Cell Biology & Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305-5454, USA
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270
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Almanac 2012, cell therapy in cardiovascular disease: The national society journals present selected research that has driven recent advances in clinical cardiology. Egypt Heart J 2013. [DOI: 10.1016/j.ehj.2012.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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271
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Fukushima S, Sawa Y, Suzuki K. Choice of cell-delivery route for successful cell transplantation therapy for the heart. Future Cardiol 2013; 9:215-27. [PMID: 23463974 DOI: 10.2217/fca.12.85] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The cell-delivery route is one of the major factors influencing the therapeutic effect and complications of cell transplantation therapy for cardiac diseases. There are four major clinically practical routes, with each method having its own advantages and disadvantages. First, intramyocardial injection allows targeted cell delivery into the areas of interest, although this induces mechanical injury, inflammation and islet-like donor cell clusters, leading to limited donor cell survival and arrhythmogenicity. Second, intracoronary injection is less likely to induce inflammation, whereas poor initial cell retention in the heart is a concern. Third, intravenous injection is easy and economical, but cell recruitment into the heart is not frequent. Finally, epicardial placement of 'cell sheets' enables higher efficiency of cell engraftment, but poor integration into the myocardium may be an issue. This review summarizes up-to-date clinical and preclinical knowledge regarding these cell-delivery methods. We further discuss the ways to refine these methods towards optimizing cell transplantation therapy for the heart.
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Affiliation(s)
- Satsuki Fukushima
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Japan
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272
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Penn MS, Mendelsohn FO, Schaer GL, Sherman W, Farr M, Pastore J, Rouy D, Clemens R, Aras R, Losordo DW. An open-label dose escalation study to evaluate the safety of administration of nonviral stromal cell-derived factor-1 plasmid to treat symptomatic ischemic heart failure. Circ Res 2013; 112:816-25. [PMID: 23429605 DOI: 10.1161/circresaha.111.300440] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
RATIONALE Preclinical studies indicate that adult stem cells induce tissue repair by activating endogenous stem cells through the stromal cell-derived factor-1:chemokine receptor type 4 axis. JVS-100 is a DNA plasmid encoding human stromal cell-derived factor-1. OBJECTIVE We tested in a phase 1, open-label, dose-escalation study with 12 months of follow-up in subjects with ischemic cardiomyopathy to see if JVS-100 improves clinical parameters. METHODS AND RESULTS Seventeen subjects with ischemic cardiomyopathy, New York Heart Association class III heart failure, with an ejection fraction ≤40% on stable medical therapy, were enrolled to receive 5, 15, or 30 mg of JVS-100 via endomyocardial injection. The primary end points for safety and efficacy were at 1 and 4 months, respectively. The primary safety end point was a major adverse cardiac event. Efficacy end points were change in quality of life, New York Heart Association class, 6-minute walk distance, single photon emission computed tomography, N-terminal pro-brain natruretic peptide, and echocardiography at 4 and 12 months. The primary safety end point was met. At 4 months, all of the cohorts demonstrated improvements in 6-minute walk distance, quality of life, and New York Heart Association class. Subjects in the 15- and 30-mg dose groups exhibited improvements in 6-minute walk distance (15 mg: median [range]: 41 minutes [3-61 minutes]; 30 mg: 31 minutes [22-74 minutes]) and quality of life (15 mg: -16 points [+1 to -32 points]; 30 mg: -24 points [+17 to -38 points]) over baseline. At 12 months, improvements in symptoms were maintained. CONCLUSIONS These data highlight the importance of defining the molecular mechanisms of stem cell-based tissue repair and suggest that overexpression of stromal cell-derived factor-1 via gene therapy is a strategy for improving heart failure symptoms in patients with ischemic cardiomyopathy.
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Affiliation(s)
- Marc S Penn
- Summa Cardiovascular Institute, Summa Health System, Skirball Laboratory for Cardiovascular Cellular Therapeutics, Department of Integrative Medical Sciences, Northeast Ohio Medical University, Akron, OH 44304, USA.
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273
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Abstract
The possibility of using stem cells to regenerate damaged myocardium has been actively investigated since the late 1990s. Consistent with the traditional view that the heart is a "postmitotic" organ that possesses minimal capacity for self-repair, much of the preclinical and clinical work has focused exclusively on introducing stem cells into the heart, with the hope of differentiation of these cells into functioning cardiomyocytes. This approach is ongoing and retains promise but to date has yielded inconsistent successes. More recently, it has become widely appreciated that the heart possesses endogenous repair mechanisms that, if adequately stimulated, might regenerate damaged cardiac tissue from in situ cardiac stem cells. Accordingly, much recent work has focused on engaging and enhancing endogenous cardiac repair mechanisms. This article reviews the literature on stem cell-based myocardial regeneration, placing emphasis on the mutually enriching interaction between basic and clinical research.
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Affiliation(s)
- Ramesh Mazhari
- The George Washington University School of Medicine, Washington, DC 20037, USA
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274
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Tzouvelekis A, Ntolios P, Bouros D. Stem cell treatment for chronic lung diseases. Respiration 2013; 85:179-92. [PMID: 23364286 DOI: 10.1159/000346525] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Chronic lung diseases such as idiopathic pulmonary fibrosis and cystic fibrosis or chronic obstructive pulmonary disease and asthma are leading causes of morbidity and mortality worldwide with a considerable human, societal and financial burden. In view of the current disappointing status of available pharmaceutical agents, there is an urgent need for alternative more effective therapeutic approaches that will not only help to relieve patient symptoms but will also affect the natural course of the respective disease. Regenerative medicine represents a promising option with several fruitful therapeutic applications in patients suffering from chronic lung diseases. Nevertheless, despite relative enthusiasm arising from experimental data, application of stem cell therapy in the clinical setting has been severely hampered by several safety concerns arising from the major lack of knowledge on the fate of exogenously administered stem cells within chronically injured lung as well as the mechanisms regulating the activation of resident progenitor cells. On the other hand, salient data arising from few 'brave' pilot investigations of the safety of stem cell treatment in chronic lung diseases seem promising. The main scope of this review article is to summarize the current state of knowledge regarding the application status of stem cell treatment in chronic lung diseases, address important safety and efficacy issues and present future challenges and perspectives. In this review, we argue in favor of large multicenter clinical trials setting realistic goals to assess treatment efficacy. We propose the use of biomarkers that reflect clinically inconspicuous alterations of the disease molecular phenotype before rigid conclusions can be safely drawn.
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Affiliation(s)
- Argyris Tzouvelekis
- Department of Pneumonology, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.
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276
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Generation of human secondary cardiospheres as a potent cell processing strategy for cell-based cardiac repair. Biomaterials 2013; 34:651-61. [DOI: 10.1016/j.biomaterials.2012.10.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 10/04/2012] [Indexed: 12/12/2022]
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277
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Malecki M. Improved targeting and enhanced retention of the human, autologous, fibroblast-derived, induced, pluripotent stem cells to the sarcomeres of the infarcted myocardium with the aid of the bioengineered, heterospecific, tetravalent antibodies. ACTA ACUST UNITED AC 2013; 3. [PMID: 23956947 DOI: 10.4172/2157-7633.1000138] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Clinical trials, to regenerate the human heart injured by myocardial infarction, involve the delivery of stem cells to the site of the injury. However, only a small fraction of the introduced stem cells are detected at the site of the injury, merely two weeks after this therapeutic intervention. This significantly hampers the effectiveness of the stem cell therapy. To resolve the aforementioned problem, we genetically and molecularly bioengineered heterospecific, tetravalent antibodies (htAbs), which have both exquisite specificity and high affinity towards human, pluripotent, stem cells through the htAbs' domains binding SSEA-4, SSEA-3, TRA-1-60, and TRA-1-81, as well as towards the injured cardiac muscle through the htAbs' domains binding human cardiac myosin, α-actinin, actin, and titin. The cardiac tissue was acquired from the patients, who were receiving heart transplants. The autologous, human, induced, pluripotent stem cells (hiPSCs) were generated from the patients' fibroblasts by non-viral delivery and transient expression of the DNA constructs for: Oct4, Nanog, Sox2, Lin28, Klf4, c-Myc. In the trials involving the htAbs, the human, induced, pluripotent stem cells anchored to the myocardial sarcomeres with the efficiency, statistically, significantly higher, than in the trials with non-specific or without antibodies (p < 0.0003). Moreover, application of the htAbs resulted in cross-linking of the sarcomeric proteins to create the stable scaffolds for anchoring of the stem cells. Thereafter, these human, induced pluripotent stem cells differentiated into cardiomyocytes at their anchorage sites. By bioengineering of these novel heterospecific, tetravalent antibodies and using them to guide and to anchor the stem cells specifically to the stabilized sarcomeric scaffolds, we demonstrated the proof of concept in vitro for improving effectiveness of regenerative therapy of myocardial infarction and created the foundations for the trials in vivo.
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Affiliation(s)
- Marek Malecki
- Phoenix Biomolecular Engineering Foundation, San Francisco, CA, USA
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278
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Abstract
The past decade has witnessed a marked increase in the number of clinical trials of cardiac repair with adult bone marrow cells (BMCs). These trials included patients with acute myocardial infarction (MI) as well as chronic ischemic heart disease (IHD) and utilized different types of BMCs with variable numbers, routes of administration, and timings after MI. Given these differences in methods, the outcomes from these trials have been often disparate and controversial. However, analysis of pooled data suggests that BMC injection enhances left ventricular function, reduces infarct scar size, and improves remodeling in patients with acute MI as well as chronic IHD. BMC therapy also improves clinical outcomes during follow-up without any increase in adverse effects. Although the underlying mechanisms of heart repair are difficult to elucidate in human studies, valuable insights may be gleaned from subgroup analysis of key variables. This information may be utilized to design future randomized controlled trials to carefully determine the long-term safety and benefits of BMC therapy.
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279
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Abstract
This article discusses current understanding of myocardial biology, emphasizing the regeneration potential of the adult human heart and the mechanisms involved. In the last decade, a novel conceptual view has emerged. The heart is no longer considered a postmitotic organ, but is viewed as a self-renewing organ characterized by a resident stem cell compartment responsible for tissue homeostasis and cardiac repair following injury. Additionally, HSCs possess the ability to transdifferentiate and acquire the cardiomyocyte, vascular endothelial, and smooth muscle cell lineages. Both cardiac and hematopoietic stem cells may be used therapeutically in an attempt to reverse the devastating consequences of chronic heart failure of ischemic and nonischemic origin.
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Affiliation(s)
- Piero Anversa
- Department of Anesthesia and Division of Cardiovascular Medicine, 75 Francis Street, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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280
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Huu AL, Paul A, Prakash S, Shum-Tim D. Route of delivery, cell retention, and efficiency of polymeric microcapsules in cellular cardiomyoplasty. Methods Mol Biol 2013; 1036:121-35. [PMID: 23807792 DOI: 10.1007/978-1-62703-511-8_11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Stem cell transplantation has been considered as a major breakthrough for treating ischemic heart disease. However, survival and retention of transplanted cells at the site of infarction remains tenuous. This chapter details a method of creating polymeric microcapsules for cell delivery, resulting in increased retention of transplanted cells at the target site, while achieving minimal mechanical trauma and cell loss. Simultaneously biocompatible and biodegradable, polymeric microcapsules have important implications in regenerative cell therapy.
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Affiliation(s)
- Alice Le Huu
- Division of Cardiac Surgery, Department of Surgery, McGill University Health Center, McGill University, Montreal, QC, Canada
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281
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Malecki M, Sabo C, Putzer E, Stampe C, Foorohar A, Quach C, Beauchaine M, Tombokan X, Anderson M. Recruitment and retention of human autologous CD34+ CD117+ CD133+ bone marrow stem cells to infarcted myocardium followed by directed vasculogenesis: Novel strategy for cardiac regeneration. MOLECULAR AND CELLULAR THERAPIES 2013; 1. [PMID: 25045527 PMCID: PMC4100620 DOI: 10.1186/2052-8426-1-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Ongoing clinical trials, in regenerative therapy of patients suffering from myocardial infarctions, rely primarily upon administration of bone marrow stem cells to the infarcted zones. Unfortunately, low retention of these cells, to the therapeutic delivery sites, reduces effectiveness of this strategy; thus it has been identified as the most critical problem for advancement of cardiac regenerative medicine. Specific aims The specific aim of this work was three-fold: (1) to isolate highly viable populations of human, autologous CD34+, CD117+, and CD133+ bone marrow stem cells; (2) to bioengineer heterospecific, tetravalent antibodies and to use them for recruiting of the stem cells to regenerated zones of infarcted myocardium; (3) to direct vasculogenesis of the retained stem cells with the defined factors. Patients methods Cardiac tissue was biopsied from the hearts of the patients, who were receiving orthotopic heart transplants after multiple cardiac infarctions. This tissue was used to engineer fully human in vitro models of infarcted myocardium. Bone marrow was acquired from these patients. The marrow cells were sorted into populations of cells displaying CD34, CD117, and CD133. Heterospecific, tetravalent antibodies were bioengineered to bridge CD34, CD117, CD133 displayed on the stem cells with cardiac myosin of the infarcted myocardium. The sorted stem cells were administered to the infarcted myocardium in the in vitro models. Results Administration of the bioengineered, heterospecific antibodies preceding administration of the stem cells greatly improved the stem cells’ recruitment and retention to the infarcted myocardium. Treatment of the retained stem cells with vascular endothelial growth factor and angiopoietin efficiently directed their differentiation into endothelial cells, which expressed vascular endothelial cadherin, platelet/endothelial cell adhesion molecule, claudin, and occludin, while forming tight and adherens junctions. Conclusions This novel strategy improved retention of the patients’ autologous bone marrow cells to the infarcted myocardium followed by directed vasculogenesis. Therefore, it is worth pursuing it in support of the ongoing clinical trials of cardiac regenerative therapy.
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Affiliation(s)
- Marek Malecki
- Phoenix Biomolecular Engineering Foundation, San Francisco, CA, USA ; National Magnetic Resonance Facility, National Institutes of Health ; University of Wisconsin, Madison, WI, USA
| | - Chelsea Sabo
- University of Wisconsin, Madison, WI, USA ; University of Sheffield, Sheffield, EU, UK
| | - Emily Putzer
- University of Wisconsin, Madison, WI, USA ; American Youth Center, Washington, DC, USA
| | | | - Afsoon Foorohar
- Phoenix Biomolecular Engineering Foundation, San Francisco, CA, USA ; Western University, Lebanon, OR, USA
| | - Carol Quach
- Phoenix Biomolecular Engineering Foundation, San Francisco, CA, USA ; Western University, Pomona, CA, USA
| | | | | | - Mark Anderson
- National Magnetic Resonance Facility, National Institutes of Health ; University of Wisconsin, Madison, WI, USA
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282
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O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX, Anderson JL, Jacobs AK, Halperin JL, Albert NM, Brindis RG, Creager MA, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Kushner FG, Ohman EM, Stevenson WG, Yancy CW. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2012; 127:e362-425. [PMID: 23247304 DOI: 10.1161/cir.0b013e3182742cf6] [Citation(s) in RCA: 1071] [Impact Index Per Article: 89.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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283
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O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2012; 61:e78-e140. [PMID: 23256914 DOI: 10.1016/j.jacc.2012.11.019] [Citation(s) in RCA: 2191] [Impact Index Per Article: 182.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Traverse JH, Henry TD, Pepine CJ, Willerson JT, Zhao DX, Ellis SG, Forder JR, Anderson RD, Hatzopoulos AK, Penn MS, Perin EC, Chambers J, Baran KW, Raveendran G, Lambert C, Lerman A, Simon DI, Vaughan DE, Lai D, Gee AP, Taylor DA, Cogle CR, Thomas JD, Olson RE, Bowman S, Francescon J, Geither C, Handberg E, Kappenman C, Westbrook L, Piller LB, Simpson LM, Baraniuk S, Loghin C, Aguilar D, Richman S, Zierold C, Spoon DB, Bettencourt J, Sayre SL, Vojvodic RW, Skarlatos SI, Gordon DJ, Ebert RF, Kwak M, Moyé LA, Simari RD. Effect of the use and timing of bone marrow mononuclear cell delivery on left ventricular function after acute myocardial infarction: the TIME randomized trial. JAMA 2012; 308:2380-9. [PMID: 23129008 PMCID: PMC3652242 DOI: 10.1001/jama.2012.28726] [Citation(s) in RCA: 295] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
CONTEXT While the delivery of cell therapy after ST-segment elevation myocardial infarction (STEMI) has been evaluated in previous clinical trials, the influence of the timing of cell delivery on the effect on left ventricular function has not been analyzed. OBJECTIVES To determine the effect of intracoronary autologous bone marrow mononuclear cell (BMC) delivery after STEMI on recovery of global and regional left ventricular function and whether timing of BMC delivery (3 days vs 7 days after reperfusion) influences this effect. DESIGN, SETTING, AND PATIENTS A randomized, 2 × 2 factorial, double-blind, placebo-controlled trial, Timing In Myocardial infarction Evaluation (TIME) enrolled 120 patients with left ventricular dysfunction (left ventricular ejection fraction [LVEF] ≤ 45%) after successful primary percutaneous coronary intervention (PCI) of anterior STEMI between July 17, 2008, and November 15, 2011, as part of the Cardiovascular Cell Therapy Research Network sponsored by the National Heart, Lung, and Blood Institute. INTERVENTIONS Intracoronary infusion of 150 × 106 BMCs or placebo (randomized 2:1) within 12 hours of aspiration and cell processing administered at day 3 or day 7 (randomized 1:1) after treatment with PCI. MAIN OUTCOME MEASURES The primary end points were change in global (LVEF) and regional (wall motion) left ventricular function in infarct and border zones at 6 months measured by cardiac magnetic resonance imaging and change in left ventricular function as affected by timing of treatment on day 3 vs day 7. The secondary end points included major adverse cardiovascular events as well as changes in left ventricular volumes and infarct size. RESULTS The mean (SD) patient age was 56.9 (10.9) years and 87.5% of participants were male. At 6 months, there was no significant increase in LVEF for the BMC group (45.2% [95% CI, 42.8% to 47.6%] to 48.3% [95% CI, 45.3% to 51.3%) vs the placebo group (44.5% [95% CI, 41.0% to 48.0%] to 47.8% [95% CI, 43.4% to 52.2%]) (P = .96). There was no significant treatment effect on regional left ventricular function observed in either infarct or border zones. There were no significant differences in change in global left ventricular function for patients treated at day 3 (−0.9% [95% CI, −6.6% to 4.9%], P = .76) or day 7 (1.1% [95% CI, −4.7% to 6.9%], P = .70). The timing of treatment had no significant effect on regional left ventricular function recovery. Major adverse events were rare among all treatment groups. CONCLUSION Among patients with STEMI treated with primary PCI, the administration of intracoronary BMCs at either 3 days or 7 days after the event had no significant effect on recovery of global or regional left ventricular function compared with placebo. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00684021.
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Welt FGP, Gallegos R, Connell J, Kajstura J, D'Amario D, Kwong RY, Coelho-Filho O, Shah R, Mitchell R, Leri A, Foley L, Anversa P, Pfeffer MA. Effect of cardiac stem cells on left-ventricular remodeling in a canine model of chronic myocardial infarction. Circ Heart Fail 2012; 6:99-106. [PMID: 23212553 DOI: 10.1161/circheartfailure.112.972273] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Regenerative medicine, including cell therapy, is a promising strategy for recovery of the damaged myocardium. C-kit-positive cardiac stem cells (CSCs) have been shown to improve myocardial function after ischemic injury in animal models and in early clinical experience. We used a chronic large animal model of myocardial infarction with substantial reductions in left-ventricular (LV) ejection fraction and adverse remodeling to examine the effect of late autologous CSC intramyocardial injection on long-term cardiac structure and function. METHODS AND RESULTS Thoracotomy and ligation of the proximal left anterior descending artery, additional diagonal branches, and atrial biopsy for CSC culture were performed in canines. Baseline cardiac MRI was performed at 6 weeks postinfarct followed by repeat thoracotomy for randomization to intramyocardial injection of CSCs (n=13) or vehicle alone (n=6). At 30 weeks postmyocardial infarction, repeat MRI was performed. Data were analyzed using nonparametric tests (Wilcoxon signed-rank and rank-sum tests). In control animals, LV end-systolic volume and end-diastolic volume increased from 6 to 30 weeks (median and interquartile range, 51.3 mL [43.3-57.4] to 76.1 mL [72.0-82.4]; P=0.03 and 78.5 mL [69.7-86.1] to 99.2 mL [97.1-100.4]; P=0.03). Left-ventricular ejection fraction declined further (35.2% [27.9-38.7] to 26.4% [22.0-31.0]; P=0.12). In the cell-treated animals, this late adverse LV remodeling was attenuated (LV end-systolic volume, 42.6 mL [38.5-50.5] to 56.1 mL [50.3-63.0]; P=0.01 versus control). There was a nonsignificant attenuation in the increase in LV end-diastolic volume (64.8 mL [60.7-71.3] to 83.5 mL [74.7-90.8]; P=0.14 versus control) and LV ejection fraction change over time differed (30.5% [28.4-33.4] to 32.9% [28.6-36.9]; P=0.04 versus control). CONCLUSIONS Intramyocardial injection of autologous CSCs in a late phase model of chronic infarction resulted in less increase in LV end-systolic volume and preservation of LV ejection fraction.
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286
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Allogeneic stem cell transplantation for ischemic myocardial dysfunction. Curr Opin Organ Transplant 2012; 17:675-80. [DOI: 10.1097/mot.0b013e32835a66a1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Sharma RK, Voelker DJ, Sharma R, Reddy HK. Understanding the application of stem cell therapy in cardiovascular diseases. STEM CELLS AND CLONING-ADVANCES AND APPLICATIONS 2012; 5:29-37. [PMID: 24198536 PMCID: PMC3781763 DOI: 10.2147/sccaa.s28500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Throughout their lifetime, an individual may sustain many injuries and recover spontaneously over a period of time, without even realizing the injury in the first place. Wound healing occurs due to a proliferation of stem cells capable of restoring the injured tissue. The ability of adult stem cells to repair tissue is dependent upon the intrinsic ability of tissues to proliferate. The amazing capacity of embryonic stem cells to give rise to virtually any type of tissue has intensified the search for similar cell lineage in adults to treat various diseases including cardiovascular diseases. The ability to convert adult stem cells into pluripotent cells that resemble embryonic cells, and to transplant those in the desired organ for regenerative therapy is very attractive, and may offer the possibility of treating harmful disease-causing mutations. The race is on to find the best cells for treatment of cardiovascular disease. There is a need for the ideal stem cell, delivery strategies, myocardial retention, and time of administration in the ideal patient population. There are multiple modes of stem cell delivery to the heart with different cell retention rates that vary depending upon method and site of injection, such as intra coronary, intramyocardial or via coronary sinus. While there are crucial issues such as retention of stem cells, microvascular plugging, biodistribution, homing to myocardium, and various proapoptotic factors in the ischemic myocardium, the regenerative potential of stem cells offers an enormous impact on clinical applications in the management of cardiovascular diseases.
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Affiliation(s)
- Rakesh K Sharma
- University of Arkansas for Medical Sciences, Medical Center of South Arkansas, El Dorado, AR, USA
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289
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Evolution of the chronic congestive heart failure paradigm. Cardiol Rev 2012; 21:121-6. [PMID: 23059652 DOI: 10.1097/crd.0b013e318277c990] [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: 11/26/2022]
Abstract
Paradigms are a part of our human nature. In the world of medicine and science, they allow investigators to work within a particular, previously accepted framework that provides certain constraints. This is the crux of Newton's quote, "If I've seen so far it's because I stood upon the shoulders of giants." However, in the same way that it allows us to build, it can constrain our thought processes if we fail to accept new data that are ill suited to an accepted paradigm. The physiological mechanisms to explain the phenomenon of chronic congestive heart failure are similar to other paradigms of science, in that they have undergone several shifts throughout their history, and continue to change with new evidence. Here, we seek to explore how our understanding of congestive heart failure has changed.
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290
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Heeger CH, Jaquet K, Thiele H, Zulkarnaen Y, Cuneo A, Haller D, Kivelitz D, Schmidt T, Krause K, Metzner A, Schneider C, Kuck KH, Bergmann MW. Percutaneous, transendocardial injection of bone marrow-derived mononuclear cells in heart failure patients following acute ST-elevation myocardial infarction: ALSTER-Stem Cell trial. EUROINTERVENTION 2012; 8:732-42. [DOI: 10.4244/eijv8i6a113] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Wu KC. CMR of microvascular obstruction and hemorrhage in myocardial infarction. J Cardiovasc Magn Reson 2012; 14:68. [PMID: 23021401 PMCID: PMC3514126 DOI: 10.1186/1532-429x-14-68] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 09/03/2012] [Indexed: 12/16/2022] Open
Abstract
Microvascular obstruction (MO) or no-reflow phenomenon is an established complication of coronary reperfusion therapy for acute myocardial infarction. It is increasingly recognized as a poor prognostic indicator and marker of subsequent adverse LV remodeling. Although MO can be assessed using various imaging modalities including electrocardiography, myocardial contrast echocardiography, nuclear scintigraphy, and coronary angiography, evaluation by cardiovascular magnetic resonance (CMR) is particularly useful in enhancing its detection, diagnosis, and quantification, as well as following its subsequent effects on infarct evolution and healing. MO assessment has become a routine component of the CMR evaluation of acute myocardial infarction and will increasingly play a role in clinical trials of adjunctive reperfusion agents and strategies. This review will summarize the pathophysiology of MO, current CMR approaches to diagnosis, clinical implications, and future directions needed for improving our understanding of this common clinical problem.
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Affiliation(s)
- Katherine C Wu
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, 600 N. Wolfe Street/Carnegie 568, Baltimore, MD 21287, USA.
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293
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Hong MK. Recent Advances in the Treatment of ST-Segment Elevation Myocardial Infarction. SCIENTIFICA 2012; 2012:683683. [PMID: 24278728 PMCID: PMC3820598 DOI: 10.6064/2012/683683] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 09/12/2012] [Indexed: 06/02/2023]
Abstract
ST-segment elevation myocardial infarction (STEMI) represents the most urgent condition for patients with coronary artery disease. Prompt diagnosis and therapy, mainly with primary angioplasty using stents, are important in improving not only acute survival but also long-term prognosis. Recent advances in angioplasty devices, including manual aspiration catheters and drug-eluting stents, and pharmacologic therapy, such as potent antiplatelet and anticoagulant agents, have significantly enhanced the acute outcome for these patients. Continuing efforts to educate the public and to decrease the door-to-balloon time are essential to further improve the outcome for these high-risk patients. Future research to normalize the left ventricular function by autologous stem cell therapy may also contribute to the quality of life and longevity of the patients surviving STEMI.
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Affiliation(s)
- Mun K. Hong
- Cardiac Catheterization Laboratory and Interventional Cardiology, St. Luke's-Roosevelt Hospital Center, 1111 Amsterdam Avenue, New York, NY 10025, USA
- Columbia University College of Physicians and Surgeons, 630 W. 168th St., New York, NY 10032, USA
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294
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Masumoto H, Sakata R. Cardiovascular surgery for realization of regenerative medicine. Gen Thorac Cardiovasc Surg 2012; 60:744-55. [PMID: 22933086 DOI: 10.1007/s11748-012-0139-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Indexed: 12/16/2022]
Abstract
Regenerative medicine is emerging as a new approach to the treatment of severe cardiovascular diseases that are resistant to conventional therapies. Although the type of cell transplanted (e.g., pluripotent stem cells, bone marrow-derived stem cells, skeletal myoblasts, or cardiac stem cells) influences the outcome of stem cell transplantation, the method of transplantation is also important, as the efficiency of engraftment after simple needle injection is poor. Scaffold-free cell sheet transplantation technology is one of the most promising methods in this regard. Although the results of clinical trials of stem cell therapy have been marginal to date, further elucidation of the actual mechanisms of cardiac repair following cell therapy would enhance the potential for full-scale implementation of stem cell therapy. In addition to stem cell therapy, the field of cardiovascular regenerative medicine includes interspecific chimera technology, drug delivery systems using biodegradable materials, and gene therapy. Integration of these new modalities with conventional therapies will be important to realize the goal of cardiovascular regenerative medicine tailored to the condition of each individual patient. Cardiovascular surgery would be an excellent means of carrying out this strategy and could potentially resolve the health problems of the increasing number of advanced cardiovascular patients. Herein, we review the recent basic and clinical research associated with the realization of regenerative medicine in the field of cardiovascular surgery.
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Affiliation(s)
- Hidetoshi Masumoto
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
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295
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Burt RK, Chen YH, Verda L, Lucena C, Navale S, Johnson J, Han X, Lomasney J, Baker JM, Ngai KL, Kino A, Carr J, Kajstura J, Anversa P. Mitotically inactivated embryonic stem cells can be used as an in vivo feeder layer to nurse damaged myocardium after acute myocardial infarction: a preclinical study. Circ Res 2012; 111:1286-96. [PMID: 22914647 DOI: 10.1161/circresaha.111.262584] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
RATIONALE Various types of viable stem cells have been reported to result in modest improvement in cardiac function after acute myocardial infarction. The mechanisms for improvement from different stem cell populations remain unknown. OBJECTIVE To determine whether irradiated (nonviable) embryonic stem cells (iESCs) improve postischemic cardiac function without adverse consequences. METHODS AND RESULTS After coronary artery ligation-induced cardiac infarction, either conditioned media or male murine or male human iESCs were injected into the penumbra of ischemic myocardial tissue of female mice or female rhesus macaque monkeys, respectively. Murine and human iESCs, despite irradiation doses that prevented proliferation and induced cell death, significantly improved cardiac function and decreased infarct size compared with untreated or media-treated controls. Fluorescent in situ hybridization of the Y chromosome revealed disappearance of iESCs within the myocardium, whereas 5-bromo-2'-deoxyuridine assays revealed de novo in vivo cardiomyocyte DNA synthesis. Microarray gene expression profiling demonstrated an early increase in metabolism, DNA proliferation, and chromatin remodeling pathways, and a decrease in fibrosis and inflammatory gene expression compared with media-treated controls. CONCLUSIONS As a result of irradiation before injection, ex vivo and in vivo iESC existence is transient, yet iESCs provide a significant improvement in cardiac function after acute myocardial infarction. The mechanism(s) of action of iESCs seems to be related to cell-cell exchange, paracrine factors, and a scaffolding effect between iESCs and neighboring host cardiomyocytes.
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Affiliation(s)
- Richard K Burt
- Division of Immunotherapy, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA.
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296
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Buxton DB, Skarlatos SI. Support for cardiovascular cell therapy research at the National Heart, Lung, and Blood Institute. Circ Res 2012; 110:1549-55. [PMID: 22679137 DOI: 10.1161/res.0b013e31825ec2a3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Denis B Buxton
- Division of Cardiovascular Sciences (DCVS), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA.
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297
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Hu J, Li C, Wang L, Zhang X, Zhang M, Gao H, Yu X, Wang F, Zhao W, Yan S, Wang Y. Long term effects of the implantation of autologous bone marrow mononuclear cells for type 2 diabetes mellitus. Endocr J 2012. [PMID: 22814142 DOI: 10.1016/j.jcyt.2013.10.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Previous studies have shown that several types of stem cells can differentiate into insulin-secreting islet beta-cells and that these cells can reduce blood glucose in some trials, but there has been no report of a long-term follow-up. We assessed the long-term effects of the use of autologous bone marrow mononuclear cells in the treatment of type 2 diabetes mellitus (T2DM). Based on the willingness to receive implantation of bone marrow mononuclear cells, One hundred and eighteen patients with T2DM were divided into two groups; the patients in group I were treated with autologous bone marrow mononuclear cells and patients in group II were treated with insulin intensification therapy. Mononuclear cells from bone marrow were injected back into the patient's pancreas via a catheter. Patients were followed-up after the operation at monthly intervals for the first 3 months and thereafter every 3 months for the next 33 months, the occurrence of any side effects and the results of laboratory examinations were evaluated. There were no reported acute or chronic side effects in group I and both the HbA1c and C-peptide in group I patients were significantly better than either pretherapy values or group II patients during the follow-up period. These data suggested that the implantation of autologous bone marrow mononuclear cells for the treatment of T2DM is safe and effective. This therapy can partially restore the function of islet beta-cells and maintain blood glucose homeostasis in a longer time.
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Affiliation(s)
- Jianxia Hu
- Stem Cell Research Center, the Affiliated Hospital of Medical College, Qingdao University, Qingdao 266003, China
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298
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Autologus transplantation of mononuclear bone marrow cells after acute myocardial infarction: A PILOT study. Int J Cardiol 2012; 158:449-50. [DOI: 10.1016/j.ijcard.2012.04.136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 04/28/2012] [Indexed: 11/18/2022]
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299
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Epstein SE, Lassance-Soares RM, Faber JE, Burnett MS. Effects of Aging on the Collateral Circulation, and Therapeutic Implications. Circulation 2012; 125:3211-9. [DOI: 10.1161/circulationaha.111.079038] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Stephen E. Epstein
- From the Cardiovascular Research Institute, MedStar Health Research Institute, Washington, DC (S.E.E., R.M.L.-S., M.S.B.), and Department of Physiology and McAllister Heart Institute, University of North Carolina, Chapel Hill, NC (J.E.F.)
| | - Roberta M. Lassance-Soares
- From the Cardiovascular Research Institute, MedStar Health Research Institute, Washington, DC (S.E.E., R.M.L.-S., M.S.B.), and Department of Physiology and McAllister Heart Institute, University of North Carolina, Chapel Hill, NC (J.E.F.)
| | - James E. Faber
- From the Cardiovascular Research Institute, MedStar Health Research Institute, Washington, DC (S.E.E., R.M.L.-S., M.S.B.), and Department of Physiology and McAllister Heart Institute, University of North Carolina, Chapel Hill, NC (J.E.F.)
| | - Mary Susan Burnett
- From the Cardiovascular Research Institute, MedStar Health Research Institute, Washington, DC (S.E.E., R.M.L.-S., M.S.B.), and Department of Physiology and McAllister Heart Institute, University of North Carolina, Chapel Hill, NC (J.E.F.)
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Jeevanantham V, Butler M, Saad A, Abdel-Latif A, Zuba-Surma EK, Dawn B. Adult bone marrow cell therapy improves survival and induces long-term improvement in cardiac parameters: a systematic review and meta-analysis. Circulation 2012; 126:551-68. [PMID: 22730444 DOI: 10.1161/circulationaha.111.086074] [Citation(s) in RCA: 384] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Despite rapid clinical translation and widespread enthusiasm, the therapeutic benefits of adult bone marrow cell (BMC) transplantation in patients with ischemic heart disease continue to remain controversial. A synthesis of the available data is critical to appreciate and underscore the true impact of this promising approach. METHODS AND RESULTS A total of 50 studies (enrolling 2625 patients) identified by database searches through January 2012 were included. Weighted mean differences for changes in left ventricular (LV) ejection fraction, infarct size, LV end-systolic volume, and LV end-diastolic volume were estimated with random-effects meta-analysis. Compared with control subjects, BMC-treated patients exhibited greater LV ejection fraction (3.96%; 95% confidence interval, 2.90-5.02; P<0.00001) and smaller infarct size (-4.03%, 95% confidence interval, -5.47 to -2.59; P<0.00001), LV end-systolic volume (-8.91 mL; 95% confidence interval, -11.57 to -6.25; P<0.00001), and LV end-diastolic volume (-5.23 mL; 95% confidence interval, -7.60 to -2.86; P<0.0001). These benefits were noted regardless of the study design (randomized controlled study versus cohort study) and the type of ischemic heart disease (acute myocardial infarction versus chronic ischemic heart disease) and persisted during long-term follow-up. Importantly, all-cause mortality, cardiac mortality, and the incidence of recurrent myocardial infarction and stent thrombosis were significantly lower in BMC-treated patients compared with control subjects. CONCLUSIONS Transplantation of adult BMCs improves LV function, infarct size, and remodeling in patients with ischemic heart disease compared with standard therapy, and these benefits persist during long-term follow-up. BMC transplantation also reduces the incidence of death, recurrent myocardial infarction, and stent thrombosis in patients with ischemic heart disease.
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Affiliation(s)
- Vinodh Jeevanantham
- Division of Cardiovascular Diseases and Cardiovascular Research Institute, University of Kansas Medical Center and Hospital, Kansas City, KS 66160, USA
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