1
|
Wu X, Wang D, Qin K, Iroegbu CD, Xiang K, Zhou Y, Guan Q, Tang W, Peng J, Guo J, Yang J, Fan C. Cardiac Repair With Echocardiography-Guided Multiple Percutaneous Left Ventricular Intramyocardial Injection of hiPSC-CMs After Myocardial Infarction. Front Cardiovasc Med 2021; 8:768873. [PMID: 34805322 PMCID: PMC8600116 DOI: 10.3389/fcvm.2021.768873] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/15/2021] [Indexed: 12/15/2022] Open
Abstract
Objective: We investigated the potency of cardiac repair based on echocardiography-guided multiple percutaneous left ventricular intramyocardial injection of human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) after myocardial infarction (MI). Methods: Mice with surgically induced MI were randomly divided into three groups (n = 8 in each group) and subjected to echocardiography-guided percutaneous left ventricular infarcted border injection of hiPSC-CMs (single dose; 10 μl 3 × 105 cells) or repeated injections of hiPSC-CMs at post-MI weeks 1 and 2 (multiple doses). The sham group of animals underwent all surgical procedures necessary for MI induction except for ligation. Then 4 weeks after MI, heart function was measured with transthoracic echocardiography. Engraftment was evaluated through the detection of human-specific cardiac troponin T. Infarct size and collagen volume were calculated with Sirius Red/Fast Green staining. Angiogenesis was evaluated with isolectin B4 staining. Cardiac remodeling was evaluated from the cardiomyocyte minimal fiber diameter in the infarcted border zone. Apoptosis was detected via TdT-mediated dUTP Nick-End Labeling (TUNEL) staining in cardiomyocytes from the infarcted border zone. Results: No mice died after echocardiography-guided percutaneous left ventricular intramyocardial injection. hiPSC-CMs were about nine-fold higher in the multiple-dose group at week 4 compared to the single-dose group. Multiple-dose transplantation was associated with significant improvement in left ventricular function, infarct size, angiogenesis, cardiac remodeling, and cardiomyocyte apoptosis. Conclusion: Echocardiography-guided multiple percutaneous left ventricular intramyocardial injection is a feasible, satisfactory, repeatable, relatively less invasive, and effective method of delivering cell therapy. The delivery of hiPSC-CMs indicates a novel therapy for MI.
Collapse
Affiliation(s)
- Xun Wu
- Department of Cardiovascular Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - Di Wang
- Hunan Provincial Key Laboratory of Cardiovascular Research, Changsha, China
| | - Kele Qin
- Department of Cardiovascular Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - Chukwuemeka Daniel Iroegbu
- Department of Cardiovascular Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - Kun Xiang
- Department of Cardiovascular Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - Yuanjing Zhou
- Hunan Provincial Key Laboratory of Cardiovascular Research, Changsha, China
| | - Qing Guan
- Department of Cardiovascular Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - Weijie Tang
- Department of Cardiovascular Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - Jun Peng
- Hunan Provincial Key Laboratory of Cardiovascular Research, Changsha, China
| | - Jianjun Guo
- Hunan Fangsheng Pharmaceutical Co., Ltd., Changsha, China
| | - Jinfu Yang
- Department of Cardiovascular Surgery, Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Provincial Key Laboratory of Cardiovascular Research, Changsha, China
| | - Chengming Fan
- Department of Cardiovascular Surgery, Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Provincial Key Laboratory of Cardiovascular Research, Changsha, China.,Hunan Fangsheng Pharmaceutical Co., Ltd., Changsha, China
| |
Collapse
|
2
|
Mitsutake Y, Pyun WB, Rouy D, Foo CWP, Stertzer SH, Altman P, Ikeno F. Improvement of Local Cell Delivery Using Helix Transendocardial Delivery Catheter in a Porcine Heart. Int Heart J 2017; 58:435-440. [DOI: 10.1536/ihj.16-179] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | - Wook Bum Pyun
- Division of Cardiovascular Medicine, Stanford University
- Division of Cardiology, Ewha Womans University School of Medicine
| | | | | | - Simon H. Stertzer
- Division of Cardiovascular Medicine, Stanford University
- BioCardia Inc
| | | | - Fumiaki Ikeno
- Division of Cardiovascular Medicine, Stanford University
| |
Collapse
|
3
|
Evertz LQ, Greising SM, Morrow DA, Sieck GC, Kaufman KR. Analysis of fluid movement in skeletal muscle using fluorescent microspheres. Muscle Nerve 2016; 54:444-50. [PMID: 26833456 DOI: 10.1002/mus.25063] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2016] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Regional variability in interstitial fluid pressure confounds use of intramuscular pressure measurement to assess muscle force. It is hypothesized that interstitial flow is dependent on intramuscular pressure. The goal of this study was to assess the feasibility of using fluorescent microspheres to evaluate movement of interstitial fluid in skeletal muscle. METHODS Two diameters of fluorescent microspheres were injected into the rat tibialis anterior during both static (n = 6) and passively lengthened (10% strain) experimental conditions (n = 6). Microsphere dispersion was evaluated using confocal imaging of transverse muscle sections. RESULTS Fluorescent microspheres tracked interstitial fluid while not penetrating the muscle fiber. When compared with the static condition, significantly greater dispersion (P = 0.003) was seen with passively lengthened conditions (17 ± 9% vs. 31 ± 7%, respectively). Dispersion did not differ for the 2 microsphere sizes (P = 0.811). CONCLUSIONS Fluorescent microspheres track movement of interstitial fluid, and dispersion is dependent on passive lengthening. Muscle Nerve 54: 444-450, 2016.
Collapse
Affiliation(s)
- Loribeth Q Evertz
- Mayo Graduate School Biomedical Engineering and Physiology Track, Rochester, Minnesota, USA
| | - Sarah M Greising
- Departments of Physiology and Biomedical Engineering, Rochester, Minnesota, USA
| | - Duane A Morrow
- Orthopedic Surgery Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, USA
| | - Gary C Sieck
- Departments of Physiology and Biomedical Engineering, Rochester, Minnesota, USA
| | - Kenton R Kaufman
- Orthopedic Surgery Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, USA
| |
Collapse
|
4
|
Hinkel R, Boekstegers P, Kupatt C. Adjuvant early and late cardioprotective therapy: access to the heart. Cardiovasc Res 2012; 94:226-36. [PMID: 22318936 DOI: 10.1093/cvr/cvs075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Coronary heart disease is still the leading cause of death in industrialized nations, occurring either as acute coronary occlusion and myocardial infarction or as chronic ischaemic cardiomyopathy caused by continuous obstruction of one or more coronary arteries. Even after successful reperfusion, an additional loss of otherwise vital cardiomyocytes may occur in the primary ischaemic area, called lethal reperfusion injury. In experimental settings, delivery of therapeutic agents targeting the reperfusion injury reduces the infarct size by 30%. In addition to the choice of therapeutic agent and time point, the mode of application may be crucial for the therapeutic success. Therefore, this review focuses on the current and future administration techniques for early and late post-myocardial infarction therapies.
Collapse
Affiliation(s)
- Rabea Hinkel
- Medizinische Klinik und Poliklinik I, Klinikum der LMU München, Marchioninistraße 15, Munich, Germany.
| | | | | |
Collapse
|
5
|
Psaltis PJ, Zannettino ACW, Gronthos S, Worthley SG. Intramyocardial Navigation and Mapping for Stem Cell Delivery. J Cardiovasc Transl Res 2009; 3:135-46. [DOI: 10.1007/s12265-009-9138-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2009] [Accepted: 09/28/2009] [Indexed: 01/16/2023]
|
6
|
Abstract
Angiogenesis is the biologic process of forming new blood vessels and is being investigated as an innovative therapeutic approach to help manage ischemic heart disease and peripheral vascular disease. Research studies have identified various angiogenic growth factors and progenitor cells that can enhance new blood vessel formation. This is Part II of an article that began publication in the July/August issue of Cardiology in Review. Preclinical investigations in animal models have explored the potential use of growth factors with and without progenitor cells to treat myocardial ischemia. The results of clinical trials with growth factor infusions and gene therapy techniques to enhance growth factor production have shown some promise, but therapeutic angiogenesis remains at an early stage of development.
Collapse
|
7
|
Hudson W, Collins MC, deFreitas D, Sun YS, Muller-Borer B, Kypson AP. Beating and arrested intramyocardial injections are associated with significant mechanical loss: implications for cardiac cell transplantation. J Surg Res 2007; 142:263-7. [PMID: 17719065 DOI: 10.1016/j.jss.2007.03.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Revised: 03/01/2007] [Accepted: 03/04/2007] [Indexed: 01/16/2023]
Abstract
BACKGROUND Cellular cardiomyoplasty is emerging as a potentially novel therapeutic option for heart failure and typically involves direct intramyocardial injection of donor cells into a beating heart. Yet, limited rates of cell engraftment remain an obstacle to be overcome before cell therapy is fully recognized. Mechanical and biological mechanisms may account for observed donor cell loss. This study examines acute mechanical loss during intramyocardial injections in beating and arrested hearts. MATERIALS AND METHODS A porcine cardiopulmonary bypass model was used. Animals underwent either beating (n = 5) or arrested (n = 5) intramyocardial injections into the left ventricle. Fluorescent microspheres were used in lieu of cells because they are biologically inert. Thirty minutes after delivery, animals were euthanized. Microspheres in cardiac and peripheral tissues were quantified using flow cytometry. RESULTS Approximately 10% of microspheres were retained within the site of injection in both groups. There was no statistical difference between microsphere retention rates in either the beating or the arrested heart group. Microspheres were found in peripheral organs, pericardial fluid, and the delivery device. CONCLUSIONS The majority of microspheres injected intramyocardially are lost in both beating and arrested hearts. Cardiac standstill does not enhance microsphere retention. Possible mechanisms include leakage from the injection site and washout via the cardiac venous/lymphatic system. Delivery strategy will need to be modified if more cells are to be retained within the target organ.
Collapse
Affiliation(s)
- Wes Hudson
- Division of Cardiothoracic Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina 27834, USA
| | | | | | | | | | | |
Collapse
|
8
|
Saborowski O, Saeed M. An overview on the advances in cardiovascular interventional MR imaging. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2007; 20:117-27. [PMID: 17487451 DOI: 10.1007/s10334-007-0074-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Revised: 03/19/2007] [Accepted: 03/20/2007] [Indexed: 10/23/2022]
Abstract
Interventional cardiovascular magnetic resonance imaging (iCMR) represents a new discipline whose systematic development will foster minimally invasive interventional procedures without radiation exposure. New generations of open, wide and short bore MR scanners and real time sequences made cardiovascular intervention possible. MR compatible endovascular catheters and guide-wires are needed for delivery of devices such as stents or atrial septal defect (ASD) closures. Catheter tracking is based on active and passive approaches. Currently performed MR-guided procedures are used to monitor, navigate and track endovascular catheters and to deliver local therapeutic agents to targets, such as infarcted myocardium and vascular walls. Heating of endovascular MR catheters, guide-wires and devices during imaging still presents high safety risks. MR contrast media improve the capabilities of MR imaging by enhancing blood signal, pathologic targets (such as myocardial infarctions and atherosclerotic plaques), endovascular catheters and by tracking injected therapeutic agents. Labeling injected soluble therapeutic agents, genes or cells with MR contrast media enables interventionalists to ensure the administration of the drugs in the target and to trace their distribution in the targets. The future clinical use of this iCMR technique requires (1) high spatial and temporal resolution imaging, (2) special catheters and devices and (3) effective therapeutic agents, genes or cells. These conditions are available at a low scale at the present time and need to be developed in the near future. Such progress will lead to improved patient care and minimize invasiveness.
Collapse
Affiliation(s)
- Olaf Saborowski
- Department of Radiology, University of California San Francisco, 513 Parnassus Avenue, HSW 207B, San Francisco, CA 94143-0628, USA
| | | |
Collapse
|
9
|
Abstract
There are a number of promising cell therapy products under development for the treatment of heart failure, whether due to myocardial infarction or cardiomyopathy. Looking forward beyond current products in development, there are a multitude of possibilities that hold significant promise; however, cell-based therapies present challenges that are unique to this platform. Results from transplant studies can often be misleading and need to be interpreted in the context of fundamental biologic properties of cells and development. Provided here is a summary of the current and future developments in the field of cell therapy for cardiac regeneration along with some critical insights to interpret the multitude of studies recently undertaken. Summarized are both clinical and preclinical studies that should serve as a useful entrée into this exciting new field of therapeutic development.
Collapse
Affiliation(s)
- Nabil Dib
- Arizona Heart Institute, Phoenix, AZ 85006, USA.
| | | |
Collapse
|
10
|
Saeed M, Martin AJ, Lee RJ, Weber O, Revel D, Saloner D, Higgins CB. MR Guidance of Targeted Injections into Border and Core of Scarred Myocardium in Pigs. Radiology 2006; 240:419-26. [PMID: 16801371 DOI: 10.1148/radiol.2402051086] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To use (a) dysprosium-based contrast agent (sprodiamide) to confirm the site of myocardial injection and (b) T1-enhancing magnetic resonance (MR) contrast media to mark the myocardial target and T2*-enhancing contrast media to demonstrate injection sites in the margins or core of infarction on delayed contrast-enhanced images. MATERIALS AND METHODS Approval of the institutional committee on animal research was obtained. A phantom and six pigs subjected to chronic infarction (8 weeks) underwent MR-guided experiments. At inversion-recovery gradient-echo imaging, gadoterate meglumine (0.1 mmol/kg) was intravenously administered to delineate scar tissue. A catheter fitted with multiple receiver coils was used to visualize catheter navigation and injection sites. A steady-state free precession (balanced fast field-echo) sequence was used for MR fluoroscopy. A high-resolution multiphase balanced gradient-echo cine MR sequence was used after intramyocardial deposition of sprodiamide. The border and core of scarred myocardium were characterized histopathologically. The 95% confidence interval (CI) was used to demonstrate the range, extent of hyperenhanced and hypoenhanced regions after contrast media administration. RESULTS In the phantom and in vivo, the actively guided catheter produced a high signal intensity at the terminal portion of the shaft and tip. Scarred myocardium was recognized as a bright region on gadoterate meglumine-enhanced images. Intramyocardial injection of sprodiamide caused local and persistent signal intensity loss, and the extent was volume dependent on balanced fast field-echo and T2-weighted turbo spin-echo images. At 5 minutes after administration of 0.2, 0.4, and 0.6 mL of sprodiamide, the 95% CIs of the extents of the hypoenhanced regions were 0.08%, 0.23%; 0.27%, 0.51%; and 0.46%, 0.70%, respectively, of left ventricular (LV) surface area (P < .05, paired t test). Failure of intramyocardial injection was confirmed by a brief signal loss of LV chamber blood. CONCLUSION Sprodiamide allows visualization of injection sites within enhanced infarction. A catheter with integrated receiver coils aided in effective catheter guidance and precise intramyocardial injection.
Collapse
Affiliation(s)
- Maythem Saeed
- Department of Radiology, University of California San Francisco, 513 Parnassus Ave, Room HSW 207 B, San Francisco, CA 94143-0628, USA.
| | | | | | | | | | | | | |
Collapse
|
11
|
Graham JJ, Lederman RJ, Dick AJ. Magnetic resonance imaging and its role in myocardial regenerative therapy. Regen Med 2006; 1:347-55. [PMID: 17465788 DOI: 10.2217/17460751.1.3.347] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
There has been extensive interest recently in cardiac stem cell therapy. Current research has been hampered by differences in cell type, methods of delivery and efficacy evaluation. In this article we review the use of magnetic resonance imaging in this growing area and argue that it is well suited to all areas of myocardial regeneration: from patient identification, through cell delivery and tracking of appropriately labeled cells, to evaluation of therapeutic effect. Potential future advances are discussed including magnetic resonance imaging-guided intervention suites and the use of higher field strength magnets for cell tracking.
Collapse
Affiliation(s)
- John J Graham
- Division of Cardiology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | | |
Collapse
|
12
|
Affiliation(s)
- Alexander J Dick
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892-1538, USA
| | | |
Collapse
|
13
|
Detillieux KA, Cattini PA, Kardami E. Beyond angiogenesis: the cardioprotective potential of fibroblast growth factor-2. Can J Physiol Pharmacol 2005; 82:1044-52. [PMID: 15644945 DOI: 10.1139/y04-126] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In the field of cardiovascular research, a number of independent approaches have been explored to protect the heart from acute and chronic ischemic damage. Fibroblast growth factor-2 (FGF-2) recently has received considerable attention with respect to its angiogenic potential. While therapeutic angiogenesis may serve to salvage chronically ischemic myocardium, more acute treatments are in demand to increase cardiac resistance to injury (preconditioning) and to guard against secondary injury after an acute ischemic insult. Here, we look beyond the angiogenic potential of FGF-2 and examine its acute cardioprotective activity as demonstrated under experimental conditions, both as an agent of a preconditioning-like response and for secondary injury prevention at the time of reperfusion. Factors to consider in moving to the clinical setting will be discussed, including issues of dosage, treatment duration, and routes of administration. Finally, issues of safety and clinical trial design will be considered. The prospect of such a multipotent growth factor having clinical usefulness opens the door to effective treatment of both acute and chronic ischemic heart disease, something well worth the attention of the cardiovascular community.
Collapse
Affiliation(s)
- Karen A Detillieux
- Department of Physiology, University of Manitoba, 730 William Avenue, Winnipeg, Manitoba R3E 3J7, Canada.
| | | | | |
Collapse
|
14
|
Krombach GA, Pfeffer JG, Kinzel S, Katoh M, Günther RW, Buecker A. MR-guided percutaneous intramyocardial injection with an MR-compatible catheter: feasibility and changes in T1 values after injection of extracellular contrast medium in pigs. Radiology 2005; 235:487-94. [PMID: 15858090 DOI: 10.1148/radiol.2352031760] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess the feasibility of percutaneous magnetic resonance (MR)-guided intramyocardial injection of gadodiamide by using real-time imaging and to quantify T1 values and the size of the enhanced region for different concentrations of contrast agent for 30 minutes after injection. MATERIALS AND METHODS Animal care committee approval was obtained. A catheter with a needle tip was advanced into the left ventricle in seven pigs by using real-time imaging with radial steady-state free precession. After intramyocardial injection of 2 mL of solution at concentrations of 0.05 or 0.10 mmol/mL gadodiamide, local changes in T1 values and size of the contrast material-enhanced region were sequentially measured at 3, 15, and 30 minutes after injection by using the Look-Locker sequence. Two-tailed paired Student t tests were used for statistical analysis. RESULTS Catheter guidance and visualization of contrast agent distribution were feasible in all animals. Regional changes in T1 values were significantly different for different contrast agent concentrations (for 0.05 mmol/mL, 456 msec +/- 5 [+/- standard error of the mean]; for 0.10 mmol/mL, 228 msec +/- 4; P < .001) measured 3 minutes after injection. T1 values increased significantly (P < .05) to 720 msec +/- 7 for 0.05 mmol/mL gadodiamide and 445 msec +/- 6 for 0.10 mmol/mL gadodiamide 30 minutes after injection but remained significantly lower than those of remote myocardium (879 msec +/- 8). The size of the contrast-enhanced region increased from 13 mm(2) +/- 2 at 3 minutes to 30 mm(2) +/- 3 at 30 minutes (P < .05). CONCLUSION Catheter MR-guided percutaneous intramyocardial injection is feasible; after intramyocardial injection of gadodiamide at concentrations of 0.05 and 0.10 mmol/mL, T1 values decreased over the observation time.
Collapse
Affiliation(s)
- Gabriele A Krombach
- Department of Diagnostic Radiology, University Hospital of the University of Technology, Pauwelstrasse 30, 52057 Aachen, Germany.
| | | | | | | | | | | |
Collapse
|
15
|
Saeed M, Saloner D, Weber O, Martin A, Henk C, Higgins C. MRI in guiding and assessing intramyocardial therapy. Eur Radiol 2005; 15:851-63. [PMID: 15856250 DOI: 10.1007/s00330-004-2622-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2004] [Revised: 12/01/2004] [Accepted: 12/07/2004] [Indexed: 01/12/2023]
Abstract
Cardiovascular intervention, using MRI guidance, is challenging for clinical applications. Real-time imaging sequences with high spatial resolution are needed for monitoring intramyocardial delivery of drug, gene, or stem cell therapies. New generation MR scanners make local intramyocardial and vascular wall therapies feasible. Contrast-enhanced MRI is used for assessing myocardial ischemia, infarction, and scar tissue. Active (microcoils) and passive (T1 and T2* mechanisms) tracking methods have been used for visualization of endovascular catheters. Safety issues related to potential heating of endovascular devices is still a major obstacle for MRI-guided interventions. Fabrication of MRI-compatible interventional devices is limited. Noninvasive imaging strategies will be critical in defining spatial and temporal characteristics of angiogenesis and myocardial repair as well as in assessing the efficacy of new therapies in ischemic heart disease. MRI contrast media improve the capability of MRI by delineating the target and vascular tree. Labeling stem cells enables MRI to trace distribution, differentiation, and survival in myocardium and vascular wall. In the long term, MRI in guiding and assessing intramyocardial therapy may circumvent the limitations of peripherally administered cell therapy, X-ray angiography, and nuclear imaging. MRI represents a highly attractive discipline whose systematic development will foster the implementation of new cardiac and vascular therapies.
Collapse
Affiliation(s)
- M Saeed
- Department of Radiology, School of Medicine, University of California-San Francisco, 94143-0628, USA.
| | | | | | | | | | | |
Collapse
|
16
|
Dick AJ, Guttman MA, Raman VK, Peters DC, Pessanha BS, Hill JM, Smith S, Scott G, McVeigh ER, Lederman RJ. Magnetic resonance fluoroscopy allows targeted delivery of mesenchymal stem cells to infarct borders in Swine. Circulation 2003; 108:2899-904. [PMID: 14656911 PMCID: PMC1325104 DOI: 10.1161/01.cir.0000095790.28368.f9] [Citation(s) in RCA: 184] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The local environment of delivered mesenchymal stem cells (MSCs) may affect their ultimate phenotype. MR fluoroscopy has the potential to guide intramyocardial MSC injection to desirable targets, such as the border between infarcted and normal tissue. We tested the ability to (1) identify infarcts, (2) navigate injection catheters to preselected targets, (3) inject safely even into fresh infarcts, and (4) confirm injection success immediately. METHODS AND RESULTS A 1.5-T MRI scanner was customized for interventional use, with rapid imaging, independent color highlighting of catheter channels, multiple-slice 3D rendering, catheter-only viewing mode, and infarct-enhanced imaging. MRI receiver coils were incorporated into guiding catheters and injection needles. These devices were tested for heating and used for targeted MSC delivery. In infarcted pigs, myocardium was targeted by MR fluoroscopy. Infarct-enhanced imaging included both saturation preparation MRI after intravenous gadolinium and wall motion. Porcine MSCs were MRI-labeled with iron-fluorescent particles. Catheter navigation and multiple cell injections were performed entirely with MR fluoroscopy at 8 frames/s with 1.7x3.3x8-mm voxels. Infarct-enhanced MR fluoroscopy permitted excellent delineation of infarct borders. All injections were safely and successfully delivered to their preselected targets, including infarct borders. Iron-fluorescent particle-labeled MSCs were readily visible on delivery in vivo and post mortem. CONCLUSIONS Precise targeted delivery of potentially regenerative cellular treatments to recent myocardial infarction borders is feasible with an MR catheter delivery system. MR fluoroscopy permits visualization of catheter navigation, myocardial function, infarct borders, and labeled cells after injection.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Robert J. Lederman
- Correspondence to Robert J. Lederman, MD, Cardiovascular Branch, Clinical Research Program, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room 2c713, Bethesda, MD 20892-1538. E-mail
| |
Collapse
|
17
|
Krombach GA, Baireuther R, Higgins CB, Saeed M. Distribution of intramyocardially injected extracellular MR contrast medium: effects of concentration and volume. Eur Radiol 2003; 14:334-40. [PMID: 14618368 DOI: 10.1007/s00330-003-2148-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2003] [Revised: 07/25/2003] [Accepted: 10/06/2003] [Indexed: 10/26/2022]
Abstract
The purpose of this study was to assess the potential of intramyocardially injected Gd-DTPA solution as a marker for distribution of intramyocardially delivered therapeutic solutions. The effects of concentration and volume of the extracellular MR contrast medium Gd-DTPA on signal intensity and spatial extent of enhancement was determined after intramyocardial delivery. In anesthetized pigs (n=11), mixtures of Gd-DTPA (0.15, 0.1 and 0.05 mmol/ml) and Evan's blue tissue dye (3%) were injected into the wall of the left ventricle. In each pig 1 ml of 0.15 mmol/ml, 2 ml of 0.1 ml and 3 ml of 0.05 mmol/ml Gd-DTPA were injected remote from each other. Arterial blood pressure, heart rate and ECG were monitored throughout the procedure. Five minutes after injections were performed, the pigs were killed and the hearts excised. T1-weighted spin-echo MR images were acquired to measure regional signal intensity (SI) and extent of the enhanced regions. The hearts were sliced and mass of blue stained regions was determined and compared with mass of enhanced areas on MRI. Gd-DTPA significantly (p<0.001) increased regional SI compared with remote myocardium in a concentration dependent fashion (109 +/- 4% at 0.05 mmol/ml, 202 +/- 7% at 0.1, and 327 +/- 6% at 0.15) while the mass of enhanced region was 0.6 +/- 0.1 g after injection of 1 ml, 1.4 +/- 0.2 g after 2 ml and 2.3 +/- 0.3 g after 3 ml (p<0.001). Regression and Bland-Altman analysis revealed that there was close correlation and agreement between MRI and histomorphometry (r=0.98, p<0.001). Magnitude and spatial extent of enhancement depend on concentration and volume of injected contrast medium. Intramyocardial injection of extracellular MR contrast media may be useful as a marker for the extent of distribution of intramyocardially delivered therapeutic solutions.
Collapse
Affiliation(s)
- Gabriele A Krombach
- Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, L308, San Francisco, CA 94143-0628, USA
| | | | | | | |
Collapse
|