Cardiac myosin light chain-1 release in acute myocardial infarction is associated with scintigraphic estimates of myocardial scar

Synthesis and evaluation of an anti-MLC1 × anti-CD90 bispecific antibody for targeting and retaining bone-marrow-derived multipotent stromal cells in infarcted myocardium

A key issue regarding the use of stem cells in cardiovascular regenerative medicine is their retention in target tissues. Here, we have generated and assessed a bispecific antibody heterodimer designed to improve the retention of bone-marrow-derived multipotent stromal cells (BMMSC) in cardiac tissue damaged by myocardial infarction. The heterodimer comprises an anti-human CD90 monoclonal antibody (mAb) (clone 5E10) and an anti-myosin light chain 1 (MLC1) mAb (clone MLM508) covalently cross-linked by a bis-arylhydrazone. We modified the anti-CD90 antibody with a pegylated-4-formylbenzamide moiety to a molar substitution ratio (MSR) of 2.6 and the anti-MLC1 antibody with a 6-hydrazinonicotinamide moiety to a MSR of 0.9. The covalent modifications had no significant deleterious effect on mAb epitope binding. Furthermore, the binding of anti-CD90 antibody to BMMSCs did not prevent their differentiation into adipo-, chondro-, or osteogenic lineages. Modified antibodies were combined under mild conditions (room temperature, pH 6, 1 h) in the presence of a catalyst (aniline) to allow for rapid generation of the covalent bis-arylhydrazone, which was monitored at A(354). We evaluated epitope immunoreactivity for each mAb in the construct. Flow cytometry demonstrated binding of the bispecific construct to BMMSCs that was competed by free anti-CD90 mAb, verifying that modification and cross-linking were not detrimental to the anti-CD90 complementarity-determining region. Similarly, ELISA-based assays demonstrated bispecific antibody binding to plastic-immobilized recombinant MLC1. Excess anti-MLC1 mAb competed for bispecific antibody binding. Finally, the anti-CD90 × anti-MLC1 bispecific antibody construct induced BMMSC adhesion to plastic-immobilized MLC1 that was resistant to shear stress, as measured in parallel-plate flow chamber assays. We used mAbs that bind both human antigens and the respective pig homologues. Thus, the anti-CD90 × anti-MLC1 bispecific antibody may be used in large animal studies of acute myocardial infarction and may provide a starting point for clinical studies.

Antibody targeting of stem cells to infarcted myocardium

Hematopoietic stem cell (HSC) therapy for myocardial repair is limited by the number of stem cells that migrate to, engraft in, and proliferate at sites of injured myocardium. To alleviate this limitation, we studied whether a strategy using a bispecific antibody (BiAb) could target human stem cells specifically to injured myocardium and preserve myocardial function. Using a xenogeneic rat model whereby ischemic injury was induced by transient ligation of the left anterior descending artery (LAD), we determined the ability of a bispecific antibody to target human CD34+ cells to specific antigens expressed in ischemic injured myocardium. A bispecific antibody comprising an anti-CD45 antibody recognizing the common leukocyte antigen found on HSCs and an antibody recognizing myosin light chain, an organ-specific injury antigen expressed by infarcted myocardium, was prepared by chemical conjugation. CD34+ cells armed and unarmed with this BiAb were injected intravenously in rats 2 days postmyocardial injury. Immunohistochemistry studies showed that the armed CD34+ cells specifically localized to the infarcted region of the heart, colocalized with troponin T-stained cells, and colocalization with vascular structures. Compared to unarmed CD34+ cells, the bispecific antibody improved delivery of the stem cells to injured myocardium, and such targeted delivery was correlated with improved myocardial function 5 weeks after infarction (p < .01). Bispecific antibody targeting offers a unique means to improve the delivery of stem cells to facilitate organ repair and a tool to study stem cell biology.

The new face of bispecific antibodies: targeting cancer and much more

The term magic bullet was first coined by bacteriologist Paul Ehrlich in the late 1800s to describe a chemical with the ability to specifically target microorganisms while sparing normal host cells. His concept was later expanded to include treatments for cancer, but it is only in recent decades, with development and improvements in monoclonal antibody (mAb) technology, that the full therapeutic implications of "magic bullet" strategies have been realized. Expanding on the success of mAb-targeting, linking the specificity of two mAbs into a single agent, called a bispecific antibody (BiAb), allows for targeting of a therapeutic biological agent or cell to specific tissue antigens. Classically, BiAbs have been used for several decades to redirect cytotoxic T cells or other effector cells to kill tumor cells. Here, we review preclinical models and ongoing phase I clinical trials in which arming polyclonally activated T cells with BiAbs may provide anti-tumor activity without dose-limiting toxicities. Additionally, we review findings from this novel strategy that merges magic bullet technology with hematopoietic stem cells to repair injured myocardium. Arming stem cells with BiAbs directed at injury-associated antigens enhances specific homing and engraftment to myocardial infarctions and may significantly improve cardiac function, strongly suggesting new paradigms for BiAb-targeting applications in tissue repair.

Virtual reality of stem cell transplantation to repair injured myocardium

The search for the fountain of youth continues into the 21st century with hopes that embryonic or hematopoietic stem cells (SC) will repair injured tissues in the heart, lungs, pancreas, muscles, nerves, liver, or skin. This commentary focuses on the potential of SC for inducing cardiac regeneration after myocardial injury, the barriers to SC treatment that need to be overcome for ensuring successful cardiac repair, and the experimental approaches that can be applied to the problem.

The utility of four biochemical markers in the triage of chest pain patients

Four biochemical markers, creatine kinase (CK)-MB isoenzyme, myoglobin, myosin light chains and troponin I, were studied in 1,338 patients presenting to the emergency department with chest pain suggestive of coronary artery disease (CAD). One hundred and eighty-seven patients had an acute myocardial infarction (MI). At least one of the four markers was over the threshold on the first sample in 78% of MI patients, as compared to only 40% with an elevated CK-MB. After 4 h, 88% had at least one marker elevated. None of the 69 patients with atypical chest pain, no history of CAD, no markers over threshold on the first sample and a normal electrocardiogram had an acute MI or unstable angina. If we had discharged this group, we would have saved USD 264,000, estimating a cost of USD 2,000 per day. Using four biochemical markers improved the early diagnosis of CAD and may help identify groups suitable for early discharge.

Myosin light chain I grade: a simple marker for the severity and prognosis of patients with acute myocardial infarction

To establish serum myosin light chain I (MLCI) as a severity and prognostic marker for patients with acute myocardial infarction (AMI), we measured the serum levels of MLCI in 71 patients with first AMI daily for 1 week after the onset and classified them into four groups by the peak LCI: group 1, > or =2.5 ng/ml but <10 ng/ml; group 2, > or =10 ng/ml but <25 ng/ml; group 3, > or =25 ng/ml but <50 ng/ml; and group 4, > or =50 ng/ml (MLCI grade). The patients in group 1 were likely to show non-Q-wave infarction. The patients in groups 1 and 2 were likely to show redistribution on exercise thallium-201 scintigraphy, suggesting frequent residual ischemia in these groups. The patients in group 4 were likely to show higher Forrester's subset and lower cardiac index at admission and lower left ventricular ejection fraction at discharge. Recurrent angina was equally found in all groups. Severe complications or death were found in patients in groups 3 and 4. Thus the MLCI grade can be used as a simple marker for evaluating the severity of patients with AMI.

Progress in myocardial damage detection: new biochemical markers for clinicians

New clinical requirements for triaging chest pain patients challenge the abilities of the current cardiac markers. Serial measurements of myoglobin, creatine kinase (CK) isoenzyme MB (CKMB) mass, or CK isoforms in emergency rooms help to rapidly rule out acute myocardial infarction (AMI). However, within the first 3 to 4 h from chest pain onset, their sensitivities are too low to contribute significantly to AMI diagnosis during this period. CKMB and lactate dehydrogenase (LDH) isoenzyme 1 are not heart-specific, which hampers reliable diagnosis in patients with concomitant skeletal muscle damage. By contrast, the regulatory proteins troponin I and troponin T are expressed in three different isoforms: one for slow-twitch skeletal muscle fibers, one for fast-twitch skeletal muscle fibers, and one for cardiac muscle (cTnI, cTnT); cardiac-specific cTnI and cTnT assays are already available for routine use. cTnT and cTnI are the most promising markers for risk stratification in patients with unstable angina pectoris. Recent reports on increased cTnT in patients with renal failure or myopathy without evidence of myocardial injury and undetectable cTnI suggest that cTnT could be reexpressed similar to CKMB and LDH-1 in chronically damaged human skeletal muscle. Therefore, cTnI is probably the most heart-specific marker. Among the recently proposed new markers for early AMI diagnosis: glycogen phosphorylase isoenzyme BB (GPBB), fatty acid binding protein, phosphoglyceric acid mutase isoenzyme MB, enolase isoenzyme alpha beta, S100a0, and annexin V, GPBB is the most promising because it increases as early as 1 to 4 h from chest pain onset and its early release appears to be essentially dependent on ischemic myocardial injury.