1
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Ahmed ZT, Zain Al-Abeden MS, Al Abdin MG, Muqresh MA, Al Jowf GI, Eijssen LMT, Haider KH. Dose-response relationship of MSCs as living Bio-drugs in HFrEF patients: a systematic review and meta-analysis of RCTs. Stem Cell Res Ther 2024; 15:165. [PMID: 38867306 PMCID: PMC11170815 DOI: 10.1186/s13287-024-03713-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/01/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Mesenchymal stem cells (MSCs) have emerged as living biodrugs for myocardial repair and regeneration. Recent randomized controlled trials (RCTs) have reported that MSC-based therapy is safe and effective in heart failure patients; however, its dose-response relationship has yet to be established. We aimed to determine the optimal MSC dose for treating HF patients with reduced ejection fraction (EF) (HFrEF). METHODS The preferred reporting items for systematic reviews and meta-analyses (PRISMA) and Cochrane Handbook guidelines were followed. Four databases and registries, i.e., PubMed, EBSCO, clinicaltrials.gov, ICTRP, and other websites, were searched for RCTs. Eleven RCTs with 1098 participants (treatment group, n = 606; control group, n = 492) were selected based on our inclusion/exclusion criteria. Two independent assessors extracted the data and performed quality assessments. The data from all eligible studies were plotted for death, major adverse cardiac events (MACE), left ventricular ejection fraction (LVEF), left ventricular end-systolic volume (LVESV), and 6-minute walk distance (6-MWD) as safety, efficacy, and performance parameters. For dose-escalation assessment, studies were categorized as low-dose (< 100 million cells) or high-dose (≥ 100 million cells). RESULTS MSC-based treatment is safe across low and high doses, with nonsignificant effects. However, low-dose treatment had a more significant protective effect than high-dose treatment. Subgroup analysis revealed the superiority of low-dose treatment in improving LVEF by 3.01% (95% CI; 0.65-5.38%) compared with high-dose treatment (-0.48%; 95% CI; -2.14-1.18). MSC treatment significantly improved the 6-MWD by 26.74 m (95% CI; 3.74-49.74 m) in the low-dose treatment group and by 36.73 m (95% CI; 6.74-66.72 m) in the high-dose treatment group. The exclusion of studies using ADRCs resulted in better safety and a significant improvement in LVEF from low- and high-dose MSC treatment. CONCLUSION Low-dose MSC treatment was safe and superior to high-dose treatment in restoring efficacy and functional outcomes in heart failure patients, and further analysis in a larger patient group is warranted.
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Affiliation(s)
- Ziyad T Ahmed
- College of Medicine, Sulaiman Al Rajhi University, Al-Bukairiyah, 52726, Saudi Arabia
| | | | | | - Mohamad Ayham Muqresh
- College of Medicine, Sulaiman Al Rajhi University, Al-Bukairiyah, 52726, Saudi Arabia
| | - Ghazi I Al Jowf
- Department of Public Health, College of Applied Medical Sciences, King Faisal University, Al-Ahsa, 31982, Saudi Arabia
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, 6200 MD, The Netherlands
- European Graduate School of Neuroscience, Maastricht University, Maastricht, 6200 MD, The Netherlands
| | - Lars M T Eijssen
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, 6200 MD, The Netherlands
- Department of Bioinformatics- BiGCaT, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 6200 MD, The Netherlands
- European Graduate School of Neuroscience, Maastricht University, Maastricht, 6200 MD, The Netherlands
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2
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Chen S, Liang B, Xu J. Unveiling heterogeneity in MSCs: exploring marker-based strategies for defining MSC subpopulations. J Transl Med 2024; 22:459. [PMID: 38750573 PMCID: PMC11094970 DOI: 10.1186/s12967-024-05294-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 05/11/2024] [Indexed: 05/19/2024] Open
Abstract
Mesenchymal stem/stromal cells (MSCs) represent a heterogeneous cell population distributed throughout various tissues, demonstrating remarkable adaptability to microenvironmental cues and holding immense promise for disease treatment. However, the inherent diversity within MSCs often leads to variability in therapeutic outcomes, posing challenges for clinical applications. To address this heterogeneity, purification of MSC subpopulations through marker-based isolation has emerged as a promising approach to ensure consistent therapeutic efficacy. In this review, we discussed the reported markers of MSCs, encompassing those developed through candidate marker strategies and high-throughput approaches, with the aim of explore viable strategies for addressing the heterogeneity of MSCs and illuminate prospective research directions in this field.
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Affiliation(s)
- Si Chen
- Shenzhen University Medical School, Shenzhen University, Shenzhen, 518000, People's Republic of China
| | - Bowei Liang
- Shenzhen University Medical School, Shenzhen University, Shenzhen, 518000, People's Republic of China
| | - Jianyong Xu
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-Implantation, Guangdong Engineering Technology Research Center of Reproductive Immunology for Peri-Implantation, Shenzhen Zhongshan Obstetrics & Gynecology Hospital (formerly Shenzhen Zhongshan Urology Hospital), Fuqiang Avenue 1001, Shenzhen, 518060, Guangdong, People's Republic of China.
- Guangdong Engineering Technology Research Center of Reproductive Immunology for Peri-Implantation, Shenzhen, 518000, People's Republic of China.
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3
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Cheng F. Comments on: "Mesenchymal stem cells transplantation for perianal fistulas: a systematic review and meta-analysis of clinical trials". Stem Cell Res Ther 2023; 14:375. [PMID: 38110978 PMCID: PMC10729403 DOI: 10.1186/s13287-023-03607-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/06/2023] [Indexed: 12/20/2023] Open
Abstract
The meta-analysis by Wang et al. (Stem Cell Res Ther 14(1):103, 2023) aims to explore whether mesenchymal stem cells are effective for perianal fistulas. The authors indicated that the difference in cell types, cell sources and cell dosages did not influence mesenchymal stem cells' efficacy, which may not be accurate. I think that local treatment with higher dosages of mesenchymal stem cells seems to not result in a higher healing rate. And, future trials should focus on donor characteristics considering past medical history of further autoimmunity, timely and cost-effective treatment to lighten the optimized therapeutic goals. In the future, it will be interesting to assess the safety and feasibility of injection of fibrin glue combined with mesenchymal stem cells in perianal fistulas.
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Affiliation(s)
- Fang Cheng
- Division of Gastroenterology, Zigong First People's Hospital, 42 Shangyihao Road, Zigong, 643000, Sichuan Province, China.
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4
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Chepeleva EV. Cell Therapy in the Treatment of Coronary Heart Disease. Int J Mol Sci 2023; 24:16844. [PMID: 38069167 PMCID: PMC10706847 DOI: 10.3390/ijms242316844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
Heart failure is a leading cause of death in patients who have suffered a myocardial infarction. Despite the timely use of modern reperfusion therapies such as thrombolysis, surgical revascularization and balloon angioplasty, they are sometimes unable to prevent the development of significant areas of myocardial damage and subsequent heart failure. Research efforts have focused on developing strategies to improve the functional status of myocardial injury areas. Consequently, the restoration of cardiac function using cell therapy is an exciting prospect. This review describes the characteristics of various cell types relevant to cellular cardiomyoplasty and presents findings from experimental and clinical studies investigating cell therapy for coronary heart disease. Cell delivery methods, optimal dosage and potential treatment mechanisms are discussed.
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Affiliation(s)
- Elena V. Chepeleva
- Federal State Budgetary Institution National Medical Research Center Named after Academician E.N. Meshalkin of the Ministry of Health of the Russian Federation, 15, Rechkunovskaya Str., 630055 Novosibirsk, Russia;
- Research Institute of Clinical and Experimental Lymphology—Branch of the Institute of Cytology and Genetics Siberian Branch of Russian Academy of Sciences, 2, Timakova Str., 630060 Novosibirsk, Russia
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5
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Wang H, Jiang HY, Zhang YX, Jin HY, Fei BY, Jiang JL. Mesenchymal stem cells transplantation for perianal fistulas: a systematic review and meta-analysis of clinical trials. Stem Cell Res Ther 2023; 14:103. [PMID: 37101285 PMCID: PMC10134595 DOI: 10.1186/s13287-023-03331-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 04/06/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Perianal fistulas, characterised as granulomatous inflammation of fistulas around the anal canal, are associated with significant morbidity resulting in a negative impact on quality of life and a tremendous burden to the healthcare system. Treatment of anal fistulas usually consists of anal surgery; however, results of closure rates are not satisfactory especially with complex perianal fistulas, after which many patients may suffer from anal incontinence. Recently, the administration of mesenchymal stem cells (MSCs) has shown promising efficacy. Herein, we aim to explore whether MSCs are effective for complex perianal fistulas and if they have either short-term, medium-term, long-term or over-long-term efficacy. Additionally, we want to elucidate whether factors such as drug dosage, MSC source, cell type, and disease aetiology influence treatment efficacy. We searched four online databases and analysed data based on information within the clinical trials registry. The outcomes of eligible trials were analysed with Review Manager 5.4.1. Relative risk and related 95% confidence interval were calculated to compare the effect between the MSCs and control groups. In addition, the Cochrane risk of bias tool was applied to evaluate the bias risk of eligible studies. Meta-analyses showed that therapy with MSCs was superior to conventional treatment for complex perianal fistulas in short-, long- and over-long-term follow-up phases. However, there was no statistical difference in treatment efficacy in the medium term between the two methods. Subgroup meta-analyses showed factors including cell type, cell source and cell dosage were superior compared to the control, but there was no significant difference between different experimental groups of those factors. Besides, local MSCs therapy has shown more promising results for fistulas as a result of Crohn's Disease (CD). Although we tend to maintain that MSCs therapy is effective for cryptoglandular fistulas equally, more studies are needed to confirm this conclusion in the future. SHORT CONCLUSION MSCs Transplantation could be a new therapeutic method for complex perianal fistulas of both cryptoglandular and CD origin showing high efficacy in the short-term to over-long-term phases, as well as high efficacy in sustained healing. The difference in cell types, cell sources and cell dosages did not influence MSCs' efficacy.
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Affiliation(s)
- H Wang
- Scientific Research Center, China-Japan Union Hospital of Jilin University, Changchun, China
| | - H Y Jiang
- Life Spring AKY Pharmaceuticals, Changchun, China
| | - Y X Zhang
- Changchun University of Chinese Medicine, Changchun, China
| | - H Y Jin
- Department of Gastrointestinal Colorectal Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - B Y Fei
- Department of Gastrointestinal Colorectal Surgery, China-Japan Union Hospital of Jilin University, Changchun, China.
| | - J L Jiang
- Scientific Research Center, China-Japan Union Hospital of Jilin University, Changchun, China.
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6
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Endothelial Progenitor Cell Therapy for Fracture Healing: A Dose-Response Study in a Rat Femoral Defect Model. J Tissue Eng Regen Med 2023. [DOI: 10.1155/2023/8105599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Endothelial progenitor cell (EPC) therapy has been successfully used in orthopaedic preclinical models to heal bone defects. However, no previous studies have investigated the dose-response relationship between EPC therapy and bone healing. This study aimed to assess the effect of different EPC doses on bone healing in a rat model to define an optimal dose. Five-millimeter segmental defects were created in the right femora of Fischer 344 rats, followed by stabilization with a miniplate and screws. Rats were assigned to one of six groups (control, 0.1 M, 0.5 M, 1.0 M, 2.0 M, and 4.0 M; n = 6), receiving 0, 1 × 105, 5 × 105, 1 × 106, 2 × 106, and 4 × 106 EPCs, respectively, delivered into the defect on a gelatin scaffold. Radiographs were taken every two weeks until the animals were euthanized 10 weeks after surgery. The operated femora were then evaluated using micro-computed tomography and biomechanical testing. Overall, the groups that received higher doses of EPCs (0.5 M, 1.0 M, 2.0 M, and 4.0 M) reached better outcomes. At 10 weeks, full radiographic union was observed in 67% of animals in the 0.5 M group, 83% of animals in the 1.0 M group, and 100% of the animals in the 2.0 M and 4.0 M groups, but none in the control and 0.1 M groups. The 2.0 M group also displayed the strongest biomechanical properties, which significantly improved relative to the control and 0.1 M groups. In summary, this study defined a dose-response relationship between EPC therapy and bone healing, with 2 × 106 EPCs being the optimal dose in this model. Our findings emphasize the importance of dosing considerations in the application of cell therapies aimed at tissue regeneration and will help guide future investigations and clinical translation of EPC therapy.
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Mahmud S, Alam S, Emon NU, Boby UH, Kamruzzaman, Ahmed F, Monjur-Al-Hossain ASM, Tahamina A, Rudra S, Ajrin M. Opportunities and challenges in stem cell therapy in cardiovascular diseases: Position standing in 2022. Saudi Pharm J 2022; 30:1360-1371. [PMID: 36249945 PMCID: PMC9563042 DOI: 10.1016/j.jsps.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 06/17/2022] [Indexed: 10/29/2022] Open
Abstract
This study intends to evaluate the development, importance, pre-clinical and clinical study evaluation of stem cell therapy for the treatment of cardiovascular disease. Cardiovascular disease is one of the main causes of fatality in the whole world. Though there are great progressions in the pharmacological and other interventional treatment options, heart diseases remain a common disorder that causes long-term warnings. Recent accession promotes the symptoms and slows down the adverse effects regarding cardiac remodelling. But they cannot locate the problems of immutable loss of cardiac tissues. In this case, stem cell treatment holds a promising challenge. Stem cells are the cells that are capable of differentiating into many cells according to their needs. So, it is assumed that these cells can distinguish into many cells and if these cells can be individualized into cardiac cells then they can be used to replace the damaged tissues of the heart. There is some abridgment in this therapy, none the less stem cell therapy remains a hopeful destination in the treatment of heart disease.
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Affiliation(s)
- Shabnur Mahmud
- School of Health and Life Sciences, Department of Pharmaceutical Sciences, North South University, Dhaka 1229, Bangladesh
| | - Safaet Alam
- Pharmaceutical Sciences Research Division, BCSIR Laboratories, Dhaka, Bangladesh Council of Scientific and Industrial Research (BCSIR), Dr. Qudrat-I-Khuda Road, Dhanmondi, Dhaka 1205, Bangladesh
| | - Nazim Uddin Emon
- Department of Pharmacy, Faculty of Science and Engineering, International Islamic University Chittagong, Chittagong 4318, Bangladesh
| | - Umme Habiba Boby
- Department of Pharmacy, Faculty of Science and Engineering, International Islamic University Chittagong, Chittagong 4318, Bangladesh
| | - Kamruzzaman
- Department of Pharmacy, Faculty of Science and Engineering, International Islamic University Chittagong, Chittagong 4318, Bangladesh
| | - Firoj Ahmed
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Dhaka, Dhaka 1205, Bangladesh
| | - A S M Monjur-Al-Hossain
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Dhaka, Dhaka 1205, Bangladesh
| | - Afroza Tahamina
- Department of Botany, Faculty of Biological Sciences, University of Chittagong, Chattogram 4331, Bangladesh
| | - Sajib Rudra
- Department of Botany, Faculty of Biological Sciences, University of Chittagong, Chattogram 4331, Bangladesh
| | - Marzina Ajrin
- Department of Pharmacy, University of Science and Technology Chittagong, Chittagong 4202, Bangladesh
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8
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Shazly T, Smith A, Uline MJ, Spinale FG. Therapeutic payload delivery to the myocardium: Evolving strategies and obstacles. JTCVS OPEN 2022; 10:185-194. [PMID: 36004211 PMCID: PMC9390211 DOI: 10.1016/j.xjon.2022.04.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/19/2022] [Accepted: 04/27/2022] [Indexed: 06/15/2023]
Key Words
- BMC, bone marrow cell
- HF, heart failure
- ID, intracoronary delivery
- IMD, intramyocardial delivery
- IPD, intrapericardial delivery
- LV, left ventricle
- MI, myocardial infarct
- MSC, mesenchymal stem cell
- TED, transendocardial delivery
- bFGF, basic fibroblast growth factor
- biomaterial
- cardiac
- injection
- local delivery
- myocardium
- payload
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Affiliation(s)
- Tarek Shazly
- College of Engineering and Computing, School of Medicine, University of South Carolina, Columbia, SC
| | - Arianna Smith
- College of Arts and Sciences, Florida Gulf Coast University, Fort Myers, Fla
| | - Mark J. Uline
- College of Engineering and Computing, School of Medicine, University of South Carolina, Columbia, SC
| | - Francis G. Spinale
- College of Engineering and Computing, School of Medicine, University of South Carolina, Columbia, SC
- Cardiovascular Translational Research Center, School of Medicine, University of South Carolina, Columbia, SC
- Columbia VA Health Care System, Columbia, SC
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9
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Tracy EP, Stielberg V, Rowe G, Benson D, Nunes SS, Hoying JB, Murfee WL, LeBlanc AJ. State of the field: cellular and exosomal therapeutic approaches in vascular regeneration. Am J Physiol Heart Circ Physiol 2022; 322:H647-H680. [PMID: 35179976 PMCID: PMC8957327 DOI: 10.1152/ajpheart.00674.2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 01/19/2023]
Abstract
Pathologies of the vasculature including the microvasculature are often complex in nature, leading to loss of physiological homeostatic regulation of patency and adequate perfusion to match tissue metabolic demands. Microvascular dysfunction is a key underlying element in the majority of pathologies of failing organs and tissues. Contributing pathological factors to this dysfunction include oxidative stress, mitochondrial dysfunction, endoplasmic reticular (ER) stress, endothelial dysfunction, loss of angiogenic potential and vascular density, and greater senescence and apoptosis. In many clinical settings, current pharmacologic strategies use a single or narrow targeted approach to address symptoms of pathology rather than a comprehensive and multifaceted approach to address their root cause. To address this, efforts have been heavily focused on cellular therapies and cell-free therapies (e.g., exosomes) that can tackle the multifaceted etiology of vascular and microvascular dysfunction. In this review, we discuss 1) the state of the field in terms of common therapeutic cell population isolation techniques, their unique characteristics, and their advantages and disadvantages, 2) common molecular mechanisms of cell therapies to restore vascularization and/or vascular function, 3) arguments for and against allogeneic versus autologous applications of cell therapies, 4) emerging strategies to optimize and enhance cell therapies through priming and preconditioning, and, finally, 5) emerging strategies to bolster therapeutic effect. Relevant and recent clinical and animal studies using cellular therapies to restore vascular function or pathologic tissue health by way of improved vascularization are highlighted throughout these sections.
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Affiliation(s)
- Evan Paul Tracy
- Cardiovascular Innovation Institute and the Department of Physiology, University of Louisville, Louisville, Kentucky
| | - Virginia Stielberg
- Cardiovascular Innovation Institute and the Department of Physiology, University of Louisville, Louisville, Kentucky
| | - Gabrielle Rowe
- Cardiovascular Innovation Institute and the Department of Physiology, University of Louisville, Louisville, Kentucky
| | - Daniel Benson
- Cardiovascular Innovation Institute and the Department of Physiology, University of Louisville, Louisville, Kentucky
- Department of Bioengineering, University of Louisville, Louisville, Kentucky
| | - Sara S Nunes
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Heart & Stroke/Richard Lewar Centre of Excellence, University of Toronto, Toronto, Ontario, Canada
| | - James B Hoying
- Advanced Solutions Life Sciences, Manchester, New Hampshire
| | - Walter Lee Murfee
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida
| | - Amanda Jo LeBlanc
- Cardiovascular Innovation Institute and the Department of Physiology, University of Louisville, Louisville, Kentucky
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10
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Campos de Carvalho AC, Kasai-Brunswick TH, Bastos Carvalho A. Cell-Based Therapies for Heart Failure. Front Pharmacol 2021; 12:641116. [PMID: 33912054 PMCID: PMC8072383 DOI: 10.3389/fphar.2021.641116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 02/11/2021] [Indexed: 02/05/2023] Open
Abstract
Heart failure has reached epidemic proportions with the advances in cardiovascular therapies for ischemic heart diseases and the progressive aging of the world population. Efficient pharmacological therapies are available for treating heart failure, but unfortunately, even with optimized therapy, prognosis is often poor. Their last therapeutic option is, therefore, a heart transplantation with limited organ supply and complications related to immunosuppression. In this setting, cell therapies have emerged as an alternative. Many clinical trials have now been performed using different cell types and injection routes. In this perspective, we will analyze the results of such trials and discuss future perspectives for cell therapies as an efficacious treatment of heart failure.
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Affiliation(s)
- Antonio Carlos Campos de Carvalho
- Laboratory of Cellular and Molecular Cardiology, Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- National Center of Structural Biology and Bioimaging (CENABIO), Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- National Institute of Science and Technology in Regenerative Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- *Correspondence: Antonio Carlos Campos de Carvalho,
| | - Tais H. Kasai-Brunswick
- National Center of Structural Biology and Bioimaging (CENABIO), Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- National Institute of Science and Technology in Regenerative Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Adriana Bastos Carvalho
- Laboratory of Cellular and Molecular Cardiology, Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- National Institute of Science and Technology in Regenerative Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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11
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Mesenchymal Stem/Progenitor Cells: The Prospect of Human Clinical Translation. Stem Cells Int 2020; 2020:8837654. [PMID: 33953753 PMCID: PMC8063852 DOI: 10.1155/2020/8837654] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/19/2020] [Accepted: 07/20/2020] [Indexed: 12/13/2022] Open
Abstract
Mesenchymal stem/progenitor cells (MSCs) are key players in regenerative medicine, relying principally on their differentiation/regeneration potential, immunomodulatory properties, paracrine effects, and potent homing ability with minimal if any ethical concerns. Even though multiple preclinical and clinical studies have demonstrated remarkable properties for MSCs, the clinical applicability of MSC-based therapies is still questionable. Several challenges exist that critically hinder a successful clinical translation of MSC-based therapies, including but not limited to heterogeneity of their populations, variability in their quality and quantity, donor-related factors, discrepancies in protocols for isolation, in vitro expansion and premodification, and variability in methods of cell delivery, dosing, and cell homing. Alterations of MSC viability, proliferation, properties, and/or function are also affected by various drugs and chemicals. Moreover, significant safety concerns exist due to possible teratogenic/neoplastic potential and transmission of infectious diseases. Through the current review, we aim to highlight the major challenges facing MSCs' human clinical translation and shed light on the undergoing strategies to overcome them.
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12
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Zarniko N, Skorska A, Steinhoff G, David R, Gaebel R. Dose-Independent Therapeutic Benefit of Bone Marrow Stem Cell Transplantation after MI in Mice. Biomedicines 2020; 8:biomedicines8060157. [PMID: 32545336 PMCID: PMC7345933 DOI: 10.3390/biomedicines8060157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 02/06/2023] Open
Abstract
Several cell populations derived from bone marrow (BM) have been shown to possess cardiac regenerative potential. Among these are freshly isolated CD133+ hematopoietic as well as culture-expanded mesenchymal stem cells. Alternatively, by purifying CD271+ cells from BM, mesenchymal progenitors can be enriched without an ex vivo cultivation. With regard to the limited available number of freshly isolated BM-derived stem cells, the effect of the dosage on the therapeutic efficiency is of particular interest. Therefore, in the present pre-clinical study, we investigated human BM-derived CD133+ and CD271+ stem cells for their cardiac regenerative potential three weeks post-myocardial infarction (MI) in a dose-dependent manner. The improvement of the hemodynamic function as well as cardiac remodeling showed no therapeutic difference after the transplantation of both 100,000 and 500,000 stem cells. Therefore, beneficial stem cell transplantation post-MI is widely independent of the cell dose and detrimental stem cell amplification in vitro can likely be avoided.
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Affiliation(s)
- Nicole Zarniko
- Department of Cardiac Surgery, Rostock University Medical Center, 18059 Rostock, Germany; (N.Z.); (A.S.); (G.S.); (R.G.)
| | - Anna Skorska
- Department of Cardiac Surgery, Rostock University Medical Center, 18059 Rostock, Germany; (N.Z.); (A.S.); (G.S.); (R.G.)
- Department Life, Light & Matter (LL&M), University of Rostock, A.-Einstein-Str. 25, 18057 Rostock, Germany
| | - Gustav Steinhoff
- Department of Cardiac Surgery, Rostock University Medical Center, 18059 Rostock, Germany; (N.Z.); (A.S.); (G.S.); (R.G.)
- Department Life, Light & Matter (LL&M), University of Rostock, A.-Einstein-Str. 25, 18057 Rostock, Germany
| | - Robert David
- Department of Cardiac Surgery, Rostock University Medical Center, 18059 Rostock, Germany; (N.Z.); (A.S.); (G.S.); (R.G.)
- Department Life, Light & Matter (LL&M), University of Rostock, A.-Einstein-Str. 25, 18057 Rostock, Germany
- Correspondence: ; Tel.: +49-381-4988973; Fax: +49-381-4988970
| | - Ralf Gaebel
- Department of Cardiac Surgery, Rostock University Medical Center, 18059 Rostock, Germany; (N.Z.); (A.S.); (G.S.); (R.G.)
- Department Life, Light & Matter (LL&M), University of Rostock, A.-Einstein-Str. 25, 18057 Rostock, Germany
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13
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Rostom DM, Attia N, Khalifa HM, Abou Nazel MW, El Sabaawy EA. The Therapeutic Potential of Extracellular Vesicles Versus Mesenchymal Stem Cells in Liver Damage. Tissue Eng Regen Med 2020; 17:537-552. [PMID: 32506351 DOI: 10.1007/s13770-020-00267-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/05/2020] [Accepted: 04/15/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The extracellular vesicles (EVs) secreted by bone marrow-derived mesenchymal stem cells (MSCs) hold significant potential as a novel alternative to whole-cell therapy. We herein compare the therapeutic potential of BM-MSCs versus their EVs (MSC-EVs) in an experimental Carbon tetrachloride (CCl4)-induced liver damage rat model. METHODS Rats with liver damage received a single IV injection of MSC-EVs, 1 million MSCs, or 3 million MSCs. The therapeutic efficacy of each treatment was assessed using liver histopathology, liver function tests and immunohistochemistry for liver fibrosis and hepatocellular injury. RESULTS Animals that received an injection of either MSCs-EVs or 3 million MSCs depicted significant regression of collagen deposition in the liver tissue and marked attenuation of hepatocellular damage, both structurally and functionally. CONCLUSION Similar to high doses of MSC-based therapy (3 million MSCs), MSC-EVs mitigated the fibrogenesis and hepatocellular injury in a rat model of CCl4-induced liver fibrosis. The anti-fibrinogenic effect was induced by attenuating hepatic stellate cell activation. Therefore, the administration of MSC-EVs could be considered as a candidate cell-free therapeutic strategy for liver fibrosis and hepatocellular damage.
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Affiliation(s)
- Dina M Rostom
- Department of Medical Histology and Cell Biology, Faculty of Medicine, University of Alexandria, Dr. Fahmi Abdelmeguid St., Mowassah Campus, Alexandria, 21561, Egypt
| | - Noha Attia
- Department of Medical Histology and Cell Biology, Faculty of Medicine, University of Alexandria, Dr. Fahmi Abdelmeguid St., Mowassah Campus, Alexandria, 21561, Egypt. .,Department of Basic Sciences, The American University of Antigua - College of Medicine, University Park, Jabberwock Beach Road, P.O. Box 1451, Coolidge, Antigua and Barbuda.
| | - Hoda M Khalifa
- Department of Medical Histology and Cell Biology, Faculty of Medicine, University of Alexandria, Dr. Fahmi Abdelmeguid St., Mowassah Campus, Alexandria, 21561, Egypt
| | - Maha W Abou Nazel
- Department of Medical Histology and Cell Biology, Faculty of Medicine, University of Alexandria, Dr. Fahmi Abdelmeguid St., Mowassah Campus, Alexandria, 21561, Egypt
| | - Eshrak A El Sabaawy
- Department of Medical Histology and Cell Biology, Faculty of Medicine, University of Alexandria, Dr. Fahmi Abdelmeguid St., Mowassah Campus, Alexandria, 21561, Egypt
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14
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Tompkins BA, Balkan W, Winkler J, Gyöngyösi M, Goliasch G, Fernández-Avilés F, Hare JM. Preclinical Studies of Stem Cell Therapy for Heart Disease. Circ Res 2019; 122:1006-1020. [PMID: 29599277 DOI: 10.1161/circresaha.117.312486] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
As part of the TACTICS (Transnational Alliance for Regenerative Therapies in Cardiovascular Syndromes) series to enhance regenerative medicine, here, we discuss the role of preclinical studies designed to advance stem cell therapies for cardiovascular disease. The quality of this research has improved over the past 10 to 15 years and overall indicates that cell therapy promotes cardiac repair. However, many issues remain, including inability to provide complete cardiac recovery. Recent studies question the need for intact cells suggesting that harnessing what the cells release is the solution. Our contribution describes important breakthroughs and current directions in a cell-based approach to alleviating cardiovascular disease.
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Affiliation(s)
- Bryon A Tompkins
- From the Interdisciplinary Stem Cell Institute (B.A.T., W.B., J.M.H.), Department of Surgery (B.A.T.), and Department of Medicine (W.B., J.M.H.), University of Miami Miller School of Medicine, FL; Department of Cardiology, Medical University of Vienna, Austria (J.W., M.G., G.G.); Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain (F.F.-A.); and CIBERCV, ISCIII, Madrid, Spain (F.F.-A.)
| | - Wayne Balkan
- From the Interdisciplinary Stem Cell Institute (B.A.T., W.B., J.M.H.), Department of Surgery (B.A.T.), and Department of Medicine (W.B., J.M.H.), University of Miami Miller School of Medicine, FL; Department of Cardiology, Medical University of Vienna, Austria (J.W., M.G., G.G.); Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain (F.F.-A.); and CIBERCV, ISCIII, Madrid, Spain (F.F.-A.)
| | - Johannes Winkler
- From the Interdisciplinary Stem Cell Institute (B.A.T., W.B., J.M.H.), Department of Surgery (B.A.T.), and Department of Medicine (W.B., J.M.H.), University of Miami Miller School of Medicine, FL; Department of Cardiology, Medical University of Vienna, Austria (J.W., M.G., G.G.); Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain (F.F.-A.); and CIBERCV, ISCIII, Madrid, Spain (F.F.-A.)
| | - Mariann Gyöngyösi
- From the Interdisciplinary Stem Cell Institute (B.A.T., W.B., J.M.H.), Department of Surgery (B.A.T.), and Department of Medicine (W.B., J.M.H.), University of Miami Miller School of Medicine, FL; Department of Cardiology, Medical University of Vienna, Austria (J.W., M.G., G.G.); Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain (F.F.-A.); and CIBERCV, ISCIII, Madrid, Spain (F.F.-A.)
| | - Georg Goliasch
- From the Interdisciplinary Stem Cell Institute (B.A.T., W.B., J.M.H.), Department of Surgery (B.A.T.), and Department of Medicine (W.B., J.M.H.), University of Miami Miller School of Medicine, FL; Department of Cardiology, Medical University of Vienna, Austria (J.W., M.G., G.G.); Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain (F.F.-A.); and CIBERCV, ISCIII, Madrid, Spain (F.F.-A.)
| | - Francisco Fernández-Avilés
- From the Interdisciplinary Stem Cell Institute (B.A.T., W.B., J.M.H.), Department of Surgery (B.A.T.), and Department of Medicine (W.B., J.M.H.), University of Miami Miller School of Medicine, FL; Department of Cardiology, Medical University of Vienna, Austria (J.W., M.G., G.G.); Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain (F.F.-A.); and CIBERCV, ISCIII, Madrid, Spain (F.F.-A.)
| | - Joshua M Hare
- From the Interdisciplinary Stem Cell Institute (B.A.T., W.B., J.M.H.), Department of Surgery (B.A.T.), and Department of Medicine (W.B., J.M.H.), University of Miami Miller School of Medicine, FL; Department of Cardiology, Medical University of Vienna, Austria (J.W., M.G., G.G.); Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain (F.F.-A.); and CIBERCV, ISCIII, Madrid, Spain (F.F.-A.).
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15
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Abstract
Advanced heart failure (HF) is a progressive disease characterized by recurrent hospitalizations and high risk of mortality. Indeed, outcomes in late stages of HF approximate those seen in patients with various aggressive malignancies. Clinical trials assessing beneficial outcomes of new treatments in patients with cancer have used innovative approaches to measure impact on total disease burden or surrogates to assess treatment efficacy. Although most cardiovascular outcomes trials continue to use time-to-first event analyses to assess the primary efficacy end point, such analyses do not adequately reflect the impact of new treatments on the totality of the chronic disease burden. Consequently, patient enrichment and other strategies for ongoing clinical trial design, as well as new statistical methodologies, are important considerations, particularly when studying a population with advanced chronic HF. The DREAM-HF trial (Double-Blind Randomized Assessment of Clinical Events With Allogeneic Mesenchymal Precursor Cells in Advanced Heart Failure) is an ongoing, randomized, sham-controlled phase 3 study of the efficacy and safety of mesenchymal precursor cells as immunotherapy in patients with advanced chronic HF with reduced ejection fraction. Mesenchymal precursor cells have a unique multimodal mechanism of action that is believed to result in polarization of proinflammatory type 1 macrophages in the heart to an anti-inflammatory type 2 macrophage state, inhibition of maladaptive adverse left ventricular remodeling, reversal of cardiac and peripheral endothelial dysfunction, and recovery of deranged vasculature. The objective of DREAM-HF is to confirm earlier phase 2 results and evaluate whether mesenchymal precursor cells will reduce the rate of nonfatal recurrent HF-related major adverse cardiac events while delaying or preventing progression of HF to terminal cardiac events. DREAM-HF is an example of an ongoing contemporary events-driven cardiovascular cell-based immunotherapy study that has utilized the concepts of baseline disease enrichment, prognostic enrichment, and predictive enrichment to improve its efficiency by using accumulating data from within as well as external to the trial. Adaptive enrichment designs and strategies are important components of a rational approach to achieve clinical research objectives in shorter clinical trial timelines and with increased cost-effectiveness without compromising ethical standards or the overall statistical integrity of the study. The DREAM-HF trial also presents an alternative approach to traditional composite time-to-first event primary efficacy end points. Statistical methodologies such as the joint frailty model provide opportunities to expand the scope of events-driven HF with reduced ejection fraction clinical trials to utilize time to recurrent nonfatal HF-related major adverse cardiac events as the primary efficacy end point without compromising the integrity of the statistical analyses for terminal cardiac events. In advanced chronic HF with reduced ejection fraction studies, the joint frailty model is utilized to reflect characteristics of the high-risk patient population with important unmet therapeutic needs. In some cases, use of the joint frailty model may substantially reduce sample size requirements. In addition, using an end point that is acceptable to the Food and Drug Administration and the European Medicines Agency, such as recurrent nonfatal HF-related major adverse cardiac events, enables generation of clinically relevant pharmacoeconomic data while providing comprehensive views of the patient's overall cardiovascular disease burden. The major goal of this review is to provide lessons learned from the ongoing DREAM-HF trial that relate to biologic plausibility and flexible clinical trial design and are potentially applicable to other development programs of innovative therapies for patients with advanced cardiovascular disease. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02032004.
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Affiliation(s)
| | | | - Barry Greenberg
- University of California, San Diego School of Medicine, La Jolla (B.G.)
- Advanced Heart Failure Treatment Program, Sulpizio Cardiovascular Center, University of California, San Diego Healthcare System, La Jolla (B.G.)
| | - Emerson C. Perin
- Stem Cell Center and Adult Cardiology, Texas Heart Institute, Houston (E.C.P.)
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16
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Gugjoo MB, Amarpal. Mesenchymal stem cell research in sheep: Current status and future prospects. Small Rumin Res 2018. [DOI: 10.1016/j.smallrumres.2018.08.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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17
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Vahabzadeh-Hagh AM, Goel AN, Frederick JW, Berke GS, Long JL. Transplanted human multipotent stromal cells reduce acute tongue fibrosis in rats. Laryngoscope Investig Otolaryngol 2018; 3:450-456. [PMID: 30599029 PMCID: PMC6302725 DOI: 10.1002/lio2.202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2018] [Indexed: 12/25/2022] Open
Abstract
Background Tongue fibrosis resulting from head and neck cancer, surgery, radiation, chemotherapy, or a combination thereof devastates one's quality of life. Therapeutic options are limited. Here we investigate human bone marrow-derived multipotent stromal cells (MSC) as a novel injectable treatment for post-injury tongue fibrosis. Methods MSCs were grown in culture. Eighteen athymic rats underwent unilateral partial glossectomy. After two weeks for scar formation, a single injection was performed in the tongue scar. Three treatment groups were studied: low and high concentration MSC, and control media injection. Tongues were harvested for evaluation at three weeks post-treatment. Results Dense fibrosis was achieved in control animals at five weeks. High concentration MSC reduced cross sectional scar burden (P = .007) and pathologic score for inflammation and fibrosis. Conclusion This study establishes the feasibility of a novel rodent tongue fibrosis model, and begins to assess the utility of human MSCs to reduce scar burden. Level of Evidence N/a.
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Affiliation(s)
| | - Alexander N Goel
- From the Department of Head and Neck Surgery, UCLA David Geffen School of Medicine Los Angeles California U.S.A
| | - John W Frederick
- From the Department of Head and Neck Surgery, UCLA David Geffen School of Medicine Los Angeles California U.S.A
| | - Gerald S Berke
- From the Department of Head and Neck Surgery, UCLA David Geffen School of Medicine Los Angeles California U.S.A
| | - Jennifer L Long
- From the Department of Head and Neck Surgery, UCLA David Geffen School of Medicine Los Angeles California U.S.A.,Research Service Greater Los Angeles VA Healthcare System Los Angeles California U.S.A
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18
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Luc JGY, Tchantchaleishvili V. Update on Stem Cell-Based Therapy and Mechanical Cardiac Support: A North American Perspective. Artif Organs 2018; 42:866-870. [PMID: 30328627 DOI: 10.1111/aor.13334] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 07/17/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Jessica G Y Luc
- Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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19
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Abstract
Frailty is a medical syndrome associated with advancing age characterized by reduced functional reserve, strength, endurance, and susceptibility to infection associated with high morbidity, hospitalization, and death. Nonspecific interventions to improve the healthspan of affected patients include physical therapy, exercise, improved nutrition, etc. Among the hallmarks of aging, depletion of stem cells with resultant compromise of regeneration and repair of tissues informs a rational stem cell-based replacement strategy. This hypothesis has been evaluated in a randomized, double-blind, placebo-controlled clinical trial utilizing human allogeneic mesenchymal stem cells (allo-hMSCs), a facile, scalable stem cell replacement therapy. Intravenous infusion of 100 or 200 million allo-hMSCs was deemed safe in aged frail individuals. However, modest improvement outcomes were limited to the lower dose, a finding that remains difficult to explain. Future studies are definitely warranted given the magnitude of this increasingly important medical syndrome.
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Affiliation(s)
- James W Larrick
- 1 Panorama Research Institute , Sunnyvale, California.,2 Regenerative Sciences Institute , Sunnyvale, California
| | - Andrew R Mendelsohn
- 1 Panorama Research Institute , Sunnyvale, California.,2 Regenerative Sciences Institute , Sunnyvale, California
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20
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Bolli R, Hare JM, Henry TD, Lenneman CG, March KL, Miller K, Pepine CJ, Perin EC, Traverse JH, Willerson JT, Yang PC, Gee AP, Lima JA, Moyé L, Vojvodic RW, Sayre SL, Bettencourt J, Cohen M, Ebert RF, Simari RD. Rationale and Design of the SENECA (StEm cell iNjECtion in cAncer survivors) Trial. Am Heart J 2018; 201:54-62. [PMID: 29910056 PMCID: PMC7282462 DOI: 10.1016/j.ahj.2018.02.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 02/07/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVES SENECA (StEm cell iNjECtion in cAncer survivors) is a phase I, randomized, double-blind, placebo-controlled study to evaluate the safety and feasibility of delivering allogeneic mesenchymal stromal cells (allo-MSCs) transendocardially in subjects with anthracycline-induced cardiomyopathy (AIC). BACKGROUND AIC is an incurable and often fatal syndrome, with a prognosis worse than that of ischemic or nonischemic cardiomyopathy. Recently, cell therapy with MSCs has emerged as a promising new approach to repair damaged myocardium. METHODS The study population is 36 cancer survivors with a diagnosis of AIC, left ventricular (LV) ejection fraction ≤40%, and symptoms of heart failure (NYHA class II-III) on optimally-tolerated medical therapy. Subjects must be clinically free of cancer for at least two years with a ≤ 30% estimated five-year risk of recurrence. The first six subjects participated in an open-label, lead-in phase and received 100 million allo-MSCs; the remaining 30 will be randomized 1:1 to receive allo-MSCs or vehicle via 20 transendocardial injections. Efficacy measures (obtained at baseline, 6 months, and 12 months) include MRI evaluation of LV function, LV volumes, fibrosis, and scar burden; assessment of exercise tolerance (six-minute walk test) and quality of life (Minnesota Living with Heart Failure Questionnaire); clinical outcomes (MACE and cumulative days alive and out of hospital); and biomarkers of heart failure (NT-proBNP). CONCLUSIONS This is the first clinical trial using direct cardiac injection of cells for the treatment of AIC. If administration of allo-MSCs is found feasible and safe, SENECA will pave the way for larger phase II/III studies with therapeutic efficacy as the primary outcome.
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Affiliation(s)
| | - Joshua M Hare
- University of Miami Miller School of Medicine, Miami, Florida
| | | | | | - Keith L March
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Kathy Miller
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Carl J Pepine
- University of Florida School of Medicine, Gainesville, Florida
| | | | - Jay H Traverse
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN
| | | | - Phillip C Yang
- Stanford University School of Medicine, Stanford, California
| | | | | | - Lem Moyé
- UT Health School of Public Health, Houston, TX.
| | | | | | | | | | - Ray F Ebert
- NIH, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Robert D Simari
- University of Kansas School of Medicine, Kansas City, Kansas
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21
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Systemically administered allogeneic mesenchymal stem cells do not aggravate the progression of precancerous lesions: a new biosafety insight. Stem Cell Res Ther 2018; 9:137. [PMID: 29751770 PMCID: PMC5948822 DOI: 10.1186/s13287-018-0878-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 12/12/2022] Open
Abstract
Background Mesenchymal stem cells (MSCs) are a heterogeneous subset of stromal cells currently tested for multiple therapeutic purposes. Their potential to home into tumors, to secrete trophic/vasculogenic factors, and to suppress immune response raises questions regarding their biosafety. Our aim was to evaluate whether systemically administered allogeneic MSCs modify the natural progression of precancerous lesions and whether their putative effect depends on cancer stage and/or cell dose. Methods Oral squamous cell carcinoma (OSCC) was induced in Syrian golden hamsters by topical application of 7,12-dimethylbenz[a]anthracene in one buccal pouch. At hyperplasia, dysplasia, or papilloma stage, animals received intracardially the vehicle or 0.7 × 106, 7 × 106, or 21 × 106 allogeneic bone marrow-derived MSCs/kg. OSCC progression was assessed according to the presence of erythroplakia and leukoplakia, extent of inflammation and vascularization, and appearance, volume, and staging of tumors. Also, the homing of donor cells was studied. Results Precancerous lesions progressed from hyperplasia to dysplasia in 2 weeks, from dysplasia to papilloma in 3 weeks, and from papilloma to carcinoma in 4 weeks. This time course was unmodified by the systemic administration of MSCs at hyperplasia or dysplasia stages. When MSCs were administered at papilloma stage, lesions did not progress to carcinoma stage. Tumors developed in hamsters receiving 0.7 × 106 or 7 × 106 MSCs/kg at hyperplasia stage were significantly smaller than those found in control animals (25 ± 4 or 23 ± 4 mm3 versus 72 ± 19 mm3, p < 0.05). Similar results were obtained when 0.7 × 106, 7 × 106, or 21 × 106 MSCs/kg were administered at papilloma stage (44 ± 15, 28 ± 7, or 28 ± 5 mm3 versus 104 ± 26 mm3, p < 0.05). For dysplasia stage, only the lower concentration of MSCs reached statistical significance (21 ± 9 mm3 versus 94 ± 39 mm3, p < 0.05). Animals receiving 21 × 106 MSCs/kg at hyperplasia stage developed tumors larger than those found in animals that received the vehicle (147 ± 47 mm3 versus 72 ± 19 mm3, p < 0.05). Donor cells were rarely found in precancerous lesions. Conclusions Systemically administered allogeneic MSCs do not aggravate the progression of precancerous lesions. Moreover, they preclude cancer progression and tumor growth. Electronic supplementary material The online version of this article (10.1186/s13287-018-0878-1) contains supplementary material, which is available to authorized users.
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22
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Washington EA, Barber SR, Murray CM, Davies HMS, Kimpton WG, Yen HH. Lymphatic cannulation models in sheep: Recent advances for immunological and biomedical research. J Immunol Methods 2018; 457:6-14. [PMID: 29625076 DOI: 10.1016/j.jim.2018.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/22/2018] [Accepted: 03/27/2018] [Indexed: 10/17/2022]
Abstract
Lymphatic cannulation models are useful tools for studying the immunobiology of the lymphatic system and the immunopathology of specific tissues in diseases. Sheep cannulations have been used extensively, as models for human physiology, fetal and neonatal development, human diseases, and for studies of ruminant pathobiology. The development of new and improved cannulation techniques in recent years has meant that difficult to access sites, such as mucosal associated tissues, are now more readily available to researchers. This review highlights the new approaches to cannulation and how these, in combination with advanced omics technologies, will direct future research using the sheep model.
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Affiliation(s)
- Elizabeth A Washington
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Stuart R Barber
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Christina M Murray
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Helen M S Davies
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Wayne G Kimpton
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Hung-Hsun Yen
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria 3010, Australia..
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23
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Harrison RP, Medcalf N, Rafiq QA. Cell therapy-processing economics: small-scale microfactories as a stepping stone toward large-scale macrofactories. Regen Med 2018; 13:159-173. [PMID: 29509065 DOI: 10.2217/rme-2017-0103] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
AIM Manufacturing methods for cell-based therapies differ markedly from those established for noncellular pharmaceuticals and biologics. Attempts to 'shoehorn' these into existing frameworks have yielded poor outcomes. Some excellent clinical results have been realized, yet emergence of a 'blockbuster' cell-based therapy has so far proved elusive. MATERIALS & METHODS The pressure to provide these innovative therapies, even at a smaller scale, remains. In this process, economics research paper, we utilize cell expansion research data combined with operational cost modeling in a case study to demonstrate the alternative ways in which a novel mesenchymal stem cell-based therapy could be provided at small scale. RESULTS & CONCLUSIONS This research outlines the feasibility of cell microfactories but highlighted that there is a strong pressure to automate processes and split the quality control cost-burden over larger production batches. The study explores one potential paradigm of cell-based therapy provisioning as a potential exemplar on which to base manufacturing strategy.
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Affiliation(s)
- Richard P Harrison
- Centre for Biological Engineering, Holywell Park, Loughborough University, Loughborough, LE11 3TU, UK.,Wolfson Centre for Stem cells, Tissue Engineering & Modelling (STEM), The University of Nottingham, Centre for Biomolecular Sciences, University Park, Nottingham, NG7 2RD, UK.,Department for Biochemical Engineering, School of Life & Health Sciences, Aston University, Aston Triangle, Birmingham, B4 7ET, UK
| | - Nicholas Medcalf
- Centre for Biological Engineering, Holywell Park, Loughborough University, Loughborough, LE11 3TU, UK
| | - Qasim A Rafiq
- Department of Biochemical Engineering, Faculty of Engineering Science, University College London, Gower Street, London, WC1E 6BT, UK.,Department for Biochemical Engineering, School of Life & Health Sciences, Aston University, Aston Triangle, Birmingham, B4 7ET, UK
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24
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Wijnand JGJ, Teraa M, Gremmels H, van Rhijn-Brouwer FCC, de Borst GJ, Verhaar MC. Rationale and design of the SAIL trial for intramuscular injection of allogeneic mesenchymal stromal cells in no-option critical limb ischemia. J Vasc Surg 2017; 67:656-661. [PMID: 29242062 DOI: 10.1016/j.jvs.2017.09.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 09/30/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Critical limb ischemia (CLI) represents the most severe form of peripheral artery disease and has an immense impact on quality of life, morbidity, and mortality. A considerable proportion of CLI patients are ineligible for revascularization, leaving amputation as the only option. Mesenchymal stromal cells (MSCs), because of their vasculoregenerative and immunomodulatory characteristics, have emerged as a potential new treatment. METHODS The primary objective of this trial is to investigate whether intramuscular administration of allogeneic bone marrow (BM)-derived MSCs is safe and potentially effective. The SAIL (allogeneic mesenchymal Stromal cells for Angiogenesis and neovascularization in no-option Ischemic Limbs) trial is a double-blind, placebo-controlled randomized clinical trial to investigate the effect of allogeneic BM-MSCs in patients with CLI who are not eligible for conventional revascularization. A total of 66 patients will be included and randomized (1:1) to undergo 30 intramuscular injections with either BM-MSCs (5 × 106 MSCs per injection) or placebo in the ischemic lower extremity. Primary outcome, that is, therapy success, a composite outcome consisting of mortality, limb status, clinical status, and changes in pain score, will be assessed at 6 months. All study-related procedures will take place in the University Medical Center Utrecht in The Netherlands. CONCLUSIONS If our results indicate that intramuscular allogeneic BM-MSC therapy for CLI is safe and potentially effective, this will have important consequences for treatment of patients with CLI. A large multicenter clinical trial with longer follow-up focusing on hard end points should then be initiated to confirm these findings.
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Affiliation(s)
- Joep G J Wijnand
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martin Teraa
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hendrik Gremmels
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands.
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25
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Tompkins BA, DiFede DL, Khan A, Landin AM, Schulman IH, Pujol MV, Heldman AW, Miki R, Goldschmidt-Clermont PJ, Goldstein BJ, Mushtaq M, Levis-Dusseau S, Byrnes JJ, Lowery M, Natsumeda M, Delgado C, Saltzman R, Vidro-Casiano M, Da Fonseca M, Golpanian S, Premer C, Medina A, Valasaki K, Florea V, Anderson E, El-Khorazaty J, Mendizabal A, Green G, Oliva AA, Hare JM. Allogeneic Mesenchymal Stem Cells Ameliorate Aging Frailty: A Phase II Randomized, Double-Blind, Placebo-Controlled Clinical Trial. J Gerontol A Biol Sci Med Sci 2017; 72:1513-1522. [PMID: 28977399 PMCID: PMC5861900 DOI: 10.1093/gerona/glx137] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 07/17/2017] [Indexed: 12/31/2022] Open
Abstract
Background Aging frailty, characterized by decreased physical and immunological functioning, is associated with stem cell depletion. Human allogeneic mesenchymal stem cells (allo-hMSCs) exert immunomodulatory effects and promote tissue repair. Methods This is a randomized, double-blinded, dose-finding study of intravenous allo-hMSCs (100 or 200-million [M]) vs placebo delivered to patients (n = 30, mean age 75.5 ± 7.3) with frailty. The primary endpoint was incidence of treatment-emergent serious adverse events (TE-SAEs) at 1-month postinfusion. Secondary endpoints included physical performance, patient-reported outcomes, and immune markers of frailty measured at 6 months postinfusion. Results No therapy-related TE-SAEs occurred at 1 month. Physical performance improved preferentially in the 100M-group; immunologic improvement occurred in both the 100M- and 200M-groups. The 6-minute walk test, short physical performance exam, and forced expiratory volume in 1 second improved in the 100M-group (p = .01), not in the 200M- or placebo groups. The female sexual quality of life questionnaire improved in the 100M-group (p = .03). Serum TNF-α levels decreased in the 100M-group (p = .03). B cell intracellular TNF-α improved in both the 100M- (p < .0001) and 200M-groups (p = .002) as well as between groups compared to placebo (p = .003 and p = .039, respectively). Early and late activated T-cells were also reduced by MSC therapy. Conclusion Intravenous allo-hMSCs were safe in individuals with aging frailty. Treated groups had remarkable improvements in physical performance measures and inflammatory biomarkers, both of which characterize the frailty syndrome. Given the excellent safety and efficacy profiles demonstrated in this study, larger clinical trials are warranted to establish the efficacy of hMSCs in this multisystem disorder. Clinical Trial Registration www.clinicaltrials.gov: CRATUS (#NCT02065245).
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Affiliation(s)
- Bryon A Tompkins
- The Interdisciplinary Stem Cell Institute.,Department of Surgery
| | - Darcy L DiFede
- The Interdisciplinary Stem Cell Institute.,Longeveron LLC, Miami, Florida
| | - Aisha Khan
- The Interdisciplinary Stem Cell Institute
| | | | - Ivonne Hernandez Schulman
- The Interdisciplinary Stem Cell Institute.,Department of Medicine, University of Miami Miller School of Medicine, Florida
| | | | | | - Roberto Miki
- Department of Medicine, University of Miami Miller School of Medicine, Florida
| | | | | | - Muzammil Mushtaq
- Department of Medicine, University of Miami Miller School of Medicine, Florida
| | | | - John J Byrnes
- Department of Medicine, University of Miami Miller School of Medicine, Florida
| | - Maureen Lowery
- Department of Medicine, University of Miami Miller School of Medicine, Florida
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Joshua M Hare
- The Interdisciplinary Stem Cell Institute.,Department of Medicine, University of Miami Miller School of Medicine, Florida
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26
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Florea V, Rieger AC, DiFede DL, El-Khorazaty J, Natsumeda M, Banerjee MN, Tompkins BA, Khan A, Schulman IH, Landin AM, Mushtaq M, Golpanian S, Lowery MH, Byrnes JJ, Hendel RC, Cohen MG, Valasaki K, Pujol MV, Ghersin E, Miki R, Delgado C, Abuzeid F, Vidro-Casiano M, Saltzman RG, DaFonseca D, Caceres LV, Ramdas KN, Mendizabal A, Heldman AW, Mitrani RD, Hare JM. Dose Comparison Study of Allogeneic Mesenchymal Stem Cells in Patients With Ischemic Cardiomyopathy (The TRIDENT Study). Circ Res 2017; 121:1279-1290. [PMID: 28923793 DOI: 10.1161/circresaha.117.311827] [Citation(s) in RCA: 137] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 09/12/2017] [Accepted: 09/14/2017] [Indexed: 12/31/2022]
Abstract
RATIONALE Cell dose and concentration play crucial roles in phenotypic responses to cell-based therapy for heart failure. OBJECTIVE To compare the safety and efficacy of 2 doses of allogeneic bone marrow-derived human mesenchymal stem cells identically delivered in patients with ischemic cardiomyopathy. METHODS AND RESULTS Thirty patients with ischemic cardiomyopathy received in a blinded manner either 20 million (n=15) or 100 million (n=15) allogeneic human mesenchymal stem cells via transendocardial injection (0.5 cc per injection × 10 injections per patient). Patients were followed for 12 months for safety and efficacy end points. There were no treatment-emergent serious adverse events at 30 days or treatment-related serious adverse events at 12 months. The Major Adverse Cardiac Event rate was 20.0% (95% confidence interval [CI], 6.9% to 50.0%) in 20 million and 13.3% (95% CI, 3.5% to 43.6%) in 100 million (P=0.58). Worsening heart failure rehospitalization was 20.0% (95% CI, 6.9% to 50.0%) in 20 million and 7.1% (95% CI, 1.0% to 40.9%) in 100 million (P=0.27). Whereas scar size reduced to a similar degree in both groups: 20 million by -6.4 g (interquartile range, -13.5 to -3.4 g; P=0.001) and 100 million by -6.1 g (interquartile range, -8.1 to -4.6 g; P=0.0002), the ejection fraction improved only with 100 million by 3.7 U (interquartile range, 1.1 to 6.1; P=0.04). New York Heart Association class improved at 12 months in 35.7% (95% CI, 12.7% to 64.9%) in 20 million and 42.9% (95% CI, 17.7% to 71.1%) in 100 million. Importantly, proBNP (pro-brain natriuretic peptide) increased at 12 months in 20 million by 0.32 log pg/mL (95% CI, 0.02 to 0.62; P=0.039), but not in 100 million (-0.07 log pg/mL; 95% CI, -0.36 to 0.23; P=0.65; between group P=0.07). CONCLUSIONS Although both cell doses reduced scar size, only the 100 million dose increased ejection fraction. This study highlights the crucial role of cell dose in the responses to cell therapy. Determining optimal dose and delivery is essential to advance the field, decipher mechanism(s) of action and enhance planning of pivotal Phase III trials. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT02013674.
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Affiliation(s)
- Victoria Florea
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Angela C Rieger
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Darcy L DiFede
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Jill El-Khorazaty
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Makoto Natsumeda
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Monisha N Banerjee
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Bryon A Tompkins
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Aisha Khan
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Ivonne H Schulman
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Ana Marie Landin
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Muzammil Mushtaq
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Samuel Golpanian
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Maureen H Lowery
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - John J Byrnes
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Robert C Hendel
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Mauricio G Cohen
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Krystalenia Valasaki
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Marietsy V Pujol
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Eduard Ghersin
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Roberto Miki
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Cindy Delgado
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Fouad Abuzeid
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Mayra Vidro-Casiano
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Russell G Saltzman
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Daniel DaFonseca
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Lina V Caceres
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Kevin N Ramdas
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Adam Mendizabal
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Alan W Heldman
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Raul D Mitrani
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Joshua M Hare
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.).
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Wobma HM, Liu D, Vunjak-Novakovic G. Paracrine Effects of Mesenchymal Stromal Cells Cultured in Three-Dimensional Settings on Tissue Repair. ACS Biomater Sci Eng 2017; 4:1162-1175. [PMID: 33418654 DOI: 10.1021/acsbiomaterials.7b00005] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Mesenchymal stromal cells (MSCs) are a promising cell source for promoting tissue repair, due to their ability to release growth, angiogenic, and immunomodulatory factors. However, when injected as a suspension, these cells suffer from poor survival and localization, and suboptimal release of paracrine factors. While there have been attempts to overcome these limitations by modifying MSCs themselves, a more versatile solution is to grow them in three dimensions, as aggregates or embedded into biomaterials. Here we review the mechanisms by which 3D culture can influence the regenerative capacity of undifferentiated MSCs, focusing on recent examples from the literature. We further discuss how knowledge of these mechanisms can lead to strategic design of MSC therapies that overcome some of the challenges to their effective translation.
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Ryska O, Serclova Z, Mestak O, Matouskova E, Vesely P, Mrazova I. Local application of adipose-derived mesenchymal stem cells supports the healing of fistula: prospective randomised study on rat model of fistulising Crohn's disease. Scand J Gastroenterol 2017; 52:543-550. [PMID: 28116942 DOI: 10.1080/00365521.2017.1281434] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Local application of adipose-derived mesenchymal stem cells (ADSC) represents a novel approach for the management of perianal fistula in patients with Crohn's disease. A randomised study on an animal model was performed to investigate the efficacy and to detect the distribution of implanted ADSCs by bioluminescence (BLI). MATERIALS AND METHODS A caecostomy was used as a fistula model in 32 Lewis rats. The ADSCs were isolated from transgenic donor expressing firefly luciferase. Animals were randomly assigned to groups given injections of 4 × 106 cells (n = 16, group A) or placebo (n = 16, group B) in the perifistular tissue. Fistula drainage assessment was used to evaluate the fistula healing. After application of D-luciferin, cell viability and distribution was detected using an IVIS Lumina XR camera on days 0, 2, 7, 14 and 30. RESULTS The fistula was identified as healed in 6 (38%) animals in group A vs. 1 case (6.3%) in group B (p = .033). The BLI was strongest immediately after administration of ADSCs 31.2 × 104 (6.09-111 × 104) p/s/cm2/sr. The fastest decrease was observed within the first 2 days when values fell by 50.2%. The BLI 30 days after injection was significantly higher in animals with healed fistulas - 8.23 × 104 (1.18-16.9 × 104) vs. 1.74 × 104 (0.156-6.88 × 104); p = .0393. CONCLUSIONS Local application of ADSCs resulted in significantly higher fistula closure rate on an animal model. BLI monitoring was proved to be feasible and showed rapid reduction of the ADSC mass after application. More viable cells were detected in animals with healed fistula at the end of the follow-up.
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Affiliation(s)
- Ondrej Ryska
- a Institute of Animal Physiology and Genetics, Czech Academy of Science, Libechov , Czech Republic.,b Department of Surgery, Royal Lancaster Infirmary , University Hospitals of Morecambe Bay NHS Foundation Trust , Lancaster , UK
| | - Zuzana Serclova
- c Department of Surgery , Horovice Hospital , Horovice , Czech Republic
| | - Ondrej Mestak
- d Department of Plastic Surgery , Hospital Bulovka , Prague , Czech Republic
| | - Eva Matouskova
- e Department of Burns Medicine , Third Faculty of Medicine Charles University , Prague , Czech Republic
| | - Pavel Vesely
- d Department of Plastic Surgery , Hospital Bulovka , Prague , Czech Republic
| | - Iveta Mrazova
- f Centre of Experimental Medicine, Institute for Clinical and Experimental Medicine , Prague , Czech Republic
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Cao Y, Ding Z, Han C, Shi H, Cui L, Lin R. Efficacy of Mesenchymal Stromal Cells for Fistula Treatment of Crohn's Disease: A Systematic Review and Meta-Analysis. Dig Dis Sci 2017; 62:851-860. [PMID: 28168575 DOI: 10.1007/s10620-017-4453-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 01/10/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM The introduction of mesenchymal stromal cells (MSCs) has changed the management of Crohn's fistula, while it remains controversial. The aim of this study was to provide an overview of efficacy and optimum state of MSCs treatment on Crohn's fistula. METHODS Studies reporting MSCs treatment on Crohn's fistula were searched and included. A fixed-effects model was used to assess the efficacy of MSCs, and outcomes of healing and recurrence were used to evaluate the best states of MSCs intervention. RESULTS Fourteen articles were enrolled (n = 477). Pooled analysis showed MSCs had a significant efficacy compared to other treatments [risk difference: 0.21 (0.09, 0.32), P = 0.000]. Notably, after MSCs treatment, the group of Crohn's disease activity index (CDAI) baseline >150 group had a higher healing rate (HR) and a clinical response (a change in CDAI of >50 points) (79.17 ± 8.78 vs. 47.54 ± 15.90, P = 0.011) compared to CDAI baseline of <150. The duration time of CD and fistulas had a negative correlation with HR accompanied by MSC therapy (r = -0.900, -0.925). Then, a moderate dose MSCs (2-4 × 107 cells/ml) had a higher HR (80.07%) and lower recurrence rate (RR 13.98%) compared to other dosages. Moreover, adipose-derived MSCs therapy had an advantage over bone marrow-derived MSCs in terms of low RR (7.4 ± 4.28 vs. 13.39 ± 0.89). CONCLUSIONS The evidence supported the effect of MSCs at a more appropriate time of Crohn's fistula. And CDAI baseline (the points >150) has been a candidate for evaluating effectiveness of MSCs application on Crohn's fistula.
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Affiliation(s)
- Yantian Cao
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei Province, China
| | - Zhen Ding
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei Province, China
| | - Chaoqun Han
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei Province, China
| | - Huiying Shi
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei Province, China
| | - Lianlian Cui
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei Province, China
| | - Rong Lin
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei Province, China.
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Mitochondrial transplantation: From animal models to clinical use in humans. Mitochondrion 2017; 34:127-134. [PMID: 28342934 DOI: 10.1016/j.mito.2017.03.004] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/06/2017] [Accepted: 03/16/2017] [Indexed: 12/21/2022]
Abstract
Mitochondrial transplantation is a novel therapeutic intervention to treat ischemia/reperfusion related disorders. The method for mitochondrial transplantation is simple and rapid and can be delivered to the end organ either by direct injection or vascular infusion. In this review, we provide mechanistic and histological studies in large animal models and present data to show clinical efficacy in human patients.
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Fitter S, Gronthos S, Ooi SS, Zannettino AC. The Mesenchymal Precursor Cell Marker Antibody STRO-1 Binds to Cell Surface Heat Shock Cognate 70. Stem Cells 2017; 35:940-951. [DOI: 10.1002/stem.2560] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/25/2016] [Accepted: 12/02/2016] [Indexed: 01/07/2023]
Affiliation(s)
- Stephen Fitter
- Myeloma Research Laboratory, Faculty of Health and Medical Science, Adelaide Medical School
- Cancer Theme, South Australian Health and Medical Research Institute; Adelaide South Australia Australia
| | - Stan Gronthos
- Mesenchymal Stem Cell Laboratory, Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide; Adelaide South Australia Australia
- Cancer Theme, South Australian Health and Medical Research Institute; Adelaide South Australia Australia
| | - Soo Siang Ooi
- Myeloma Research Laboratory, Faculty of Health and Medical Science, Adelaide Medical School
- Cancer Theme, South Australian Health and Medical Research Institute; Adelaide South Australia Australia
| | - Andrew C.W. Zannettino
- Myeloma Research Laboratory, Faculty of Health and Medical Science, Adelaide Medical School
- Cancer Theme, South Australian Health and Medical Research Institute; Adelaide South Australia Australia
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Psaltis PJ, Schwarz N, Toledo-Flores D, Nicholls SJ. Cellular Therapy for Heart Failure. Curr Cardiol Rev 2016; 12:195-215. [PMID: 27280304 PMCID: PMC5011188 DOI: 10.2174/1573403x12666160606121858] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 12/18/2015] [Accepted: 12/31/1969] [Indexed: 12/12/2022] Open
Abstract
The pathogenesis of cardiomyopathy and heart failure (HF) is underpinned by complex changes at subcellular, cellular and extracellular levels in the ventricular myocardium. For all of the gains that conventional treatments for HF have brought to mortality and morbidity, they do not adequately address the loss of cardiomyocyte numbers in the remodeling ventricle. Originally conceived to address this problem, cellular transplantation for HF has already gone through several stages of evolution over the past two decades. Various cell types and delivery routes have been implemented to positive effect in preclinical models of ischemic and nonischemic cardiomyopathy, with pleiotropic benefits observed in terms of myocardial remodeling, systolic and diastolic performance, perfusion, fibrosis, inflammation, metabolism and electrophysiology. To a large extent, these salubrious effects are now attributed to the indirect, paracrine capacity of transplanted stem cells to facilitate endogenous cardiac repair processes. Promising results have also followed in early phase human studies, although these have been relatively modest and somewhat inconsistent. This review details the preclinical and clinical evidence currently available regarding the use of pluripotent stem cells and adult-derived progenitor cells for cardiomyopathy and HF. It outlines the important lessons that have been learned to this point in time, and balances the promise of this exciting field against the key challenges and questions that still need to be addressed at all levels of research, to ensure that cell therapy realizes its full potential by adding to the armamentarium of HF management.
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Affiliation(s)
- Peter J Psaltis
- Co-Director of Vascular Research Centre, Heart Health Theme, South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia, Australia 5000.
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Mo M, Wang S, Zhou Y, Li H, Wu Y. Mesenchymal stem cell subpopulations: phenotype, property and therapeutic potential. Cell Mol Life Sci 2016; 73:3311-21. [PMID: 27141940 PMCID: PMC11108490 DOI: 10.1007/s00018-016-2229-7] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/16/2016] [Accepted: 04/14/2016] [Indexed: 12/11/2022]
Abstract
Mesenchymal stem cells (MSC) are capable of differentiating into cells of multiple cell lineages and have potent paracrine effects. Due to their easy preparation and low immunogenicity, MSC have emerged as an extremely promising therapeutic agent in regenerative medicine for diverse diseases. However, MSC are heterogeneous with respect to phenotype and function in current isolation and cultivation regimes, which often lead to incomparable experimental results. In addition, there may be specific stem cell subpopulations with definite differentiation capacity toward certain lineages in addition to stem cells with multi-differentiation potential. Recent studies have identified several subsets of MSC which exhibit distinct features and biological activities, and enhanced therapeutic potentials for certain diseases. In this review, we give an overview of these subsets for their phenotypic, biological and functional properties.
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Affiliation(s)
- Miaohua Mo
- School of Life Sciences, Tsinghua University, Beijing, China
- The Shenzhen Key Laboratory of Health Sciences and Technology, Graduate School at Shenzhen, Tsinghua University, L406A, Tsinghua Campus, The University Town, Shenzhen, China
| | - Shan Wang
- School of Life Sciences, Tsinghua University, Beijing, China
- The Shenzhen Key Laboratory of Health Sciences and Technology, Graduate School at Shenzhen, Tsinghua University, L406A, Tsinghua Campus, The University Town, Shenzhen, China
| | - Ying Zhou
- School of Life Sciences, Tsinghua University, Beijing, China
- The Shenzhen Key Laboratory of Health Sciences and Technology, Graduate School at Shenzhen, Tsinghua University, L406A, Tsinghua Campus, The University Town, Shenzhen, China
| | - Hong Li
- Department of General Surgery, Qingdao Municipal Hospital, 5 Donghai M Rd, Qingdao, China.
| | - Yaojiong Wu
- The Shenzhen Key Laboratory of Health Sciences and Technology, Graduate School at Shenzhen, Tsinghua University, L406A, Tsinghua Campus, The University Town, Shenzhen, China.
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Westerdahl DE, Chang DH, Hamilton MA, Nakamura M, Henry TD. Allogeneic mesenchymal precursor cells (MPCs): an innovative approach to treating advanced heart failure. Expert Opin Biol Ther 2016; 16:1163-9. [DOI: 10.1080/14712598.2016.1206526] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Hnatiuk AP, Ong SG, Olea FD, Locatelli P, Riegler J, Lee WH, Jen CH, De Lorenzi A, Giménez CS, Laguens R, Wu JC, Crottogini A. Allogeneic Mesenchymal Stromal Cells Overexpressing Mutant Human Hypoxia-Inducible Factor 1-α (HIF1-α) in an Ovine Model of Acute Myocardial Infarction. J Am Heart Assoc 2016; 5:JAHA.116.003714. [PMID: 27385426 PMCID: PMC5015403 DOI: 10.1161/jaha.116.003714] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Bone marrow mesenchymal stromal cells (BMMSCs) are cardioprotective in acute myocardial infarction (AMI) because of release of paracrine angiogenic and prosurvival factors. Hypoxia‐inducible factor 1‐α (HIF1‐α), rapidly degraded during normoxia, is stabilized during ischemia and upregulates various cardioprotective genes. We hypothesized that BMMSCs engineered to overexpress mutant, oxygen‐resistant HIF1‐α would confer greater cardioprotection than nontransfected BMMSCs in sheep with AMI. Methods and Results Allogeneic BMMSCs transfected with a minicircle vector encoding mutant HIF1‐α (BMMSC‐HIF) were injected in the peri‐infarct of sheep (n=6) undergoing coronary occlusion. Over 2 months, infarct volume measured by cardiac magnetic resonance (CMR) imaging decreased by 71.7±1.3% (P<0.001), and left ventricular (LV) percent ejection fraction (%EF) increased near 2‐fold (P<0.001) in the presence of markedly decreased end‐systolic volume. Sheep receiving nontransfected BMMSCs (BMMSC; n=6) displayed less infarct size limitation and percent LVEF improvement, whereas in placebo‐treated animals (n=6), neither parameters changed over time. HIF1‐α‐transfected BMMSCs (BMMSC‐HIF) induced angio‐/arteriogenesis and decreased apoptosis by HIF1‐mediated overexpression of erythropoietin, inducible nitrous oxide synthase, vascular endothelial growth factor, and angiopoietin‐1. Cell tracking using paramagnetic iron nanoparticles in 12 additional sheep revealed enhanced long‐term retention of BMMSC‐HIF. Conclusions Intramyocardial delivery of BMMSC‐HIF reduced infarct size and improved LV systolic performance compared to BMMSC, attributed to increased neovascularization and cardioprotective effects induced by HIF1‐mediated overexpression of paracrine factors and enhanced retention of injected cells. Given the safety of the minicircle vector and the feasibility of BMMSCs for allogeneic application, this treatment may be potentially useful in the clinic.
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Affiliation(s)
- Anna P Hnatiuk
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMETTYB), Universidad Favaloro-CONICET, Buenos Aires, Argentina Departamento de Fisiología, Facultad de Ciencias Médicas, Universidad Favaloro, Buenos Aires, Argentina
| | - Sang-Ging Ong
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Fernanda D Olea
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMETTYB), Universidad Favaloro-CONICET, Buenos Aires, Argentina Departamento de Fisiología, Facultad de Ciencias Médicas, Universidad Favaloro, Buenos Aires, Argentina
| | - Paola Locatelli
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMETTYB), Universidad Favaloro-CONICET, Buenos Aires, Argentina Departamento de Fisiología, Facultad de Ciencias Médicas, Universidad Favaloro, Buenos Aires, Argentina
| | - Johannes Riegler
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Won Hee Lee
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | | | - Andrea De Lorenzi
- Departmento de Cardiología, Hospital Universitario de la Foundación Favaloro, Buenos Aires, Argentina
| | - Carlos S Giménez
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMETTYB), Universidad Favaloro-CONICET, Buenos Aires, Argentina Departamento de Fisiología, Facultad de Ciencias Médicas, Universidad Favaloro, Buenos Aires, Argentina
| | - Rubén Laguens
- Departmento de Patología, Facultad de Ciencias Médicas, Universidad Favaloro, Buenos Aires, Argentina
| | - Joseph C Wu
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Alberto Crottogini
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMETTYB), Universidad Favaloro-CONICET, Buenos Aires, Argentina Departamento de Fisiología, Facultad de Ciencias Médicas, Universidad Favaloro, Buenos Aires, Argentina
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Golpanian S, Wolf A, Hatzistergos KE, Hare JM. Rebuilding the Damaged Heart: Mesenchymal Stem Cells, Cell-Based Therapy, and Engineered Heart Tissue. Physiol Rev 2016; 96:1127-68. [PMID: 27335447 PMCID: PMC6345247 DOI: 10.1152/physrev.00019.2015] [Citation(s) in RCA: 221] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Mesenchymal stem cells (MSCs) are broadly distributed cells that retain postnatal capacity for self-renewal and multilineage differentiation. MSCs evade immune detection, secrete an array of anti-inflammatory and anti-fibrotic mediators, and very importantly activate resident precursors. These properties form the basis for the strategy of clinical application of cell-based therapeutics for inflammatory and fibrotic conditions. In cardiovascular medicine, administration of autologous or allogeneic MSCs in patients with ischemic and nonischemic cardiomyopathy holds significant promise. Numerous preclinical studies of ischemic and nonischemic cardiomyopathy employing MSC-based therapy have demonstrated that the properties of reducing fibrosis, stimulating angiogenesis, and cardiomyogenesis have led to improvements in the structure and function of remodeled ventricles. Further attempts have been made to augment MSCs' effects through genetic modification and cell preconditioning. Progression of MSC therapy to early clinical trials has supported their role in improving cardiac structure and function, functional capacity, and patient quality of life. Emerging data have supported larger clinical trials that have been either completed or are currently underway. Mechanistically, MSC therapy is thought to benefit the heart by stimulating innate anti-fibrotic and regenerative responses. The mechanisms of action involve paracrine signaling, cell-cell interactions, and fusion with resident cells. Trans-differentiation of MSCs to bona fide cardiomyocytes and coronary vessels is also thought to occur, although at a nonphysiological level. Recently, MSC-based tissue engineering for cardiovascular disease has been examined with quite encouraging results. This review discusses MSCs from their basic biological characteristics to their role as a promising therapeutic strategy for clinical cardiovascular disease.
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Affiliation(s)
- Samuel Golpanian
- Interdisciplinary Stem Cell Institute, Department of Medicine, and Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Ariel Wolf
- Interdisciplinary Stem Cell Institute, Department of Medicine, and Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Konstantinos E Hatzistergos
- Interdisciplinary Stem Cell Institute, Department of Medicine, and Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Joshua M Hare
- Interdisciplinary Stem Cell Institute, Department of Medicine, and Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
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McCully JD, Levitsky S, del Nido PJ, Cowan DB. Mitochondrial transplantation for therapeutic use. Clin Transl Med 2016; 5:16. [PMID: 27130633 PMCID: PMC4851669 DOI: 10.1186/s40169-016-0095-4] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 04/19/2016] [Indexed: 01/15/2023] Open
Abstract
Mitochondria play a key role in the homeostasis of the vast majority of the body's cells. In the myocardium where mitochondria constitute 30 % of the total myocardial cell volume, temporary attenuation or obstruction of blood flow and as a result oxygen delivery to myocardial cells (ischemia) severely alters mitochondrial structure and function. These alterations in mitochondrial structure and function occur during ischemia and continue after blood flow and oxygen delivery to the myocardium is restored, and significantly decrease myocardial contractile function and myocardial cell survival. We hypothesized that the augmentation or replacement of mitochondria damaged by ischemia would provide a mechanism to enhance cellular function and cellular rescue following the restoration of blood flow. To test this hypothesis we have used a model of myocardial ischemia and reperfusion. Our studies demonstrate that the transplantation of autologous mitochondria, isolated from the patient's own body, and then directly injected into the myocardial during early reperfusion augment the function of native mitochondria damaged during ischemia and enhances myocardial post-ischemic functional recovery and cellular viability. The transplanted mitochondria act both extracellularly and intracellularly. Extracellularly, the transplanted mitochondria enhance high energy synthesis and cellular adenosine triphosphate stores and alter the myocardial proteome. Once internalized the transplanted mitochondria rescue cellular function and replace damaged mitochondrial DNA. There is no immune or auto-immune reaction and there is no pro-arrhythmia as a result of the transplanted mitochondria. Our studies and those of others demonstrate that mitochondrial transplantation can be effective in a number of cell types and diseases. These include cardiac and skeletal muscle, pulmonary and hepatic tissue and cells and in neuronal tissue. In this review we discuss the mechanisms leading to mitochondrial dysfunction and the effects on cellular function. We provide a methodology for the isolation of mitochondria to allow for clinical relevance and we discuss the methods we and others have used for the uptake and internalization of mitochondria. We foresee that mitochondrial transplantation will be a valued treatment in the armamentarium of all clinicians and surgeons for the treatment of varied ischemic disorders, mitochondrial diseases and related disorders.
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Affiliation(s)
- James D. McCully
- />Division of Cardiac Surgery, Boston Children’s Hospital, 300 Longwood Ave., Enders Building, EN 407, Boston, MA 02115 USA
- />Harvard Medical School, Boston, MA USA
| | - Sidney Levitsky
- />Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, 110 Francis Street, Suite 2A, Boston, MA 02115 USA
- />Harvard Medical School, Boston, MA USA
| | - Pedro J. del Nido
- />Division of Cardiac Surgery, Boston Children’s Hospital, 300 Longwood Ave., Enders Building, EN 407, Boston, MA 02115 USA
- />Harvard Medical School, Boston, MA USA
| | - Douglas B. Cowan
- />Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, 300 Longwood Ave., Endres Building, EN 312, Boston, MA 02115 USA
- />Harvard Medical School, Boston, MA USA
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Golpanian S, Schulman IH, Ebert RF, Heldman AW, DiFede DL, Yang PC, Wu JC, Bolli R, Perin EC, Moyé L, Simari RD, Wolf A, Hare JM. Concise Review: Review and Perspective of Cell Dosage and Routes of Administration From Preclinical and Clinical Studies of Stem Cell Therapy for Heart Disease. Stem Cells Transl Med 2015; 5:186-91. [PMID: 26683870 PMCID: PMC4729551 DOI: 10.5966/sctm.2015-0101] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 09/14/2015] [Indexed: 02/06/2023] Open
Abstract
An important stage in the development of any new therapeutic agent is establishment of the optimal dosage and route of administration. Inconsistent findings have been reported regarding the relationship between the cell dose and clinical benefit. The present study summarizes the data regarding the optimal cell dosage and route of administration from studies of stem cell therapy for heart disease and offers a perspective on future directions. An important stage in the development of any new therapeutic agent is establishment of the optimal dosage and route of administration. This can be particularly challenging when the treatment is a biologic agent that might exert its therapeutic effects via complex or poorly understood mechanisms. Multiple preclinical and clinical studies have shown paradoxical results, with inconsistent findings regarding the relationship between the cell dose and clinical benefit. Such phenomena can, at least in part, be attributed to variations in cell dosing or concentration and the route of administration (ROA). Although clinical trials of cell-based therapy for cardiovascular disease began more than a decade ago, specification of the optimal dosage and ROA has not been established. The present review summarizes what has been learned regarding the optimal cell dosage and ROA from preclinical and clinical studies of stem cell therapy for heart disease and offers a perspective on future directions. Significance Preclinical and clinical studies on cell-based therapy for cardiovascular disease have shown inconsistent results, in part because of variations in study-specific dosages and/or routes of administration (ROA). Future preclinical studies and smaller clinical trials implementing cell-dose and ROA comparisons are warranted before proceeding to pivotal trials.
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Affiliation(s)
- Samuel Golpanian
- Interdisciplinary Stem Cell Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Ivonne H Schulman
- Interdisciplinary Stem Cell Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Ray F Ebert
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Alan W Heldman
- Interdisciplinary Stem Cell Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Darcy L DiFede
- Interdisciplinary Stem Cell Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Phillip C Yang
- School of Medicine, Stanford University, Stanford, California, USA
| | - Joseph C Wu
- School of Medicine, Stanford University, Stanford, California, USA
| | - Roberto Bolli
- School of Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Emerson C Perin
- Texas Heart Institute, CHI St. Luke's Health, Baylor College of Medicine Medical Center, Houston, Texas, USA
| | - Lem Moyé
- School of Public Health, University of Texas Health Science Center, Houston, Texas, USA
| | - Robert D Simari
- School of Medicine, University of Kansas, Kansas City, Kansas, USA
| | - Ariel Wolf
- Interdisciplinary Stem Cell Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Joshua M Hare
- Interdisciplinary Stem Cell Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida, USA
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Carvalho E, Verma P, Hourigan K, Banerjee R. Myocardial infarction: stem cell transplantation for cardiac regeneration. Regen Med 2015; 10:1025-43. [PMID: 26563414 DOI: 10.2217/rme.15.63] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
It is estimated that by 2030, almost 23.6 million people will perish from cardiovascular disease, according to the WHO. The review discusses advances in stem cell therapy for myocardial infarction, including cell sources, methods of differentiation, expansion selection and their route of delivery. Skeletal muscle cells, hematopoietic cells and mesenchymal stem cells (MSCs) and embryonic stem cells (ESCs)-derived cardiomyocytes have advanced to the clinical stage, while induced pluripotent cells (iPSCs) are yet to be considered clinically. Delivery of cells to the sites of injury and their subsequent retention is a major issue. The development of supportive scaffold matrices to facilitate stem cell retention and differentiation are analyzed. The review outlines clinical translation of conjugate stem cell-based cellular therapeutics post-myocardial infarction.
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Affiliation(s)
- Edmund Carvalho
- IITB Monash Research Academy, Indian Institute of Technology Bombay, Mumbai, India
| | - Paul Verma
- Turretfield Research Centre, South Australian Research & Development Institute (SARDI), SA, Australia.,Stem Cells & Reprogramming Group, Monash University, Australia
| | - Kerry Hourigan
- FLAIR/Laboratory for Biomedical Engineering & Department of Mechanical & Aerospace Engineering, Monash University, Australia
| | - Rinti Banerjee
- Department of Biosciences & Bioengineering, Indian Institute of Technology Bombay, India
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Molendijk I, Bonsing BA, Roelofs H, Peeters KCMJ, Wasser MNJM, Dijkstra G, van der Woude CJ, Duijvestein M, Veenendaal RA, Zwaginga JJ, Verspaget HW, Fibbe WE, van der Meulen-de Jong AE, Hommes DW. Allogeneic Bone Marrow-Derived Mesenchymal Stromal Cells Promote Healing of Refractory Perianal Fistulas in Patients With Crohn's Disease. Gastroenterology 2015; 149:918-27.e6. [PMID: 26116801 DOI: 10.1053/j.gastro.2015.06.014] [Citation(s) in RCA: 225] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 04/23/2015] [Accepted: 06/17/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Patients with perianal fistulizing Crohn's disease have a poor prognosis because these lesions do not heal well. We evaluated the effects of local administration of bone marrow-derived mesenchymal stromal cells (MSCs) to these patients from healthy donors in a double-blind, placebo-controlled study. METHODS Twenty-one patients with refractory perianal fistulizing Crohn's disease were randomly assigned to groups given injections of 1 × 10(7) (n = 5, group 1), 3 × 10(7) (n = 5, group 2), or 9 × 10(7) (n = 5, group 3) MSCs, or placebo (solution with no cells, n = 6), into the wall of curettaged fistula, around the trimmed and closed internal opening. The primary outcome, fistula healing, was determined by physical examination 6, 12, and 24 weeks later; healing was defined as absence of discharge and <2 cm of fluid collection-the latter determined by magnetic resonance imaging at week 12. All procedures were performed at Leiden University Medical Center, The Netherlands, from June 2012 through July 2014. RESULTS No adverse events were associated with local injection of any dose of MSCs. Healing at week 6 was observed in 3 patients in group 1 (60.0%), 4 patients in group 2 (80.0%), and 1 patient in group 3 (20.0%), vs 1 patient in the placebo group (16.7%) (P = .08 for group 2 vs placebo). At week 12, healing was observed in 2 patients in group 1 (40.0%), 4 patients in group 2 (80.0%), and 1 patient in group 3 (20.0%), vs 2 patients in the placebo group (33.3%); these effects were maintained until week 24 and even increased to 4 (80.0%) in group 1. At week six, 4 of 9 individual fistulas had healed in group 1 (44.4%), 6 of 7 had healed in group 2 (85.7%), and 2 of 7 had healed in group 3 (28.6%) vs 2 of 9 (22.2%) in the placebo group (P = .04 for group 2 vs placebo). At week twelve, 3 of 9 individual fistulas had healed in group 1 (33.3%), 6 of 7 had healed in group 2 (85.7%), 2 of 7 had healed in group 3 (28.6%), and 3 of 9 had healed in the placebo group (33.3%). These effects were stable through week 24 and even increased to 6 of 9 (66.7%) in group 1 (P = .06 group 2 vs placebo, weeks 12 and 24). CONCLUSIONS Local administration of allogeneic MSCs was not associated with severe adverse events in patients with perianal fistulizing Crohn's disease. Injection of 3 × 10(7) MSCs appeared to promote healing of perianal fistulas. ClinicalTrials.gov ID NCT01144962.
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Affiliation(s)
- Ilse Molendijk
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Bert A Bonsing
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Helene Roelofs
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Koen C M J Peeters
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin N J M Wasser
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gerard Dijkstra
- Department Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, The Netherlands
| | - C Janneke van der Woude
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marjolijn Duijvestein
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Roeland A Veenendaal
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jaap-Jan Zwaginga
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands; The Jon J van Rood Center for Clinical Transfusion Research, Sanquin-Leiden University Medical Center, Leiden, The Netherlands
| | - Hein W Verspaget
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Willem E Fibbe
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Daniel W Hommes
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands; Division of Digestive Diseases, University of California Los Angeles, Los Angeles, California
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Kim HJ, Kim MH, Kim JT, Lee WJ, Kim E, Lim KS, Kim JK, Yang YI, Park KD, Kim YH. Intracellular transduction of TAT-Hsp27 fusion protein enhancing cell survival and regeneration capacity of cardiac stem cells in acute myocardial infarction. J Control Release 2015; 215:55-72. [PMID: 26232724 DOI: 10.1016/j.jconrel.2015.07.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 07/01/2015] [Accepted: 07/24/2015] [Indexed: 12/11/2022]
Abstract
Myocardial infarction (MI) results in the substantial loss of functional cardiomyocytes, which frequently leads to intractable heart disorders. Cardiac stem cells (CSCs) that retain the capacity to replace all cardiac cells might be a promising strategy for providing a source of new functional cardiomyocytes; however, the poor survival and engraftment of transplanted CSCs in the hostile environment of MI critically mitigate their therapeutic benefits. To capitalize their therapeutic potential, an ex vivo strategy in which CSCs were introduced to the recombinant heat shock protein 27 (Hsp27) through a TAT protein transduction domain for increasing the viability and engraftment in the infarcted myocardium was designed. A recombinant TAT fused Hsp27 (TAT-Hsp27) was able to enter CSCs in a dose-dependent manner. CSCs transduced with TAT-Hsp27 expressed not only endogenous Hsp27 but externally introduced Hsp27, resulting in substantial increase of their anti-oxidative and anti-apoptotic properties via suppressing reactive oxygen species production, the MAPKs signaling pathway, and caspase activation. TAT-Hsp27 enabled CSCs to be protected from apoptotic- and hypoxic-induced cell death during in vitro cardiomyogenic differentiation. In vivo studies demonstrated that CSCs transduced TAT-Hsp27 significantly increased the survival and engraftment in the acutely infarcted myocardium, which is closely related to caspase activity suppression. Finally, CSCs transduced TAT-Hsp27 improved cardiac function and attenuated cardiac remodeling in comparison with non-transduced CSCs. Overall, our approach, which is based on the ex vivo intracellular transduction of TAT-Hsp27 into CSCs before myocardial delivery, might be effective in treating MI.
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Affiliation(s)
- Hye Jung Kim
- Paik Institute for Clinical Research, Inje University College of Medicine, 633-165 Gaegum-dong, Busanjin-gu, Busan 614-735, Republic of Korea
| | - Myoung-Hun Kim
- Paik Institute for Clinical Research, Inje University College of Medicine, 633-165 Gaegum-dong, Busanjin-gu, Busan 614-735, Republic of Korea
| | - Jong Tae Kim
- Paik Institute for Clinical Research, Inje University College of Medicine, 633-165 Gaegum-dong, Busanjin-gu, Busan 614-735, Republic of Korea
| | - Won-Jin Lee
- Paik Institute for Clinical Research, Inje University College of Medicine, 633-165 Gaegum-dong, Busanjin-gu, Busan 614-735, Republic of Korea
| | - Eunjung Kim
- Paik Institute for Clinical Research, Inje University College of Medicine, 633-165 Gaegum-dong, Busanjin-gu, Busan 614-735, Republic of Korea
| | - Kwang Suk Lim
- Department of Bioengineering, Hanyang University, 17 Haengdang-dong, Seongdong-gu, Seoul 133-791, Republic of Korea
| | - Jang Kyoung Kim
- Department of Bioengineering, Hanyang University, 17 Haengdang-dong, Seongdong-gu, Seoul 133-791, Republic of Korea
| | - Young Il Yang
- Paik Institute for Clinical Research, Inje University College of Medicine, 633-165 Gaegum-dong, Busanjin-gu, Busan 614-735, Republic of Korea.
| | - Ki Dong Park
- Department of Molecular Science and Technology, Ajou University, San 5, Woncheon, Yeongtong, Suwon 443-749, Republic of Korea
| | - Yong-Hee Kim
- Department of Bioengineering, Hanyang University, 17 Haengdang-dong, Seongdong-gu, Seoul 133-791, Republic of Korea
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Perin EC, Borow KM, Silva GV, DeMaria AN, Marroquin OC, Huang PP, Traverse JH, Krum H, Skerrett D, Zheng Y, Willerson JT, Itescu S, Henry TD. A Phase II Dose-Escalation Study of Allogeneic Mesenchymal Precursor Cells in Patients With Ischemic or Nonischemic Heart Failure. Circ Res 2015; 117:576-84. [PMID: 26148930 DOI: 10.1161/circresaha.115.306332] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 07/06/2015] [Indexed: 12/18/2022]
Abstract
RATIONALE Allogeneic mesenchymal precursor cells (MPCs) have been effective in large animal models of ischemic and nonischemic heart failure (HF). OBJECTIVE To evaluate the feasibility and safety of 3 doses (25, 75, or 150 million cells) of immunoselected allogeneic MPCs in chronic HF patients in a phase 2 trial. METHODS AND RESULTS We sequentially allocated 60 patients to a dosing cohort (20 per dose group) and randomized them to transendocardial MPC injections (n=15) or mock procedures (n=5). The primary objective was safety, including antibody testing. Secondary efficacy end points included major adverse cardiac events (MACE; cardiac death, myocardial infarction, or revascularization), left ventricular imaging, and other clinical-event surrogates. Safety and MACE were evaluated for up to 3 years. MPC injections were feasible and safe. Adverse events were similar across groups. No clinically symptomatic immune responses were noted. MACE was seen in 15 patients: 10 of 45 (22%) MPC-treated and 5 of 15 (33%) control patients. We found no differences between MPC-treated and control patients in survival probability, MACE-free probability, and all-cause mortality. We conducted a post hoc analysis of HF-related MACE (HF hospitalization, successfully resuscitated cardiac death, or cardiac death) and events were significantly reduced in the 150 million MPC group (0/15) versus control (5/15; 33%), 25 million MPC group (3/15; 20%), and 75 million MPC group (6/15; 40%); the 150 million MPC group differed significantly from all groups according to Kaplan-Meier statistics >3 years (P=0.025 for 150 million MPC group versus control). CONCLUSIONS Transendocardial injections of allogeneic MPCs were feasible and safe in chronic HF patients. High-dose allogeneic MPCs may provide benefits in this population.
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Affiliation(s)
- Emerson C Perin
- From the Stem Cell Center (E.C.P., G.V.S., Y.Z., J.T.W.), Adult Cardiology (E.C.P., G.V.S., J.T.W.), Texas Heart Institute, Houston; Borow Consulting Group, LLC, Bryn Mawr, PA (K.M.B.); Division of Cardiology, School of Medicine, University of California San Diego (A.N.D.M.); Heart and Vascular Institute, Center for Heart and Vascular Quality, Outcomes, and Clinical Research, University of Pittsburgh Medical Center, PA (O.C.M.); Heart and Vascular Institute, Swedish Medical Center, Seattle, WA (P.P.H.); Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T.); Monash University, Melbourne, Australia (H.K.); Mesoblast, Inc, New York (D.S.); Mesoblast, Inc, Melbourne, Victoria, Australia (S.I.); and Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.).
| | - Kenneth M Borow
- From the Stem Cell Center (E.C.P., G.V.S., Y.Z., J.T.W.), Adult Cardiology (E.C.P., G.V.S., J.T.W.), Texas Heart Institute, Houston; Borow Consulting Group, LLC, Bryn Mawr, PA (K.M.B.); Division of Cardiology, School of Medicine, University of California San Diego (A.N.D.M.); Heart and Vascular Institute, Center for Heart and Vascular Quality, Outcomes, and Clinical Research, University of Pittsburgh Medical Center, PA (O.C.M.); Heart and Vascular Institute, Swedish Medical Center, Seattle, WA (P.P.H.); Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T.); Monash University, Melbourne, Australia (H.K.); Mesoblast, Inc, New York (D.S.); Mesoblast, Inc, Melbourne, Victoria, Australia (S.I.); and Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.)
| | - Guilherme V Silva
- From the Stem Cell Center (E.C.P., G.V.S., Y.Z., J.T.W.), Adult Cardiology (E.C.P., G.V.S., J.T.W.), Texas Heart Institute, Houston; Borow Consulting Group, LLC, Bryn Mawr, PA (K.M.B.); Division of Cardiology, School of Medicine, University of California San Diego (A.N.D.M.); Heart and Vascular Institute, Center for Heart and Vascular Quality, Outcomes, and Clinical Research, University of Pittsburgh Medical Center, PA (O.C.M.); Heart and Vascular Institute, Swedish Medical Center, Seattle, WA (P.P.H.); Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T.); Monash University, Melbourne, Australia (H.K.); Mesoblast, Inc, New York (D.S.); Mesoblast, Inc, Melbourne, Victoria, Australia (S.I.); and Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.)
| | - Anthony N DeMaria
- From the Stem Cell Center (E.C.P., G.V.S., Y.Z., J.T.W.), Adult Cardiology (E.C.P., G.V.S., J.T.W.), Texas Heart Institute, Houston; Borow Consulting Group, LLC, Bryn Mawr, PA (K.M.B.); Division of Cardiology, School of Medicine, University of California San Diego (A.N.D.M.); Heart and Vascular Institute, Center for Heart and Vascular Quality, Outcomes, and Clinical Research, University of Pittsburgh Medical Center, PA (O.C.M.); Heart and Vascular Institute, Swedish Medical Center, Seattle, WA (P.P.H.); Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T.); Monash University, Melbourne, Australia (H.K.); Mesoblast, Inc, New York (D.S.); Mesoblast, Inc, Melbourne, Victoria, Australia (S.I.); and Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.)
| | - Oscar C Marroquin
- From the Stem Cell Center (E.C.P., G.V.S., Y.Z., J.T.W.), Adult Cardiology (E.C.P., G.V.S., J.T.W.), Texas Heart Institute, Houston; Borow Consulting Group, LLC, Bryn Mawr, PA (K.M.B.); Division of Cardiology, School of Medicine, University of California San Diego (A.N.D.M.); Heart and Vascular Institute, Center for Heart and Vascular Quality, Outcomes, and Clinical Research, University of Pittsburgh Medical Center, PA (O.C.M.); Heart and Vascular Institute, Swedish Medical Center, Seattle, WA (P.P.H.); Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T.); Monash University, Melbourne, Australia (H.K.); Mesoblast, Inc, New York (D.S.); Mesoblast, Inc, Melbourne, Victoria, Australia (S.I.); and Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.)
| | - Paul P Huang
- From the Stem Cell Center (E.C.P., G.V.S., Y.Z., J.T.W.), Adult Cardiology (E.C.P., G.V.S., J.T.W.), Texas Heart Institute, Houston; Borow Consulting Group, LLC, Bryn Mawr, PA (K.M.B.); Division of Cardiology, School of Medicine, University of California San Diego (A.N.D.M.); Heart and Vascular Institute, Center for Heart and Vascular Quality, Outcomes, and Clinical Research, University of Pittsburgh Medical Center, PA (O.C.M.); Heart and Vascular Institute, Swedish Medical Center, Seattle, WA (P.P.H.); Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T.); Monash University, Melbourne, Australia (H.K.); Mesoblast, Inc, New York (D.S.); Mesoblast, Inc, Melbourne, Victoria, Australia (S.I.); and Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.)
| | - Jay H Traverse
- From the Stem Cell Center (E.C.P., G.V.S., Y.Z., J.T.W.), Adult Cardiology (E.C.P., G.V.S., J.T.W.), Texas Heart Institute, Houston; Borow Consulting Group, LLC, Bryn Mawr, PA (K.M.B.); Division of Cardiology, School of Medicine, University of California San Diego (A.N.D.M.); Heart and Vascular Institute, Center for Heart and Vascular Quality, Outcomes, and Clinical Research, University of Pittsburgh Medical Center, PA (O.C.M.); Heart and Vascular Institute, Swedish Medical Center, Seattle, WA (P.P.H.); Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T.); Monash University, Melbourne, Australia (H.K.); Mesoblast, Inc, New York (D.S.); Mesoblast, Inc, Melbourne, Victoria, Australia (S.I.); and Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.)
| | - Henry Krum
- From the Stem Cell Center (E.C.P., G.V.S., Y.Z., J.T.W.), Adult Cardiology (E.C.P., G.V.S., J.T.W.), Texas Heart Institute, Houston; Borow Consulting Group, LLC, Bryn Mawr, PA (K.M.B.); Division of Cardiology, School of Medicine, University of California San Diego (A.N.D.M.); Heart and Vascular Institute, Center for Heart and Vascular Quality, Outcomes, and Clinical Research, University of Pittsburgh Medical Center, PA (O.C.M.); Heart and Vascular Institute, Swedish Medical Center, Seattle, WA (P.P.H.); Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T.); Monash University, Melbourne, Australia (H.K.); Mesoblast, Inc, New York (D.S.); Mesoblast, Inc, Melbourne, Victoria, Australia (S.I.); and Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.)
| | - Donna Skerrett
- From the Stem Cell Center (E.C.P., G.V.S., Y.Z., J.T.W.), Adult Cardiology (E.C.P., G.V.S., J.T.W.), Texas Heart Institute, Houston; Borow Consulting Group, LLC, Bryn Mawr, PA (K.M.B.); Division of Cardiology, School of Medicine, University of California San Diego (A.N.D.M.); Heart and Vascular Institute, Center for Heart and Vascular Quality, Outcomes, and Clinical Research, University of Pittsburgh Medical Center, PA (O.C.M.); Heart and Vascular Institute, Swedish Medical Center, Seattle, WA (P.P.H.); Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T.); Monash University, Melbourne, Australia (H.K.); Mesoblast, Inc, New York (D.S.); Mesoblast, Inc, Melbourne, Victoria, Australia (S.I.); and Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.)
| | - Yi Zheng
- From the Stem Cell Center (E.C.P., G.V.S., Y.Z., J.T.W.), Adult Cardiology (E.C.P., G.V.S., J.T.W.), Texas Heart Institute, Houston; Borow Consulting Group, LLC, Bryn Mawr, PA (K.M.B.); Division of Cardiology, School of Medicine, University of California San Diego (A.N.D.M.); Heart and Vascular Institute, Center for Heart and Vascular Quality, Outcomes, and Clinical Research, University of Pittsburgh Medical Center, PA (O.C.M.); Heart and Vascular Institute, Swedish Medical Center, Seattle, WA (P.P.H.); Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T.); Monash University, Melbourne, Australia (H.K.); Mesoblast, Inc, New York (D.S.); Mesoblast, Inc, Melbourne, Victoria, Australia (S.I.); and Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.)
| | - James T Willerson
- From the Stem Cell Center (E.C.P., G.V.S., Y.Z., J.T.W.), Adult Cardiology (E.C.P., G.V.S., J.T.W.), Texas Heart Institute, Houston; Borow Consulting Group, LLC, Bryn Mawr, PA (K.M.B.); Division of Cardiology, School of Medicine, University of California San Diego (A.N.D.M.); Heart and Vascular Institute, Center for Heart and Vascular Quality, Outcomes, and Clinical Research, University of Pittsburgh Medical Center, PA (O.C.M.); Heart and Vascular Institute, Swedish Medical Center, Seattle, WA (P.P.H.); Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T.); Monash University, Melbourne, Australia (H.K.); Mesoblast, Inc, New York (D.S.); Mesoblast, Inc, Melbourne, Victoria, Australia (S.I.); and Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.)
| | - Silviu Itescu
- From the Stem Cell Center (E.C.P., G.V.S., Y.Z., J.T.W.), Adult Cardiology (E.C.P., G.V.S., J.T.W.), Texas Heart Institute, Houston; Borow Consulting Group, LLC, Bryn Mawr, PA (K.M.B.); Division of Cardiology, School of Medicine, University of California San Diego (A.N.D.M.); Heart and Vascular Institute, Center for Heart and Vascular Quality, Outcomes, and Clinical Research, University of Pittsburgh Medical Center, PA (O.C.M.); Heart and Vascular Institute, Swedish Medical Center, Seattle, WA (P.P.H.); Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T.); Monash University, Melbourne, Australia (H.K.); Mesoblast, Inc, New York (D.S.); Mesoblast, Inc, Melbourne, Victoria, Australia (S.I.); and Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.)
| | - Timothy D Henry
- From the Stem Cell Center (E.C.P., G.V.S., Y.Z., J.T.W.), Adult Cardiology (E.C.P., G.V.S., J.T.W.), Texas Heart Institute, Houston; Borow Consulting Group, LLC, Bryn Mawr, PA (K.M.B.); Division of Cardiology, School of Medicine, University of California San Diego (A.N.D.M.); Heart and Vascular Institute, Center for Heart and Vascular Quality, Outcomes, and Clinical Research, University of Pittsburgh Medical Center, PA (O.C.M.); Heart and Vascular Institute, Swedish Medical Center, Seattle, WA (P.P.H.); Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T.); Monash University, Melbourne, Australia (H.K.); Mesoblast, Inc, New York (D.S.); Mesoblast, Inc, Melbourne, Victoria, Australia (S.I.); and Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.)
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Abstract
Despite substantial clinical advances over the past 65 years, cardiovascular disease remains the leading cause of death in America. The past 15 years has witnessed major basic and translational interest in the use of stem and precursor cells as a therapeutic agent for chronically injured organs. Among the cell types under investigation, adult mesenchymal stem cells are widely studied, and in early stage, clinical studies show promise for repair and regeneration of cardiac tissues. The ability of mesenchymal stem cells to differentiate into mesoderm- and nonmesoderm-derived tissues, their immunomodulatory effects, their availability, and their key role in maintaining and replenishing endogenous stem cell niches have rendered them one of the most heavily investigated and clinically tested type of stem cell. Accumulating data from preclinical and early phase clinical trials document their safety when delivered as either autologous or allogeneic forms in a range of cardiovascular diseases, but also importantly define parameters of clinical efficacy that justify further investigation in larger clinical trials. Here, we review the biology of mesenchymal stem cells, their interaction with endogenous molecular and cellular pathways, and their modulation of immune responses. Additionally, we discuss factors that enhance their proliferative and regenerative ability and factors that may hinder their effectiveness in the clinical setting.
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Affiliation(s)
- Vasileios Karantalis
- From the University of Miami Miller School of Medicine, Interdisciplinary Stem Cell Institute, FL
| | - Joshua M Hare
- From the University of Miami Miller School of Medicine, Interdisciplinary Stem Cell Institute, FL.
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44
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García AN, Sanz-Ruiz R, Santos MEF, Fernández-Avilés F. “Second-generation” stem cells for cardiac repair. World J Stem Cells 2015; 7:352-367. [PMID: 25815120 PMCID: PMC4369492 DOI: 10.4252/wjsc.v7.i2.352] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 09/26/2014] [Accepted: 11/10/2014] [Indexed: 02/06/2023] Open
Abstract
Over the last years, stem cell therapy has emerged as an inspiring alternative to restore cardiac function after myocardial infarction. A large body of evidence has been obtained in this field but there is no conclusive data on the efficacy of these treatments. Preclinical studies and early reports in humans have been encouraging and have fostered a rapid clinical translation, but positive results have not been uniformly observed and when present, they have been modest. Several types of stem cells, manufacturing methods and delivery routes have been tested in different clinical settings but direct comparison between them is challenging and hinders further research. Despite enormous achievements, major barriers have been found and many fundamental issues remain to be resolved. A better knowledge of the molecular mechanisms implicated in cardiac development and myocardial regeneration is critically needed to overcome some of these hurdles. Genetic and pharmacological priming together with the discovery of new sources of cells have led to a “second generation” of cell products that holds an encouraging promise in cardiovascular regenerative medicine. In this report, we review recent advances in this field focusing on the new types of stem cells that are currently being tested in human beings and on the novel strategies employed to boost cell performance in order to improve cardiac function and outcomes after myocardial infarction.
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45
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Locatelli P, Olea FD, Hnatiuk A, De Lorenzi A, Cerdá M, Giménez CS, Sepúlveda D, Laguens R, Crottogini A. Mesenchymal stromal cells overexpressing vascular endothelial growth factor in ovine myocardial infarction. Gene Ther 2015; 22:449-57. [PMID: 25789461 DOI: 10.1038/gt.2015.28] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 03/06/2015] [Accepted: 03/11/2015] [Indexed: 01/23/2023]
Abstract
Mesenchymal stromal cells (MSCs) are cardioprotective in acute myocardial infarction (AMI). Besides, we have shown that intramyocardial injection of plasmid-VEGF(165) (pVEGF) in ovine AMI reduces infarct size and improves left ventricular (LV) function. We thus hypothesized that MSCs overexpressing VEGF(165) (MSCs-pVEGF) would afford greater cardioprotection than non-modified MSCs or pVEGF alone. Sheep underwent an anteroapical AMI and, 1 week later, received intramyocardial MSCs-pVEGF in the infarct border. One month post treatment, infarct size (magnetic resonance) decreased by 31% vs pre-treatment. Of note, myocardial salvage occurred predominantly at the subendocardium, the myocardial region displaying the largest contribution to systolic performance. Consistently, LV ejection fraction recovered to almost its baseline value because of marked decrease in end-systolic volume. None of these effects were observed in sheep receiving non-transfected MSCs or pVEGF. Although myocardial retention of MSCs decreased steeply over time, the treatment induced significant capillary and arteriolar proliferation, which reduced subendocardial fibrosis. We conclude that in ovine AMI, allogeneic VEGF-overexpressing MSCs induce subendocardial myocardium salvage through microvascular proliferation, reducing infarct size and improving LV function more than non-transfected MSCs or the naked plasmid. Importantly, the use of a plasmid rather than a virus allows for repeated treatments, likely needed in ischemic heart disease.
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Affiliation(s)
- P Locatelli
- Department of Physiology, Favaloro University, Buenos Aires, Argentina
| | - F D Olea
- Department of Physiology, Favaloro University, Buenos Aires, Argentina
| | - A Hnatiuk
- Department of Physiology, Favaloro University, Buenos Aires, Argentina
| | - A De Lorenzi
- Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - M Cerdá
- Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - C S Giménez
- Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - D Sepúlveda
- Department of Pathology, Favaloro University, Buenos Aires, Argentina
| | - R Laguens
- Department of Pathology, Favaloro University, Buenos Aires, Argentina
| | - A Crottogini
- Department of Physiology, Favaloro University, Buenos Aires, Argentina
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46
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Chou SH, Lin SZ, Kuo WW, Pai P, Lin JY, Lai CH, Kuo CH, Lin KH, Tsai FJ, Huang CY. Mesenchymal stem cell insights: prospects in cardiovascular therapy. Cell Transplant 2015; 23:513-29. [PMID: 24816448 DOI: 10.3727/096368914x678436] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Ischemic heart damage usually triggers cardiomyopathological remodeling and fibrosis, thus promoting the development of heart functional failure. Mesenchymal stem cells (MSCs) are a heterogeneous group of cells in culture, with multipotent and hypoimmunogenic characters to aid tissue repair and avoid immune responses, respectively. Numerous experimental findings have proven the feasibility, safety, and efficiency of MSC therapy for cardiac regeneration. Despite that the exact mechanism remains unclear, the therapeutic ability of MSCs to treat ischemia heart diseases has been tested in phase I/II clinical trials. Based on encouraging preliminary findings, MSCs might become a potentially efficacious tool in the therapeutic options available to treat ischemic and nonischemic cardiovascular disorders. The molecular mechanism behind the efficacy of MSCs on promoting engraftment and accelerating the speed of heart functional recovery is still waiting for clarification. It is hypothesized that cardiomyocyte regeneration, paracrine mechanisms for cardiac repair, optimization of the niche for cell survival, and cardiac remodeling by inflammatory control are involved in the interaction between MSCs and the damaged myocardial environment. This review focuses on recent experimental and clinical findings related to cellular cardiomyoplasticity. We focus on MSCs, highlighting their roles in cardiac tissue repair, transdifferentiation, the MSC niche in myocardial tissues, discuss their therapeutic efficacy that has been tested for cardiac therapy, and the current bottleneck of MSC-based cardiac therapies.
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Affiliation(s)
- Shiu-Huey Chou
- Department of Life Science, Fu-Jen Catholic University, Xinzhuang District, New Taipei City, Taiwan
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Sharp TE, George JC. Stem cell therapy and breast cancer treatment: review of stem cell research and potential therapeutic impact against cardiotoxicities due to breast cancer treatment. Front Oncol 2014; 4:299. [PMID: 25405100 PMCID: PMC4217360 DOI: 10.3389/fonc.2014.00299] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 10/14/2014] [Indexed: 12/16/2022] Open
Abstract
A new problem has emerged with the ever-increasing number of breast cancer survivors. While early screening and advances in treatment have allowed these patients to overcome their cancer, these treatments often have adverse cardiovascular side effects that can produce abnormal cardiovascular function. Chemotherapeutic and radiation therapy have both been linked to cardiotoxicity; these therapeutics can cause a loss of cardiac muscle and deterioration of vascular structure that can eventually lead to heart failure (HF). This cardiomyocyte toxicity can leave the breast cancer survivor with a probable diagnosis of dilated or restrictive cardiomyopathy (DCM or RCM). While current HF standard of care can alleviate symptoms, other than heart transplantation, there is no therapy that replaces cardiac myocytes that are killed during cancer therapies. There is a need to develop novel therapeutics that can either prevent or reverse the cardiac injury caused by cancer therapeutics. These new therapeutics should promote the regeneration of lost or deteriorating myocardium. Over the last several decades, the therapeutic potential of cell-based therapy has been investigated for HF patients. In this review, we discuss the progress of pre-clinical and clinical stem cell research for the diseased heart and discuss the possibility of utilizing these novel therapies to combat cardiotoxicity observed in breast cancer survivors.
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Affiliation(s)
- Thomas E Sharp
- Cardiovascular Research Center, Temple University School of Medicine , Philadelphia, PA , USA
| | - Jon C George
- Cardiovascular Research Center, Temple University School of Medicine , Philadelphia, PA , USA ; Division of Cardiovascular Medicine, Temple University Hospital , Philadelphia, PA , USA
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48
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Richardson JD, Nelson AJ, Zannettino ACW, Gronthos S, Worthley SG, Psaltis PJ. Optimization of the cardiovascular therapeutic properties of mesenchymal stromal/stem cells-taking the next step. Stem Cell Rev Rep 2014; 9:281-302. [PMID: 22529015 DOI: 10.1007/s12015-012-9366-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Despite current treatment options, cardiac failure is associated with significant morbidity and mortality highlighting a compelling clinical need for novel therapeutic approaches. Based on promising pre-clinical data, stem cell therapy has been suggested as a possible therapeutic strategy. Of the candidate cell types evaluated, mesenchymal stromal/stem cells (MSCs) have been widely evaluated due to their ease of isolation and ex vivo expansion, potential allogeneic utility and capacity to promote neo-angiogenesis and endogenous cardiac repair. However, the clinical application of MSCs for mainstream cardiovascular use is currently hindered by several important limitations, including suboptimal retention and engraftment and restricted capacity for bona fide cardiomyocyte regeneration. Consequently, this has prompted intense efforts to advance the therapeutic properties of MSCs for cardiovascular disease. In this review, we consider the scope of benefit from traditional plastic adherence-isolated MSCs and the lessons learned from their conventional use in preclinical and clinical studies. Focus is then given to the evolving strategies aimed at optimizing MSC therapy, including discussion of cell-targeted techniques that encompass the preparation, pre-conditioning and manipulation of these cells ex vivo, methods to improve their delivery to the heart and innovative substrate-directed strategies to support their interaction with the host myocardium.
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Affiliation(s)
- James D Richardson
- Cardiovascular Research Centre, Royal Adelaide Hospital and Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia
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49
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Heldman AW, DiFede DL, Fishman JE, Zambrano JP, Trachtenberg BH, Karantalis V, Mushtaq M, Williams AR, Suncion VY, McNiece IK, Ghersin E, Soto V, Lopera G, Miki R, Willens H, Hendel R, Mitrani R, Pattany P, Feigenbaum G, Oskouei B, Byrnes J, Lowery MH, Sierra J, Pujol MV, Delgado C, Gonzalez PJ, Rodriguez JE, Bagno LL, Rouy D, Altman P, Foo CWP, da Silva J, Anderson E, Schwarz R, Mendizabal A, Hare JM. Transendocardial mesenchymal stem cells and mononuclear bone marrow cells for ischemic cardiomyopathy: the TAC-HFT randomized trial. JAMA 2014; 311:62-73. [PMID: 24247587 PMCID: PMC4111133 DOI: 10.1001/jama.2013.282909] [Citation(s) in RCA: 400] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Whether culture-expanded mesenchymal stem cells or whole bone marrow mononuclear cells are safe and effective in chronic ischemic cardiomyopathy is controversial. OBJECTIVE To demonstrate the safety of transendocardial stem cell injection with autologous mesenchymal stem cells (MSCs) and bone marrow mononuclear cells (BMCs) in patients with ischemic cardiomyopathy. DESIGN, SETTING, AND PATIENTS A phase 1 and 2 randomized, blinded, placebo-controlled study involving 65 patients with ischemic cardiomyopathy and left ventricular (LV) ejection fraction less than 50% (September 1, 2009-July 12, 2013). The study compared injection of MSCs (n=19) with placebo (n = 11) and BMCs (n = 19) with placebo (n = 10), with 1 year of follow-up. INTERVENTIONS Injections in 10 LV sites with an infusion catheter. MAIN OUTCOMES AND MEASURES Treatment-emergent 30-day serious adverse event rate defined as a composite of death, myocardial infarction, stroke, hospitalization for worsening heart failure, perforation, tamponade, or sustained ventricular arrhythmias. RESULTS No patient had a treatment-emergent serious adverse events at day 30. The 1-year incidence of serious adverse events was 31.6% (95% CI, 12.6% to 56.6%) for MSCs, 31.6% (95% CI, 12.6%-56.6%) for BMCs, and 38.1% (95% CI, 18.1%-61.6%) for placebo. Over 1 year, the Minnesota Living With Heart Failure score improved with MSCs (-6.3; 95% CI, -15.0 to 2.4; repeated measures of variance, P=.02) and with BMCs (-8.2; 95% CI, -17.4 to 0.97; P=.005) but not with placebo (0.4; 95% CI, -9.45 to 10.25; P=.38). The 6-minute walk distance increased with MSCs only (repeated measures model, P = .03). Infarct size as a percentage of LV mass was reduced by MSCs (-18.9%; 95% CI, -30.4 to -7.4; within-group, P = .004) but not by BMCs (-7.0%; 95% CI, -15.7% to 1.7%; within-group, P = .11) or placebo (-5.2%; 95% CI, -16.8% to 6.5%; within-group, P = .36). Regional myocardial function as peak Eulerian circumferential strain at the site of injection improved with MSCs (-4.9; 95% CI, -13.3 to 3.5; within-group repeated measures, P = .03) but not BMCs (-2.1; 95% CI, -5.5 to 1.3; P = .21) or placebo (-0.03; 95% CI, -1.9 to 1.9; P = .14). Left ventricular chamber volume and ejection fraction did not change. CONCLUSIONS AND RELEVANCE Transendocardial stem cell injection with MSCs or BMCs appeared to be safe for patients with chronic ischemic cardiomyopathy and LV dysfunction. Although the sample size and multiple comparisons preclude a definitive statement about safety and clinical effect, these results provide the basis for larger studies to provide definitive evidence about safety and to assess efficacy of this new therapeutic approach. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00768066.
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Affiliation(s)
- Alan W Heldman
- The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine2Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Darcy L DiFede
- The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine
| | - Joel E Fishman
- Department of Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Juan P Zambrano
- The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine2Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Barry H Trachtenberg
- The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine2Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Vasileios Karantalis
- The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine
| | - Muzammil Mushtaq
- The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine2Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Adam R Williams
- The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine4Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Viky Y Suncion
- The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine
| | - Ian K McNiece
- The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine2Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida8MD Anderson Cancer Center, Houston, Texas
| | - Eduard Ghersin
- Department of Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Victor Soto
- The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine2Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Gustavo Lopera
- The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine2Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida5Miami Veterans Affairs Healthcare System, Miami, Florida
| | - Roberto Miki
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Howard Willens
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Robert Hendel
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Raul Mitrani
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Gary Feigenbaum
- The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine2Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Behzad Oskouei
- The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine2Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - John Byrnes
- The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine2Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Maureen H Lowery
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Julio Sierra
- The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine
| | - Mariesty V Pujol
- The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine
| | - Cindy Delgado
- The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine
| | - Phillip J Gonzalez
- The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine
| | - Jose E Rodriguez
- The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine
| | - Luiza Lima Bagno
- The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine
| | - Didier Rouy
- Biocardia Corporation, San Carlos, California
| | | | | | - Jose da Silva
- The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine
| | | | - Richard Schwarz
- The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine
| | | | - Joshua M Hare
- The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine2Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
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50
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Cheng Y, Yi G, Conditt GB, Sheehy A, Kolodgie FD, Tellez A, Polyakov I, Gu A, Aboodi MS, Wallace-Bradley D, Schuster M, Martens T, Itescu S, Kaluza GL, Basu S, Virmani R, Granada JF, Sherman W. Catheter-Based Endomyocardial Delivery of Mesenchymal Precursor Cells Using 3D Echo Guidance Improves Cardiac Function in a Chronic Myocardial Injury Ovine Model. Cell Transplant 2013; 22:2299-309. [DOI: 10.3727/096368912x658016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
The administration of bone marrow-derived stem cells may provide a new treatment option for patients with heart failure. Transcatheter cell injection may require multi-imaging modalities to optimize delivery. This study sought to evaluate whether endomyocardial injection of mesenchymal precursor cells (MPCs) could be guided by real-time 3D echocardiography (RT3DE) in treating chronic, postinfarction (MI) left ventricular (LV) dysfunction in sheep. Four weeks after induction of an anterior wall myocardial infarction in 39 sheep, allogeneic MPCs in doses of either 25 × 106 ( n = 10), 75 × 106 ( n = 9), or 225 × 106 ( n = 10) cells or nonconditioned control media ( n = 10) were administered intramyocardially into infarct and border zone areas using a catheter designed for combined fluoroscopic and RT3DE-guided injections. LV function was assessed before and after injection. Infarct dimension and vascular density were evaluated histologically. RT3DE-guided injection procedures were safe. Compared to controls, the highest dose MPC treatment led to increments in ejection fraction (3±3% in 225M MPCs vs. −5±4% in the control group, p < 0.01) and wall thickening in both infarct (4±4% in 225M MPCs vs. −3±6% in the control group, p = 0.02) and border zones (4±6% in 225M MPCs vs. −8±9% in the control group, p = 0.01). Histology analysis demonstrated significantly higher arteriole density in the infarct and border zones in the highest dose MPC-treated animals compared to the lower dose or control groups. Endomyocardial implantation of MPCs under RT3DE guidance was safe and without observed logistical obstacles. Significant increases in LV performance (ejection fraction and wall thickening) and neovascularization resulted from this technique, and so this technique has important implications for treating patients with postischemic LV dysfunction.
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Affiliation(s)
- Yanping Cheng
- The Jack Skirball Center for Cardiovascular Research, Cardiovascular Research Foundation, Orangeburg, NY, USA
| | - Genghua Yi
- The Jack Skirball Center for Cardiovascular Research, Cardiovascular Research Foundation, Orangeburg, NY, USA
| | - Gerard B. Conditt
- The Jack Skirball Center for Cardiovascular Research, Cardiovascular Research Foundation, Orangeburg, NY, USA
| | | | | | - Armando Tellez
- The Jack Skirball Center for Cardiovascular Research, Cardiovascular Research Foundation, Orangeburg, NY, USA
| | | | - Anguo Gu
- The Jack Skirball Center for Cardiovascular Research, Cardiovascular Research Foundation, Orangeburg, NY, USA
| | - Michael S. Aboodi
- The Jack Skirball Center for Cardiovascular Research, Cardiovascular Research Foundation, Orangeburg, NY, USA
| | - David Wallace-Bradley
- The Jack Skirball Center for Cardiovascular Research, Cardiovascular Research Foundation, Orangeburg, NY, USA
| | | | | | | | - Greg L. Kaluza
- The Jack Skirball Center for Cardiovascular Research, Cardiovascular Research Foundation, Orangeburg, NY, USA
| | | | | | - Juan F. Granada
- The Jack Skirball Center for Cardiovascular Research, Cardiovascular Research Foundation, Orangeburg, NY, USA
| | - Warren Sherman
- The Jack Skirball Center for Cardiovascular Research, Cardiovascular Research Foundation, Orangeburg, NY, USA
- Abbott Vascular, Santa Clara, CA, USA
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