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Baccouche BM, Elde S, Wang H, Woo YJ. Structural, angiogenic, and immune responses influencing myocardial regeneration: a glimpse into the crucible. NPJ Regen Med 2024; 9:18. [PMID: 38688935 PMCID: PMC11061134 DOI: 10.1038/s41536-024-00357-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/15/2024] [Indexed: 05/02/2024] Open
Abstract
Complete cardiac regeneration remains an elusive therapeutic goal. Although much attention has been focused on cardiomyocyte proliferation, especially in neonatal mammals, recent investigations have unearthed mechanisms by which non-cardiomyocytes, such as endothelial cells, fibroblasts, macrophages, and other immune cells, play critical roles in modulating the regenerative capacity of the injured heart. The degree to which each of these cell types influence cardiac regeneration, however, remains incompletely understood. This review highlights the roles of these non-cardiomyocytes and their respective contributions to cardiac regeneration, with emphasis on natural heart regeneration after cardiac injury during the neonatal period.
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Affiliation(s)
- Basil M Baccouche
- Stanford University Department of Cardiothoracic Surgery, Palo Alto, CA, USA
| | - Stefan Elde
- Stanford University Department of Cardiothoracic Surgery, Palo Alto, CA, USA
| | - Hanjay Wang
- Stanford University Department of Cardiothoracic Surgery, Palo Alto, CA, USA
| | - Y Joseph Woo
- Stanford University Department of Cardiothoracic Surgery, Palo Alto, CA, USA.
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2
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Perez-Estenaga I, Chevalier MT, Peña E, Abizanda G, Alsharabasy AM, Larequi E, Cilla M, Perez MM, Gurtubay J, Garcia-Yebenes Castro M, Prosper F, Pandit A, Pelacho B. A Multimodal Scaffold for SDF1 Delivery Improves Cardiac Function in a Rat Subacute Myocardial Infarct Model. ACS APPLIED MATERIALS & INTERFACES 2023; 15:50638-50651. [PMID: 37566441 PMCID: PMC10636708 DOI: 10.1021/acsami.3c04245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/02/2023] [Indexed: 08/12/2023]
Abstract
Ischemic heart disease is one of the leading causes of death worldwide. The efficient delivery of therapeutic growth factors could counteract the adverse prognosis of post-myocardial infarction (post-MI). In this study, a collagen hydrogel that is able to load and appropriately deliver pro-angiogenic stromal cell-derived factor 1 (SDF1) was physically coupled with a compact collagen membrane in order to provide the suture strength required for surgical implantation. This bilayer collagen-on-collagen scaffold (bCS) showed the suitable physicochemical properties that are needed for efficient implantation, and the scaffold was able to deliver therapeutic growth factors after MI. In vitro collagen matrix biodegradation led to a sustained SDF1 release and a lack of cytotoxicity in the relevant cell cultures. In vivo intervention in a rat subacute MI model resulted in the full integration of the scaffold into the heart after implantation and biocompatibility with the tissue, with a prevalence of anti-inflammatory and pro-angiogenic macrophages, as well as evidence of revascularization and improved cardiac function after 60 days. Moreover, the beneficial effect of the released SDF1 on heart remodeling was confirmed by a significant reduction in cardiac tissue stiffness. Our findings demonstrate that this multimodal scaffold is a desirable matrix that can be used as a drug delivery system and a scaffolding material to promote functional recovery after MI.
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Affiliation(s)
- Iñigo Perez-Estenaga
- Regenerative
Medicine Department, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona 31008, Spain
| | - Merari Tumin Chevalier
- CÚRAM,
SFI Research Center for Medical Devices, University of Galway, Galway H91 TK33, Ireland
| | - Estefania Peña
- Aragon
Institute of Engineering Research, University
of Zaragoza, Zaragoza 50009, Spain
- CIBER-BBN—Centro
de Investigación Biomédica en Red en Bioingeniería
Biomateriales y Nanomedicina, Zaragoza 50018, Spain
| | - Gloria Abizanda
- Regenerative
Medicine Department, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona 31008, Spain
- Instituto
de Investigación Sanitaria de Navarra (IdiSNA), Pamplona 31009, Spain
| | - Amir M. Alsharabasy
- CÚRAM,
SFI Research Center for Medical Devices, University of Galway, Galway H91 TK33, Ireland
| | - Eduardo Larequi
- Regenerative
Medicine Department, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona 31008, Spain
| | - Myriam Cilla
- Aragon
Institute of Engineering Research, University
of Zaragoza, Zaragoza 50009, Spain
- CIBER-BBN—Centro
de Investigación Biomédica en Red en Bioingeniería
Biomateriales y Nanomedicina, Zaragoza 50018, Spain
| | - Marta M. Perez
- Department
of Anatomy, Embryology and Animal Genetics, University of Zaragoza, Zaragoza 50009, Spain
| | - Jon Gurtubay
- Regenerative
Medicine Department, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona 31008, Spain
| | | | - Felipe Prosper
- Regenerative
Medicine Department, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona 31008, Spain
- Instituto
de Investigación Sanitaria de Navarra (IdiSNA), Pamplona 31009, Spain
- Department
of Cell Therapy and Hematology, Clínica
Universidad de Navarra, Pamplona 31008, Spain
- CIBERONC, Madrid 28029, Spain
| | - Abhay Pandit
- CÚRAM,
SFI Research Center for Medical Devices, University of Galway, Galway H91 TK33, Ireland
| | - Beatriz Pelacho
- Regenerative
Medicine Department, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona 31008, Spain
- Instituto
de Investigación Sanitaria de Navarra (IdiSNA), Pamplona 31009, Spain
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3
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Stapleton LM, Farry JM, Zhu Y, Lucian HJ, Wang H, Paulsen MJ, Totherow KP, Roth GA, Brower KK, Fordyce PM, Appel EA, Woo YPJ. Microfluidic encapsulation of photosynthetic cyanobacteria in hydrogel microparticles augments oxygen delivery to rescue ischemic myocardium. J Biosci Bioeng 2023; 135:493-499. [PMID: 36966053 DOI: 10.1016/j.jbiosc.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/27/2023]
Abstract
Cardiovascular disease, primarily caused by coronary artery disease, is the leading cause of death in the United States. While standard clinical interventions have improved patient outcomes, mortality rates associated with eventual heart failure still represent a clinical challenge. Macrorevascularization techniques inadequately address the microvascular perfusion deficits that persist beyond primary and secondary interventions. In this work, we investigate a photosynthetic oxygen delivery system that rescues the myocardium following acute ischemia. Using a simple microfluidic system, we encapsulated Synechococcus elongatus into alginate hydrogel microparticles (HMPs), which photosynthetically deliver oxygen to ischemic tissue in the absence of blood flow. We demonstrate that HMPs improve the viability of S. elongatus during the injection process and allow for simple oxygen diffusion. Adult male Wistar rats (n = 45) underwent sham surgery, acute ischemia reperfusion surgery, or a chronic ischemia reperfusion surgery, followed by injection of phosphate buffered saline (PBS), S. elongatus suspended in PBS, HMPs, or S. elongatus encapsulated in HMPs. Treatment with S. elongatus-HMPs mitigated cellular apoptosis and improved left ventricular function. Thus, delivery of S. elongatus encapsulated in HMPs improves clinical translation by utilizing a minimally invasive delivery platform that improves S. elongatus viability and enhances the therapeutic benefit of a novel photosynthetic system for the treatment of myocardial ischemia.
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Affiliation(s)
- Lyndsay Mariah Stapleton
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA; Department of Cardiothoracic Surgery, Stanford University, Stanford, CA 94305, USA
| | - Justin Michael Farry
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA 94305, USA
| | - Yuanjia Zhu
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA; Department of Cardiothoracic Surgery, Stanford University, Stanford, CA 94305, USA
| | - Haley Joan Lucian
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA 94305, USA
| | - Hanjay Wang
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA 94305, USA
| | - Michael John Paulsen
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA 94305, USA
| | | | - Gillie Agmon Roth
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
| | | | - Polly Morrell Fordyce
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA; Department of Genetics, Stanford University, Stanford, CA 94305, USA; ChEM-H Institute, Stanford University, Stanford, CA 94305, USA; Chan Zuckerberg Biohub, San Francisco, CA 94110, USA
| | - Eric Andrew Appel
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA; Department of Materials Science & Engineering, Stanford University, Stanford, CA 94305, USA
| | - Yi-Ping Joseph Woo
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA; Department of Cardiothoracic Surgery, Stanford University, Stanford, CA 94305, USA.
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4
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Wang H, Pong T, Obafemi OO, Lucian HJ, Aparicio-Valenzuela J, Tran NA, Mullis DM, Elde S, Tada Y, Baker SW, Wang CY, Cyr KJ, Paulsen MJ, Zhu Y, Lee AM, Woo YJ. Electrophysiologic Conservation of Epicardial Conduction Dynamics After Myocardial Infarction and Natural Heart Regeneration in Newborn Piglets. Front Cardiovasc Med 2022; 9:829546. [PMID: 35355973 PMCID: PMC8959497 DOI: 10.3389/fcvm.2022.829546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
Newborn mammals, including piglets, exhibit natural heart regeneration after myocardial infarction (MI) on postnatal day 1 (P1), but this ability is lost by postnatal day 7 (P7). The electrophysiologic properties of this naturally regenerated myocardium have not been examined. We hypothesized that epicardial conduction is preserved after P1 MI in piglets. Yorkshire-Landrace piglets underwent left anterior descending coronary artery ligation at age P1 (n = 6) or P7 (n = 7), After 7 weeks, cardiac magnetic resonance imaging was performed with late gadolinium enhancement for analysis of fibrosis. Epicardial conduction mapping was performed using custom 3D-printed high-resolution mapping arrays. Age- and weight-matched healthy pigs served as controls (n = 6). At the study endpoint, left ventricular (LV) ejection fraction was similar for controls and P1 pigs (46.4 ± 3.0% vs. 40.3 ± 4.9%, p = 0.132), but significantly depressed for P7 pigs (30.2 ± 6.6%, p < 0.001 vs. control). The percentage of LV myocardial volume consisting of fibrotic scar was 1.0 ± 0.4% in controls, 9.9 ± 4.4% in P1 pigs (p = 0.002 vs. control), and 17.3 ± 4.6% in P7 pigs (p < 0.001 vs. control, p = 0.007 vs. P1). Isochrone activation maps and apex activation time were similar between controls and P1 pigs (9.4 ± 1.6 vs. 7.8 ± 0.9 ms, p = 0.649), but significantly prolonged in P7 pigs (21.3 ± 5.1 ms, p < 0.001 vs. control, p < 0.001 vs. P1). Conduction velocity was similar between controls and P1 pigs (1.0 ± 0.2 vs. 1.1 ± 0.4 mm/ms, p = 0.852), but slower in P7 pigs (0.7 ± 0.2 mm/ms, p = 0.129 vs. control, p = 0.052 vs. P1). Overall, our data suggest that epicardial conduction dynamics are conserved in the setting of natural heart regeneration in piglets after P1 MI.
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Affiliation(s)
- Hanjay Wang
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, United States
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, United States
| | - Terrence Pong
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, United States
| | | | - Haley J. Lucian
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, United States
| | | | - Nicholas A. Tran
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, United States
| | - Danielle M. Mullis
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, United States
| | - Stefan Elde
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, United States
| | - Yuko Tada
- Department of Cardiovascular Medicine, Stanford University, Stanford, CA, United States
| | - Sam W. Baker
- Department of Comparative Medicine, Stanford University, Stanford, CA, United States
| | - Caroline Y. Wang
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, United States
| | - Kevin J. Cyr
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, United States
| | - Michael J. Paulsen
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, United States
| | - Yuanjia Zhu
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, United States
- Department of Bioengineering, Stanford University, Stanford, CA, United States
| | - Anson M. Lee
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, United States
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, United States
| | - Y. Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, United States
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, United States
- Department of Bioengineering, Stanford University, Stanford, CA, United States
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5
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Wang H, Wisneski A, Imbrie-Moore AM, Paulsen MJ, Wang Z, Xuan Y, Lopez Hernandez H, Hironaka CE, Lucian HJ, Shin HS, Anilkumar S, Thakore AD, Farry JM, Eskandari A, Williams KM, Grady F, Wu MA, Jung J, Stapleton LM, Steele AN, Zhu Y, Woo YJ. Natural cardiac regeneration conserves native biaxial left ventricular biomechanics after myocardial infarction in neonatal rats. J Mech Behav Biomed Mater 2022; 126:105074. [PMID: 35030471 PMCID: PMC8899021 DOI: 10.1016/j.jmbbm.2022.105074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 12/23/2021] [Accepted: 01/02/2022] [Indexed: 02/03/2023]
Abstract
After myocardial infarction (MI), adult mammals exhibit scar formation, adverse left ventricular (LV) remodeling, LV stiffening, and impaired contractility, ultimately resulting in heart failure. Neonatal mammals, however, are capable of natural heart regeneration after MI. We hypothesized that neonatal cardiac regeneration conserves native biaxial LV mechanics after MI. Wistar rat neonates (1 day old, n = 46) and adults (8-10 weeks old, n = 20) underwent sham surgery or permanent left anterior descending coronary artery ligation. At 6 weeks after neonatal MI, Masson's trichrome staining revealed negligible fibrosis. Echocardiography for the neonatal MI (n = 15) and sham rats (n = 14) revealed no differences in LV wall thickness or chamber diameter, and both groups had normal ejection fraction (72.7% vs 77.5%, respectively, p = 0.1946). Biaxial tensile testing revealed similar stress-strain curves along both the circumferential and longitudinal axes across a full range of physiologic stresses and strains. The circumferential modulus (267.9 kPa vs 274.2 kPa, p = 0.7847), longitudinal modulus (269.3 kPa vs 277.1 kPa, p = 0.7435), and maximum shear stress (3.30 kPa vs 3.95 kPa, p = 0.5418) did not differ significantly between the neonatal MI and sham groups, respectively. In contrast, transmural scars were observed at 4 weeks after adult MI. Adult MI hearts (n = 7) exhibited profound LV wall thinning (p < 0.0001), chamber dilation (p = 0.0246), and LV dysfunction (ejection fraction 45.4% vs 79.7%, p < 0.0001) compared to adult sham hearts (n = 7). Adult MI hearts were significantly stiffer than adult sham hearts in both the circumferential (321.5 kPa vs 180.0 kPa, p = 0.0111) and longitudinal axes (315.4 kPa vs 172.3 kPa, p = 0.0173), and also exhibited greater maximum shear stress (14.87 kPa vs 3.23 kPa, p = 0.0162). Our study is the first to show that native biaxial LV mechanics are conserved after neonatal heart regeneration following MI, thus adding biomechanical support for the therapeutic potential of cardiac regeneration in the treatment of ischemic heart disease.
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Affiliation(s)
- Hanjay Wang
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Andrew Wisneski
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Annabel M Imbrie-Moore
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA; Department of Mechanical Engineering, Stanford University, Stanford, CA, USA
| | - Michael J Paulsen
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Zhongjie Wang
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Yue Xuan
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | | | - Camille E Hironaka
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Haley J Lucian
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Hye Sook Shin
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Shreya Anilkumar
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Akshara D Thakore
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Justin M Farry
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Anahita Eskandari
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Kiah M Williams
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Frederick Grady
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Matthew A Wu
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Jinsuh Jung
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Lyndsay M Stapleton
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA; Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Amanda N Steele
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA; Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Yuanjia Zhu
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA; Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA; Department of Bioengineering, Stanford University, Stanford, CA, USA.
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6
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Wang H, Hironaka CE, Mullis DM, Lucian HJ, Shin HS, Tran NA, Thakore AD, Anilkumar S, Wu MA, Paulsen MJ, Zhu Y, Baker SW, Woo YJ. A neonatal leporine model of age-dependent natural heart regeneration after myocardial infarction. J Thorac Cardiovasc Surg 2021; 164:e389-e405. [PMID: 34649718 DOI: 10.1016/j.jtcvs.2021.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 07/13/2021] [Accepted: 08/01/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Neonatal rodents and piglets naturally regenerate the injured heart after myocardial infarction. We hypothesized that neonatal rabbits also exhibit natural heart regeneration after myocardial infarction. METHODS New Zealand white rabbit kits underwent sham surgery or left coronary ligation on postnatal day 1 (n = 94), postnatal day 4 (n = 11), or postnatal day 7 (n = 52). Hearts were explanted 1 day postsurgery to confirm ischemic injury, at 1 week postsurgery to assess cardiomyocyte proliferation, and at 3 weeks postsurgery to assess left ventricular ejection fraction and scar size. Data are presented as mean ± standard deviation. RESULTS Size of ischemic injury as a percentage of left ventricular area was similar after myocardial infarction on postnatal day 1 versus on postnatal day 7 (42.3% ± 5.4% vs 42.3% ± 4.7%, P = .9984). Echocardiography confirmed severely reduced ejection fraction at 1 day after postnatal day 1 myocardial infarction (33.7% ± 5.3% vs 65.2% ± 5.5% for postnatal day 1 sham, P = .0001), but no difference at 3 weeks after postnatal day 1 myocardial infarction (56.0% ± 4.0% vs 58.0% ± 3.3% for postnatal day 1 sham, P = .2198). Ejection fraction failed to recover after postnatal day 4 myocardial infarction (49.2% ± 1.8% vs 58.5% ± 5.8% for postnatal day 4 sham, P = .0109) and postnatal day 7 myocardial infarction (39.0% ± 7.8% vs 60.2% ± 5.0% for postnatal day 7 sham, P < .0001). At 3 weeks after infarction, fibrotic scar represented 5.3% ± 1.9%, 14.3% ± 4.9%, and 25.4% ± 13.3% of the left ventricle area in the postnatal day 1, postnatal day 4, and postnatal day 7 groups, respectively. An increased proportion of peri-infarct cardiomyocytes expressed Ki67 (15.9% ± 1.8% vs 10.2% ± 0.8%, P = .0039) and aurora B kinase (4.0% ± 0.9% vs 1.5% ± 0.6%, P = .0088) after postnatal day 1 myocardial infarction compared with sham, but no increase was observed after postnatal day 7 myocardial infarction. CONCLUSIONS A neonatal leporine myocardial infarction model reveals that newborn rabbits are capable of age-dependent natural heart regeneration.
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Affiliation(s)
- Hanjay Wang
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif; Stanford Cardiovascular Institute, Stanford University, Stanford, Calif
| | - Camille E Hironaka
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
| | - Danielle M Mullis
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
| | - Haley J Lucian
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
| | - Hye Sook Shin
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
| | - Nicholas A Tran
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
| | - Akshara D Thakore
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
| | - Shreya Anilkumar
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
| | - Matthew A Wu
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
| | - Michael J Paulsen
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
| | - Yuanjia Zhu
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif; Department of Bioengineering, Stanford University, Stanford, Calif
| | - Sam W Baker
- Department of Comparative Medicine, Stanford University, Stanford, Calif
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif; Stanford Cardiovascular Institute, Stanford University, Stanford, Calif; Department of Bioengineering, Stanford University, Stanford, Calif.
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7
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Elde S, Wang H, Woo YJ. The Expanding Armamentarium of Innovative Bioengineered Strategies to Augment Cardiovascular Repair and Regeneration. Front Bioeng Biotechnol 2021; 9:674172. [PMID: 34141702 PMCID: PMC8205517 DOI: 10.3389/fbioe.2021.674172] [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: 02/28/2021] [Accepted: 04/13/2021] [Indexed: 11/27/2022] Open
Abstract
Cardiovascular disease remains the leading cause of death worldwide. While clinical trials of cell therapy have demonstrated largely neutral results, recent investigations into the mechanisms of natural myocardial regeneration have demonstrated promising new intersections between molecular, cellular, tissue, biomaterial, and biomechanical engineering solutions. New insight into the crucial role of inflammation in natural regenerative processes may explain why previous efforts have yielded only modest degrees of regeneration. Furthermore, the new understanding of the interdependent relationship of inflammation and myocardial regeneration have catalyzed the emergence of promising new areas of investigation at the intersection of many fields.
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Affiliation(s)
- Stefan Elde
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, United States
| | - Hanjay Wang
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, United States.,Stanford Cardiovascular Institute, Stanford University, Stanford, CA, United States
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, United States.,Stanford Cardiovascular Institute, Stanford University, Stanford, CA, United States.,Department of Bioengineering, Stanford University, Stanford, CA, United States
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8
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Elde S, Wang H, Woo YJ. Navigating the Crossroads of Cell Therapy and Natural Heart Regeneration. Front Cell Dev Biol 2021; 9:674180. [PMID: 34046410 PMCID: PMC8148343 DOI: 10.3389/fcell.2021.674180] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/15/2021] [Indexed: 01/14/2023] Open
Abstract
Cardiovascular disease remains the leading cause of death worldwide despite significant advances in our understanding of the disease and its treatment. Consequently, the therapeutic potential of cell therapy and induction of natural myocardial regeneration have stimulated a recent surge of research and clinical trials aimed at addressing this challenge. Recent developments in the field have shed new light on the intricate relationship between inflammation and natural regeneration, an intersection that warrants further investigation.
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Affiliation(s)
- Stefan Elde
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, United States
| | - Hanjay Wang
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, United States.,Stanford Cardiovascular Institute, Stanford University, Stanford, CA, United States
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, United States.,Stanford Cardiovascular Institute, Stanford University, Stanford, CA, United States.,Department of Bioengineering, Stanford University, Stanford, CA, United States
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9
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Cohen JE, Goldstone AB, Wang H, Purcell BP, Shudo Y, MacArthur JW, Steele AN, Paulsen MJ, Edwards BB, Aribeana CN, Cheung NC, Burdick JA, Woo YJ. A Bioengineered Neuregulin-Hydrogel Therapy Reduces Scar Size and Enhances Post-Infarct Ventricular Contractility in an Ovine Large Animal Model. J Cardiovasc Dev Dis 2020; 7:jcdd7040053. [PMID: 33212844 PMCID: PMC7711763 DOI: 10.3390/jcdd7040053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 09/26/2020] [Accepted: 10/26/2020] [Indexed: 12/11/2022] Open
Abstract
The clinical efficacy of neuregulin (NRG) in the treatment of heart failure is hindered by off-target exposure due to systemic delivery. We previously encapsulated neuregulin in a hydrogel (HG) for targeted and sustained myocardial delivery, demonstrating significant induction of cardiomyocyte proliferation and preservation of post-infarct cardiac function in a murine myocardial infarction (MI) model. Here, we performed a focused evaluation of our hydrogel-encapsulated neuregulin (NRG-HG) therapy’s potential to enhance cardiac function in an ovine large animal MI model. Adult male Dorset sheep (n = 21) underwent surgical induction of MI by coronary artery ligation. The sheep were randomized to receive an intramyocardial injection of saline, HG only, NRG only, or NRG-HG circumferentially around the infarct borderzone. Eight weeks after MI, closed-chest intracardiac pressure–volume hemodynamics were assessed, followed by heart explant for infarct size analysis. Compared to each of the control groups, NRG-HG significantly augmented left ventricular ejection fraction (p = 0.006) and contractility based on the slope of the end-systolic pressure–volume relationship (p = 0.006). NRG-HG also significantly reduced infarct scar size (p = 0.002). Overall, using a bioengineered hydrogel delivery system, a one-time dose of NRG delivered intramyocardially to the infarct borderzone at the time of MI in adult sheep significantly reduces scar size and enhances ventricular contractility at 8 weeks after MI.
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Affiliation(s)
- Jeffrey E. Cohen
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA 94305, USA; (J.E.C.); (A.B.G.); (H.W.); (Y.S.); (J.W.M.); (A.N.S.); (M.J.P.); (B.B.E.); (C.N.A.); (N.C.C.)
| | - Andrew B. Goldstone
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA 94305, USA; (J.E.C.); (A.B.G.); (H.W.); (Y.S.); (J.W.M.); (A.N.S.); (M.J.P.); (B.B.E.); (C.N.A.); (N.C.C.)
| | - Hanjay Wang
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA 94305, USA; (J.E.C.); (A.B.G.); (H.W.); (Y.S.); (J.W.M.); (A.N.S.); (M.J.P.); (B.B.E.); (C.N.A.); (N.C.C.)
| | - Brendan P. Purcell
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA; (B.P.P.); (J.A.B.)
| | - Yasuhiro Shudo
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA 94305, USA; (J.E.C.); (A.B.G.); (H.W.); (Y.S.); (J.W.M.); (A.N.S.); (M.J.P.); (B.B.E.); (C.N.A.); (N.C.C.)
| | - John W. MacArthur
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA 94305, USA; (J.E.C.); (A.B.G.); (H.W.); (Y.S.); (J.W.M.); (A.N.S.); (M.J.P.); (B.B.E.); (C.N.A.); (N.C.C.)
| | - Amanda N. Steele
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA 94305, USA; (J.E.C.); (A.B.G.); (H.W.); (Y.S.); (J.W.M.); (A.N.S.); (M.J.P.); (B.B.E.); (C.N.A.); (N.C.C.)
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
| | - Michael J. Paulsen
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA 94305, USA; (J.E.C.); (A.B.G.); (H.W.); (Y.S.); (J.W.M.); (A.N.S.); (M.J.P.); (B.B.E.); (C.N.A.); (N.C.C.)
| | - Bryan B. Edwards
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA 94305, USA; (J.E.C.); (A.B.G.); (H.W.); (Y.S.); (J.W.M.); (A.N.S.); (M.J.P.); (B.B.E.); (C.N.A.); (N.C.C.)
| | - Chiaka N. Aribeana
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA 94305, USA; (J.E.C.); (A.B.G.); (H.W.); (Y.S.); (J.W.M.); (A.N.S.); (M.J.P.); (B.B.E.); (C.N.A.); (N.C.C.)
| | - Nicholas C. Cheung
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA 94305, USA; (J.E.C.); (A.B.G.); (H.W.); (Y.S.); (J.W.M.); (A.N.S.); (M.J.P.); (B.B.E.); (C.N.A.); (N.C.C.)
| | - Jason A. Burdick
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA; (B.P.P.); (J.A.B.)
| | - Y. Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA 94305, USA; (J.E.C.); (A.B.G.); (H.W.); (Y.S.); (J.W.M.); (A.N.S.); (M.J.P.); (B.B.E.); (C.N.A.); (N.C.C.)
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
- Correspondence: ; Tel.: 1-650-725-3828
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10
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Wang H, Bennett-Kennett R, Paulsen MJ, Hironaka CE, Thakore AD, Farry JM, Eskandari A, Lucian HJ, Shin HS, Wu MA, Imbrie-Moore AM, Steele AN, Stapleton LM, Zhu Y, Dauskardt RH, Woo YJ. Multiaxial Lenticular Stress-Strain Relationship of Native Myocardium is Preserved by Infarct-Induced Natural Heart Regeneration in Neonatal Mice. Sci Rep 2020; 10:7319. [PMID: 32355240 PMCID: PMC7193551 DOI: 10.1038/s41598-020-63324-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 03/13/2020] [Indexed: 12/16/2022] Open
Abstract
Neonatal mice exhibit natural heart regeneration after myocardial infarction (MI) on postnatal day 1 (P1), but this ability is lost by postnatal day 7 (P7). Cardiac biomechanics intricately affect long-term heart function, but whether regenerated cardiac muscle is biomechanically similar to native myocardium remains unknown. We hypothesized that neonatal heart regeneration preserves native left ventricular (LV) biomechanical properties after MI. C57BL/6J mice underwent sham surgery or left anterior descending coronary artery ligation at age P1 or P7. Echocardiography performed 4 weeks post-MI showed that P1 MI and sham mice (n = 22, each) had similar LV wall thickness, diameter, and ejection fraction (59.6% vs 60.7%, p = 0.6514). Compared to P7 shams (n = 20), P7 MI mice (n = 20) had significant LV wall thinning, chamber enlargement, and depressed ejection fraction (32.6% vs 61.8%, p < 0.0001). Afterward, the LV was explanted and pressurized ex vivo, and the multiaxial lenticular stress-strain relationship was tracked. While LV tissue modulus for P1 MI and sham mice were similar (341.9 kPa vs 363.4 kPa, p = 0.6140), the modulus for P7 MI mice was significantly greater than that for P7 shams (691.6 kPa vs 429.2 kPa, p = 0.0194). We conclude that, in neonatal mice, regenerated LV muscle has similar biomechanical properties as native LV myocardium.
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Affiliation(s)
- Hanjay Wang
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Ross Bennett-Kennett
- Department of Materials Science and Engineering, Stanford University, Stanford, CA, USA
| | - Michael J Paulsen
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Camille E Hironaka
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Akshara D Thakore
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Justin M Farry
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Anahita Eskandari
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Haley J Lucian
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Hye Sook Shin
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Matthew A Wu
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Annabel M Imbrie-Moore
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
- Department of Mechanical Engineering, Stanford University, Stanford, CA, USA
| | - Amanda N Steele
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Lyndsay M Stapleton
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Yuanjia Zhu
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Reinhold H Dauskardt
- Department of Materials Science and Engineering, Stanford University, Stanford, CA, USA
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA.
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA.
- Department of Bioengineering, Stanford University, Stanford, CA, USA.
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11
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Steele AN, Paulsen MJ, Wang H, Stapleton LM, Lucian HJ, Eskandari A, Hironaka CE, Farry JM, Baker SW, Thakore AD, Jaatinen KJ, Tada Y, Hollander MJ, Williams KM, Seymour AJ, Totherow KP, Yu AC, Cochran JR, Appel EA, Woo YJ. Multi-phase catheter-injectable hydrogel enables dual-stage protein-engineered cytokine release to mitigate adverse left ventricular remodeling following myocardial infarction in a small animal model and a large animal model. Cytokine 2020; 127:154974. [DOI: 10.1016/j.cyto.2019.154974] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/18/2019] [Accepted: 12/26/2019] [Indexed: 10/25/2022]
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12
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Natural Heart Regeneration in a Neonatal Rat Myocardial Infarction Model. Cells 2020; 9:cells9010229. [PMID: 31963369 PMCID: PMC7017245 DOI: 10.3390/cells9010229] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/06/2020] [Accepted: 01/13/2020] [Indexed: 01/09/2023] Open
Abstract
Newborn mice and piglets exhibit natural heart regeneration after myocardial infarction (MI). Discovering other mammals with this ability would provide evidence that neonatal cardiac regeneration after MI may be a conserved phenotype, which if activated in adults could open new options for treating ischemic cardiomyopathy in humans. Here, we hypothesized that newborn rats undergo natural heart regeneration after MI. Using a neonatal rat MI model, we performed left anterior descending coronary artery ligation or sham surgery in one-day-old rats under hypothermic circulatory arrest (n = 74). Operative survival was 97.3%. At 1 day post-surgery, rats in the MI group exhibited significantly reduced ejection fraction (EF) compared to shams (87.1% vs. 53.0%, p < 0.0001). At 3 weeks post-surgery, rats in the sham and MI groups demonstrated no difference in EF (71.1% vs. 69.2%, respectively, p = 0.2511), left ventricular wall thickness (p = 0.9458), or chamber diameter (p = 0.7801). Masson's trichome and picrosirius red staining revealed minimal collagen scar after MI. Increased numbers of cardiomyocytes positive for 5-ethynyl-2'-deoxyuridine (p = 0.0072), Ki-67 (p = 0.0340), and aurora B kinase (p = 0.0430) were observed within the peri-infarct region after MI, indicating ischemia-induced cardiomyocyte proliferation. Overall, we present a neonatal rat MI model and demonstrate that newborn rats are capable of endogenous neocardiomyogenesis after MI.
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