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Wu M, Pokreisz P, Claus P, Casazza A, Gillijns H, Caluwé E, De Petrini M, Belmans A, Reyns G, Collen D, Janssens SP. Recombinant human placental growth factor-2 in post-infarction left ventricular dysfunction: a randomized, placebo-controlled, preclinical study. Basic Res Cardiol 2024:10.1007/s00395-024-01069-7. [PMID: 39090343 DOI: 10.1007/s00395-024-01069-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 07/10/2024] [Accepted: 07/11/2024] [Indexed: 08/04/2024]
Abstract
Placental growth factor (PlGF)-2 induces angio- and arteriogenesis in rodents but its therapeutic potential in a clinically representative post-infarction left ventricular (LV) dysfunction model remains unclear. We, therefore, investigated the safety and efficacy of recombinant human (rh)PlGF-2 in the infarcted porcine heart in a randomized, placebo-controlled blinded study. We induced myocardial infarction (MI) in pigs using 75 min mid-LAD balloon occlusion followed by reperfusion. After 4 w, we randomized pigs with marked LV dysfunction (LVEF < 40%) to receive continuous intravenous infusion of 5, 15, 45 µg/kg/day rhPlGF-2 or PBS (CON) for 2 w using osmotic pumps. We evaluated the treatment effect at 8 w using comprehensive MRI and immunohistochemistry and measured myocardial PlGF-2 receptor transcript levels. At 4 w after MI, infarct size was 16-18 ± 4% of LV mass, resulting in significantly impaired systolic function (LVEF 34 ± 4%). In the pilot study (3 pigs/dose), PIGF administration showed sustained dose-dependent increases in plasma concentrations for 14 days without systemic toxicity and was associated with favorable post-infarct remodeling. In the second phase (n = 42), we detected no significant differences at 8 w between CON and PlGF-treated pigs in infarct size, capillary or arteriolar density, global LV function and regional myocardial blood flow at rest or during stress. Molecular analysis showed significant downregulation of the main PlGF-2 receptor, pVEGFR-1, in dysfunctional myocardium. Chronic rhPIGF-2 infusion was safe but failed to induce therapeutic neovascularization and improve global cardiac function after myocardial infarction in pigs. Our data emphasize the critical need for properly designed trials in representative large animal models before translating presumed promising therapies to patients.
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Affiliation(s)
- Ming Wu
- Department of Cardiovascular Sciences, KU Leuven, Campus Gasthuisberg, O&N1, 49 Herestraat, 3000, Leuven, Belgium
| | - Peter Pokreisz
- Department of Cardiovascular Sciences, KU Leuven, Campus Gasthuisberg, O&N1, 49 Herestraat, 3000, Leuven, Belgium
- Center for Biomedical Research and Translational Surgery, Medical University of Vienna, Vienna, Austria
- CoBioRes NV, Leuven, Belgium
| | - Piet Claus
- Department of Cardiovascular Sciences, KU Leuven, Campus Gasthuisberg, O&N1, 49 Herestraat, 3000, Leuven, Belgium
| | | | - Hilde Gillijns
- Department of Cardiovascular Sciences, KU Leuven, Campus Gasthuisberg, O&N1, 49 Herestraat, 3000, Leuven, Belgium
| | - Ellen Caluwé
- Department of Cardiovascular Sciences, KU Leuven, Campus Gasthuisberg, O&N1, 49 Herestraat, 3000, Leuven, Belgium
| | | | - Ann Belmans
- Leuven Biostatistics and Statistical Bioinformatics Center, KU Leuven, Leuven, Belgium
| | | | - Desire Collen
- Department of Cardiovascular Sciences, KU Leuven, Campus Gasthuisberg, O&N1, 49 Herestraat, 3000, Leuven, Belgium
- CoBioRes NV, Leuven, Belgium
| | - Stefan P Janssens
- Department of Cardiovascular Sciences, KU Leuven, Campus Gasthuisberg, O&N1, 49 Herestraat, 3000, Leuven, Belgium.
- Department of Cardiology, University Hospital Leuven, Leuven, Belgium.
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Wu M, Pelacho B, Claus P, De Buck S, Veltman D, Gillijns H, Holemans P, Pokreisz P, Caluwé E, Iglesias Colino E, Cohen S, Prosper F, Janssens S. Alginate sulfate-nanoparticles loaded with hepatocyte growth factor and insulin-like growth factor-1 improve left ventricular repair in a porcine model of myocardial ischemia reperfusion injury. Eur J Pharm Biopharm 2023; 184:83-91. [PMID: 36693545 DOI: 10.1016/j.ejpb.2023.01.012] [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: 09/28/2022] [Revised: 01/09/2023] [Accepted: 01/19/2023] [Indexed: 01/22/2023]
Abstract
Nanomedicine offers great potential for the treatment of cardiovascular disease and particulate systems have the capacity to markedly improve bioavailability of therapeutics. The delivery of pro-angiogenic hepatocyte growth factor (HGF) and pro-survival and pro-myogenic insulin-like growth factor (IGF-1) encapsulated in Alginate-Sulfate nanoparticles (AlgS-NP) might improve left ventricular (LV) functional recovery after myocardial infarction (MI). In a porcine ischemia-reperfusion model, MI is induced by 75 min balloon occlusion of the mid-left anterior descending coronary artery followed by reperfusion. After 1 week, pigs (n = 12) with marked LV-dysfunction (LV ejection fraction, LVEF < 45%) are randomized to fusion imaging-guided intramyocardial injections of 8 mg AlgS-NP prepared with 200 µg HGF and IGF-1 (HGF/IGF1-NP) or PBS (Control). Intramyocardial injection is safe and pharmacokinetic studies of Cy5-labeled NP confirm superior cardiac retention compared to intracoronary infusion. Seven weeks after intramyocardial-injection of HGF/IGF1-NP, infarct size, measured using magnetic resonance imaging, is significantly smaller than in controls and is associated with increased coronary flow reserve. Importantly, HGF/IGF1-NP-treated pigs show significantly increased LVEF accompanied by improved myocardial remodeling. These findings demonstrate the feasibility and efficacy of using AlgS-NP as a delivery system for growth factors and offer the prospect of innovative treatment for refractory ischemic cardiomyopathy.
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Affiliation(s)
- Ming Wu
- Department of Cardiovascular Sciences, University of Leuven, KU Leuven, B-3000 Leuven, Belgium
| | - Beatriz Pelacho
- Hematology-Oncology and Regenerative Medicine, Clínica Universidad de Navarra and Center for Applied Medical Research, University of Navarra, Pamplona, PC 31008, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, PC 31008, Spain
| | - Piet Claus
- Department of Cardiovascular Sciences, University of Leuven, KU Leuven, B-3000 Leuven, Belgium
| | - Stijn De Buck
- Department of Cardiology, University Hospital Leuven, B-3000 Leuven, Belgium
| | - Denise Veltman
- Department of Cardiovascular Sciences, University of Leuven, KU Leuven, B-3000 Leuven, Belgium
| | - Hilde Gillijns
- Department of Cardiovascular Sciences, University of Leuven, KU Leuven, B-3000 Leuven, Belgium
| | - Patricia Holemans
- Department of Cardiovascular Sciences, University of Leuven, KU Leuven, B-3000 Leuven, Belgium
| | - Peter Pokreisz
- Department of Cardiovascular Sciences, University of Leuven, KU Leuven, B-3000 Leuven, Belgium; Center for Biomedical Research and Translational Surgery, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Ellen Caluwé
- Department of Cardiovascular Sciences, University of Leuven, KU Leuven, B-3000 Leuven, Belgium
| | - Estefania Iglesias Colino
- Hematology-Oncology and Regenerative Medicine, Clínica Universidad de Navarra and Center for Applied Medical Research, University of Navarra, Pamplona, PC 31008, Spain
| | - Smadar Cohen
- Avram and Stella Goldstein-Goren Department of Biotechnology Engineering and Regenerative Medicine and Stem Cell Research Center, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
| | - Felipe Prosper
- Hematology-Oncology and Regenerative Medicine, Clínica Universidad de Navarra and Center for Applied Medical Research, University of Navarra, Pamplona, PC 31008, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, PC 31008, Spain; Centro de Investigación Biomédica en Red de Cáncer, CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | - Stefan Janssens
- Department of Cardiovascular Sciences, University of Leuven, KU Leuven, B-3000 Leuven, Belgium; Department of Cardiology, University Hospital Leuven, B-3000 Leuven, Belgium.
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Amoni M, Dries E, Ingelaere S, Vermoortele D, Roderick HL, Claus P, Willems R, Sipido KR. Ventricular Arrhythmias in Ischemic Cardiomyopathy-New Avenues for Mechanism-Guided Treatment. Cells 2021; 10:2629. [PMID: 34685609 PMCID: PMC8534043 DOI: 10.3390/cells10102629] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 12/13/2022] Open
Abstract
Ischemic heart disease is the most common cause of lethal ventricular arrhythmias and sudden cardiac death (SCD). In patients who are at high risk after myocardial infarction, implantable cardioverter defibrillators are the most effective treatment to reduce incidence of SCD and ablation therapy can be effective for ventricular arrhythmias with identifiable culprit lesions. Yet, these approaches are not always successful and come with a considerable cost, while pharmacological management is often poor and ineffective, and occasionally proarrhythmic. Advances in mechanistic insights of arrhythmias and technological innovation have led to improved interventional approaches that are being evaluated clinically, yet pharmacological advancement has remained behind. We review the mechanistic basis for current management and provide a perspective for gaining new insights that centre on the complex tissue architecture of the arrhythmogenic infarct and border zone with surviving cardiac myocytes as the source of triggers and central players in re-entry circuits. Identification of the arrhythmia critical sites and characterisation of the molecular signature unique to these sites can open avenues for targeted therapy and reduce off-target effects that have hampered systemic pharmacotherapy. Such advances are in line with precision medicine and a patient-tailored therapy.
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Affiliation(s)
- Matthew Amoni
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium; (M.A.); (E.D.); (S.I.); (H.L.R.); (R.W.)
- Division of Cardiology, University Hospitals Leuven, 3000 Leuven, Belgium
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7935, South Africa
| | - Eef Dries
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium; (M.A.); (E.D.); (S.I.); (H.L.R.); (R.W.)
| | - Sebastian Ingelaere
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium; (M.A.); (E.D.); (S.I.); (H.L.R.); (R.W.)
- Division of Cardiology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Dylan Vermoortele
- Imaging and Cardiovascular Dynamics, Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium; (D.V.); (P.C.)
| | - H. Llewelyn Roderick
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium; (M.A.); (E.D.); (S.I.); (H.L.R.); (R.W.)
| | - Piet Claus
- Imaging and Cardiovascular Dynamics, Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium; (D.V.); (P.C.)
| | - Rik Willems
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium; (M.A.); (E.D.); (S.I.); (H.L.R.); (R.W.)
- Division of Cardiology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Karin R. Sipido
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium; (M.A.); (E.D.); (S.I.); (H.L.R.); (R.W.)
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Veltman D, Wu M, Pokreisz P, Claus P, Gillijns H, Caluwé E, Vanhaverbeke M, Gsell W, Himmelreich U, Sinnaeve PR, Janssens SP. Clec4e-Receptor Signaling in Myocardial Repair After Ischemia-Reperfusion Injury. JACC Basic Transl Sci 2021; 6:631-646. [PMID: 34466750 PMCID: PMC8385568 DOI: 10.1016/j.jacbts.2021.07.001] [Citation(s) in RCA: 9] [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] [Received: 04/05/2021] [Revised: 07/02/2021] [Accepted: 07/02/2021] [Indexed: 01/02/2023]
Abstract
The role of the CLEC4E during myocardial healing after ischemia-reperfusion injury is unknown. CLEC4E deletion is associated with reduced cardiac injury, inflammation, and left ventricular structural and functional remodeling. CLEC4E is a promising target to modulate myocardial inflammation and enhance repair after ischemia-reperfusion injury.
The bacterial C-type lectin domain family 4 member E (CLEC4E) has an important role in sterile inflammation, but its role in myocardial repair is unknown. Using complementary approaches in porcine, murine, and human samples, we show that CLEC4E expression levels in the myocardium and in blood correlate with the extent of myocardial injury and left ventricular (LV) functional impairment. CLEC4E expression is markedly increased in the vasculature, cardiac myocytes, and infiltrating leukocytes in the ischemic heart. Loss of Clec4e signaling is associated with reduced acute cardiac injury, neutrophil infiltration, and infarct size. Reduced myocardial injury in Clec4e–/– translates into significantly improved LV structural and functional remodeling at 4 weeks’ follow-up. The early transcriptome of LV tissue from Clec4e–/– mice versus wild-type mice reveals significant upregulation of transcripts involved in myocardial metabolism, radical scavenging, angiogenesis, and extracellular matrix organization. Therefore, targeting CLEC4E in the early phase of ischemia-reperfusion injury is a promising therapeutic strategy to modulate myocardial inflammation and enhance repair after ischemia-reperfusion injury.
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Key Words
- ACS, acute coronary syndrome
- AMI, acute myocardial infarction
- ANOVA, analysis of variance
- CAD, coronary artery disease
- CLEC4E
- CLEC4E, C-type lectin domain family 4 member E
- CMC, cardiac myocyte
- Car3, carbonic anhydrase 3
- Cxcl2, CXC chemokine ligand 2
- Cxcr2, CXC chemokine receptor 2
- DAMP, damage-associated molecular pattern
- ECM, extracellular matrix
- ESV, end-systolic volume
- Efna2, ephrin A2
- Grk2, G protein–coupled receptor kinase 2
- I/R, ischemia-reperfusion
- LAD, left anterior descending coronary artery
- LV, left ventricular
- MPO, myeloperoxidase
- MRI, magnetic resonance imaging
- NS, not significant
- PRR, pattern recognition receptor
- RNA, ribonucleic acid
- SMC, smooth muscle cell
- STEMI, ST-segment elevation myocardial infarction
- TnT, troponin T
- WT, wild-type
- hs-TnI, high-sensitivity troponin I
- inflammation
- ischemia-reperfusion injury
- magnetic resonance imaging
- myocardial remodeling
- qRT-PCR, quantitative reverse transcription polymerase chain reaction
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Affiliation(s)
- Denise Veltman
- Department of Cardiovascular Sciences, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Ming Wu
- Department of Cardiovascular Sciences, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Peter Pokreisz
- Department of Cardiovascular Sciences, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Piet Claus
- Department of Cardiovascular Sciences, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Hilde Gillijns
- Department of Cardiovascular Sciences, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Ellen Caluwé
- Department of Cardiovascular Sciences, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Maarten Vanhaverbeke
- Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
| | - Willy Gsell
- Department of Imaging and Pathology, Biomedical MRI, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Uwe Himmelreich
- Department of Imaging and Pathology, Biomedical MRI, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Peter R. Sinnaeve
- Department of Cardiovascular Sciences, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
| | - Stefan P. Janssens
- Department of Cardiovascular Sciences, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
- Address for correspondence: Dr Stefan P. Janssens, Department of Cardiovascular Sciences, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
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Pyridoxamine improves survival and limits cardiac dysfunction after MI. Sci Rep 2017; 7:16010. [PMID: 29167580 PMCID: PMC5700185 DOI: 10.1038/s41598-017-16255-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/09/2017] [Indexed: 01/13/2023] Open
Abstract
Advanced glycation end products (AGEs) play a key role in the progression of heart failure. Whether treatments limiting AGEs formation would prevent adverse left ventricular remodeling after myocardial infarction (MI) remain unknown. We investigated whether pyridoxamine (PM) could limit adverse cardiac outcome in MI. Rats were divided into MI, MI + PM and Sham. Echocardiography and hemodynamic parameters were used to assess cardiac function 8 weeks post-surgery. Total interstitial collagen, collagen I and collagen III were quantified using Sirius Red and polarized light microscopy. PM improved survival following LAD occlusion. Pre-treatment with PM significantly decreased the plasma AGEs levels. MI rats treated with PM displayed reduced left ventricular end-diastolic pressure and tau compared to untreated MI rats. Deformation parameters were also improved with PM. The preserved diastolic function was related to the reduced collagen content, in particular in the highly cross-linked collagen type I, mainly in the peri-infarct region, although not via TGF-β1 pathway. Our data indicate that PM treatment prevents the increase in AGEs levels and reduces collagen levels in a rat model of MI, resulting in an improved cardiac phenotype. As such, therapies targeting formation of AGEs might be beneficial in the prevention and/or treatment of maladaptive remodeling following MI.
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Galan DT, Bito V, Claus P, Holemans P, Abi-Char J, Nagaraju CK, Dries E, Vermeulen K, Ventura-Clapier R, Sipido KR, Driesen RB. Reduced mitochondrial respiration in the ischemic as well as in the remote nonischemic region in postmyocardial infarction remodeling. Am J Physiol Heart Circ Physiol 2016; 311:H1075-H1090. [PMID: 27614227 DOI: 10.1152/ajpheart.00945.2015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 08/07/2016] [Indexed: 11/22/2022]
Abstract
Scarring and remodeling of the left ventricle (LV) after myocardial infarction (MI) results in ischemic cardiomyopathy with reduced contractile function. Regional differences related to persisting ischemia may exist. We investigated the hypothesis that mitochondrial function and structure is altered in the myocardium adjacent to MI with reduced perfusion (MIadjacent) and less so in the remote, nonischemic myocardium (MIremote). We used a pig model of chronic coronary stenosis and MI (n = 13). Functional and perfusion MR imaging 6 wk after intervention showed reduced ejection fraction and increased global wall stress compared with sham-operated animals (Sham; n = 14). Regional strain in MIadjacent was reduced with reduced contractile reserve; in MIremote strain was also reduced but responsive to dobutamine and perfusion was normal compared with Sham. Capillary density was unchanged. Cardiac myocytes isolated from both regions had reduced basal and maximal oxygen consumption rate, as well as through complex I and II, but complex IV activity was unchanged. Reduced respiration was not associated with detectable reduction of mitochondrial density. There was no significant change in AMPK or glucose transporter expression levels, but glycogen content was significantly increased in both MIadjacent and MIremote Glycogen accumulation was predominantly perinuclear; mitochondria in this area were smaller but only in MIadjacent where also subsarcolemmal mitochondria were smaller. In conclusion, after MI reduction of mitochondrial respiration and glycogen accumulation occur in all LV regions suggesting that reduced perfusion does not lead to additional specific changes and that increased hemodynamic load is the major driver for changes in mitochondrial function.
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Affiliation(s)
- Diogo T Galan
- Division of Experimental Cardiology, KU Leuven, University of Leuven, Leuven, Belgium
| | - Virginie Bito
- Division of Experimental Cardiology, KU Leuven, University of Leuven, Leuven, Belgium
| | - Piet Claus
- Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, KU Leuven, University of Leuven, Leuven, Belgium; and
| | - Patricia Holemans
- Division of Experimental Cardiology, KU Leuven, University of Leuven, Leuven, Belgium
| | - Joëlle Abi-Char
- Division of Experimental Cardiology, KU Leuven, University of Leuven, Leuven, Belgium
| | - Chandan K Nagaraju
- Division of Experimental Cardiology, KU Leuven, University of Leuven, Leuven, Belgium
| | - Eef Dries
- Division of Experimental Cardiology, KU Leuven, University of Leuven, Leuven, Belgium
| | - Kristel Vermeulen
- Division of Experimental Cardiology, KU Leuven, University of Leuven, Leuven, Belgium
| | | | - Karin R Sipido
- Division of Experimental Cardiology, KU Leuven, University of Leuven, Leuven, Belgium;
| | - Ronald B Driesen
- Division of Experimental Cardiology, KU Leuven, University of Leuven, Leuven, Belgium
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Karim R, Bhagirath P, Claus P, James Housden R, Chen Z, Karimaghaloo Z, Sohn HM, Lara Rodríguez L, Vera S, Albà X, Hennemuth A, Peitgen HO, Arbel T, Gonzàlez Ballester MA, Frangi AF, Götte M, Razavi R, Schaeffter T, Rhode K. Evaluation of state-of-the-art segmentation algorithms for left ventricle infarct from late Gadolinium enhancement MR images. Med Image Anal 2016; 30:95-107. [PMID: 26891066 DOI: 10.1016/j.media.2016.01.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 11/12/2015] [Accepted: 01/15/2016] [Indexed: 11/17/2022]
Abstract
Studies have demonstrated the feasibility of late Gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging for guiding the management of patients with sequelae to myocardial infarction, such as ventricular tachycardia and heart failure. Clinical implementation of these developments necessitates a reproducible and reliable segmentation of the infarcted regions. It is challenging to compare new algorithms for infarct segmentation in the left ventricle (LV) with existing algorithms. Benchmarking datasets with evaluation strategies are much needed to facilitate comparison. This manuscript presents a benchmarking evaluation framework for future algorithms that segment infarct from LGE CMR of the LV. The image database consists of 30 LGE CMR images of both humans and pigs that were acquired from two separate imaging centres. A consensus ground truth was obtained for all data using maximum likelihood estimation. Six widely-used fixed-thresholding methods and five recently developed algorithms are tested on the benchmarking framework. Results demonstrate that the algorithms have better overlap with the consensus ground truth than most of the n-SD fixed-thresholding methods, with the exception of the Full-Width-at-Half-Maximum (FWHM) fixed-thresholding method. Some of the pitfalls of fixed thresholding methods are demonstrated in this work. The benchmarking evaluation framework, which is a contribution of this work, can be used to test and benchmark future algorithms that detect and quantify infarct in LGE CMR images of the LV. The datasets, ground truth and evaluation code have been made publicly available through the website: https://www.cardiacatlas.org/web/guest/challenges.
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Affiliation(s)
- Rashed Karim
- Department of Imaging Sciences & Biomedical Engineering, King's College London, UK.
| | - Pranav Bhagirath
- Department of Cardiology, Haga Teaching Hospital, The Netherlands
| | - Piet Claus
- Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, Universiteit Leuven, Belgium
| | - R James Housden
- Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, Universiteit Leuven, Belgium
| | - Zhong Chen
- Department of Imaging Sciences & Biomedical Engineering, King's College London, UK
| | | | - Hyon-Mok Sohn
- Department of Imaging Sciences & Biomedical Engineering, King's College London, UK
| | | | | | - Xènia Albà
- Centre for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Anja Hennemuth
- Fraunhofer Institute for Medical Image Computing, Fraunhofer MEVIS, Germany
| | - Heinz-Otto Peitgen
- Fraunhofer Institute for Medical Image Computing, Fraunhofer MEVIS, Germany
| | - Tal Arbel
- The Centre for Intelligence Machines, McGill University, Canada
| | | | - Alejandro F Frangi
- Centre for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), Department of Electronic & Electrical Engineering, University of Sheffield, Sheffield, UK
| | - Marco Götte
- Department of Cardiology, Haga Teaching Hospital, The Netherlands
| | - Reza Razavi
- Department of Imaging Sciences & Biomedical Engineering, King's College London, UK
| | - Tobias Schaeffter
- Department of Imaging Sciences & Biomedical Engineering, King's College London, UK
| | - Kawal Rhode
- Department of Imaging Sciences & Biomedical Engineering, King's College London, UK
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Placental growth factor 2 — A potential therapeutic strategy for chronic myocardial ischemia. Int J Cardiol 2016; 203:534-42. [DOI: 10.1016/j.ijcard.2015.10.177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 10/22/2015] [Accepted: 10/24/2015] [Indexed: 12/17/2022]
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9
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Cyclosporine A reduces microvascular obstruction and preserves left ventricular function deterioration following myocardial ischemia and reperfusion. Basic Res Cardiol 2015; 110:18. [PMID: 25720581 PMCID: PMC4342514 DOI: 10.1007/s00395-015-0475-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 01/31/2015] [Accepted: 02/18/2015] [Indexed: 12/13/2022]
Abstract
Postconditioning and cyclosporine A prevent mitochondrial permeability transition pore opening providing cardioprotection during ischemia/reperfusion. Whether microvascular obstruction is affected by these interventions is largely unknown. Pigs subjected to coronary occlusion for 1 h followed by 3 h of reperfusion were assigned to control (n = 8), postconditioning (n = 9) or cyclosporine A intravenous infusion 10–15 min before the end of ischemia (n = 8). Postconditioning was induced by 8 cycles of repeated 30-s balloon inflation and deflation. After 3 h of reperfusion magnetic resonance imaging, triphenyltetrazolium chloride/Evans blue staining and histopathology were performed. Microvascular obstruction (MVO, percentage of gadolinium-hyperenhanced area) was measured early (3 min) and late (12 min) after contrast injection. Infarct size with double staining was smaller in cyclosporine (46.2 ± 3.1 %, P = 0.016) and postconditioning pigs (47.6 ± 3.9 %, P = 0.008) versus controls (53.8 ± 4.1 %). Late MVO was significantly reduced by cyclosporine (13.9 ± 9.6 %, P = 0.047) but not postconditioning (23.6 ± 11.7 %, P = 0.66) when compared with controls (32.0 ± 16.9 %). Myocardial blood flow in the late MVO was improved with cyclosporine versus controls (0.30 ± 0.06 vs 0.21 ± 0.03 ml/g/min, P = 0.002) and was inversely correlated with late-MVO extent (R2 = 0.93, P < 0.0001). Deterioration of left ventricular ejection fraction (LVEF) between baseline and 3 h of reperfusion was smaller with cyclosporine (−7.9 ± 2.4 %, P = 0.008) but not postconditioning (−12.0 ± 5.5 %, P = 0.22) when compared with controls (−16.4 ± 5.5 %). In the three groups, infarct size (β = −0.69, P < 0.001) and late MVO (β = −0.33, P = 0.02) were independent predictors of LVEF deterioration following ischemia/reperfusion (R2 = 0.73, P < 0.001). Despite both cyclosporine A and postconditioning reduce infarct size, only cyclosporine A infusion had a beneficial effect on microvascular damage and was associated with better preserved LV function when compared with controls.
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Gheysens O, Akurathi V, Chekol R, Dresselaers T, Celen S, Koole M, Dauwe D, Cleynhens BJ, Claus P, Janssens S, Verbruggen AM, Nuyts J, Himmelreich U, Bormans GM. Preclinical evaluation of carbon-11 and fluorine-18 sulfonamide derivatives for in vivo radiolabeling of erythrocytes. EJNMMI Res 2013; 3:4. [PMID: 23316861 PMCID: PMC3561128 DOI: 10.1186/2191-219x-3-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 01/02/2013] [Indexed: 11/25/2022] Open
Abstract
UNLABELLED BACKGROUND To date, few PET tracers for in vivo labeling of red blood cells (RBCs) are available. In this study, we report the radiosynthesis and in vitro and in vivo evaluation of 11C and 18F sulfonamide derivatives targeting carbonic anhydrase II (CA II), a metallo-enzyme expressed in RBCs, as potential blood pool tracers. A proof-of-concept in vivo imaging study was performed to demonstrate the feasibility to assess cardiac function and volumes using electrocardiogram (ECG)-gated positron emission tomography (PET) acquisition in comparison with cine magnetic resonance imaging (cMRI) in rats and a pig model of myocardial infarction. METHODS The inhibition constants (Ki) of CA II were determined in vitro for the different compounds by assaying CA-catalyzed CO2 hydration activity. Binding to human RBCs was estimated after in vitro incubation of the compounds with whole blood. Biodistribution studies were performed to evaluate tracer kinetics in NMRI mice. ECG-gated PET acquisition was performed in Wistar rats at rest and during pharmacological stress by infusing dobutamine at 10 μg/kg/min and in a pig model of myocardial infarction. Left ventricular ejection fraction (LVEF) and volumes were compared with values from cMRI. RESULTS The Ki of the investigated compounds for human CA II was found to be in the range of 8 to 422 nM. The fraction of radioactivity associated with RBCs was found to be ≥90% at 10- and 60-min incubation of tracers with heparinized human blood at room temperature for all tracers studied. Biodistribution studies in mice indicated that 30% to 67% of the injected dose was retained in the blood pool at 60 min post injection. A rapid and sustained tracer uptake in the heart region with an average standardized uptake value of 2.5 was observed from micro-PET images. The LVEF values obtained after pharmacological stress in rats closely matched between the cMRI and micro-PET values, whereas at rest, a larger variation between LVEF values obtained by both techniques was observed. In the pig model, a good agreement was observed between PET and MRI for quantification of left ventricular volumes and ejection fraction. CONCLUSIONS The 11C and 18F sulfonamide derivatives can be used for efficient in vivo radiolabeling of RBCs, and proof-of-concept in vivo imaging studies have shown the feasibility and potential of these novel tracers to assess cardiac function.
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Affiliation(s)
- Olivier Gheysens
- Nuclear Medicine, University Hospital Leuven, Herestraat 49, Leuven BE-3000, Belgium
- Department of Imaging and Pathology, Katholieke Universiteit Leuven, Herestraat 49, Leuven, BE-3000, Belgium
| | - Vamsidhar Akurathi
- Laboratory of Radiopharmacy, Katholieke Universiteit Leuven, O&N2, Herestraat 49, Box 821, Leuven, BE-3000, Belgium
| | - Rufael Chekol
- Laboratory of Radiopharmacy, Katholieke Universiteit Leuven, O&N2, Herestraat 49, Box 821, Leuven, BE-3000, Belgium
| | - Tom Dresselaers
- Biomedical NMR Unit, Katholieke Universiteit Leuven, O&N2, Herestraat 49, Leuven, BE-3000, Belgium
| | - Sofie Celen
- Laboratory of Radiopharmacy, Katholieke Universiteit Leuven, O&N2, Herestraat 49, Box 821, Leuven, BE-3000, Belgium
| | - Michel Koole
- Nuclear Medicine, University Hospital Leuven, Herestraat 49, Leuven BE-3000, Belgium
- Department of Imaging and Pathology, Katholieke Universiteit Leuven, Herestraat 49, Leuven, BE-3000, Belgium
| | - Dieter Dauwe
- Cardiovascular Diseases, University Hospital Leuven, Herestraat 49, Leuven, BE-3000, Belgium
- Division of Cardiology, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Herestraat 49, Leuven, BE-3000, Belgium
| | - Bernard J Cleynhens
- Laboratory of Radiopharmacy, Katholieke Universiteit Leuven, O&N2, Herestraat 49, Box 821, Leuven, BE-3000, Belgium
| | - Piet Claus
- Division of Imaging and Cardiovascular Dynamics, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Herestraat 49, Leuven, BE-3000, Belgium
| | - Stefan Janssens
- Cardiovascular Diseases, University Hospital Leuven, Herestraat 49, Leuven, BE-3000, Belgium
- Division of Cardiology, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Herestraat 49, Leuven, BE-3000, Belgium
| | - Alfons M Verbruggen
- Laboratory of Radiopharmacy, Katholieke Universiteit Leuven, O&N2, Herestraat 49, Box 821, Leuven, BE-3000, Belgium
| | - Johan Nuyts
- Nuclear Medicine, University Hospital Leuven, Herestraat 49, Leuven BE-3000, Belgium
- Department of Imaging and Pathology, Katholieke Universiteit Leuven, Herestraat 49, Leuven, BE-3000, Belgium
| | - Uwe Himmelreich
- Biomedical NMR Unit, Katholieke Universiteit Leuven, O&N2, Herestraat 49, Leuven, BE-3000, Belgium
| | - Guy M Bormans
- Laboratory of Radiopharmacy, Katholieke Universiteit Leuven, O&N2, Herestraat 49, Box 821, Leuven, BE-3000, Belgium
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Liu X, Claus P, Wu M, Reyns G, Verhamme P, Pokreisz P, Vandenwijngaert S, Dubois C, Vanhaecke J, Verbeken E, Bogaert J, Janssens S. Placental growth factor increases regional myocardial blood flow and contractile function in chronic myocardial ischemia. Am J Physiol Heart Circ Physiol 2013; 304:H885-94. [PMID: 23316060 DOI: 10.1152/ajpheart.00587.2012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Placental growth factor (PlGF) has a distinct biological phenotype with a predominant proangiogenic role in disease without affecting quiescent vessels in healthy organs. We tested whether systemic administration of recombinant human (rh)PlGF improves regional myocardial blood flow (MBF) and systolic function recovery in a porcine chronic myocardial ischemia model. We implanted a flow-limiting stent in the proximal left anterior descending coronary artery and measured systemic hemodynamics, regional myocardial function using MRI, and blood flow using colored microspheres 4 wk later. Animals were then randomized in a blinded way to receive an infusion of rhPlGF (15 μg·kg(-1)·day(-1), n = 9) or PBS (control; n = 10) for 2 wk. At 8 wk, myocardial perfusion and function were reassessed. Infusion of rhPlGF transiently increased PlGF serum levels >30-fold (1,153 ± 180 vs. 33 ± 18 pg/ml at baseline, P < 0.001) without affecting systemic hemodynamics. From 4 to 8 wk, rhPlGF increased regional MBF from 0.46 ± 0.11 to 0.85 ± 0.16 ml·min(-1)·g(-1), with a concomitant increase in systolic wall thickening from 11 ± 3% to 26 ± 5% in the ischemic area. In control animals, no significant changes from 4 to 8 wk were observed (MBF: 0.45 ± 0.07 to 0.49 ± 0.08 ml·min(-1)·g(-1) and systolic wall thickening: 14 ± 4% to 18 ± 1%). rhPlGF-induced functional improvement was accompanied by increased myocardial neovascularization, enhanced glycogen utilization, and reduced oxidative stress and cardiomyocyte apoptosis in the ischemic zone. In conclusion, systemic rhPlGF infusion significantly enhances regional blood flow and contractile function of the chronic ischemic myocardium without adverse effects. PlGF protein infusion may represent an attractive therapeutic strategy to increase myocardial perfusion and energetics in chronic ischemic cardiomyopathy.
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Affiliation(s)
- Xiaoshun Liu
- Division of Clinical Cardiology and Department of Cardiovascular Sciences, Gasthuisberg University Hospitals, Leuven, Belgium
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Giordano C, Kuraitis D, Beanlands RSB, Suuronen EJ, Ruel M. Cell-based vasculogenic studies in preclinical models of chronic myocardial ischaemia and hibernation. Expert Opin Biol Ther 2012; 13:411-28. [PMID: 23256710 DOI: 10.1517/14712598.2013.748739] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Coronary artery disease commonly leads to myocardial ischaemia and hibernation. Relevant preclinical models of these conditions are essential to evaluate new therapeutic options such as cell-based vasculogenic therapies. AREAS COVERED In this article, the authors first review basic concepts of myocardial ischaemia/hibernation and relevant techniques to assess myocardial viability. Then, preclinical models of chronic myocardial ischaemia and hibernation, induced by devices such as ameroid constrictors, Delrin stenosis, hydraulic occluders, and coils/stents are described. Lastly, the authors discuss cell-based vasculogenic therapy, and summarise studies conducted in large animal models of chronic myocardial ischaemia and hibernation. EXPERT OPINION Approximately one-third of patients with viable myocardium do not undergo revascularisation; however, this population is at high risk for cardiac events and would surely benefit from effective cell-based therapy. Because of the modest benefits in clinical studies, preclinical models accurately representing clinical myocardial ischemia/hibernation are necessary to better understand and appropriately direct regenerative therapy research.
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Affiliation(s)
- Céline Giordano
- University of Ottawa Heart Institute, Division of Cardiac Surgery, 40 Ruskin Street, Suite 3403, Ottawa, Ontario, K1Y 4W7, Canada
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Slavich M, Florian A, Bogaert J. The emerging role of magnetic resonance imaging and multidetector computed tomography in the diagnosis of dilated cardiomyopathy. Insights Imaging 2012; 2:453-469. [PMID: 22347967 PMCID: PMC3259418 DOI: 10.1007/s13244-011-0101-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 02/25/2011] [Accepted: 05/02/2011] [Indexed: 12/12/2022] Open
Abstract
Magnetic resonance imaging and multidetector computed tomography are new imaging methods that have much to offer clinicians caring for patients with dilated cardiomyopathy. In this article we briefly describe the clinical, pathophysiological and histological aspects of dilated cardiomyopathy. Then we discuss in detail the use of both imaging methods for measurement of chamber size, global and regional function, for myocardial tissue characterisation, including myocardial viability assessment, and determination of arrhythmogenic substrate, and their emerging role in cardiac resynchronisation therapy.
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Affiliation(s)
- Massimo Slavich
- Department of Radiology and Medical Imaging Research Center, UZ Leuven, Herestraat 49, 3000 Leuven, Belgium
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Floré V, Claus P, Antoons G, Oosterhoff P, Holemans P, Vos MA, Sipido KR, Willems R. Microvolt T-wave alternans and beat-to-beat variability of repolarization during early postischemic remodeling in a pig heart. Heart Rhythm 2011; 8:1050-7. [DOI: 10.1016/j.hrthm.2011.02.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2010] [Accepted: 02/11/2011] [Indexed: 10/18/2022]
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