Epicardium: interstitial Cajal-like cells (ICLC) highlighted by immunofluorescence

Dermal Telocytes: A Different Viewpoint of Skin Repairing and Regeneration

Fifteen years after their discovery, telocytes (TCs) are yet perceived as a new stromal cell type. Their presence was initially documented peri-digestively, and gradually throughout the interstitia of many (non-)cavitary mammalian, human, and avian organs, including skin. Each time, TCs proved to be involved in diverse spatial relations with elements of interstitial (ultra)structure (blood vessels, nerves, immune cells, etc.). To date, transmission electron microscopy (TEM) remained the single main microscopic technique able to correctly and certainly attest TCs by their well-acknowledged (ultra)structure. In skin, dermal TCs reiterate almost all (ultra)structural features ascribed to TCs in other locations, with apparent direct implications in skin physiology and/or pathology. TCs' uneven distribution within skin, mainly located in stem cell niches, suggests involvement in either skin homeostasis or dermatological pathologies. On the other hand, different skin diseases involve different patterns of disruption of TCs' structure and ultrastructure. TCs' cellular cooperation with other interstitial elements, their immunological profile, and their changes during remission of diseases suggest their role(s) in tissue regeneration/repair processes. Thus, expanding the knowledge on dermal TCs could offer new insights into the natural skin capacity of self-repairing. Moreover, it would become attractive to consider that augmenting dermal TCs' presence/density could become an attractive therapeutic alternative for treating various skin defects.

Telocytes in the hearts of Saanen goats

Telocytes, new interstitial cells that have received significant attention in recent years, have been detected in many organs, including the heart. The distinction between telocytes and other interstitial cells can only be made based on their ultrastructural characterization and immunophenotypic features. In this study, we examined the interstitial cells in the healthy heart tissues of Saanen goats to determine whether they are telocytes or not, by using a scanning electron microscope (SEM) and immunohistochemical and immunofluorescence staining methods. The SEM revealed oval and round telocytes with two to four telopodes. Some telopodes also had podoms. The staining for immunohistochemical and immunofluorescence methods used for CD34, c-kit (CD117), and vimentin antibodies. Positive cells were detected in the heart muscle and heart valves by immunohistochemical staining. As these antigens can also be expressed by other non-telocyte cells, we used double immunofluorescence staining with CD34/c-kit and CD34/vimentin antibodies to identify true telocytes. Telocytes were determined in the right atrium and aortic valve. While telocytes were CD34+/c-kit+ and CD34+/vimentin+, fibroblasts were CD34-/vimentin+. These results confirm the presence of telocytes in the hearts of Saanen goats.

Telocytes express ANO-1-encoded chloride channels in canine ventricular myocardium

INTRODUCTION

It is unknown if ANO-1 is expressed in the heart, though the presence of a calcium-activated chloride current has been proposed to mediate some cardiac dysrhythmias. Furthermore, a specific cell type termed telocytes, morphologically mimicking Cajal cells which use ANO-1 to modulate their pacemaker activity in the gut, have been described in the heart. We therefore sought to determine whether this channel is expressed in the canine heart.

METHODS

Myocardium was sampled from the ventricles of five canines. Sections were labeled with anti-Kit and anti-ANO-1 antibodies. Slides were reviewed by four investigators looking at cell morphology, distribution, and co-localization. Identification of telocytes was based on criteria including morphology, Kit positivity (+), and ANO-1 positivity (+).

RESULTS

Clusters of cells meeting criteria for telocytes were seen in the epicardium, sub-epicardium, and mid-myocardium. A small subset of cells that were morphologically similar to myocytes was ANO-1 (+) but Kit (-). In total, three different cell classes were found: (i) Kit (+), ANO-1 (+) cells with the appearance of telocytes; (ii) Kit (+), ANO-1 (-) cells; and (iii) Kit (-), ANO-1 (+) cells with the morphologic appearance of cardiac myocytes.

CONCLUSIONS

Telocytes are present in the canine ventricle and express ANO-1. These data merit further study to elucidate the functional expression of these channels in the heart and whether they may be targets for cardiac arrhythmias.

The Telocytes in the Subepicardial Niche

A great interest has developed over the last several years in research on interstitial Cajal-like cells (ICLCs), later renamed to telocytes (TCs). Such studies are restricted by diverse limitations. We aimed to critically review (sub)epicardial ICLCs/TCs and to bring forward supplemental immunohistochemical evidence on (sub)epicardial stromal niche inhabitants. We tested the epicardial expressions of CD117/c-kit, CD34, Cytokeratin 7 (CK7), Ki67, Platelet-Derived Growth Factor Receptor (PDGFR)-α and D2-40 in adult human cardiac samples. The mesothelial epicardial cells expressed D2-40, CK7, CD117/c-kit and PDGFR-α. Subepicardial D2-40-positive lymphatic vessels and isolated D2-40-positive and CK7-positive subepicardial cells were also found. Immediate submesothelial spindle-shaped cells expressed Ki-67. Submesothelial stromal cells and endothelial tubes were PDGFR-α-positive and CD34-positive. The expression of CD34 was pan-stromal, so a particular stromal cell type could not be distinguished. The stromal expression of CD117/c-kit was also noted. It seems that epicardial TCs could not be regarded as belonging to a unique cell type until (pre)lymphatic endothelial cells are inadequately excluded. Markers such as CD117/c-kit or CD34 seem to be improper for identifying TCs as a distinctive cell type. Care should be taken when using the immunohistochemical method and histological interpretations, as they may not produce accurate results.

Critical review: Cardiac telocytes vs cardiac lymphatic endothelial cells

The study of cardiac interstitial Cajal-like cells (ICLCs) began in 2005 and continued until 2010, when these cells were renamed as telocytes (TCs). Since then, numerous papers on cardiac ICLCs and TCs have been published. However, in the initial descriptions upon which further research was based, lymphatic endothelial cells (LECs) and initial lymphatics were not considered. No specific antibodies for LECs (such as podoplanin or LYVE-1) were used in cardiac TC studies, although ultrastructurally, LECs and TCs have similar morphological traits, including the lack of a basal lamina. When tissues are longitudinally cut, migrating LECs involved in adult lymphangiogenesis have an ICLC or TC morphology, both in light and transmission electron microscopy. In this paper, we present evidence that at least some cardiac TCs are actually LECs. Therefore, a clear-cut distinction should be made between TCs and LECs, at both the molecular and the ultrastructural levels, in order to avoid obtaining invalid data.

Identification of telocytes in the porcine heart

Recently, a new interstitial cell type called telocyte has been identified. Telocytes are found in many organs including the heart, where they are especially well described. However, their presence in the porcine heart has not yet been proven. The pig is a valuable animal model in research because of its resemblance with man, making it interesting to determine whether telocytes can be found in pigs as well. The focus of this study is the identification and ultrastructural description of telocytes in the heart tissue of pig. Using transmission electron microscopy, telocytes were found in both left and right atrium and ventricle, usually close to cardiomyocytes and/or blood vessels. Their most important characteristic is the long cytoplasmic processes called telopodes, which have a moniliform aspect, measure tens of μm and usually have a thickness below 0.2 μm. This unique morphological feature enables telocytes to be recognized from other interstitial cells such as fibroblasts. Additional observations include the ability to release extracellular vesicles and to make contacts with other structures such as endothelial cells, suggesting a role in intercellular communication.

[Role of telocytes in the heart in health and diseases]

This review summarizes the data available in the literature on the development, structure, and function of telocytes (TCs) and their role in the heart in health and diseases. At the present time, TCs have been found in many organs of mammals and humans. TC is a small oval cell that contains a nucleus surrounded by small amounts of cytoplasm, with extremely long and thin processes named telopodias. TCs have unique ultrastructural and immunohistochemical features; double positive labeling for CD34/PDGFR-β and CD34/vimentin is suitable for their identification. The role of TCs in the heart at different study stages is the subject of debate. There are currently available data on a decline in the number of cardiac TCs in patients with various heart diseases. Relying on a number of investigations showing that TCs are present in the subepicardial stem cell niches, the authors consider a hypothesis for the key role of cardiac TCs in the regeneration and reparation of the heart.

Telocytes - a Hope for Cardiac Repair after Myocardial Infarction

Cardiovascular diseases, particularly myocardial infarction, remain the leading cause of morbidity and mortality worldwide, even though pharmacological and interventional therapies improved significantly in the last years. Moreover, despite encouraging results of cell - based therapies in experimental myocardial infarction models, clinical trials showed inconsistent and modest efficiency. Therefore the next step should be the revealing of a new cell type, capable of regenerating the damaged myocardium. Telocytes (TCs), a relatively new type of interstitial cells, were described few years ago and are credited with important roles in regenerative therapies. In this paper we review their most important characteristics and functions, showing the evidences of their potential role in cardiac repair and regeneration. Our research leads to the conclusion that TCs might be a novel target for therapeutic strategies in myocardial infarction.

The potential role of telocytes in Tissue Engineering and Regenerative Medicine

Research and ideas for potential applications in the field of Tissue Engineering (TE) and Regenerative Medicine (RM) have been constantly increasing over recent years, basically driven by the fundamental human dream of repairing and regenerating lost tissue and organ functions. The basic idea of TE is to combine cells with putative stem cell properties with extracellular matrix components, growth factors and supporting matrices to achieve independently growing tissue. As a side effect, in the past years, more insights have been gained into cell-cell interaction and how to manipulate cell behavior. However, to date the ideal cell source has still to be found. Apart from commonly known various stem cell sources, telocytes (TC) have recently attracted increasing attention because they might play a potential role for TE and RM. It becomes increasingly evident that TC provide a regenerative potential and act in cellular communication through their network-forming telopodes. While TE in vitro experiments can be the first step, the key for elucidating their regenerative role will be the investigation of the interaction of TC with the surrounding tissue. For later clinical applications further steps have to include an upscaling process of vascularization of engineered tissue. Arteriovenous loop models to vascularize such constructs provide an ideal platform for preclinical testing of future therapeutic concepts in RM. The following review article should give an overview of what is known so far about the potential role of TC in TE and RM.

Hepatic Telocytes

Telocytes (TCs), a novel peculiar interstitial cell found in many tissues and organs, play pivotal roles in maintaining tissue homeostasis and regulating tissue and organ development and immune surveillance. In recent years, the existence of TCs in liver has been confirmed. In this chapter, we evaluate the role of TCs on promoting liver regeneration and the therapeutic effects on liver fibrosis.

iPSC-derived human cardiac progenitor cells improve ventricular remodelling via angiogenesis and interstitial networking of infarcted myocardium

We investigate the effects of myocardial transplantation of human induced pluripotent stem cell (iPSC)‐derived progenitors and cardiomyocytes into acutely infarcted myocardium in severe combined immune deficiency mice. A total of 2 × 10⁵ progenitors, cardiomyocytes or cell‐free saline were injected into peri‐infarcted anterior free wall. Sham‐operated animals received no injection. Myocardial function was assessed at 2‐week and 4‐week post‐infarction by using echocardiography and pressure‐volume catheterization. Early myocardial remodelling was observed at 2‐week with echocardiography derived stroke volume (SV) in saline (20.45 ± 7.36 μl, P < 0.05) and cardiomyocyte (19.52 ± 3.97 μl, P < 0.05) groups, but not in progenitor group (25.65 ± 3.61 μl), significantly deteriorated as compared to sham control group (28.41 ± 4.41 μl). Consistently, pressure–volume haemodynamic measurements showed worsening chamber dilation in saline (EDV: 23.24 ± 5.01 μl, P < 0.05; ESV: 17.08 ± 5.82 μl, P < 0.05) and cardiomyocyte (EDV: 26.45 ± 5.69 μl, P < 0.05; ESV: 18.03 ± 6.58 μl, P < 0.05) groups by 4‐week post‐infarction as compared to control (EDV: 15.26 ± 2.96 μl; ESV: 8.41 ± 2.94 μl). In contrast, cardiac progenitors (EDV: 20.09 ± 7.76 μl; ESV: 13.98 ± 6.74 μl) persistently protected chamber geometry against negative cardiac remodelling. Similarly, as compared to sham control (54.64 ± 11.37%), LV ejection fraction was preserved in progenitor group from 2‐(38.68 ± 7.34%) to 4‐week (39.56 ± 13.26%) while cardiomyocyte (36.52 ± 11.39%, P < 0.05) and saline (35.34 ± 11.86%, P < 0.05) groups deteriorated early at 2‐week. Improvements of myocardial function in the progenitor group corresponded to increased vascularization (16.12 ± 1.49/mm² to 25.48 ± 2.08/mm² myocardial tissue, P < 0.05) and coincided with augmented networking of cardiac telocytes in the interstitial space of infarcted zone.

Distribution and characteristics of telocytes as nurse cells in the architectural organization of engineered heart tissues

Interstitial Cajal-like cells are a distinct type of interstitial cell with a wide distribution in mammalian organs and tissues, and have been given the name "telocytes". Recent studies have demonstrated the potential roles of telocytes in heart development, renewal, and repair. However, further research on the functions of telocytes is limited by the complicated in vivo environment. This study was designed to construct engineered heart tissue (EHT) as a three-dimensional model in vitro to better understand the role of telocytes in the architectural organization of the myocardium. EHTs were constructed by seeding neonatal cardiomyocytes in collagen/Matrigel scaffolds followed by culture under persistent static stretch. Telocytes in EHTs were identified by histology, toluidine blue staining, immunofluorescence, and transmission electron microscopy. The results from histology and toluidine blue staining demonstrated widespread putative telocytes with compact toluidine blue-stained nuclei, which were located around cardiomyocytes. Prolongations from the cell bodies showed a characteristic dichotomous branching pattern and formed networks in EHTs. Immunofluorescence revealed positive staining of telocytes for CD34 and vimentin with typical moniliform prolongations. A series of electron microscopy images further showed that typical telocytes embraced the cardiomyocytes with their long prolongations and exhibited a marked appearance of nursing cardiomyocytes during the construction of EHTs. This finding highlights the great importance of telocytes in the architectural organization of EHTs. It also suggests that EHT is an appropriate physical and pathological model system in vitro to study the roles of telocytes during heart development and regeneration.

Telocyte morphologies and potential roles in diseases

Telocytes (TCs) are a new type of interstitial cells, a small cellular body with the presence of 2-5 prolongations named as telopode (Tp)-very thin (less than 0.2 µm) and extremely long (10-1,000 µm), a moniliform aspect, and caveolae, containing a nucleus surrounded by a small amount of cytoplasm. The nucleus occupies about 25% of TC body volume and contains clusters of heterochromatin attached to the nuclear envelope. The perinuclear cytoplasm is rich in mitochondria and contains a small Golgi complex, rough and smooth endoplasmic reticulum and cytoskeletal elements. TCs have several immunophenotypes such as CD34, c-kit, and vimentin. TCs were found in many organs of mammals with potential biological functions, even though the exact function remains unclear. Recently, we identified and isolated TCs from the trachea for the first time and confirmed the existence of TC in lung tissues, which could have the potential significance in the pathogenesis of pulmonary diseases. Future efforts are required to clarify pathophysiological functions of TCs in the disease.

Telocytes in trachea and lungs

We show the existence of a novel type of interstitial cell-telocytes (TC) in mouse trachea and lungs. We used cell cultures, vital stainings, as well as scanning electron microscopy (SEM), transmission electron microscopy (TEM) and immunohistochemistry (IHC). Phase contrast microscopy on cultured cells showed cells with unequivocally characteristic morphology of typical TC (cells with telopodes-Tp). SEM revealed typical TC with two to three Tp-very long and branched cell prolongations. Tp consist of an alternation of thin segments (podomers) and thick segments (podoms). The latter accommodate mitochondria (as shown by Janus Green and MitoTracker), rough endoplasmic reticulum and caveolae. TEM showed characteristic podomers and podoms as well as close relationships with nerve endings and blood capillaries. IHC revealed positive expression of TC for c-kit, vimentin and CD34. In conclusion, this study shows the presence in trachea and lungs of a peculiar type of cells, which fulfils the criteria for TC.

miR-193 expression differentiates telocytes from other stromal cells

Telocytes (TCs) are a particular type of interstitial (stromal) cells defined by very long, moniliform telopodes. Their tissue location, between blood vessels and other cells such as cardiomyocytes (CMC) and neurons, suggests a role in intercellular signalling. In order to define a microRNA (miR) signature in cardiac TCs, we have found that miR-193 is differentially expressed between TCs and other interstitial cells. Because miR-193 regulates c-kit, our data support the previous finding that TCs express c-kit in certain circumstances. In addition, the miRs which are specific to CMC and other muscle cells (e.g. miR-133a, miR-208a) are absent in TCs. Overall the data reinforce the view that TCs are a particular type of interstitial (mesenchymal) cells.

Telocytes

Here, we review the history, morphology, immunohistochemical phenotype, and presumptive roles of a new type of interstitial tissue cells, formerly called interstitial Cajal-like cells (ICLC) and by 2010 named ‘telocytes’ (TC). Many different techniques have been used to characterize TC and provide their unequivocal identification: (i) in vitro, cultures and isolated cells; (ii) in situ, fixed specimens examined by light and fluorescence microscopy, transmission (TEM) and scanning electron microscopy, and electron tomography. TEM allowed sure identification and characterization of the most peculiar feature of TC: the long, thin, and convoluted prolongations named ‘telopodes’. An enormous variety of antibodies have been tested, but presently none are reliable to specifically label TC. TC have a mesenchymal origin and are resident connective tissue (stromal) cells. Possible identification with ‘already identified’ stromal cell types (fibroblasts, fibrocytes, fibroblast-like cells, and mesenchymal stromal cells) is discussed. We conclude that in adulthood, most of the TC have the morphology of fibrocytes. Apparently, immunocytochemistry suggests that a variety of TC populations showing different, likely organ-specific, immunophenotypes might exist. Several roles have been hypothesized for TC: mechanical roles, intercellular signaling, guiding and nursing of immature cells during organogenesis, and being themselves a pool of precursors for many of the mesenchyme-derived cells in adulthood; however, none of these roles have been proven yet. On the basis of the available data, we propose TC may be key players in organ regeneration and repair.

Heterocellular communication in the heart: electron tomography of telocyte-myocyte junctions

Myocardium is composed of two main cell populations: cardiomyocytes (CMs) and interstitial cells (e.g. fibroblasts, immunoreactive cells, capillaries). However, very recently we have showed that a novel type of interstitial cell called telocytes (TCs) does exist in epi-, myo- and endocardium. They have very long and thin telopodes (Tp) formed by alternating podomeres and podoms. Heterocellular communication between TCs and CMs it is supposed to occur by shed vesicles and close apposition. If TCs have to play a role in cardiac physiology it is expected to develop direct and unambiguous contacts with CMs. Because a clear membrane-to-membrane junction has not been reported by electron microscopy we have investigated the heterocellular communication in the mouse heart by electron tomography. This advanced technique showed that small dense structures (10-15 nm nanocontacts) directly connect TCs with CMs. More complex and atypical junctions could be observed between TCs and CMs at the level of intercalated discs. This study proves that TCs and CMs are directly connected and might represent a 'functional unit'.

Telocytes and putative stem cells in the lungs: electron microscopy, electron tomography and laser scanning microscopy

This study describes a novel type of interstitial (stromal) cell — telocytes (TCs) — in the human and mouse respiratory tree (terminal and respiratory bronchioles, as well as alveolar ducts). TCs have recently been described in pleura, epicardium, myocardium, endocardium, intestine, uterus, pancreas, mammary gland, etc. (see www.telocytes.com). TCs are cells with specific prolongations called telopodes (Tp), frequently two to three per cell. Tp are very long prolongations (tens up to hundreds of μm) built of alternating thin segments known as podomers (≤ 200 nm, below the resolving power of light microscope) and dilated segments called podoms, which accommodate mitochondria, rough endoplasmic reticulum and caveolae. Tp ramify dichotomously, making a 3-dimensional network with complex homo- and heterocellular junctions. Confocal microscopy reveals that TCs are c-kit- and CD34-positive. Tp release shed vesicles or exosomes, sending macromolecular signals to neighboring cells and eventually modifying their transcriptional activity. At bronchoalveolar junctions, TCs have been observed in close association with putative stem cells (SCs) in the subepithelial stroma. SCs are recognized by their ultrastructure and Sca-1 positivity. Tp surround SCs, forming complex TC-SC niches (TC-SCNs). Electron tomography allows the identification of bridging nanostructures, which connect Tp with SCs. In conclusion, this study shows the presence of TCs in lungs and identifies a TC-SC tandem in subepithelial niches of the bronchiolar tree. In TC-SCNs, the synergy of TCs and SCs may be based on nanocontacts and shed vesicles.

Cardiac telocytes: serial dynamic images in cell culture

Telocytes (TC) are interstitial cells with telopodes (Tp). These prolongations (Tp) are quite unique: very long (several tens of micrometres) and very thin (≤0.5 μm), with moniliform aspect: thin segments (podomeres) alternating with dilations (podoms). To avoid any confusion, TC were previously named interstitial Cajal-like cells (ICLC). Myocardial TC were repeatedly documented by electron microscopy, immunohistochemistry and immunofluorescence. TC form a network by their Tp, either in situ or in vitro. Cardiac TC are (completely) different of ‘classic’ fibroblasts or fibrocytes. We hereby present a synopsis of monitoring, by time-lapse videomicroscopy, of Tp network development in cell culture. We used a protocol that favoured interstitial cell selection from adult mouse myocardium. Videomicroscopy showed dynamic interactions of neighbour TC during the network formation. During their movement, TC leave behind distal segments (podomeres) of their Tp as guiding marks for the neighbouring cells to follow during network rearrangement.

Telocytes in endocardium: electron microscope evidence

The term TELOCYTES was very recently introduced, for replacing the name Interstitial Cajal-Like Cells (ICLC). In fact, telocytes are not really Cajal-like cells, they being different from all other interstitial cells by the presence of telopodes, which are cell-body prolongations, very thin (under the resolving power of light microscopy), extremely long (tens up to hundreds of micrometers), with a moniliform aspect (many dilations along), and having caveolae. The presence of telocytes in epicardium and myocardium was previously documented. We present here electron microscope images showing the existence of telocytes, with telopodes, at the level of mouse endocardium. Telocytes are located in the subendothelial layer of endocardium, and their telopodes are interposed in between the endocardial endothelium and the cardiomyocytes bundles. Some telopodes penetrate from the endocardium among the cardiomyocytes and surround them, eventually. Telopodes frequently establish close spatial relationships with myocardial blood capillaries and nerve endings. Because we may consider endocardium as a 'blood-heart barrier', or more exactly as a 'blood-myocardium barrier', telocytes might have an important role in such a barrier being the dominant cell population in subendothelial layer of endocardium.

Telocytes in pleura: two- and three-dimensional imaging by transmission electron microscopy

Information about the ultrastructure of connective (interstitial) cells supporting the pleural mesothelium is scarce. Our aim has been to examine whether telocytes (TCs) are present in pleura, as in epicardium and mesentery. TCs are a distinct type of cell, characterized by specific prolongations named telopodes (Tp). We have used transmission electron microscopy (TEM) and electron tomography (ET) to determine whether ultrastructural diagnostic criteria accepted for TCs are fulfilled by any of the cell subpopulations existing in the sub-mesothelial layer in mouse and human pleura. TCs have been identified with TEM by their characteristic prolongations. Tp appear long and moniliform, because of the alternation of podomeres (thin segments of less than 0.2 μm) and podoms (small dilations accommodating caveolae, mitochondria, and endoplasmic reticulum). Tp ramifications follow a dichotomic pattern and establish specialized cell-to-cell junctional complexes. TCs, via their Tp, seem to form an interstitial network beneath the mesothelium, covering about two-thirds of the abluminal mesothelial layer. ET has revealed complex junctional structures and tight junctions connecting pleural TCs, and small vesicles at this level in Tp. Thus, pleural TCs share significant similarities with TCs described in other serosae. Whether TCs are a (major) player in mesothelial-cell-induced tissue repair remains to be established. Nevertheless, the extremely long thin Tp and complex junctional structures that they form and the release of vesicles (or exosomes) indicate the participation of TCs in long-distance homo- or heterocellular communication.

A dynamic notch injury response activates epicardium and contributes to fibrosis repair

RATIONALE

Transgenic Notch reporter mice express enhanced green fluorescent protein in cells with C-promoter binding factor-1 response element transcriptional activity (CBF1-RE(x)₄-EGFP), providing a unique and powerful tool for identifying and isolating "Notch-activated" progenitors.

OBJECTIVE

We asked whether, as in other tissues of this mouse, EGFP localized and functionally tagged adult cardiac tissue progenitors, and, if so, whether this cell-based signal could serve as a quantitative and qualitative biosensor of the injury repair response of the heart.

METHODS AND RESULTS

In addition to scattered endothelial and interstitial cells, Notch-activated (EGFP(+)) cells unexpectedly richly populated the adult epicardium. We used fluorescence-activated cell sorting to isolate EGFP(+) cells and excluded hematopoietic (CD45(+)) and endothelial (CD31(+)) subsets. We analyzed EGFP(+)/CD45⁻/CD31⁻ cells, a small (<2%) but distinct subpopulation, by gene expression profiling and functional analyses. We called this mixed cell pool, which had dual multipotent stromal cell and epicardial lineage signatures, Notch-activated epicardial-derived cells (NECs). Myocardial infarction and thoracic aortic banding amplified the NEC pool, increasing fibroblast differentiation. Validating the functional vitality of clonal NEC lines, serum growth factors triggered epithelial-mesenchymal transition and the immobilized Notch ligand Delta-like 1-activated downstream target genes. Moreover, cardiomyocyte coculture and engraftment in NOD-SCID (nonobese diabetic-severe combined immunodeficiency) mouse myocardium increased cardiac gene expression in NECs.

CONCLUSIONS

A dynamic Notch injury response activates adult epicardium, producing a multipotent cell population that contributes to fibrosis repair.

Telocytes in human epicardium

The existence of the epicardial telocytes was previously documented by immunohistochemistry (IHC) or immunofluorescence. We have also demonstrated recently that telocytes are present in mice epicardium, within the cardiac stem-cell niches, and, possibly, they are acting as nurse cells for the cardiomyocyte progenitors. The rationale of this study was to show that telocytes do exist in human (sub)epicardium, too. Human autopsy hearts from 10 adults and 15 foetuses were used for conventional IHC for c-kit/CD117, CD34, vimentin, S-100, τ, Neurokinin 1, as well as using laser confocal microscopy. Tissue samples obtained by surgical biopsies from 10 adults were studied by digital transmission electron microscopy (TEM). Double immunolabelling for c-kit/CD34 and, for c-kit/vimentin suggests that in human beings, epicardial telocytes share similar immunophenotype features with myocardial telocytes. The presence of the telocytes in human epicardium is shown by TEM. Epicardial telocytes, like any of the telocytes are defined by telopodes, their cell prolongations, which are very long (several tens of μm), very thin (0.1-0.2 μm, below the resolving power of light microscopy) and with moniliform configuration. The interconnected epicardial telocytes create a 3D cellular network, connected with the 3D network of myocardial telocytes. TEM documented that telocytes release shed microvesicles or exocytotic multivesicular bodies in the intercellular space. The human epicardial telocytes have similar phenotype (TEM and IHC) with telocytes located among human working cardiomyocyte. It remains to be established the role(s) of telocytes in cardiac renewing/repair/regeneration processes, and also the pathological aspects induced by their 'functional inhibition', or by their variation in number. We consider telocytes as a real candidate for future developments of autologous cell-based therapy in heart diseases.

Myocardial telocytes: a specific new cellular entity

The existence of a new type of interstitial cells in the heart namely, interstitial Cajal-like cells (ICLC), has been described for the first time by Hinescu and Popescu in 2005. This study was then followed by an ascending trend of publications regarding the morphology, phenotype and distribution of myocardial ICLC in diverse species including human patients. Recently the new term ‘telocytes’ has been proposed for cells formerly known as ICLC, and the term ‘telopodes’ has been proposed for the prolongations of these cells. The identification of these cells is based on ultrastructural criteria. In addition, telocyters/telyopodes can be identified by several complementary approaches including methylene blue vital staining, silver impregnation and immunoreactivity against CD117/c-kit, vimentin, etc. This point of view presents critical data existing in literature, as well as own results, which unequivocally provide compelling evidence that telocytes are a new distinct cellular entity of myocardial interstitium. Several presumable functions of the myocardial telocytes are discussed: (i) intercellular signalling, (ii) cardiac repair/remodelling and (iii) stem cell nursing in cardiac renewal.

Cardiomyocyte precursors and telocytes in epicardial stem cell niche: electron microscope images

A highly heterogeneous population of stem and progenitor cells has been described by light immunohistochemistry in the mammalian adult heart, but the ultrastructural identity of cardiac stem cells remains unknown. Using electron microscopy, we demonstrate the presence of cells with stem features in the adult mouse heart. These putative cardiac stem cells are small (6-10 microm), round cells, with an irregular shaped nucleus, large nucleolus, few endoplasmic reticulum cisternae and mitochondria, but numerous ribosomes. Stem cells located in the epicardial stem cell niche undergo mitosis and apoptosis. Cells with intermediate features between stem cells and cardiomyocyte progenitors have also been seen. Moreover, electron microscopy showed that cardiomyocyte progenitors were added to the peripheral working cardiomyocytes. Telocytes make a supportive interstitial network for stem cells and progenitors in the stem cell niche. This study enhances the hypothesis of a unique type of cardiac stem cell and progenitors in different stages of differentiation. In our opinion, stem cells, cardiomyocyte progenitors and telocytes sustain a continuous cardiac renewal process in the adult mammalian heart.

TELOCYTES - a case of serendipity: the winding way from Interstitial Cells of Cajal (ICC), via Interstitial Cajal-Like Cells (ICLC) to TELOCYTES

Ramon y Cajal discovered a particular cell type in the gut, which he named ‘interstitial neurons’ more that 100 years ago. In the early 1970s, electron microscopy/electron microscope (EM) studies showed that indeed a special interstitial cell type corresponding to the cells discovered by Cajal is localized in the gut muscle coat, but it became obvious that they were not neurons. Consequently, they were renamed ‘interstitial cells of Cajal’ (ICC) and considered to be pace-makers for gut motility. For the past 10 years many groups were interested in whether or not ICC are present outside the gastrointestinal tract, and indeed, peculiar interstitial cells were found in: upper and lower urinary tracts, blood vessels, pancreas, male and female reproductive tracts, mammary gland, placenta, and, recently, in the heart as well as in the gut. Such cells, now mostly known as interstitial Cajal-like cells (ICLC), were given different and confusing names. Moreover, ICLC are only apparently similar to canonical ICC. In fact, EM and cell cultures revealed very particular features of ICLC, which unequivocally distinguishes them from ICC and all other interstitial cells: the presence of 2–5 cell body prolongations that are very thin (less than 0.2 μm, under resolving power of light microscopy), extremely long (tens to hundreds of μm), with a moniliform aspect (many dilations along), as well as caveolae. Given the unique dimensions of these prolongations (very long and very thin) and to avoid further confusion with other interstitial cell types (e.g. fibroblast, fibrocyte, fibroblast-like cells, mesenchymal cells), we are proposing the term TELOCYTES for them, and TELOPODES for their prolongations, by using the Greek affix ‘telos’.

Myometrial interstitial cells and the coordination of myometrial contractility

A strict regulation of contractility in the uterus and fallopian tube is essential for various reproductive functions. The uterus contributes, through either increased contractility or periods of relative quiescence, to: (i) expulsion of menstrual debris, (ii) sperm transport, (iii) adequate embryo placement during implantation, (iv) enlarging its capacity during pregnancy and (v) parturition. The dominant cell population of the uterine wall consists of smooth muscle cells that contain the contractile apparatus responsible for the generation of contractile force. Recent interest has focused on a new population of cells located throughout the myometrium on the borders of smooth muscle bundles. These cells are similar to interstitial cells of Cajal (ICC) in the gut that are responsible for the generation of electrical slow waves that control peristalsis. A precise role for myometrial Cajal-like interstitial cells (m-ICLC) has not been identified. m-ICLC express the c-kit receptor, involved in creating and maintaining the ICC phenotype in the gastrointestinal tract. However, both acute and prolonged inhibition of this receptor with the c-kit antagonist imatinib mesylate does not appear to affect the spontaneous contractility of myometrium. Calcium imaging of live tissue slices suggests that contractile signalling starts on the borders of smooth muscle bundles where m-ICLC are located and recently the possible role of extracellular ATP signalling from m-ICLC has been studied. This manuscript reviews the evidence regarding tissue-level signalling in the myometrium with a particular emphasis on the anatomical and possible functional aspects of m-ICLC as new elements of the contractile mechanisms in the uterus.

Human epicardium: ultrastructural ancestry of mesothelium and mesenchymal cells

The human sub-epicardial area contains an unexplored cellular population under a layer of mesothelial cells. Transmission electron microscopy revealed the existence of interstitial Cajal-like cells (ICLCs), isolated smooth muscle cells (iSMC) and mesenchymal cells besides other well-known cells. The presence of iSMC in the sub-epicardial space is quite unique and could explain why epicardial-derived cells isolated from human epicardium generate smooth muscle cells in culture. Mesenchymal cells, guided by ICLCs, were found migrating from sub-epicardial area in the mesothelial layer. These findings suggest that epithelial-mesenchymal transition is not a common process involved in cardiac regeneration in vivo.

Cardiac renewing: interstitial Cajal-like cells nurse cardiomyocyte progenitors in epicardial stem cell niches

Recent studies suggested that various cell lineages exist within the subepicardium and we supposed that this area could host cardiac stem cell niches (CSCNs). Using transmission electron microscopy, we have found at least 10 types of cells coexisting in the subepicardium of normal adult mice: adipocytes, fibroblasts, Schwann cells and nerve fibres, isolated smooth muscle cells, mast cells, macrophages, lymphocytes, interstitial Cajal-like cells (ICLCs) and cardiomyocytes progenitors (CMPs). The latter cells, sited in the area of origin of coronary arteries and aorta, showed typical features of either very immature or developing cardiomyocytes. Some of these cells were connected to each other to form columns surrounded by a basal lamina and embedded in a cellular network made by ICLCs. Complex intercellular communication occurs between the ICLCs and CMPs through electron-dense nanostructures or through shed vesicles. We provide here for the first time the ultrastructural description of CSCN in the adult mice myocardium, mainly containing ICLCs and CMPs. The existence of resident CMPs in different developmental stages proves that cardiac renewing is a continuous process. We suggest that ICLCs might act as supporting nurse cells of the cardiac niches and may be responsible for activation, commitment and migration of the stem cells out of the niches. Briefly, not only resident cardiac stem cells but also ICLCs regulate myocyte turnover and contribute to both cardiac cellular homeostasis and endogenous repair/remodelling after injuries.