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Wang J, Yang ZG, Guo YK, Jiang Y, Yan WF, Qian WL, Fang H, Min CY, Li Y. Incremental effect of coronary obstruction on myocardial microvascular dysfunction in type 2 diabetes mellitus patients evaluated by first-pass perfusion CMR study. Cardiovasc Diabetol 2023; 22:154. [PMID: 37381007 DOI: 10.1186/s12933-023-01873-w] [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: 03/18/2023] [Accepted: 05/30/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) frequently coexists with obstructive coronary artery disease (OCAD), which are at increased risk for cardiovascular morbidity and mortality. This study aimed to investigate the impact of coronary obstruction on myocardial microcirculation function in T2DM patients, and explore independent predictors of reduced coronary microvascular perfusion. METHODS Cardiac magnetic resonance (CMR) scanning was performed on 297 T2DM patients {188 patients without OCAD [T2DM(OCAD -)] and 109 with [T2DM(OCAD +)]} and 89 control subjects. CMR-derived perfusion parameters, including upslope, max signal intensity (MaxSI), and time to maximum signal intensity (TTM) in global and segmental (basal, mid-ventricular, and apical slices) were measured and compared among observed groups. According to the median of Gensini score (64), T2DM(OCAD +) patients were subdivided into two groups. Univariable and multivariable linear regression analyses were performed to identify independent predictors of microcirculation dysfunction. RESULTS T2DM(OCAD -) patients, when compared to control subjects, had reduced upslope and prolonged TTM in global and all of three slices (all P < 0.05). T2DM(OCAD +) patients showed a significantly more severe impairment of microvascular perfusion than T2DM(OCAD -) patients and control subjects with a more marked decline upslope and prolongation TTM in global and three slices (all P < 0.05). From control subjects, through T2DM(OCAD +) patients with Gensini score ≤ 64, to those patients with Gensini score > 64 group, the upslope declined and TTM prolonged progressively in global and mid-ventricular slice (all P < 0.05). The presence of OCAD was independently correlated with reduced global upslope (β = - 0.104, P < 0.05) and global TTM (β = 0.105, P < 0.05) in patients with T2DM. Among T2DM(OCAD +) patients, Gensini score was associated with prolonged global TTM (r = 0.34, P < 0.001). CONCLUSIONS Coronary artery obstruction in the context of T2DM exacerbated myocardial microcirculation damage. The presence of OCAD and Gensini score were independent predictors of decreased microvascular function. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Jin Wang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Ying-Kun Guo
- Department of Radiology, Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, 20# Section 3, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Yu Jiang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Wei-Feng Yan
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Wen-Lei Qian
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Han Fang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Chen-Yan Min
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yuan Li
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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2
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Hu D, Li X, Li J, Tong P, Li Z, Lin G, Sun Y, Wang J. The preclinical and clinical progress of cell sheet engineering in regenerative medicine. Stem Cell Res Ther 2023; 14:112. [PMID: 37106373 PMCID: PMC10136407 DOI: 10.1186/s13287-023-03340-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Cell therapy is an accessible method for curing damaged organs or tissues. Yet, this approach is limited by the delivery efficiency of cell suspension injection. Over recent years, biological scaffolds have emerged as carriers of delivering therapeutic cells to the target sites. Although they can be regarded as revolutionary research output and promote the development of tissue engineering, the defect of biological scaffolds in repairing cell-dense tissues is apparent. Cell sheet engineering (CSE) is a novel technique that supports enzyme-free cell detachment in the shape of a sheet-like structure. Compared with the traditional method of enzymatic digestion, products harvested by this technique retain extracellular matrix (ECM) secreted by cells as well as cell-matrix and intercellular junctions established during in vitro culture. Herein, we discussed the current status and recent progress of CSE in basic research and clinical application by reviewing relevant articles that have been published, hoping to provide a reference for the development of CSE in the field of stem cells and regenerative medicine.
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Affiliation(s)
- Danping Hu
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, 410008, China
- HANGZHOU CHEXMED TECHNOLOGY CO., LTD, Hangzhou, 310000, China
| | - Xinyu Li
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, 410008, China
| | - Jie Li
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, 410008, China
| | - Pei Tong
- Hospital of Hunan Guangxiu, Medical College of Hunan Normal University, Hunan Normal University, Changsha, 410008, China
| | - Zhe Li
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, 410008, China
| | - Ge Lin
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, 410008, China
- National Engineering and Research Center of Human Stem Cells, Changsha, 410008, China
- Key Laboratory of Stem Cells and Reproductive Engineering, Ministry of Health, Changsha, 410008, China
| | - Yi Sun
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, 410008, China.
- National Engineering and Research Center of Human Stem Cells, Changsha, 410008, China.
- Key Laboratory of Stem Cells and Reproductive Engineering, Ministry of Health, Changsha, 410008, China.
| | - Juan Wang
- Shanghai Biomass Pharmaceutical Product Evaluation Professional Public Service Platform, Center for Pharmacological Evaluation and Research, China State Institute of Pharmaceutical Industry, Shanghai, 200437, China.
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3
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Shin HS, Thakore A, Tada Y, Pedroza AJ, Ikeda G, Chen IY, Chan D, Jaatinen KJ, Yajima S, Pfrender EM, Kawamura M, Yang PC, Wu JC, Appel EA, Fischbein MP, Woo YJ, Shudo Y. Angiogenic stem cell delivery platform to augment post-infarction neovasculature and reverse ventricular remodeling. Sci Rep 2022; 12:17605. [PMID: 36266453 PMCID: PMC9584918 DOI: 10.1038/s41598-022-21510-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 09/28/2022] [Indexed: 01/13/2023] Open
Abstract
Many cell-based therapies are challenged by the poor localization of introduced cells and the use of biomaterial scaffolds with questionable biocompatibility or bio-functionality. Endothelial progenitor cells (EPCs), a popular cell type used in cell-based therapies due to their robust angiogenic potential, are limited in their therapeutic capacity to develop into mature vasculature. Here, we demonstrate a joint delivery of human-derived endothelial progenitor cells (EPC) and smooth muscle cells (SMC) as a scaffold-free, bi-level cell sheet platform to improve ventricular remodeling and function in an athymic rat model of myocardial infarction. The transplanted bi-level cell sheet on the ischemic heart provides a biomimetic microenvironment and improved cell-cell communication, enhancing cell engraftment and angiogenesis, thereby improving ventricular remodeling. Notably, the increased density of vessel-like structures and upregulation of biological adhesion and vasculature developmental genes, such as Cxcl12 and Notch3, particularly in the ischemic border zone myocardium, were observed following cell sheet transplantation. We provide compelling evidence that this SMC-EPC bi-level cell sheet construct can be a promising therapy to repair ischemic cardiomyopathy.
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Affiliation(s)
- Hye Sook Shin
- Department of Cardiothoracic Surgery, Falk Cardiovascular Research Center, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, USA
| | - Akshara Thakore
- Department of Cardiothoracic Surgery, Falk Cardiovascular Research Center, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, USA
| | - Yuko Tada
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, USA
| | - Albert J Pedroza
- Department of Cardiothoracic Surgery, Falk Cardiovascular Research Center, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, USA
| | - Gentaro Ikeda
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, USA
| | - Ian Y Chen
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, USA
| | - Doreen Chan
- Department of Chemistry, Department of Materials Science & Engineering, Stanford University, Stanford University, Stanford, USA
| | - Kevin J Jaatinen
- Department of Cardiothoracic Surgery, Falk Cardiovascular Research Center, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Shin Yajima
- Department of Cardiothoracic Surgery, Falk Cardiovascular Research Center, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, USA
| | - Eric M Pfrender
- Department of Cardiothoracic Surgery, Falk Cardiovascular Research Center, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, USA
| | - Masashi Kawamura
- Department of Cardiothoracic Surgery, Falk Cardiovascular Research Center, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Phillip C Yang
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, USA
| | - Joseph C Wu
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, USA
| | - Eric A Appel
- Department of Materials Science & Engineering, Department of Bioengineering, Department of Pediatric (Endocrinology), Stanford University, Stanford, USA
| | - Michael P Fischbein
- Department of Cardiothoracic Surgery, Falk Cardiovascular Research Center, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, USA
| | - YJoseph Woo
- Department of Cardiothoracic Surgery, Falk Cardiovascular Research Center, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, USA
| | - Yasuhiro Shudo
- Department of Cardiothoracic Surgery, Falk Cardiovascular Research Center, Stanford University School of Medicine, Stanford, CA, 94305, USA.
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, USA.
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4
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Xiao W, Chen W, Wang Y, Zhang C, Zhang X, Zhang S, Wu W. Recombinant DTβ4-inspired porous 3D vascular graft enhanced antithrombogenicity and recruited circulating CD93 +/CD34 + cells for endothelialization. SCIENCE ADVANCES 2022; 8:eabn1958. [PMID: 35857526 PMCID: PMC9278867 DOI: 10.1126/sciadv.abn1958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 05/27/2022] [Indexed: 05/31/2023]
Abstract
Matching material degradation with host remodeling, including endothelialization and muscular remodeling, is important to vascular regeneration. We fabricated 3D PGS-PCL vascular grafts, which presented tunable polymer components, porosity, mechanical strength, and degrading rate. Furthermore, highly porous structures enabled 3D patterning of conjugated heparin-binding peptide, dimeric thymosin β4 (DTβ4), which played key roles in antiplatelets, fibrinogenesis inhibition, and recruiting circulating progenitor cells, thereafter contributed to high patency rate, and unprecedentedly acquired carotid arterial regeneration in rabbit model. Through single-cell RNA sequencing analysis and cell tracing studies, a subset of endothelial progenitor cells, myeloid-derived CD93+/CD34+ cells, was identified as the main contributor to final endothelium regeneration. To conclude, DTβ4-inspired porous 3DVGs present adjustable physical properties, superior anticoagulating, and re-endothelializing potentials, which leads to the regeneration of small-caliber artery, thus offering a promising tool for vessel replacement in clinical applications.
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Affiliation(s)
- Weiwei Xiao
- Departments of Oral and Maxillofacial Surgery, State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, School of Stomatology, Fourth Military Medical University, Xi’an, China
| | - Wanli Chen
- Departments of Oral and Maxillofacial Surgery, State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, School of Stomatology, Fourth Military Medical University, Xi’an, China
| | - Yinggang Wang
- Departments of Oral and Maxillofacial Surgery, State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, School of Stomatology, Fourth Military Medical University, Xi’an, China
| | - Cun Zhang
- State Key Laboratory of Cancer Biology Biotechnology Center, School of Pharmacy, Fourth Military Medical University, Xi’an, China
| | - Xinchi Zhang
- Departments of Oral and Maxillofacial Surgery, State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, School of Stomatology, Fourth Military Medical University, Xi’an, China
| | - Siqian Zhang
- Departments of Oral and Maxillofacial Surgery, State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, School of Stomatology, Fourth Military Medical University, Xi’an, China
| | - Wei Wu
- Departments of Oral and Maxillofacial Surgery, State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, School of Stomatology, Fourth Military Medical University, Xi’an, China
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5
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Shi H, Zhao Z, Jiang W, Zhu P, Zhou N, Huang X. A Review Into the Insights of the Role of Endothelial Progenitor Cells on Bone Biology. Front Cell Dev Biol 2022; 10:878697. [PMID: 35686054 PMCID: PMC9173585 DOI: 10.3389/fcell.2022.878697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/11/2022] [Indexed: 11/23/2022] Open
Abstract
In addition to its important transport functions, the skeletal system is involved in complex biological activities for the regulation of blood vessels. Endothelial progenitor cells (EPCs), as stem cells of endothelial cells (ECs), possess an effective proliferative capacity and a powerful angiogenic capacity prior to their differentiation. They demonstrate synergistic effects to promote bone regeneration and vascularization more effectively by co-culturing with multiple cells. EPCs demonstrate a significant therapeutic potential for the treatment of various bone diseases by secreting a combination of growth factors, regulating cellular functions, and promoting bone regeneration. In this review, we retrospect the definition and properties of EPCs, their interaction with mesenchymal stem cells, ECs, smooth muscle cells, and immune cells in bone regeneration, vascularization, and immunity, summarizing their mechanism of action and contribution to bone biology. Additionally, we generalized their role and potential mechanisms in the treatment of various bone diseases, possibly indicating their clinical application.
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Affiliation(s)
- Henglei Shi
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guangxi Medical University, Nanning, China.,Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Disease Treatment, Guangxi Clinical Research Center for Craniofacia Reconstruction, Guangxi Key Laboratory of Oral and Maxillofacial Surg Deformity, Nanning, China
| | - Zhenchen Zhao
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guangxi Medical University, Nanning, China.,Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Disease Treatment, Guangxi Clinical Research Center for Craniofacia Reconstruction, Guangxi Key Laboratory of Oral and Maxillofacial Surg Deformity, Nanning, China
| | - Weidong Jiang
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guangxi Medical University, Nanning, China.,Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Disease Treatment, Guangxi Clinical Research Center for Craniofacia Reconstruction, Guangxi Key Laboratory of Oral and Maxillofacial Surg Deformity, Nanning, China
| | - Peiqi Zhu
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guangxi Medical University, Nanning, China.,Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Disease Treatment, Guangxi Clinical Research Center for Craniofacia Reconstruction, Guangxi Key Laboratory of Oral and Maxillofacial Surg Deformity, Nanning, China
| | - Nuo Zhou
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guangxi Medical University, Nanning, China.,Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Disease Treatment, Guangxi Clinical Research Center for Craniofacia Reconstruction, Guangxi Key Laboratory of Oral and Maxillofacial Surg Deformity, Nanning, China
| | - Xuanping Huang
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guangxi Medical University, Nanning, China.,Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Disease Treatment, Guangxi Clinical Research Center for Craniofacia Reconstruction, Guangxi Key Laboratory of Oral and Maxillofacial Surg Deformity, Nanning, China
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6
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Huang H, Huang W. Regulation of Endothelial Progenitor Cell Functions in Ischemic Heart Disease: New Therapeutic Targets for Cardiac Remodeling and Repair. Front Cardiovasc Med 2022; 9:896782. [PMID: 35677696 PMCID: PMC9167961 DOI: 10.3389/fcvm.2022.896782] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/02/2022] [Indexed: 12/16/2022] Open
Abstract
Ischemic heart disease (IHD) is the leading cause of morbidity and mortality worldwide. Ischemia and hypoxia following myocardial infarction (MI) cause subsequent cardiomyocyte (CM) loss, cardiac remodeling, and heart failure. Endothelial progenitor cells (EPCs) are involved in vasculogenesis, angiogenesis and paracrine effects and thus have important clinical value in alternative processes for repairing damaged hearts. In fact, this study showed that the endogenous repair of EPCs may not be limited to a single cell type. EPC interactions with cardiac cell populations and mesenchymal stem cells (MSCs) in ischemic heart disease can attenuate cardiac inflammation and oxidative stress in a microenvironment, regulate cell survival and apoptosis, nourish CMs, enhance mature neovascularization, alleviate adverse ventricular remodeling after infarction and enhance ventricular function. In this review, we introduce the definition and discuss the origin and biological characteristics of EPCs and summarize the mechanisms of EPC recruitment in ischemic heart disease. We focus on the crosstalk between EPCs and endothelial cells (ECs), smooth muscle cells (SMCs), CMs, cardiac fibroblasts (CFs), cardiac progenitor cells (CPCs), and MSCs during cardiac remodeling and repair. Finally, we discuss the translation of EPC therapy to the clinic and treatment strategies.
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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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Xue F, Bai Y, Jiang Y, Liu J, Jian K. Construction and a preliminary study of paracrine effect of bone marrow-derived endothelial progenitor cell sheet. Cell Tissue Bank 2021; 23:185-197. [PMID: 34052984 PMCID: PMC8854320 DOI: 10.1007/s10561-021-09932-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/21/2021] [Indexed: 12/14/2022]
Abstract
The release of paracrine factors from endothelial progenitor cell (EPC) sheet is a central mechanism of tissue repair. The purpose of this study was to constuct the rat bone marrow derived-endothelial progenitor cell (BM-EPCs) sheet and investigate invest the role of stromal cell-derived factor-1α (SDF-1α)/CXCR4 axis in the biological function of BM-EPCs sheet. BM-EPC cells were identified by the cell-surface markers-CD34/CD133/VE-cadherin/KDR using flow cytometry and dual affinity for acLDL and UEA-1. After 7 days of incubation, the BM-EPC single-cell suspensions were seeded on thermo-sensitive plate to harvest the BM-EPC cell sheets. The expression levels of SDF-1α/CXCR4 axis-associated genes and proteins were examined using RT-qPCR and western blot analysis, and enzyme-linked immunosorbent assay (ELISA) was applied to determine the concentration of vascular endothelial growth factor (VEGF), epidermal growth factor (EGF) and SDF-1α in the cell culture medium. The BM-EPC cell sheets were successfully harvested. Moreover, BM-EPC cell sheets have superior migration and tube formation activity when compared with single cell suspension. When capillary-like tube were formed from EPCs sheets, the releasing of paracrine factors such as VEGF, EGF and SDF-1α were increased. To reveal the mechanism of tube formation of BM-EPCs sheets, our research showed that the activation of PI3K/AKT/eNOS pathway was involved in the process, because the phosphorylation of CXCR, PI3K, AKT and eNOS were increased. BM-EPC cell sheets have superior paracrine and tube formation activity than the BM-EPC single-cell. The strong ability to secrete paracrine factors was be potentially related to the SDF-1α/CXCR4 axis through PI3K/AKT/eNOS pathway.
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Affiliation(s)
- Fenlong Xue
- Department of Cardiovascular Surgery, Tianjin First Central Hospital, Tianjin, 300192, China
| | - Yunpeng Bai
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, 300051, China
| | - Yiyao Jiang
- Department of Cardiovascular Surgery, Tianjin First Central Hospital, Tianjin, 300192, China
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Bengbu Medical College, Anhui, 233004, China
| | - Jianshi Liu
- Department of Cardiovascular Surgery, DeltaHealth Hospital Shanghai, Shanghai, 200336, China
| | - Kaitao Jian
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, 300051, China.
- Department of Cardiovascular Surgery, DeltaHealth Hospital Shanghai, Shanghai, 200336, China.
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9
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Shudo Y, MacArthur JW, Kunitomi Y, Joubert L, Kawamura M, Ono J, Thakore A, Jaatinen K, Eskandari A, Hironaka C, Shin HS, Woo YPJ. Three-Dimensional Multilayered Microstructure Using Needle Array Bioprinting System. Tissue Eng Part A 2021; 26:350-357. [PMID: 32085692 DOI: 10.1089/ten.tea.2019.0313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Tissue engineering is an essential component of developing effective regenerative therapies. In this study, we introduce a promising method to create scaffold-free three-dimensional (3D) tissue engineered multilayered microstructures from cultured cells using the "3D tissue fabrication system" (Regenova®; Cyfuse, Tokyo, Japan). This technique utilizes the adhesive nature of cells. When cells are cultured in nonadhesive wells, they tend to aggregate and form a spheroidal structure. The advantage of this approach is that cellular components can be mixed into one spheroid, thereby promoting the formation of extracellular matrices, such as collagen and elastin. This system enables one to create a predesigned 3D structure composed of cultured cells. We found that the advantages of this system to be (1) the length, size, and shape of the structure that were designable and highly reproducible because of the computer controlled robotics system, (2) the graftable structure could be created within a reasonable period (8 days), and (3) the constructed tissue did not contain any foreign material, which may avoid the potential issues of contamination, biotoxicity, and allergy. The utilization of this robotic system enabled the creation of a 3D multilayered microstructure made of cell-based spheres with a satisfactory mechanical properties and abundant extracellular matrix during a short period of time. These results suggest that this new technology will represent a promising, attractive, and practical strategy in the field of tissue engineering. Impact statement The utilization of the "three dimensional tissue fabrication system" enabled the creation of a three-dimensional (3D) multilayered microstructure made of cell-based spheres with a satisfactory mechanical properties and abundant extracellular matrix during a short period of time. These results suggest that this new technology will represent a promising, attractive, and practical strategy in the field of tissue engineering.
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Affiliation(s)
- Yasuhiro Shudo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - John W MacArthur
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | | | - Lydia Joubert
- Cell Sciences Imaging Facility, Stanford School of Medicine, Stanford University, Stanford, California
| | - Masashi Kawamura
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Jiro Ono
- Cyfuse Biomedical K.K., Tokyo, Japan
| | - Akshara Thakore
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Kevin Jaatinen
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Anahita Eskandari
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Camille Hironaka
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Hye Sook Shin
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Yi-Ping Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
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10
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Shin HS, Shin HH, Shudo Y. Current Status and Limitations of Myocardial Infarction Large Animal Models in Cardiovascular Translational Research. Front Bioeng Biotechnol 2021; 9:673683. [PMID: 33996785 PMCID: PMC8116580 DOI: 10.3389/fbioe.2021.673683] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/06/2021] [Indexed: 01/16/2023] Open
Abstract
Establishing an appropriate disease model that mimics the complexities of human cardiovascular disease is critical for evaluating the clinical efficacy and translation success. The multifaceted and complex nature of human ischemic heart disease is difficult to recapitulate in animal models. This difficulty is often compounded by the methodological biases introduced in animal studies. Considerable variations across animal species, modifications made in surgical procedures, and inadequate randomization, sample size calculation, blinding, and heterogeneity of animal models used often produce preclinical cardiovascular research that looks promising but is irreproducible and not translatable. Moreover, many published papers are not transparent enough for other investigators to verify the feasibility of the studies and the therapeutics' efficacy. Unfortunately, successful translation of these innovative therapies in such a closed and biased research is difficult. This review discusses some challenges in current preclinical myocardial infarction research, focusing on the following three major inhibitors for its successful translation: Inappropriate disease model, frequent modifications to surgical procedures, and insufficient reporting transparency.
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Affiliation(s)
- Hye Sook Shin
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, United States
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States
| | - Heather Hyeyoon Shin
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Yasuhiro Shudo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, United States
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States
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11
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Yan J, Wang WB, Fan YJ, Bao H, Li N, Yao QP, Huo YL, Jiang ZL, Qi YX, Han Y. Cyclic Stretch Induces Vascular Smooth Muscle Cells to Secrete Connective Tissue Growth Factor and Promote Endothelial Progenitor Cell Differentiation and Angiogenesis. Front Cell Dev Biol 2020; 8:606989. [PMID: 33363166 PMCID: PMC7755638 DOI: 10.3389/fcell.2020.606989] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/10/2020] [Indexed: 02/05/2023] Open
Abstract
Endothelial progenitor cells (EPCs) play a vital role in endothelial repair following vascular injury by maintaining the integrity of endothelium. As EPCs home to endothelial injury sites, they may communicate with exposed vascular smooth muscle cells (VSMCs), which are subjected to cyclic stretch generated by blood flow. In this study, the synergistic effect of cyclic stretch and communication with neighboring VSMCs on EPC function during vascular repair was investigated. In vivo study revealed that EPCs adhered to the injury site and were contacted to VSMCs in the Sprague-Dawley (SD) rat carotid artery injury model. In vitro, EPCs were cocultured with VSMCs, which were exposed to cyclic stretch at a magnitude of 5% (which mimics physiological stretch) and a constant frequency of 1.25 Hz for 12 h. The results indicated that stretched VSMCs modulated EPC differentiation into mature endothelial cells (ECs) and promoted angiogenesis. Meanwhile, cyclic stretch upregulated the mRNA expression and secretion level of connective tissue growth factor (CTGF) in VSMCs. Recombinant CTGF (r-CTGF) treatment promoted endothelial differentiation of EPCs and angiogenesis, and increased their protein levels of FZD8 and β-catenin. CTGF knockdown in VSMCs inhibited cyclic stretch-induced EPC differentiation into ECs and attenuated EPC tube formation via modulation of the FZD8/β-catenin signaling pathway. FZD8 knockdown repressed endothelial differentiation of EPCs and their angiogenic activity. Wnt signaling inhibitor decreased the endothelial differentiation and angiogenetic ability of EPCs cocultured with stretched VSMCs. Consistently, an in vivo Matrigel plug assay demonstrated that r-CTGF-treated EPCs exhibited enhanced angiogenesis; similarly, stretched VSMCs also induced cocultured EPC differentiation toward ECs. In a rat vascular injury model, r-CTGF improved EPC reendothelialization capacity. The present results indicate that cyclic stretch induces VSMC-derived CTGF secretion, which, in turn, activates FZD8 and β-catenin to promote both differentiation of cocultured EPCs into the EC lineage and angiogenesis, suggesting that CTGF acts as a key intercellular mediator and a potential therapeutic target for vascular repair.
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Affiliation(s)
- Jing Yan
- School of Life Sciences and Biotechnology, Institute of Mechanobiology and Medical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Wen-Bin Wang
- School of Life Sciences and Biotechnology, Institute of Mechanobiology and Medical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yang-Jing Fan
- School of Life Sciences and Biotechnology, Institute of Mechanobiology and Medical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Han Bao
- School of Life Sciences and Biotechnology, Institute of Mechanobiology and Medical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Na Li
- School of Life Sciences and Biotechnology, Institute of Mechanobiology and Medical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Qing-Ping Yao
- School of Life Sciences and Biotechnology, Institute of Mechanobiology and Medical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yun-Long Huo
- School of Life Sciences and Biotechnology, Institute of Mechanobiology and Medical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Zong-Lai Jiang
- School of Life Sciences and Biotechnology, Institute of Mechanobiology and Medical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Ying-Xin Qi
- School of Life Sciences and Biotechnology, Institute of Mechanobiology and Medical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yue Han
- School of Life Sciences and Biotechnology, Institute of Mechanobiology and Medical Engineering, Shanghai Jiao Tong University, Shanghai, China
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12
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Zhu Y, Thakore AD, Farry JM, Jung J, Anilkumar S, Wang H, Imbrie-Moore AM, Park MH, Tran NA, Woo YPJ. Collagen-Supplemented Incubation Rapidly Augments Mechanical Property of Fibroblast Cell Sheets. Tissue Eng Part A 2020; 27:328-335. [PMID: 32703108 DOI: 10.1089/ten.tea.2020.0128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Cell sheet technology using UpCell™ (Thermo Fisher Scientific, Roskilde, Denmark) plates is a modern tool that enables the rapid creation of single-layered cells without using extracellular matrix (ECM) enzymatic digestion. Although this technique has the advantage of maintaining a sheet of cells without needing artificial scaffolds, these cell sheets remain extremely fragile. Collagen, the most abundant ECM component, is an attractive candidate for modulating tissue mechanical properties given its tunable property. In this study, we demonstrated rapid mechanical property augmentation of human dermal fibroblast cell sheets after incubation with bovine type I collagen for 24 h on UpCell plates. We showed that treatment with collagen resulted in increased collagen I incorporation within the cell sheet without affecting cell morphology, cell type, or cell sheet quality. Atomic force microscopy measurements for controls, and cell sheets that received 50 and 100 μg/mL collagen I treatments revealed an average Young's modulus of their respective intercellular regions: 6.6 ± 1.0, 14.4 ± 6.6, and 19.8 ± 3.8 kPa during the loading condition, and 10.3 ± 4.7, 11.7 ± 2.2, and 18.1 ± 3.4 kPa during the unloading condition. This methodology of rapid mechanical property augmentation of a cell sheet has a potential impact on cell sheet technology by improving the ease of construct manipulation, enabling new translational tissue engineering applications.
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Affiliation(s)
- Yuanjia Zhu
- Department of Bioengineering, Stanford University, Stanford, California, USA.,Department of Cardiothoracic Surgery, and Stanford University, Stanford, California, USA
| | - Akshara D Thakore
- Department of Cardiothoracic Surgery, and Stanford University, Stanford, California, USA
| | - Justin M Farry
- Department of Cardiothoracic Surgery, and Stanford University, Stanford, California, USA
| | - Jinsuh Jung
- Department of Cardiothoracic Surgery, and Stanford University, Stanford, California, USA
| | - Shreya Anilkumar
- Department of Cardiothoracic Surgery, and Stanford University, Stanford, California, USA
| | - Hanjay Wang
- Department of Cardiothoracic Surgery, and Stanford University, Stanford, California, USA
| | - Annabel M Imbrie-Moore
- Department of Cardiothoracic Surgery, and Stanford University, Stanford, California, USA.,Department of Mechanical Engineering, Stanford University, Stanford, California, USA
| | - Matthew H Park
- Department of Cardiothoracic Surgery, and Stanford University, Stanford, California, USA.,Department of Mechanical Engineering, Stanford University, Stanford, California, USA
| | - Nicholas A Tran
- Department of Cardiothoracic Surgery, and Stanford University, Stanford, California, USA
| | - Yi-Ping Joseph Woo
- Department of Bioengineering, Stanford University, Stanford, California, USA.,Department of Cardiothoracic Surgery, and Stanford University, Stanford, California, USA
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13
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Shi L, Tee BC, Cotter L, Sun Z. Enhance Mandibular Symphyseal Surface Bone Growth with Autologous Mesenchymal Stem Cell Sheets: An Animal Study. Aesthetic Plast Surg 2020; 44:191-200. [PMID: 31701201 DOI: 10.1007/s00266-019-01494-3] [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: 07/05/2019] [Accepted: 08/31/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The size and shape of the chin strongly influence facial profile and harmony. The current correction of chin deficiency mostly relies on genioplasty surgery involving osteotomy. To avoid osteotomy, one possible alternative is to enhance bone growth at the mental protuberance area with cell sheet transplantation. This study was undertaken to evaluate the efficacy of this approach in a pig model. MATERIALS AND METHODS Five 4-month-old pigs were included for mandibular bone marrow aspiration and MSC isolation. Triple-layer MSC sheets were then fabricated and utilized using culture-expanded MSCs. Four weeks after bone marrow aspiration, subperiosteal pockets were created on the labial symphyseal surface, followed by transplantation of autogenous MSC sheets to one randomly chosen side with the other side (control) receiving no transplantation. Six weeks after the surgery, the pigs were euthanized and the specimens from both sides were collected for computed tomography (CT) and histological and immunohistochemical analysis. Measurements between the experimental and control sides were compared using paired t tests. RESULTS MSC sheet fabrication and transplantation were reliably conducted. The labial cortical bone thickness increased significantly with MSC sheet transplantation by an average of 2 mm (p = 0.0001). The average measurements of mineral apposition rate and cell proliferation at the cell sheet side tended to be higher than the control side although the differences did not reach statistical significance (p = 0.1-0.2). Tissue mineral density measurements from CT images and bone volume fraction (BV/TV) measurements from histologic images were identical between the two sides (p > 0.5). CONCLUSION These data provide a proof of concept that autologous MSC sheets may be transplanted to the subperiosteal region of the mandibular symphysis to stimulate local surface bone growth. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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14
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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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15
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von Bornstädt D, Wang H, Paulsen MJ, Goldstone AB, Eskandari A, Thakore A, Stapleton L, Steele AN, Truong VN, Jaatinen K, Hironaka C, Woo YJ. Rapid Self-Assembly of Bioengineered Cardiovascular Bypass Grafts From Scaffold-Stabilized, Tubular Bilevel Cell Sheets. Circulation 2019; 138:2130-2144. [PMID: 30474423 DOI: 10.1161/circulationaha.118.035231] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Cardiovascular bypass grafting is an essential treatment for complex cases of atherosclerotic disease. Because the availability of autologous arterial and venous conduits is patient-limited, self-assembled cell-only grafts have been developed to serve as functional conduits with off-the-shelf availability. The unacceptably long production time required to generate these conduits, however, currently limits their clinical utility. Here, we introduce a novel technique to significantly accelerate the production process of self-assembled engineered vascular conduits. METHODS Human aortic smooth muscle cells and skin fibroblasts were used to construct bilevel cell sheets. Cell sheets were wrapped around a 22.5-gauge Angiocath needle to form tubular vessel constructs. A thin, flexible membrane of clinically approved biodegradable tissue glue (Dermabond Advanced) served as a temporary, external scaffold, allowing immediate perfusion and endothelialization of the vessel construct in a bioreactor. Subsequently, the matured vascular conduits were used as femoral artery interposition grafts in rats (n=20). Burst pressure, vasoreactivity, flow dynamics, perfusion, graft patency, and histological structure were assessed. RESULTS Compared with engineered vascular conduits formed without external stabilization, glue membrane-stabilized conduits reached maturity in the bioreactor in one-fifth the time. After only 2 weeks of perfusion, the matured conduits exhibited flow dynamics similar to that of control arteries, as well as physiological responses to vasoconstricting and vasodilating drugs. The matured conduits had burst pressures exceeding 500 mm Hg and had sufficient mechanical stability for surgical anastomoses. The patency rate of implanted conduits at 8 weeks was 100%, with flow rate and hind-limb perfusion similar to those of sham controls. Grafts explanted after 8 weeks showed a histological structure resembling that of typical arteries, including intima, media, adventitia, and internal and external elastic membrane layers. CONCLUSIONS Our technique reduces the production time of self-assembled, cell sheet-derived engineered vascular conduits to 2 weeks, thereby permitting their use as bypass grafts within the clinical time window for elective cardiovascular surgery. Furthermore, our method uses only clinically approved materials and can be adapted to various cell sources, simplifying the path toward future clinical translation.
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Affiliation(s)
- Daniel von Bornstädt
- Departments of Cardiothoracic Surgery (D.v.B., H.W., M.J.P., A.B.G., A.E., A.T., L.S., A.N.S., V.N.T., K.J., C.H., Y.J.W.), Stanford University, CA
| | - Hanjay Wang
- Departments of Cardiothoracic Surgery (D.v.B., H.W., M.J.P., A.B.G., A.E., A.T., L.S., A.N.S., V.N.T., K.J., C.H., Y.J.W.), Stanford University, CA
| | - Michael J Paulsen
- Departments of Cardiothoracic Surgery (D.v.B., H.W., M.J.P., A.B.G., A.E., A.T., L.S., A.N.S., V.N.T., K.J., C.H., Y.J.W.), Stanford University, CA
| | - Andrew B Goldstone
- Departments of Cardiothoracic Surgery (D.v.B., H.W., M.J.P., A.B.G., A.E., A.T., L.S., A.N.S., V.N.T., K.J., C.H., Y.J.W.), Stanford University, CA
| | - Anahita Eskandari
- Departments of Cardiothoracic Surgery (D.v.B., H.W., M.J.P., A.B.G., A.E., A.T., L.S., A.N.S., V.N.T., K.J., C.H., Y.J.W.), Stanford University, CA
| | - Akshara Thakore
- Departments of Cardiothoracic Surgery (D.v.B., H.W., M.J.P., A.B.G., A.E., A.T., L.S., A.N.S., V.N.T., K.J., C.H., Y.J.W.), Stanford University, CA
| | - Lyndsay Stapleton
- Departments of Cardiothoracic Surgery (D.v.B., H.W., M.J.P., A.B.G., A.E., A.T., L.S., A.N.S., V.N.T., K.J., C.H., Y.J.W.), Stanford University, CA.,Bioengineering (L.S., A.N.S., Y.J.W.), Stanford University, CA
| | - Amanda N Steele
- Departments of Cardiothoracic Surgery (D.v.B., H.W., M.J.P., A.B.G., A.E., A.T., L.S., A.N.S., V.N.T., K.J., C.H., Y.J.W.), Stanford University, CA.,Bioengineering (L.S., A.N.S., Y.J.W.), Stanford University, CA
| | - Vi N Truong
- Departments of Cardiothoracic Surgery (D.v.B., H.W., M.J.P., A.B.G., A.E., A.T., L.S., A.N.S., V.N.T., K.J., C.H., Y.J.W.), Stanford University, CA
| | - Kevin Jaatinen
- Departments of Cardiothoracic Surgery (D.v.B., H.W., M.J.P., A.B.G., A.E., A.T., L.S., A.N.S., V.N.T., K.J., C.H., Y.J.W.), Stanford University, CA
| | - Camille Hironaka
- Departments of Cardiothoracic Surgery (D.v.B., H.W., M.J.P., A.B.G., A.E., A.T., L.S., A.N.S., V.N.T., K.J., C.H., Y.J.W.), Stanford University, CA
| | - Y Joseph Woo
- Departments of Cardiothoracic Surgery (D.v.B., H.W., M.J.P., A.B.G., A.E., A.T., L.S., A.N.S., V.N.T., K.J., C.H., Y.J.W.), Stanford University, CA.,Bioengineering (L.S., A.N.S., Y.J.W.), Stanford University, CA
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16
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Stephens CJ, Spector JA, Butcher JT. Biofabrication of thick vascularized neo-pedicle flaps for reconstructive surgery. Transl Res 2019; 211:84-122. [PMID: 31170376 PMCID: PMC6702068 DOI: 10.1016/j.trsl.2019.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 05/06/2019] [Accepted: 05/14/2019] [Indexed: 01/01/2023]
Abstract
Wound chronicity due to intrinsic and extrinsic factors perturbs adequate lesion closure and reestablishment of the protective skin barrier. Immediate and proper care of chronic wounds is necessary for a swift recovery and a reduction of patient vulnerability to infection. Advanced therapies supplemented with standard wound care procedures have been clinically implemented to restore aberrant tissue; however, these treatments are ineffective if local vasculature is too compromised to support minimally-invasive strategies. Autologous "flaps", which are tissues equipped with their own hierarchical vascular supply, can be harvested from one region of the patient and transplanted to the wound where it is reperfused upon microsurgical anastomosis to appropriate recipient vessels. Despite the success of autologous flap transfer, these procedures are extremely invasive, incur obligatory donor-site morbidity, and require sufficient donor-tissue availability, microsurgical expertise, and specialized equipment. 3D-bioprinting modalities, such as extrusion-based bioprinting, can be used to address the clinical constraints of autologous flap transfer, primarily addressing donor-site morbidity and tissue availability. This advancement in regenerative medicine allows the biofabrication of heterogeneous tissue structures with high shape fidelity and spatial resolution to generate biomimetic constructs with the anatomically-precise geometries of native tissue to ensure tissue-specific function. Yet, meaningful progress toward this clinical application has been limited by the lack of vascularization required to meet the nutrient and oxygen demands of clinically relevant tissue volumes. Thus, various criteria for the fabrication of functional tissues with hierarchical, patent vasculature must be considered when implementing 3D-bioprinting technologies for deep, chronic wounds.
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Affiliation(s)
- Chelsea J Stephens
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York
| | - Jason A Spector
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York; Division of Plastic Surgery, Weill Cornell Medical College, New York, New York
| | - Jonathan T Butcher
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York.
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17
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Affiliation(s)
- Amanda N Steele
- From the Departments of Cardiothoracic Surgery (A.N.S., J.W.M., Y.J.W.) and Bioengineering (A.N.S., Y.J.W.), Stanford University, CA
| | - John W MacArthur
- From the Departments of Cardiothoracic Surgery (A.N.S., J.W.M., Y.J.W.) and Bioengineering (A.N.S., Y.J.W.), Stanford University, CA
| | - Y Joseph Woo
- From the Departments of Cardiothoracic Surgery (A.N.S., J.W.M., Y.J.W.) and Bioengineering (A.N.S., Y.J.W.), Stanford University, CA.
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18
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Jia Z, Guo H, Xie H, Bao X, Huang Y, Yang G, Chen F. Harvesting prevascularized smooth muscle cell sheets from common polystyrene culture dishes. PLoS One 2018; 13:e0204677. [PMID: 30256839 PMCID: PMC6157888 DOI: 10.1371/journal.pone.0204677] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 09/12/2018] [Indexed: 02/07/2023] Open
Abstract
Cell sheet engineering has recently emerged as a promising strategy for scaffold-free tissue engineering. However, the primary method of harvesting cell sheets using temperature-responsive dishes has potential limitations. Here we report a novel cell sheet technology based on a coculture system in which SMCs are cocultured with EPCs on common polystyrene dishes. We found that an intact and highly viable cell sheet could be harvested using mechanical methods when SMCs and EPCs were cocultured on common polystyrene dishes at a ratio of 6:1 for 5 to 6 days; the method is simple, cost-effective and highly repeatable. Moreover, the cocultured cell sheet contained capillary-like networks and could secrete a variety of angiogenic factors. Finally, in vivo studies proved that the cocultured cell sheets were more favorable for the fabrication of vascularized smooth muscle tissues compared to single SMC sheets. This study provides a promising avenue for smooth muscle tissue engineering.
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Affiliation(s)
- Zhiming Jia
- Department of Urology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hailin Guo
- Department of Urology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hua Xie
- Department of Urology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xingqi Bao
- Department of Urology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yichen Huang
- Department of Urology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ganggang Yang
- Department of Urology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Fang Chen
- Department of Urology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
- * E-mail:
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19
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Kawamura M, Paulsen MJ, Goldstone AB, Shudo Y, Wang H, Steele AN, Stapleton LM, Edwards BB, Eskandari A, Truong VN, Jaatinen KJ, Ingason AB, Miyagawa S, Sawa Y, Woo YJ. Tissue-engineered smooth muscle cell and endothelial progenitor cell bi-level cell sheets prevent progression of cardiac dysfunction, microvascular dysfunction, and interstitial fibrosis in a rodent model of type 1 diabetes-induced cardiomyopathy. Cardiovasc Diabetol 2017; 16:142. [PMID: 29096622 PMCID: PMC5668999 DOI: 10.1186/s12933-017-0625-4] [Citation(s) in RCA: 21] [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: 07/26/2017] [Accepted: 10/24/2017] [Indexed: 12/21/2022] Open
Abstract
Background Diabetes mellitus is a risk factor for coronary artery disease and diabetic cardiomyopathy, and adversely impacts outcomes following coronary artery bypass grafting. Current treatments focus on macro-revascularization and neglect the microvascular disease typical of diabetes mellitus-induced cardiomyopathy (DMCM). We hypothesized that engineered smooth muscle cell (SMC)-endothelial progenitor cell (EPC) bi-level cell sheets could improve ventricular dysfunction in DMCM. Methods Primary mesenchymal stem cells (MSCs) and EPCs were isolated from the bone marrow of Wistar rats, and MSCs were differentiated into SMCs by culturing on a fibronectin-coated dish. SMCs topped with EPCs were detached from a temperature-responsive culture dish to create an SMC-EPC bi-level cell sheet. A DMCM model was induced by intraperitoneal streptozotocin injection. Four weeks after induction, rats were randomized into 3 groups: control (no DMCM induction), untreated DMCM, and treated DMCM (cell sheet transplant covering the anterior surface of the left ventricle). Results SMC-EPC cell sheet therapy preserved cardiac function and halted adverse ventricular remodeling, as demonstrated by echocardiography and cardiac magnetic resonance imaging at 8 weeks after DMCM induction. Myocardial contrast echocardiography demonstrated that myocardial perfusion and microvascular function were preserved in the treatment group compared with untreated animals. Histological analysis demonstrated decreased interstitial fibrosis and increased microvascular density in the SMC-EPC cell sheet-treated group. Conclusions Treatment of DMCM with tissue-engineered SMC-EPC bi-level cell sheets prevented cardiac dysfunction and microvascular disease associated with DMCM. This multi-lineage cellular therapy is a novel, translatable approach to improve microvascular disease and prevent heart failure in diabetic patients.
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Affiliation(s)
- Masashi Kawamura
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA.,Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, 565-0871, Japan
| | - Michael J Paulsen
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Andrew B Goldstone
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Yasuhiro Shudo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA.,Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, 565-0871, Japan
| | - Hanjay Wang
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Amanda N Steele
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Lyndsay M Stapleton
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Bryan B Edwards
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Anahita Eskandari
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Vi N Truong
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Kevin J Jaatinen
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Arnar B Ingason
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, 565-0871, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, 565-0871, Japan
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA.
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Balsam LB. Recapitulating nature's design: Myocardial repair with cell sheet technology. J Thorac Cardiovasc Surg 2017. [PMID: 28629840 DOI: 10.1016/j.jtcvs.2017.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Leora B Balsam
- Department of Cardiothoracic Surgery, New York University-Langone Medical Center, New York, NY.
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Engineering biomimetic periosteum with β-TCP scaffolds to promote bone formation in calvarial defects of rats. Stem Cell Res Ther 2017; 8:134. [PMID: 28583167 PMCID: PMC5460346 DOI: 10.1186/s13287-017-0592-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 04/26/2017] [Accepted: 05/18/2017] [Indexed: 01/01/2023] Open
Abstract
Background There is a critical need for the management of large bone defects. The purpose of this study was to engineer a biomimetic periosteum and to combine this with a macroporous β-tricalcium phosphate (β-TCP) scaffold for bone tissue regeneration. Methods Rat bone marrow-derived mesenchymal stem cells (rBMSCs) were harvested and cultured in different culture media to form undifferentiated rBMSC sheets (undifferentiated medium (UM)) and osteogenic cell sheets (osteogenic medium (OM)). Simultaneously, rBMSCs were differentiated to induced endothelial-like cells (iECs), and the iECs were further cultured on a UM to form a vascularized cell sheet. At the same time, flow cytometry was used to detect the conversion rates of rBMSCs to iECs. The pre-vascularized cell sheet (iECs/UM) and the osteogenic cell sheet (OM) were stacked together to form a biomimetic periosteum with two distinct layers, which mimicked the fibrous layer and cambium layer of native periosteum. The biomimetic periostea were wrapped onto porous β-TCP scaffolds (BP/β-TCP) and implanted in the calvarial bone defects of rats. As controls, autologous periostea with β-TCP (AP/β-TCP) and β-TCP alone were implanted in the calvarial defects of rats, with a no implantation group as another control. At 2, 4, and 8 weeks post-surgery, implants were retrieved and X-ray, microcomputed tomography (micro-CT), histology, and immunohistochemistry staining analyses were performed. Results Flow cytometry results showed that rBMSCs were partially differentiated into iECs with a 35.1% conversion rate in terms of CD31. There were still 20.97% rBMSCs expressing CD90. Scanning electron microscopy (SEM) results indicated that cells from the wrapped cell sheet on the β-TCP scaffold apparently migrated into the pores of the β-TCP scaffold. The histology and immunohistochemistry staining results from in vivo implantation indicated that the BP/β-TCP and AP/β-TCP groups promoted the formation of blood vessels and new bone tissues in the bone defects more than the other two control groups. In addition, micro-CT showed that more new bone tissue formed in the BP/β-TCP and AP/β-TCP groups than the other groups. Conclusions Inducing rBMSCs to iECs could be a good strategy to obtain an endothelial cell source for prevascularization. Our findings indicate that the biomimetic periosteum with porous β-TCP scaffold has a similar ability to promote osteogenesis and angiogenesis in vivo compared to the autologous periosteum. This function could result from the double layers of biomimetic periosteum. The prevascularized cell sheet served a mimetic fibrous layer and the osteogenic cell sheet served a cambium layer of native periosteum. The biomimetic periosteum with a porous ceramic scaffold provides a new promising method for bone healing.
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Shudo Y, Goldstone AB, Cohen JE, Patel JB, Hopkins MS, Steele AN, Edwards BB, Kawamura M, Miyagawa S, Sawa Y, Woo YJ. Layered smooth muscle cell-endothelial progenitor cell sheets derived from the bone marrow augment postinfarction ventricular function. J Thorac Cardiovasc Surg 2017; 154:955-963. [PMID: 28651946 DOI: 10.1016/j.jtcvs.2017.04.081] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 04/08/2017] [Accepted: 04/12/2017] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The angiogenic potential of endothelial progenitor cells (EPCs) may be limited by the absence of their natural biologic foundation, namely smooth muscle pericytes. We hypothesized that joint delivery of EPCs and smooth muscle cells (SMCs) in a novel, totally bone marrow-derived cell sheet will mimic the native architecture of a mature blood vessel and act as an angiogenic construct to limit post infarction ventricular remodeling. METHODS Primary EPCs and mesenchymal stem cells were isolated from bone marrow of Wistar rats. Mesenchymal stem cells were transdifferentiated into SMCs by culture on fibronectin-coated culture dishes. Confluent SMCs topped with confluent EPCs were detached from an Upcell dish to create a SMC-EPC bi-level cell sheet. A rodent model of ischemic cardiomyopathy was then created by ligating the left anterior descending artery. Rats were randomized into 3 groups: cell sheet transplantation (n = 9), no treatment (n = 12), or sham surgery control (n = 7). RESULTS Four weeks postinfarction, mature vessel density tended to increase in cell sheet-treated animals compared with controls. Cell sheet therapy significantly attenuated the extent of cardiac fibrosis compared with that of the untreated group (untreated vs cell sheet, 198 degrees [interquartile range (IQR), 151-246 degrees] vs 103 degrees [IQR, 92-113 degrees], P = .04). Furthermore, EPC-SMC cell sheet transplantation attenuated myocardial dysfunction, as evidenced by an increase in left ventricular ejection fraction (untreated vs cell sheet vs sham, 33.5% [IQR, 27.8%-35.7%] vs 45.9% [IQR, 43.6%-48.4%] vs 59.3% [IQR, 58.8%-63.5%], P = .001) and decreases in left ventricular dimensions. CONCLUSIONS The bone marrow-derived, spatially arranged SMC-EPC bi-level cell sheet is a novel, multilineage cellular therapy obtained from a translationally practical source. Interactions between SMCs and EPCs augment mature neovascularization, limit adverse remodeling, and improve ventricular function after myocardial infarction.
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Affiliation(s)
- Yasuhiro Shudo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Andrew B Goldstone
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Jeffrey E Cohen
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Jay B Patel
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Michael S Hopkins
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Amanda N Steele
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Bryan B Edwards
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Masashi Kawamura
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka City, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka City, Japan
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif.
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MacArthur JW, Steele AN, Goldstone AB, Cohen JE, Hiesinger W, Woo YJ. Injectable Bioengineered Hydrogel Therapy in the Treatment of Ischemic Cardiomyopathy. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:30. [PMID: 28337717 DOI: 10.1007/s11936-017-0530-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OPINION STATEMENT Over the past two decades, the field of cardiovascular medicine has seen the rapid development of multiple different modalities for the treatment of ischemic myocardial disease. Most research efforts have focused on strategies aimed at coronary revascularization, with significant technological advances made in percutaneous coronary interventions as well as coronary artery bypass graft surgery. However, recent research efforts have shifted towards ways to address the downstream effects of myocardial infarction on both cellular and molecular levels. To this end, the broad application of injectable hydrogel therapy after myocardial infarction has stimulated tremendous interest. In this article, we will review what hydrogels are, how they can be bioengineered in unique ways to optimize therapeutic potential, and how they can be used as part of a treatment strategy after myocardial infarction.
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Affiliation(s)
- John W MacArthur
- Department of Cardiothoracic Surgery, Stanford University, Falk Cardiovascular Research Bldg, 2nd Floor, 300 Pasteur Drive, Stanford, CA, 94305-5407, USA
| | - Amanda N Steele
- Department of Cardiothoracic Surgery, Stanford University, Falk Cardiovascular Research Bldg, 2nd Floor, 300 Pasteur Drive, Stanford, CA, 94305-5407, USA
| | - Andrew B Goldstone
- Department of Cardiothoracic Surgery, Stanford University, Falk Cardiovascular Research Bldg, 2nd Floor, 300 Pasteur Drive, Stanford, CA, 94305-5407, USA
| | - Jeffrey E Cohen
- Department of Cardiothoracic Surgery, Stanford University, Falk Cardiovascular Research Bldg, 2nd Floor, 300 Pasteur Drive, Stanford, CA, 94305-5407, USA
| | - William Hiesinger
- Department of Cardiothoracic Surgery, Stanford University, Falk Cardiovascular Research Bldg, 2nd Floor, 300 Pasteur Drive, Stanford, CA, 94305-5407, USA
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University, Falk Cardiovascular Research Bldg, 2nd Floor, 300 Pasteur Drive, Stanford, CA, 94305-5407, USA.
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Shudo Y, Miyagawa S, Ohkura H, Fukushima S, Saito A, Kawaguchi N, Matsuura N, Toda K, Sakaguchi T, Nishi H, Yoshikawa Y, Shimizu T, Okano T, Matsuyama A, Sawa Y. Adipose tissue-derived multi-lineage progenitor cells improve left ventricular dysfunction in porcine ischemic cardiomyopathy model. J Heart Lung Transplant 2017; 36:237-239. [PMID: 28159019 DOI: 10.1016/j.healun.2016.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 11/25/2016] [Accepted: 11/30/2016] [Indexed: 11/21/2022] Open
Affiliation(s)
- Yasuhiro Shudo
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hanayuki Ohkura
- Laboratory for Somatic Stem Cell Therapy, Foundation of Biomedical Research and Innovation, Kobe, Japan
| | - Satsuki Fukushima
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Atsuhiro Saito
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Naomasa Kawaguchi
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Nariaki Matsuura
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Taichi Sakaguchi
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroyuki Nishi
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasushi Yoshikawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tatsuya Shimizu
- Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan
| | - Teruo Okano
- Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan
| | - Akifumi Matsuyama
- Laboratory for Somatic Stem Cell Therapy, Foundation of Biomedical Research and Innovation, Kobe, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Shudo Y, Cohen JE, Goldstone AB, MacArthur JW, Patel J, Edwards BB, Hopkins MS, Steele AN, Joubert LM, Miyagawa S, Sawa Y, Woo YJ. Isolation and trans-differentiation of mesenchymal stromal cells into smooth muscle cells: Utility and applicability for cell-sheet engineering. Cytotherapy 2016; 18:510-7. [PMID: 26971679 DOI: 10.1016/j.jcyt.2016.01.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 01/04/2016] [Accepted: 01/23/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Bone marrow (BM)-derived mesenchymal stromal cells (MSCs) have shown potential to differentiate into various cell types, including smooth muscle cells (SMCs). The extracellular matrix (ECM) represents an appealing and readily available source of SMCs for use in tissue engineering. In this study, we hypothesized that the ECM could be used to induce MSC differentiation to SMCs for engineered cell-sheet construction. METHODS Primary MSCs were isolated from the BM of Wistar rats, transferred and cultured on dishes coated with 3 different types of ECM: collagen type IV (Col IV), fibronectin (FN), and laminin (LM). Primary MSCs were also included as a control. The proportions of SMC (a smooth muscle actin [aSMA] and SM22a) and MSC markers were examined with flow cytometry and Western blotting, and cell proliferation rates were also quantified. RESULTS Both FN and LM groups were able to induce differentiation of MSCs toward smooth muscle-like cell types, as evidenced by an increase in the proportion of SMC markers (aSMA; Col IV 42.3 ± 6.9%, FN 65.1 ± 6.5%, LM 59.3 ± 7.0%, Control 39.9 ± 3.1%; P = 0.02, SM22; Col IV 56.0 ± 7.7%, FN 74.2 ± 6.7%, LM 60.4 ± 8.7%, Control 44.9 ± 3.6%) and a decrease in that of MSC markers (CD105: Col IV 64.0 ± 5.2%, FN 57.6 ± 4.0%, LM 60.3 ± 7.0%, Control 85.3 ± 4.2%; P = 0.03). The LM group showed a decrease in overall cell proliferation, whereas FN and Col IV groups remained similar to control MSCs (Col IV, 9.0 ± 2.3%; FN, 9.8 ± 2.5%; LM, 4.3 ± 1.3%; Control, 9.8 ± 2.8%). CONCLUSIONS Our findings indicate that ECM selection can guide differentiation of MSCs into the SMC lineage. Fibronectin preserved cellular proliferative capacity while yielding the highest proportion of differentiated SMCs, suggesting that FN-coated materials may be facilitate smooth muscle tissue engineering.
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Affiliation(s)
- Yasuhiro Shudo
- Department of Cardiothoracic Surgery, School of Medicine, Stanford University, Stanford, CA, USA; Department of Cardiovascular Surgery, School of Medicine, Osaka University Graduate, Osaka, Japan
| | - Jeffrey E Cohen
- Department of Cardiothoracic Surgery, School of Medicine, Stanford University, Stanford, CA, USA
| | - Andrew B Goldstone
- Department of Cardiothoracic Surgery, School of Medicine, Stanford University, Stanford, CA, USA
| | - John W MacArthur
- Department of Cardiothoracic Surgery, School of Medicine, Stanford University, Stanford, CA, USA
| | - Jay Patel
- Department of Cardiothoracic Surgery, School of Medicine, Stanford University, Stanford, CA, USA
| | - Bryan B Edwards
- Department of Cardiothoracic Surgery, School of Medicine, Stanford University, Stanford, CA, USA
| | - Michael S Hopkins
- Department of Cardiothoracic Surgery, School of Medicine, Stanford University, Stanford, CA, USA
| | - Amanda N Steele
- Department of Cardiothoracic Surgery, School of Medicine, Stanford University, Stanford, CA, USA
| | - Lydia-Marie Joubert
- Cell Sciences Imaging Facility, Stanford School of Medicine, Stanford University, Stanford, CA, USA
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, School of Medicine, Osaka University Graduate, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, School of Medicine, Osaka University Graduate, Osaka, Japan
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, School of Medicine, Stanford University, Stanford, CA, USA.
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Novakova V, Sandhu GS, Dragomir-Daescu D, Klabusay M. Apelinergic system in endothelial cells and its role in angiogenesis in myocardial ischemia. Vascul Pharmacol 2016; 76:1-10. [DOI: 10.1016/j.vph.2015.08.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 08/01/2015] [Accepted: 08/03/2015] [Indexed: 12/21/2022]
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Park JS, Yang HN, Yi SW, Kim JH, Park KH. Neoangiogenesis of human mesenchymal stem cells transfected with peptide-loaded and gene-coated PLGA nanoparticles. Biomaterials 2016; 76:226-37. [DOI: 10.1016/j.biomaterials.2015.10.062] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 10/22/2015] [Accepted: 10/26/2015] [Indexed: 12/12/2022]
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Shudo Y, Cohen JE, MacArthur JW, Goldstone AB, Otsuru S, Trubelja A, Patel J, Edwards BB, Hung G, Fairman AS, Brusalis C, Hiesinger W, Atluri P, Hiraoka A, Miyagawa S, Sawa Y, Woo YJ. A Tissue-Engineered Chondrocyte Cell Sheet Induces Extracellular Matrix Modification to Enhance Ventricular Biomechanics and Attenuate Myocardial Stiffness in Ischemic Cardiomyopathy. Tissue Eng Part A 2015; 21:2515-25. [PMID: 26154752 DOI: 10.1089/ten.tea.2014.0155] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
There exists a substantial body of work describing cardiac support devices to mechanically support the left ventricle (LV); however, these devices lack biological effects. To remedy this, we implemented a cell sheet engineering approach utilizing chondrocytes, which in their natural environment produce a relatively elastic extracellular matrix (ECM) for a cushioning effect. Therefore, we hypothesized that a chondrocyte cell sheet applied to infarcted and borderzone myocardium will biologically enhance the ventricular ECM and increase elasticity to augment cardiac function in a model of ischemic cardiomyopathy (ICM). Primary articular cartilage chondrocytes of Wistar rats were isolated and cultured on temperature-responsive culture dishes to generate cell sheets. A rodent ICM model was created by ligating the left anterior descending coronary artery. Rats were divided into two groups: cell sheet transplantation (1.0 × 10(7) cells/dish) and no treatment. The cell sheet was placed onto the surface of the heart covering the infarct and borderzone areas. At 4 weeks following treatment, the decreased fibrotic extension and increased elastic microfiber networks in the infarct and borderzone areas correlated with this technology's potential to stimulate ECM formation. The enhanced ventricular elasticity was further confirmed by the axial stretch test, which revealed that the cell sheet tended to attenuate tensile modulus, a parameter of stiffness. This translated to increased wall thickness in the infarct area, decreased LV volume, wall stress, mass, and improvement of LV function. Thus, the chondrocyte cell sheet strengthens the ventricular biomechanical properties by inducing the formation of elastic microfiber networks in ICM, resulting in attenuated myocardial stiffness and improved myocardial function.
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Affiliation(s)
- Yasuhiro Shudo
- 1 Department of Cardiothoracic Surgery, Stanford University School of Medicine , Stanford, California
- 4 Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine , Osaka, Japan
| | - Jeffrey E Cohen
- 1 Department of Cardiothoracic Surgery, Stanford University School of Medicine , Stanford, California
- 2 Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania School of Medicine , Philadelphia, Pennsylvania
| | - John W MacArthur
- 1 Department of Cardiothoracic Surgery, Stanford University School of Medicine , Stanford, California
- 2 Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania School of Medicine , Philadelphia, Pennsylvania
| | - Andrew B Goldstone
- 1 Department of Cardiothoracic Surgery, Stanford University School of Medicine , Stanford, California
- 2 Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania School of Medicine , Philadelphia, Pennsylvania
| | - Satoru Otsuru
- 3 Center for Childhood Cancer and Blood Diseases, The Research Institute , Nationwide Children's Hospital, Columbus, Ohio
| | - Alen Trubelja
- 2 Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania School of Medicine , Philadelphia, Pennsylvania
| | - Jay Patel
- 1 Department of Cardiothoracic Surgery, Stanford University School of Medicine , Stanford, California
| | - Bryan B Edwards
- 1 Department of Cardiothoracic Surgery, Stanford University School of Medicine , Stanford, California
| | - George Hung
- 2 Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania School of Medicine , Philadelphia, Pennsylvania
| | - Alexander S Fairman
- 2 Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania School of Medicine , Philadelphia, Pennsylvania
| | - Christopher Brusalis
- 2 Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania School of Medicine , Philadelphia, Pennsylvania
| | - William Hiesinger
- 2 Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania School of Medicine , Philadelphia, Pennsylvania
| | - Pavan Atluri
- 2 Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania School of Medicine , Philadelphia, Pennsylvania
| | - Arudo Hiraoka
- 2 Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania School of Medicine , Philadelphia, Pennsylvania
| | - Shigeru Miyagawa
- 4 Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine , Osaka, Japan
| | - Yoshiki Sawa
- 4 Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine , Osaka, Japan
| | - Y Joseph Woo
- 1 Department of Cardiothoracic Surgery, Stanford University School of Medicine , Stanford, California
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Xu Y, Zhang G, Kang Z, Xu Y, Jiang W, Zhang S. Cornin increases angiogenesis and improves functional recovery after stroke via the Ang1/Tie2 axis and the Wnt/β-catenin pathway. Arch Pharm Res 2015; 39:133-42. [DOI: 10.1007/s12272-015-0652-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 08/11/2015] [Indexed: 11/28/2022]
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Xu Y, Zhang J, Jiang W, Zhang S. Astaxanthin induces angiogenesis through Wnt/β-catenin signaling pathway. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2015; 22:744-751. [PMID: 26141761 DOI: 10.1016/j.phymed.2015.05.054] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 05/21/2015] [Accepted: 05/24/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE In the present study, we sought to elucidate whether astaxanthin contributes to induce angiogenesis and its mechanisms. MATERIALS AND METHODS To this end, we examined the role of astaxanthin on human brain microvascular endothelial cell line (HBMEC) and rat aortic smooth muscle cell (RASMC) proliferation, invasion and tube formation in vitro. For study of mechanism, the Wnt/β-catenin signaling pathway inhibitor IWR-1-endo was used. HMBECs and RASMCs proliferation were tested by cell counting. Scratch adhesion test was used to assess the ability of invasion. A matrigel tube formation assay was performed to test capillary tube formation ability. The Wnt/β-catenin pathway activation in HMBECs and RASMCs were tested by Western blot. RESULTS Our data suggested that astaxanthin induces angiogenesis by increasing proliferation, invasion and tube formation in vitro. Wnt and β-catenin expression were increased by astaxanthin and counteracted by IWR-1-endo in HMBECs and RASMCs. Tube formation was increased by astaxanthin and counteracted by IWR-1-endo. CONCLUSIONS It may be suggested that astaxanthin induces angiogenesis in vitro via a programmed Wnt/β-catenin signaling pathway.
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Affiliation(s)
- Yangyang Xu
- School of Pharmaceutical Sciences, Binzhou Medical University, Yantai, 264003, PR. China
| | - Jie Zhang
- School of Pharmaceutical Sciences, Binzhou Medical University, Yantai, 264003, PR. China
| | - Wanglin Jiang
- School of Pharmaceutical Sciences, Binzhou Medical University, Yantai, 264003, PR. China.
| | - Shuping Zhang
- School of Pharmaceutical Sciences, Binzhou Medical University, Yantai, 264003, PR. China.
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Berezin AE, Kremzer AA, Samura TA, Martovitskaya YV, Malinovskiy YV, Oleshko SV, Berezina TA. Predictive value of apoptotic microparticles to mononuclear progenitor cells ratio in advanced chronic heart failure patients. J Cardiol 2015; 65:403-11. [PMID: 25123603 DOI: 10.1016/j.jjcc.2014.06.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 06/19/2014] [Accepted: 06/25/2014] [Indexed: 10/24/2022]
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Simons M, Alitalo K, Annex BH, Augustin HG, Beam C, Berk BC, Byzova T, Carmeliet P, Chilian W, Cooke JP, Davis GE, Eichmann A, Iruela-Arispe ML, Keshet E, Sinusas AJ, Ruhrberg C, Woo YJ, Dimmeler S. State-of-the-Art Methods for Evaluation of Angiogenesis and Tissue Vascularization: A Scientific Statement From the American Heart Association. Circ Res 2015; 116:e99-132. [PMID: 25931450 DOI: 10.1161/res.0000000000000054] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Taylor DA, Sampaio LC, Gobin A. Building new hearts: a review of trends in cardiac tissue engineering. Am J Transplant 2014; 14:2448-59. [PMID: 25293671 DOI: 10.1111/ajt.12939] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 06/26/2014] [Accepted: 07/12/2014] [Indexed: 01/25/2023]
Abstract
Cardiovascular disease (CVD) is the number one cause of death in the United States. However, few treatments for CVD provide a means to regain full cardiac function with no long-term side effects. Novel tissue-engineered products may provide a way to overcome the limitations of current CVD therapies by replacing injured myocardium with functioning tissue or by inducing more constructive forms of endogenous repair. In this review, we discuss some of the factors that should be considered in the development of tissue-engineered products, and we review the methods currently being investigated to generate more effective heart valves, cardiac patches and whole hearts.
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Affiliation(s)
- D A Taylor
- Department of Regenerative Medicine Research, Texas Heart Institute, Houston, TX
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Cohen JE, Purcell BP, MacArthur JW, Mu A, Shudo Y, Patel JB, Brusalis CM, Trubelja A, Fairman AS, Edwards BB, Davis MS, Hung G, Hiesinger W, Atluri P, Margulies KB, Burdick JA, Woo YJ. A bioengineered hydrogel system enables targeted and sustained intramyocardial delivery of neuregulin, activating the cardiomyocyte cell cycle and enhancing ventricular function in a murine model of ischemic cardiomyopathy. Circ Heart Fail 2014; 7:619-26. [PMID: 24902740 DOI: 10.1161/circheartfailure.113.001273] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Neuregulin-1β (NRG) is a member of the epidermal growth factor family possessing a critical role in cardiomyocyte development and proliferation. Systemic administration of NRG demonstrated efficacy in cardiomyopathy animal models, leading to clinical trials using daily NRG infusions. This approach is hindered by requiring daily infusions and off-target exposure. Therefore, this study aimed to encapsulate NRG in a hydrogel to be directly delivered to the myocardium, accomplishing sustained localized NRG delivery. METHODS AND RESULTS NRG was encapsulated in hydrogel, and release over 14 days was confirmed by ELISA in vitro. Sprague-Dawley rats were used for cardiomyocyte isolation. Cells were stimulated by PBS, NRG, hydrogel, or NRG-hydrogel (NRG-HG) and evaluated for proliferation. Cardiomyocytes demonstrated EdU (5-ethynyl-2'-deoxyuridine) and phosphorylated histone H3 positivity in the NRG-HG group only. For in vivo studies, 2-month-old mice (n=60) underwent left anterior descending coronary artery ligation and were randomized to the 4 treatment groups mentioned. Only NRG-HG-treated mice demonstrated phosphorylated histone H3 and Ki67 positivity along with decreased caspase-3 activity compared with all controls. NRG was detected in myocardium 6 days after injection without evidence of off-target exposure in NRG-HG animals. At 2 weeks, the NRG-HG group exhibited enhanced left ventricular ejection fraction, decreased left ventricular area, and augmented borderzone thickness. CONCLUSIONS Targeted and sustained delivery of NRG directly to the myocardial borderzone augments cardiomyocyte mitotic activity, decreases apoptosis, and greatly enhances left ventricular function in a model of ischemic cardiomyopathy. This novel approach to NRG administration avoids off-target exposure and represents a clinically translatable strategy in myocardial regenerative therapeutics.
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Affiliation(s)
- Jeffrey E Cohen
- From the Department of Cardiothoracic Surgery, Stanford University, CA (J.E.C., J.W.M., Y.S., J.B.P., B.B.E., Y.J.W.); and Departments of Surgery, Division of Cardiovascular Surgery (J.E.C., J.W.M., C.M.B., A.T., A.S.F., G.H., W.H., P.A.), Bioengineering (B.P.P., M.S.D., J.A.B.), and Cardiology (A.M., K.B.M.), University of Pennsylvania, Philadelphia
| | - Brendan P Purcell
- From the Department of Cardiothoracic Surgery, Stanford University, CA (J.E.C., J.W.M., Y.S., J.B.P., B.B.E., Y.J.W.); and Departments of Surgery, Division of Cardiovascular Surgery (J.E.C., J.W.M., C.M.B., A.T., A.S.F., G.H., W.H., P.A.), Bioengineering (B.P.P., M.S.D., J.A.B.), and Cardiology (A.M., K.B.M.), University of Pennsylvania, Philadelphia
| | - John W MacArthur
- From the Department of Cardiothoracic Surgery, Stanford University, CA (J.E.C., J.W.M., Y.S., J.B.P., B.B.E., Y.J.W.); and Departments of Surgery, Division of Cardiovascular Surgery (J.E.C., J.W.M., C.M.B., A.T., A.S.F., G.H., W.H., P.A.), Bioengineering (B.P.P., M.S.D., J.A.B.), and Cardiology (A.M., K.B.M.), University of Pennsylvania, Philadelphia
| | - Anbin Mu
- From the Department of Cardiothoracic Surgery, Stanford University, CA (J.E.C., J.W.M., Y.S., J.B.P., B.B.E., Y.J.W.); and Departments of Surgery, Division of Cardiovascular Surgery (J.E.C., J.W.M., C.M.B., A.T., A.S.F., G.H., W.H., P.A.), Bioengineering (B.P.P., M.S.D., J.A.B.), and Cardiology (A.M., K.B.M.), University of Pennsylvania, Philadelphia
| | - Yasuhiro Shudo
- From the Department of Cardiothoracic Surgery, Stanford University, CA (J.E.C., J.W.M., Y.S., J.B.P., B.B.E., Y.J.W.); and Departments of Surgery, Division of Cardiovascular Surgery (J.E.C., J.W.M., C.M.B., A.T., A.S.F., G.H., W.H., P.A.), Bioengineering (B.P.P., M.S.D., J.A.B.), and Cardiology (A.M., K.B.M.), University of Pennsylvania, Philadelphia
| | - Jay B Patel
- From the Department of Cardiothoracic Surgery, Stanford University, CA (J.E.C., J.W.M., Y.S., J.B.P., B.B.E., Y.J.W.); and Departments of Surgery, Division of Cardiovascular Surgery (J.E.C., J.W.M., C.M.B., A.T., A.S.F., G.H., W.H., P.A.), Bioengineering (B.P.P., M.S.D., J.A.B.), and Cardiology (A.M., K.B.M.), University of Pennsylvania, Philadelphia
| | - Christopher M Brusalis
- From the Department of Cardiothoracic Surgery, Stanford University, CA (J.E.C., J.W.M., Y.S., J.B.P., B.B.E., Y.J.W.); and Departments of Surgery, Division of Cardiovascular Surgery (J.E.C., J.W.M., C.M.B., A.T., A.S.F., G.H., W.H., P.A.), Bioengineering (B.P.P., M.S.D., J.A.B.), and Cardiology (A.M., K.B.M.), University of Pennsylvania, Philadelphia
| | - Alen Trubelja
- From the Department of Cardiothoracic Surgery, Stanford University, CA (J.E.C., J.W.M., Y.S., J.B.P., B.B.E., Y.J.W.); and Departments of Surgery, Division of Cardiovascular Surgery (J.E.C., J.W.M., C.M.B., A.T., A.S.F., G.H., W.H., P.A.), Bioengineering (B.P.P., M.S.D., J.A.B.), and Cardiology (A.M., K.B.M.), University of Pennsylvania, Philadelphia
| | - Alexander S Fairman
- From the Department of Cardiothoracic Surgery, Stanford University, CA (J.E.C., J.W.M., Y.S., J.B.P., B.B.E., Y.J.W.); and Departments of Surgery, Division of Cardiovascular Surgery (J.E.C., J.W.M., C.M.B., A.T., A.S.F., G.H., W.H., P.A.), Bioengineering (B.P.P., M.S.D., J.A.B.), and Cardiology (A.M., K.B.M.), University of Pennsylvania, Philadelphia
| | - Bryan B Edwards
- From the Department of Cardiothoracic Surgery, Stanford University, CA (J.E.C., J.W.M., Y.S., J.B.P., B.B.E., Y.J.W.); and Departments of Surgery, Division of Cardiovascular Surgery (J.E.C., J.W.M., C.M.B., A.T., A.S.F., G.H., W.H., P.A.), Bioengineering (B.P.P., M.S.D., J.A.B.), and Cardiology (A.M., K.B.M.), University of Pennsylvania, Philadelphia
| | - Mollie S Davis
- From the Department of Cardiothoracic Surgery, Stanford University, CA (J.E.C., J.W.M., Y.S., J.B.P., B.B.E., Y.J.W.); and Departments of Surgery, Division of Cardiovascular Surgery (J.E.C., J.W.M., C.M.B., A.T., A.S.F., G.H., W.H., P.A.), Bioengineering (B.P.P., M.S.D., J.A.B.), and Cardiology (A.M., K.B.M.), University of Pennsylvania, Philadelphia
| | - George Hung
- From the Department of Cardiothoracic Surgery, Stanford University, CA (J.E.C., J.W.M., Y.S., J.B.P., B.B.E., Y.J.W.); and Departments of Surgery, Division of Cardiovascular Surgery (J.E.C., J.W.M., C.M.B., A.T., A.S.F., G.H., W.H., P.A.), Bioengineering (B.P.P., M.S.D., J.A.B.), and Cardiology (A.M., K.B.M.), University of Pennsylvania, Philadelphia
| | - William Hiesinger
- From the Department of Cardiothoracic Surgery, Stanford University, CA (J.E.C., J.W.M., Y.S., J.B.P., B.B.E., Y.J.W.); and Departments of Surgery, Division of Cardiovascular Surgery (J.E.C., J.W.M., C.M.B., A.T., A.S.F., G.H., W.H., P.A.), Bioengineering (B.P.P., M.S.D., J.A.B.), and Cardiology (A.M., K.B.M.), University of Pennsylvania, Philadelphia
| | - Pavan Atluri
- From the Department of Cardiothoracic Surgery, Stanford University, CA (J.E.C., J.W.M., Y.S., J.B.P., B.B.E., Y.J.W.); and Departments of Surgery, Division of Cardiovascular Surgery (J.E.C., J.W.M., C.M.B., A.T., A.S.F., G.H., W.H., P.A.), Bioengineering (B.P.P., M.S.D., J.A.B.), and Cardiology (A.M., K.B.M.), University of Pennsylvania, Philadelphia
| | - Kenneth B Margulies
- From the Department of Cardiothoracic Surgery, Stanford University, CA (J.E.C., J.W.M., Y.S., J.B.P., B.B.E., Y.J.W.); and Departments of Surgery, Division of Cardiovascular Surgery (J.E.C., J.W.M., C.M.B., A.T., A.S.F., G.H., W.H., P.A.), Bioengineering (B.P.P., M.S.D., J.A.B.), and Cardiology (A.M., K.B.M.), University of Pennsylvania, Philadelphia
| | - Jason A Burdick
- From the Department of Cardiothoracic Surgery, Stanford University, CA (J.E.C., J.W.M., Y.S., J.B.P., B.B.E., Y.J.W.); and Departments of Surgery, Division of Cardiovascular Surgery (J.E.C., J.W.M., C.M.B., A.T., A.S.F., G.H., W.H., P.A.), Bioengineering (B.P.P., M.S.D., J.A.B.), and Cardiology (A.M., K.B.M.), University of Pennsylvania, Philadelphia
| | - Y Joseph Woo
- From the Department of Cardiothoracic Surgery, Stanford University, CA (J.E.C., J.W.M., Y.S., J.B.P., B.B.E., Y.J.W.); and Departments of Surgery, Division of Cardiovascular Surgery (J.E.C., J.W.M., C.M.B., A.T., A.S.F., G.H., W.H., P.A.), Bioengineering (B.P.P., M.S.D., J.A.B.), and Cardiology (A.M., K.B.M.), University of Pennsylvania, Philadelphia.
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