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Schwarzkopf L, Büttner P, Scholtyssek K, Schröter T, Hiller R, Hindricks G, Bollmann A, Laufs U, Ueberham L. C-kit pos cells in the human left atrial appendage. Heliyon 2023; 9:e21268. [PMID: 37954289 PMCID: PMC10637945 DOI: 10.1016/j.heliyon.2023.e21268] [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: 07/14/2023] [Revised: 10/09/2023] [Accepted: 10/18/2023] [Indexed: 11/14/2023] Open
Abstract
Background Subpopulations of myocardial c-kitpos cells have the ability to stimulate regeneration in ischemic heart disease by paracrine effects. The left atrial appendage (LAA), which is easy accessible during cardiac surgery, may represent a perfect source for c-kitpos cell extraction for autologous cell therapies in the living human. So far, frequency and distribution of c-kitpos cells in LAA are unknown. Methods LAAs of patients who underwent cardiac surgery due to coronary artery disease (coronary artery bypass graft, CABG), valvular heart disease or both and of two body donors were examined. Tissue was fixed in 4 % paraformaldehyde, embedded in paraffin, dissected in consecutive sections and stained for c-kitpos cells. In parallel, grade of fibrosis, amount of fat per section and cells positive for mast cell tryptase were examined. Results We collected 27 LAAs (37.0 % female, mean left ventricular ejection fraction 50.4 %, 63.0 % persistent atrial fibrillation (AF)). Most of the patients underwent combined CABG and valve surgery (51.9 %). C-kitpos cells were detected in 3 different regions: A) Attached to the epicardial fat layer, B) close to vascular structures and C) between cardiomyocytes. C-kitpos cells ranged from 0.05 c-kitpos cells per mm2 to 67.5 c-kitpos cells per mm2. We found no association between number of c-kitpos cells and type of AF, amount of fibrosis or amount of fat. Up to 72 % of c-kitpos cells also showed a positive staining for mast cell tryptase. Conclusion C-kitpos cells are frequent in LAAs of cardiovascular patients with a rather homogenous distribution throughout the LAA. The LAA can therefore be considered as a source for extraction of a reasonable quantity of autologous cardiac progenitor cells in the living human patient.
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Affiliation(s)
- Lea Schwarzkopf
- St. Elisabeth-Krankenhaus Leipzig, Department of Anaesthesiology, Leipzig, Germany
- German Heart Center Berlin, Department of Electrophysiology, Berlin, Germany
| | - Petra Büttner
- Heart Center Leipzig at University of Leipzig, Department of Cardiology, Leipzig, Germany
| | - Karl Scholtyssek
- German Heart Center Berlin, Department of Electrophysiology, Berlin, Germany
| | - Thomas Schröter
- Heart Center Leipzig at University of Leipzig, Department of Cardiac Surgery, Leipzig, Germany
| | - Ruth Hiller
- Insitut für Pathologie, University of Leipzig Medical Center, Leipzig, Germany
| | - Gerhard Hindricks
- German Heart Center Berlin, Department of Electrophysiology, Berlin, Germany
- Leipzig Heart Institute, Leipzig, Germany
| | - Andreas Bollmann
- German Heart Center Berlin, Department of Electrophysiology, Berlin, Germany
- Leipzig Heart Institute, Leipzig, Germany
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, University of Leipzig Medical Center, Leipzig, Germany
| | - Laura Ueberham
- German Heart Center Berlin, Department of Electrophysiology, Berlin, Germany
- Leipzig Heart Institute, Leipzig, Germany
- Klinik und Poliklinik für Kardiologie, University of Leipzig Medical Center, Leipzig, Germany
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2
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Chabanovska O, Lemcke H, Lang H, Vollmar B, Dohmen PM, David R, Etz C, Neßelmann C. Sarcomeric network analysis of ex vivo cultivated human atrial appendage tissue using super-resolution microscopy. Sci Rep 2023; 13:13041. [PMID: 37563225 PMCID: PMC10415305 DOI: 10.1038/s41598-023-39962-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/02/2023] [Indexed: 08/12/2023] Open
Abstract
Investigating native human cardiac tissue with preserved 3D macro- and microarchitecture is fundamental for clinical and basic research. Unfortunately, the low accessibility of the human myocardium continues to limit scientific progress. To overcome this issue, utilizing atrial appendages of the human heart may become highly beneficial. Atrial appendages are often removed during open-heart surgery and can be preserved ex vivo as living tissue with varying durability depending on the culture method. In this study, we prepared living thin myocardial slices from left atrial appendages that were cultured using an air-liquid interface system for overall 10 days. Metabolic activity of the cultured slices was assessed using a conventional methyl thiazolyl tetrazolium (MTT) assay. To monitor the structural integrity of cardiomyocytes within the tissue, we implemented our recently described super-resolution microscopy approach that allows both qualitative and quantitative in-depth evaluation of sarcomere network based on parameters such as overall sarcomere content, filament size and orientation. Additionally, expression of mRNAs coding for key structural and functional proteins was analyzed by real-time reverse transcription polymerase chain reaction (qRT-PCR). Our findings demonstrate highly significant disassembly of contractile apparatus represented by degradation of [Formula: see text]-actinin filaments detected after three days in culture, while metabolic activity was constantly rising and remained high for up to seven days. However, gene expression of crucial cardiac markers strongly decreased after the first day in culture indicating an early destructive response to ex vivo conditions. Therefore, we suggest static cultivation of living myocardial slices derived from left atrial appendage and prepared according to our protocol only for short-termed experiments (e.g. medicinal drug testing), while introduction of electro-mechanical stimulation protocols may offer the possibility for long-term integrity of such constructs.
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Affiliation(s)
- Oleksandra Chabanovska
- Reference and Translation Center for Cardiac Stem Cell therapy (RTC), Department of Cardiac Surgery, Rostock University Medical Center, 18057, Rostock, Germany
- Department of Life, Light, and Matter of the Interdisciplinary Faculty, Rostock University, 18059, Rostock, Germany
- Department of Operative Dentistry and Periodontology, Rostock University Medical Center, 18059, Rostock, Germany
| | - Heiko Lemcke
- Reference and Translation Center for Cardiac Stem Cell therapy (RTC), Department of Cardiac Surgery, Rostock University Medical Center, 18057, Rostock, Germany
- Department of Life, Light, and Matter of the Interdisciplinary Faculty, Rostock University, 18059, Rostock, Germany
| | - Hermann Lang
- Department of Operative Dentistry and Periodontology, Rostock University Medical Center, 18059, Rostock, Germany
| | - Brigitte Vollmar
- Rudolf-Zenker-Institute of Experimental Surgery, Rostock University Medical Center, 18059, Rostock, Germany
| | - Pascal M Dohmen
- Department of Cardiac Surgery, Rostock University Medical Center, 18059, Rostock, Germany
- Department of Cardiothoracic Surgery, Faculty of Health Science, University of the Free State, Bloemfontein, 9301, South Africa
| | - Robert David
- Reference and Translation Center for Cardiac Stem Cell therapy (RTC), Department of Cardiac Surgery, Rostock University Medical Center, 18057, Rostock, Germany.
- Department of Life, Light, and Matter of the Interdisciplinary Faculty, Rostock University, 18059, Rostock, Germany.
| | - Christian Etz
- Department of Cardiac Surgery, Rostock University Medical Center, 18059, Rostock, Germany
| | - Catharina Neßelmann
- Department of Cardiac Surgery, Rostock University Medical Center, 18059, Rostock, Germany
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3
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Alkhouli M, Di Biase L, Natale A, Rihal CS, Holmes DR, Asirvatham S, Bartus K, Lakkireddy D, Friedman PA. Nonthrombogenic Roles of the Left Atrial Appendage: JACC Review Topic of the Week. J Am Coll Cardiol 2023; 81:1063-1075. [PMID: 36922093 DOI: 10.1016/j.jacc.2023.01.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 03/18/2023]
Abstract
The atrial appendage (LAA) is a well-established source of cardioembolism in patients with atrial fibrillation. Therefore, research involving the LAA has largely focused on its thrombogenic attribute and the utility of its exclusion in stroke prevention. However, recent studies have highlighted several novel functions of the LAA that may have important therapeutic implications. In this paper, we provide a concise overview of the LAA anatomy and summarize the emerging data on its nonthrombogenic roles.
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Affiliation(s)
- Mohamad Alkhouli
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, Minnesota, USA.
| | - Luigi Di Biase
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Andrea Natale
- St David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas, USA
| | - Charanjit S Rihal
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - David R Holmes
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Samuel Asirvatham
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Krzysztof Bartus
- Department of Cardiovascular Surgery and Transplantology, Medical College, John Paul Hospital, Jagiellonian University, Krakow, Poland
| | | | - Paul A Friedman
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
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4
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Structural and Functional Support by Left Atrial Appendage Transplant to the Left Ventricle after a Myocardial Infarction. Int J Mol Sci 2022; 23:ijms23094661. [PMID: 35563050 PMCID: PMC9104858 DOI: 10.3390/ijms23094661] [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: 03/23/2022] [Revised: 04/15/2022] [Accepted: 04/19/2022] [Indexed: 12/04/2022] Open
Abstract
The left atrial appendage (LAA) of the adult heart has been shown to contain cardiac and myeloid progenitor cells. The resident myeloid progenitor population expresses an array of pro-regenerative paracrine factors. Cardiac constructs have been shown to inhibit deleterious remodeling of the heart using physical support. Due to these aspects, LAA holds promise as a regenerative transplant. LAAs from adult mT/mG mice were transplanted to the recipient 129X1-SvJ mice simultaneously as myocardial infarction (MI) was performed. A decellularized LAA patch was implanted in the control group. Two weeks after MI, the LAA patch had integrated to the ventricular wall, and migrated cells were seen in the MI area. The cells had two main phenotypes: small F4/80+ cells and large troponin C+ cells. After follow-up at 8 weeks, the LAA patch remained viable, and the functional status of the heart improved. Cardiac echo demonstrated that, after 6 weeks, the mice in the LAA-patch-treated group showed an increasing and statistically significant improvement in cardiac performance when compared to the MI and MI + decellularized patch controls. Physical patch-support (LAA and decellularized LAA patch) had an equal effect on the inhibition of deleterious remodeling, but only the LAA patch inhibited the hypertrophic response. Our study demonstrates that the LAA transplantation has the potential for use as a treatment for myocardial infarction. This method can putatively combine cell therapy (regenerative effect) and physical support (inhibition of deleterious remodeling).
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5
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Pour-Ghaz I, Heckle MR, Maturana M, Seitz MP, Zare P, Khouzam RN, Kabra R. Percutaneous Left Atrial Appendage Closure: Review of Anatomy, Imaging, and Outcomes. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2022. [DOI: 10.1007/s11936-022-00958-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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6
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Yosefy O, Sharon B, Yagil C, Shlapoberski M, Livoff A, Novitski I, Beeri R, Yagil Y, Yosefy C. Diabetes induces remodeling of the left atrial appendage independently of atrial fibrillation in a rodent model of type-2 diabetes. Cardiovasc Diabetol 2021; 20:149. [PMID: 34301258 PMCID: PMC8306366 DOI: 10.1186/s12933-021-01347-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/15/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Diabetic patients have an increased predisposition to thromboembolic events, in most cases originating from thrombi in the left atrial appendage (LAA). Remodeling of the LAA, which predisposes to thrombi formation, has been previously described in diabetic patients with atrial fibrillation, but whether remodeling of the LAA occurs in diabetics also in the absence of atrial fibrillation is unknown. To investigate the contribution of diabetes, as opposed to atrial fibrillation, to remodeling of the LAA, we went from humans to the animal model. METHODS We studied by echocardiography the structure and function of the heart over multiple time points during the evolution of diabetes in the Cohen diabetic sensitive rat (CDs/y) provided diabetogenic diet over a period of 4 months; CDs/y provided regular diet and the Cohen diabetic resistant (CDr/y), which do not develop diabetes, served as controls. All animals were in sinus rhythm throughout the study period. RESULTS Compared to controls, CDs/y developed during the evolution of diabetes a greater heart mass, larger left atrial diameter, wider LAA orifice, increased LAA depth, greater end-diastolic and end-systolic diameter, and lower E/A ratio-all indicative of remodeling of the LAA and left atrium (LA), as well as the development of left ventricular diastolic dysfunction. To investigate the pathophysiology involved, we studied the histology of the hearts at the end of the study. We found in diabetic CDs/y, but not in any of the other groups, abundance of glycogen granules in the atrial appendages , atria and ventricles, which may be of significance as glycogen granules have previously been associated with cell and organ dysfunction in the diabetic heart. CONCLUSIONS We conclude that our rodent model of diabetes, which was in sinus rhythm, reproduced structural and functional alterations previously observed in hearts of human diabetics with atrial fibrillation. Remodeling of the LAA and of the LA in our model was unrelated to atrial fibrillation and associated with accumulation of glycogen granules. We suggest that myocardial accumulation of glycogen granules is related to the development of diabetes and may play a pathophysiological role in remodeling of the LAA and LA, which predisposes to atrial fibrillation, thromboembolic events and left ventricular diastolic dysfunction in the diabetic heart.
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Affiliation(s)
- Or Yosefy
- Department of Cardiology, Barzilai University Medical Center, 2 Hahistadrut Street, 78278, Ashkelon, Israel
| | - Barucha Sharon
- Department of Cardiology, Barzilai University Medical Center, 2 Hahistadrut Street, 78278, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Chana Yagil
- Laboratory for Molecular Medicine and Israeli Rat Genome Center, Barzilai University Medical Center, 2 Hahistadrut Street, 78278, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Mark Shlapoberski
- Department of Pathology, Barzilai University Medical Center, Ashkelon, Israel
| | - Alejandro Livoff
- Department of Pathology, Barzilai University Medical Center, Ashkelon, Israel
| | - Ilana Novitski
- Department of Pathology, Barzilai University Medical Center, Ashkelon, Israel
| | - Ronen Beeri
- Diagnostic Cardiology Unit, Heart Institute, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Yoram Yagil
- Laboratory for Molecular Medicine and Israeli Rat Genome Center, Barzilai University Medical Center, 2 Hahistadrut Street, 78278, Ashkelon, Israel.
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel.
| | - Chaim Yosefy
- Department of Cardiology, Barzilai University Medical Center, 2 Hahistadrut Street, 78278, Ashkelon, Israel.
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel.
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7
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Krziminski C, Kammann S, Hansmann J, Edenhofer F, Dandekar G, Walles H, Leistner M. Development of a bioreactor system for pre-endothelialized cardiac patch generation with enhanced viscoelastic properties by combined collagen I compression and stromal cell culture. J Tissue Eng Regen Med 2020; 14:1749-1762. [PMID: 32893470 DOI: 10.1002/term.3129] [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] [Received: 08/16/2019] [Revised: 07/13/2020] [Accepted: 08/26/2020] [Indexed: 12/13/2022]
Abstract
Treatment of terminal heart failure still poses a significant clinical problem. Cardiac tissue engineering could offer autologous solutions for the replacement of nonfunctional myocardial tissue. So far, soft matrix construction and missing large-scale prevascularization prevented the application of sizeable cardiac repair patches. We developed a novel bioreactor system for semi-automatic compression of a collagen I hydrogel applying 16 times higher pressure than in previous studies. Resistance towards compression stress was investigated for multiple cardiac-related cell types. For scaffold prevascuarization, a tubular cavity was imprinted during the compaction process. Primary cardiac-derived endothelial cells (ECs) were isolated from human left atrial appendages (HLAAs) and characterized by fluorescence-activated cell sorting (FACS) and immunocytology. EC were then seeded into the preformed channel with dermal fibroblasts as interstitial cell component of the fully cellularized patch. After 8 days of constant perfusion culture within the same bioreactor, scaffold dynamic modulus and cell viability were analyzed. Endothelial proliferation and vessel maturation were examined by immunohistochemistry and transmission electron microscopy. Our design allowed for scaffold production and dynamic culture in a one-stop-shop model. Enhanced compression and cell-mediated matrix remodeling induced a significant increase in scaffold stiffness while ensuring excellent cell survival. For the first time, we could isolate HLAA-derived EC with proliferative potential. ECs within the central channel proliferated during flow culture, continuously expressing endothelial markers (CD31) and displaying basal membrane synthesis (collagen IV, ultrastructural analysis). After 7 days of culture, a complete endothelial monolayer could be observed. Covering cells aligned themselves in flow direction and developed mature cell-cell contacts.
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Affiliation(s)
- Carolin Krziminski
- Chair of Tissue Engineering and Regenerative Medicine, Wuerzburg University Hospital, Wuerzburg, Germany
| | - Sebastian Kammann
- Chair of Tissue Engineering and Regenerative Medicine, Wuerzburg University Hospital, Wuerzburg, Germany.,Fraunhofer Institute for Production Technology (IPT), Aachen, Germany
| | - Jan Hansmann
- Faculty Electrical Engineering, University for Applied Sciences Wuerzburg-Schweinfurt, Schweinfurt, Germany.,Translational Center Regenerative Therapies, Fraunhofer Institute for Silicate Research (ISC), Wuerzburg, Germany
| | - Frank Edenhofer
- Institute of Anatomy and Cell Biology, University of Wuerzburg, Wuerzburg, Germany.,Institute of Molecular Biology, University of Innsbruck, Innsbruck, Austria.,Research Center Dynamic Systems: Systems Engineering, Otto-von-Guericke-University, Magdeburg, Germany
| | - Gudrun Dandekar
- Chair of Tissue Engineering and Regenerative Medicine, Wuerzburg University Hospital, Wuerzburg, Germany.,Translational Center Regenerative Therapies, Fraunhofer Institute for Silicate Research (ISC), Wuerzburg, Germany
| | - Heike Walles
- Chair of Tissue Engineering and Regenerative Medicine, Wuerzburg University Hospital, Wuerzburg, Germany.,Institute of Molecular Biology, University of Innsbruck, Innsbruck, Austria.,Research Center Dynamic Systems: Systems Engineering, Otto-von-Guericke-University, Magdeburg, Germany
| | - Marcus Leistner
- Chair of Tissue Engineering and Regenerative Medicine, Wuerzburg University Hospital, Wuerzburg, Germany.,Research Center Dynamic Systems: Systems Engineering, Otto-von-Guericke-University, Magdeburg, Germany.,Department of Thoracic, Cardiac and Vascular Surgery, University Medical Center Goettingen, Goettingen, Germany
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8
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Della Rocca DG, Tarantino N, Trivedi C, Mohanty S, Anannab A, Salwan AS, Gianni C, Bassiouny M, Al‐Ahmad A, Romero J, Briceño DF, Burkhardt JD, Gallinghouse GJ, Horton RP, Di Biase L, Natale A. Non‐pulmonary vein triggers in nonparoxysmal atrial fibrillation: Implications of pathophysiology for catheter ablation. J Cardiovasc Electrophysiol 2020; 31:2154-2167. [DOI: 10.1111/jce.14638] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 12/24/2022]
Affiliation(s)
| | - Nicola Tarantino
- Arrhythmia Services, Department of Medicine, Montefiore Medical CenterAlbert Einstein College of MedicineBronx New York
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia InstituteSt. David's Medical CenterAustin Texas
| | | | - Alisara Anannab
- Texas Cardiac Arrhythmia InstituteSt. David's Medical CenterAustin Texas
- Department of Cardiovascular InterventionCentral Chest Institute of ThailandNonthaburi Thailand
| | - Anu S. Salwan
- Texas Cardiac Arrhythmia InstituteSt. David's Medical CenterAustin Texas
| | - Carola Gianni
- Texas Cardiac Arrhythmia InstituteSt. David's Medical CenterAustin Texas
| | - Mohamed Bassiouny
- Texas Cardiac Arrhythmia InstituteSt. David's Medical CenterAustin Texas
| | - Amin Al‐Ahmad
- Texas Cardiac Arrhythmia InstituteSt. David's Medical CenterAustin Texas
| | - Jorge Romero
- Arrhythmia Services, Department of Medicine, Montefiore Medical CenterAlbert Einstein College of MedicineBronx New York
| | - David F. Briceño
- Arrhythmia Services, Department of Medicine, Montefiore Medical CenterAlbert Einstein College of MedicineBronx New York
| | - J. David Burkhardt
- Texas Cardiac Arrhythmia InstituteSt. David's Medical CenterAustin Texas
| | | | - Rodney P. Horton
- Texas Cardiac Arrhythmia InstituteSt. David's Medical CenterAustin Texas
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia InstituteSt. David's Medical CenterAustin Texas
- Arrhythmia Services, Department of Medicine, Montefiore Medical CenterAlbert Einstein College of MedicineBronx New York
- Department of Clinical and Experimental MedicineUniversity of FoggiaFoggia Italy
| | - Andrea Natale
- Texas Cardiac Arrhythmia InstituteSt. David's Medical CenterAustin Texas
- Interventional ElectrophysiologyScripps ClinicLa Jolla California
- Department of Cardiology, MetroHealth Medical CenterCase Western Reserve University School of MedicineCleveland Ohio
- Division of CardiologyStanford UniversityStanford California
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9
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Epicardial transplantation of atrial appendage micrograft patch salvages myocardium after infarction. J Heart Lung Transplant 2020; 39:707-718. [PMID: 32334944 DOI: 10.1016/j.healun.2020.03.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/06/2020] [Accepted: 03/25/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Ischemic heart disease remains the leading cause of mortality and morbidity worldwide despite improved possibilities in medical care. Alongside interventional therapies, such as coronary artery bypass grafting, adjuvant tissue-engineered and cell-based treatments can provide regenerative improvement. Unfortunately, most of these advanced approaches require multiple lengthy and costly preparation stages without delivering significant clinical benefits. METHODS We evaluated the effect of epicardially delivered minute pieces of atrial appendage tissue material, defined as atrial appendage micrografts (AAMs), in a mouse myocardial infarction model. An extracellular matrix patch was used to cover and fix the AAMs onto the surface of the infarcted heart. RESULTS The matrix-covered AAMs salvaged the heart from the infarction-induced loss of functional myocardium and attenuated scarring. Site-selective proteomics of injured ischemic and uninjured distal myocardium from AAMs-treated and -untreated tissue sections revealed increased expression of several cardiac regeneration-associated proteins (i.e., periostin, transglutaminases, and glutathione peroxidases) and activation of pathways responsible for angiogenesis and cardiogenesis in relation to AAMs therapy. CONCLUSIONS Epicardial delivery of AAMs encased in an extracellular matrix patch scaffold salvages functional cardiac tissue from ischemic injury and restricts fibrosis after myocardial infarction. Our results support the use of AAMs as tissue-based therapy adjuvants for salvaging the ischemic myocardium.
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10
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Akella K, Yarlagadda B, Murtaza G, Della Rocca DG, Gopinathannair R, Natale A, Lakkireddy D. Epicardial versus Endocardial Closure: Is One Better than the Other? Card Electrophysiol Clin 2020; 12:97-108. [PMID: 32067652 DOI: 10.1016/j.ccep.2019.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Left atrial appendage occlusion is an evolving technology with demonstrable benefits of stroke prophylaxis in patients with atrial fibrillation unsuitable for anticoagulation. This has resulted in the development of a plethora of transcatheter devices to achieve epicardial exclusion and endocardial occlusion. In this review, the authors summarize the differences in technique, target patient population, outcomes, and complication profiles of endocardial and epicardial techniques.
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Affiliation(s)
- Krishna Akella
- The Kansas City heart rhythm institution and research foundation, HCA MIDWEST HEALTH, Second Floor, 5100 W 110th St, Overland Park, KS 66211, USA
| | - Bharath Yarlagadda
- Department of Cardiology, University of New Mexico, 1 University of New Mexico, Albuquerque, NM 87131, USA
| | - Ghulam Murtaza
- The Kansas City heart rhythm institution and research foundation, HCA MIDWEST HEALTH, Second Floor, 5100 W 110th St, Overland Park, KS 66211, USA
| | - Domenico G Della Rocca
- Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at St. David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA; Department of Biomedical Engineering, University of Texas, 107 West Dean Keeton Street, Austin, TX 78712, USA
| | - Rakesh Gopinathannair
- The Kansas City heart rhythm institution and research foundation, HCA MIDWEST HEALTH, Second Floor, 5100 W 110th St, Overland Park, KS 66211, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at St. David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA; Department of Biomedical Engineering, University of Texas, 107 West Dean Keeton Street, Austin, TX 78712, USA
| | - Dhanunjaya Lakkireddy
- The Kansas City heart rhythm institution and research foundation, HCA MIDWEST HEALTH, Second Floor, 5100 W 110th St, Overland Park, KS 66211, USA.
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11
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Tan NY, Yasin OZ, Sugrue A, El Sabbagh A, Foley TA, Asirvatham SJ. Anatomy and Physiologic Roles of the Left Atrial Appendage: Implications for Endocardial and Epicardial Device Closure. Interv Cardiol Clin 2019. [PMID: 29526287 DOI: 10.1016/j.iccl.2017.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The left atrial appendage has been implicated as a major nidus for thrombus formation, particularly in atrial fibrillation. This discovery has prompted substantial interest in the development of left atrial appendage exclusion devices aimed at decreasing systemic thromboembolism risk. Its deceptively simple appearance belies the remarkable complexity that characterizes its anatomy and physiology. We highlight the key anatomic features and variations of the left atrial appendage as well as its relationships with surrounding structures. We also summarize crucial anatomic factors that should be taken into account by the interventional cardiologist when planning for or performing left atrial appendage exclusion procedures.
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Affiliation(s)
- Nicholas Y Tan
- Department of Internal Medicine, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Omar Z Yasin
- Department of Internal Medicine, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Alan Sugrue
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Abdallah El Sabbagh
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Thomas A Foley
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN 55905, USA.
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12
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Oldershaw R, Owens WA, Sutherland R, Linney M, Liddle R, Magana L, Lash GE, Gill JH, Richardson G, Meeson A. Human Cardiac-Mesenchymal Stem Cell-Like Cells, a Novel Cell Population with Therapeutic Potential. Stem Cells Dev 2019; 28:593-607. [PMID: 30803370 PMCID: PMC6486668 DOI: 10.1089/scd.2018.0170] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Cardiac stem/progenitors are being used in the clinic to treat patients with a range of cardiac pathologies. However, improvements in heart function following treatment have been reported to be variable, with some showing no response. This discrepancy in response remains unresolved. Mesenchymal stem cells (MSCs) have been highlighted as a regenerative tool as these cells display both immunomodulatory and proregenerative activities. The purpose of this study was to derive a cardiac MSC population to provide an alternative/support to current therapies. We derived human cardiac-mesenchymal stem cell-like cells (CMSCLC), so named as they share some MSC characteristics. However, CMSCLC lack the MSC trilineage differentiation capacity, being capable of only rare adipogenic differentiation and demonstrating low/no osteogenic or chondrogenic potential, a phenotype that may have advantages following transplantation. Furthermore, CMSCLC expressed low levels of p16, high levels of MHCI, and low levels of MHCII. A lack of senescent cells would also be advantageous for cells to be used therapeutically, as would the ability to modulate the immune response. Crucially, CMSCLC display a transcriptional profile that includes genes associated with cardioprotective/cardiobeneficial effects. CMSCLC are also secretory and multipotent, giving rise to cardiomyocytes and endothelial cells. Our findings support CMSCLC as a novel cell population suitable for use for transplantation.
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Affiliation(s)
- Rachel Oldershaw
- 1 Department of Musculoskeletal Biology, Faculty of Health and Life Sciences, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom
| | - W Andrew Owens
- 2 Institute of Genetic Medicine, Cardiovascular Research Centre, International Centre for Life, Newcastle University, Newcastle upon Tyne, United Kingdom.,3 Department of Cardiothoracic Surgery, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
| | - Rachel Sutherland
- 2 Institute of Genetic Medicine, Cardiovascular Research Centre, International Centre for Life, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Martin Linney
- 2 Institute of Genetic Medicine, Cardiovascular Research Centre, International Centre for Life, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rachel Liddle
- 2 Institute of Genetic Medicine, Cardiovascular Research Centre, International Centre for Life, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Lissette Magana
- 2 Institute of Genetic Medicine, Cardiovascular Research Centre, International Centre for Life, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Gendie E Lash
- 4 Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Jason H Gill
- 5 The Faculty of Medical Sciences, School of Pharmacy, Northern Institute for Cancer Research (NICR), Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Gavin Richardson
- 2 Institute of Genetic Medicine, Cardiovascular Research Centre, International Centre for Life, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Annette Meeson
- 2 Institute of Genetic Medicine, Cardiovascular Research Centre, International Centre for Life, Newcastle University, Newcastle upon Tyne, United Kingdom
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Sayed A, Valente M, Sassoon D. Does cardiac development provide heart research with novel therapeutic approaches? F1000Res 2018; 7. [PMID: 30450195 PMCID: PMC6221076 DOI: 10.12688/f1000research.15609.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2018] [Indexed: 01/04/2023] Open
Abstract
Embryonic heart progenitors arise at specific spatiotemporal periods that contribute to the formation of distinct cardiac structures. In mammals, the embryonic and fetal heart is hypoxic by comparison to the adult heart. In parallel, the cellular metabolism of the cardiac tissue, including progenitors, undergoes a glycolytic to oxidative switch that contributes to cardiac maturation. While oxidative metabolism is energy efficient, the glycolytic-hypoxic state may serve to maintain cardiac progenitor potential. Consistent with this proposal, the adult epicardium has been shown to contain a reservoir of quiescent cardiac progenitors that are activated in response to heart injury and are hypoxic by comparison to adjacent cardiac tissues. In this review, we discuss the development and potential of the adult epicardium and how this knowledge may provide future therapeutic approaches for cardiac repair.
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Affiliation(s)
- Angeliqua Sayed
- Cellular, Molecular, and Physiological Mechanisms of Heart Failure, Paris-Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital (HEGP), INSERM U970, F-75737 Paris Cedex 15, Paris, France
| | - Mariana Valente
- Cellular, Molecular, and Physiological Mechanisms of Heart Failure, Paris-Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital (HEGP), INSERM U970, F-75737 Paris Cedex 15, Paris, France
| | - David Sassoon
- Cellular, Molecular, and Physiological Mechanisms of Heart Failure, Paris-Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital (HEGP), INSERM U970, F-75737 Paris Cedex 15, Paris, France
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Domínguez H, Madsen CV, Westh ONH, Pallesen PA, Carrranza CL, Irmukhamedov A, Park-Hansen J. Does Left Atrial Appendage Amputation During Routine Cardiac Surgery Reduce Future Atrial Fibrillation and Stroke? Curr Cardiol Rep 2018; 20:99. [PMID: 30171381 PMCID: PMC6132740 DOI: 10.1007/s11886-018-1033-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Purpose of Review Stroke is the most feared complication of atrial fibrillation. To prevent stroke, left atrial appendage exclusion has been targeted, as it is the prevalent site for formation of heart thrombi during atrial fibrillation. We review the historic development of methods for exclusion of the left atrial appendage and the evidence to support its amputation during routine cardiac surgery. Recent Findings Evidence is not yet sufficient to routinely recommend left atrial exclusion during heart surgery, despite a high prevalence of postoperative atrial fibrillation. Observational studies indicate that electrical isolation of scarring from clip or suture techniques reduces the arrhythmogenic substrate. Summary Randomized studies comparing different methods of closure of the left atrial appendage before amputation do not exist. Such studies are therefore warranted, as well as studies that can elucidate whether amputation is superior to leaving the left atrial appendage stump. Potentially, thrombogenic remaining pouch after closure should be addressed.
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Affiliation(s)
- Helena Domínguez
- Department of Cardiology, Bispebjerg-Frederiksberg University Hospital, Nordre Fasanvej 57, vej 4, Building 3, 3rd Floor, DK-2000, Frederiksberg, Denmark. .,Department of Biomedicine, University of Copenhagen, Blegdamsvej 3B, Panum Building 10.5, DK-2400, Copenhagen, Denmark.
| | - Christoffer Valdorff Madsen
- Department of Cardiology, Bispebjerg-Frederiksberg University Hospital, Nordre Fasanvej 57, vej 4, Building 3, 3rd Floor, DK-2000, Frederiksberg, Denmark
| | - Oliver Nøhr Hjorth Westh
- Department of Cardiology, Bispebjerg-Frederiksberg University Hospital, Nordre Fasanvej 57, vej 4, Building 3, 3rd Floor, DK-2000, Frederiksberg, Denmark
| | - Peter Appel Pallesen
- Department of Heart, Lung and Vascular Surgery, Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense, Denmark
| | - Christian Lildal Carrranza
- Department of Cardio-thoracic Surgery, Blegdamsvej 9, 2100 København, Copenhagen, Rigshospitalet, Denmark
| | - Akhmadjon Irmukhamedov
- Department of Heart, Lung and Vascular Surgery, Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense, Denmark
| | - Jesper Park-Hansen
- Department of Cardiology, Bispebjerg-Frederiksberg University Hospital, Nordre Fasanvej 57, vej 4, Building 3, 3rd Floor, DK-2000, Frederiksberg, Denmark.,Department of Biomedicine, University of Copenhagen, Blegdamsvej 3B, Panum Building 10.5, DK-2400, Copenhagen, Denmark
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15
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Naksuk N, Padmanabhan D, Yogeswaran V, Asirvatham SJ. Left Atrial Appendage. JACC Clin Electrophysiol 2016; 2:403-412. [DOI: 10.1016/j.jacep.2016.06.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/11/2016] [Accepted: 06/24/2016] [Indexed: 02/08/2023]
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16
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Kaur K, Yang J, Edwards JG, Eisenberg CA, Eisenberg LM. G9a histone methyltransferase inhibitor BIX01294 promotes expansion of adult cardiac progenitor cells without changing their phenotype or differentiation potential. Cell Prolif 2016; 49:373-85. [PMID: 27109896 DOI: 10.1111/cpr.12255] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 03/02/2016] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES As a follow-up to our previous reports showing that the G9a histone methyltransferase-specific inhibitor BIX01294 enhances bone marrow cell cardiac potential, this drug was examined for its effects on cardiomyocytes and mouse cardiac progenitor cells (CPCs). MATERIALS AND METHODS Cardiomyocytes and cardiac explants were cultured ± BIX01294, and examined for changes in cardiac function, protein and gene expression. Additionally, enriched populations of CPCs, contained in the 'phase bright cell' component of explants, were harvested from non-treated and BIX01294-treated cardiac tissue, and assayed for differences in cell phenotype and differentiation potential. Mouse CPCs were cultured with rat cardiomyocytes to allow differentiation of the progenitors to be assayed using species-specific PCR primers. RESULTS While BIX01294 had no discernible effect on myocyte function and sarcomeric organization, treatment with this drug significantly increased CPC proliferation, as indicated by enhanced MTT metabolization and BrdUrd incorporation (4.1- and 2.0-fold, respectively, P < 0.001) after 48 h labelling, and increased Ki67 expression (4.8-fold, P < 0.001) after 7 days culture. Heart explants exposed to BIX01294 generated 3.6-fold (P < 0.005) greater yields of CPCs by 2 weeks culture. Importantly, CPCs obtained from non-treated and BIX01294-treated cultures did not differ in phenotype or differentiation potential. CONCLUSIONS These data indicate that BIX01294 can expand CPCs without undermining their capacity as cardiac progenitors, and suggest that this drug may have utility for generating large numbers of CPCs for cardiac repair.
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Affiliation(s)
- K Kaur
- New York Medical College/Westchester Medical Center Stem Cell Laboratory, Departments of Physiology and Medicine, New York Medical College, Valhalla, New York, 10595, USA
| | - J Yang
- New York Medical College/Westchester Medical Center Stem Cell Laboratory, Departments of Physiology and Medicine, New York Medical College, Valhalla, New York, 10595, USA
- Department of Biology and Genomics, New York University, New York, New York, 10003, USA
| | - J G Edwards
- Department of Physiology and Medicine, New York Medical College, Valhalla, New York, 10595, USA
| | - C A Eisenberg
- New York Medical College/Westchester Medical Center Stem Cell Laboratory, Departments of Physiology and Medicine, New York Medical College, Valhalla, New York, 10595, USA
| | - L M Eisenberg
- New York Medical College/Westchester Medical Center Stem Cell Laboratory, Departments of Physiology and Medicine, New York Medical College, Valhalla, New York, 10595, USA
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Macrophage precursor cells from the left atrial appendage of the heart spontaneously reprogram into a C-kit+/CD45- stem cell-like phenotype. Int J Cardiol 2016; 209:296-306. [PMID: 26913371 DOI: 10.1016/j.ijcard.2016.02.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 12/21/2015] [Accepted: 02/02/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The developmental origin of the c-kit expressing progenitor cell pool in the adult heart has remained elusive. Recently, it has been discovered that the injured heart is enriched with c-kit(+) cells, which also express the hematopoietic marker CD45. METHODS AND RESULTS In this study, we characterize the phenotype and transcriptome of the c-kit+/CD45+/CD11b+/Flk-1+/Sca-1±(B-type) cell population, originating from the left atrial appendage. These cells are defined as cardiac macrophage progenitors. We also demonstrate that the CD45+ progenitor cell population activates heart development, neural crest and pluripotency-associated pathways in vitro, in conjunction with CD45 down-regulation, and acquire a c-kit+/CD45-/CD11b-/Flk-1-/Sca-1+ (A-type) phenotype through cell fusion and asymmetric division. This putative spontaneous reprogramming evolves into a highly proliferative, partially myogenic phenotype (C-type). CONCLUSIONS Our data suggests that A-type cells and cardiac macrophage precursor cells (B-type) have a common lineage origin, possibly resolving some current conundrums in the field of cardiac regeneration.
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18
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Dixit P, Katare R. Challenges in identifying the best source of stem cells for cardiac regeneration therapy. Stem Cell Res Ther 2015; 6:26. [PMID: 25886612 PMCID: PMC4357059 DOI: 10.1186/s13287-015-0010-8] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 02/17/2015] [Indexed: 12/14/2022] Open
Abstract
The overall clinical cardiac regeneration experience suggests that stem cell therapy can be safely performed, but it also underlines the need for reproducible results for their effective use in a real-world scenario. One of the significant challenges is the identification and selection of the best suited stem cell type for regeneration therapy. Bone marrow mononuclear cells, bone marrow-derived mesenchymal stem cells, resident or endogenous cardiac stem cells, endothelial progenitor cells and induced pluripotent stem cells are some of the stem cell types which have been extensively tested for their ability to regenerate the lost myocardium. While most of these cell types are being evaluated in clinical trials for their safety and efficacy, results show significant heterogeneity in terms of efficacy. The enthusiasm surrounding regenerative medicine in the heart has been dampened by the reports of poor survival, proliferation, engraftment, and differentiation of the transplanted cells. Therefore, the primary challenge is to create clearcut evidence on what actually drives the improvement of cardiac function after the administration of stem cells. In this review, we provide an overview of different types of stem cells currently being considered for cardiac regeneration and discuss why associated factors such as practicality and difficulty in cell collection should also be considered when selecting the stem cells for transplantation. Next, we discuss how the experimental variables (type of disease, marker-based selection and use of different isolation techniques) can influence the study outcome. Finally, we provide an outline of the molecular and genetic approaches to increase the functional ability of stem cells before and after transplantation.
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Affiliation(s)
- Parul Dixit
- Department of Physiology, HeartOtago, Otago School of Medical Sciences, University of Otago, Dunedin, 9010, New Zealand.
| | - Rajesh Katare
- Department of Physiology, HeartOtago, Otago School of Medical Sciences, University of Otago, Dunedin, 9010, New Zealand.
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19
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Windmolders S, Willems L, Daniëls A, Linsen L, Fanton Y, Hendrikx M, Koninckx R, Rummens JL, Hensen K. Clinical-scale in vitro expansion preserves biological characteristics of cardiac atrial appendage stem cells. Cell Prolif 2015; 48:175-86. [PMID: 25630660 DOI: 10.1111/cpr.12166] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 10/14/2014] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Cardiac atrial appendage stem cells (CASCs) have recently emerged as an attractive candidate for cardiac regeneration after myocardial infarction. As with other cardiac stem cells, CASCs have to be expanded ex vivo to obtain clinically relevant cell numbers. However, foetal calf serum (FCS), which is routinely used for cell culturing, is unsuitable for clinical purposes, and influence of long-term in vitro culture on CASC behaviour is unknown. MATERIALS AND METHODS We examined effects on CASC biology of prolonged expansion, and evaluated a culture protocol suitable for human use. RESULTS In FCS-supplemented medium, CASCs could be kept in culture for 55.75 ± 3.63 days, before reaching senescence. Despite a small reduction in numbers of proliferating CASCs (1.37 ± 0.52% per passage) and signs of progressive telomere shortening (0.04 ± 0.02 kb per passage), their immunophenotype and myocardial differentiation potential remained unaffected during the entire culture period. The cells were successfully expanded in human platelet plasma supernatant, while maintaining their biological properties. CONCLUSIONS We successfully developed a protocol for long-term culture, to obtain clinically relevant CASC numbers, while retaining their cardiogenic potential. These insights in CASC biology and optimization of a humanized platelet-based culture method are an important step towards clinical application of CASCs for cardiac regenerative medicine.
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Affiliation(s)
- S Windmolders
- Laboratory of Experimental Hematology, Jessa Hospital, 3500, Hasselt, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, 3590, Diepenbeek, Belgium
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20
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Sakellaridis T, Argiriou M, Charitos C, Tsakiridis K, Zarogoulidis P, Katsikogiannis N, Kougioumtzi I, Machairiotis N, Tsiouda T, Arikas S, Mpakas A, Beleveslis T, Beslevis T, Koletas A, Zarogoulidis K. Left atrial appendage exclusion-Where do we stand? J Thorac Dis 2014; 6 Suppl 1:S70-7. [PMID: 24672702 DOI: 10.3978/j.issn.2072-1439.2013.10.24] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 10/29/2013] [Indexed: 11/14/2022]
Abstract
Atrial fibrillation (AF) is consider to be the most common cardiac arrhythmia with an increasingly prevalence. It is postulated that the source of thromboembolism in 90% of patients with non-valvular AF arises from the left atrial appendage (LAA). Stroke is the most feared and life threatening consequence of thromboembolism. Oral anticoagulation (OAC) with vitamin-K-antagonists is the standard medical therapy for stroke prevention in patients with AF. Unfortunately, chronic therapy with vitamin-K-antagonists is contraindicated in 14% to 44% of patients with AF who are at risk for stroke, and its benefits are limited by underutilization, narrow therapeutic window and increased risk for bleeding, making it often undesired. Therefore, mechanical LAA exclusion is a means of preventing thrombus formation in the appendage and subsequent thromboembolic events in these patients. The LAA can be excluded from the systemic circulation via surgical, percutaneous, or thoracoscopic approaches. Several studies of percutaneous transcatheter delivery of dedicated LAA exclusion devices, such as the percutaneous left atrial appendage transcatheter occlusion (PLAATO) device, Watchman device and the Amplatzer cardiac plug, have shown encouraging results as an alternative to vitamin-K-antagonists therapy for selected patients, good feasibility and efficacy, with a high rate of successful implantation. We discuss the current evidence for LAA exclusion in patients and review their results.
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Affiliation(s)
- Timothy Sakellaridis
- 1 Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 2 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 3 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 6 Cardiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece ; 7 Anesthisiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece
| | - Mihalis Argiriou
- 1 Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 2 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 3 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 6 Cardiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece ; 7 Anesthisiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece
| | - Christos Charitos
- 1 Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 2 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 3 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 6 Cardiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece ; 7 Anesthisiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece
| | - Kosmas Tsakiridis
- 1 Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 2 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 3 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 6 Cardiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece ; 7 Anesthisiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece
| | - Paul Zarogoulidis
- 1 Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 2 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 3 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 6 Cardiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece ; 7 Anesthisiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece
| | - Nikolaos Katsikogiannis
- 1 Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 2 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 3 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 6 Cardiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece ; 7 Anesthisiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece
| | - Ioanna Kougioumtzi
- 1 Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 2 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 3 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 6 Cardiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece ; 7 Anesthisiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece
| | - Nikolaos Machairiotis
- 1 Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 2 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 3 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 6 Cardiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece ; 7 Anesthisiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece
| | - Theodora Tsiouda
- 1 Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 2 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 3 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 6 Cardiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece ; 7 Anesthisiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece
| | - Stamatis Arikas
- 1 Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 2 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 3 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 6 Cardiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece ; 7 Anesthisiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece
| | - Andreas Mpakas
- 1 Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 2 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 3 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 6 Cardiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece ; 7 Anesthisiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece
| | - Thomas Beleveslis
- 1 Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 2 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 3 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 6 Cardiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece ; 7 Anesthisiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece
| | | | - Alexander Koletas
- 1 Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 2 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 3 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 6 Cardiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece ; 7 Anesthisiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece
| | - Konstantinos Zarogoulidis
- 1 Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 2 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 3 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 6 Cardiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece ; 7 Anesthisiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece
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