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Nemati N, Burton T, Fathieh F, Gillins HR, Shadforth I, Ramchandani S, Bridges CR. Pulmonary Hypertension Detection Non-Invasively at Point-of-Care Using a Machine-Learned Algorithm. Diagnostics (Basel) 2024; 14:897. [PMID: 38732312 PMCID: PMC11083349 DOI: 10.3390/diagnostics14090897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/10/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Artificial intelligence, particularly machine learning, has gained prominence in medical research due to its potential to develop non-invasive diagnostics. Pulmonary hypertension presents a diagnostic challenge due to its heterogeneous nature and similarity in symptoms to other cardiovascular conditions. Here, we describe the development of a supervised machine learning model using non-invasive signals (orthogonal voltage gradient and photoplethysmographic) and a hand-crafted library of 3298 features. The developed model achieved a sensitivity of 87% and a specificity of 83%, with an overall Area Under the Receiver Operator Characteristic Curve (AUC-ROC) of 0.93. Subgroup analysis showed consistent performance across genders, age groups and classes of PH. Feature importance analysis revealed changes in metrics that measure conduction, repolarization and respiration as significant contributors to the model. The model demonstrates promising performance in identifying pulmonary hypertension, offering potential for early detection and intervention when embedded in a point-of-care diagnostic system.
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Affiliation(s)
- Navid Nemati
- Analytics for Life, Toronto, ON M5X 1C9, Canada; (N.N.); (F.F.)
| | - Timothy Burton
- Analytics for Life, Toronto, ON M5X 1C9, Canada; (N.N.); (F.F.)
| | - Farhad Fathieh
- Analytics for Life, Toronto, ON M5X 1C9, Canada; (N.N.); (F.F.)
| | - Horace R. Gillins
- Analytics for Life, Bethesda, MD 20814, USA; (H.R.G.); (I.S.); (C.R.B.)
| | - Ian Shadforth
- Analytics for Life, Bethesda, MD 20814, USA; (H.R.G.); (I.S.); (C.R.B.)
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Burton T, Fathieh F, Nemati N, Gillins HR, Shadforth IP, Ramchandani S, Bridges CR. Development of a Non-Invasive Machine-Learned Point-of-Care Rule-Out Test for Coronary Artery Disease. Diagnostics (Basel) 2024; 14:719. [PMID: 38611631 PMCID: PMC11012183 DOI: 10.3390/diagnostics14070719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
The current standard of care for coronary artery disease (CAD) requires an intake of radioactive or contrast enhancement dyes, radiation exposure, and stress and may take days to weeks for referral to gold-standard cardiac catheterization. The CAD diagnostic pathway would greatly benefit from a test to assess for CAD that enables the physician to rule it out at the point of care, thereby enabling the exploration of other diagnoses more rapidly. We sought to develop a test using machine learning to assess for CAD with a rule-out profile, using an easy-to-acquire signal (without stress/radiation) at the point of care. Given the historic disparate outcomes between sexes and urban/rural geographies in cardiology, we targeted equal performance across sexes in a geographically accessible test. Noninvasive photoplethysmogram and orthogonal voltage gradient signals were simultaneously acquired in a representative clinical population of subjects before invasive catheterization for those with CAD (gold-standard for the confirmation of CAD) and coronary computed tomographic angiography for those without CAD (excellent negative predictive value). Features were measured from the signal and used in machine learning to predict CAD status. The machine-learned algorithm achieved a sensitivity of 90% and specificity of 59%. The rule-out profile was maintained across both sexes, as well as all other relevant subgroups. A test to assess for CAD using machine learning on a noninvasive signal has been successfully developed, showing high performance and rule-out ability. Confirmation of the performance on a large clinical, blinded, enrollment-gated dataset is required before implementation of the test in clinical practice.
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Affiliation(s)
- Timothy Burton
- Analytics for Life, Toronto, ON M5X 1C9, Canada; (T.B.); (F.F.); (N.N.)
| | - Farhad Fathieh
- Analytics for Life, Toronto, ON M5X 1C9, Canada; (T.B.); (F.F.); (N.N.)
| | - Navid Nemati
- Analytics for Life, Toronto, ON M5X 1C9, Canada; (T.B.); (F.F.); (N.N.)
| | | | | | - Shyam Ramchandani
- Analytics for Life, Toronto, ON M5X 1C9, Canada; (T.B.); (F.F.); (N.N.)
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3
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Katz MG, Gubara SM, Hadas Y, Weber T, Kumar A, Eliyahu E, Bridges CR, Fargnoli AS. Effects of genetic transfection on calcium cycling pathways mediated by double-stranded adeno-associated virus in postinfarction remodeling. J Thorac Cardiovasc Surg 2019; 159:1809-1819.e3. [PMID: 31679707 DOI: 10.1016/j.jtcvs.2019.08.089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/16/2019] [Accepted: 08/20/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Restoring calcium sensor protein (S100A1) activity in failing hearts poses a promising therapeutic strategy. We hypothesize that cardiac overexpression of the S100A1 gene mediated by a double-stranded adeno-associated virus (scAAV) results in better functional and molecular improvements compared with the single-stranded virus (ssAAV). METHODS Heart failure was induced by coronary artery ligation. Then, intramyocardial injections of saline, AAV9 empty capsid, scAAV9.S100A1, and ssAAV9.S100A1 were performed. Ten weeks postinfarction, all rats received cardiac evaluation; serum and tissue were collected for genetic analysis, cytokine profiling, and assessments of mitochondrial function and structure. RESULTS Overexpression of AAV9.S100A1 improved systolic and diastolic function. Compared with control, ejection fraction was greater in treated groups (54.8% vs 32.3%, P < .05). Similarly, end-diastolic volume index was significantly less in the treated group than in control (1.14 vs 1.59 mL/cm2), whereas fractional shortening was greater in treated groups than control (26% vs 38%, P < .05). Interestingly, cardiac mechanics were significantly better when treated with double-stranded virus compared with single-stranded. Quantitative polymerase chain reaction demonstrated robust transfection of myocardium with the S100A1 gene, with more infection in the self-complimentary group compared with the single-stranded group (5.68 ± 0.44 vs 4.09 ± 0.25 log10 genome copies per 100 ng of DNA; P < .0001). Concentrations of the inflammatory cytokines were elevated in the ssAAV9/S100A1 group compared with the scAAV9/S100A1. Assessment of mitochondrial respiration and morphology demonstrated that injection of self-complementary vector saved both mitochondrial structure and function. CONCLUSIONS Gene therapy of S100A1 can prevent pathologic postmyocardial infarction remodeling and decrease inflammatory response in ischemic heart failure.
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Affiliation(s)
- Michael G Katz
- Department of Cardiology, Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Sarah M Gubara
- Department of Cardiology, Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yoav Hadas
- Department of Genetics and Genomic Sciences, Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Thomas Weber
- Department of Cardiology, Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Arvind Kumar
- Department of Cardiology, Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Efrat Eliyahu
- Department of Genetics and Genomic Sciences, Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Charles R Bridges
- Department of Cardiology, Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Anthony S Fargnoli
- Department of Cardiology, Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, NY
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Abstract
Rodent surgical animal models of heart failure (HF) are critically important for understanding the proof of principle of the cellular alterations underlying the development of the disease as well as evaluating therapeutics. Robust, reproducible rodent models are a prerequisite to the development of pharmacological and molecular strategies for the treatment of HF in patients. Due to the absence of standardized guidelines regarding surgical technique and clear criteria for HF progression in rats, objectivity is compromised. Scientific publications in rats rarely fully disclose the actual surgical details, and technical and physiological challenges. This lack of reporting is one of the main reasons that the outcomes specified in similar studies are highly variable and associated with unnecessary loss of animals, compromising scientific assessment. This review details rat circulatory and coronary arteries anatomy, the surgical details of rat models that recreate the HF phenotype of myocardial infarction, ischemia/reperfusion, left and right ventricular pressure, and volume overload states, and summarizes the technical and physiological challenges of creating HF. The purpose of this article is to help investigators understand the underlying issues of current HF models in order to reduce variable results and ensure successful, reproducible models of HF.
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Affiliation(s)
- Michael G Katz
- Cardiovascular Research Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave., Box 1030, New York, NY, 10029-6574, USA.
| | - Anthony S Fargnoli
- Cardiovascular Research Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave., Box 1030, New York, NY, 10029-6574, USA
| | - Sarah M Gubara
- Cardiovascular Research Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave., Box 1030, New York, NY, 10029-6574, USA
| | - Elena Chepurko
- Cardiovascular Research Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave., Box 1030, New York, NY, 10029-6574, USA
| | - Charles R Bridges
- Cardiovascular Research Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave., Box 1030, New York, NY, 10029-6574, USA
| | - Roger J Hajjar
- Cardiovascular Research Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave., Box 1030, New York, NY, 10029-6574, USA
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Katz MG, Fargnoli AS, Gubara SM, Bisserier M, Sassi Y, Bridges CR, Hajjar RJ, Hadri L. The Left Pneumonectomy Combined with Monocrotaline or Sugen as a Model of Pulmonary Hypertension in Rats. J Vis Exp 2019. [PMID: 30907889 DOI: 10.3791/59050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
In this protocol, we detail the correct procedural steps and necessary precautions to successfully perform a left pneumonectomy and induce PAH in rats with the additional administration of monocrotaline (MCT) or SU5416 (Sugen). We also compare these two models to other PAH models commonly used in research. In the last few years, the focus of animal PAH models has moved towards studying the mechanism of angioproliferation of plexiform lesions, in which the role of increased pulmonary blood flow is considered as an important trigger in the development of severe pulmonary vascular remodeling. One of the most promising rodent models of increased pulmonary flow is the unilateral left pneumonectomy combined with a "second hit" of MCT or Sugen. The removal of the left lung leads to increased and turbulent pulmonary blood flow and vascular remodeling. Currently, there is no detailed procedure of the pneumonectomy surgery in rats. This article details a step-by-step protocol of the pneumonectomy surgical procedure and post-operative care in male Sprague-Dawley rats. Briefly, the animal is anesthetized and the chest is opened. Once the left pulmonary artery, pulmonary vein, and bronchus are visualized, they are ligated and the left lung is removed. The chest then closed and the animal recovered. Blood is forced to circulate only on the right lung. This increased vascular pressure leads to a progressive remodeling and occlusion of small pulmonary arteries. The second hit of MCT or Sugen is used one week post-surgery to induce endothelial dysfunction. The combination of increased blood flow in the lung and endothelial dysfunction produces severe PAH. The primary limitation of this procedure is that it requires general surgical skills.
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Affiliation(s)
- Michael G Katz
- Cardiovascular Research Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai
| | - Anthony S Fargnoli
- Cardiovascular Research Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai
| | - Sarah M Gubara
- Cardiovascular Research Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai
| | - Malik Bisserier
- Cardiovascular Research Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai
| | - Yassine Sassi
- Cardiovascular Research Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai
| | - Charles R Bridges
- Cardiovascular Research Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai
| | - Roger J Hajjar
- Cardiovascular Research Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai
| | - Lahouaria Hadri
- Cardiovascular Research Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai;
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Katz MG, Fargnoli AS, Bridges CR, Hajjar RJ. Lentiviral-Mediated Interleukin-10 Gene Therapy for Lung Transplantation. J Thorac Cardiovasc Surg 2019; 157:817-818. [PMID: 30669242 DOI: 10.1016/j.jtcvs.2018.07.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 07/11/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Michael G Katz
- Department of Cardiology, Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Anthony S Fargnoli
- Department of Cardiology, Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Charles R Bridges
- Department of Cardiology, Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Roger J Hajjar
- Department of Cardiology, Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, NY
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Katz MG, Fargnoli AS, Yarnall C, Perez A, Isidro A, Hajjar RJ, Bridges CR. Technique of Complete Heart Isolation with Continuous Cardiac Perfusion During Cardiopulmonary Bypass: New Opportunities for Gene Therapy. J Extra Corpor Technol 2018; 50:193-198. [PMID: 30250349 PMCID: PMC6146280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 04/28/2018] [Indexed: 06/08/2023]
Abstract
Cardiopulmonary bypass (CPB) featuring complete heart isolation and continuous cardiac perfusion is a very promising approach for solving the problem of efficient gene delivery. In the technique presented here, separate pumps are used for the systemic and cardiac circuits. This system permits continuous isolated arrested heart perfusion through optimizing a number of delivery parameters including temperature, flow rate, driving pressure, ionic composition, and exposure time to the cardiac vessels. During complete cardiac isolation, the blood vector concentration trended from 11.51 ± 1.73 log genome copies (GCs)/cm3 to 9.84 ± 1.65 log GC/cm3 (p > .05). Despite restructuring a very high concentration to the heart, GCs were detectable in the systemic circuit. These values over time were near negligible by comparison but detectable 1.66 ± .26 during 20 minutes of recirculation and did not change (p > .05). After the completion of the recirculation interval and subsequent washing procedure, the initial systemic blood vector GC concentration slightly increased to 2.08 ± .38 log GCs/cm3 (p > .05). During the recirculation period, we supported flow via the cardiac circuit around 300 mL/min. In this technique of heart isolation with continuous cardiac perfusion, >99% of the vector remains in coronary circulation during recirculation period. The animal's non recirculation blood, or that in the system, was routinely tested during and after recirculation to contain much less than 1% of the original dose obtained via logging concentration of therapeutic over time. All of the sheep in this group recovered from anesthesia and received critical postoperative care, including all organ function, in the first 24-36 hours. Twenty-one sheep (84%) survived to euthanasia at 12 weeks. Average CPB time was 107 ± 19.0 minutes and cross-clamp time was 49 ± 7.9 minutes. This technology readily provides multiple pass recirculation of genes through the heart with minimal side effects of collateral expression of other organs.
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Affiliation(s)
- Michael G. Katz
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anthony S. Fargnoli
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Angel Perez
- Sanger Heart and Vascular Institute, Charlotte, North Carolina; and
| | - Alice Isidro
- Main Line Hospital Lankenau, Wynnewood, Pennsylvania
| | - Roger J. Hajjar
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Charles R. Bridges
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York
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8
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Stiasny MH, Mittermayer FH, Göttler G, Bridges CR, Falk-Petersen IB, Puvanendran V, Mortensen A, Reusch TBH, Clemmesen C. Effects of parental acclimation and energy limitation in response to high CO 2 exposure in Atlantic cod. Sci Rep 2018; 8:8348. [PMID: 29844541 PMCID: PMC5974321 DOI: 10.1038/s41598-018-26711-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 05/18/2018] [Indexed: 12/20/2022] Open
Abstract
Ocean acidification (OA), the dissolution of excess anthropogenic carbon dioxide in ocean waters, is a potential stressor to many marine fish species. Whether species have the potential to acclimate and adapt to changes in the seawater carbonate chemistry is still largely unanswered. Simulation experiments across several generations are challenging for large commercially exploited species because of their long generation times. For Atlantic cod (Gadus morhua), we present first data on the effects of parental acclimation to elevated aquatic CO2 on larval survival, a fundamental parameter determining population recruitment. The parental generation in this study was exposed to either ambient or elevated aquatic CO2 levels simulating end-of-century OA levels (~1100 µatm CO2) for six weeks prior to spawning. Upon fully reciprocal exposure of the F1 generation, we quantified larval survival, combined with two larval feeding regimes in order to investigate the potential effect of energy limitation. We found a significant reduction in larval survival at elevated CO2 that was partly compensated by parental acclimation to the same CO2 exposure. Such compensation was only observed in the treatment with high food availability. This complex 3-way interaction indicates that surplus metabolic resources need to be available to allow a transgenerational alleviation response to ocean acidification.
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Affiliation(s)
- M H Stiasny
- GEOMAR Helmholtz Centre for Ocean Research Kiel, Evolutionary Ecology of Marine Fishes, Düsternbrooker Weg 20, 24105, Kiel, Germany.,University of Kiel, Department of Economics, Wilhelm-Seelig-Platz 1, 24118, Kiel, Germany
| | - F H Mittermayer
- GEOMAR Helmholtz Centre for Ocean Research Kiel, Evolutionary Ecology of Marine Fishes, Düsternbrooker Weg 20, 24105, Kiel, Germany
| | - G Göttler
- Heinrich-Heine Universität Düsseldorf, Institute of Metabolic Physiology, 40225, Düsseldorf, Germany
| | - C R Bridges
- Heinrich-Heine Universität Düsseldorf, Institute of Metabolic Physiology, 40225, Düsseldorf, Germany
| | - I-B Falk-Petersen
- University of Tromsø, Faculty of Biosciences, Fisheries and Economics, Tromsø, Norway
| | | | - A Mortensen
- Nofima AS, Postboks 6122, NO-9291, Tromsø, Norway
| | - T B H Reusch
- GEOMAR Helmholtz Centre for Ocean Research Kiel, Evolutionary Ecology of Marine Fishes, Düsternbrooker Weg 20, 24105, Kiel, Germany
| | - C Clemmesen
- GEOMAR Helmholtz Centre for Ocean Research Kiel, Evolutionary Ecology of Marine Fishes, Düsternbrooker Weg 20, 24105, Kiel, Germany.
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9
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Gordon HP, Katz MG, Fargnoli AS, Gillespie VL, Hajjar RJ, Bridges CR. Scar Size and Other Parameters for Tracking Left Ventricular Dysfunction after Induction of Myocardial Infarcts in Sheep ( Ovisaries). Comp Med 2018; 68:215-220. [PMID: 29747722 DOI: 10.30802/aalas-cm-17-000040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
In humans, cardiovascular disease (CVD) is the most frequent cause of death worldwide. Myocardial infarction (MI) is a leading cause of heart failure due to myocardial impairment, yet the progression of the resultant dysfunction is often undetected after incidental or induced myocardial infarction. In this study we tracked the progression of left-sided heart failure in 6-mo-old male castrated sheep in which we created 2 models of myocardial infarction, small and large. Myocardial infarction was induced through ligation of a single branch (obtuse marginal [OM] 1) of the left circumflex coronary artery to create small (mild) infarcts and of 2 branches (OM1 and OM2) for large (severe) infarcts. Progression of heart failure was evaluated by assessing scar size, the left ventricular ejection fraction, hematology, cardiac serum biochemical biomarkers, ST elevation, and clinical observation. All parameters were assessed at baseline and at 3 wk and 3 mo after infarction, except that clinical observation of the animals was conducted daily. The different parameters differed in their usefulness: some verified appropriate creation of the model, whereas others enabled assessment of the progression of heart disease. We hypothesize that myocardial scar size, as a function of induced ischemia, coupled with left ventricular ejection fraction are predictive indicators of postinfarction cardiac dysfunction.
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Affiliation(s)
- Hylton P Gordon
- Center for Comparative Medicine and Surgery, Icahn School of Medicine, Mt Sinai, New York, New York, USA.
| | - Michael G Katz
- Cardiovascular Research Center, Icahn School of Medicine, Mt Sinai, New York, New York, USA
| | - Anthony S Fargnoli
- Cardiovascular Research Center, Icahn School of Medicine, Mt Sinai, New York, New York, USA
| | - Virginia L Gillespie
- Center for Comparative Medicine and Surgery, Icahn School of Medicine, Mt Sinai, New York, New York, USA
| | - Roger J Hajjar
- Cardiovascular Research Center, Icahn School of Medicine, Mt Sinai, New York, New York, USA
| | - Charles R Bridges
- Cardiovascular Research Center, Icahn School of Medicine, Mt Sinai, New York, New York, USA
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10
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Bueno-Beti C, Katz MGM, Fargnoli AS, Kohlbrenner E, Bridges CR, Sassi Y, Hajjar RJ, Hadri L. Abstract 277: Lung Gene Transfer With Sarcoplasmic Reticulum Calcium ATPase Prevent Disease Progression in Pulmonary Arterial Hypertension. Arterioscler Thromb Vasc Biol 2018. [DOI: 10.1161/atvb.38.suppl_1.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pulmonary arterial hypertension (PAH) is a fatal disease characterized by vascular remodeling leading to high pulmonary arterial pressure (PAP) and right ventricular (RV) heart failure. Gene therapy is a promising approach to treat PAH. The most used monocrotaline (MCT) rat model of PAH does not mimic the pathophysiology of the PAH in humans. A refined rat model, the pneumonectomy plus MCT (PNT-MCT), displays all of the features of PAH and most importantly plexiform lesions whereby therapeutics aim to reverse. In this study, we investigated whether intratracheal delivery of sarcoplasmic reticulum calcium ATPase (SERCA2a) gene reverse the severity of PAH in the PNT- MCT model. Left pneumonectomy was performed in rats. One week later, the animals received the MCT injection. At 3 weeks, the severity of PAH disease was confirmed. Thereafter, PNT-MCT rats received either intratracheal delivery of gene construct with adeno-associated virus/SERCA2a (AAV1/SERCA2a) or saline. Hemodynamic parameters were determined by magnetic resonance imaging (MRI) and RV catheterization. RV hypertrophy, heart and lung fibrosis were assessed. Molecular biology assays for gene expression and immunostaining were used to quantify SERCA2a and disease markers. Four weeks after gene delivery, RV function was improved in AAV1.SERCA2a treated-animals with an increase of stroke volume and ejection fraction compared to saline group (275 ± 22 μl vs. 192 ± 22 μl and 56 ± 3 μl vs. 44 ± 3 μl, p<0.05), while RV end systolic volume was decreased (199 ± 16 μl vs. 283 ± 24 μl, p<0.05). Hemodynamic parameters including mean pulmonary pressure were improved in AAV1.SERCA2a group (26 ± 3 mmHg vs. 61 ± 6 mmHg and 21 ± 3 mmHg vs. 41 ± 3 mmHg respectively, p<0.01) compared to control. RV hypertrophy was reduced in AAV1.SERCA2a treated animals (0.37g ± 0.03 vs. 0.63g ± 0.02, p<0.0001). All serotypes of collagen demonstrated decreased expression after AAV1/SERCA2a administration. Histologically, the animals after gene therapy showed a significant regression of plexiform lesions from grade 4 to grade 1-2. In conclusion, intratracheal administration of AAV1/SERCA2a gene can reverse the severe PAH phenotype and may be considered as a potential treatment.
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11
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Katz MG, Hadas Y, Fargnoli AS, Hadas S, Zangi L, Bridges CR. [GENE THERAPY POTENTIAL AS A TREATMENT FOR HEART FAILURE]. Harefuah 2018; 157:112-116. [PMID: 29484868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Advances in understanding the molecular biology of heart failure, the evolution of vector technology, as well as defining the targets for therapeutic interventions has placed heart failure within the reach of gene-based therapy. During the last decade the concept of delivering cDNA encoding a therapeutic gene to failing cardiomyocytes has moved from hypothesis to the bench of preclinical applications and clinical trials. However, despite significant promise, several obstacles exist, which are described in this review. We anticipate that advances in the field will improve gene therapy in heart failure in future clinical approaches.
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Affiliation(s)
- Michael G Katz
- Cardiovascular Research Center, Mount Sinai School of Medicine, New York, NY, USA
| | - Yoav Hadas
- Cardiovascular Research Center, Mount Sinai School of Medicine, New York, NY, USA
| | - Antony S Fargnoli
- Cardiovascular Research Center, Mount Sinai School of Medicine, New York, NY, USA
| | - Smadar Hadas
- Harlem Hebrew Language Academy Charter School, New York, NY, USA
| | - Lior Zangi
- Cardiovascular Research Center, Mount Sinai School of Medicine, New York, NY, USA
| | - Charles R Bridges
- Cardiovascular Research Center, Mount Sinai School of Medicine, New York, NY, USA
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12
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Abstract
Fundamentally, cardiac gene therapy clinical trials have demonstrated that route efficiency is paramount in achieving maximum myocardial expression within safety limits. Gene transfer phenomena are largely influenced by physical transport principles (i.e., pressure, residence time, dispersion trafficking, mechanical resistance) that are independent of therapeutic characteristics. An alternative to intracoronary infusion methods, in an effort to improve efficiency in terms of cardiac specificity, is direct myocardial delivery via surgical injection. Direct injection methods circumvent the blood's immunological components and the cardiac system's native anatomical barriers by directly administering product into the myocardium. In addition, this approach offers the advantage of precise site selection. Two unresolved problems with direct delivery wherein the novel needleless liquid jet approach may resolve are: (1) initial therapeutic retention and (2) subsequent host responses associated with highly focal expression.In this protocol, we present a novel approach to improve direct cardiac gene delivery using a needleless liquid jet methodology. The liquid jet application is essentially a device concept that accelerates and disperses the therapeutic at a targeted myocardial site. The core hypothesis offered is that this approach, with optimized settings, could result in increased therapeutic retention in the initial delivery phase. This would theoretically result in more total myocardial expression per dose while at the same time providing a more homogenous profile around the injection site. Therefore, this would increase efficiency in terms of transduced muscle per delivery site and offer a significant improvement to standard intramuscular injection.
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Affiliation(s)
- Anthony S Fargnoli
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1030, New York, NY, 10029-6574, USA.
| | - Michael G Katz
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1030, New York, NY, 10029-6574, USA
| | - Charles R Bridges
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1030, New York, NY, 10029-6574, USA
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Katz MG, Fargnoli AS, Weber T, Hajjar RJ, Bridges CR. Use of Adeno-Associated Virus Vector for Cardiac Gene Delivery in Large-Animal Surgical Models of Heart Failure. HUM GENE THER CL DEV 2017; 28:157-164. [PMID: 28726495 DOI: 10.1089/humc.2017.070] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The advancement of gene therapy-based approaches to treat heart disease represents a need for clinically relevant animal models with characteristics equivalent to human pathologies. Rodent models of cardiac disease do not precisely reproduce heart failure phenotype and molecular defects. This has motivated researchers to use large animals whose heart size and physiological processes more similar and comparable to those of humans. Today, adeno-associated viruses (AAV)-based vectors are undoubtedly among the most promising DNA delivery vehicles. Here, AAV biology and technology are reviewed and discussed in the context of their use and efficacy for cardiac gene delivery in large-animal models of heart failure, using different surgical approaches. The remaining challenges and opportunities for the use of AAV-based vector delivery for gene therapy applications in the clinic are also highlighted.
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Affiliation(s)
- Michael G Katz
- Cardiovascular Research Center , Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anthony S Fargnoli
- Cardiovascular Research Center , Icahn School of Medicine at Mount Sinai, New York, New York
| | - Thomas Weber
- Cardiovascular Research Center , Icahn School of Medicine at Mount Sinai, New York, New York
| | - Roger J Hajjar
- Cardiovascular Research Center , Icahn School of Medicine at Mount Sinai, New York, New York
| | - Charles R Bridges
- Cardiovascular Research Center , Icahn School of Medicine at Mount Sinai, New York, New York
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14
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Katz MG, Fargnoli AS, Hajjar RJ, Bridges CR. Delivery of drugs, growth factors, genes and stem cells via intrapericardial, epicardial and intramyocardial routes for sustained local targeted therapy of myocardial disease. Expert Opin Drug Deliv 2017. [PMID: 28627940 DOI: 10.1080/17425247.2017.1342405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- M G Katz
- a Cardiovascular Research Center , Mount Sinai School of Medicine , New York , NY , USA
| | - A S Fargnoli
- a Cardiovascular Research Center , Mount Sinai School of Medicine , New York , NY , USA
| | - R J Hajjar
- a Cardiovascular Research Center , Mount Sinai School of Medicine , New York , NY , USA
| | - C R Bridges
- a Cardiovascular Research Center , Mount Sinai School of Medicine , New York , NY , USA
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Abstract
Despite progress in clinical treatment, cardiovascular diseases are still the leading cause of morbidity and mortality worldwide. Therefore, novel therapeutic approaches are needed, targeting the underlying molecular mechanisms of disease with improved outcomes for patients. Gene therapy is one of the most promising fields for the development of new treatments for the advanced stages of cardiovascular diseases. The establishment of clinically relevant methods of gene transfer remains one of the principal limitations on the effectiveness of gene therapy. Recently, there have been significant advances in direct and transvascular gene delivery methods. The ideal gene transfer method should be explored in clinically relevant large animal models of heart disease to evaluate the roles of specific molecular pathways in disease pathogenesis. Characteristics of the optimal technique for gene delivery include low morbidity, an increased myocardial transcapillary gradient, esxtended vector residence time in the myocytes, and the exclusion of residual vector from the systemic circulation after delivery to minimize collateral expression and immune response. Here we describe myocardial gene transfer techniques with molecular cardiac surgery with recirculating delivery in a large animal model of post ischemic heart failure.
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Affiliation(s)
- Michael G Katz
- Cardiovascular Research Center, Icahn school of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1030, New York, NY, 10029-6574, USA.
| | - Anthony S Fargnoli
- Cardiovascular Research Center, Icahn school of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1030, New York, NY, 10029-6574, USA
| | | | - Charles R Bridges
- Cardiovascular Research Center, Icahn school of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1030, New York, NY, 10029-6574, USA
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16
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Katz MG, Fargnoli AS, Hajjar RJ, Bridges CR. In Situ Heart Isolation Featuring Closed Loop Recirculation: The Gold Standard for Optimum Cardiac Gene Transfer? ACTA ACUST UNITED AC 2017; 5. [PMID: 29682631 PMCID: PMC5905412 DOI: 10.4172/2379-1764.1000241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The concept of delivering nucleic material encoding a therapeutic gene to the heart has arduously moved from hypothesis to a variety of high potential clinical applications. Despite the promise however, the results achieved have yet to be realized due to several problems that persist in the clinic. One of these identified problems is the need for an efficient delivery method which facilitates complete cardiotropism and minimizes collateral effects. Additional parameters impacting gene delivery that most need to be improved have been identified as follows: (1) Increasing the contact time of vector in coronary circulation permitting transfer, (2) Sustained intravascular flow rate and perfusion pressure to facilitate proper kinetics, (3) Modulation of cellular permeability to increase uptake efficiency, and once in the cells (4) Enhancing transcription and translation within the transfected cardiac cells, and (5) Obtaining the global gene distribution for maximum efficacy. Recently it was hypothesized that use of cardiopulmonary bypass may facilitate cardiac-selective gene transfer and permit vector delivery in the arrested heart in isolated "closed loop" recirculating model. This system was named molecular cardiac surgery with recirculating delivery (MCARD). The key components of this approach include: isolation of the heart from systemic organs, multiple pass recirculation of vector through the coronary vasculature, and removing the residual vector from the coronary circulation to minimize collateral expression. These attributes unique to a surgical approach such as MCARD can effectively increase vector transduction efficiency in coronary vasculature.
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Affiliation(s)
- Michael G Katz
- Cardiovascular Research Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Anthony S Fargnoli
- Cardiovascular Research Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Roger J Hajjar
- Cardiovascular Research Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Charles R Bridges
- Cardiovascular Research Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, USA
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17
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Hadas Y, Katz MG, Bridges CR, Zangi L. Modified mRNA as a therapeutic tool to induce cardiac regeneration in ischemic heart disease. Wiley Interdiscip Rev Syst Biol Med 2016; 9. [PMID: 27911047 DOI: 10.1002/wsbm.1367] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 10/03/2016] [Accepted: 10/12/2016] [Indexed: 01/14/2023]
Abstract
Ischemic heart disease (IHD) is a leading cause of morbidity and mortality in developed countries. Current pharmacological and interventional therapies provide significant improvement in the life quality of patient; however, they are mostly symptom-oriented and not curative. A high disease and economic burden of IHD requires the search for new therapeutic strategies to significantly improve patients' prognosis and quality of life. One of the main challenges during IHD is the massive loss of cardiomyocytes that possess minimal regenerative capacity. Recent understanding of the pathophysiological mechanisms underlying IHD, as well as new therapeutic approaches provide new hope for patients suffering from IHD. Synthetic modified mRNA (modRNA) is a new gene delivery vector that is increasingly used in in vivo applications. modRNA is a relatively stable, non-immunogenic, highly-expressed molecule that has been shown to mediate high and transient expression of proteins in different type of cells and tissues including cardiomyocytes. modRNA properties, together with its expression kinetics in the heart make it an attractive option for the treatment of IHD, especially after myocardial infarction. In this review we discuss the role of gene therapy in cardiac regeneration as an approach to treat IHD; traditional and innovative gene delivery methods; and focus specifically on modRNA structure, mode of delivery, and its use for the induction of endogenous regenerative capacity, mainly in the context of IHD. WIREs Syst Biol Med 2017, 9:e1367. doi: 10.1002/wsbm.1367 For further resources related to this article, please visit the WIREs website.
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Affiliation(s)
- Yoav Hadas
- Cardiovascular Research Center, Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Genetics and Genomic Sciences, Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael G Katz
- Cardiovascular Research Center, Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Charles R Bridges
- Cardiovascular Research Center, Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lior Zangi
- Cardiovascular Research Center, Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Genetics and Genomic Sciences, Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Katz MG, Fargnoli AS, Kendle AP, Hajjar RJ, Bridges CR. Gene Therapy in Cardiac Surgery: Clinical Trials, Challenges, and Perspectives. Ann Thorac Surg 2016; 101:2407-16. [PMID: 26801060 DOI: 10.1016/j.athoracsur.2015.12.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 10/24/2015] [Accepted: 12/07/2015] [Indexed: 12/28/2022]
Abstract
The concept of gene therapy was introduced in the 1970s after the development of recombinant DNA technology. Despite the initial great expectations, this field experienced early setbacks. Recent years have seen a revival of clinical programs of gene therapy in different fields of medicine. There are many promising targets for genetic therapy as an adjunct to cardiac surgery. The first positive long-term results were published for adenoviral administration of vascular endothelial growth factor with coronary artery bypass grafting. In this review we analyze the past, present, and future of gene therapy in cardiac surgery. The articles discussed were collected through PubMed and from author experience. The clinical trials referenced were found through the Wiley clinical trial database (http://www.wiley.com/legacy/wileychi/genmed/clinical/) as well as the National Institutes of Health clinical trial database (Clinicaltrials.gov).
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Affiliation(s)
- Michael G Katz
- Sanger Heart and Vascular Institute, Charlotte, North Carolina; Mount Sinai School of Medicine, New York, New York
| | - Anthony S Fargnoli
- Sanger Heart and Vascular Institute, Charlotte, North Carolina; Mount Sinai School of Medicine, New York, New York
| | - Andrew P Kendle
- Sanger Heart and Vascular Institute, Charlotte, North Carolina
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Abstract
Heart failure is a significant burden to the global healthcare system and represents an underserved market for new pharmacologic strategies, especially therapies which can address root cause myocyte dysfunction. Modern drugs, surgeries, and state-of-the-art interventions are costly and do not improve survival outcome measures. Gene therapy is an attractive strategy, whereby selected gene targets and their associated regulatory mechanisms can be permanently managed therapeutically in a single treatment. This in theory could be sustainable for the patient's life. Despite the promise, however, gene therapy has numerous challenges that must be addressed together as a treatment plan comprising these key elements: myocyte physiologic target validation, gene target manipulation strategy, vector selection for the correct level of manipulation, and carefully utilizing an efficient delivery route that can be implemented in the clinic to efficiently transfer the therapy within safety limits. This chapter summarizes the key developments in cardiac gene therapy from the perspective of understanding each of these components of the treatment plan. The latest pharmacologic gene targets, gene therapy vectors, delivery routes, and strategies are reviewed.
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Affiliation(s)
- Anthony S Fargnoli
- Icahn School of Medicine at Mount Sinai, Cardiovascular Research Center, New York, NY, USA.
| | - Michael G Katz
- Icahn School of Medicine at Mount Sinai, Cardiovascular Research Center, New York, NY, USA
| | - Charles R Bridges
- Icahn School of Medicine at Mount Sinai, Cardiovascular Research Center, New York, NY, USA
| | - Roger J Hajjar
- Icahn School of Medicine at Mount Sinai, Cardiovascular Research Center, New York, NY, USA
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20
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Katz MG, Fargnoli AS, Kendle AP, Hajjar RJ, Bridges CR. The role of microRNAs in cardiac development and regenerative capacity. Am J Physiol Heart Circ Physiol 2015; 310:H528-41. [PMID: 26702142 DOI: 10.1152/ajpheart.00181.2015] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 12/16/2015] [Indexed: 12/14/2022]
Abstract
The mammalian heart has long been considered to be a postmitotic organ. It was thought that, in the postnatal period, the heart underwent a transition from hyperplasic growth (more cells) to hypertrophic growth (larger cells) due to the conversion of cardiomyocytes from a proliferative state to one of terminal differentiation. This hypothesis was gradually disproven, as data were published showing that the myocardium is a more dynamic tissue in which cardiomyocyte karyokinesis and cytokinesis produce new cells, leading to the hyperplasic regeneration of some of the muscle mass lost in various pathological processes. microRNAs have been shown to be critical regulators of cardiomyocyte differentiation and proliferation and may offer the novel opportunity of regenerative hyperplasic therapy. Here we summarize the relevant processes and recent progress regarding the functions of specific microRNAs in cardiac development and regeneration.
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Affiliation(s)
- Michael G Katz
- Sanger Heart & Vascular Institute, Carolinas HealthCare System, Charlotte, North Carolina; and Cardiovascular Research Center, Mount Sinai School of Medicine, New York, New York
| | - Anthony S Fargnoli
- Sanger Heart & Vascular Institute, Carolinas HealthCare System, Charlotte, North Carolina; and
| | - Andrew P Kendle
- Sanger Heart & Vascular Institute, Carolinas HealthCare System, Charlotte, North Carolina; and
| | - Roger J Hajjar
- Cardiovascular Research Center, Mount Sinai School of Medicine, New York, New York
| | - Charles R Bridges
- Sanger Heart & Vascular Institute, Carolinas HealthCare System, Charlotte, North Carolina; and
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21
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Katz MG, Brandon-Warner E, Fargnoli AS, Williams RD, Kendle AP, Hajjar RJ, Schrum LW, Bridges CR. Mitigation of myocardial fibrosis by molecular cardiac surgery-mediated gene overexpression. J Thorac Cardiovasc Surg 2015; 151:1191-200.e3. [PMID: 26769537 DOI: 10.1016/j.jtcvs.2015.11.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 11/11/2015] [Accepted: 11/19/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Heart failure is accompanied by up-regulation of transforming growth factor beta signaling, accumulation of collagen and dysregulation of sarcoplasmic reticulum calcium adenosine triphosphatase cardiac isoform 2a (SERCA2a). We examined the fibrotic response in small and large myocardial infarct, and the effect of overexpression of the SERCA2a gene. METHODS Ischemic cardiomyopathy was induced via creation of large or small infarct in 26 sheep. Animals were divided into 4 groups: small infarct; large infarct with heart failure; gene-treated (large infarct with heart failure followed by adeno-associated viral vector, serotype 1.SERCA2a gene construct transfer by molecular cardiac surgery with recirculating delivery); and control. RESULTS Heart failure was significantly less pronounced in the gene-treated and small-infarct groups than in the large-infarct group. Expression of transforming growth factor beta signaling components was significantly higher in the large-infarct group, compared with the small-infarct and gene-treated groups. Both the angiotensin II type 1 receptor and angiotensin II were significantly elevated in the small- and large-infarct groups, whereas gene treatment diminished this effect. Active fibrosis with de novo collagen synthesis was evident in the large-infarct group; the small-infarct and gene-treated groups showed less fibrosis, with a lower ratio of de novo to mature collagen. CONCLUSIONS The data presented provide evidence that progression of fibrosis is mediated through increased transforming growth factor beta and angiotensin II signaling, which is mitigated by increased SERCA2a gene expression.
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Affiliation(s)
- Michael G Katz
- Department of Cardiothoracic Surgery, Sanger Heart and Vascular Institute, Charlotte, NC; Cardiovascular Research Center, Mount Sinai School of Medicine, New York, NY.
| | | | - Anthony S Fargnoli
- Department of Cardiothoracic Surgery, Sanger Heart and Vascular Institute, Charlotte, NC; Cardiovascular Research Center, Mount Sinai School of Medicine, New York, NY
| | - Richard D Williams
- Department of Cardiothoracic Surgery, Sanger Heart and Vascular Institute, Charlotte, NC
| | - Andrew P Kendle
- Department of Cardiothoracic Surgery, Sanger Heart and Vascular Institute, Charlotte, NC
| | - Roger J Hajjar
- Cardiovascular Research Center, Mount Sinai School of Medicine, New York, NY
| | - Laura W Schrum
- Liver Pathobiology Laboratory, Carolinas Medical Center, Charlotte, NC
| | - Charles R Bridges
- Department of Cardiothoracic Surgery, Sanger Heart and Vascular Institute, Charlotte, NC.
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Fargnoli AS, Katz MG, Williams RD, Kendle AP, Steuerwald N, Bridges CR. Liquid jet delivery method featuring S100A1 gene therapy in the rodent model following acute myocardial infarction. Gene Ther 2015; 23:151-7. [PMID: 26461176 PMCID: PMC4742412 DOI: 10.1038/gt.2015.100] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/12/2015] [Accepted: 09/17/2015] [Indexed: 01/16/2023]
Abstract
The S100A1 gene is a promising target enhancing contractility and survival post myocardial infarction (MI). Achieving sufficient gene delivery within safety limits is a major translational problem. This proof of concept study evaluates viral-mediated S100A1 overexpression featuring a novel liquid jet delivery (LJ) method. 24 rats after successful MI were divided into 3 groups (n=8 ea.): saline control (SA), ssAAV9.S100A1 (SS) delivery, and scAAV9.S100A1 (SC) delivery (both 1.2×1011 viral particles). For each post MI rat, the LJ device fired three separate 100 μL injections into the myocardium. Following 10 weeks, all rats were evaluated with echocardiography, quantitative polymerase chain reaction (qPCR), and overall S100A1 and CD38 immune protein. At 10 weeks all groups demonstrated a functional decline from baseline, but the S100A1 therapy groups displayed preserved LV function with significantly higher ejection fraction %; SS group [60±3] and SC group [57±4] versus saline [46±3], p<0.05. Heart qPCR testing showed robust S100A1 in the SS [10,147±3993] and SC [35,155±5808] copies per 100 ng DNA, while off target liver detection was lower in both SS [40±40], SC [34,841±3164] respectively. Cardiac S100A1 protein expression was [4.3±0.2] and [6.1±0.3] fold higher than controls in the SS and SC groups respectively, p<0.05.
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Affiliation(s)
- A S Fargnoli
- Department of Thoracic and Cardiac Surgery, Sanger Heart and Vascular Institute, Carolinas HealthCare System, Charlotte, NC, USA
| | - M G Katz
- Department of Thoracic and Cardiac Surgery, Sanger Heart and Vascular Institute, Carolinas HealthCare System, Charlotte, NC, USA
| | - R D Williams
- Department of Thoracic and Cardiac Surgery, Sanger Heart and Vascular Institute, Carolinas HealthCare System, Charlotte, NC, USA
| | - A P Kendle
- Department of Thoracic and Cardiac Surgery, Sanger Heart and Vascular Institute, Carolinas HealthCare System, Charlotte, NC, USA
| | - N Steuerwald
- Molecular Biology Core, Department of Therapeutic Research and Development, Cannon Research Center, Carolinas HealthCare System, Charlotte, NC, USA
| | - C R Bridges
- Department of Thoracic and Cardiac Surgery, Sanger Heart and Vascular Institute, Carolinas HealthCare System, Charlotte, NC, USA
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Abstract
Pathogenesis of heart diseases is associated with an altered expression profile of hundreds of genes. miRNAs are a newly identified layer of gene regulation operating at the post-transcriptional level by pairing to complementary base sequences in target mRNAs. Genetic data have identified the roles of miRNAs in basic pathological processes associated with heart failure: apoptosis, fibrosis, myocardial hypertrophy and cardiac remodeling. Many reports demonstrated that aberrantly expressed miRNAs and their modulation have effects on cardiac insufficiency. Here, we overview the advances in miRNAs as potential targets in the modulation of the heart failure phenotype. miRNA-based therapy holds great promise as a future strategy for treating heart diseases and identifying emerging signaling pathways responsible for the progression of heart failure.
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Affiliation(s)
- Michael G Katz
- Sanger Heart & Vascular Institute, Carolinas HealthCare System, Charlotte, NC, USA
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Williams RD, Katz MG, Fargnoli AS, Kendle AP, Mihalko KL, Bridges CR. Bochdalek Congenital Diaphragmatic Hernia in an Adult Sheep. Anat Histol Embryol 2015; 45:246-8. [PMID: 26293994 DOI: 10.1111/ahe.12200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 07/05/2015] [Indexed: 11/26/2022]
Abstract
Congenital diaphragmatic hernia (CDH) is a rare condition. The aetiology of CDH is often unclear. In our case, a hollow mass was noted on MRI. Cardiac ejection fraction was diminished (47.0%) compared to 60.5% (average of 10 other normal animals, P < 0.05). The final diagnosis of congenital diaphragmatic hernia (Bochdalek type) was made when the sheep underwent surgery. The hernia was right-sided and contained the abomasum. Lung biopsy demonstrated incomplete development with a low number of bronchopulmonary segments and vessels. The likely cause of this hernia was genetic malformation.
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Affiliation(s)
- R D Williams
- Sanger Heart & Vascular Institute, Carolinas HealthCare System, Charlotte, NC, USA
| | - M G Katz
- Sanger Heart & Vascular Institute, Carolinas HealthCare System, Charlotte, NC, USA
| | - A S Fargnoli
- Sanger Heart & Vascular Institute, Carolinas HealthCare System, Charlotte, NC, USA
| | - A P Kendle
- Sanger Heart & Vascular Institute, Carolinas HealthCare System, Charlotte, NC, USA
| | - K L Mihalko
- Cannon Research Center, Comparative Medicine, Carolinas HealthCare System, Charlotte, NC, USA
| | - C R Bridges
- Sanger Heart & Vascular Institute, Carolinas HealthCare System, Charlotte, NC, USA
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Fargnoli AS, Katz MG, Alexander MP, Kendle AP, Bridges CR. A Corticosteroid Gene Therapy Combination Strategy to Maximize Intramuscular-Mediated Delivery in Postischemic Myocardium. HUM GENE THER CL DEV 2015. [PMID: 26207446 DOI: 10.1089/humc.2015.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Anthony S Fargnoli
- Thoracic and Cardiac Surgery, Sanger Heart & Vascular Institute , Carolinas Medical Center, Charlotte, North Carolina
| | - Michael G Katz
- Thoracic and Cardiac Surgery, Sanger Heart & Vascular Institute , Carolinas Medical Center, Charlotte, North Carolina
| | - Michael P Alexander
- Thoracic and Cardiac Surgery, Sanger Heart & Vascular Institute , Carolinas Medical Center, Charlotte, North Carolina
| | - Andrew P Kendle
- Thoracic and Cardiac Surgery, Sanger Heart & Vascular Institute , Carolinas Medical Center, Charlotte, North Carolina
| | - Charles R Bridges
- Thoracic and Cardiac Surgery, Sanger Heart & Vascular Institute , Carolinas Medical Center, Charlotte, North Carolina
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26
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Kendle AP, Katz MG, Fargnoli AS, Steuerwald NM, Bridges CR. 548. Self-Complementary Adeno-Associated Virus 9 Encoding S100A1 Decreases Serum Levels of Proinflammatory Cytokines Compared To Single-Stranded AAV9 after Myocardial Delivery Post MI. Mol Ther 2015. [DOI: 10.1016/s1525-0016(16)34157-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Katz MG, Fargnoli AS, Kendle AP, Bridges CR. Characterizing preclinical model of ischemic heart failure: difference between LAD and LCx infarctions. Am J Physiol Heart Circ Physiol 2015; 308:H364. [PMID: 25684738 DOI: 10.1152/ajpheart.00807.2014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Michael G Katz
- Sanger Heart and Vascular Institute, Carolinas HealthCare System, Charlotte, North Carolina
| | - Anthony S Fargnoli
- Sanger Heart and Vascular Institute, Carolinas HealthCare System, Charlotte, North Carolina
| | - Andrew P Kendle
- Sanger Heart and Vascular Institute, Carolinas HealthCare System, Charlotte, North Carolina
| | - Charles R Bridges
- Sanger Heart and Vascular Institute, Carolinas HealthCare System, Charlotte, North Carolina
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Katz MG, Kendle AP, Fargnoli AS, Mihalko KL, Bridges CR. Sheep (Ovis aries) as a model for cardiovascular surgery and management before, during, and after cardiopulmonary bypass. J Am Assoc Lab Anim Sci 2015; 54:7-8. [PMID: 25651084 PMCID: PMC4311734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Fargnoli AS, Katz MG, Williams RD, Margulies KB, Bridges CR. A needleless liquid jet injection delivery method for cardiac gene therapy: a comparative evaluation versus standard routes of delivery reveals enhanced therapeutic retention and cardiac specific gene expression. J Cardiovasc Transl Res 2014; 7:756-67. [PMID: 25315468 PMCID: PMC4261917 DOI: 10.1007/s12265-014-9593-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 09/30/2014] [Indexed: 01/16/2023]
Abstract
This study evaluates needleless liquid jet method and compares it with three common experimental methods: (1) intramuscular injection (IM), (2) left ventricular intracavitary infusion (LVIC), and (3) LV intracavitary infusion with aortic and pulmonary occlusion (LVIC-OCCL). Two protocols were executed. First (n = 24 rats), retention of dye was evaluated 10 min after delivery in an acute model. The acute study revealed the following: significantly higher dye retention (expressed as % myocardial cross-section area) in the left ventricle in both the liquid jet [52 ± 4] % and LVIC-OCCL [58 ± 3] % groups p < 0.05 compared with IM [31 ± 8] % and LVIC [35 ± 4] %. In the second (n = 16 rats), each animal received adeno-associated virus encoding green fluorescent protein (AAV.EGFP) at a single dose with terminal 6-week endpoint. In the second phase with AAV.EGFP at 6 weeks post-delivery, a similar trend was found with liquid jet [54 ± 5] % and LVIC-OCCL [60 ± 8] % featuring more LV expression as compared with IM [30 ± 9] % and LVIC [23 ± 9] %. The IM and LVIC-OCCL cross sections revealed myocardial fibrosis. With more detailed development in future model studies, needleless liquid jet delivery offers a promising strategy to improve direct myocardial delivery.
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Affiliation(s)
- A S Fargnoli
- Sanger Heart & Vascular Institute, Thoracic and Cardiac Surgery, Cannon Research Center, Carolinas Healthcare System, 1542 Garden Terrace, Charlotte, NC, 28203, USA
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Fargnoli AS, Katz MG, Williams RD, Walling TL, Margulies KB, Bridges CR. An Innovative Needleless Liquid Jet Injection Delivery Method for Heart Failure Gene Therapy: Preliminary Study Featuring AAV9 Demonstrates Greater Cardiac Specificity Versus Standard Approaches. J Card Fail 2014; 20:S1-132. [DOI: 10.1016/j.cardfail.2014.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Katz MG, Fargnoli AS, Williams RD, Bridges CR. Surgical methods for cardiac gene transfer. Future Cardiol 2014; 10:323-6. [PMID: 24976468 DOI: 10.2217/fca.14.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Michael G Katz
- Sanger Heart & Vascular Institute, Cannon Research Center, Carolinas HealthCare System, 1001 Blythe Blvd, Charlotte, NC 28203, USA
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Fargnoli AS, Mu A, Katz MG, Williams RD, Margulies KB, Weiner DB, Yang S, Bridges CR. Anti-inflammatory loaded poly-lactic glycolic acid nanoparticle formulations to enhance myocardial gene transfer: an in-vitro assessment of a drug/gene combination therapeutic approach for direct injection. J Transl Med 2014; 12:171. [PMID: 24934216 PMCID: PMC4068839 DOI: 10.1186/1479-5876-12-171] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 06/10/2014] [Indexed: 12/21/2022] Open
Abstract
Background Cardiac gene therapy for heart disease is a major translational research area with potential, yet problems with safe and efficient gene transfer into cardiac muscle remain unresolved. Existing methodology to increase vector uptake include modifying the viral vector, non-viral particle encapsulation and or delivery with device systems. These advanced methods have made improvements, however fail to address the key problem of inflammation in the myocardium, which is known to reduce vector uptake and contribute to immunogenic adverse events. Here we propose an alternative method to co-deliver anti-inflammatory drugs in a controlled release polymer with gene product to improve therapeutic effects. Methods A robust, double emulsion production process was developed to encapsulate drugs into nanoparticles. Briefly in this proof of concept study, aspirin and prednisolone anti-inflammatory drugs were encapsulated in various poly-lactic glycolic acid polymer (PLGA) formulations. The resultant particle systems were characterized, co-delivered with GFP plasmid, and evaluated in harvested myocytes in culture for uptake. Results High quality nanoparticles were harvested from multiple production runs, with an average 64 ± 10 mg yield. Four distinct particle drug system combinations were characterized and evaluated in vitro: PLGA(50:50) Aspirin, PLGA(65:35) Prednisolone, PLGA(65:35) Aspirin and PLGA(50:50) Prednisolone Particles consisted of spherical shape with a narrow size distribution 265 ± 104 nm as found in scanning electron microscopy imaging. Prednisolone particles regardless of PLGA type were found on average ≈ 100 nm smaller than the aspirin types. All four groups demonstrated high zeta potential stability and re-constitution testing prior to in vitro. In vitro results demonstrated co uptake of GFP plasmid (green) and drug loaded particles (red) in culture with no incidence of toxicity. Conclusions Nano formulated anti-inflammatories in combination with standalone gene product therapy may offer a clinical solution to maximize cardiac gene therapy product effects while minimizing the risk of the host response in the inflammatory myocardial environment.
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Affiliation(s)
- Anthony S Fargnoli
- Thoracic and Cardiovascular Surgery, Sanger Heart & Vascular Institute, Carolinas Healthcare System, Charlotte, NC, USA.
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Katz MG, Fargnoli AS, Williams RD, Steuerwald NM, Isidro A, Ivanina AV, Sokolova IM, Bridges CR. Safety and efficacy of high-dose adeno-associated virus 9 encoding sarcoplasmic reticulum Ca(2+) adenosine triphosphatase delivered by molecular cardiac surgery with recirculating delivery in ovine ischemic cardiomyopathy. J Thorac Cardiovasc Surg 2014; 148:1065-72, 1073e1-2; discussion1072-3. [PMID: 25037619 DOI: 10.1016/j.jtcvs.2014.05.070] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 05/26/2014] [Accepted: 05/27/2014] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Therapeutic safety and efficacy are the basic prerequisites for clinical gene therapy. We investigated the effect of high-dose molecular cardiac surgery with recirculating delivery (MCARD)-mediated adeno-associated virus 9 (AAV9)/sarcoplasmic reticulum Ca(2+) adenosine triphosphatase (SERCA2a) gene delivery on clinical parameters, oxidative stress, humoral and cellular immune responses, and cardiac remodeling. METHODS Ischemic cardiomyopathy was generated in a sheep model. The sheep were assigned to 1 of 2 groups: control (n = 10) and study (MCARD, n = 6). The control group underwent no intervention and the study group received 10(14) genome copies of AAV9/SERCA2a 4 weeks after infarction. RESULTS Our ischemic model produced reliable infarcts leading to heart failure. The baseline ejection fraction in the MCARD group was 57.6% ± 1.6% versus 61.2% ± 1.9% in the control group (P > .05). At 12 weeks after infarction, the MCARD group had superior left ventricular function compared with the control group: stroke volume index, 46.6 ± 1.8 versus 35.8 ± 2.5 mL/m(2) (P < .05); ejection fraction, 46.2% ± 1.9% versus 38.7% ± 2.5% (P < .05); and left ventricular end-systolic and end-diastolic dimensions, 41.3 ± 1.7 versus 48.2 ± 1.4 mm and 51.2 ± 1.5 versus 57.6 ± 1.7 mm, respectively (P < .05). The markers of oxidative stress were significantly reduced in the infarct zone in the MCARD group. No positive T-cell-mediated immune response was seen in the MCARD group at any point. Myocyte hypertrophy was also significantly attenuated in the MCARD group compared with the control group. CONCLUSIONS Cardiac overexpression of the SERCA2a gene by way of MCARD is a safe therapeutic intervention. It significantly improves left ventricular function, decreases markers of oxidative stress, abrogates myocyte hypertrophy, arrests remodeling, and does not induce a T-cell-mediated immune response.
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Affiliation(s)
- Michael G Katz
- Sanger Heart and Vascular Institute, Cannon Research Center, Carolinas Healthcare System, Charlotte, NC
| | - Anthony S Fargnoli
- Sanger Heart and Vascular Institute, Cannon Research Center, Carolinas Healthcare System, Charlotte, NC
| | - Richard D Williams
- Sanger Heart and Vascular Institute, Cannon Research Center, Carolinas Healthcare System, Charlotte, NC
| | - Nury M Steuerwald
- Molecular Biology Core Facility, Cannon Research Center, Carolinas Healthcare System, Charlotte, NC
| | - Alice Isidro
- Sanger Heart and Vascular Institute, Cannon Research Center, Carolinas Healthcare System, Charlotte, NC
| | - Anna V Ivanina
- Department of Biological Sciences, University of North Carolina Charlotte, Charlotte, NC
| | - Inna M Sokolova
- Department of Biological Sciences, University of North Carolina Charlotte, Charlotte, NC
| | - Charles R Bridges
- Sanger Heart and Vascular Institute, Cannon Research Center, Carolinas Healthcare System, Charlotte, NC.
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Katz MG, Fargnoli AS, Williams RD, Bridges CR. Gene therapy delivery systems for enhancing viral and nonviral vectors for cardiac diseases: current concepts and future applications. Hum Gene Ther 2014; 24:914-27. [PMID: 24164239 DOI: 10.1089/hum.2013.2517] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Gene therapy is one of the most promising fields for developing new treatments for the advanced stages of ischemic and monogenetic, particularly autosomal or X-linked recessive, cardiomyopathies. The remarkable ongoing efforts in advancing various targets have largely been inspired by the results that have been achieved in several notable gene therapy trials, such as the hemophilia B and Leber's congenital amaurosis. Rate-limiting problems preventing successful clinical application in the cardiac disease area, however, are primarily attributable to inefficient gene transfer, host responses, and the lack of sustainable therapeutic transgene expression. It is arguable that these problems are directly correlated with the choice of vector, dose level, and associated cardiac delivery approach as a whole treatment system. Essentially, a delicate balance exists in maximizing gene transfer required for efficacy while remaining within safety limits. Therefore, the development of safe, effective, and clinically applicable gene delivery techniques for selected nonviral and viral vectors will certainly be invaluable in obtaining future regulatory approvals. The choice of gene transfer vector, dose level, and the delivery system are likely to be critical determinants of therapeutic efficacy. It is here that the interactions between vector uptake and trafficking, delivery route means, and the host's physical limits must be considered synergistically for a successful treatment course.
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Affiliation(s)
- Michael G Katz
- Sanger Heart and Vascular Institute , Cannon Research Center, Carolinas HealthCare System, Charlotte, NC 28203
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Pritchette LA, Carty AJ, Katz MG, Fargnoli AS, Kirsch J, Bridges CR. Swallow syncope after cardiac surgery in a sheep. Vet Surg 2013; 42:898-9. [PMID: 24033841 DOI: 10.1111/j.1532-950x.2013.12056.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 08/03/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Louella A Pritchette
- Division of Cardiovascular Surgery, Department of Surgery, The University of Pennsylvania Medical Center, Philadelphia, PA
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Fargnoli AS, Katz MG, Williams RD, Dvorak J, Walling T, Margulies KB, Bridges CR. A Novel Needleless Liquid Jet Injection System for Heart Failure Gene Therapy: Feasibility Study Demonstrates Enhanced Myocardial Distribution and Safety Profile in the Rodent Model. J Card Fail 2013. [DOI: 10.1016/j.cardfail.2013.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fargnoli AS, Katz MG, Yarnall C, Isidro A, Petrov M, Steuerwald N, Ghosh S, Richardville KC, Hillesheim R, Williams RD, Kohlbrenner E, Stedman HH, Hajjar RJ, Bridges CR. Cardiac surgical delivery of the sarcoplasmic reticulum calcium ATPase rescues myocytes in ischemic heart failure. Ann Thorac Surg 2013; 96:586-95. [PMID: 23773730 DOI: 10.1016/j.athoracsur.2013.04.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 04/03/2013] [Accepted: 04/08/2013] [Indexed: 01/16/2023]
Abstract
BACKGROUND The sarcoplasmic reticulum calcium ATPase (SERCA2a) is an important molecular regulator of contractile dysfunction in heart failure. Gene transfer of SERCA2a mediated by molecular cardiac surgery with recirculating delivery (MCARD) is a novel and clinically translatable strategy. METHODS Ischemic heart failure was induced by ligation of OM1 and OM2 in 14 sheep. Seven sheep underwent MCARD-mediated AAV1-SERCA2a delivery 4 weeks after myocardial infarction, and seven sheep served as untreated controls. Magnetic resonance imaging-based mechanoenergetic studies were performed at baseline, 3 weeks, and 12 weeks after infarction. Myocyte apoptosis was quantified by Tdt-mediated nick-end labeling assay. Myocyte cross-sectional area and caspase-8 and caspase-9 activity was measured with imaging software, specific fluorogenic peptides, and immunohistochemistry. RESULTS MCARD-mediated AAV1-SERCA2a gene delivery resulted in robust cardiac-specific SERCA2a expression and stable improvements in global and regional contractility. There were significantly higher stroke volume index, left ventricular fractional thickening, and ejection fraction at 12 weeks in the MCARD group than in the control group (30 ± 3 vs 21 ± 2 mL/m(2); 12% ± 5% vs 3% ± 3%; and 43 ± 4 vs 32 ± 4, respectively, all p < 0.05). Apoptotic myocytes were observed more frequently in the control group than in the MCARD-SERCA2a group (0.57.2 ± 0.16 AU vs 0.32.4 ± 0.08 AU, p < 0.05). MCARD-SERCA2a also resulted in decreased caspase-8 and caspase-9 expression and decreased myocyte area in the border zone of transgenic sheep compared with control sheep (14.6% ± 1.2% vs 2.9% ± 0.7%; 18.2% ± 1.9% vs 8.6% ± 1.4%; and 102.1 ± 3.8 μm(2) vs 88.1 ± 3.6 μm(2), all p < 0.05). CONCLUSIONS MCARD-mediated SERCA2a delivery results in robust cardiac specific gene expression, improved contractility, and a decrease in both myocyte apoptosis and myocyte hypertrophy.
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Affiliation(s)
- Anthony S Fargnoli
- Sanger Heart & Vascular Institute, Carolinas Healthcare System, Charlotte, North Carolina, USA
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Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Zoghbi WA, Arend TE, Oetgen WJ, May C, Bradfield L, Keller S, Ramadhan E, Tomaselli GF, Brown N, Robertson RM, Whitman GR, Bezanson JL, Hundley J. 2012 ACCF/AHA Focused Update Incorporated Into the ACCF/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction. Circulation 2013; 127:e663-828. [DOI: 10.1161/cir.0b013e31828478ac] [Citation(s) in RCA: 181] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Jneid H, Ettinger SM, Ganiats TG, Philippides GJ, Jacobs AK, Halperin JL, Albert NM, Creager MA, DeMets D, Guyton RA, Kushner FG, Ohman EM, Stevenson W, Yancy CW. 2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013; 61:e179-347. [PMID: 23639841 DOI: 10.1016/j.jacc.2013.01.014] [Citation(s) in RCA: 373] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Katz MG, Fargnoli AS, Bridges CR. Myocardial gene transfer: routes and devices for regulation of transgene expression by modulation of cellular permeability. Hum Gene Ther 2013; 24:375-92. [PMID: 23427834 DOI: 10.1089/hum.2012.241] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Heart diseases are major causes of morbidity and mortality in Western society. Gene therapy approaches are becoming promising therapeutic modalities to improve underlying molecular processes affecting failing cardiomyocytes. Numerous cardiac clinical gene therapy trials have yet to demonstrate strong positive results and advantages over current pharmacotherapy. The success of gene therapy depends largely on the creation of a reliable and efficient delivery method. The establishment of such a system is determined by its ability to overcome the existing biological barriers, including cellular uptake and intracellular trafficking as well as modulation of cellular permeability. In this article, we describe a variety of physical and mechanical methods, based on the transient disruption of the cell membrane, which are applied in nonviral gene transfer. In addition, we focus on the use of different physiological techniques and devices and pharmacological agents to enhance endothelial permeability. Development of these methods will undoubtedly help solve major problems facing gene therapy.
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Affiliation(s)
- Michael G Katz
- Thoracic and Cardiovascular Surgery, Sanger Heart & Vascular Institute, Carolinas Healthcare System, Charlotte, NC 28203, USA
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Swain JD, Fargnoli AS, Katz MG, Tomasulo CE, Sumaroka M, Richardville KC, Koch WJ, Rabinowitz JE, Bridges CR. MCARD-mediated gene transfer of GRK2 inhibitor in ovine model of acute myocardial infarction. J Cardiovasc Transl Res 2012. [PMID: 23208013 DOI: 10.1007/s12265-012-9418-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
β-Adrenergic receptor (βAR) dysfunction in acute myocardial infarction (MI) is associated with elevated levels of the G-protein-coupled receptor kinase-2 (GRK2), which plays a key role in heart failure progression. Inhibition of GRK2 via expression of a peptide βARKct transferred by molecular cardiac surgery with recirculating delivery (MCARD) may be a promising intervention. Five sheep underwent scAAV6-mediated MCARD delivery of βARKct, and five received no treatment (control). After a 3-week period, the branch of the circumflex artery (OM1) was ligated. Quantitative PCR data showed intense βARKct expression in the left ventricle (LV). Circumferential fractional shortening was 23.4 ± 7.1 % (baseline) vs. -2.9 ± 5.2 % (p < 0.05) in the control at 10 weeks. In the MCARD-βARKct group, this parameter was close to baseline. The same trend was observed with LV wall thickening. Cardiac index fully recovered in the MCARD-βARKct group. LV end-diastolic volume and LV end-diastolic pressure did not differ in both groups. MCARD-mediated βARKct gene expression results in preservation of regional and global systolic function after acute MI without arresting progressive ventricular remodeling.
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Affiliation(s)
- JaBaris D Swain
- Department of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania Medical Center, Philadelphia, PA, USA
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Jneid H, Anderson JL, Wright RS, Adams CD, Bridges CR, Casey DE, Ettinger SM, Fesmire FM, Ganiats TG, Lincoff AM, Peterson ED, Philippides GJ, Theroux P, Wenger NK, Zidar JP. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2012; 60:645-81. [PMID: 22809746 DOI: 10.1016/j.jacc.2012.06.004] [Citation(s) in RCA: 446] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Jneid H, Anderson JL, Wright RS, Adams CD, Bridges CR, Casey DE, Ettinger SM, Fesmire FM, Ganiats TG, Lincoff AM, Peterson ED, Philippides GJ, Theroux P, Wenger NK, Zidar JP, Anderson JL. 2012 ACCF/AHA focused update of the guideline for the management of patients with unstable angina/Non-ST-elevation myocardial infarction (updating the 2007 guideline and replacing the 2011 focused update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 2012; 126:875-910. [PMID: 22800849 DOI: 10.1161/cir.0b013e318256f1e0] [Citation(s) in RCA: 356] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Bashore TM, Balter S, Barac A, Byrne JG, Cavendish JJ, Chambers CE, Hermiller JB, Kinlay S, Landzberg JS, Laskey WK, McKay CR, Miller JM, Moliterno DJ, Moore JW, Oliver-McNeil SM, Popma JJ, Tommaso ACL, Harrington RA, Bates ER, Bhatt DL, Bridges CR, Eisenberg MJ, Ferrari VA, Fisher JD, Gardner T, Gentile F, Gilson MF, Hlatky MA, Jacobs AK, Kaul S, Moliterno DJ, Mukherjee D, Rosenson RS, Weitz HH, Wesley DJ. 2012 American college of cardiology foundation/society for cardiovascular angiography and interventions expert consensus document on cardiac catheterization laboratory standards update: American college of cardiology foundation task force on expert consen. Catheter Cardiovasc Interv 2012; 80:E37-49. [DOI: 10.1002/ccd.24466] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Pousis C, Santamaria N, Zupa R, De Giorgi C, Mylonas CC, Bridges CR, de la Gándara F, Vassallo-Agius R, Bello G, Corriero A. Expression of vitellogenin receptor gene in the ovary of wild and captive Atlantic bluefin tuna (Thunnus thynnus). Anim Reprod Sci 2012; 132:101-10. [PMID: 22541277 DOI: 10.1016/j.anireprosci.2012.03.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 03/22/2012] [Accepted: 03/23/2012] [Indexed: 10/28/2022]
Abstract
The cDNA sequences of vitellogenin receptor proteins (VgR(+) and VgR(-)), containing or lacking the O-linked sugar domain, were determined in Atlantic bluefin tuna (Thunnus thynnus L.). VgR(-) gene expression in the ovary was compared in captive-reared and wild Atlantic bluefin tuna during the reproductive cycle. Gonad samples from adult fish were sampled from 2008 to 2010 from stocks reared in captivity at different commercial fattening operations in the Mediterranean Sea and from wild individuals caught either by traditional tuna traps during their migration towards the spawning grounds in the Mediterranean Sea or by the long-line artisanal fishery. In addition, juvenile male and female Atlantic bluefin tuna were sampled from a farming facility, to obtain baseline information and pre-adulthood amounts of VgR(-). The total length of VgR(+) cDNA was 4006 nucleotides (nt) and that of VgR(-) was 3946 nt. Relative amounts of VgR(-) were greater in juvenile females and in those adults having only previtellogenic oocytes (119 ± 55 and 146 ± 26 folds more than juvenile males, respectively). Amounts of VgR(-) were less in individuals with yolked oocytes (ripening stage, May-June) and increased after spawning in July (92 ± 20 and 113 ± 13 folds more than juvenile males in ripening and post-spawning fish, respectively). These data suggest that regulation of VgR(-) is not under oestrogen control. During the ripening period, greater VgR(-) gene expression was observed in wild fish than in fish reared in captivity, possibly because of (a) differences in water temperature exposure and/or energy storage, and/or (b) an inadequate diet in reared Atlantic bluefin tuna.
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Affiliation(s)
- C Pousis
- University of Bari Aldo Moro, Department of Animal Production, Valenzano, Italy
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Abstract
Ischemic heart disease (IHD) and heart failure (HF) are major causes of morbidity and mortality in the Western society. Advances in understanding the molecular pathology of these diseases, the evolution of vector technology, as well as defining the targets for therapeutic interventions has placed these conditions within the reach of gene-based therapy. One of the cornerstones of limiting the effectiveness of gene therapy is the establishment of clinically relevant methods of genetic transfer. Recently there have been advances in direct and transvascular gene delivery methods with the use of new technologies. Current research efforts in IHD are focused primarily on the stimulation of angiogenesis, modify the coronary vascular environment and improve endothelial function with localized gene-eluting catheters and stents. In contrast to standard IHD treatments, gene therapy in HF primarily targets inhibition of apoptosis, reduction in adverse remodeling and increase in contractility through global cardiomyocyte transduction for maximal efficacy. This article will review a variety of gene-transfer strategies in models of coronary artery disease and HF and discuss the relative success of these strategies in improving the efficiency of vector-mediated cardiac gene delivery.
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Affiliation(s)
- M G Katz
- Department of Thoracic and Cardiovascular Surgery, Sanger Heart and Vascular Institute, Cannon Research Center, Carolinas HealthCare System, Charlotte, NC, USA
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Katz MG, Fargnoli AS, Tomasulo CE, Pritchette LA, Bridges CR. Model-specific selection of molecular targets for heart failure gene therapy. J Gene Med 2012; 13:573-86. [PMID: 21954055 DOI: 10.1002/jgm.1610] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Heart failure (HF) is a complex multifaceted problem of abnormal ventricular function and structure. In recent years, new information has been accumulated allowing for a more detailed understanding of the cellular and molecular alterations that are the underpinnings of diverse causes of HF, including myocardial ischemia, pressure-overload, volume-overload or intrinsic cardiomyopathy. Modern pharmacological approaches to treat HF have had a significant impact on the course of the disease, although they do not reverse the underlying pathological state of the heart. Therefore gene-based therapy holds a great potential as a targeted treatment for cardiovascular diseases. Here, we survey the relative therapeutic efficacy of genetic modulation of β-adrenergic receptor signaling, Ca(2+) handling proteins and angiogenesis in the most common extrinsic models of HF.
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Affiliation(s)
- Michael G Katz
- Department of Surgery, Division of Cardiovascular Surgery, The University of Pennsylvania Medical Center, Philadelphia, PA, USA
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Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, Cigarroa JE, DiSesa VJ, Hiratzka LF, Hutter AM, Jessen ME, Keeley EC, Lahey SJ, Lange RA, London MJ, Mack MJ, Patel MR, Puskas JD, Sabik JF, Selnes O, Shahian DM, Trost JC, Winniford MD, Jacobs AK, Anderson JL, Albert N, Creager MA, Ettinger SM, Guyton RA, Halperin JL, Hochman JS, Kushner FG, Ohman EM, Stevenson W, Yancy CW. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg 2012; 143:4-34. [PMID: 22172748 DOI: 10.1016/j.jtcvs.2011.10.015] [Citation(s) in RCA: 197] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Rosenfeld H, Mylonas CC, Bridges CR, Heinisch G, Corriero A, Vassallo-Aguis R, Medina A, Belmonte A, Garcia A, De la Gándara F, Fauvel C, De Metrio G, Meiri-Ashkenazi I, Gordin H, Zohar Y. GnRHa-mediated stimulation of the reproductive endocrine axis in captive Atlantic bluefin tuna, Thunnus thynnus. Gen Comp Endocrinol 2012; 175:55-64. [PMID: 22015989 DOI: 10.1016/j.ygcen.2011.09.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 09/21/2011] [Accepted: 09/23/2011] [Indexed: 10/16/2022]
Abstract
A controlled-release implant loaded with GnRH agonist (GnRHa) was used to induce spawning in Atlantic bluefin tuna (Thunnus thynnus) during two consecutive reproductive seasons. The fish were implanted underwater and sampled between days 2 and 8 after treatment. At the time of GnRHa treatment, females were in full vitellogenesis and males in spermiation. There was a rapid burst of pituitary luteinizing hormone (LH) release at day 2 after treatment in GnRHa-treated fish, and circulating LH remained elevated up to day 8 after treatment. In contrast, control fish had significantly lower levels in the plasma, but higher LH content in the pituitary, as observed in many other cultured fishes that fail to undergo oocyte maturation, ovulation and spawning unless induced by an exogenous GnRHa. Plasma testosterone (T) and 17β-estradiol (E(2)) were elevated in response to the GnRHa treatment in females, while 11-ketotestosterone (11-KT) but not T was elevated in males. Even though oocyte maturation and ovulation did occur in GnRHa-induced fish, no significant elevations in 17,20β-dihydroxy-4-pregnen-3-one (17,20β-P) or 17,20β,21-trihydroxy-4-pregnen-3-one (20β-S), in either the free, conjugated or 5β-reduced,3α-hydroxylated forms was observed in fish sampled within 6 days after treatment. Interestingly, a significant peak in plasma free 17,20β-P levels occurred in both males and females at day 8 after treatment. Histological sections of the ovaries in these females contained oocytes at the migrating germinal vesicle stage, suggesting the role of this hormone as a maturation-inducing steroid in Atlantic bluefin tuna. In conclusion, the GnRHa implants activated effectively the reproductive endocrine axis in captive Atlantic bluefin tuna broodstocks, through stimulation of sustained elevations in plasma LH, which in turn evoked the synthesis and secretion of the relevant sex steroids leading to gamete maturation and release.
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Affiliation(s)
- H Rosenfeld
- Israel Oceanographic and Limnological Research, National Center for Mariculture, PO Box 1212, Eilat 88112, Israel.
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Jassar AS, Ford PA, Haber HL, Isidro A, Swain JD, Bavaria JE, Bridges CR. Cardiac Surgery in Jehovah's Witness Patients: Ten-Year Experience. Ann Thorac Surg 2012; 93:19-25. [DOI: 10.1016/j.athoracsur.2011.06.029] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 06/09/2011] [Accepted: 06/14/2011] [Indexed: 11/15/2022]
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