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Penn MS, MacRae C, Goldfaden RF, Choksi RR, Smith S, Wrenn D, Saghir MX, Klemes AB. Association of chronic neutrophil activation with risk of mortality. PLoS One 2023; 18:e0288712. [PMID: 37471318 PMCID: PMC10358907 DOI: 10.1371/journal.pone.0288712] [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: 05/16/2022] [Accepted: 07/03/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Levels of free myeloperoxidase (MPO), a cardiovascular risk marker, have been reported to decline with standard care. Whether such declines signify decreased risk of mortality remains unknown. DESIGN Cox proportional hazard models were generated using data from a retrospective cohort study of prospectively collected measures. PARTICIPANTS Patients (3,658) who had MPO measurements and LDL-C ≥ 90 mg/dL during 2011-2015 were selected based on a stratified random sampling on MPO risk level. Baseline MPO was either low (<470 pmol/L), moderate (470-539 pmol/L), or high (≥540 pmol/L). MAIN OUTCOMES AND MEASURES First occurrence of MACE (myocardial infarction, stroke, coronary revascularization, or all-cause death). RESULTS Mean age was 66.5 years, and 64.7% were women. During a mean 6.5-year follow-up, crude incidence per 1000 patient years was driven by death. The incidence and all-cause death was highest for patients with high MPO (21.2; 95% CI, 19.0-23.7), then moderate (14.6; 95% CI, 11.5-18.5) and low (2.3; 95% CI, 1.2-4.6) MPO. After adjusting for age, sex, and cardiovascular risk factors, risk of cardiovascular death did not differ significantly between patients with high and low MPO (HR, 1.57; 95% CI, 0.56-4.39), but patients with high MPO had greater risk of non-cardiovascular (HR, 6.15; 95% CI, 2.27-16.64) and all-cause (HR, 3.83; 95% CI, 1.88-7.78) death. During follow-up, a 100 pmol/L decrease in MPO correlated with a 5% reduction in mortality (HR, 0.95; 95% CI, 0.93-0.97) over 5 years. CONCLUSIONS Free circulating MPO is a strong marker of risk of mortality. Monitoring changes in MPO levels over time may provide insight into changes in physiology that mark a patient for increased risk of mortality.
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Affiliation(s)
- Marc S Penn
- Summa Health Heart and Vascular Institute, Summa Health, Akron, Ohio, United States of America
- Quest Center of Excellence for Cardiometabolic Testing at Cleveland HeartLab, Cleveland, Ohio, United States of America
| | - Calum MacRae
- Department of Medicine, One Brave Idea - American Heart Association, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Rebecca F Goldfaden
- East Coast Institute of Research, Jacksonville, Florida, United States of America
| | - Rushab R Choksi
- East Coast Institute of Research, Jacksonville, Florida, United States of America
| | - Steven Smith
- Department of Pharmacotherapy & Translational Research, College of Pharmacy, University of Florida, Gainesville, Florida, United States of America
| | - David Wrenn
- Quest Center of Excellence for Cardiometabolic Testing at Cleveland HeartLab, Cleveland, Ohio, United States of America
| | - Mouris X Saghir
- Quest Center of Excellence for Cardiometabolic Testing at Cleveland HeartLab, Cleveland, Ohio, United States of America
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Weinstock RS, Bode BW, Garg SK, Klonoff DC, El Sanadi C, Geho WB, Muchmore DB, Penn MS. Reduced hypoglycaemia using liver-targeted insulin in individuals with type 1 diabetes. Diabetes Obes Metab 2022; 24:1762-1769. [PMID: 35546449 PMCID: PMC9546184 DOI: 10.1111/dom.14761] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/03/2022] [Accepted: 05/08/2022] [Indexed: 11/27/2022]
Abstract
AIM To investigate whether an increased bolus: basal insulin ratio (BBR) with liver-targeted bolus insulin (BoI) would increase BoI use and decrease hypoglycaemic events (HEv). PATIENT POPULATION AND METHODS We enrolled 52 persons (HbA1c 6.9% ± 0.12%, mean ± SEM) with type 1 diabetes using multiple daily injections. Hepatic-directed vesicle (HDV) was used to deliver 1% of peripheral injected BoI to the liver. A 90-day run-in period was used to introduce subjects to unblinded continuous glucose monitoring and optimize standard basal insulin (BaI) (degludec) and BoI (lispro) dosing. At 90 days, BoI was changed to HDV-insulin lispro and subjects were randomized to an immediate 10% or 40% decrease in BaI dose. RESULTS At 90 days postrandomization, total insulin dosing was increased by ~7% in both cohorts. The -10% and -40% BaI cohorts were on 7.7% and 13% greater BoI with 6.9% and 30% (P = .02) increases in BBR, respectively. Compared with baseline at randomization, nocturnal level 2 HEv were reduced by 21% and 43%, with 54% and 59% reductions in patient-reported HEv in the -10% and -40% BaI cohorts, respectively. CONCLUSIONS Our study shows that liver-targeted BoI safely decreases HEv and symptoms without compromising glucose control. We further show that with initiation of liver-targeted BoI, the BBR can be safely increased by significantly lowering BaI dosing, leading to greater BoI usage.
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Affiliation(s)
| | | | - Satish K. Garg
- Barbara Davis Center for Childhood DiabetesUniversity of Colorado DenverAuroraColorado
| | | | | | | | | | - Marc S. Penn
- Diasome Pharmaceuticals, Inc.ClevelandOhio
- Summa HealthAkronOhio
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Nara PL, Sindelar D, Penn MS, Potempa J, Griffin WST. Porphyromonas gingivalis Outer Membrane Vesicles as the Major Driver of and Explanation for Neuropathogenesis, the Cholinergic Hypothesis, Iron Dyshomeostasis, and Salivary Lactoferrin in Alzheimer's Disease. J Alzheimers Dis 2021; 82:1417-1450. [PMID: 34275903 PMCID: PMC8461682 DOI: 10.3233/jad-210448] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 12/22/2022]
Abstract
Porphyromonas gingivalis (Pg) is a primary oral pathogen in the widespread biofilm-induced "chronic" multi-systems inflammatory disease(s) including Alzheimer's disease (AD). It is possibly the only second identified unique example of a biological extremophile in the human body. Having a better understanding of the key microbiological and genetic mechanisms of its pathogenesis and disease induction are central to its future diagnosis, treatment, and possible prevention. The published literature around the role of Pg in AD highlights the bacteria's direct role within the brain to cause disease. The available evidence, although somewhat adopted, does not fully support this as the major process. There are alternative pathogenic/virulence features associated with Pg that have been overlooked and may better explain the pathogenic processes found in the "infection hypothesis" of AD. A better explanation is offered here for the discrepancy in the relatively low amounts of "Pg bacteria" residing in the brain compared to the rather florid amounts and broad distribution of one or more of its major bacterial protein toxins. Related to this, the "Gingipains Hypothesis", AD-related iron dyshomeostasis, and the early reduced salivary lactoferrin, along with the resurrection of the Cholinergic Hypothesis may now be integrated into one working model. The current paper suggests the highly evolved and developed Type IX secretory cargo system of Pg producing outer membrane vesicles may better explain the observed diseases. Thus it is hoped this paper can provide a unifying model for the sporadic form of AD and guide the direction of research, treatment, and possible prevention.
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Affiliation(s)
| | | | - Marc S. Penn
- Summa Heart Health and Vascular Institute, Akron, OH, USA
| | - Jan Potempa
- Department of Oral Immunology and Infectious Diseases in the School of Dentistry, University of Louisville, Louisville, KY, USA
| | - W. Sue T. Griffin
- Department of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Jin Z, Collier TS, Dai DLY, Chen V, Hollander Z, Ng RT, McManus BM, Balshaw R, Apostolidou S, Penn MS, Bystrom C. Development and Validation of Apolipoprotein AI-Associated Lipoprotein Proteome Panel for the Prediction of Cholesterol Efflux Capacity and Coronary Artery Disease. Clin Chem 2019; 65:282-290. [DOI: 10.1373/clinchem.2018.291922] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 10/23/2018] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
Cholesterol efflux capacity (CEC) is a measure of HDL function that, in cell-based studies, has demonstrated an inverse association with cardiovascular disease. The cell-based measure of CEC is complex and low-throughput. We hypothesized that assessment of the lipoprotein proteome would allow for precise, high-throughput CEC prediction.
METHODS
After isolating lipoprotein particles from serum, we used LC-MS/MS to quantify 21 lipoprotein-associated proteins. A bioinformatic pipeline was used to identify proteins with univariate correlation to cell-based CEC measurements and generate a multivariate algorithm for CEC prediction (pCE). Using logistic regression, protein coefficients in the pCE model were reweighted to yield a new algorithm predicting coronary artery disease (pCAD).
RESULTS
Discovery using targeted LC-MS/MS analysis of 105 training and test samples yielded a pCE model comprising 5 proteins (Spearman r = 0.86). Evaluation of pCE in a case–control study of 231 specimens from healthy individuals and patients with coronary artery disease revealed lower pCE in cases (P = 0.03). Derived within this same study, the pCAD model significantly improved classification (P < 0.0001). Following analytical validation of the multiplexed proteomic method, we conducted a case–control study of myocardial infarction in 137 postmenopausal women that confirmed significant separation of specimen cohorts in both the pCE (P = 0.015) and pCAD (P = 0.001) models.
CONCLUSIONS
Development of a proteomic pCE provides a reproducible high-throughput alternative to traditional cell-based CEC assays. The pCAD model improves stratification of case and control cohorts and, with further studies to establish clinical validity, presents a new opportunity for the assessment of cardiovascular health.
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Affiliation(s)
| | | | - Darlene L Y Dai
- Proof Centre of Excellence, Vancouver, British Columbia, Canada
| | - Virginia Chen
- Proof Centre of Excellence, Vancouver, British Columbia, Canada
| | | | - Raymond T Ng
- Proof Centre of Excellence, Vancouver, British Columbia, Canada
| | - Bruce M McManus
- Proof Centre of Excellence, Vancouver, British Columbia, Canada
| | - Robert Balshaw
- Proof Centre of Excellence, Vancouver, British Columbia, Canada
| | - Sophia Apostolidou
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
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Khalifa AO, Kavran M, Mahran A, Isali I, Woda J, Flask CA, Penn MS, Hijaz AK. Stromal derived factor-1 plasmid as a novel injection for treatment of stress urinary incontinence in a rat model. Int Urogynecol J 2019; 31:107-115. [PMID: 30666428 DOI: 10.1007/s00192-019-03867-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 01/02/2019] [Indexed: 12/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS SDF-1 chemokine enhances tissue regeneration through stem cell chemotaxis, neovascularization and neuronal regeneration. We hypothesized that non-viral delivery of human plasmids that express SDF-1 (pSDF-1) may represent a novel regenerative therapy for stress urinary incontinence (SUI). METHODS Seventy-six female rats underwent vaginal distention (VD). They were then divided into four groups according to treatment: pSDF-1 (n = 42), sham (n = 30), PBS (n = 1) and luciferase-tagged pSDF-1 (n = 3). Immediately after VD, the pSDF-1 group underwent immediate periurethral injection of pSDF-1, and the sham group received a vehicle injection followed by leak point pressure (LPP) measurement at the 4th, 7th and 14th days. Urogenital tissues were collected for histology. H&E and trichrome slides were analyzed for vascularity and collagen/muscle components of the sphincter. For the luciferase-tagged pSDF-1 group, bioluminescence scans (BLIs) were obtained on the 3rd, 7th and 14th days following injections. Statistical analysis was conducted using ANOVA with post hoc LSD tests. The Mann-Whitney U test was employed to make pair-wise comparisons between the treated and sham groups. We used IBM SPSS, version 22, for statistical analyses. RESULTS BLI showed high expression of luciferase-tagged pSDF-1 in the pelvic area over time. VD resulted in a decline of LPP at the 4th day in both groups. The pSDF1-treated group demonstrated accelerated recovery that was significantly higher than that of the sham-treated group at the 7th day (22.64 cmH2O versus 13.99 cmH2O, p < 0.001). Functional improvement persisted until the 14th day (30.51 cmH2O versus 24.11 cmH2O, p = 0.067). Vascularity density in the pSDF-1-treated group was higher than in the sham group at the 7th and 14th days (p < 0.05). The muscle density/sphincter area increased significantly from the 4th to 14th day only in the pSDF-1 group. CONCLUSIONS Periurethral injection of pSDF-1 after simulated childbirth accelerated the recovery of continence and regeneration of the urethral sphincter in a rat SUI model. This intervention can potentially be translated to the treatment of post-partum urinary incontinence.
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Affiliation(s)
- Ahmad O Khalifa
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA.,Department of Urology, Menoufia University, Shibin El Kom, Egypt
| | - Michael Kavran
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Amr Mahran
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Ilaha Isali
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | | | - Chris A Flask
- Departments of Radiology, Case Western Reserve University, Cleveland, OH, USA.,Departments of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.,Departments of Pediatrics, Case Western Reserve University, Cleveland, OH, USA
| | - Marc S Penn
- Summa Health Heart and Vascular Institute, Akron, OH, USA
| | - Adonis K Hijaz
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
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Alcivar-Franco D, Purvis S, Penn MS, Klemes A. Knowledge of an inflammatory biomarker of cardiovascular risk leads to biomarker-based decreased risk in pre-diabetic and diabetic patients. J Int Med Res 2018; 48:300060517749111. [PMID: 29383972 PMCID: PMC7113488 DOI: 10.1177/0300060517749111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 11/16/2022] Open
Abstract
Objective Diabetes is a risk equivalent for cardiovascular events. The increase in
vascular inflammation with diabetes is believed to be responsible for
increased risk of ischemic events in diabetic patients. Our goal was to
assess whether knowledge of vascular inflammation alters cardiovascular risk
over time, and how knowledge of vascular inflammation changes risk in
non-diabetic, pre-diabetic and diabetic patients. Methods We retrospectively studied >100,000 primary-care patients per annum for 5
years (baseline in 2011 through 2015) with tests including lipoprotein
profile, hemoglobin A1C and the vascular-specific inflammation risk marker
myeloperoxidase. Results were obtained during the patient’s MD Value In
Prevention (MDVIP) annual wellness program physical. Results We show that rates of patients with elevated myeloperoxidase levels were
reduced from 14.4%, 15.2% and 21.3% to 4.0%, 4.0% and 6.7% in non-diabetic,
pre-diabetic and diabetic patients, respectively, over the 5-year period.
Decreases in vascular inflammation were achieved without decreases in the
prevalence of pre-diabetes (hemoglobin A1C 5.7%–6.4%) or diabetes
(hemoglobin A1C >6.4%) and were observed in patients below or above
guideline low-density lipoprotein targets. Conclusions These data demonstrate that physicians informed of elevated markers of
vascular inflammation can lower vascular inflammation correlating with
biomarker-based decreased risk of cardiovascular events.
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Affiliation(s)
| | | | - Marc S Penn
- Summa Cardiovascular Institute, 1080 Summa Health System , Akron, OH, USA.,Cleveland HeartLab Inc., Cleveland, OH, USA
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Traverse JH, Henry TD, Pepine CJ, Willerson JT, Chugh A, Yang PC, Zhao DXM, Ellis SG, Forder JR, Perin EC, Penn MS, Hatzopoulos AK, Chambers JC, Baran KW, Raveendran G, Gee AP, Taylor DA, Moyé L, Ebert RF, Simari RD. TIME Trial: Effect of Timing of Stem Cell Delivery Following ST-Elevation Myocardial Infarction on the Recovery of Global and Regional Left Ventricular Function: Final 2-Year Analysis. Circ Res 2017; 122:479-488. [PMID: 29208679 DOI: 10.1161/circresaha.117.311466] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [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: 06/06/2017] [Revised: 11/29/2017] [Accepted: 12/01/2017] [Indexed: 02/07/2023]
Abstract
RATIONALE The TIME trial (Timing in Myocardial Infarction Evaluation) was the first cell therapy trial sufficiently powered to determine if timing of cell delivery after ST-segment-elevation myocardial infarction affects recovery of left ventricular (LV) function. OBJECTIVE To report the 2-year clinical and cardiac magnetic resonance imaging results and their modification by microvascular obstruction. METHODS AND RESULTS TIME was a randomized, double-blind, placebo-controlled trial comparing 150 million bone marrow mononuclear cells versus placebo in 120 patients with anterior ST-segment-elevation myocardial infarctions resulting in LV dysfunction. Primary end points included changes in global (LV ejection fraction) and regional (infarct and border zone) function. Secondary end points included changes in LV volumes, infarct size, and major adverse cardiac events. Here, we analyzed the continued trajectory of these measures out to 2 years and the influence of microvascular obstruction present at baseline on these long-term outcomes. At 2 years (n=85), LV ejection fraction was similar in the bone marrow mononuclear cells (48.7%) and placebo groups (51.6%) with no difference in regional LV function. Infarct size and LV mass decreased ≥30% in each group at 6 months and declined gradually to 2 years. LV volumes increased ≈10% at 6 months and remained stable to 2 years. Microvascular obstruction was present in 48 patients at baseline and was associated with significantly larger infarct size (56.5 versus 36.2 g), greater adverse LV remodeling, and marked reduction in LV ejection fraction recovery (0.2% versus 6.2%). CONCLUSIONS In one of the longest serial cardiac magnetic resonance imaging analyses of patients with large anterior ST-segment-elevation myocardial infarctions, bone marrow mononuclear cells administration did not improve recovery of LV function over 2 years. Microvascular obstruction was associated with reduced recovery of LV function, greater adverse LV remodeling, and more device implantations. The use of cardiac magnetic resonance imaging leads to greater dropout of patients over time because of device implantation in patients with more severe LV dysfunction resulting in overestimation of clinical stability of the cohort. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00684021.
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Affiliation(s)
- Jay H Traverse
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Timothy D Henry
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Carl J Pepine
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - James T Willerson
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Atul Chugh
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Phillip C Yang
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - David X M Zhao
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Stephen G Ellis
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - John R Forder
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Emerson C Perin
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Marc S Penn
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Antonis K Hatzopoulos
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Jeffrey C Chambers
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Kenneth W Baran
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Ganesh Raveendran
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Adrian P Gee
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Doris A Taylor
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Lem Moyé
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.).
| | - Ray F Ebert
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Robert D Simari
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
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Mayorga ME, Kiedrowski M, McCallinhart P, Forudi F, Ockunzzi J, Weber K, Chilian W, Penn MS, Dong F. Role of SDF-1:CXCR4 in Impaired Post-Myocardial Infarction Cardiac Repair in Diabetes. Stem Cells Transl Med 2017; 7:115-124. [PMID: 29119710 PMCID: PMC5746149 DOI: 10.1002/sctm.17-0172] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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] [Received: 07/05/2017] [Accepted: 10/06/2017] [Indexed: 12/13/2022] Open
Abstract
Diabetes is a risk factor for worse outcomes following acute myocardial infarction (AMI). In this study, we tested the hypothesis that SDF‐1:CXCR4 expression is compromised in post‐AMI in diabetes, and that reversal of this defect can reverse the adverse effects of diabetes. Mesenchymal stem cells (MSC) isolated from green fluorescent protein (GFP) transgenic mice (control MSC) were induced to overexpress stromal cell‐derived factor‐1 (SDF‐1). SDF‐1 expression in control MSC and SDF‐1‐overexpressing MSC (SDF‐1:MSC) were quantified using enzyme‐linked immunosorbent assay (ELISA). AMI was induced on db/db and control mice. Mice were randomly selected to receive infusion of control MSC, SDF‐1:MSC, or saline into the border zone after AMI. Serial echocardiography was used to assess cardiac function. SDF‐1 and CXCR4 mRNA expression in the infarct zone of db/db mice and control mice were quantified. Compared to control mice, SDF‐1 levels were decreased 82%, 91%, and 45% at baseline, 1 day and 3 days post‐AMI in db/db mice, respectively. CXCR4 levels are increased 233% at baseline and 54% 5 days post‐AMI in db/db mice. Administration of control MSC led to a significant improvement in ejection fraction (EF) in control mice but not in db/db mice 21 days after AMI. In contrast, administration of SDF‐1:MSC produced a significant improvement in EF in both control mice and db/db mice 21 days after AMI. The SDF‐1:CXCR4 axis is compromised in diabetes, which appears to augment the deleterious consequences of AMI. Over‐express of SDF‐1 expression in diabetes rescues cardiac function post AMI. Our results suggest that modulation of SDF‐1 may improve post‐AMI cardiac repair in diabetes. stemcellstranslationalmedicine2018;7:115–124
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Affiliation(s)
- Maritza E Mayorga
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Matthew Kiedrowski
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Patricia McCallinhart
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Farhad Forudi
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Jeremiah Ockunzzi
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Kristal Weber
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - William Chilian
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Marc S Penn
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, Ohio, USA.,Summa Cardiovascular Institute, Summa Health System, Akron, Ohio, USA
| | - Feng Dong
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, Ohio, USA
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Dong F, Patnaik S, Duan ZH, Kiedrowski M, Penn MS, Mayorga ME. A Novel Role for CAMKK1 in the Regulation of the Mesenchymal Stem Cell Secretome. Stem Cells Transl Med 2017; 6:1759-1766. [PMID: 28688176 PMCID: PMC5689779 DOI: 10.1002/sctm.17-0046] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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] [Received: 02/28/2017] [Accepted: 04/21/2017] [Indexed: 02/06/2023] Open
Abstract
Transplantation of adult stem cells into myocardial tissue after acute myocardial infarction (AMI), has been shown to improve tissue recovery and prevent progression to ischemic cardiomyopathy. Studies suggest that the effects of mesenchymal stem cells (MSC) are due to paracrine factors released by MSC, as the benefits of MSC can be achieved through delivery of conditioned media (CM) alone. We previously demonstrated that downregulation of Dab2 enhances MSC cardiac protein expression and improves cardiac function after AMI following MSC engraftment. In order to define the molecular mechanisms that regulate MSC secretome, we analyzed gene arrays in MSC following downregulation of Dab2 via TGFβ1 pretreatment or transfection with Dab2:siRNA or miR‐145. We identified 23 genes whose expressions were significantly changed in all three conditions. Among these genes, we have initially focused our validation and functional work on calcium/calmodulin‐dependent protein kinase kinase‐1 (CAMKK1). We quantified the effects of CAMKK1 overexpression in MSC following injection of CM after AMI. Injections of CM from MSC with CAMKK1 over‐expression correlated with an increase in vascular density (CAMKK1 CM: 2,794.95 ± 44.2 versus Control: 1,290.69 ± 2.8 vessels/mm2) and decreased scar formation (CAMKK1 CM 50% ± 3.2% versus Control: 28% ± 1.4%), as well as improved cardiac function. Direct overexpression of CAMKK1 in infarcted tissue using a CAMKK1‐encoding plasmid significantly improved ejection fraction (CAMKK1: 83.2% ± 5.4% versus saline: 51.7% ± 5.8%. Baseline: 91.3% ± 4.3%) and decreased infarct size after AMI. Our data identify a novel role for CAMKK1 as regulator of the MSC secretome and demonstrate that direct overexpression of CAMKK1 in infarcted cardiac tissue, results in therapeutic beneficial effects. Stem Cells Translational Medicine2017;6:1759–1766
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Affiliation(s)
- Feng Dong
- Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Shyam Patnaik
- Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | | | - Matthew Kiedrowski
- Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Marc S Penn
- Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, Ohio, USA.,Cardiovascular Department, Summa Cardiovascular Institute, Summa Health System, Akron, Ohio, USA
| | - Maritza E Mayorga
- Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, Ohio, USA
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Abstract
Prolongation or reestablishment of stem cell homing through the expression of SDF-1 in the myocardium has been shown to lead to homing of endothelial progenitor cells to the infarct zone with a subsequent increase in vascular density and cardiac function. While the increase in vascular density is important, there could clearly be other mechanisms involved. In a recent study we demonstrated that the infusion of mesenchymal stem cells (MSC) and MSC that were engineered to overexpress SDF-1 led to significant decreases in cardiac myocyte apoptosis and increases in vascular density and cardiac function compared to control. In that study there was no evidence of cardiac regeneration from either endogenous stem cells or the infused mesenchymal stem cells. In this study we performed further detailed immunohistochemistry on these tissues and demonstrate that the overexpression of SDF-1 in the newly infracted myocardium led to recruitment of small cardiac myosin-expressing cells that had proliferated within 2 weeks of acute MI. These cells did not differentiate into mature cardiac myocytes, at least by 5 weeks after acute MI. However, based on optical mapping studies, these cells appear capable of depolarizing. We observed greater optical action potential amplitude in the infarct border in those animals that received SDF-1 overexpressing MSC than observed in noninfarcted animals and those that received control MSC. Further immunohistochemistry revealed that these proliferated cardiac myosin-positive cells did not express connexin 43, but did express connexin 45. In summary, our study suggests that the prolongation of SDF-1 expression at the time of acute MI leads to the recruitment of endogenous cardiac myosin stem cells that may represent cardiac stem cells. These cells are capable of depolarizing and thus may contribute to increased contractile function even in the absence of maturation into a mature cardiac myocyte.
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Affiliation(s)
- Samuel Unzek
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Ming Zhang
- Department of Cell Biology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Niladri Mal
- Department of Cell Biology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - William R. Mills
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, OH, USA
| | - Kenneth R. Laurita
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, OH, USA
| | - Marc S. Penn
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
- Department of Cell Biology, Cleveland Clinic Foundation, Cleveland, OH, USA
- Department of Biomedical Engineering, Cleveland Clinic Foundation, Cleveland, OH, USA
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11
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Affiliation(s)
- Marc S Penn
- From the Research and Cardiovascular Medicine Fellowship, Summa Cardiovascular Institute, Summa Health, Akron, OH; Skirball Laboratory for Cardiovascular Cellular Therapeutics, Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, OH; and Black Beret Life Sciences, LLC, Houston, TX.
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Hammonds TL, Gathright EC, Goldstein CM, Penn MS, Hughes JW. Effects of exercise on c-reactive protein in healthy patients and in patients with heart disease: A meta-analysis. Heart Lung 2016; 45:273-82. [PMID: 26916454 DOI: 10.1016/j.hrtlng.2016.01.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 01/20/2016] [Accepted: 01/21/2016] [Indexed: 02/06/2023]
Abstract
Decreases in circulating hsCRP have been associated with increased physical activity and exercise training, although the ability of exercise interventions to reduce hsCRP and which individuals benefit the most remains unclear. This meta-analysis evaluates the ability of exercise to reduce hsCRP levels in healthy individuals and in individuals with heart disease. A systematic review and meta-analysis was conducted that included exercise interventions trials from 1995 to 2012. Forty-three studies were included in the final analysis for a total of 3575 participants. Exercise interventions significantly reduced hsCRP (standardized mean difference -0.53 mg/L; 95% CI, -0.74 to -0.33). Results of sub-analysis revealed no significant difference in reductions in hsCRP between healthy adults and those with heart disease (p = .20). Heterogeneity between studies could not be attributed to age, gender, intervention length, intervention type, or inclusion of diet modification. Exercise interventions reduced hsCRP levels in adults irrespective of the presence of heart disease..
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Affiliation(s)
- Tracy L Hammonds
- Kent State University, P.O. Box 5190, Kent, OH, USA; Cardiovascular Institute, Summa Health System, 95 Arch St, Akron, OH, USA
| | | | - Carly M Goldstein
- Kent State University, P.O. Box 5190, Kent, OH, USA; Cardiovascular Institute, Summa Health System, 95 Arch St, Akron, OH, USA; Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Marc S Penn
- Cardiovascular Institute, Summa Health System, 95 Arch St, Akron, OH, USA; Department of Integrated Medical Sciences, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Joel W Hughes
- Kent State University, P.O. Box 5190, Kent, OH, USA; Cardiovascular Institute, Summa Health System, 95 Arch St, Akron, OH, USA.
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Alosco ML, Penn MS, Spitznagel MB, Cleveland MJ, Ott BR, Gunstad J. Reduced Physical Fitness in Patients With Heart Failure as a Possible Risk Factor for Impaired Driving Performance. Am J Occup Ther 2015; 69:6902260010p1-8. [PMID: 26122681 DOI: 10.5014/ajot.2015.013573] [Citation(s) in RCA: 7] [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: 11/17/2022] Open
Abstract
OBJECTIVE Reduced physical fitness secondary to heart failure (HF) may contribute to poor driving; reduced physical fitness is a known correlate of cognitive impairment and has been associated with decreased independence in driving. No study has examined the associations among physical fitness, cognition, and driving performance in people with HF. METHOD Eighteen people with HF completed a physical fitness assessment, a cognitive test battery, and a validated driving simulator scenario. RESULTS Partial correlations showed that poorer physical fitness was correlated with more collisions and stop signs missed and lower scores on a composite score of attention, executive function, and psychomotor speed. Cognitive dysfunction predicted reduced driving simulation performance. CONCLUSION Reduced physical fitness in participants with HF was associated with worse simulated driving, possibly because of cognitive dysfunction. Larger studies using on-road testing are needed to confirm our findings and identify clinical interventions to maximize safe driving.
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Affiliation(s)
- Michael L Alosco
- Michael L. Alosco, MA, is Doctoral Student, Department of Psychological Sciences, Kent State University, Kent, OH
| | - Marc S Penn
- Marc S. Penn, MD, PhD, is Director of Research, Summa Cardiovascular Institute, Akron, OH
| | - Mary Beth Spitznagel
- Mary Beth Spitznagel, PhD, is Assistant Professor, Department of Psychology, Kent State University, Kent, OH
| | - Mary Jo Cleveland
- Mary Jo Cleveland, PhD, is Geriatrician, Center for Senior Health, Summa Health System, Akron, OH
| | - Brian R Ott
- Brian R. Ott, MD, is Director, The Alzheimer's Disease & Memory Disorders Center, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - John Gunstad
- John Gunstad, PhD, is Associate Professor, Department of Psychology, Kent State University, Kent, OH;
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Mayorga M, Kiedrowski M, Shamhart P, Forudi F, Weber K, Chilian WM, Penn MS, Dong F. Early upregulation of myocardial CXCR4 expression is critical for dimethyloxalylglycine-induced cardiac improvement in acute myocardial infarction. Am J Physiol Heart Circ Physiol 2015; 310:H20-8. [PMID: 26519029 DOI: 10.1152/ajpheart.00449.2015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 06/09/2015] [Accepted: 10/04/2015] [Indexed: 12/23/2022]
Abstract
The stromal cell-derived factor-1 (SDF-1):CXCR4 is important in myocardial repair. In this study we tested the hypothesis that early upregulation of cardiomyocyte CXCR4 (CM-CXCR4) at a time of high myocardial SDF-1 expression could be a strategy to engage the SDF-1:CXCR4 axis and improve cardiac repair. The effects of the hypoxia inducible factor (HIF) hydroxylase inhibitor dimethyloxalylglycine (DMOG) on CXCR4 expression was tested on H9c2 cells. In mice a myocardial infarction (MI) was produced in CM-CXCR4 null and wild-type controls. Mice were randomized to receive injection of DMOG (DMOG group) or saline (Saline group) into the border zone after MI. Protein and mRNA expression of CM-CXCR4 were quantified. Echocardiography was used to assess cardiac function. During hypoxia, DMOG treatment increased CXCR4 expression of H9c2 cells by 29 and 42% at 15 and 24 h, respectively. In vivo DMOG treatment increased CM-CXCR4 expression at 15 h post-MI in control mice but not in CM-CXCR4 null mice. DMOG resulted in increased ejection fraction in control mice but not in CM-CXCR4 null mice 21 days after MI. Consistent with greater cardiomyocyte survival with DMOG treatment, we observed a significant increase in cardiac myosin-positive area within the infarct zone after DMOG treatment in control mice, but no increase in CM-CXCR4 null mice. Inhibition of cardiomyocyte death in MI through the stabilization of HIF-1α requires downstream CM-CXCR4 expression. These data suggest that engagement of the SDF-1:CXCR4 axis through the early upregulation of CM-CXCR4 is a strategy for improving cardiac repair after MI.
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Affiliation(s)
- Mari Mayorga
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, and
| | - Matthew Kiedrowski
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, and
| | - Patricia Shamhart
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, and
| | - Farhad Forudi
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, and
| | - Kristal Weber
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, and
| | - William M Chilian
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, and
| | - Marc S Penn
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, and Summa Cardiovascular Institute, Summa Health System, Akron, Ohio
| | - Feng Dong
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, and
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Affiliation(s)
- Marc S Penn
- From the Department of Cardiology, Summa Cardiovascular Institute, Summa Health, Akron, OH.
| | - Deephak Swaminath
- From the Department of Cardiology, Summa Cardiovascular Institute, Summa Health, Akron, OH
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Chung ES, Miller L, Patel AN, Anderson RD, Mendelsohn FO, Traverse J, Silver KH, Shin J, Ewald G, Farr MJ, Anwaruddin S, Plat F, Fisher SJ, AuWerter AT, Pastore JM, Aras R, Penn MS. Changes in ventricular remodelling and clinical status during the year following a single administration of stromal cell-derived factor-1 non-viral gene therapy in chronic ischaemic heart failure patients: the STOP-HF randomized Phase II trial. Eur Heart J 2015; 36:2228-38. [PMID: 26056125 PMCID: PMC4554960 DOI: 10.1093/eurheartj/ehv254] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 05/20/2015] [Indexed: 12/22/2022] Open
Abstract
Background Stromal cell-derived factor-1 (SDF-1) promotes tissue repair through mechanisms of cell survival, endogenous stem cell recruitment, and vasculogenesis. Stromal Cell-Derived Factor-1 Plasmid Treatment for Patients with Heart Failure (STOP-HF) is a Phase II, double-blind, randomized, placebo-controlled trial to evaluate safety and efficacy of a single treatment of plasmid stromal cell-derived factor-1 (pSDF-1) delivered via endomyocardial injection to patients with ischaemic heart failure (IHF). Methods Ninety-three subjects with IHF on stable guideline-based medical therapy and left ventricular ejection fraction (LVEF) ≤40%, completed Minnesota Living with Heart Failure Questionnaire (MLWHFQ) and 6-min walk distance (6 MWD), were randomized 1 : 1 : 1 to receive a single treatment of either a 15 or 30 mg dose of pSDF-1 or placebo via endomyocardial injections. Safety and efficacy parameters were assessed at 4 and 12 months after injection. Left ventricular functional and structural measures were assessed by contrast echocardiography and quantified by a blinded independent core laboratory. Stromal Cell-Derived Factor-1 Plasmid Treatment for Patients with Heart Failure was powered based on change in 6 MWD and MLWHFQ at 4 months. Results Subject profiles at baseline were (mean ± SD): age 65 ± 9 years, LVEF 28 ± 7%, left ventricular end-systolic volume (LVESV) 167 ± 66 mL, N-terminal pro brain natriuretic peptide (BNP) (NTproBNP) 1120 ± 1084 pg/mL, MLWHFQ 50 ± 20 points, and 6 MWD 289 ± 99 m. Patients were 11 ± 9 years post most recent myocardial infarction. Study injections were delivered without serious adverse events in all subjects. Sixty-two patients received drug with no unanticipated serious product-related adverse events. The primary endpoint was a composite of change in 6 MWD and MLWHFQ from baseline to 4 months follow-up. The primary endpoint was not met (P = 0.89). For the patients treated with pSDF-1, there was a trend toward an improvement in LVEF at 12 months (placebo vs. 15 mg vs. 30 mg ΔLVEF: −2 vs. −0.5 vs. 1.5%, P = 0.20). A pre-specified analysis of the effects of pSDF-1 based on tertiles of LVEF at entry revealed improvements in EF and LVESV from lowest-to-highest LVEF. Patients in the first tertile of EF (<26%) that received 30 mg of pSDF-1 demonstrated a 7% increase in EF compared with a 4% decrease in placebo (ΔLVEF = 11%, P = 0.01) at 12 months. There was also a trend towards improvement in LVESV, with treated patients demonstrating an 18.5 mL decrease compared with a 15 mL increase for placebo at 12 months (ΔLVESV = 33.5 mL, P = 0.12). The change in end-diastolic and end-systolic volume equated to a 14 mL increase in stroke volume in the patients treated with 30 mg of pSDF-1 compared with a decrease of −11 mL in the placebo group (ΔSV = 25 mL, P = 0.09). In addition, the 30 mg-treated cohort exhibited a trend towards improvement in NTproBNP compared with placebo at 12 months (−784 pg/mL, P = 0.23). Conclusions The blinded placebo-controlled STOP-HF trial demonstrated the safety of a single endocardial administration of pSDF-1 but failed to demonstrate its primary endpoint of improved composite score at 4 months after treatment. Through a pre-specified analysis the STOP-HF trial demonstrates the potential for attenuating LV remodelling and improving EF in high-risk ischaemic cardiomyopathy. The safety profile supports repeat dosing with pSDF-1 and the degree of left ventricular remodelling suggests the potential for improved outcomes in larger future trials.
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Affiliation(s)
| | | | | | | | | | - Jay Traverse
- Minneapolis Heart Institute, Minneapolis, MN, USA
| | | | - Julia Shin
- Montefiore-Einstein Medical Center, New York, NY, USA
| | | | | | - Saif Anwaruddin
- Hospital of University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | - Rahul Aras
- Juventas Therapeutics, Inc., Cleveland, OH, USA
| | - Marc S Penn
- Summa Cardiovascular Institute, Akron, OH, USA Juventas Therapeutics, Inc., Cleveland, OH, USA
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Penn MS, Yenikomshian MA, Cummings AKG, Klemes A, Damron JM, Purvis S, Beidelschies M, Birnbaum HG. The economic impact of implementing a multiple inflammatory biomarker-based approach to identify, treat, and reduce cardiovascular risk. J Med Econ 2015; 18:483-91. [PMID: 25763924 DOI: 10.3111/13696998.2015.1029490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To develop an economic model to estimate the change in the number of events and costs of non-fatal myocardial infarction (MI) and non-fatal ischemic stroke (IS) as a result of implementing routine risk-stratification with a multiple inflammatory biomarker approach. METHODS Reductions in the numbers of non-fatal MI and non-fatal IS events and in related per-member-per-month (PMPM) and 5-year costs (excluding test costs) due to biomarker testing were modeled for a US health plan with one million beneficiaries. Inputs for the model included literature-based MI and IS incidence rates, healthcare costs associated with MI and IS, laboratory results of biomarker testing, MI and IS hazard ratios related to biomarker levels, patient monitoring and intervention costs and use/costs of preventative pharmacotherapy. Preventative pharmacotherapy inputs were based on an analysis of pharmacy claims data. Costs savings (2013 USD) were assessed for patients undergoing biomarker testing compared to the standard of care. Data from MDVIP and Cleveland Heart Lab supported two critical inputs: (1) treatment success rates and (2) the population distribution of biomarker testing. Incidence rates, hazard ratios, and other healthcare costs were obtained from the literature. RESULTS For a health plan with one million members, an estimated 21,104 MI and 22,589 IS events occurred in a 5-year period. Routine biomarker testing among a sub-group of beneficiaries ≥35 years old reduced non-fatal MI and IS events by 2039 and 1869, respectively, yielding cost savings of over $187 million over 5 years ($3.13 PMPM), excluding test costs. Results were sensitive to changes in treatment response rates. Nonetheless, cost savings were observed for all input values. CONCLUSIONS This study suggests that health plans can realize substantial cost savings by preventing non-fatal MI and IS events after implementation of routine biomarker testing. Five-year cost savings before test costs could exceed $3.13 PMPM.
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Affiliation(s)
- M S Penn
- Cleveland HeartLab, Inc., Cleveland, OH, USA, and Summa Cardiovascular Institute, Summa Health System , Akron, OH , USA
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Deng K, Lin DL, Hanzlicek B, Balog B, Penn MS, Kiedrowski MJ, Hu Z, Ye Z, Zhu H, Damaser MS. Mesenchymal stem cells and their secretome partially restore nerve and urethral function in a dual muscle and nerve injury stress urinary incontinence model. Am J Physiol Renal Physiol 2014; 308:F92-F100. [PMID: 25377914 DOI: 10.1152/ajprenal.00510.2014] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [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: 01/06/2023] Open
Abstract
Childbirth injures muscles and nerves responsible for urinary continence. Mesenchymal stem cells (MSCs) or their secretome given systemically could provide therapeutic benefit for this complex multisite injury. We investigated whether MSCs or their secretome, as collected from cell culture, facilitate recovery from simulated childbirth injury. Age-matched female Sprague-Dawley rats received pudendal nerve crush and vaginal distension (PNC+VD) and a single intravenous (iv) injection of 2 million MSCs or saline. Controls received sham injury and iv saline. Additional rats received PNC+VD and a single intraperitoneal (ip) injection of concentrated media conditioned by MSCs (CCM) or concentrated control media (CM). Controls received a sham injury and ip CM. Urethral and nerve function were assessed with leak point pressure (LPP) and pudendal nerve sensory branch potential (PNSBP) recordings 3 wk after injury. Urethral and pudendal nerve anatomy were assessed qualitatively by blinded investigators. Quantitative data were analyzed using one-way ANOVA and Holm-Sidak post hoc tests with P < 0.05 indicating significant differences. Both LPP and PNSBP were significantly decreased 3 wk after PNC+VD with saline or CM compared with sham-injured rats, but not with MSC or CCM. Elastic fiber density in the urethra increased and changed in orientation after PNC+VD, with a greater increase in elastic fibers with MSC or CCM. Pudendal nerve fascicles were less dense and irregularly shaped after PNC+VD and had reduced pathology with MSC or CCM. MSC and CCM provide similar protective effects after PNC+VD, suggesting that MSCs act via their secretions in this dual muscle and nerve injury.
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Affiliation(s)
- Kangli Deng
- Advanced Platform Technology Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio; Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio
| | - Dan Li Lin
- Advanced Platform Technology Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio; Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio
| | - Brett Hanzlicek
- Advanced Platform Technology Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio; Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio
| | - Brian Balog
- Advanced Platform Technology Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio; Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio
| | - Marc S Penn
- Department of Integrative Medical Sciences, Northeast Ohio University College of Medicine, Rootstown, Ohio; Summa Cardiovascular Institute, Summa Health System, Akron, Ohio; and
| | - Matthew J Kiedrowski
- Department of Integrative Medical Sciences, Northeast Ohio University College of Medicine, Rootstown, Ohio
| | - Zhiquan Hu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hui Zhu
- Advanced Platform Technology Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio; Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Margot S Damaser
- Advanced Platform Technology Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio; Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio; Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
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Panda NC, Zuckerman ST, Mesubi OO, Rosenbaum DS, Penn MS, Donahue JK, Alsberg E, Laurita KR. Improved conduction and increased cell retention in healed MI using mesenchymal stem cells suspended in alginate hydrogel. J Interv Card Electrophysiol 2014; 41:117-27. [PMID: 25234602 DOI: 10.1007/s10840-014-9940-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [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: 11/25/2013] [Accepted: 07/22/2014] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Mesenchymal stem cells (MSCs) have been associated with reduced arrhythmias; however, the mechanism of this action is unknown. In addition, limited retention and survival of MSCs can significantly reduce efficacy. We hypothesized that MSCs can improve impulse conduction and that alginate hydrogel will enhance retention of MSCs in a model of healed myocardial infarction (MI). METHODS AND RESULTS Four weeks after temporary occlusion of the left anterior descending artery (LAD), pigs (n = 13) underwent a sternotomy to access the infarct and then were divided into two studies. In study 1, designed to investigate impulse conduction, animals were administered, by border zone injection, 9-15 million MSCs (n = 7) or phosphate-buffered saline (PBS) (control MI, n = 5). Electrogram width measured in the border zone 2 weeks after injections was significantly decreased with MSCs (-30 ± 8 ms, p < 0.008) but not in shams (4 ± 10 ms, p = NS). Optical mapping from border zone tissue demonstrated that conduction velocity was higher in regions with MSCs (0.49 ± 0.03 m/s) compared to regions without MSCs (0.39 ± 0.03 m/s, p < 0.03). In study 2, designed to investigate MSC retention, animals were administered an equal number of MSCs suspended in either alginate (2 or 1 % w/v) or PBS (n = 6/group) by border zone injection. Greater MSC retention and survival were observed with 2% alginate compared to PBS or 1% alginate. Confocal immunofluorescence demonstrated that MSCs survive and are associated with expression of connexin-43 (Cx43) for either PBS (control), 1%, or 2% alginate. CONCLUSIONS For the first time, we are able to directly associate MSCs with improved impulse conduction and increased retention and survival using an alginate scaffold in a clinically relevant model of healed MI.
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Affiliation(s)
- Nikhil C Panda
- Heart & Vascular Research Center, MetroHealth Campus of Case Western Reserve University, 2500, MetroHealth Drive, Rammelkamp, 6th floor, Cleveland, OH, 44109-1998, USA
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Alosco ML, Penn MS, Brickman AM, Spitznagel MB, Cleveland MJ, Griffith EY, Narkhede A, Gunstad J. Preliminary observations on MRI correlates of driving independence and performance in persons with heart failure. Int J Neurosci 2014; 125:424-32. [DOI: 10.3109/00207454.2014.945643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Chung ES, Penn MS, Sherman W, Anderson RD, Mendelsohn FO, Fisher SJ, Pastore JM, Aras R, Miller L, Patel AN. SDF-1 Plasmid Attenuates Adverse Remodeling in Ischemic Heart Failure Patients in a Randomized Phase II Trial. J Card Fail 2014. [DOI: 10.1016/j.cardfail.2014.06.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cheng JW, Sadeghi Z, Levine AD, Penn MS, von Recum HA, Caplan AI, Hijaz A. The role of CXCL12 and CCL7 chemokines in immune regulation, embryonic development, and tissue regeneration. Cytokine 2014; 69:277-83. [PMID: 25034237 DOI: 10.1016/j.cyto.2014.06.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 05/23/2014] [Accepted: 06/04/2014] [Indexed: 12/20/2022]
Abstract
Chemotactic factors direct the migration of immune cells, multipotent stem cells, and progenitor cells under physiologic and pathologic conditions. Chemokine ligand 12 and chemokine ligand 7 have been identified and investigated in multiple studies for their role in cellular trafficking in the setting of tissue regeneration. Recent early phase clinical trials have suggested that these molecules may lead to clinical benefit in patients with chronic disease. Importantly, these two proteins may play additional significant roles in directing the migration of multipotent cells, such as mesenchymal stem cells and hematopoietic progenitor cells. This article reviews the functions of these two chemokines, focusing on recruitment to sites of injury, immune function modulation, and contributions to embryonic development. Additional research would provide valuable insight into the potential clinical application of these two proteins in stem cell therapy.
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Affiliation(s)
- Julie W Cheng
- Urology Institute, University Hospitals Case Medical Center, Department of Urology, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, United States
| | - Zhina Sadeghi
- Urology Institute, University Hospitals Case Medical Center, Department of Urology, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, United States
| | - Alan D Levine
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, United States; Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, United States; Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, United States; Department of Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, United States
| | - Marc S Penn
- Skirball Laboratory for Cardiovascular Cellular Therapeutics, Summa Cardiovascular Institute, Summa Health System, 525 East Market Street, Akron, OH 44304, United States
| | - Horst A von Recum
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, United States
| | - Arnold I Caplan
- Skeletal Research Center, Department of Biology, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, United States
| | - Adonis Hijaz
- Urology Institute, University Hospitals Case Medical Center, Department of Urology, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, United States.
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Dadabayev AR, Yin G, Latchoumycandane C, McIntyre TM, Lesnefsky EJ, Penn MS. Apolipoprotein A1 regulates coenzyme Q10 absorption, mitochondrial function, and infarct size in a mouse model of myocardial infarction. J Nutr 2014; 144:1030-6. [PMID: 24759932 PMCID: PMC4056643 DOI: 10.3945/jn.113.184291] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 09/27/2013] [Accepted: 03/25/2014] [Indexed: 11/14/2022] Open
Abstract
HDL and apolipoprotein A1 (apoA1) concentrations inversely correlate with risk of death from ischemic heart disease; however, the role of apoA1 in the myocardial response to ischemia has not been well defined. To test whether apoA1, the primary HDL apolipoprotein, has an acute anti-inflammatory role in ischemic heart disease, we induced myocardial infarction via direct left anterior descending coronary artery ligation in apoA1 null (apoA1(-/-)) and apoA1 heterozygous (apoA1(+/-)) mice. We observed that apoA1(+/-) and apoA1(-/-) mice had a 52% and 125% increase in infarct size as a percentage of area at risk, respectively, compared with wild-type (WT) C57BL/6 mice. Mitochondrial oxidation contributes to tissue damage in ischemia-reperfusion injury. A substantial defect was present at baseline in the electron transport chain of cardiac myocytes from apoA1(-/-) mice localized to the coenzyme Q (CoQ) pool with impaired electron transfer (67% decrease) from complex II to complex III. Administration of coenzyme Q10 (CoQ10) to apoA1 null mice normalized the cardiac mitochondrial CoQ pool and reduced infarct size to that observed in WT mice. CoQ10 administration did not significantly alter infarct size in WT mice. These data identify CoQ pool content leading to impaired mitochondrial function as major contributors to infarct size in the setting of low HDL/apoA1. These data suggest a previously unappreciated mechanism for myocardial stunning, cardiac dysfunction, and muscle pain associated with low HDL and low apoA1 concentrations that can be corrected by CoQ10 supplementation and suggest populations of patients that may benefit particularly from CoQ10 supplementation.
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Affiliation(s)
| | - Guotian Yin
- Department of Cardiology, School of Medicine, Virginia Commonwealth University, McGuire Veterans Affairs Medical Center, Richmond, VA Department of Cardiology, Third Affiliated Hospital, Xinxiang Medical University, Xinxiang, China
| | | | - Thomas M McIntyre
- Department of Cell Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Edward J Lesnefsky
- Department of Cardiology, School of Medicine, Virginia Commonwealth University, McGuire Veterans Affairs Medical Center, Richmond, VA
| | - Marc S Penn
- Department of Integrated Medical Sciences, Northeast Ohio Medical University, Rootstown, OH; and Summa Cardiovascular Institute, Summa Health System, Akron, OH
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Abstract
Coronary artery disease is the leading cause of death in Americans. After myocardial infarction, significant ventricular damage persists despite timely reperfusion and pharmacological management. Treatment is limited, as current modalities do not cure this damage. In the past decade, stem cell therapy has emerged as a promising therapeutic solution to restore myocardial function. Clinical trials have demonstrated safety and beneficial effects in patients suffering from acute myocardial infarction, heart failure, and dilated cardiomyopathy. These benefits include improved ventricular function, increased ejection fraction, and decreased infarct size. Mechanisms of therapy are still not clearly understood. However, it is believed that paracrine factors, including stromal cell-derived factor-1, contribute significantly to stem cell benefits. The purpose of this article is to provide medical professionals with an overview on stem cell therapy for the heart and to discuss potential future directions.
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Affiliation(s)
- Shannon B Puliafico
- Northeast Ohio Cardiovascular Specialists (NEOCS), 95 Arch St. Suite 300, Akron, OH, 44304, USA
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Kerr BA, Ma L, West XZ, Ding L, Malinin NL, Weber ME, Tischenko M, Goc A, Somanath PR, Penn MS, Podrez EA, Byzova TV. Interference with akt signaling protects against myocardial infarction and death by limiting the consequences of oxidative stress. Sci Signal 2013; 6:ra67. [PMID: 23921086 DOI: 10.1126/scisignal.2003948] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The intricacy of multiple feedback loops in the pathways downstream of Akt allows this kinase to control multiple cellular processes in the cardiovascular system and precludes inferring consequences of its activation in specific pathological conditions. Akt1, the major Akt isoform in the heart and vasculature, has a protective role in the endothelium during atherosclerosis. However, Akt1 activation may also have detrimental consequences in the cardiovascular system. Mice lacking both the high-density lipoprotein receptor SR-BI (scavenger receptor class B type I) and ApoE (apolipoprotein E), which promotes clearance of remnant lipoproteins, are a model of severe dyslipidemia and spontaneous myocardial infarction. We found that Akt1 was activated in these mice, and this activation correlated with cardiac dysfunction, hypertrophy, and fibrosis; increased infarct area; cholesterol accumulation in macrophages and atherosclerosis; and reduced life span. Akt1 activation was associated with inflammation, oxidative stress, accumulation of oxidized lipids, and increased abundance of CD36, a major sensor of oxidative stress, and these events created a positive feedback loop that exacerbated the consequences of oxidative stress. Genetic deletion of Akt1 in this mouse model resulted in decreased mortality, alleviation of multiple complications of heart disease, and reduced occurrence of spontaneous myocardial infarction. Thus, interference with Akt1 signaling in vivo could be protective and improve survival under dyslipidemic conditions by reducing oxidative stress and responses to oxidized lipids.
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Affiliation(s)
- Bethany A Kerr
- Department of Molecular Cardiology, Joseph J. Jacobs Center for Thrombosis and Vascular Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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Dissaranan C, Cruz MA, Kiedrowski MJ, Balog BM, Gill BC, Penn MS, Goldman HB, Damaser MS. Rat mesenchymal stem cell secretome promotes elastogenesis and facilitates recovery from simulated childbirth injury. Cell Transplant 2013; 23:1395-406. [PMID: 23866688 PMCID: PMC4464671 DOI: 10.3727/096368913x670921] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Vaginal delivery is a risk factor for stress urinary incontinence (SUI). Mesenchymal stem cells (MSCs) home to injured organs and can facilitate repair. The goal of this study was to determine if MSCs home to pelvic organs after simulated childbirth injury and facilitate recovery from SUI via paracrine factors. Three experiments were performed. Eighteen female rats received vaginal distension (VD) or sham VD and labeled intravenous (IV) MSCs to investigate if MSCs home to the pelvic organs. Whole-organ imaging and immunofluorescence were performed 1 week later. Thirty-four female rats received VD and IV MSCs, VD and IV saline, or sham VD and IV saline to investigate if MSCs accelerate recovery of continence. Twenty-nine female rats received VD and periurethral concentrated conditioned media (CCM), VD and periurethral control media, or sham VD and periurethral control media to investigate if factors secreted by MSCs accelerate recovery from VD. Urethral histology and function were assessed 1 week later. Significantly more MSCs were observed in the urethra, vagina, and spleen after VD compared to sham VD. Continence as measured by leak point pressure (LPP) was significantly reduced after VD in rats treated with saline or control media compared to sham VD but not in those given MSCs or CCM. External urethral sphincter (EUS) function as measured by electromyography (EMG) was not improved with MSCs or CCM. Rats treated with MSCs or CCM demonstrated an increase in elastin fibers near the EUS and urethral smooth muscle more similar to that of sham-injured animals than rats treated with saline or control media. MSCs homed to the urethra and vagina and facilitated recovery of continence most likely via secretion of paracrine factors. Both MSCs and CCM have promise as novel noninvasive therapies for SUI.
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Finan A, Sopko N, Dong F, Turturice B, Kiedrowski M, Penn MS. Bone marrow SSEA1+ cells support the myocardium in cardiac pressure overload. PLoS One 2013; 8:e68528. [PMID: 23874657 PMCID: PMC3706399 DOI: 10.1371/journal.pone.0068528] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Accepted: 05/30/2013] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Stage specific embryonic antigen 1+ (SSEA1+) cells have been described as the most primitive mesenchymal progenitor cell in the bone marrow. Cardiac injury mobilizes SSEA1+ cells into the peripheral blood but their in vivo function has not been characterized. OBJECTIVE We generated animals with chimeric bone marrow to determine the fate and function of bone marrow SSEA1+ cells in response to acute cardiac pressure overload. METHODS AND RESULTS Lethally irradiated mice were transplanted with normal bone marrow where the wild-type SSEA1+ cells were replaced with green fluorescent protein (GFP) SSEA1+ cells. Cardiac injury was induced by trans-aortic constriction (TAC). We identified significant GFP+ cell engraftment into the myocardium after TAC. Bone marrow GFP+ SSEA1 derived cells acquired markers of endothelial lineage, but did not express markers of c-kit+ cardiac progenitor cells. The function of bone marrow SSEA1+ cells after TAC was determined by transplanting lethally irradiated mice with bone marrow depleted of SSEA1+ cells (SSEA1-BM). The cardiac function of SSEA1-BM mice declined at a greater rate after TAC compared to their complete bone marrow transplant counterparts and was associated with decreased bone marrow cell engraftment and greater vessel rarefication in the myocardium. CONCLUSIONS These results provide evidence for the recruitment of endogenous bone marrow SSEA1+ cells to the myocardium after TAC. We demonstrate that, in vivo, bone marrow SSEA1+ cells have the differentiation potential to acquire endothelial lineage markers. We also show that bone marrow SSEA1+ deficiency is associated with a reduced compensatory capacity to cardiac pressure overload, suggesting their importance in cardiac homeostasis. These data demonstrate that bone marrow SSEA1+ cells are critical for sustaining vascular density and cardiac repair to pressure overload.
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Affiliation(s)
- Amanda Finan
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, Ohio, United States of America
| | - Nikolai Sopko
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, Ohio, United States of America
| | - Feng Dong
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, Ohio, United States of America
| | - Ben Turturice
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, Ohio, United States of America
| | - Matthew Kiedrowski
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, Ohio, United States of America
| | - Marc S. Penn
- Summa Cardiovascular Institute, Summa Health System, Akron, Ohio, United States of America
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, Ohio, United States of America
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Abstract
The widespread use of lipids to define risk has been a success based on the dramatic decrease in the incidence of transmural myocardial infarctions. This success and the fact that many patients with normal lipid levels go on to have acute coronary syndrome have led to investigations on the use of nonlipid-based inflammatory biomarkers to predict risk. Interestingly, as the physiology reflected by distinct biomarkers is better understood, there is increasing interest in multimarker approaches to determine risk and where a given patient may be on a spectrum of risk. In this perspective, we review data from over 95,000 patients who had a multimarker annual wellness panel to demonstrate the utility of multiple markers in defining those patients at risk. We discuss a novel multimarker panel for cardiovascular risk, define the differences between a multimarker approach and expensive amalgamations of multiple markers, and discuss how the field may develop in the future.
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Affiliation(s)
- Marc S Penn
- Cleveland Heart Lab, 6701 Carnegie Avenue, Cleveland, OH 44106, USA
- Summa Cardiovascular Institute, Summa Health System, 525 East Market Street, Akron, OH 44309, USA
| | - Andrea B Klemes
- MDVIP, Inc., 1875 Corporate Boulevard, Northwest Boca Raton, FL 33431, USA
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Penn MS, Mendelsohn FO, Schaer GL, Sherman W, Farr M, Pastore J, Rouy D, Clemens R, Aras R, Losordo DW. An open-label dose escalation study to evaluate the safety of administration of nonviral stromal cell-derived factor-1 plasmid to treat symptomatic ischemic heart failure. Circ Res 2013; 112:816-25. [PMID: 23429605 DOI: 10.1161/circresaha.111.300440] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [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] [Indexed: 01/28/2023]
Abstract
RATIONALE Preclinical studies indicate that adult stem cells induce tissue repair by activating endogenous stem cells through the stromal cell-derived factor-1:chemokine receptor type 4 axis. JVS-100 is a DNA plasmid encoding human stromal cell-derived factor-1. OBJECTIVE We tested in a phase 1, open-label, dose-escalation study with 12 months of follow-up in subjects with ischemic cardiomyopathy to see if JVS-100 improves clinical parameters. METHODS AND RESULTS Seventeen subjects with ischemic cardiomyopathy, New York Heart Association class III heart failure, with an ejection fraction ≤40% on stable medical therapy, were enrolled to receive 5, 15, or 30 mg of JVS-100 via endomyocardial injection. The primary end points for safety and efficacy were at 1 and 4 months, respectively. The primary safety end point was a major adverse cardiac event. Efficacy end points were change in quality of life, New York Heart Association class, 6-minute walk distance, single photon emission computed tomography, N-terminal pro-brain natruretic peptide, and echocardiography at 4 and 12 months. The primary safety end point was met. At 4 months, all of the cohorts demonstrated improvements in 6-minute walk distance, quality of life, and New York Heart Association class. Subjects in the 15- and 30-mg dose groups exhibited improvements in 6-minute walk distance (15 mg: median [range]: 41 minutes [3-61 minutes]; 30 mg: 31 minutes [22-74 minutes]) and quality of life (15 mg: -16 points [+1 to -32 points]; 30 mg: -24 points [+17 to -38 points]) over baseline. At 12 months, improvements in symptoms were maintained. CONCLUSIONS These data highlight the importance of defining the molecular mechanisms of stem cell-based tissue repair and suggest that overexpression of stromal cell-derived factor-1 via gene therapy is a strategy for improving heart failure symptoms in patients with ischemic cardiomyopathy.
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Affiliation(s)
- Marc S Penn
- Summa Cardiovascular Institute, Summa Health System, Skirball Laboratory for Cardiovascular Cellular Therapeutics, Department of Integrative Medical Sciences, Northeast Ohio Medical University, Akron, OH 44304, USA.
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Traverse JH, Henry TD, Pepine CJ, Willerson JT, Zhao DX, Ellis SG, Forder JR, Anderson RD, Hatzopoulos AK, Penn MS, Perin EC, Chambers J, Baran KW, Raveendran G, Lambert C, Lerman A, Simon DI, Vaughan DE, Lai D, Gee AP, Taylor DA, Cogle CR, Thomas JD, Olson RE, Bowman S, Francescon J, Geither C, Handberg E, Kappenman C, Westbrook L, Piller LB, Simpson LM, Baraniuk S, Loghin C, Aguilar D, Richman S, Zierold C, Spoon DB, Bettencourt J, Sayre SL, Vojvodic RW, Skarlatos SI, Gordon DJ, Ebert RF, Kwak M, Moyé LA, Simari RD. Effect of the use and timing of bone marrow mononuclear cell delivery on left ventricular function after acute myocardial infarction: the TIME randomized trial. JAMA 2012; 308:2380-9. [PMID: 23129008 PMCID: PMC3652242 DOI: 10.1001/jama.2012.28726] [Citation(s) in RCA: 323] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
CONTEXT While the delivery of cell therapy after ST-segment elevation myocardial infarction (STEMI) has been evaluated in previous clinical trials, the influence of the timing of cell delivery on the effect on left ventricular function has not been analyzed. OBJECTIVES To determine the effect of intracoronary autologous bone marrow mononuclear cell (BMC) delivery after STEMI on recovery of global and regional left ventricular function and whether timing of BMC delivery (3 days vs 7 days after reperfusion) influences this effect. DESIGN, SETTING, AND PATIENTS A randomized, 2 × 2 factorial, double-blind, placebo-controlled trial, Timing In Myocardial infarction Evaluation (TIME) enrolled 120 patients with left ventricular dysfunction (left ventricular ejection fraction [LVEF] ≤ 45%) after successful primary percutaneous coronary intervention (PCI) of anterior STEMI between July 17, 2008, and November 15, 2011, as part of the Cardiovascular Cell Therapy Research Network sponsored by the National Heart, Lung, and Blood Institute. INTERVENTIONS Intracoronary infusion of 150 × 106 BMCs or placebo (randomized 2:1) within 12 hours of aspiration and cell processing administered at day 3 or day 7 (randomized 1:1) after treatment with PCI. MAIN OUTCOME MEASURES The primary end points were change in global (LVEF) and regional (wall motion) left ventricular function in infarct and border zones at 6 months measured by cardiac magnetic resonance imaging and change in left ventricular function as affected by timing of treatment on day 3 vs day 7. The secondary end points included major adverse cardiovascular events as well as changes in left ventricular volumes and infarct size. RESULTS The mean (SD) patient age was 56.9 (10.9) years and 87.5% of participants were male. At 6 months, there was no significant increase in LVEF for the BMC group (45.2% [95% CI, 42.8% to 47.6%] to 48.3% [95% CI, 45.3% to 51.3%) vs the placebo group (44.5% [95% CI, 41.0% to 48.0%] to 47.8% [95% CI, 43.4% to 52.2%]) (P = .96). There was no significant treatment effect on regional left ventricular function observed in either infarct or border zones. There were no significant differences in change in global left ventricular function for patients treated at day 3 (−0.9% [95% CI, −6.6% to 4.9%], P = .76) or day 7 (1.1% [95% CI, −4.7% to 6.9%], P = .70). The timing of treatment had no significant effect on regional left ventricular function recovery. Major adverse events were rare among all treatment groups. CONCLUSION Among patients with STEMI treated with primary PCI, the administration of intracoronary BMCs at either 3 days or 7 days after the event had no significant effect on recovery of global or regional left ventricular function compared with placebo. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00684021.
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Ma L, Kerr BA, West XZ, Malinin NL, Weber ME, Ding L, Somanath PR, Penn MS, Podrez EA, Byzova TV, Ma L. INTERFERENCE WITH AKT SIGNALING IN DYSLIPIDEMIA DIMINISHES MYOCARDIAL INFARCTION AND PROMOTES SURVIVAL BY INHIBITING OXIDATIVE STRESS. Heart 2012. [DOI: 10.1136/heartjnl-2012-302920a.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Penn MS, Silver KH. Strategy for cardiovascular repair: role of stem cells in 2012 and beyond. Minerva Cardioangiol 2012; 60:451-460. [PMID: 23018426] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Stem cell based repair of the heart has captured the mind and imagination of cardiovascular specialists and the lay public. Significant progress has been made at the bench defining the mechanisms of action. This work has gone on further to demonstrate that there is an endogenous stem cell based repair process that attempts to repair the myocardium in response to acute ischemic injury. At the same time investigators at both the bench and in clinical populations have investigated the effects of distinct adult stem cell populations in the peri-infarct period as well as patients with chronic heart failure. In this review we attempt to lay a framework to review how cardiovascular regenerative medicine has progressed to date, summarize what we have learned to date, and discuss how the field may evolve in the future.
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Affiliation(s)
- M S Penn
- Summa Cardiovascular Institute, Summa Health System, Akron, OH, USA.
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Lenis AT, Kuang M, Woo LL, Hijaz A, Penn MS, Butler RS, Rackley R, Damaser MS, Wood HM. Impact of parturition on chemokine homing factor expression in the vaginal distention model of stress urinary incontinence. J Urol 2012; 189:1588-94. [PMID: 23022009 DOI: 10.1016/j.juro.2012.09.096] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 09/13/2012] [Indexed: 01/12/2023]
Abstract
PURPOSE Human childbirth simulated by vaginal distention is known to increase the expression of chemokines and receptors involved in stem cell homing and tissue repair. We hypothesized that pregnancy and parturition in rats contributes to the expression of chemokines and receptors after vaginal distention. MATERIALS AND METHODS We used 72 age matched female Lewis rats, including virgin rats with and without vaginal distention, and delivered rats with and without vaginal distention. Each rat was sacrificed immediately, or 3 or 7 days after vaginal distention and/or parturition, and the urethra was harvested. Relative expression of chemokines and receptors was determined by real-time polymerase chain reaction. Mixed models were used with the Bonferroni correction for multiple comparisons. RESULTS Vaginal distention up-regulated urethral expression of CCL7 immediately after injury in virgin and postpartum rats. Hypoxia inducible factor-1α and vascular endothelial growth factor were up-regulated only in virgin rats immediately after vaginal distention. CD191 expression was immediately up-regulated in postpartum rats without vaginal distention compared to virgin rats without vaginal distention. CD195 was up-regulated in virgin rats 3 days after vaginal distention compared to virgin rats without vaginal distention. CD193 and CXCR4 showed delayed up-regulation in virgin rats 7 days after vaginal distention. CXCL12 was up-regulated in virgin rats 3 days after vaginal distention compared to immediately after vaginal distention. Interleukin-8 and CD192 showed no differential expression. CONCLUSIONS Vaginal distention results in up-regulation of the chemokines and receptors expressed during tissue injury, which may facilitate the spontaneous functional recovery previously noted. Pregnancy and delivery up-regulated CD191 and attenuated the expression of hypoxia inducible factor-1α and vascular endothelial growth factor in the setting of vaginal distention, likely by decreasing hypoxia.
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Affiliation(s)
- Andrew T Lenis
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio 44195, USA
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Mayorga ME, Penn MS. miR-145 is differentially regulated by TGF-β1 and ischaemia and targets Disabled-2 expression and wnt/β-catenin activity. J Cell Mol Med 2012; 16:1106-13. [PMID: 21762377 PMCID: PMC4365889 DOI: 10.1111/j.1582-4934.2011.01385.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The effect of wnt/β-catenin signalling in the response to acute myocardial infarction (AMI) remains controversial. The membrane receptor adaptor protein Disabled-2 (Dab2) is a tumour suppressor protein and has a critical role in stem cell specification. We recently demonstrated that down-regulation of Dab2 regulates cardiac protein expression and wnt/β-catenin activity in mesenchymal stem cells (MSC) in response to transforming growth factor-β(1) (TGF-β(1)). Although Dab2 expression has been shown to have effects in stem cells and tumour suppression, the molecular mechanisms regulating this expression are still undefined. We identified putative binding sites for miR-145 in the 3'-UTR of Dab2. In MSC in culture, we observed that TGF-β(1) treatment led to rapid and sustained up-regulation of pri-miR-145. Through gain and loss of function studies we demonstrate that miR-145 up-regulation was required for the down-regulation of Dab2 and increased β-catenin activity in response to TGF-β(1). To begin to define how Dab2 might regulate wnt/β-catenin in the heart following AMI, we quantified myocardial Dab2 as a function of time after left anterior descending ligation. There was no significant Dab2 expression in sham-operated myocardium. Following AMI, Dab2 levels were rapidly up-regulated in cardiac myocytes in the infarct border zone. The increase in cardiac myocyte Dab2 expression correlated with the rapid and sustained down-regulation of myocardial pri-miR-145 expression following AMI. Our data demonstrate a novel and critical role for miR-145 expression as a regulator of Dab2 expression and β-catenin activity in response to TGF-β(1) and hypoxia.
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Affiliation(s)
- Maritza E Mayorga
- Skirball Laboratory for Cardiovascular Cellular Therapeutics, Cleveland, OH, USA
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Abstract
Stem cell therapy for the prevention and treatment of cardiac dysfunction holds significant promise for patients with ischemic heart disease. Excitingly early clinical studies have demonstrated safety and some clinical feasibility, while at the same time studies in the laboratory have investigated mechanisms of action and strategies to optimize the effects of regenerative cardiac therapies. One of the key pathways that has been demonstrated critical in stem cell-based cardiac repair is (stromal cell-derived factor-1) SDF-1:CXCR4. SDF-1:CXCR4 has been shown to affect stem cell homing, cardiac myocyte survival and ventricular remodeling in animal studies of acute myocardial infarction and chronic heart failure. Recently released clinical data suggest that SDF-1 alone is sufficient to induce cardiac repair. Most importantly, studies like those on the SDF-1:CXCR4 axis have suggested mechanisms critical for cardiac regenerative therapies that if clinical investigators continue to ignore will result in poorly designed studies that will continue to yield negative results.
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Affiliation(s)
- M S Penn
- Summa Cardiovascular Institute, Summa Health System, Akron, OH, USA.
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Penn MS, Mendelsohn FO, Schaer GL, Sherman W, Farr M, Pastore JM, Aras R, Rouy D, Clemens R, Cotts W. Re-Establishment of SDF-1 Expression Through Non-Viral Gene Therapy Improves Clinical Parameters Through 12 Months in Patients With Ischemic Class III Heart Failure. J Card Fail 2012. [DOI: 10.1016/j.cardfail.2012.06.202] [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: 10/28/2022]
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Affiliation(s)
- Marc S. Penn
- From the Summa Cardiovascular Institute (M.S.P.), Summa Health System, Akron, OH; and Skirball Laboratory for Cardiovascular Cellular Therapeutics (M.S.P.), Department of Integrated Medical Sciences, Northeast Ohio Medical University, Rootstown, OH
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Dong F, Harvey J, Finan A, Weber K, Agarwal U, Penn MS. Myocardial CXCR4 expression is required for mesenchymal stem cell mediated repair following acute myocardial infarction. Circulation 2012; 126:314-24. [PMID: 22685115 DOI: 10.1161/circulationaha.111.082453] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [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] [Indexed: 12/11/2022]
Abstract
BACKGROUND Overexpression of stromal cell-derived factor-1 in injured tissue leads to improved end-organ function. In this study, we quantify the local trophic effects of mesenchymal stem cell (MSC) stromal cell-derived factor-1 release on the effects of MSC engraftment in the myocardium after acute myocardial infarction. METHODS AND RESULTS Conditional cardiac myocyte CXCR4 (CM-CXCR4) null mice were generated by use of tamoxifen-inducible cardiac-specific cre by crossing CXCR4 floxed with MCM-cre mouse. Studies were performed in littermates with (CM-CXCR4 null) or without (control) tamoxifen injection 3 weeks before acute myocardial infarction. One day after acute myocardial infarction, mice received 100,000 MSC or saline via tail vein. We show α-myosin heavy chain MerCreMer and the MLC-2v promoters are active in cardiac progenitor cells. MSC engraftment in wild-type mice decreased terminal deoxynucleotidyltransferase-mediated dUTP nick-end labeling positive CM (-44%, P<0.01), increased cardiac progenitor cell recruitment (100.9%, P<0.01), and increased cardiac myosin-positive area (39%, P<0.05) at 4, 7, and 21 days after acute myocardial infarction, respectively. MSC in wild-type mice resulted in 107.4% (P<0.05) increase in ejection fraction in comparison with 25.9% (P=NS) increase in CM-CXCR4 null mice. These differences occurred despite equivalent increases (16%) in vascular density in response to MSC infusion in wild-type and CM-CXCR4 null mice. CONCLUSIONS These data demonstrate that the local trophic effects of MSC require cardiac progenitor cell and CM-CXCR4 expression and are mediated by MSC stromal cell-derived factor-1 secretion. Our results further demonstrate and quantify for the first time a specific paracrine mechanism of MSC engraftment. In the absence of CM-CXCR4 expression, there is a significant loss of functional benefit in MSC-mediated repair despite equal increases in vascular density.
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Affiliation(s)
- Feng Dong
- Skirball Laboratory for Cardiovascular Cellular Therapeutics, Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, OH, USA
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Frolova EG, Sopko N, Blech L, Popović ZB, Li J, Vasanji A, Drumm C, Krukovets I, Jain MK, Penn MS, Plow EF, Stenina OI. Thrombospondin-4 regulates fibrosis and remodeling of the myocardium in response to pressure overload. FASEB J 2012; 26:2363-73. [PMID: 22362893 PMCID: PMC3360147 DOI: 10.1096/fj.11-190728] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 02/10/2012] [Indexed: 12/29/2022]
Abstract
Thrombospondin-4 (TSP-4) expression increases dramatically in hypertrophic and failing hearts in rodent models and in humans. The aim of this study was to address the function of TSP-4 in the heart. TSP-4-knockout (Thbs4(-/-)) and wild-type (WT) mice were subjected to transverse aortic constriction (TAC) to increase left ventricle load. After 2 wk, Thbs4(-/-) mice had a significantly higher heart weight/body weight ratio than WT mice. The additional increase in the heart weight in TAC Thbs4(-/-) mice was due to increased deposition of extracellular matrix (ECM). The levels of interstitial collagens were higher in the knockout mice, but the size of cardiomyocytes and apoptosis in the myocardium was unaffected by TSP-4 deficiency, suggesting that increased reactive fibrosis was the primary cause of the higher heart weight. The increased ECM deposition in Thbs4(-/-) mice was accompanied by changes in functional parameters of the heart and decreased vessel density. The expression of inflammatory and fibrotic genes known to be influential in myocardial remodeling changed as a result of TSP-4 deficiency in vivo and as a result of incubation of cells with recombinant TSP-4 in vitro. Thus, TSP-4 is involved in regulating the adaptive responses of the heart to pressure overload, suggesting its important role in myocardial remodeling. Our study showed a direct influence of TSP-4 on heart function and to identify the mechanism of its effects on heart remodeling.
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Affiliation(s)
- Ella G. Frolova
- Department of Molecular Cardiology
- Joseph J. Jacob Center for Thrombosis and Vascular Biology
| | | | - Lauren Blech
- Department of Molecular Cardiology
- Joseph J. Jacob Center for Thrombosis and Vascular Biology
| | | | - Jianbo Li
- Department of Quantitative Health Sciences
| | | | - Carla Drumm
- Department of Molecular Cardiology
- Joseph J. Jacob Center for Thrombosis and Vascular Biology
| | - Irene Krukovets
- Department of Molecular Cardiology
- Joseph J. Jacob Center for Thrombosis and Vascular Biology
| | - Mukesh K. Jain
- Case Cardiovascular Research Institute, Case Western Reserve University School of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Edward F. Plow
- Department of Molecular Cardiology
- Joseph J. Jacob Center for Thrombosis and Vascular Biology
| | - Olga I. Stenina
- Department of Molecular Cardiology
- Joseph J. Jacob Center for Thrombosis and Vascular Biology
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Dong F, Khalil M, Anwaruddin S, Penn MS. Abstract 151: Role of Hypoxia Inducible Factor-1α in Leukocyte Recruitment to Sites of Vascular Injury and Atherosclerotic Progression in ApoE-/SRB - mice. Arterioscler Thromb Vasc Biol 2012. [DOI: 10.1161/atvb.32.suppl_1.a151] [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
Introduction:
HIF-1α is an inducible protein stabilized by hypoxia and is thought to be an important mediator of leukocyte metabolism and inflammation. The role of HIF-1α in acute coronary syndrome (ACS) remains undefined. Since HIF-1α is a lethal knockout, we generated ApoE/SRB double null (DN) mice with HIF-1α null leukocytes using bone marrow transplantation (BMT) and hematopoietic stem cells (HSC) transducted with a lentivirus encoding a siRNA to HIF-1α or scramble.
Methods:
Donor bone marrow was harvested from 6 week-old ApoE/SRB DN mice. At age 6 weeks, following lethal irradiation ApoE/SRB DN mice received 50,000 scramble or HIF-1 α: siRNA transfected HSC. Mice were weaned from probucol 2 weeks after BMT. Serial echocardiography was used to assess cardiac function. Burden of coronary atherosclerosis and macrophage recruitment were assessed.
Results:
White blood cells from HIF-1 α: siRNA mice exhibited significantly less HIF-1α expression following culture in hypoxic conditions (p<0.05). HIF-1 α: siRNA mice demonstrated significantly less coronary atherosclerosis (p <0.05) and macrophage recruitment (p=0.02) in the plaque. HIF-1 α: siRNA mice showed significantly delayed time to myocardial infarction. Six weeks after cessation of probucol in the diet, control animals had an ejection fraction of 43 ± 6% compared to 73 ± 7% in HIF-1 α: siRNA mice. HIF-1 α: siRNA mice did not exhibit evidence of left ventricular dysfunction until 7.9 ± 0.4 weeks after weaning off probucol as compared to 5.3 ± 0.3 weeks in the controls. Consistent with delayed onset of myocardial infarction in HIF-1α: siRNA transplanted mice, the mice with decreased HIF-1α expression survived longer than control mice (8.6 ± 0.4 vs. 6.3 ± 0.3, p<0.05).
Conclusion:
Leukocyte derived HIF-1 α plays a critical role in leukocyte recruitment to the site of vascular injury and appears to be involved in the progression of coronary atherosclerosis.
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Affiliation(s)
- Feng Dong
- Integrative Med Sciences, Northeast Ohio Med Univ, Rootstown, OH
| | | | - Saif Anwaruddin
- Penn Heart and Vascular Cntr, Hosp of the Univ of Pennsylvania, Philadelphia, PA
| | - Marc S Penn
- Integrative Med Sciences, Summa Cardiovascular Institute, Northeast Ohio Med Univ, Rootstown, OH
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Penn MS, Latchoumycandane C, McIntyre TM, Lesnefsky EJ. Abstract 407: Role of Apoa1 in Regulating Mitochondrial Function in Acute Myocardial Infarction. Arterioscler Thromb Vasc Biol 2012. [DOI: 10.1161/atvb.32.suppl_1.a407] [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
Background:
High density lipoprotein (HDL) and apoA-I levels inversely correlate with risk of death from ischemic heart disease; however, the role of apoA-I in myocardial response to ischemia has not been well defined.
Methods and results:
To test whether apoA-I, the primary HDL apolipoprotein, has an acute anti-inflammatory role in ischemic heart disease, we induced myocardial infarctions in apoA-I
-/-
and apoA-1 heterozygotic animals. We observed a 52% increase in infarct size as a percent of area at risk in heterozygotic and a 125% increase in apoA-I null animals compared to wild-type mice. Mitochondrial oxidation contributes to tissue damage in ischemic reperfusion injury, and we found a significant defect in the electron transport chain of cardiac myocytes from apoA-I
-/-
mice. This was localized to the coenzyme Q pool that impaired electron transfer from complex II to complex III. Administration of CoQ10 to apoA-I null animals normalized the cardiac mitochondrial CoQ pool, and it reduced infarct size to that observed of wild type animals. CoQ10 administration did not significantly alter infarct size in wild-type mice.
Conclusions:
These data identify CoQ pool size and impaired mitochondrial function as major contributors to infarct size in the setting of low HDL/apoA-I. These data suggest a previously unappreciated mechanism for myocardial stunning, cardiac dysfunction, and muscle pain associated with low HDL/apoA-I levels that can be corrected by CoQ10 supplementation and suggest populations of patients that may particularly benefit from CoQ10 supplementation.
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Affiliation(s)
- Marc S Penn
- Northeast Ohio Med Univ/Summa Health Systems, Akron, OH
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Perin EC, Willerson JT, Pepine CJ, Henry TD, Ellis SG, Zhao DX, Silva GV, Lai D, Thomas JD, Kronenberg MW, Martin AD, Anderson RD, Traverse JH, Penn MS, Anwaruddin S, Hatzopoulos AK, Gee AP, Taylor DA, Cogle CR, Smith D, Westbrook L, Chen J, Handberg E, Olson RE, Geither C, Bowman S, Francescon J, Baraniuk S, Piller LB, Simpson LM, Loghin C, Aguilar D, Richman S, Zierold C, Bettencourt J, Sayre SL, Vojvodic RW, Skarlatos SI, Gordon DJ, Ebert RF, Kwak M, Moyé LA, Simari RD. Effect of transendocardial delivery of autologous bone marrow mononuclear cells on functional capacity, left ventricular function, and perfusion in chronic heart failure: the FOCUS-CCTRN trial. JAMA 2012; 307:1717-26. [PMID: 22447880 PMCID: PMC3600947 DOI: 10.1001/jama.2012.418] [Citation(s) in RCA: 335] [Impact Index Per Article: 27.9] [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] [Indexed: 12/13/2022]
Abstract
CONTEXT Previous studies using autologous bone marrow mononuclear cells (BMCs) in patients with ischemic cardiomyopathy have demonstrated safety and suggested efficacy. OBJECTIVE To determine if administration of BMCs through transendocardial injections improves myocardial perfusion, reduces left ventricular end-systolic volume (LVESV), or enhances maximal oxygen consumption in patients with coronary artery disease or LV dysfunction, and limiting heart failure or angina. DESIGN, SETTING, AND PATIENTS A phase 2 randomized double-blind, placebo-controlled trial of symptomatic patients (New York Heart Association classification II-III or Canadian Cardiovascular Society classification II-IV) with a left ventricular ejection fraction of 45% or less, a perfusion defect by single-photon emission tomography (SPECT), and coronary artery disease not amenable to revascularization who were receiving maximal medical therapy at 5 National Heart, Lung, and Blood Institute-sponsored Cardiovascular Cell Therapy Research Network (CCTRN) sites between April 29, 2009, and April 18, 2011. INTERVENTION Bone marrow aspiration (isolation of BMCs using a standardized automated system performed locally) and transendocardial injection of 100 million BMCs or placebo (ratio of 2 for BMC group to 1 for placebo group). MAIN OUTCOME MEASURES Co-primary end points assessed at 6 months: changes in LVESV assessed by echocardiography, maximal oxygen consumption, and reversibility on SPECT. Phenotypic and functional analyses of the cell product were performed by the CCTRN biorepository core laboratory. RESULTS Of 153 patients who provided consent, a total of 92 (82 men; average age: 63 years) were randomized (n = 61 in BMC group and n = 31 in placebo group). Changes in LVESV index (-0.9 mL/m(2) [95% CI, -6.1 to 4.3]; P = .73), maximal oxygen consumption (1.0 [95% CI, -0.42 to 2.34]; P = .17), and reversible defect (-1.2 [95% CI, -12.50 to 10.12]; P = .84) were not statistically significant. There were no differences found in any of the secondary outcomes, including percent myocardial defect, total defect size, fixed defect size, regional wall motion, and clinical improvement. CONCLUSION Among patients with chronic ischemic heart failure, transendocardial injection of autologous BMCs compared with placebo did not improve LVESV, maximal oxygen consumption, or reversibility on SPECT. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00824005.
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Affiliation(s)
| | | | | | - Timothy D. Henry
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota
- University of Minnesota School of Medicine, Minneapolis
| | | | - David X.M. Zhao
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | - Dejian Lai
- The University of Texas School of Public Health, Houston
| | | | | | - A. Daniel Martin
- University of Florida College of Public Health and Health Professions, Gainesville
| | | | - Jay H. Traverse
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota
- University of Minnesota School of Medicine, Minneapolis
| | | | - Saif Anwaruddin
- Penn Heart and Vascular Hospital of the University of Pennsylvania, Philadelphia
| | | | | | | | | | - Deirdre Smith
- Texas Heart Institute, St. Luke’s Episcopal Hospital, Houston
| | | | - James Chen
- Texas Heart Institute, St. Luke’s Episcopal Hospital, Houston
| | | | - Rachel E. Olson
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | | | - Sherry Bowman
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Judy Francescon
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Sarah Baraniuk
- The University of Texas School of Public Health, Houston
| | | | | | | | | | | | | | | | | | | | | | - David J. Gordon
- National Heart, Lung and Blood Institute, Bethesda, Maryland
| | - Ray F. Ebert
- National Heart, Lung and Blood Institute, Bethesda, Maryland
| | - Minjung Kwak
- National Heart, Lung and Blood Institute, Bethesda, Maryland
| | - Lemuel A. Moyé
- The University of Texas School of Public Health, Houston
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Chilian WM, Penn MS, Pung YF, Dong F, Mayorga M, Ohanyan V, Logan S, Yin L. Coronary collateral growth--back to the future. J Mol Cell Cardiol 2011; 52:905-11. [PMID: 22210280 DOI: 10.1016/j.yjmcc.2011.12.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [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: 11/25/2011] [Revised: 12/09/2011] [Accepted: 12/10/2011] [Indexed: 01/17/2023]
Abstract
The coronary collateral circulation is critically important as an adaptation of the heart to prevent the damage from ischemic insults. In their native state, collaterals in the heart would be classified as part of the microcirculation, existing as arterial-arterial anastomotic connections in the range of 30 to 100 μM in diameter. However, these vessels also show a propensity to remodel into components of the macrocirculation and can become arteries larger than 1000 μM in diameter. This process of outward remodeling is critically important in the adaptation of the heart to ischemia because the resistance to blood flow is inversely related to the fourth power of the diameter of the vessel. Thus, an expansion of a vessel from 100 to 1000 μM would reduce resistance (in this part of the circuit) to a negligible amount and enable delivery of flow to the region at risk. Our goal in this review is to highlight the voids in understanding this adaptation to ischemia-the growth of the coronary collateral circulation. In doing so we discuss the controversies and unknown aspects of the causal factors that stimulate growth of the collateral circulation, the role of genetics, and the role of endogenous stem and progenitor cells in the context of the normal, physiological situation and under more pathological conditions of ischemic heart disease or with some of the underlying risk factors, e.g., diabetes. The major conclusion of this review is that there are many gaps in our knowledge of coronary collateral growth and this knowledge is critical before the potential of stimulating collateralization in the hearts of patients can be realized. This article is part of a Special Issue entitled "Coronary Blood Flow".
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Affiliation(s)
- William M Chilian
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, Ohio 44272, USA.
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Traverse JH, Henry TD, Ellis SG, Pepine CJ, Willerson JT, Zhao DX, Forder JR, Byrne BJ, Hatzopoulos AK, Penn MS, Perin EC, Baran KW, Chambers J, Lambert C, Raveendran G, Simon DI, Vaughan DE, Simpson LM, Gee AP, Taylor DA, Cogle CR, Thomas JD, Silva GV, Jorgenson BC, Olson RE, Bowman S, Francescon J, Geither C, Handberg E, Smith DX, Baraniuk S, Piller LB, Loghin C, Aguilar D, Richman S, Zierold C, Bettencourt J, Sayre SL, Vojvodic RW, Skarlatos SI, Gordon DJ, Ebert RF, Kwak M, Moyé LA, Simari RD. Effect of intracoronary delivery of autologous bone marrow mononuclear cells 2 to 3 weeks following acute myocardial infarction on left ventricular function: the LateTIME randomized trial. JAMA 2011; 306:2110-9. [PMID: 22084195 PMCID: PMC3600981 DOI: 10.1001/jama.2011.1670] [Citation(s) in RCA: 344] [Impact Index Per Article: 26.5] [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] [Indexed: 12/13/2022]
Abstract
CONTEXT Clinical trial results suggest that intracoronary delivery of autologous bone marrow mononuclear cells (BMCs) may improve left ventricular (LV) function when administered within the first week following myocardial infarction (MI). However, because a substantial number of patients may not present for early cell delivery, the efficacy of autologous BMC delivery 2 to 3 weeks post-MI warrants investigation. OBJECTIVE To determine if intracoronary delivery of autologous BMCs improves global and regional LV function when delivered 2 to 3 weeks following first MI. DESIGN, SETTING, AND PATIENTS A randomized, double-blind, placebo-controlled trial (LateTIME) of the National Heart, Lung, and Blood Institute-sponsored Cardiovascular Cell Therapy Research Network of 87 patients with significant LV dysfunction (LV ejection fraction [LVEF] ≤45%) following successful primary percutaneous coronary intervention (PCI) between July 8, 2008, and February 28, 2011. INTERVENTIONS Intracoronary infusion of 150 × 10(6) autologous BMCs (total nucleated cells) or placebo (BMC:placebo, 2:1) was performed within 12 hours of bone marrow aspiration after local automated cell processing. MAIN OUTCOME MEASURES Changes in global (LVEF) and regional (wall motion) LV function in the infarct and border zone between baseline and 6 months, measured by cardiac magnetic resonance imaging. Secondary end points included changes in LV volumes and infarct size. RESULTS A total of 87 patients were randomized (mean [SD] age, 57 [11] years; 83% men). Harvesting, processing, and intracoronary delivery of BMCs in this setting was feasible. Change between baseline and 6 months in the BMC group vs placebo for mean LVEF (48.7% to 49.2% vs 45.3% to 48.8%; between-group mean difference, -3.00; 95% CI, -7.05 to 0.95), wall motion in the infarct zone (6.2 to 6.5 mm vs 4.9 to 5.9 mm; between-group mean difference, -0.70; 95% CI, -2.78 to 1.34), and wall motion in the border zone (16.0 to 16.6 mm vs 16.1 to 19.3 mm; between-group mean difference, -2.60; 95% CI, -6.03 to 0.77) were not statistically significant. No significant change in LV volumes and infarct volumes was observed; both groups decreased by a similar amount at 6 months vs baseline. CONCLUSION Among patients with MI and LV dysfunction following reperfusion with PCI, intracoronary infusion of autologous BMCs vs intracoronary placebo infusion, 2 to 3 weeks after PCI, did not improve global or regional function at 6 months. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00684060.
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Affiliation(s)
- Jay H. Traverse
- Minneapolis Heart Institute at Abbott Northwestern Hospital
- University of Minnesota School of Medicine
| | - Timothy D. Henry
- Minneapolis Heart Institute at Abbott Northwestern Hospital
- University of Minnesota School of Medicine
| | | | | | | | | | | | | | | | | | | | | | | | | | - Ganesh Raveendran
- University of Minnesota School of Medicine
- Lillehei Heart Institute, University of Minnesota
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Penn MS, Ellis S, Gandhi S, Greenbaum A, Hodes Z, Mendelsohn FO, Strasser D, Ting AE, Sherman W. Adventitial delivery of an allogeneic bone marrow-derived adherent stem cell in acute myocardial infarction: phase I clinical study. Circ Res 2011; 110:304-11. [PMID: 22052917 DOI: 10.1161/circresaha.111.253427] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [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] [Indexed: 01/28/2023]
Abstract
RATIONALE MultiStem is an allogeneic bone marrow-derived adherent adult stem cell product that has shown efficacy in preclinical models of acute myocardial infarction (AMI). In this phase I clinical trial in patients with first ST-elevation-myocardial infarction (STEMI), we combine first-in-man delivery of MultiStem with a first-in-coronary adventitial delivery system to determine the effects of this system on left ventricular function at 4 months after AMI. OBJECTIVE Test the effects of adventitial delivery of Multistem in the peri-infarct period in patients with first STEMI. METHODS AND RESULTS This study was a phase I, open-label, dose-escalating registry control group study. Nineteen patients received MultiStem (20 million, n=6; 50 million, n=7; or 100 million, n=6) and 6 subjects were assigned to the registry control group. Two to 5 days after AMI, we delivered MultiStem to the adventitia of the infarct-related vessel in patients with first-time STEMI. All patients underwent primary percutaneous coronary intervention with resulting Thrombolysis In Myocardial Infarction grade 3 flow and with ejection fraction (EF) ≤45% as determined by echocardiogram or left ventriculogram within 12 hours of primary percutaneous coronary intervention. The cell product (20 million, 50 million, or 100 million) was well tolerated, and no serious adverse events were deemed related to MultiStem. There was no increase in creatine kinase-MB or troponin associated with the adventitial delivery of MultiStem. In patients with EF determined to be ≤45% by a core laboratory within 24 hours before the MultiStem injection, we observed a 0.9 (n=4), 3.9 (n=4), 13.5 (n=5), and 10.9 (n=2) percent absolute increases in EF in the registry, 20 million, 50 million, and 100 million dose groups, respectively. The increases in EF in the 50 million and 100 million groups were accompanied by 25.4 and 8.4 mL increases in left ventricular stroke volume. CONCLUSIONS In this study, the delivery of MultiStem to the myocardium in patients with recent STEMI was well tolerated and safe. In patients who exhibited significant myocardial damage, the delivery of ≥50 million MultiStem resulted in improved EF and stroke volume 4 months later. These findings support further development of MultiStem in patients with AMI and they validate the potential of a system for delivery of adult stem cells at any time after primary percutaneous coronary intervention.
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Affiliation(s)
- Marc S Penn
- Summa Cardiovascular Institute, 525 E. Market St., Akron, OH 44309, USA.
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Costa AR, Panda NC, Yong S, Mayorga ME, Pawlowski GP, Fan K, Penn MS, Laurita KR. Optical mapping of cryoinjured rat myocardium grafted with mesenchymal stem cells. Am J Physiol Heart Circ Physiol 2011; 302:H270-7. [PMID: 22037193 DOI: 10.1152/ajpheart.00019.2011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Mesenchymal stem cells (MSCs) have been shown to improve cardiac electrophysiology when administered in the setting of acute myocardial infarction. However, the electrophysiological phenotype of MSCs in situ is not clear. We hypothesize that MSCs delivered intramyocardially to cryoinjured myocardium can engraft, but will not actively generate, action potentials. Cryoinjury-induced scar was created on the left ventricular epicardial surface of adult rat hearts. Within 30 min, hearts were injected with saline (sham, n = 11) or bone marrow-derived MSCs (2 × 10(6)) labeled with 1,1'-dioctadecyl-3,3,3,3'-tetramethylindocarbocyanine percholate (DiI; n = 16). At 3 wk, optical mapping and cell isolation were used to measure optical action potentials and calcium transients, respectively. Histological analysis confirmed subepicardial scar thickness and the presence of DiI-positive cells that express connexin-43. Optical action potential amplitude within the scar at MSC-positive sites (53.8 ± 14.3%) was larger compared with sites devoid of MSCs (35.3 ± 14.2%, P < 0.05) and sites within the scar of shams (33.5 ± 6.9%, P < 0.05). Evidence of simultaneous action potential upstroke, the loss of action potential activity following ablation of adjacent viable myocardium, and no rapid calcium transient response in isolated DiI+ cells suggest that the electrophysiological influence of engrafted MSCs is electrotonic. MSCs can engraft when directly injected into a cryoinjury and are associated with evidence of action potential activity. However, our results suggest that this activity is not due to generation of action potentials, but rather passive influence coupled from neighboring viable myocardium.
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Affiliation(s)
- Andrea R Costa
- MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA
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Medicetty S, Wiktor D, Lehman N, Raber A, Popovic ZB, Deans R, Ting AE, Penn MS. Percutaneous adventitial delivery of allogeneic bone marrow-derived stem cells via infarct-related artery improves long-term ventricular function in acute myocardial infarction. Cell Transplant 2011; 21:1109-20. [PMID: 22004910 DOI: 10.3727/096368911x603657] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Acute myocardial infarction (AMI) results in ischemic damage and death of cardiomyocytes and loss of vasculature. Stem cell therapy has emerged as a potentially promising strategy for maximizing cardiac function following ischemic injury. Issues of cell source, delivery, and quantification of response have challenged development of clinically viable strategies. In this study we investigate the effects of a well-defined bone marrow-derived allogeneic cell product delivered by catheter directly to the myocardium via the infarct-related vessel on global and regional measures of left ventricular (LV) function in a porcine model of anterior wall myocardial infarction. Multipotent adult progenitor cells (MAPCs) were derived and expanded from the bone marrow of a donor Yorkshire pig. Anterior wall myocardial infarction (AMI) was induced by 90 min of mid-LAD occlusion using a balloon catheter. Two days after AMI was induced, either vehicle (Plasma Lyte-A, n = 7), low-dose (20 million, n = 6), or high-dose (200 million, n = 6) MAPCs were delivered directly to the myocardium via the infarct-related vessel using a transarterial microsyringe catheter-based delivery system. Echocardiography was used to measure LV function as a function of time after AMI. Animals that received low-dose cell treatment showed significant improvement in regional and global LV function and remodeling compared to the high-dose or control animals. Direct myocardial delivery of allogeneic MAPCs 2 days following AMI through the vessel wall of the infarct-related vessel is safe and results in delivery of cells throughout the infarct zone and improved cardiac function despite lack of long-term cell survival. These data further support the hypothesis of cell-based myocardial tissue repair by a paracrine mechanism and suggest a clinically translatable strategy for delivering cells at any time after AMI to modulate cardiac remodeling and function.
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Affiliation(s)
- Satish Medicetty
- Regenerative Medicine Department, Athersys, Inc., Cleveland, OH 44309, USA
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