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Nguyen PK. Thrombotic complications of influenza and COVID-19 infections. Clin Adv Hematol Oncol 2024; 22:106-107. [PMID: 38588268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
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Yarahmadi P, Forouzannia SM, Forouzannia SA, Malik SB, Yousefifard M, Nguyen PK. Prognostic Value of Qualitative and Quantitative Stress CMR in Patients With Known or Suspected CAD. JACC Cardiovasc Imaging 2024; 17:248-265. [PMID: 37632499 DOI: 10.1016/j.jcmg.2023.05.025] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/12/2023] [Accepted: 05/18/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Recent studies suggest that quantitative cardiac magnetic resonance (CMR) may have more accuracy than qualitative CMR in coronary artery disease (CAD) diagnosis. However, the prognostic value of quantitative and qualitative CMR has not been compared systematically. OBJECTIVES The objective was to conduct a systematic review and meta-analysis assessing the utility of qualitative and quantitative stress CMR in the prognosis of patients with known or suspected CAD. METHODS A comprehensive search was performed through Embase, Scopus, Web of Science, and Medline. Studies that used qualitative vasodilator CMR or quantitative CMR assessments to compare the prognosis of patients with positive and negative CMR results were extracted. A meta-analysis was then performed to assess: 1) major adverse cardiovascular events (MACE) including cardiac death, nonfatal myocardial infarction (MI), unstable angina, and coronary revascularization; and 2) cardiac hard events defined as the composite of cardiac death and nonfatal MI. RESULTS Forty-one studies with 38,030 patients were included in this systematic review. MACE occurred significantly more in patients with positive qualitative (HR: 3.86; 95% CI: 3.28-4.54) and quantitative (HR: 4.60; 95% CI: 1.60-13.21) CMR assessments. There was no significant difference between qualitative and quantitative CMR assessments in predicting MACE (P = 0.75). In studies with qualitative CMR assessment, cardiac hard events (OR: 7.21; 95% CI: 4.99-10.41), cardiac death (OR: 5.63; 95% CI: 2.46-12.92), nonfatal MI (OR: 7.46; 95% CI: 3.49-15.96), coronary revascularization (OR: 6.34; 95% CI: 3.42-1.75), and all-cause mortality (HR: 1.66; 95% CI: 1.12-2.47) were higher in patients with positive CMR. CONCLUSIONS The presence of myocardial ischemia on CMR is associated with worse clinical outcomes in patients with known or suspected CAD. Both qualitative and quantitative stress CMR assessments are helpful tools for predicting clinical outcomes.
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Affiliation(s)
- Pourya Yarahmadi
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA; Stanford Cardiovascular Institute, Stanford, California, USA
| | | | - Seyed Ali Forouzannia
- Department of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sachin B Malik
- Department of Radiology, Division of Cardiovascular Imaging, Stanford University, Stanford, California, USA
| | - Mahmoud Yousefifard
- Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Patricia K Nguyen
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA; Stanford Cardiovascular Institute, Stanford, California, USA.
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3
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Yarahmadi P, Nguyen PK. PET-FDG for vascular imaging: a "visual barometer" for inflammatory risk? J Nucl Cardiol 2023; 30:1653-1655. [PMID: 37127724 DOI: 10.1007/s12350-023-03250-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 05/03/2023]
Affiliation(s)
- Pourya Yarahmadi
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
- Stanford Cardiovascular Institute, Stanford, CA, USA
| | - Patricia K Nguyen
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, USA.
- Stanford Cardiovascular Institute, Stanford, CA, USA.
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Zhao L, Lee AS, Sasagawa K, Sokol J, Wang Y, Ransom RC, Zhao X, Ma C, Steininger HM, Koepke LS, Borrelli MR, Brewer RE, Lee LL, Huang X, Ambrosi TH, Sinha R, Hoover MY, Seita J, Weissman IL, Wu JC, Wan DC, Xiao J, Longaker MT, Nguyen PK, Chan CK. A Combination of Distinct Vascular Stem/Progenitor Cells for Neovascularization and Ischemic Rescue. Arterioscler Thromb Vasc Biol 2023; 43:1262-1277. [PMID: 37051932 PMCID: PMC10281192 DOI: 10.1161/atvbaha.122.317943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/09/2023] [Accepted: 03/28/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Peripheral vascular disease remains a leading cause of vascular morbidity and mortality worldwide despite advances in medical and surgical therapy. Besides traditional approaches, which can only restore blood flow to native arteries, an alternative approach is to enhance the growth of new vessels, thereby facilitating the physiological response to ischemia. METHODS The ActinCreER/R26VT2/GK3 Rainbow reporter mouse was used for unbiased in vivo survey of injury-responsive vasculogenic clonal formation. Prospective isolation and transplantation were used to determine vessel-forming capacity of different populations. Single-cell RNA-sequencing was used to characterize distinct vessel-forming populations and their interactions. RESULTS Two populations of distinct vascular stem/progenitor cells (VSPCs) were identified from adipose-derived mesenchymal stromal cells: VSPC1 is CD45-Ter119-Tie2+PDGFRa-CD31+CD105highSca1low, which gives rise to stunted vessels (incomplete tubular structures) in a transplant setting, and VSPC2 which is CD45-Ter119-Tie2+PDGFRa+CD31-CD105lowSca1high and forms stunted vessels and fat. Interestingly, cotransplantation of VSPC1 and VSPC2 is required to form functional vessels that improve perfusion in the mouse hindlimb ischemia model. Similarly, VSPC1 and VSPC2 populations isolated from human adipose tissue could rescue the ischemic condition in mice. CONCLUSIONS These findings suggest that autologous cotransplantation of synergistic VSPCs from nonessential adipose tissue can promote neovascularization and represents a promising treatment for ischemic disease.
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Affiliation(s)
- Liming Zhao
- Institute for Stem Cell Biology and Regenerative Medicine (L.Z., Y.W., R.C.R., X.Z., C.M., H.M.S., L.S.K., M.R.B., R.E.B., L.Y.L., T.H.A., R.S., M.Y.H., I.L.W., J.C.W., M.T.L., C.K.F.C.), Stanford University School of Medicine, CA
- Department of Surgery, Division of Plastic and Reconstructive Surgery (L.Z., Y.W., R.C.R., C.M., H.M.S., L.S.K., M.R.B., L.L.Y.L., T.H.A., D.C.W., M.T.L., C.K.F.C.), Stanford University School of Medicine, CA
- Department of Orthopaedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (L.Z., Y.W., J.X.)
| | - Andrew S. Lee
- School of Chemical Biology and Biotechnology, Peking University Shenzhen Graduate School, China (A.S.L.)
- Institute for Cancer Research, Shenzhen Bay Laboratory, China (A.S.L.)
| | - Koki Sasagawa
- Stanford Cardiovascular Institute (K.S., J.S., X.Z., X.H., J.C.W., M.T.L., P.K.N., C.K.F.C.), Stanford University School of Medicine, CA
- Department of Medicine, Division of Cardiovascular Medicine (K.S., J.S., X.Z., X.H., J.C.W., P.K.N.), Stanford University School of Medicine, CA
| | - Jan Sokol
- Stanford Cardiovascular Institute (K.S., J.S., X.Z., X.H., J.C.W., M.T.L., P.K.N., C.K.F.C.), Stanford University School of Medicine, CA
- Department of Medicine, Division of Cardiovascular Medicine (K.S., J.S., X.Z., X.H., J.C.W., P.K.N.), Stanford University School of Medicine, CA
- Center for Integrative Medical Sciences and Advanced Data Science Project, RIKEN, Tokyo, Japan (J.S.)
| | - Yuting Wang
- Institute for Stem Cell Biology and Regenerative Medicine (L.Z., Y.W., R.C.R., X.Z., C.M., H.M.S., L.S.K., M.R.B., R.E.B., L.Y.L., T.H.A., R.S., M.Y.H., I.L.W., J.C.W., M.T.L., C.K.F.C.), Stanford University School of Medicine, CA
- Department of Surgery, Division of Plastic and Reconstructive Surgery (L.Z., Y.W., R.C.R., C.M., H.M.S., L.S.K., M.R.B., L.L.Y.L., T.H.A., D.C.W., M.T.L., C.K.F.C.), Stanford University School of Medicine, CA
- Department of Orthopaedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (L.Z., Y.W., J.X.)
| | - Ryan C. Ransom
- Institute for Stem Cell Biology and Regenerative Medicine (L.Z., Y.W., R.C.R., X.Z., C.M., H.M.S., L.S.K., M.R.B., R.E.B., L.Y.L., T.H.A., R.S., M.Y.H., I.L.W., J.C.W., M.T.L., C.K.F.C.), Stanford University School of Medicine, CA
- Department of Surgery, Division of Plastic and Reconstructive Surgery (L.Z., Y.W., R.C.R., C.M., H.M.S., L.S.K., M.R.B., L.L.Y.L., T.H.A., D.C.W., M.T.L., C.K.F.C.), Stanford University School of Medicine, CA
| | - Xin Zhao
- Institute for Stem Cell Biology and Regenerative Medicine (L.Z., Y.W., R.C.R., X.Z., C.M., H.M.S., L.S.K., M.R.B., R.E.B., L.Y.L., T.H.A., R.S., M.Y.H., I.L.W., J.C.W., M.T.L., C.K.F.C.), Stanford University School of Medicine, CA
- Stanford Cardiovascular Institute (K.S., J.S., X.Z., X.H., J.C.W., M.T.L., P.K.N., C.K.F.C.), Stanford University School of Medicine, CA
- Department of Medicine, Division of Cardiovascular Medicine (K.S., J.S., X.Z., X.H., J.C.W., P.K.N.), Stanford University School of Medicine, CA
| | - Chao Ma
- Institute for Stem Cell Biology and Regenerative Medicine (L.Z., Y.W., R.C.R., X.Z., C.M., H.M.S., L.S.K., M.R.B., R.E.B., L.Y.L., T.H.A., R.S., M.Y.H., I.L.W., J.C.W., M.T.L., C.K.F.C.), Stanford University School of Medicine, CA
- Department of Surgery, Division of Plastic and Reconstructive Surgery (L.Z., Y.W., R.C.R., C.M., H.M.S., L.S.K., M.R.B., L.L.Y.L., T.H.A., D.C.W., M.T.L., C.K.F.C.), Stanford University School of Medicine, CA
| | - Holly M. Steininger
- Institute for Stem Cell Biology and Regenerative Medicine (L.Z., Y.W., R.C.R., X.Z., C.M., H.M.S., L.S.K., M.R.B., R.E.B., L.Y.L., T.H.A., R.S., M.Y.H., I.L.W., J.C.W., M.T.L., C.K.F.C.), Stanford University School of Medicine, CA
- Department of Surgery, Division of Plastic and Reconstructive Surgery (L.Z., Y.W., R.C.R., C.M., H.M.S., L.S.K., M.R.B., L.L.Y.L., T.H.A., D.C.W., M.T.L., C.K.F.C.), Stanford University School of Medicine, CA
| | - Lauren S. Koepke
- Institute for Stem Cell Biology and Regenerative Medicine (L.Z., Y.W., R.C.R., X.Z., C.M., H.M.S., L.S.K., M.R.B., R.E.B., L.Y.L., T.H.A., R.S., M.Y.H., I.L.W., J.C.W., M.T.L., C.K.F.C.), Stanford University School of Medicine, CA
- Department of Surgery, Division of Plastic and Reconstructive Surgery (L.Z., Y.W., R.C.R., C.M., H.M.S., L.S.K., M.R.B., L.L.Y.L., T.H.A., D.C.W., M.T.L., C.K.F.C.), Stanford University School of Medicine, CA
| | - Mimi R. Borrelli
- Institute for Stem Cell Biology and Regenerative Medicine (L.Z., Y.W., R.C.R., X.Z., C.M., H.M.S., L.S.K., M.R.B., R.E.B., L.Y.L., T.H.A., R.S., M.Y.H., I.L.W., J.C.W., M.T.L., C.K.F.C.), Stanford University School of Medicine, CA
| | - Rachel E. Brewer
- Institute for Stem Cell Biology and Regenerative Medicine (L.Z., Y.W., R.C.R., X.Z., C.M., H.M.S., L.S.K., M.R.B., R.E.B., L.Y.L., T.H.A., R.S., M.Y.H., I.L.W., J.C.W., M.T.L., C.K.F.C.), Stanford University School of Medicine, CA
| | - Lorene L.Y. Lee
- Institute for Stem Cell Biology and Regenerative Medicine (L.Z., Y.W., R.C.R., X.Z., C.M., H.M.S., L.S.K., M.R.B., R.E.B., L.Y.L., T.H.A., R.S., M.Y.H., I.L.W., J.C.W., M.T.L., C.K.F.C.), Stanford University School of Medicine, CA
- Department of Surgery, Division of Plastic and Reconstructive Surgery (L.Z., Y.W., R.C.R., C.M., H.M.S., L.S.K., M.R.B., L.L.Y.L., T.H.A., D.C.W., M.T.L., C.K.F.C.), Stanford University School of Medicine, CA
| | - Xianxi Huang
- Stanford Cardiovascular Institute (K.S., J.S., X.Z., X.H., J.C.W., M.T.L., P.K.N., C.K.F.C.), Stanford University School of Medicine, CA
- Department of Medicine, Division of Cardiovascular Medicine (K.S., J.S., X.Z., X.H., J.C.W., P.K.N.), Stanford University School of Medicine, CA
| | - Thomas H. Ambrosi
- Institute for Stem Cell Biology and Regenerative Medicine (L.Z., Y.W., R.C.R., X.Z., C.M., H.M.S., L.S.K., M.R.B., R.E.B., L.Y.L., T.H.A., R.S., M.Y.H., I.L.W., J.C.W., M.T.L., C.K.F.C.), Stanford University School of Medicine, CA
- Department of Surgery, Division of Plastic and Reconstructive Surgery (L.Z., Y.W., R.C.R., C.M., H.M.S., L.S.K., M.R.B., L.L.Y.L., T.H.A., D.C.W., M.T.L., C.K.F.C.), Stanford University School of Medicine, CA
| | - Rahul Sinha
- Institute for Stem Cell Biology and Regenerative Medicine (L.Z., Y.W., R.C.R., X.Z., C.M., H.M.S., L.S.K., M.R.B., R.E.B., L.Y.L., T.H.A., R.S., M.Y.H., I.L.W., J.C.W., M.T.L., C.K.F.C.), Stanford University School of Medicine, CA
| | - Malachia Y. Hoover
- Institute for Stem Cell Biology and Regenerative Medicine (L.Z., Y.W., R.C.R., X.Z., C.M., H.M.S., L.S.K., M.R.B., R.E.B., L.Y.L., T.H.A., R.S., M.Y.H., I.L.W., J.C.W., M.T.L., C.K.F.C.), Stanford University School of Medicine, CA
| | - Jun Seita
- Institute for Stem Cell Biology and Regenerative Medicine (L.Z., Y.W., R.C.R., X.Z., C.M., H.M.S., L.S.K., M.R.B., R.E.B., L.Y.L., T.H.A., R.S., M.Y.H., I.L.W., J.C.W., M.T.L., C.K.F.C.), Stanford University School of Medicine, CA
- Department of Surgery, Division of Plastic and Reconstructive Surgery (L.Z., Y.W., R.C.R., C.M., H.M.S., L.S.K., M.R.B., L.L.Y.L., T.H.A., D.C.W., M.T.L., C.K.F.C.), Stanford University School of Medicine, CA
- Stanford Cardiovascular Institute (K.S., J.S., X.Z., X.H., J.C.W., M.T.L., P.K.N., C.K.F.C.), Stanford University School of Medicine, CA
- Department of Medicine, Division of Cardiovascular Medicine (K.S., J.S., X.Z., X.H., J.C.W., P.K.N.), Stanford University School of Medicine, CA
- Department of Developmental Biology (I.L.W., C.K.F.C.), Stanford University School of Medicine, CA
- Department of Orthopaedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (L.Z., Y.W., J.X.)
- School of Chemical Biology and Biotechnology, Peking University Shenzhen Graduate School, China (A.S.L.)
- Institute for Cancer Research, Shenzhen Bay Laboratory, China (A.S.L.)
- Center for Integrative Medical Sciences and Advanced Data Science Project, RIKEN, Tokyo, Japan (J.S.)
| | - Irving L. Weissman
- Institute for Stem Cell Biology and Regenerative Medicine (L.Z., Y.W., R.C.R., X.Z., C.M., H.M.S., L.S.K., M.R.B., R.E.B., L.Y.L., T.H.A., R.S., M.Y.H., I.L.W., J.C.W., M.T.L., C.K.F.C.), Stanford University School of Medicine, CA
- Department of Developmental Biology (I.L.W., C.K.F.C.), Stanford University School of Medicine, CA
| | - Joseph C. Wu
- Institute for Stem Cell Biology and Regenerative Medicine (L.Z., Y.W., R.C.R., X.Z., C.M., H.M.S., L.S.K., M.R.B., R.E.B., L.Y.L., T.H.A., R.S., M.Y.H., I.L.W., J.C.W., M.T.L., C.K.F.C.), Stanford University School of Medicine, CA
- Stanford Cardiovascular Institute (K.S., J.S., X.Z., X.H., J.C.W., M.T.L., P.K.N., C.K.F.C.), Stanford University School of Medicine, CA
- Department of Medicine, Division of Cardiovascular Medicine (K.S., J.S., X.Z., X.H., J.C.W., P.K.N.), Stanford University School of Medicine, CA
| | - Derrick C. Wan
- Department of Surgery, Division of Plastic and Reconstructive Surgery (L.Z., Y.W., R.C.R., C.M., H.M.S., L.S.K., M.R.B., L.L.Y.L., T.H.A., D.C.W., M.T.L., C.K.F.C.), Stanford University School of Medicine, CA
| | - Jun Xiao
- Department of Orthopaedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (L.Z., Y.W., J.X.)
| | - Michael T. Longaker
- Institute for Stem Cell Biology and Regenerative Medicine (L.Z., Y.W., R.C.R., X.Z., C.M., H.M.S., L.S.K., M.R.B., R.E.B., L.Y.L., T.H.A., R.S., M.Y.H., I.L.W., J.C.W., M.T.L., C.K.F.C.), Stanford University School of Medicine, CA
- Department of Surgery, Division of Plastic and Reconstructive Surgery (L.Z., Y.W., R.C.R., C.M., H.M.S., L.S.K., M.R.B., L.L.Y.L., T.H.A., D.C.W., M.T.L., C.K.F.C.), Stanford University School of Medicine, CA
| | - Patricia K. Nguyen
- Stanford Cardiovascular Institute (K.S., J.S., X.Z., X.H., J.C.W., M.T.L., P.K.N., C.K.F.C.), Stanford University School of Medicine, CA
- Department of Medicine, Division of Cardiovascular Medicine (K.S., J.S., X.Z., X.H., J.C.W., P.K.N.), Stanford University School of Medicine, CA
| | - Charles K.F. Chan
- Institute for Stem Cell Biology and Regenerative Medicine (L.Z., Y.W., R.C.R., X.Z., C.M., H.M.S., L.S.K., M.R.B., R.E.B., L.Y.L., T.H.A., R.S., M.Y.H., I.L.W., J.C.W., M.T.L., C.K.F.C.), Stanford University School of Medicine, CA
- Department of Surgery, Division of Plastic and Reconstructive Surgery (L.Z., Y.W., R.C.R., C.M., H.M.S., L.S.K., M.R.B., L.L.Y.L., T.H.A., D.C.W., M.T.L., C.K.F.C.), Stanford University School of Medicine, CA
- Department of Developmental Biology (I.L.W., C.K.F.C.), Stanford University School of Medicine, CA
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Brandt EJ, Tobb K, Cambron JC, Ferdinand K, Douglass P, Nguyen PK, Vijayaraghavan K, Islam S, Thamman R, Rahman S, Pendyal A, Sareen N, Yong C, Palaniappan L, Ibebuogu U, Tran A, Bacong AM, Lundberg G, Watson K. Assessing and Addressing Social Determinants of Cardiovascular Health: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 81:1368-1385. [PMID: 37019584 DOI: 10.1016/j.jacc.2023.01.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 04/07/2023]
Abstract
Social determinants of health (SDOH) are the social conditions in which people are born, live, and work. SDOH offers a more inclusive view of how environment, geographic location, neighborhoods, access to health care, nutrition, socioeconomics, and so on are critical in cardiovascular morbidity and mortality. SDOH will continue to increase in relevance and integration of patient management, thus, applying the information herein to clinical and health systems will become increasingly commonplace. This state-of-the-art review covers the 5 domains of SDOH, including economic stability, education, health care access and quality, social and community context, and neighborhood and built environment. Recognizing and addressing SDOH is an important step toward achieving equity in cardiovascular care. We discuss each SDOH within the context of cardiovascular disease, how they can be assessed by clinicians and within health care systems, and key strategies for clinicians and health care systems to address these SDOH. Summaries of these tools and key strategies are provided.
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Affiliation(s)
- Eric J Brandt
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA; Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
| | - Kardie Tobb
- Cone Health Medical Group, Greensboro, North Carolina, USA
| | | | - Keith Ferdinand
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Paul Douglass
- Wellstar Health System Center for Cardiovascular Care, Marietta, Georgia, USA
| | - Patricia K Nguyen
- Stanford University School of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Stanford, California, USA; VA Palo Alto Healthcare System, Palo Alto, California, USA
| | | | - Sabrina Islam
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Ritu Thamman
- University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania, USA
| | - Shahid Rahman
- Memorial Hermann Heart and Vascular Institute, Houston, Texas, USA
| | - Akshay Pendyal
- University of North Carolina School of Medicine, Novant Health Charlotte Campus, Charlotte, North Carolina, USA
| | - Nishtha Sareen
- Ascension Medical Group, Ascension St Mary's Hospital, Saginaw, Michigan, USA
| | - Celina Yong
- Stanford University School of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Stanford, California, USA; VA Palo Alto Healthcare System, Palo Alto, California, USA
| | - Latha Palaniappan
- Stanford University School of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Stanford, California, USA
| | - Uzoma Ibebuogu
- Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Andrew Tran
- The Heart Center, Nationwide Children's Hospital, Columbus, Ohio, USA; Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Adrian M Bacong
- Stanford University School of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Stanford, California, USA
| | - Gina Lundberg
- Emory Women's Heart Center, Emory Heart and Vascular Center, Marietta, Georgia, USA
| | - Karol Watson
- Division of Cardiology, University of California, Los Angeles, California, USA
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6
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Sokol J, Nguyen PK. Risk prediction for abdominal aortic aneurysm: One size does not necessarily fit all. J Nucl Cardiol 2023; 30:814-817. [PMID: 35174443 PMCID: PMC9378744 DOI: 10.1007/s12350-021-02680-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Jan Sokol
- Division of Cardiovascular Medicine, Stanford University, Falk CVRB, 877 Quarry Road, Stanford, CA, 94305, USA
- Cardiology Section, Department of Veteran Affairs, Palo Alto, CA, 94304, USA
- Stanford Cardiovascular Institute, Stanford, CA, 94305, USA
| | - Patricia K Nguyen
- Division of Cardiovascular Medicine, Stanford University, Falk CVRB, 877 Quarry Road, Stanford, CA, 94305, USA.
- Cardiology Section, Department of Veteran Affairs, Palo Alto, CA, 94304, USA.
- Stanford Cardiovascular Institute, Stanford, CA, 94305, USA.
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7
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Chowdhury RR, Valainis JR, Dubey M, von Boehmer L, Sola E, Wilhelmy J, Guo J, Kask O, Ohanyan M, Sun M, Huang H, Huang X, Nguyen PK, Scriba TJ, Davis MM, Bendall SC, Chien YH. NK-like CD8 + γδ T cells are expanded in persistent Mycobacterium tuberculosis infection. Sci Immunol 2023; 8:eade3525. [PMID: 37000856 PMCID: PMC10408713 DOI: 10.1126/sciimmunol.ade3525] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 08/10/2022] [Accepted: 03/09/2023] [Indexed: 04/03/2023]
Abstract
The response of gamma delta (γδ) T cells in the acute versus chronic phases of the same infection is unclear. How γδ T cells function in acute Mycobacterium tuberculosis (Mtb) infection is well characterized, but their response during persistent Mtb infection is not well understood, even though most infections with Mtb manifest as a chronic, clinically asymptomatic state. Here, we analyze peripheral blood γδ T cells from a South African adolescent cohort and show that a unique CD8+ γδ T cell subset with features of "memory inflation" expands in chronic Mtb infection. These cells are hyporesponsive to T cell receptor (TCR)-mediated signaling but, like NK cells, can mount robust CD16-mediated cytotoxic responses. These CD8+ γδ T cells comprise a highly focused TCR repertoire, with clonotypes that are Mycobacterium specific but not phosphoantigen reactive. Using multiparametric single-cell pseudo-time trajectory analysis, we identified the differentiation paths that these CD8+ γδ T cells follow to develop into effectors in this infection state. Last, we found that circulating CD8+ γδ T cells also expand in other chronic inflammatory conditions, including cardiovascular disease and cancer, suggesting that persistent antigenic exposure may drive similar γδ T cell effector programs and differentiation fates.
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Affiliation(s)
- Roshni Roy Chowdhury
- Department of Microbiology and Immunology, Stanford University, Stanford, CA, USA
- Program in Immunology, Stanford University, Stanford, CA, USA
- Department of Medicine, Section of Genetic Medicine, University of Chicago, Chicago, IL, USA
| | | | - Megha Dubey
- Department of Microbiology and Immunology, Stanford University, Stanford, CA, USA
| | - Lotta von Boehmer
- Institute for Immunity, Transplantation, and Infection, Stanford University, Stanford, CA, USA
| | - Elsa Sola
- Institute for Immunity, Transplantation, and Infection, Stanford University, Stanford, CA, USA
| | - Julie Wilhelmy
- Institute for Immunity, Transplantation, and Infection, Stanford University, Stanford, CA, USA
| | - Jing Guo
- Department of Microbiology and Immunology, Stanford University, Stanford, CA, USA
| | - Oliver Kask
- Department of Microbiology and Immunology, Stanford University, Stanford, CA, USA
| | - Mane Ohanyan
- Department of Microbiology and Immunology, Stanford University, Stanford, CA, USA
| | - Meng Sun
- Institute for Immunity, Transplantation, and Infection, Stanford University, Stanford, CA, USA
| | - Huang Huang
- Institute for Immunity, Transplantation, and Infection, Stanford University, Stanford, CA, USA
| | - Xianxi Huang
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
- The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Patricia K. Nguyen
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - Thomas J. Scriba
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine and Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Mark M. Davis
- Department of Microbiology and Immunology, Stanford University, Stanford, CA, USA
- Program in Immunology, Stanford University, Stanford, CA, USA
- Institute for Immunity, Transplantation, and Infection, Stanford University, Stanford, CA, USA
- The Howard Hughes Medical Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Sean C. Bendall
- Program in Immunology, Stanford University, Stanford, CA, USA
- Department of Pathology, Stanford University, Stanford, CA, USA
| | - Yueh-hsiu Chien
- Department of Microbiology and Immunology, Stanford University, Stanford, CA, USA
- Program in Immunology, Stanford University, Stanford, CA, USA
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8
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Nguyen PK, Wu SM. Sex differences in ICI myocarditis: Hormones to the rescue. Sci Transl Med 2022; 14:eade4035. [PMID: 36322630 DOI: 10.1126/scitranslmed.ade4035] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Sex hormones may account for sex differences observed in the prevalence and susceptibility of ICI myocarditis (Zhang et al., this issue).
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Affiliation(s)
- Patricia K Nguyen
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Sean M Wu
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA 94305, USA
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9
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Zhu H, Galdos FX, Lee D, Waliany S, Huang YV, Ryan J, Dang K, Neal JW, Wakelee HA, Reddy SA, Srinivas S, Lin LL, Witteles RM, Maecker HT, Davis MM, Nguyen PK, Wu SM. Identification of Pathogenic Immune Cell Subsets Associated With Checkpoint Inhibitor-Induced Myocarditis. Circulation 2022; 146:316-335. [PMID: 35762356 PMCID: PMC9397491 DOI: 10.1161/circulationaha.121.056730] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [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] [Indexed: 12/14/2022]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) are monoclonal antibodies used to activate the immune system against tumor cells. Despite therapeutic benefits, ICIs have the potential to cause immune-related adverse events such as myocarditis, a rare but serious side effect with up to 50% mortality in affected patients. Histologically, patients with ICI myocarditis have lymphocytic infiltrates in the heart, implicating T cell-mediated mechanisms. However, the precise pathological immune subsets and molecular changes in ICI myocarditis are unknown. METHODS To identify immune subset(s) associated with ICI myocarditis, we performed time-of-flight mass cytometry on peripheral blood mononuclear cells from 52 individuals: 29 patients with autoimmune adverse events (immune-related adverse events) on ICI, including 8 patients with ICI myocarditis, and 23 healthy control subjects. We also used multiomics single-cell technology to immunophenotype 30 patients/control subjects using single-cell RNA sequencing, single-cell T-cell receptor sequencing, and cellular indexing of transcriptomes and epitopes by sequencing with feature barcoding for surface marker expression confirmation. To correlate between the blood and the heart, we performed single-cell RNA sequencing/T-cell receptor sequencing/cellular indexing of transcriptomes and epitopes by sequencing on MRL/Pdcd1-/- (Murphy Roths large/programmed death-1-deficient) mice with spontaneous myocarditis. RESULTS Using these complementary approaches, we found an expansion of cytotoxic CD8+ T effector cells re-expressing CD45RA (Temra CD8+ cells) in patients with ICI myocarditis compared with control subjects. T-cell receptor sequencing demonstrated that these CD8+ Temra cells were clonally expanded in patients with myocarditis compared with control subjects. Transcriptomic analysis of these Temra CD8+ clones confirmed a highly activated and cytotoxic phenotype. Longitudinal study demonstrated progression of these Temra CD8+ cells into an exhausted phenotype 2 months after treatment with glucocorticoids. Differential expression analysis demonstrated elevated expression levels of proinflammatory chemokines (CCL5/CCL4/CCL4L2) in the clonally expanded Temra CD8+ cells, and ligand receptor analysis demonstrated their interactions with innate immune cells, including monocytes/macrophages, dendritic cells, and neutrophils, as well as the absence of key anti-inflammatory signals. To complement the human study, we performed single-cell RNA sequencing/T-cell receptor sequencing/cellular indexing of transcriptomes and epitopes by sequencing in Pdcd1-/- mice with spontaneous myocarditis and found analogous expansions of cytotoxic clonal effector CD8+ cells in both blood and hearts of such mice compared with controls. CONCLUSIONS Clonal cytotoxic Temra CD8+ cells are significantly increased in the blood of patients with ICI myocarditis, corresponding to an analogous increase in effector cytotoxic CD8+ cells in the blood/hearts of Pdcd1-/- mice with myocarditis. These expanded effector CD8+ cells have unique transcriptional changes, including upregulation of chemokines CCL5/CCL4/CCL4L2, which may serve as attractive diagnostic/therapeutic targets for reducing life-threatening cardiac immune-related adverse events in ICI-treated patients with cancer.
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Affiliation(s)
- Han Zhu
- Department of Medicine, Stanford University; Stanford, California 94305, USA;,Stanford Cardiovascular Institute, Stanford University; Stanford, California 94305, USA,Division of Cardiovascular Medicine, Stanford University School of Medicine; Stanford, California 94305, USA
| | - Francisco X. Galdos
- Stanford Cardiovascular Institute, Stanford University; Stanford, California 94305, USA,Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine; Stanford, California 94305
| | - Daniel Lee
- Stanford Cardiovascular Institute, Stanford University; Stanford, California 94305, USA
| | - Sarah Waliany
- Department of Medicine, Stanford University; Stanford, California 94305, USA
| | | | - Julia Ryan
- Stanford Cardiovascular Institute, Stanford University; Stanford, California 94305, USA
| | - Katherine Dang
- University of California, Santa Barbara, California, 93106
| | - Joel W. Neal
- Department of Medicine, Stanford University; Stanford, California 94305, USA;,Division of Oncology, Stanford University School of Medicine; Stanford, California 94305, USA.,Stanford Cancer Institute, Stanford University; Stanford, California 94305, USA
| | - Heather A. Wakelee
- Department of Medicine, Stanford University; Stanford, California 94305, USA;,Division of Oncology, Stanford University School of Medicine; Stanford, California 94305, USA.,Stanford Cancer Institute, Stanford University; Stanford, California 94305, USA
| | - Sunil A. Reddy
- Department of Medicine, Stanford University; Stanford, California 94305, USA;,Division of Oncology, Stanford University School of Medicine; Stanford, California 94305, USA.,Stanford Cancer Institute, Stanford University; Stanford, California 94305, USA
| | - Sandy Srinivas
- Department of Medicine, Stanford University; Stanford, California 94305, USA;,Division of Oncology, Stanford University School of Medicine; Stanford, California 94305, USA.,Stanford Cancer Institute, Stanford University; Stanford, California 94305, USA
| | - Lih-Ling Lin
- Checkpoint Immunology Cluster, Immunology and Inflammation, Sanofi US, Cambridge, MA, USA
| | - Ronald M. Witteles
- Department of Medicine, Stanford University; Stanford, California 94305, USA;,Division of Cardiovascular Medicine, Stanford University School of Medicine; Stanford, California 94305, USA
| | - Holden T. Maecker
- Department of Microbiology & Immunology, Stanford University School of Medicine; Stanford, California 94305, USA.,Institute for Immunity, Transplantation and Infection, Stanford University School of Medicine; Stanford, California 94305, USA
| | - Mark M. Davis
- Department of Microbiology & Immunology, Stanford University School of Medicine; Stanford, California 94305, USA.,Institute for Immunity, Transplantation and Infection, Stanford University School of Medicine; Stanford, California 94305, USA.,Howard Hughes Medical Institute, Stanford University; Stanford, California 94035
| | - Patricia K. Nguyen
- Department of Medicine, Stanford University; Stanford, California 94305, USA;,Stanford Cardiovascular Institute, Stanford University; Stanford, California 94305, USA,Division of Cardiovascular Medicine, Stanford University School of Medicine; Stanford, California 94305, USA
| | - Sean M. Wu
- Department of Medicine, Stanford University; Stanford, California 94305, USA;,Stanford Cardiovascular Institute, Stanford University; Stanford, California 94305, USA,Division of Cardiovascular Medicine, Stanford University School of Medicine; Stanford, California 94305, USA
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10
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Chowdhury RR, D’Addabbo J, Huang X, Veizades S, Sasagawa K, Louis DM, Cheng P, Sokol J, Jensen A, Tso A, Shankar V, Wendel BS, Bakerman I, Liang G, Koyano T, Fong R, Nau A, Ahmad H, Gopakumar JK, Wirka R, Lee A, Boyd J, Joseph Woo Y, Quertermous T, Gulati G, Jaiswal S, Chien YH, Chan C, Davis MM, Nguyen PK. Human Coronary Plaque T Cells Are Clonal and Cross-React to Virus and Self. Circ Res 2022; 130:1510-1530. [PMID: 35430876 PMCID: PMC9286288 DOI: 10.1161/circresaha.121.320090] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 02/05/2023]
Abstract
BACKGROUND Coronary artery disease is an incurable, life-threatening disease that was once considered primarily a disorder of lipid deposition. Coronary artery disease is now also characterized by chronic inflammation' notable for the buildup of atherosclerotic plaques containing immune cells in various states of activation and differentiation. Understanding how these immune cells contribute to disease progression may lead to the development of novel therapeutic strategies. METHODS We used single-cell technology and in vitro assays to interrogate the immune microenvironment of human coronary atherosclerotic plaque at different stages of maturity. RESULTS In addition to macrophages, we found a high proportion of αβ T cells in the coronary plaques. Most of these T cells lack high expression of CCR7 and L-selectin, indicating that they are primarily antigen-experienced memory cells. Notably, nearly one-third of these cells express the HLA-DRA surface marker, signifying activation through their TCRs (T-cell receptors). Consistent with this, TCR repertoire analysis confirmed the presence of activated αβ T cells (CD4<CD8), exhibiting clonal expansion of specific TCRs. Interestingly, we found that these plaque T cells had TCRs specific for influenza, coronavirus, and other viral epitopes, which share sequence homologies to proteins found on smooth muscle cells and endothelial cells, suggesting potential autoimmune-mediated T-cell activation in the absence of active infection. To better understand the potential function of these activated plaque T cells, we then interrogated their transcriptome at the single-cell level. Of the 3 T-cell phenotypic clusters with the highest expression of the activation marker HLA-DRA, 2 clusters expressed a proinflammatory and cytolytic signature characteristic of CD8 cells, while the other expressed AREG (amphiregulin), which promotes smooth muscle cell proliferation and fibrosis, and, thus, contributes to plaque progression. CONCLUSIONS Taken together, these findings demonstrate that plaque T cells are clonally expanded potentially by antigen engagement, are potentially reactive to self-epitopes, and may interact with smooth muscle cells and macrophages in the plaque microenvironment.
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Affiliation(s)
- Roshni Roy Chowdhury
- Department of Microbiology and Immunology, Stanford University
- Department of Medicine (Section of Genetic Medicine), University of Chicago
| | - Jessica D’Addabbo
- Department of Medicine (Cardiovascular Medicine), Stanford University
| | - Xianxi Huang
- The First Affiliated Hospital of Shantou University Medical College
- Stanford Cardiovascular Institute, Stanford University
| | - Stefan Veizades
- Department of Medicine (Cardiovascular Medicine), Stanford University
- Stanford Cardiovascular Institute, Stanford University
- Edinburgh Medical School, United Kingdom
| | - Koki Sasagawa
- Department of Medicine (Cardiovascular Medicine), Stanford University
| | | | - Paul Cheng
- Department of Medicine (Cardiovascular Medicine), Stanford University
- Stanford Cardiovascular Institute, Stanford University
| | - Jan Sokol
- Department of Medicine (Cardiovascular Medicine), Stanford University
- Stanford Cardiovascular Institute, Stanford University
| | - Annie Jensen
- Department of Medicine (Cardiovascular Medicine), Stanford University
- Stanford Cardiovascular Institute, Stanford University
- Institute for Immunity, Transplantation and Infection, Stanford University
| | - Alexandria Tso
- Department of Medicine (Cardiovascular Medicine), Stanford University
- Stanford Cardiovascular Institute, Stanford University
- Institute for Immunity, Transplantation and Infection, Stanford University
| | - Vishnu Shankar
- Institute for Immunity, Transplantation and Infection, Stanford University
| | - Ben Shogo Wendel
- Institute for Immunity, Transplantation and Infection, Stanford University
| | - Isaac Bakerman
- Department of Medicine (Cardiovascular Medicine), Stanford University
- Stanford Cardiovascular Institute, Stanford University
| | - Grace Liang
- Department of Medicine (Cardiovascular Medicine), Stanford University
- Stanford Cardiovascular Institute, Stanford University
| | - Tiffany Koyano
- Department of Cardiothoracic Surgery, Stanford University
| | - Robyn Fong
- Department of Cardiothoracic Surgery, Stanford University
| | - Allison Nau
- Department of Microbiology and Immunology, Stanford University
| | - Herra Ahmad
- Department of Pathology, Stanford University
| | | | - Robert Wirka
- Department of Medicine (Cardiovascular Medicine), Stanford University
| | - Andrew Lee
- Stanford Cardiovascular Institute, Stanford University
- Department of Pathology, Stanford University
- Institute for Cancer Research, Shenzhen Bay Laboratory, Shenzhen, 518055, China
| | - Jack Boyd
- Department of Surgery, Stanford University
| | | | - Thomas Quertermous
- Department of Medicine (Cardiovascular Medicine), Stanford University
- Stanford Cardiovascular Institute, Stanford University
| | - Gunsagar Gulati
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University
| | | | - Yueh-Hsiu Chien
- Department of Microbiology and Immunology, Stanford University
| | - Charles Chan
- Stanford Cardiovascular Institute, Stanford University
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University
| | - Mark M. Davis
- Department of Microbiology and Immunology, Stanford University
- Edinburgh Medical School, United Kingdom
- Howard Hughes Medical Institute, Stanford University
| | - Patricia K. Nguyen
- Department of Medicine (Cardiovascular Medicine), Stanford University
- Stanford Cardiovascular Institute, Stanford University
- Institute for Immunity, Transplantation and Infection, Stanford University
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11
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Veizades S, Tso A, Nguyen PK. Infection, inflammation and thrombosis: a review of potential mechanisms mediating arterial thrombosis associated with influenza and severe acute respiratory syndrome coronavirus 2. Biol Chem 2021; 403:231-241. [PMID: 34957734 DOI: 10.1515/hsz-2021-0348] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 08/19/2021] [Accepted: 12/07/2021] [Indexed: 12/30/2022]
Abstract
Thrombosis has long been reported as a potentially deadly complication of respiratory viral infections and has recently received much attention during the global coronavirus disease 2019 pandemic. Increased risk of myocardial infarction has been reported during active infections with respiratory viruses, including influenza and severe acute respiratory syndrome coronavirus 2, which persists even after the virus has cleared. These clinical observations suggest an ongoing interaction between these respiratory viruses with the host's coagulation and immune systems that is initiated at the time of infection but may continue long after the virus has been cleared. In this review, we discuss the epidemiology of viral-associated myocardial infarction, highlight recent clinical studies supporting a causal connection, and detail how the virus' interaction with the host's coagulation and immune systems can potentially mediate arterial thrombosis.
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Affiliation(s)
- Stefan Veizades
- Department of Medicine (Cardiovascular Medicine), Stanford University, Stanford, CA 94305, USA.,Stanford Cardiovascular Institute, Stanford University, Stanford, CA 94305, USA.,Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Alexandria Tso
- Department of Medicine (Cardiovascular Medicine), Stanford University, Stanford, CA 94305, USA.,Stanford Cardiovascular Institute, Stanford University, Stanford, CA 94305, USA
| | - Patricia K Nguyen
- Department of Medicine (Cardiovascular Medicine), Stanford University, Stanford, CA 94305, USA.,Stanford Cardiovascular Institute, Stanford University, Stanford, CA 94305, USA
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12
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Affiliation(s)
- Xianxi Huang
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA, 94305, USA
- Stanford Cardiovascular Institute, Stanford, CA, 94305, USA
- The First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
| | - Jessica D'Addabbo
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA, 94305, USA
- Stanford Cardiovascular Institute, Stanford, CA, 94305, USA
| | - Patricia K Nguyen
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA, 94305, USA.
- Stanford Cardiovascular Institute, Stanford, CA, 94305, USA.
- Department of Veteran Affairs, Palo Alto, CA, 94304, USA.
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13
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Nous FMA, Geisler T, Kruk MBP, Alkadhi H, Kitagawa K, Vliegenthart R, Hell MM, Hausleiter J, Nguyen PK, Budde RPJ, Nikolaou K, Kepka C, Manka R, Sakuma H, Malik SB, Coenen A, Zijlstra F, Klotz E, van der Harst P, Artzner C, Dedic A, Pugliese F, Bamberg F, Nieman K. Dynamic Myocardial Perfusion CT for the Detection of Hemodynamically Significant Coronary Artery Disease. JACC Cardiovasc Imaging 2021; 15:75-87. [PMID: 34538630 PMCID: PMC8741746 DOI: 10.1016/j.jcmg.2021.07.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/14/2021] [Accepted: 07/21/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES In this international, multicenter study, using third-generation dual-source computed tomography (CT), we investigated the diagnostic performance of dynamic stress CT myocardial perfusion imaging (CT-MPI) in addition to coronary CT angiography (CTA) compared to invasive coronary angiography (ICA) and invasive fractional flow reserve (FFR). BACKGROUND CT-MPI combined with coronary CTA integrates coronary artery anatomy with inducible myocardial ischemia, showing promising results for the diagnosis of hemodynamically significant coronary artery disease in single-center studies. METHODS At 9 centers in Europe, Japan, and the United States, 132 patients scheduled for ICA were enrolled; 114 patients successfully completed coronary CTA, adenosine-stress dynamic CT-MPI, and ICA. Invasive FFR was performed in vessels with 25% to 90% stenosis. Data were analyzed by independent core laboratories. For the primary analysis, for each coronary artery the presence of hemodynamically significant obstruction was interpreted by coronary CTA with CT-MPI compared to coronary CTA alone, using an FFR of ≤0.80 and angiographic severity as reference. Territorial absolute myocardial blood flow (MBF) and relative MBF were compared using C-statistics. RESULTS ICA and FFR identified hemodynamically significant stenoses in 74 of 289 coronary vessels (26%). Coronary CTA with ≥50% stenosis demonstrated a per-vessel sensitivity, specificity, and accuracy for the detection of hemodynamically significant stenosis of 96% (95% CI: 91–100), 72% (95% CI: 66–78), and 78% (95% CI: 73–83), respectively. Coronary CTA with CT-MPI showed a lower sensitivity (84%; 95% CI: 75–92) but higher specificity (89%; 95% CI: 85–93) and accuracy (88%; 95% CI: 84–92). The areas under the receiver-operating characteristic curve of absolute MBF and relative MBF were 0.79 (95% CI: 0.71–0.86) and 0.82 (95% CI: 0.74–0.88), respectively. The median dose-length product of CT-MPI and coronary CTA were 313 mGy·cm and 138 mGy·cm, respectively. CONCLUSIONS Dynamic CT-MPI offers incremental diagnostic value over coronary CTA alone for the identification of hemodynamically significant coronary artery disease. Generalized results from this multicenter study encourage broader consideration of dynamic CT-MPI in clinical practice. (Dynamic Stress Perfusion CT for Detection of Inducible Myocardial Ischemia [SPECIFIC]; NCT02810795)
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Affiliation(s)
- Fay M A Nous
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Cardiology, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Tobias Geisler
- Department of Cardiology, University of Tuebingen, Tuebingen, Germany
| | - Mariusz B P Kruk
- Coronary Disease and Structural Heart Diseases Department, Institute of Cardiology, Warsaw, Poland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Kakuya Kitagawa
- Department of Advanced Diagnostic Imaging, Mie University Graduate School of Medicine, Tsu, Japan
| | - Rozemarijn Vliegenthart
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Michaela M Hell
- Department of Cardiology, Faculty of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Jörg Hausleiter
- Department of Cardiology, Ludwig-Maximilians University, Munich, Germany
| | - Patricia K Nguyen
- Veterans Affairs Palo Alto Healthcare System, Cardiology Section, Palo Alto, California, USA; Stanford University, Division of Cardiovascular Medicine, Stanford, California, USA; Stanford Cardiovascular Institute, Stanford, California, USA
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Cardiology, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Cezary Kepka
- Coronary Disease and Structural Heart Diseases Department, Institute of Cardiology, Warsaw, Poland
| | - Robert Manka
- Department of Cardiology, University Heart Center and Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hajime Sakuma
- Department of Radiology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Sachin B Malik
- Veterans Affairs Palo Alto Healthcare System, Thoracic and Cardiovascular Imaging Section, Palo Alto, California, USA; Stanford University, Division of Cardiovascular Imaging (Affiliated), Stanford, California, USA
| | - Adriaan Coenen
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Cardiology, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Felix Zijlstra
- Department of Cardiology, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Pim van der Harst
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Christoph Artzner
- Department of Cardiology, University of Tuebingen, Tuebingen, Germany
| | - Admir Dedic
- Department of Cardiology, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Francesca Pugliese
- Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts National Institute for Health Research Biomedical Research Centre, Queen Mary University of London, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, Barts Health National Health Service Trust, West Smithfield, London, United Kingdom
| | - Fabian Bamberg
- Department of Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Koen Nieman
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Cardiology, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; Stanford University School of Medicine and Cardiovascular Institute, Stanford, California, USA.
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14
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Zhu H, Ivanovic M, Nguyen A, Nguyen PK, Wu SM. Immune checkpoint inhibitor cardiotoxicity: Breaking barriers in the cardiovascular immune landscape. J Mol Cell Cardiol 2021; 160:121-127. [PMID: 34303670 DOI: 10.1016/j.yjmcc.2021.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 05/06/2021] [Revised: 06/28/2021] [Accepted: 07/17/2021] [Indexed: 12/14/2022]
Abstract
Immune checkpoint inhibitors (ICI) have changed the landscape of cancer therapy, but their use carries a high risk of cardiac immune related adverse events (iRAEs). With the expanding utilization of ICI therapy, there is a growing need to understand the underlying mechanisms behind their anti-tumor activity as well as their immune-mediated toxicities. In this review, we will focus on clinical characteristics and immune pathways of ICI cardiotoxicity, with an emphasis on single-cell technologies used to gain insights in this field. We will focus on three key areas of ICI-mediated immune pathways, including the anti-tumor immune response, the augmentation of the immune response by ICIs, and the pathologic "autoimmune" response in some individuals leading to immune-mediated toxicity, as well as local factors in the myocardial immune environment predisposing to autoimmunity. Discerning the underlying mechanisms of these immune pathways is necessary to inform the development of targeted therapies for ICI cardiotoxicities and reduce treatment related morbidity and mortality.
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Affiliation(s)
- Han Zhu
- Department of Medicine, Stanford University, Stanford, California 94305, USA; Stanford Cardiovascular Institute, Stanford University, Stanford, California 94305, USA; Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California 94305, USA
| | - Maja Ivanovic
- Department of Medicine, Stanford University, Stanford, California 94305, USA
| | - Andrew Nguyen
- Department of Medicine, Stanford University, Stanford, California 94305, USA
| | - Patricia K Nguyen
- Department of Medicine, Stanford University, Stanford, California 94305, USA; Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California 94305, USA.
| | - Sean M Wu
- Department of Medicine, Stanford University, Stanford, California 94305, USA; Stanford Cardiovascular Institute, Stanford University, Stanford, California 94305, USA; Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California 94305, USA.
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15
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Haring B, Reiner AP, Liu J, Tobias DK, Whitsel E, Berger JS, Desai P, Wassertheil-Smoller S, LaMonte MJ, Hayden KM, Bick AG, Natarajan P, Weinstock JS, Nguyen PK, Stefanick M, Simon MS, Eaton CB, Kooperberg C, Manson JE. Healthy Lifestyle and Clonal Hematopoiesis of Indeterminate Potential: Results From the Women's Health Initiative. J Am Heart Assoc 2021; 10:e018789. [PMID: 33619969 PMCID: PMC8174283 DOI: 10.1161/jaha.120.018789] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background Presence of clonal hematopoiesis of indeterminate potential (CHIP) is associated with a higher risk of atherosclerotic cardiovascular disease, cancer, and mortality. The relationship between a healthy lifestyle and CHIP is unknown. Methods and Results This analysis included 8709 postmenopausal women (mean age, 66.5 years) enrolled in the WHI (Women's Health Initiative), free of cancer or cardiovascular disease, with deep‐coverage whole genome sequencing data available. Information on lifestyle factors (body mass index, smoking, physical activity, and diet quality) was obtained, and a healthy lifestyle score was created on the basis of healthy criteria met (0 point [least healthy] to 4 points [most healthy]). CHIP was derived on the basis of a prespecified list of leukemogenic driver mutations. The prevalence of CHIP was 8.6%. A higher healthy lifestyle score was not associated with CHIP (multivariable‐adjusted odds ratio [OR] [95% CI], 0.99 [0.80–1.23] and 1.13 [0.93–1.37]) for the upper (3 or 4 points) and middle category (2 points), respectively, versus referent (0 or 1 point). Across score components, a normal and overweight body mass index compared with obese was significantly associated with a lower odds for CHIP (OR, 0.71 [95% CI, 0.57–0.88] and 0.83 [95% CI, 0.68–1.01], respectively; P‐trend 0.0015). Having never smoked compared with being a current smoker tended to be associated with lower odds for CHIP. Conclusions A healthy lifestyle, based on a composite score, was not related to CHIP among postmenopausal women. However, across individual lifestyle factors, having a normal body mass index was strongly associated with a lower prevalence of CHIP. These findings support the idea that certain healthy lifestyle factors are associated with a lower frequency of CHIP.
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Affiliation(s)
- Bernhard Haring
- Department of Internal Medicine I University of Würzburg Bavaria Germany
| | - Alexander P Reiner
- Division of Public Health Sciences Department of Epidemiology Fred Hutchinson Cancer Research CenterUniversity of Washington Seattle WA
| | | | - Deirdre K Tobias
- Department of Nutrition Harvard T.H. Chan School of Public Health Boston MA.,Division of Preventive Medicine Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston MA
| | - Eric Whitsel
- Department of Epidemiology and Medicine University of North Carolina Chapel Hill NC
| | - Jeffrey S Berger
- Department of Medicine Center for the Prevention of Cardiovascular Disease New York University School of Medicine New York City NY
| | - Pinkal Desai
- Division of Hematology and Oncology Weill Cornell Medical College New York NY
| | | | - Michael J LaMonte
- Department of Epidemiology and Environmental Health School of Public Health and Health Professions University at Buffalo-SUNY Buffalo NY
| | - Kathleen M Hayden
- Division of Public Health Sciences Department of Social Sciences and Health Policy Wake Forest School of Medicine Winston-Salem NC
| | - Alexander G Bick
- Department of Medicine Program in Medical and Population Genetics Harvard Medical SchoolBroad Institute of Harvard and MIT Cambridge MA
| | - Pradeep Natarajan
- Department of Medicine Program in Medical and Population Genetics Harvard Medical SchoolBroad Institute of Harvard and MIT Cambridge MA
| | - Joshua S Weinstock
- Department of Biostatistics and Center for Statistical Genetics University of Michigan School of Public Health Ann Arbor MI
| | - Patricia K Nguyen
- Department of Medicine Stanford University Medical Center Palo Alto CA
| | - Marcia Stefanick
- Department of Medicine Stanford University Medical Center Palo Alto CA.,Departments of Obstetrics and Gynecology Stanford University Palo Alto CA
| | - Michael S Simon
- Department of Oncology Karmanos Cancer Institute at Wayne State University Detroit MI
| | - Charles B Eaton
- Department of Epidemiology Center for Primary Care and Prevention Brown University Providence RI
| | | | - JoAnn E Manson
- Division of Preventive Medicine Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston MA
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16
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Sallam K, Bhumireddy GP, Evuri VD, Abella JP, Haddad F, Valentine HA, Nguyen PK, Pham MX. Sirolimus Adverse Event Profile in a Non-Clinical Trial Cohort of Heart Transplantation Patients. Ann Transplant 2021; 26:e923536. [PMID: 33462174 PMCID: PMC7824988 DOI: 10.12659/aot.923536] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Sirolimus has been used increasingly in heart transplantation for its ability to reduce acute rejection, prevent the progression of cardiac allograft vasculopathy (CAV), and preserve renal function. We sought to assess the adverse reactions associated with the use of sirolimus compared to mycophenolate mofetil (MMF). Material/Methods We retrospectively reviewed the charts of 221 adult heart transplant patients who received either sirolimus or MMF as part of their immunosuppression from June 1, 2001 to April 1, 2005. Patients were assigned to 2 groups based upon immunosuppression use. The prevalence and types of complications were recorded in each group. Results Sirolimus was received by 109 patients and 112 patients received MMF during the study period. Seventy-seven patients (71%) in the sirolimus group experienced adverse reactions compared to 45 patients (40%) in the MMF group (P<0.01). Compared to MMF, the use of sirolimus was associated with a higher prevalence of elevated triglyceride levels, lower-extremity edema, and oral ulcerations. Sirolimus was discontinued due to adverse reactions in 22% of patients, whereas no patients in the MMF group experienced adverse effects requiring drug discontinuation. Conclusions Compared to MMF, sirolimus use is associated with a higher prevalence of adverse reactions requiring drug discontinuation, but most patients were able to stay on therapy despite adverse effects.
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Affiliation(s)
- Karim Sallam
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.,VA Palo Alto Health Care System, Palo Alto, CA, USA
| | | | | | | | - Francois Haddad
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Hannah A Valentine
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Patricia K Nguyen
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University School of Medicine, Palo Alto, CA, USA.,VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Michael X Pham
- California Pacific Medical Center, San Francisco, CA, USA
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17
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Huang X, Shen W, Veizades S, Liang G, Sayed N, Nguyen PK. Single-Cell Transcriptional Profiling Reveals Sex and Age Diversity of Gene Expression in Mouse Endothelial Cells. Front Genet 2021; 12:590377. [PMID: 33679877 PMCID: PMC7929607 DOI: 10.3389/fgene.2021.590377] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 01/05/2021] [Indexed: 02/05/2023] Open
Abstract
Although it is well-known that sex and age are important factors regulating endothelial cell (EC) function, the impact of sex and age on the gene expression of ECs has not been systematically analyzed at the single cell level. In this study, we performed an integrated characterization of the EC transcriptome of five major organs (e.g., fat, heart-aorta, lung, limb muscle, and kidney) isolated from male and female C57BL/6 mice at 3 and 18 months of age. A total of 590 and 252 differentially expressed genes (DEGS) were identified between females and males in the 3- and 18-month subgroups, respectively. Within the younger and older group, there were 177 vs. 178 DEGS in fat, 305 vs. 469 DEGS in heart/aorta, 22 vs. 37 DEGS in kidney, 26 vs. 439 DEGS in limb muscle, and 880 vs. 274 DEGS in lung. Interestingly, LARS2, a mitochondrial leucyl tRNA synthase, involved in the translation of mitochondrially encoded genes was differentially expressed in all organs in males compared to females in the 3-month group while S100a8 and S100a9, which are calcium binding proteins that are increased in inflammatory and autoimmune states, were upregulated in all organs in males at 18 months. Importantly, findings from RNAseq were confirmed by qPCR and Western blot. Gene enrichment analysis found genes enriched in protein targeting, catabolism, mitochondrial electron transport, IL 1- and IL 2- signaling, and Wnt signaling in males vs. angiogenesis and chemotaxis in females at 3 months. In contrast, ECs from males and females at 18-months had up-regulation in similar pathways involved in inflammation and apoptosis. Taken together, our findings suggest that gene expression is largely similar between males and females in both age groups. Compared to younger mice, however, older mice have increased expression of genes involved in inflammation in endothelial cells, which may contribute to the development of chronic, non-communicable diseases like atherosclerosis, hypertension, and Alzheimer's disease with age.
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Affiliation(s)
- Xianxi Huang
- Department of Critical Care Medicine, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA, United States
- Stanford Cardiovascular Institute, Stanford, CA, United States
| | - Wenjun Shen
- Department of Bioinformatics, Shantou University Medical College, Shantou, China
- Center for Biomedical Informatics Research, Stanford University, Stanford, CA, United States
| | - Stefan Veizades
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA, United States
- Stanford Cardiovascular Institute, Stanford, CA, United States
- Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Grace Liang
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA, United States
- Stanford Cardiovascular Institute, Stanford, CA, United States
- Cardiology Section, Department of Veteran Affairs, Palo Alto, CA, United States
| | - Nazish Sayed
- Stanford Cardiovascular Institute, Stanford, CA, United States
| | - Patricia K. Nguyen
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA, United States
- Stanford Cardiovascular Institute, Stanford, CA, United States
- Cardiology Section, Department of Veteran Affairs, Palo Alto, CA, United States
- *Correspondence: Patricia K. Nguyen
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18
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Liang G, Huang X, Hirsch J, Mehmi S, Fonda H, Chan K, Huang NF, Aalami O, Froelicher VF, Lee DP, Myers J, Lee AS, Nguyen PK. Modest Gains After an 8-Week Exercise Program Correlate With Reductions in Non-traditional Markers of Cardiovascular Risk. Front Cardiovasc Med 2021; 8:669110. [PMID: 34222367 PMCID: PMC8245677 DOI: 10.3389/fcvm.2021.669110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/13/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Although engaging in physical exercise has been shown to reduce the incidence of cardiovascular events, the molecular mechanisms by which exercise mediates these benefits remain unclear. Based on epidemiological evidence, reductions in traditional risk factors only accounts for 50% of the protective effects of exercise, leaving the remaining mechanisms unexplained. The objective of this study was to determine whether engaging in a regular exercise program in a real world clinical setting mediates cardiovascular protection via modulation of non-traditional risk factors, such as those involved in coagulation, inflammation and metabolic regulation. Methods and Results: We performed a prospective, cohort study in 52 sedentary patients with cardiovascular disease or cardiovascular risk factors at two tertiary medical centers between January 1, 2016 and December 31, 2019. Prior to and at the completion of an 8-week exercise program, we collected information on traditional cardiovascular risk factors, exercise capacity, and physical activity and performed plasma analysis to measure levels of fibrinolytic, inflammatory and metabolic biomarkers to assess changes in non-traditional cardiovascular risk factors. The median weight change, improvement in physical fitness, and change in physical activity for the entire cohort were: -4.6 pounds (IQR: +2 pounds, -11.8 pounds), 0.37 METs (IQR: -0.076 METs, 1.06 METs), and 252.7 kcals/week (IQR: -119, 921.2 kcals/week). In addition to improvement in blood pressure and cholesterol, patients who lost at least 5 pounds, expended at least 1,000 additional kcals/week, and/or achieved ≥0.5 MET increase in fitness had a significant reduction in plasminogen activator inhibitor-1 [9.07 ng/mL (95% CI: 2.78-15.35 ng/mL); P = 0.026], platelet derived growth factor beta [376.077 pg/mL (95% CI: 44.69-707.46 pg/mL); P = 0.026); and angiopoietin-1 [(1104.11 pg/mL (95% CI: 2.92-2205.30 pg/mL); P = 0.049)]. Conclusion: Modest improvements in physical fitness, physical activity, and/or weight loss through a short-term exercise program was associated with decreased plasma levels of plasminogen activator inhibitor, platelet derived growth factor beta, and angiopoietin, which have been associated with impaired fibrinolysis and inflammation.
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Affiliation(s)
- Grace Liang
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA, United States
| | - Xianxi Huang
- Department of Critical Care Medicine, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Stanford Cardiovascular Institute, Stanford, CA, United States
| | - James Hirsch
- Cardiology Section, Department of Veteran Affairs, Palo Alto, CA, United States
| | - Sanjeev Mehmi
- Cardiology Section, Department of Veteran Affairs, Palo Alto, CA, United States
| | - Holly Fonda
- Cardiology Section, Department of Veteran Affairs, Palo Alto, CA, United States
| | - Khin Chan
- Cardiology Section, Department of Veteran Affairs, Palo Alto, CA, United States
| | - Ngan F. Huang
- Department of Cardiovascular Surgery, Stanford University, Stanford, CA, United States
| | - Oliver Aalami
- Vascular Surgery Section, Department of Veteran Affairs, Palo Alto, CA, United States
| | - Victor F. Froelicher
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA, United States
- Cardiology Section, Department of Veteran Affairs, Palo Alto, CA, United States
| | - David P. Lee
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA, United States
| | - Jonathan Myers
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA, United States
- Stanford Cardiovascular Institute, Stanford, CA, United States
- Cardiology Section, Department of Veteran Affairs, Palo Alto, CA, United States
| | - Andrew S. Lee
- Stanford Cardiovascular Institute, Stanford, CA, United States
- Department of Pathology, Stanford University, Stanford, CA, United States
| | - Patricia K. Nguyen
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA, United States
- Stanford Cardiovascular Institute, Stanford, CA, United States
- Cardiology Section, Department of Veteran Affairs, Palo Alto, CA, United States
- *Correspondence: Patricia K. Nguyen
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19
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Miller CR, Wactawski-Wende J, Manson JE, Haring B, Hovey KM, Laddu D, Shadyab AH, Wild RA, Bea JW, Tinker LF, Martin LW, Nguyen PK, Garcia L, Andrews CA, Eaton CB, Stefanick ML, LaMonte MJ. Walking Volume and Speed Are Inversely Associated With Incidence of Treated Hypertension in Postmenopausal Women. Hypertension 2020; 76:1435-1443. [PMID: 32981366 DOI: 10.1161/hypertensionaha.120.15839] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 12/15/2022]
Abstract
Few studies have evaluated hypertension incidence in relation to walking, which is a common physical activity among adults. We examined the association between walking and hypertension incidence in 83 435 postmenopausal women who at baseline were aged 50 to 79 years, without known hypertension, heart failure, coronary heart disease, or stroke, and reported the ability to walk at least one block without assistance. Walking volume (metabolic equivalent hours per week) and speed (miles per hour) were assessed by questionnaire. Incident physician-diagnosed hypertension treated with medication was ascertained through annual questionnaires. During a mean 11-year follow-up, 38 230 hypertension cases were identified. After adjustment for covariates including nonwalking activities, a significant inverse association with hypertension was observed across categories of baseline walking volume (0 [referent], >0-3.5, 3.6-7.5, and >7.5 metabolic equivalent hours per week), hazard ratio: 1.00 (referent), 0.98, 0.95, 0.89; trend P<0.001. Faster walking speeds (<2, 2-3, 3-4, and >4 miles per hour) also were associated with lower hypertension risk, hazard ratio: 1.00 (referent), 1.07, 0.95, 0.86, 0.79; trend P<0.001. Further adjustment for walking duration (h/wk) had little impact on the association for walking speed (hazard ratio: 1.00 [referent], 1.08, 0.96, 0.86, 0.77; trend P<0.001). Significant inverse associations for walking volume and speed persisted after additional control for baseline blood pressure. Results for time-varying walking were comparable to those for baseline exposures. This study showed that walking at guideline-recommended volumes (>7.5 metabolic equivalent hours per week) and at faster speeds (≥2 miles per hour) is associated with lower hypertension risk in postmenopausal women. Walking should be encouraged as part of hypertension prevention in older adults.
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Affiliation(s)
- Connor R Miller
- From the Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo-SUNY, NY (C.R.M., J.W.-W., K.M.H., M.J.L.)
| | - Jean Wactawski-Wende
- From the Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo-SUNY, NY (C.R.M., J.W.-W., K.M.H., M.J.L.)
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard University Medical School, Boston, MA (J.E.M.)
| | - Bernhard Haring
- Department of Internal Medicine I, University of Würzburg, Bavaria, Germany (B.H.)
| | - Kathleen M Hovey
- From the Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo-SUNY, NY (C.R.M., J.W.-W., K.M.H., M.J.L.)
| | - Deepika Laddu
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois-Chicago (D.L.)
| | - Aladdin H Shadyab
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego (A.H.S.)
| | - Robert A Wild
- Departments of Obstetrics and Gynecology and Clinical Epidemiology, University of Oklahoma Health Sciences Center (R.A.W.)
| | - Jennifer W Bea
- Departments of Medicine and Nutritional Sciences, College of Medicine, University of Arizona, Tucson (J.W.B.)
| | - Lesley F Tinker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (L.F.T.)
| | - Lisa W Martin
- Division of Cardiology, George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.)
| | - Patricia K Nguyen
- Department of Medicine (P.K.N., M.L.S.), Stanford University School of Medicine, Palo Alto, CA
| | - Lorena Garcia
- Division of Epidemiology, Department of Public Health Sciences, School of Medicine, University of California, Davis (L.G.)
| | - Christopher A Andrews
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Michigan, Ann Arbor (C.A.A.)
| | - Charles B Eaton
- Departments of Family Medicine and Epidemiology, Alpert Medical School, Brown University, Providence, RI (C.B.E.)
| | - Marcia L Stefanick
- Department of Medicine (P.K.N., M.L.S.), Stanford University School of Medicine, Palo Alto, CA.,Departments of Medicine and Obstetrics and Gynecology (M.L.S.), Stanford University School of Medicine, Palo Alto, CA
| | - Michael J LaMonte
- From the Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo-SUNY, NY (C.R.M., J.W.-W., K.M.H., M.J.L.)
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20
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Zhu H, Rhee JW, Cheng P, Waliany S, Chang A, Witteles RM, Maecker H, Davis MM, Nguyen PK, Wu SM. Correction to: Cardiovascular Complications in Patients with COVID-19: Consequences of Viral Toxicities and Host Immune Response. Curr Cardiol Rep 2020; 22:36. [PMID: 32405913 PMCID: PMC7220624 DOI: 10.1007/s11886-020-01302-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Han Zhu
- Department of Medicine, Stanford University, Room G1120A, Lokey Stem Cell Building, 265 Campus Drive, Stanford, CA, 94305, USA.,Stanford Cardiovascular Institute, Stanford, CA, USA.,Division of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - June-Wha Rhee
- Department of Medicine, Stanford University, Room G1120A, Lokey Stem Cell Building, 265 Campus Drive, Stanford, CA, 94305, USA.,Stanford Cardiovascular Institute, Stanford, CA, USA.,Division of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - Paul Cheng
- Department of Medicine, Stanford University, Room G1120A, Lokey Stem Cell Building, 265 Campus Drive, Stanford, CA, 94305, USA.,Stanford Cardiovascular Institute, Stanford, CA, USA.,Division of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - Sarah Waliany
- Department of Medicine, Stanford University, Room G1120A, Lokey Stem Cell Building, 265 Campus Drive, Stanford, CA, 94305, USA
| | - Amy Chang
- Department of Medicine, Stanford University, Room G1120A, Lokey Stem Cell Building, 265 Campus Drive, Stanford, CA, 94305, USA.,Division of Infectious Disease, Stanford University, Stanford, CA, USA
| | - Ronald M Witteles
- Department of Medicine, Stanford University, Room G1120A, Lokey Stem Cell Building, 265 Campus Drive, Stanford, CA, 94305, USA.,Division of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - Holden Maecker
- Department of Microbiology and Immunology, Stanford University, Stanford, CA, USA.,Stanford Institute for Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA, USA
| | - Mark M Davis
- Department of Microbiology and Immunology, Stanford University, Stanford, CA, USA.,Stanford Institute for Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA, USA.,Howard Hughes Medical Institute, Stanford, CA, USA
| | - Patricia K Nguyen
- Department of Medicine, Stanford University, Room G1120A, Lokey Stem Cell Building, 265 Campus Drive, Stanford, CA, 94305, USA.,Stanford Cardiovascular Institute, Stanford, CA, USA.,Division of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - Sean M Wu
- Department of Medicine, Stanford University, Room G1120A, Lokey Stem Cell Building, 265 Campus Drive, Stanford, CA, 94305, USA. .,Stanford Cardiovascular Institute, Stanford, CA, USA.
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21
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Zhu H, Rhee JW, Cheng P, Waliany S, Chang A, Witteles RM, Maecker H, Davis MM, Nguyen PK, Wu SM. Cardiovascular Complications in Patients with COVID-19: Consequences of Viral Toxicities and Host Immune Response. Curr Cardiol Rep 2020; 22:32. [PMID: 32318865 PMCID: PMC7171437 DOI: 10.1007/s11886-020-01292-3] [Citation(s) in RCA: 121] [Impact Index Per Article: 30.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW Coronavirus disease of 2019 (COVID-19) is a cause of significant morbidity and mortality worldwide. While cardiac injury has been demonstrated in critically ill COVID-19 patients, the mechanism of injury remains unclear. Here, we review our current knowledge of the biology of SARS-CoV-2 and the potential mechanisms of myocardial injury due to viral toxicities and host immune responses. RECENT FINDINGS A number of studies have reported an epidemiological association between history of cardiac disease and worsened outcome during COVID infection. Development of new onset myocardial injury during COVID-19 also increases mortality. While limited data exist, potential mechanisms of cardiac injury include direct viral entry through the angiotensin-converting enzyme 2 (ACE2) receptor and toxicity in host cells, hypoxia-related myocyte injury, and immune-mediated cytokine release syndrome. Potential treatments for reducing viral infection and excessive immune responses are also discussed. COVID patients with cardiac disease history or acquire new cardiac injury are at an increased risk for in-hospital morbidity and mortality. More studies are needed to address the mechanism of cardiotoxicity and the treatments that can minimize permanent damage to the cardiovascular system.
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Affiliation(s)
- Han Zhu
- Department of Medicine, Stanford University, Room G1120A, Lokey Stem Cell Building, 265 Campus Drive, Stanford, CA 94305 USA
- Stanford Cardiovascular Institute, Stanford, CA USA
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA USA
| | - June-Wha Rhee
- Department of Medicine, Stanford University, Room G1120A, Lokey Stem Cell Building, 265 Campus Drive, Stanford, CA 94305 USA
- Stanford Cardiovascular Institute, Stanford, CA USA
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA USA
| | - Paul Cheng
- Department of Medicine, Stanford University, Room G1120A, Lokey Stem Cell Building, 265 Campus Drive, Stanford, CA 94305 USA
- Stanford Cardiovascular Institute, Stanford, CA USA
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA USA
| | - Sarah Waliany
- Department of Medicine, Stanford University, Room G1120A, Lokey Stem Cell Building, 265 Campus Drive, Stanford, CA 94305 USA
| | - Amy Chang
- Department of Medicine, Stanford University, Room G1120A, Lokey Stem Cell Building, 265 Campus Drive, Stanford, CA 94305 USA
- Division of Infectious Disease, Stanford University, Stanford, CA USA
| | - Ronald M. Witteles
- Department of Medicine, Stanford University, Room G1120A, Lokey Stem Cell Building, 265 Campus Drive, Stanford, CA 94305 USA
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA USA
| | - Holden Maecker
- Department of Microbiology and Immunology, Stanford University, Stanford, CA USA
- Stanford Institute for Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA USA
| | - Mark M. Davis
- Department of Microbiology and Immunology, Stanford University, Stanford, CA USA
- Stanford Institute for Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA USA
- Howard Hughes Medical Institute, Stanford, CA USA
| | - Patricia K. Nguyen
- Department of Medicine, Stanford University, Room G1120A, Lokey Stem Cell Building, 265 Campus Drive, Stanford, CA 94305 USA
- Stanford Cardiovascular Institute, Stanford, CA USA
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA USA
| | - Sean M. Wu
- Department of Medicine, Stanford University, Room G1120A, Lokey Stem Cell Building, 265 Campus Drive, Stanford, CA 94305 USA
- Stanford Cardiovascular Institute, Stanford, CA USA
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA USA
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22
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Feng W, Chen L, Nguyen PK, Wu SM, Li G. Single Cell Analysis of Endothelial Cells Identified Organ-Specific Molecular Signatures and Heart-Specific Cell Populations and Molecular Features. Front Cardiovasc Med 2019; 6:165. [PMID: 31850371 PMCID: PMC6901932 DOI: 10.3389/fcvm.2019.00165] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/30/2019] [Indexed: 12/03/2022] Open
Abstract
Endothelial cells line the inner surface of vasculature and play an important role in normal physiology and disease progression. Although most tissue is known to have a heterogeneous population of endothelial cells, transcriptional differences in organ specific endothelial cells have not been systematically analyzed at the single cell level. The Tabula Muris project profiled mouse single cells from 20 organs. We found 10 of the organs profiled by this Consortium have endothelial cells. Unsupervised analysis of these endothelial cells revealed that they were mainly grouped by organs, and organ-specific cells were further partially correlated by germ layers. Unexpectedly, we found all lymphatic endothelial cells grouped together regardless of their resident organs. To further understand the cellular heterogeneity in organ-specific endothelial cells, we used the heart as an example. As a pump of the circulation system, the heart has multiple types of endothelial cells. Detailed analysis of these cells identified an endocardial endothelial cell population, a coronary vascular endothelial cell population, and an aorta-specific cell population. Through integrated analysis of the single cell data from another two studies analyzing the aorta, we identified conserved cell populations and molecular markers across the datasets. In summary, by reanalyzing the existing endothelial cell single-cell data, we identified organ-specific molecular signatures and heart-specific subpopulations and molecular markers. We expect these findings will pave the way for a deeper understanding of vascular biology and endothelial cell-related diseases.
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Affiliation(s)
- Wei Feng
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Lyuqin Chen
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States.,Department of Pharmacology and Chemical Biology, UPMC Hillman Cancer Center, Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - Patricia K Nguyen
- Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States.,Veterans Affairs Palo Alto Health Care Administration, Palo Alto, CA, United States.,Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Sean M Wu
- Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States.,Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States.,Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Guang Li
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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23
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D’Addabbo J, Wardak M, Nguyen PK. Recent Advances in Imaging Inflammation Post-Myocardial Infarction Using Positron Emission Tomography. Curr Cardiovasc Imaging Rep 2019. [DOI: 10.1007/s12410-019-9515-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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24
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Sallam K, Rhee JW, Chour T, D'addabbo J, Lee AS, Graves E, Nguyen PK. Targeted and Selective Treatment of Pluripotent Stem Cell-derived Teratomas Using External Beam Radiation in a Small-animal Model. J Vis Exp 2019. [PMID: 30829317 DOI: 10.3791/58115] [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: 10/31/2022] Open
Abstract
The growing number of victims of "stem cell tourism," the unregulated transplantation of stem cells worldwide, has raised concerns about the safety of stem cell transplantation. Although the transplantation of differentiated rather than undifferentiated cells is common practice, teratomas can still arise from the presence of residual undifferentiated stem cells at the time of transplant or from spontaneous mutations in differentiated cells. Because stem cell therapies are often delivered into anatomically sensitive sites, even small tumors can be clinically devastating, resulting in blindness, paralysis, cognitive abnormalities, and cardiovascular dysfunction. Surgical access to these sites may also be limited, leaving patients with few therapeutic options. Controlling stem cell misbehavior is, therefore, critical for the clinical translation of stem cell therapy. External beam radiation offers an effective means of delivering targeted therapy to decrease the teratoma burden while minimizing injury to surrounding organs. Additionally, this method avoids genetic manipulation or viral transduction of stem cells-which are associated with additional clinical safety and efficacy concerns. Here, we describe a protocol to create pluripotent stem cell-derived teratomas in mice and to apply external beam radiation therapy to selectively ablate these tumors in vivo.
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Affiliation(s)
- Karim Sallam
- Stanford Cardiovascular Institute, Stanford University School of Medicine; Department of Medicine, Division of Cardiology, Stanford University School of Medicine; Medical Service, Cardiology Section, Veteran Affairs Palo Alto Health Care System
| | - June-Wha Rhee
- Stanford Cardiovascular Institute, Stanford University School of Medicine; Department of Medicine, Division of Cardiology, Stanford University School of Medicine
| | - Tony Chour
- Stanford Cardiovascular Institute, Stanford University School of Medicine
| | - Jessica D'addabbo
- Stanford Cardiovascular Institute, Stanford University School of Medicine; Department of Medicine, Division of Cardiology, Stanford University School of Medicine; Medical Service, Cardiology Section, Veteran Affairs Palo Alto Health Care System
| | - Andrew S Lee
- Stanford Cardiovascular Institute, Stanford University School of Medicine; Department of Medicine, Division of Cardiology, Stanford University School of Medicine; Department of Pathology, Stanford University School of Medicine; Department of Radiology, Molecular Imaging Program, Stanford University School of Medicine; Peking University Shenzhen Health Science Institute
| | - Edward Graves
- Department of Pathology, Stanford University School of Medicine; Department of Radiology, Molecular Imaging Program, Stanford University School of Medicine; Department of Radiation Oncology, Stanford University School of Medicine
| | - Patricia K Nguyen
- Stanford Cardiovascular Institute, Stanford University School of Medicine; Department of Medicine, Division of Cardiology, Stanford University School of Medicine; Medical Service, Cardiology Section, Veteran Affairs Palo Alto Health Care System;
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25
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Gentry CA, Nguyen PK, Thind S, Kurdgelashvili G, Skrepnek GH, Williams RJ. Fidaxomicin versus oral vancomycin for severe Clostridium difficile infection: a retrospective cohort study. Clin Microbiol Infect 2018; 25:987-993. [PMID: 30583055 DOI: 10.1016/j.cmi.2018.12.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/13/2018] [Accepted: 12/09/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This study was conducted to compare clinical outcomes of fidaxomicin versus oral vancomycin in the management of severe Clostridium difficile infection (CDI). METHODS The investigation was a retrospective, multicentre, propensity score-matched analysis using a national clinical administrative database. Veterans treated for severe CDI from any Veterans Affairs Medical Center between 1 June 2011 and 30 June 2017 were included if they received fidaxomicin or an oral vancomycin regimen for treatment. The two groups were matched by the nearest-neighbour method from a propensity score derived from independent variables associated with the selection of a fidaxomicin course. RESULTS Propensity score matching resulted in two well-matched cohorts consisting of 213 fidaxomicin and 639 oral vancomycin courses. No statistically-significant difference was found for the primary outcome of combined clinical failure or recurrence (68/213 (31.9%) versus 163/639 (25.5%), respectively, p 0.071). Additionally, no statistically significant differences were found for the secondary outcomes of 30-day (23/213 (10.8%) versus 75/639 (11.7%), respectively, p 0.71), 90-day (48/213 (22.5%) versus 140/639 (21.9%), respectively, p 0.85), and 180-day mortality (62/213 (29.1%) versus 186/639 (29.1%), respectively, p 1.0) between the two treatment groups. CONCLUSIONS Courses of fidaxomicin or oral vancomycin for severe CDI resulted in similar treatment outcomes. Study findings are consistent with current treatment guideline recommendations for the use of either agent in the management of severe CDI.
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Affiliation(s)
- C A Gentry
- Pharmacy Service, Oklahoma City VA Health Care System, Oklahoma City, OK, USA.
| | - P K Nguyen
- Pharmacy Service, Oklahoma City VA Health Care System, Oklahoma City, OK, USA
| | - S Thind
- Medical Service, Oklahoma City VA Health Care System, Oklahoma City, OK, USA
| | - G Kurdgelashvili
- Medical Service, Oklahoma City VA Health Care System, Oklahoma City, OK, USA
| | - G H Skrepnek
- Department of Pharmacy: Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, Oklahoma City, OK, USA
| | - R J Williams
- Pharmacy Service, Oklahoma City VA Health Care System, Oklahoma City, OK, USA
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26
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Chung KS, Nguyen PK. Non-invasive measures of coronary microcirculation: Taking the long road to the clinic. J Nucl Cardiol 2018; 25:2112-2115. [PMID: 28721646 PMCID: PMC6148395 DOI: 10.1007/s12350-017-0972-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 06/16/2017] [Indexed: 01/05/2023]
Abstract
Although coronary microvascular disease is now a well-recognized entity that is associated with significant morbidity and mortality, current non-invasive strategies cannot differentiate between coronary microvascular disease (CMD) and obstructive epicardial stenosis. While the evaluation of intramyocardial blood volume as a surrogate measure for microvascular health may have limited sensitivity in early-stage disease, this strategy does enable the diagnosis of CMD in the presence of concurrent epicardial disease, bringing us one step further toward improving the management of this disease. Herein, we discuss the advantages and limitations of current non-invasive measures of CMD and the need for further investment in bringing these technologies to the bedside.
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Affiliation(s)
- Kieran S Chung
- Cardiology Section, Veterans Affairs Palo Alto Health Care Administration, Palo Alto, CA, USA
| | - Patricia K Nguyen
- Cardiology Section, Veterans Affairs Palo Alto Health Care Administration, Palo Alto, CA, USA.
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, 300 Pasteur Drive, Grant Building S114, Stanford, CA, 94301, USA.
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27
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Chung KS, Nguyen PK. Erratum to: Non-invasive measures of coronary microcirculation: Taking the long road to the clinic. J Nucl Cardiol 2018; 25:2116. [PMID: 28755080 DOI: 10.1007/s12350-017-1013-x] [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: 11/24/2022]
Abstract
Reference 12 of the original editorial was cited in error. The correct reference is: Mohy-ud-Din H, et al. Quantification of intramyocardial blood volume with 99mTc-RBC SPECT-CT imaging: A preclinical study. J Nucl Cardiol 2017;1-16.
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Affiliation(s)
- Kieran S Chung
- Cardiology Section, Veterans Affairs Palo Alto Health Care Administration, Palo Alto, CA, USA
| | - Patricia K Nguyen
- Cardiology Section, Veterans Affairs Palo Alto Health Care Administration, Palo Alto, CA, USA.
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, 300 Pasteur Drive, Grant Building S114, Stanford, CA, 94301, USA.
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28
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Schaum N, Karkanias J, Neff NF, May AP, Quake SR, Wyss-Coray T, Darmanis S, Batson J, Botvinnik O, Chen MB, Chen S, Green F, Jones R, Maynard A, Penland L, Pisco AO, Sit RV, Stanley GM, Webber JT, Zanini F, Baghel AS, Bakerman I, Bansal I, Berdnik D, Bilen B, Brownfield D, Cain C, Chen MB, Chen S, Cho M, Cirolia G, Conley SD, Darmanis S, Demers A, Demir K, de Morree A, Divita T, du Bois H, Dulgeroff LBT, Ebadi H, Espinoza FH, Fish M, Gan Q, George BM, Gillich A, Green F, Genetiano G, Gu X, Gulati GS, Hang Y, Hosseinzadeh S, Huang A, Iram T, Isobe T, Ives F, Jones R, Kao KS, Karnam G, Kershner AM, Kiss BM, Kong W, Kumar ME, Lam J, Lee DP, Lee SE, Li G, Li Q, Liu L, Lo A, Lu WJ, Manjunath A, May AP, May KL, May OL, Maynard A, McKay M, Metzger RJ, Mignardi M, Min D, Nabhan AN, Neff NF, Ng KM, Noh J, Patkar R, Peng WC, Penland L, Puccinelli R, Rulifson EJ, Schaum N, Sikandar SS, Sinha R, Sit RV, Szade K, Tan W, Tato C, Tellez K, Travaglini KJ, Tropini C, Waldburger L, van Weele LJ, Wosczyna MN, Xiang J, Xue S, Youngyunpipatkul J, Zanini F, Zardeneta ME, Zhang F, Zhou L, Bansal I, Chen S, Cho M, Cirolia G, Darmanis S, Demers A, Divita T, Ebadi H, Genetiano G, Green F, Hosseinzadeh S, Ives F, Lo A, May AP, Maynard A, McKay M, Neff NF, Penland L, Sit RV, Tan W, Waldburger L, oungyunpipatkul JY, Batson J, Botvinnik O, Castro P, Croote D, Darmanis S, DeRisi JL, Karkanias J, Pisco AO, Stanley GM, Webber JT, Zanini F, Baghel AS, Bakerman I, Batson J, Bilen B, Botvinnik O, Brownfield D, Chen MB, Darmanis S, Demir K, de Morree A, Ebadi H, Espinoza FH, Fish M, Gan Q, George BM, Gillich A, Gu X, Gulati GS, Hang Y, Huang A, Iram T, Isobe T, Karnam G, Kershner AM, Kiss BM, Kong W, Kuo CS, Lam J, Lehallier B, Li G, Li Q, Liu L, Lu WJ, Min D, Nabhan AN, Ng KM, Nguyen PK, Patkar R, Peng WC, Penland L, Rulifson EJ, Schaum N, Sikandar SS, Sinha R, Szade K, Tan SY, Tellez K, Travaglini KJ, Tropini C, van Weele LJ, Wang BM, Wosczyna MN, Xiang J, Yousef H, Zhou L, Batson J, Botvinnik O, Chen S, Darmanis S, Green F, May AP, Maynard A, Pisco AO, Quake SR, Schaum N, Stanley GM, Webber JT, Wyss-Coray T, Zanini F, Beachy PA, Chan CKF, de Morree A, George BM, Gulati GS, Hang Y, Huang KC, Iram T, Isobe T, Kershner AM, Kiss BM, Kong W, Li G, Li Q, Liu L, Lu WJ, Nabhan AN, Ng KM, Nguyen PK, Peng WC, Rulifson EJ, Schaum N, Sikandar SS, Sinha R, Szade K, Travaglini KJ, Tropini C, Wang BM, Weinberg K, Wosczyna MN, Wu SM, Yousef H, Barres BA, Beachy PA, Chan CKF, Clarke MF, Darmanis S, Huang KC, Karkanias J, Kim SK, Krasnow MA, Kumar ME, Kuo CS, May AP, Metzger RJ, Neff NF, Nusse R, Nguyen PK, Rando TA, Sonnenburg J, Wang BM, Weinberg K, Weissman IL, Wu SM, Quake SR, Wyss-Coray T. Single-cell transcriptomics of 20 mouse organs creates a Tabula Muris. Nature 2018; 562:367-372. [PMID: 30283141 PMCID: PMC6642641 DOI: 10.1038/s41586-018-0590-4] [Citation(s) in RCA: 1437] [Impact Index Per Article: 239.5] [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: 12/20/2017] [Accepted: 08/20/2018] [Indexed: 12/12/2022]
Abstract
Here we present a compendium of single-cell transcriptomic data from the model organism Mus musculus that comprises more than 100,000 cells from 20 organs and tissues. These data represent a new resource for cell biology, reveal gene expression in poorly characterized cell populations and enable the direct and controlled comparison of gene expression in cell types that are shared between tissues, such as T lymphocytes and endothelial cells from different anatomical locations. Two distinct technical approaches were used for most organs: one approach, microfluidic droplet-based 3'-end counting, enabled the survey of thousands of cells at relatively low coverage, whereas the other, full-length transcript analysis based on fluorescence-activated cell sorting, enabled the characterization of cell types with high sensitivity and coverage. The cumulative data provide the foundation for an atlas of transcriptomic cell biology.
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Affiliation(s)
- Nicholas Schaum
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Jim Karkanias
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Norma F. Neff
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Andrew P. May
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Stephen R. Quake
- Chan Zuckerberg Biohub, San Francisco, California, USA
- Department of Bioengineering, Stanford University, Stanford, California, USA
| | - Tony Wyss-Coray
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
- Paul F. Glenn Center for the Biology of Aging, Stanford University School of Medicine, Stanford, California, USA
- Center for Tissue Regeneration, Repair, and Restoration, V.A. Palo Alto Healthcare System, Palo Alto, California, USA
| | | | - Joshua Batson
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | | | - Michelle B. Chen
- Department of Bioengineering, Stanford University, Stanford, California, USA
| | - Steven Chen
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Foad Green
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Robert Jones
- Department of Bioengineering, Stanford University, Stanford, California, USA
| | | | | | | | - Rene V. Sit
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Geoffrey M. Stanley
- Department of Bioengineering, Stanford University, Stanford, California, USA
| | | | - Fabio Zanini
- Department of Bioengineering, Stanford University, Stanford, California, USA
| | - Ankit S Baghel
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Isaac Bakerman
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, California, USA
| | - Ishita Bansal
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Daniela Berdnik
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Biter Bilen
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Douglas Brownfield
- Department of Biochemistry, Stanford University School of Medicine, Stanford, California, USA
| | - Corey Cain
- Flow Cytometry Core, V.A. Palo Alto Healthcare System, Palo Alto, California, USA
| | - Michelle B. Chen
- Department of Bioengineering, Stanford University, Stanford, California, USA
| | - Steven Chen
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Min Cho
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Giana Cirolia
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Stephanie D. Conley
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | | | - Aaron Demers
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Kubilay Demir
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
- Howard Hughes Medical Institute, USA
| | - Antoine de Morree
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Tessa Divita
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Haley du Bois
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Laughing Bear Torrez Dulgeroff
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Hamid Ebadi
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - F. Hernán Espinoza
- Department of Biochemistry, Stanford University School of Medicine, Stanford, California, USA
| | - Matt Fish
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
- Howard Hughes Medical Institute, USA
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, California, USA
| | - Qiang Gan
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Benson M. George
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Astrid Gillich
- Department of Biochemistry, Stanford University School of Medicine, Stanford, California, USA
| | - Foad Green
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | | | - Xueying Gu
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, California, USA
| | - Gunsagar S. Gulati
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Yan Hang
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, California, USA
| | | | - Albin Huang
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Tal Iram
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Taichi Isobe
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Feather Ives
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Robert Jones
- Department of Bioengineering, Stanford University, Stanford, California, USA
| | - Kevin S. Kao
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Guruswamy Karnam
- Department of Medicine and Liver Center, University of California San Francisco, San Francisco, California, USA
| | - Aaron M. Kershner
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Bernhard M. Kiss
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - William Kong
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Maya E. Kumar
- Sean N. Parker Center for Asthma and Allergy Research, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Division of Pulmonary and Critical Care, Stanford University School of Medicine, Stanford, California, USA
| | - Jonathan Lam
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, California, USA
| | - Davis P. Lee
- Center for Tissue Regeneration, Repair, and Restoration, V.A. Palo Alto Healthcare System, Palo Alto, California, USA
| | - Song E. Lee
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Guang Li
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA
| | - Qingyun Li
- Department of Neurobiology, Stanford University School of Medicine, Stanford, CA USA
| | - Ling Liu
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Annie Lo
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Wan-Jin Lu
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Biochemistry, Stanford University School of Medicine, Stanford, California, USA
| | - Anoop Manjunath
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Andrew P. May
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Kaia L. May
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Oliver L. May
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | | | - Marina McKay
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Ross J. Metzger
- Vera Moulton Wall Center for Pulmonary and Vascular Disease, Stanford University School of Medicine, Stanford, California, USA
- Department of Pediatrics, Division of Cardiology, Stanford University School of Medicine, Stanford, California, USA
| | - Marco Mignardi
- Department of Bioengineering, Stanford University, Stanford, California, USA
| | - Dullei Min
- Department of Pediatrics, Stanford University school of Medicine, Stanford, California, USA
| | - Ahmad N. Nabhan
- Department of Biochemistry, Stanford University School of Medicine, Stanford, California, USA
| | - Norma F. Neff
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Katharine M. Ng
- Department of Bioengineering, Stanford University, Stanford, California, USA
| | - Joseph Noh
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Rasika Patkar
- Department of Medicine and Liver Center, University of California San Francisco, San Francisco, California, USA
| | - Weng Chuan Peng
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, California, USA
| | | | | | - Eric J. Rulifson
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, California, USA
| | - Nicholas Schaum
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Shaheen S. Sikandar
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Rahul Sinha
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
- Ludwig Center for Cancer Stem Cell Research and Medicine, Stanford University School of Medicine, Stanford, California, USA
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, USA
| | - Rene V. Sit
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Krzysztof Szade
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Medical Biotechnology, Faculty of Biophysics, Biochemistry and Biotechnology, Jagiellonian University, Poland
| | - Weilun Tan
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Cristina Tato
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Krissie Tellez
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, California, USA
| | - Kyle J. Travaglini
- Department of Biochemistry, Stanford University School of Medicine, Stanford, California, USA
| | - Carolina Tropini
- Department of Microbiology & Immunology, Stanford University School of Medicine, Stanford, California, USA
| | | | - Linda J. van Weele
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Michael N. Wosczyna
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Jinyi Xiang
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Soso Xue
- Department of Bioengineering, Stanford University, Stanford, California, USA
| | | | - Fabio Zanini
- Department of Bioengineering, Stanford University, Stanford, California, USA
| | - Macy E. Zardeneta
- Center for Tissue Regeneration, Repair, and Restoration, V.A. Palo Alto Healthcare System, Palo Alto, California, USA
| | - Fan Zhang
- Vera Moulton Wall Center for Pulmonary and Vascular Disease, Stanford University School of Medicine, Stanford, California, USA
- Department of Pediatrics, Division of Cardiology, Stanford University School of Medicine, Stanford, California, USA
| | - Lu Zhou
- Department of Neurobiology, Stanford University School of Medicine, Stanford, CA USA
| | - Ishita Bansal
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Steven Chen
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Min Cho
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Giana Cirolia
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | | | - Aaron Demers
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Tessa Divita
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Hamid Ebadi
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | | | - Foad Green
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | | | - Feather Ives
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Annie Lo
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Andrew P. May
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | | | - Marina McKay
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Norma F. Neff
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | | | - Rene V. Sit
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Weilun Tan
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | | | | | - Joshua Batson
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | | | - Paola Castro
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Derek Croote
- Department of Bioengineering, Stanford University, Stanford, California, USA
| | | | - Joseph L. DeRisi
- Chan Zuckerberg Biohub, San Francisco, California, USA
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, California USA
| | - Jim Karkanias
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | | | - Geoffrey M. Stanley
- Department of Bioengineering, Stanford University, Stanford, California, USA
| | | | - Fabio Zanini
- Department of Bioengineering, Stanford University, Stanford, California, USA
| | - Ankit S. Baghel
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Isaac Bakerman
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, California, USA
| | - Joshua Batson
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Biter Bilen
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | | | - Douglas Brownfield
- Department of Biochemistry, Stanford University School of Medicine, Stanford, California, USA
| | - Michelle B. Chen
- Department of Bioengineering, Stanford University, Stanford, California, USA
| | | | - Kubilay Demir
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
- Howard Hughes Medical Institute, USA
| | - Antoine de Morree
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Hamid Ebadi
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - F. Hernán Espinoza
- Department of Biochemistry, Stanford University School of Medicine, Stanford, California, USA
| | - Matt Fish
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
- Howard Hughes Medical Institute, USA
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, California, USA
| | - Qiang Gan
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Benson M. George
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Astrid Gillich
- Department of Biochemistry, Stanford University School of Medicine, Stanford, California, USA
| | - Xueying Gu
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, California, USA
| | - Gunsagar S. Gulati
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Yan Hang
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, California, USA
| | - Albin Huang
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Tal Iram
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Taichi Isobe
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Guruswamy Karnam
- Department of Medicine and Liver Center, University of California San Francisco, San Francisco, California, USA
| | - Aaron M. Kershner
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Bernhard M. Kiss
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - William Kong
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Christin S. Kuo
- Department of Biochemistry, Stanford University School of Medicine, Stanford, California, USA
- Howard Hughes Medical Institute, USA
- Department of Pediatrics, Stanford University school of Medicine, Stanford, California, USA
| | - Jonathan Lam
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, California, USA
| | - Benoit Lehallier
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Guang Li
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA
| | - Qingyun Li
- Department of Neurobiology, Stanford University School of Medicine, Stanford, CA USA
| | - Ling Liu
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Wan-Jin Lu
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Biochemistry, Stanford University School of Medicine, Stanford, California, USA
| | - Dullei Min
- Department of Pediatrics, Stanford University school of Medicine, Stanford, California, USA
| | - Ahmad N. Nabhan
- Department of Biochemistry, Stanford University School of Medicine, Stanford, California, USA
| | - Katharine M. Ng
- Department of Bioengineering, Stanford University, Stanford, California, USA
| | - Patricia K. Nguyen
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA
| | - Rasika Patkar
- Department of Medicine and Liver Center, University of California San Francisco, San Francisco, California, USA
| | - Weng Chuan Peng
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, California, USA
| | | | - Eric J. Rulifson
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, California, USA
| | - Nicholas Schaum
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Shaheen S. Sikandar
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Rahul Sinha
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
- Ludwig Center for Cancer Stem Cell Research and Medicine, Stanford University School of Medicine, Stanford, California, USA
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, USA
| | - Krzysztof Szade
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Medical Biotechnology, Faculty of Biophysics, Biochemistry and Biotechnology, Jagiellonian University, Poland
| | - Serena Y. Tan
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Krissie Tellez
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, California, USA
| | - Kyle J. Travaglini
- Department of Biochemistry, Stanford University School of Medicine, Stanford, California, USA
| | - Carolina Tropini
- Department of Microbiology & Immunology, Stanford University School of Medicine, Stanford, California, USA
| | - Linda J. van Weele
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Bruce M. Wang
- Department of Medicine and Liver Center, University of California San Francisco, San Francisco, California, USA
| | - Michael N. Wosczyna
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Jinyi Xiang
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Hanadie Yousef
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Lu Zhou
- Department of Neurobiology, Stanford University School of Medicine, Stanford, CA USA
| | - Joshua Batson
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | | | - Steven Chen
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | | | - Foad Green
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Andrew P. May
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | | | | | - Stephen R. Quake
- Chan Zuckerberg Biohub, San Francisco, California, USA
- Department of Bioengineering, Stanford University, Stanford, California, USA
| | - Nicholas Schaum
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Geoffrey M. Stanley
- Department of Bioengineering, Stanford University, Stanford, California, USA
| | | | - Tony Wyss-Coray
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
- Paul F. Glenn Center for the Biology of Aging, Stanford University School of Medicine, Stanford, California, USA
- Center for Tissue Regeneration, Repair, and Restoration, V.A. Palo Alto Healthcare System, Palo Alto, California, USA
| | - Fabio Zanini
- Department of Bioengineering, Stanford University, Stanford, California, USA
| | - Philip A. Beachy
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Biochemistry, Stanford University School of Medicine, Stanford, California, USA
- Howard Hughes Medical Institute, USA
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, California, USA
| | - Charles K. F. Chan
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, California USA
| | - Antoine de Morree
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Benson M. George
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Gunsagar S. Gulati
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Yan Hang
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, California, USA
| | - Kerwyn Casey Huang
- Chan Zuckerberg Biohub, San Francisco, California, USA
- Department of Bioengineering, Stanford University, Stanford, California, USA
- Department of Microbiology & Immunology, Stanford University School of Medicine, Stanford, California, USA
| | - Tal Iram
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Taichi Isobe
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Aaron M. Kershner
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Bernhard M. Kiss
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - William Kong
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Guang Li
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA
| | - Qingyun Li
- Department of Neurobiology, Stanford University School of Medicine, Stanford, CA USA
| | - Ling Liu
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Wan-Jin Lu
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Biochemistry, Stanford University School of Medicine, Stanford, California, USA
| | - Ahmad N. Nabhan
- Department of Biochemistry, Stanford University School of Medicine, Stanford, California, USA
| | - Katharine M. Ng
- Department of Bioengineering, Stanford University, Stanford, California, USA
| | - Patricia K. Nguyen
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA
| | - Weng Chuan Peng
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, California, USA
| | - Eric J. Rulifson
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, California, USA
| | - Nicholas Schaum
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Shaheen S. Sikandar
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Rahul Sinha
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
- Ludwig Center for Cancer Stem Cell Research and Medicine, Stanford University School of Medicine, Stanford, California, USA
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, USA
| | - Krzysztof Szade
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Medical Biotechnology, Faculty of Biophysics, Biochemistry and Biotechnology, Jagiellonian University, Poland
| | - Kyle J. Travaglini
- Department of Biochemistry, Stanford University School of Medicine, Stanford, California, USA
| | - Carolina Tropini
- Department of Microbiology & Immunology, Stanford University School of Medicine, Stanford, California, USA
| | - Bruce M. Wang
- Department of Medicine and Liver Center, University of California San Francisco, San Francisco, California, USA
| | - Kenneth Weinberg
- Department of Pediatrics, Stanford University school of Medicine, Stanford, California, USA
| | - Michael N. Wosczyna
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Sean M. Wu
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA
| | - Hanadie Yousef
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Ben A. Barres
- Department of Neurobiology, Stanford University School of Medicine, Stanford, CA USA
| | - Philip A. Beachy
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Biochemistry, Stanford University School of Medicine, Stanford, California, USA
- Howard Hughes Medical Institute, USA
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, California, USA
| | - Charles K. F. Chan
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, California USA
| | - Michael F. Clarke
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | | | - Kerwyn Casey Huang
- Chan Zuckerberg Biohub, San Francisco, California, USA
- Department of Bioengineering, Stanford University, Stanford, California, USA
- Department of Microbiology & Immunology, Stanford University School of Medicine, Stanford, California, USA
| | - Jim Karkanias
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Seung K. Kim
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine and Stanford Diabetes Research Center, Stanford University, Stanford, California USA
| | - Mark A. Krasnow
- Department of Biochemistry, Stanford University School of Medicine, Stanford, California, USA
- Howard Hughes Medical Institute, USA
| | - Maya E. Kumar
- Sean N. Parker Center for Asthma and Allergy Research, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Division of Pulmonary and Critical Care, Stanford University School of Medicine, Stanford, California, USA
| | - Christin S. Kuo
- Department of Biochemistry, Stanford University School of Medicine, Stanford, California, USA
- Howard Hughes Medical Institute, USA
- Department of Pediatrics, Stanford University school of Medicine, Stanford, California, USA
| | - Andrew P. May
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Ross J. Metzger
- Vera Moulton Wall Center for Pulmonary and Vascular Disease, Stanford University School of Medicine, Stanford, California, USA
- Department of Pediatrics, Division of Cardiology, Stanford University School of Medicine, Stanford, California, USA
| | - Norma F. Neff
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Roel Nusse
- Department of Biochemistry, Stanford University School of Medicine, Stanford, California, USA
- Howard Hughes Medical Institute, USA
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, California, USA
| | - Patricia K. Nguyen
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA
| | - Thomas A. Rando
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
- Paul F. Glenn Center for the Biology of Aging, Stanford University School of Medicine, Stanford, California, USA
- Center for Tissue Regeneration, Repair, and Restoration, V.A. Palo Alto Healthcare System, Palo Alto, California, USA
| | - Justin Sonnenburg
- Department of Microbiology & Immunology, Stanford University School of Medicine, Stanford, California, USA
| | - Bruce M. Wang
- Department of Medicine and Liver Center, University of California San Francisco, San Francisco, California, USA
| | - Kenneth Weinberg
- Department of Pediatrics, Stanford University school of Medicine, Stanford, California, USA
| | - Irving L. Weissman
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
- Ludwig Center for Cancer Stem Cell Research and Medicine, Stanford University School of Medicine, Stanford, California, USA
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, USA
| | - Sean M. Wu
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA
| | - Stephen R. Quake
- Chan Zuckerberg Biohub, San Francisco, California, USA
- Department of Bioengineering, Stanford University, Stanford, California, USA
| | - Tony Wyss-Coray
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
- Paul F. Glenn Center for the Biology of Aging, Stanford University School of Medicine, Stanford, California, USA
- Center for Tissue Regeneration, Repair, and Restoration, V.A. Palo Alto Healthcare System, Palo Alto, California, USA
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29
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Nguyen PK, Neofytou E, Rhee JW, Wu JC. Potential Strategies to Address the Major Clinical Barriers Facing Stem Cell Regenerative Therapy for Cardiovascular Disease: A Review. JAMA Cardiol 2018; 1:953-962. [PMID: 27579998 DOI: 10.1001/jamacardio.2016.2750] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [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: 01/01/2023]
Abstract
Importance Although progress continues to be made in the field of stem cell regenerative medicine for the treatment of cardiovascular disease, significant barriers to clinical implementation still exist. Objectives To summarize the current barriers to the clinical implementation of stem cell therapy in patients with cardiovascular disease and to discuss potential strategies to overcome them. Evidence Review Information for this review was obtained through a search of PubMed and the Cochrane database for English-language studies published between January 1, 2000, and July 25, 2016. Ten randomized clinical trials and 8 systematic reviews were included. Findings One of the major clinical barriers facing the routine implementation of stem cell therapy in patients with cardiovascular disease is the limited and inconsistent benefit observed thus far. Reasons for this finding are unclear but may be owing to poor cell retention and survival, as suggested by numerous preclinical studies and a small number of human studies incorporating imaging to determine cell fate. Additional studies in humans using imaging to determine cell fate are needed to understand how these factors contribute to the limited efficacy of stem cell therapy. Treatment strategies to address poor cell retention and survival are under investigation and include the following: coadministration of immunosuppressive and prosurvival agents, delivery of cardioprotective factors packaged in exosomes rather than the cells themselves, and use of tissue-engineering strategies to provide structural support for cells. If larger grafts are achieved using these strategies, it will be imperative to carefully monitor for the potential risks of tumorigenicity, immunogenicity, and arrhythmogenicity. Conclusions and Relevance Despite important achievements to date, stem cell therapy is not yet ready for routine clinical implementation. Significant research is still needed to address the clinical barriers outlined herein before the next wave of large clinical trials is under way.
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Affiliation(s)
- Patricia K Nguyen
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California2Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California3Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Evgenios Neofytou
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California2Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - June-Wha Rhee
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California2Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Joseph C Wu
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California2Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California4Department of Radiology, Stanford University School of Medicine, Stanford, California
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30
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Abstract
Importance Stem cell therapy is a promising treatment strategy for patients with heart failure, which accounts for more than 10% of deaths in the United States annually. Despite more than a decade of research, further investigation is still needed to determine whether stem cell regenerative therapy is an effective treatment strategy and can be routinely implemented in clinical practice. Objective To describe the progress in cardiac stem cell regenerative therapy using adult stem cells and to highlight the merits and limitations of clinical trials performed to date. Evidence Review Information for this review was obtained through a search of PubMed and the Cochrane database for English-language studies published between January 1, 2000, and July 26, 2016. Twenty-nine randomized clinical trials and 7 systematic reviews and meta-analyses were included in this review. Findings Although adult stem cells were once believed to have the ability to create new heart tissue, preclinical studies suggest that these cells release cardioprotective paracrine factors that activate endogenous pathways, leading to myocardial repair. Subsequent randomized clinical trials, most of which used autologous bone marrow mononuclear cells, have found only a modest benefit in patients receiving stem cell therapy. The lack of a significant benefit may result from variations in trial methods, discrepancies in reporting, and an overreliance on surrogate end points. Conclusions and Relevance Although stem cell therapy for cardiovascular disease is not yet ready for routine clinical application, significant progress continues to be made. Physicians should be aware of the current status of this treatment so that they can better inform their patients who may be in search of alternative therapies.
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Affiliation(s)
- Patricia K Nguyen
- Stanford Cardiovascular Institute, Stanford University, Stanford, California2Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California3Veterans Affairs Palo Alto Health Care System, Stanford University, Stanford, California
| | - June-Wha Rhee
- Stanford Cardiovascular Institute, Stanford University, Stanford, California2Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California
| | - Joseph C Wu
- Stanford Cardiovascular Institute, Stanford University, Stanford, California2Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California4Department of Radiology, Stanford University, Stanford, California
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31
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Wardak M, Nguyen PK. The Gift of Light: Using Multiplexed Optical Imaging to Probe Cardiac Metabolism in Health and Disease. Circ Cardiovasc Imaging 2018; 11:e007597. [PMID: 29555838 DOI: 10.1161/circimaging.118.007597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mirwais Wardak
- From the Department of Radiology (M.W.), Molecular Imaging Program at Stanford (MIPS) (M.W.), Division of Cardiovascular Medicine, Department of Medicine (P.K.N.), and Stanford Cardiovascular Institute (M.W., P.K.N.), Stanford University School of Medicine, CA; and Cardiology Section, Veterans Affairs Palo Alto Health Care Administration, CA (P.K.N.)
| | - Patricia K Nguyen
- From the Department of Radiology (M.W.), Molecular Imaging Program at Stanford (MIPS) (M.W.), Division of Cardiovascular Medicine, Department of Medicine (P.K.N.), and Stanford Cardiovascular Institute (M.W., P.K.N.), Stanford University School of Medicine, CA; and Cardiology Section, Veterans Affairs Palo Alto Health Care Administration, CA (P.K.N.).
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32
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Lee AS, Inayathullah M, Lijkwan MA, Zhao X, Sun W, Park S, Hong WX, Parekh MB, Malkovskiy AV, Lau E, Qin X, Pothineni VR, Sanchez-Freire V, Zhang WY, Kooreman NG, Ebert AD, Chan CKF, Nguyen PK, Rajadas J, Wu JC. Prolonged survival of transplanted stem cells after ischaemic injury via the slow release of pro-survival peptides from a collagen matrix. Nat Biomed Eng 2018; 2:104-113. [PMID: 29721363 DOI: 10.1038/s41551-018-0191-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Stem-cell-based therapies hold considerable promise for regenerative medicine. However, acute donor-cell death within several weeks after cell delivery remains a critical hurdle for clinical translation. Co-transplantation of stem cells with pro-survival factors can improve cell engraftment, but this strategy has been hampered by the typically short half-lives of the factors and by the use of Matrigel and other scaffolds that are not chemically defined. Here, we report a collagen-dendrimer biomaterial crosslinked with pro-survival peptide analogues that adheres to the extracellular matrix and slowly releases the peptides, significantly prolonging stem cell survival in mouse models of ischaemic injury. The biomaterial can serve as a generic delivery system to improve functional outcomes in cell-replacement therapy.
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Affiliation(s)
- Andrew S Lee
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.,Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, CA, USA.,Biomaterials and Advanced Drug Delivery Laboratory, Stanford University School of Medicine, Stanford, CA, USA.,Pharmacology Division, Stanford University School of Medicine, Stanford, CA, USA
| | - Mohammed Inayathullah
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.,Biomaterials and Advanced Drug Delivery Laboratory, Stanford University School of Medicine, Stanford, CA, USA.,Pharmacology Division, Stanford University School of Medicine, Stanford, CA, USA
| | - Maarten A Lijkwan
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Xin Zhao
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Wenchao Sun
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.,Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, CA, USA.,Biomaterials and Advanced Drug Delivery Laboratory, Stanford University School of Medicine, Stanford, CA, USA.,Pharmacology Division, Stanford University School of Medicine, Stanford, CA, USA
| | - Sujin Park
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.,Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Wan Xing Hong
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.,Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Mansi B Parekh
- Biomaterials and Advanced Drug Delivery Laboratory, Stanford University School of Medicine, Stanford, CA, USA
| | - Andrey V Malkovskiy
- Biomaterials and Advanced Drug Delivery Laboratory, Stanford University School of Medicine, Stanford, CA, USA
| | - Edward Lau
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Xulei Qin
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Venkata Raveendra Pothineni
- Biomaterials and Advanced Drug Delivery Laboratory, Stanford University School of Medicine, Stanford, CA, USA
| | - Verónica Sanchez-Freire
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.,Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Wendy Y Zhang
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.,Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Nigel G Kooreman
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.,Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Antje D Ebert
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.,Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Charles K F Chan
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Patricia K Nguyen
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA. .,Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, CA, USA.
| | - Jayakumar Rajadas
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA. .,Biomaterials and Advanced Drug Delivery Laboratory, Stanford University School of Medicine, Stanford, CA, USA. .,Pharmacology Division, Stanford University School of Medicine, Stanford, CA, USA.
| | - Joseph C Wu
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA. .,Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA. .,Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, CA, USA. .,Pharmacology Division, Stanford University School of Medicine, Stanford, CA, USA.
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33
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Abstract
Stem cell therapy holds great promise for the repair and regeneration of damaged myocardium. Disappointing results from recent large-scale randomized trials using adult stem cells, however, have led some to question the efficacy of this new therapeutic. Because most clinical stem cell trials have not incorporated molecular imaging to track cell fate, it may be premature to abandon this approach. Herein, we will review how multimodality imaging can be incorporated into cardiac regenerative therapy to facilitate the translation of stem cell therapy.
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Affiliation(s)
- Davis Vo
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA
- Cardiology Section, Department of Medicine, Veterans Affairs, 3801 Miranda Ave, Palo Alto, CA, 94304, USA
| | - Patricia K Nguyen
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA.
- Cardiology Section, Department of Medicine, Veterans Affairs, 3801 Miranda Ave, Palo Alto, CA, 94304, USA.
- Stanford University, 300 Pasteur Drive, Grant Building, S114, Stanford, CA, 94305-5208, USA.
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InanlooRahatloo K, Liang G, Vo D, Ebert A, Nguyen I, Nguyen PK. Sex-based differences in myocardial gene expression in recently deceased organ donors with no prior cardiovascular disease. PLoS One 2017; 12:e0183874. [PMID: 28850583 PMCID: PMC5574577 DOI: 10.1371/journal.pone.0183874] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 06/12/2017] [Accepted: 08/12/2017] [Indexed: 02/08/2023] Open
Abstract
Sex differences in the development of the normal heart and the prevalence of cardiomyopathies have been reported. The molecular basis of these differences remains unclear. Sex differences in the human heart might be related to patterns of gene expression. Recent studies have shown that sex specific differences in gene expression in tissues including the brain, kidney, skeletal muscle, and liver. Similar data is limited for the heart. Herein we address this issue by analyzing donor and post-mortem adult human heart samples originating from 46 control individuals to study whole-genome gene expression in the human left ventricle. Using data from the genotype tissue expression (GTEx) project, we compared the transcriptome expression profiles of male and female hearts. We found that genes located on sex chromosomes were the most abundant ones among the sexually dimorphic genes. The majority of differentially expressed autosomal genes were those involved in the regulation of inflammation, which has been found to be an important contributor to left ventricular remodeling. Specifically, genes on autosomal chromosomes encoding chemokines with inflammatory functions (e.g. CCL4, CX3CL1, TNFAIP3) and a gene that regulates adhesion of immune cells to the endothelium (e.g., VCAM1) were identified with sex-specific expression levels. This study underlines the relevance of sex as an important modifier of cardiac gene expression. These results have important implications in the understanding of the differences in the physiology of the male and female heart transcriptome and how they may lead to different sex specific difference in human cardiac health and its control.
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Affiliation(s)
- Kolsoum InanlooRahatloo
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, United States of America
- Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, California, United States of America
- Department of Genetics, Genetic Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Grace Liang
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, United States of America
| | - Davis Vo
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, United States of America
| | - Antje Ebert
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, United States of America
| | - Ivy Nguyen
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, United States of America
| | - Patricia K. Nguyen
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, United States of America
- Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, California, United States of America
- Institute of Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, United States of America
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University and Veterans Affairs Palo Alto, Palo Alto, California, United States of America
- * E-mail: ,
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Lee AS, Tang C, Hong WX, Park S, Bazalova-Carter M, Nelson G, Sanchez-Freire V, Bakerman I, Zhang W, Neofytou E, Connolly AJ, Chan CK, Graves EE, Weissman IL, Nguyen PK, Wu JC. Brief Report: External Beam Radiation Therapy for the Treatment of Human Pluripotent Stem Cell-Derived Teratomas. Stem Cells 2017; 35:1994-2000. [PMID: 28600830 DOI: 10.1002/stem.2653] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 03/06/2017] [Accepted: 04/06/2017] [Indexed: 01/17/2023]
Abstract
Human pluripotent stem cells, including human embryonic stem cells (hESCs) and human induced PSCs (hiPSCs), have great potential as an unlimited donor source for cell-based therapeutics. The risk of teratoma formation from residual undifferentiated cells, however, remains a critical barrier to the clinical application of these cells. Herein, we describe external beam radiation therapy (EBRT) as an attractive option for the treatment of this iatrogenic growth. We present evidence that EBRT is effective in arresting growth of hESC-derived teratomas in vivo at day 28 post-implantation by using a microCT irradiator capable of targeted treatment in small animals. Within several days of irradiation, teratomas derived from injection of undifferentiated hESCs and hiPSCs demonstrated complete growth arrest lasting several months. In addition, EBRT reduced reseeding potential of teratoma cells during serial transplantation experiments, requiring irradiated teratomas to be seeded at 1 × 103 higher doses to form new teratomas. We demonstrate that irradiation induces teratoma cell apoptosis, senescence, and growth arrest, similar to established radiobiology mechanisms. Taken together, these results provide proof of concept for the use of EBRT in the treatment of existing teratomas and highlight a strategy to increase the safety of stem cell-based therapies. Stem Cells 2017;35:1994-2000.
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Affiliation(s)
- Andrew S Lee
- Institute of Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA.,Department of Radiology, Molecular Imaging Program, Stanford University School of Medicine, Stanford, California, USA.,Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA.,Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, California, USA
| | - Chad Tang
- Institute of Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA.,Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA.,Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Wan Xing Hong
- Institute of Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA.,Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA.,Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, California, USA
| | - Sujin Park
- Institute of Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA.,Department of Radiology, Molecular Imaging Program, Stanford University School of Medicine, Stanford, California, USA.,Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA.,Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, California, USA
| | - Magdalena Bazalova-Carter
- Department of Radiology, Molecular Imaging Program, Stanford University School of Medicine, Stanford, California, USA.,Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA.,Department of Physics and Astronomy, University of Victoria, Houston, Victoria, British Columbia, Canada
| | - Geoff Nelson
- Department of Radiology, Molecular Imaging Program, Stanford University School of Medicine, Stanford, California, USA.,Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA.,Department of Radiation Oncology, University of Utah, Salt Lake City, Utah, USA
| | - Veronica Sanchez-Freire
- Institute of Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA.,Department of Radiology, Molecular Imaging Program, Stanford University School of Medicine, Stanford, California, USA.,Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA.,Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, California, USA
| | - Isaac Bakerman
- Institute of Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA.,Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA.,Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, California, USA
| | - Wendy Zhang
- Department of Radiology, Molecular Imaging Program, Stanford University School of Medicine, Stanford, California, USA.,Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA.,Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, California, USA
| | - Evgenios Neofytou
- Institute of Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA.,Department of Radiology, Molecular Imaging Program, Stanford University School of Medicine, Stanford, California, USA.,Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA.,Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, California, USA
| | - Andrew J Connolly
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Charles K Chan
- Institute of Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Edward E Graves
- Department of Radiology, Molecular Imaging Program, Stanford University School of Medicine, Stanford, California, USA.,Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Irving L Weissman
- Institute of Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA.,Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA.,Stanford Ludwig Center for Cancer Stem Cell Research and Medicine
| | - Patricia K Nguyen
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA.,Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, California, USA
| | - Joseph C Wu
- Institute of Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA.,Department of Radiology, Molecular Imaging Program, Stanford University School of Medicine, Stanford, California, USA.,Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA.,Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, California, USA
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Lee WH, Nguyen PK, Fleischmann D, Wu JC. DNA damage-associated biomarkers in studying individual sensitivity to low-dose radiation from cardiovascular imaging. Eur Heart J 2016; 37:3075-3080. [PMID: 27272147 PMCID: PMC6279211 DOI: 10.1093/eurheartj/ehw206] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 04/10/2016] [Accepted: 05/04/2016] [Indexed: 12/29/2022] Open
Affiliation(s)
- Won Hee Lee
- Department of Medicine, Division of Cardiology
- Department of Radiology
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Patricia K Nguyen
- Department of Medicine, Division of Cardiology
- Department of Radiology
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Dominik Fleischmann
- Department of Radiology
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Joseph C Wu
- Department of Medicine, Division of Cardiology
- Department of Radiology
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
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Abstract
Molecular probes provide imaging signal and contrast for the visualization, characterization, and measurement of biological processes at the molecular level. These probes can be designed to target the cell or tissue of interest and must be retained at the imaging site until they can be detected by the appropriate imaging modality. In this article, we will discuss the basic design of molecular probes, differences among the various types of probes, and general strategies for their evaluation of cardiovascular disease.
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Affiliation(s)
- Grace Liang
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, 3801 Miranda Ave, Stanford, CA, 94304, USA
- Cardiology Section, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Patricia K Nguyen
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, 3801 Miranda Ave, Stanford, CA, 94304, USA.
- Cardiology Section, VA Palo Alto Health Care System, Palo Alto, CA, USA.
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Ong SG, Huber BC, Lee WH, Kodo K, Ebert AD, Ma Y, Nguyen PK, Diecke S, Chen WY, Wu JC. Microfluidic Single-Cell Analysis of Transplanted Human Induced Pluripotent Stem Cell-Derived Cardiomyocytes After Acute Myocardial Infarction. Circulation 2015; 132:762-771. [PMID: 26304668 DOI: 10.1161/circulationaha.114.015231] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Human induced pluripotent stem cells (iPSCs) are attractive candidates for therapeutic use, with the potential to replace deficient cells and to improve functional recovery in injury or disease settings. Here, we test the hypothesis that human iPSC-derived cardiomyocytes (iPSC-CMs) can secrete cytokines as a molecular basis to attenuate adverse cardiac remodeling after myocardial infarction. METHODS AND RESULTS Human iPSCs were generated from skin fibroblasts and differentiated in vitro with a small molecule-based protocol. Troponin(+) iPSC-CMs were confirmed by immunohistochemistry, quantitative polymerase chain reaction, fluorescence-activated cell sorting, and electrophysiological measurements. Afterward, 2×10(6) iPSC-CMs derived from a cell line transduced with a vector expressing firefly luciferase and green fluorescent protein were transplanted into adult NOD/SCID mice with acute left anterior descending artery ligation. Control animals received PBS injection. Bioluminescence imaging showed limited engraftment on transplantation into ischemic myocardium. However, magnetic resonance imaging of animals transplanted with iPSC-CMs showed significant functional improvement and attenuated cardiac remodeling compared with PBS-treated control animals. To understand the underlying molecular mechanism, microfluidic single-cell profiling of harvested iPSC-CMs, laser capture microdissection of host myocardium, and in vitro ischemia stimulation were used to demonstrate that the iPSC-CMs could release significant levels of proangiogenic and antiapoptotic factors in the ischemic microenvironment. CONCLUSIONS Transplantation of human iPSC-CMs into an acute mouse myocardial infarction model can improve left ventricular function and attenuate cardiac remodeling. Because of limited engraftment, most of the effects are possibly explained by paracrine activity of these cells.
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Affiliation(s)
- Sang-Ging Ong
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA.,Depts of Medicine and Radiology, Stanford University School of Medicine, Stanford, CA.,Institute of Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA
| | - Bruno C Huber
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA.,Depts of Medicine and Radiology, Stanford University School of Medicine, Stanford, CA.,Ludwig-Maximilians-University, Medical Department I, Campus Grosshadern, Munich, Germany
| | - Won Hee Lee
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA.,Depts of Medicine and Radiology, Stanford University School of Medicine, Stanford, CA
| | - Kazuki Kodo
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA.,Depts of Medicine and Radiology, Stanford University School of Medicine, Stanford, CA
| | - Antje D Ebert
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA.,Depts of Medicine and Radiology, Stanford University School of Medicine, Stanford, CA
| | - Yu Ma
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA.,Depts of Medicine and Radiology, Stanford University School of Medicine, Stanford, CA
| | - Patricia K Nguyen
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA.,Depts of Medicine and Radiology, Stanford University School of Medicine, Stanford, CA
| | - Sebastian Diecke
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA.,Depts of Medicine and Radiology, Stanford University School of Medicine, Stanford, CA
| | - Wen-Yi Chen
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA.,Depts of Medicine and Radiology, Stanford University School of Medicine, Stanford, CA
| | - Joseph C Wu
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA.,Depts of Medicine and Radiology, Stanford University School of Medicine, Stanford, CA.,Institute of Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA
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40
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Affiliation(s)
- Patricia K Nguyen
- Stanford Cardiovascular Institute, Stanford University School of Medicine, 300 Pasteur Drive, Grant Building S140, Stanford, CA, 94305-5111, USA,
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Dash R, Kim PJ, Matsuura Y, Ikeno F, Metzler S, Huang NF, Lyons JK, Nguyen PK, Ge X, Foo CWP, McConnell MV, Wu JC, Yeung AC, Harnish P, Yang PC. Manganese-Enhanced Magnetic Resonance Imaging Enables In Vivo Confirmation of Peri-Infarct Restoration Following Stem Cell Therapy in a Porcine Ischemia-Reperfusion Model. J Am Heart Assoc 2015. [PMID: 26215972 PMCID: PMC4608088 DOI: 10.1161/jaha.115.002044] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background The exact mechanism of stem cell therapy in augmenting the function of ischemic cardiomyopathy is unclear. In this study, we hypothesized that increased viability of the peri-infarct region (PIR) produces restorative benefits after stem cell engraftment. A novel multimodality imaging approach simultaneously assessed myocardial viability (manganese-enhanced magnetic resonance imaging [MEMRI]), myocardial scar (delayed gadolinium enhancement MRI), and transplanted stem cell engraftment (positron emission tomography reporter gene) in the injured porcine hearts. Methods and Results Twelve adult swine underwent ischemia–reperfusion injury. Digital subtraction of MEMRI-negative myocardium (intrainfarct region) from delayed gadolinium enhancement MRI–positive myocardium (PIR and intrainfarct region) clearly delineated the PIR in which the MEMRI-positive signal reflected PIR viability. Human amniotic mesenchymal stem cells (hAMSCs) represent a unique population of immunomodulatory mesodermal stem cells that restored the murine PIR. Immediately following hAMSC delivery, MEMRI demonstrated an increased PIR viability signal compared with control. Direct PIR viability remained higher in hAMSC-treated hearts for >6 weeks. Increased PIR viability correlated with improved regional contractility, left ventricular ejection fraction, infarct size, and hAMSC engraftment, as confirmed by immunocytochemistry. Increased MEMRI and positron emission tomography reporter gene signal in the intrainfarct region and the PIR correlated with sustained functional augmentation (global and regional) within the hAMSC group (mean change, left ventricular ejection fraction: hAMSC 85±60%, control 8±10%; P<0.05) and reduced chamber dilatation (left ventricular end-diastole volume increase: hAMSC 24±8%, control 110±30%; P<0.05). Conclusions The positron emission tomography reporter gene signal of hAMSC engraftment correlates with the improved MEMRI signal in the PIR. The increased MEMRI signal represents PIR viability and the restorative potential of the injured heart. This in vivo multimodality imaging platform represents a novel, real-time method of tracking PIR viability and stem cell engraftment while providing a mechanistic explanation of the therapeutic efficacy of cardiovascular stem cells.
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Affiliation(s)
- Rajesh Dash
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA (R.D., P.J.K., Y.M., F.I., S.M., N.F.H., J.K.L., P.K.N., X.G., M.V.M.C., J.C.W., A.C.Y., P.C.Y.) Stanford Cardiovascular Institute, Stanford University, Stanford, CA (R.D., N.F.H., P.K.N., M.V.M.C., J.C.W., P.C.Y.)
| | - Paul J Kim
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA (R.D., P.J.K., Y.M., F.I., S.M., N.F.H., J.K.L., P.K.N., X.G., M.V.M.C., J.C.W., A.C.Y., P.C.Y.)
| | - Yuka Matsuura
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA (R.D., P.J.K., Y.M., F.I., S.M., N.F.H., J.K.L., P.K.N., X.G., M.V.M.C., J.C.W., A.C.Y., P.C.Y.)
| | - Fumiaki Ikeno
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA (R.D., P.J.K., Y.M., F.I., S.M., N.F.H., J.K.L., P.K.N., X.G., M.V.M.C., J.C.W., A.C.Y., P.C.Y.)
| | - Scott Metzler
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA (R.D., P.J.K., Y.M., F.I., S.M., N.F.H., J.K.L., P.K.N., X.G., M.V.M.C., J.C.W., A.C.Y., P.C.Y.)
| | - Ngan F Huang
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA (R.D., P.J.K., Y.M., F.I., S.M., N.F.H., J.K.L., P.K.N., X.G., M.V.M.C., J.C.W., A.C.Y., P.C.Y.) Stanford Cardiovascular Institute, Stanford University, Stanford, CA (R.D., N.F.H., P.K.N., M.V.M.C., J.C.W., P.C.Y.)
| | - Jennifer K Lyons
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA (R.D., P.J.K., Y.M., F.I., S.M., N.F.H., J.K.L., P.K.N., X.G., M.V.M.C., J.C.W., A.C.Y., P.C.Y.)
| | - Patricia K Nguyen
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA (R.D., P.J.K., Y.M., F.I., S.M., N.F.H., J.K.L., P.K.N., X.G., M.V.M.C., J.C.W., A.C.Y., P.C.Y.) Stanford Cardiovascular Institute, Stanford University, Stanford, CA (R.D., N.F.H., P.K.N., M.V.M.C., J.C.W., P.C.Y.)
| | - Xiaohu Ge
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA (R.D., P.J.K., Y.M., F.I., S.M., N.F.H., J.K.L., P.K.N., X.G., M.V.M.C., J.C.W., A.C.Y., P.C.Y.)
| | | | - Michael V McConnell
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA (R.D., P.J.K., Y.M., F.I., S.M., N.F.H., J.K.L., P.K.N., X.G., M.V.M.C., J.C.W., A.C.Y., P.C.Y.) Department of Electrical Engineering, Stanford University, Stanford, CA (M.V.M.C.) Stanford Cardiovascular Institute, Stanford University, Stanford, CA (R.D., N.F.H., P.K.N., M.V.M.C., J.C.W., P.C.Y.)
| | - Joseph C Wu
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA (R.D., P.J.K., Y.M., F.I., S.M., N.F.H., J.K.L., P.K.N., X.G., M.V.M.C., J.C.W., A.C.Y., P.C.Y.) Stanford Cardiovascular Institute, Stanford University, Stanford, CA (R.D., N.F.H., P.K.N., M.V.M.C., J.C.W., P.C.Y.)
| | - Alan C Yeung
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA (R.D., P.J.K., Y.M., F.I., S.M., N.F.H., J.K.L., P.K.N., X.G., M.V.M.C., J.C.W., A.C.Y., P.C.Y.)
| | | | - Phillip C Yang
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA (R.D., P.J.K., Y.M., F.I., S.M., N.F.H., J.K.L., P.K.N., X.G., M.V.M.C., J.C.W., A.C.Y., P.C.Y.) Stanford Cardiovascular Institute, Stanford University, Stanford, CA (R.D., N.F.H., P.K.N., M.V.M.C., J.C.W., P.C.Y.)
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Nguyen PK, Lee WH, Li YF, Hong WX, Hu S, Chan C, Liang G, Nguyen I, Ong SG, Churko J, Wang J, Altman RB, Fleischmann D, Wu JC. Assessment of the Radiation Effects of Cardiac CT Angiography Using Protein and Genetic Biomarkers. JACC Cardiovasc Imaging 2015. [PMID: 26210695 DOI: 10.1016/j.jcmg.2015.04.016] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate whether radiation exposure from cardiac computed tomographic angiography (CTA) is associated with deoxyribonucleic acid (DNA) damage and whether damage leads to programmed cell death and activation of genes involved in apoptosis and DNA repair. BACKGROUND Exposure to radiation from medical imaging has become a public health concern, but whether it causes significant cell damage remains unclear. METHODS We conducted a prospective cohort study in 67 patients undergoing cardiac CTA between January 2012 and December 2013 in 2 U.S. medical centers. Median blood radiation exposure was estimated using phantom dosimetry. Biomarkers of DNA damage and apoptosis were measured by flow cytometry, whole genome sequencing, and single cell polymerase chain reaction. RESULTS The median dose length product was 1,535.3 mGy·cm (969.7 to 2,674.0 mGy·cm). The median radiation dose to the blood was 29.8 mSv (18.8 to 48.8 mSv). Median DNA damage increased 3.39% (1.29% to 8.04%, p < 0.0001) and median apoptosis increased 3.1-fold (interquartile range [IQR]: 1.4- to 5.1-fold, p < 0.0001) post-radiation. Whole genome sequencing revealed changes in the expression of 39 transcription factors involved in the regulation of apoptosis, cell cycle, and DNA repair. Genes involved in mediating apoptosis and DNA repair were significantly changed post-radiation, including DDB2 (1.9-fold [IQR: 1.5- to 3.0-fold], p < 0.001), XRCC4 (3.0-fold [IQR: 1.1- to 5.4-fold], p = 0.005), and BAX (1.6-fold [IQR: 0.9- to 2.6-fold], p < 0.001). Exposure to radiation was associated with DNA damage (odds ratio [OR]: 1.8 [1.2 to 2.6], p = 0.003). DNA damage was associated with apoptosis (OR: 1.9 [1.2 to 5.1], p < 0.0001) and gene activation (OR: 2.8 [1.2 to 6.2], p = 0.002). CONCLUSIONS Patients exposed to >7.5 mSv of radiation from cardiac CTA had evidence of DNA damage, which was associated with programmed cell death and activation of genes involved in apoptosis and DNA repair.
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Affiliation(s)
- Patricia K Nguyen
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California; Veterans Administration Palo Alto, Palo Alto, California; Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, California.
| | - Won Hee Lee
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California; Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, California
| | - Yong Fuga Li
- Department of Genetics, Stanford University School of Medicine, Stanford, California
| | - Wan Xing Hong
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California; Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, California
| | - Shijun Hu
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California; Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, California
| | - Charles Chan
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Grace Liang
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Ivy Nguyen
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Sang-Ging Ong
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California; Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, California
| | - Jared Churko
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California; Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, California
| | - Jia Wang
- Environmental Health and Safety, Stanford University School of Medicine, Stanford, California
| | - Russ B Altman
- Department of Genetics, Stanford University School of Medicine, Stanford, California
| | - Dominik Fleischmann
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California; Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Joseph C Wu
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California; Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, California; Department of Radiology, Stanford University School of Medicine, Stanford, California.
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Lan F, Lee AS, Liang P, Sanchez-Freire V, Nguyen PK, Wang L, Han L, Yen M, Wang Y, Sun N, Abilez OJ, Hu S, Ebert AD, Navarrete EG, Simmons CS, Wheeler M, Pruitt B, Lewis R, Yamaguchi Y, Ashley EA, Bers DM, Robbins RC, Longaker MT, Wu JC. Abnormal calcium handling properties underlie familial hypertrophic cardiomyopathy pathology in patient-specific induced pluripotent stem cells. Cell Stem Cell 2013; 12:101-13. [PMID: 23290139 DOI: 10.1016/j.stem.2012.10.010] [Citation(s) in RCA: 475] [Impact Index Per Article: 43.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 08/16/2012] [Accepted: 10/12/2012] [Indexed: 12/14/2022]
Abstract
Familial hypertrophic cardiomyopathy (HCM) is a prevalent hereditary cardiac disorder linked to arrhythmia and sudden cardiac death. While the causes of HCM have been identified as genetic mutations in the cardiac sarcomere, the pathways by which sarcomeric mutations engender myocyte hypertrophy and electrophysiological abnormalities are not understood. To elucidate the mechanisms underlying HCM development, we generated patient-specific induced pluripotent stem cell cardiomyocytes (iPSC-CMs) from a ten-member family cohort carrying a hereditary HCM missense mutation (Arg663His) in the MYH7 gene. Diseased iPSC-CMs recapitulated numerous aspects of the HCM phenotype including cellular enlargement and contractile arrhythmia at the single-cell level. Calcium (Ca(2+)) imaging indicated dysregulation of Ca(2+) cycling and elevation in intracellular Ca(2+) ([Ca(2+)](i)) are central mechanisms for disease pathogenesis. Pharmacological restoration of Ca(2+) homeostasis prevented development of hypertrophy and electrophysiological irregularities. We anticipate that these findings will help elucidate the mechanisms underlying HCM development and identify novel therapies for the disease.
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Affiliation(s)
- Feng Lan
- Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, CA 94305, USA
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Liang P, Lan F, Lee AS, Gong T, Sanchez-Freire V, Wang Y, Diecke S, Sallam K, Knowles JW, Wang PJ, Nguyen PK, Bers DM, Robbins RC, Wu JC. Drug screening using a library of human induced pluripotent stem cell-derived cardiomyocytes reveals disease-specific patterns of cardiotoxicity. Circulation 2013; 127:1677-91. [PMID: 23519760 DOI: 10.1161/circulationaha.113.001883] [Citation(s) in RCA: 371] [Impact Index Per Article: 33.7] [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: 12/14/2022]
Abstract
BACKGROUND Cardiotoxicity is a leading cause for drug attrition during pharmaceutical development and has resulted in numerous preventable patient deaths. Incidents of adverse cardiac drug reactions are more common in patients with preexisting heart disease than the general population. Here we generated a library of human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) from patients with various hereditary cardiac disorders to model differences in cardiac drug toxicity susceptibility for patients of different genetic backgrounds. METHODS AND RESULTS Action potential duration and drug-induced arrhythmia were measured at the single cell level in hiPSC-CMs derived from healthy subjects and patients with hereditary long QT syndrome, familial hypertrophic cardiomyopathy, and familial dilated cardiomyopathy. Disease phenotypes were verified in long QT syndrome, hypertrophic cardiomyopathy, and dilated cardiomyopathy hiPSC-CMs by immunostaining and single cell patch clamp. Human embryonic stem cell-derived cardiomyocytes (hESC-CMs) and the human ether-a-go-go-related gene expressing human embryonic kidney cells were used as controls. Single cell PCR confirmed expression of all cardiac ion channels in patient-specific hiPSC-CMs as well as hESC-CMs, but not in human embryonic kidney cells. Disease-specific hiPSC-CMs demonstrated increased susceptibility to known cardiotoxic drugs as measured by action potential duration and quantification of drug-induced arrhythmias such as early afterdepolarizations and delayed afterdepolarizations. CONCLUSIONS We have recapitulated drug-induced cardiotoxicity profiles for healthy subjects, long QT syndrome, hypertrophic cardiomyopathy, and dilated cardiomyopathy patients at the single cell level for the first time. Our data indicate that healthy and diseased individuals exhibit different susceptibilities to cardiotoxic drugs and that use of disease-specific hiPSC-CMs may predict adverse drug responses more accurately than the standard human ether-a-go-go-related gene test or healthy control hiPSC-CM/hESC-CM screening assays.
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Affiliation(s)
- Ping Liang
- Stanford University School of Medicine, Lorry I. Lokey Stem Cell Research Building, 265 Campus Drive, Stanford, CA 94305-5111
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Nguyen PK, Lee KH, Moon J, Kim SI, Ahn KA, Chen LH, Lee SM, Chen RK, Jin S, Berkowitz AE. Spark erosion: a high production rate method for producing Bi(0.5)Sb(1.5)Te3 nanoparticles with enhanced thermoelectric performance. Nanotechnology 2012; 23:415604. [PMID: 23011121 DOI: 10.1088/0957-4484/23/41/415604] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We report a new 'spark erosion' technique for producing high-quality thermoelectric nanoparticles at a remarkably high rate and with enhanced thermoelectric properties. The technique was utilized to synthesize p-type Bi(0.5)Sb(1.5)Te(3) nanoparticles with a production rate as high as 135 g h(-1), using a relatively small laboratory apparatus and low energy consumption. The compacted nanocomposite samples made from these nanoparticles exhibit a well-defined, 20-50 nm size nanograin microstructure, and show an enhanced figure of merit, ZT, of 1.36 at 360 K. Such a technique is essential for providing inexpensive, oxidation-free nanoparticles which are required for the fabrication of high performance thermoelectric devices for power generation from waste heat, and for refrigeration.
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Affiliation(s)
- P K Nguyen
- Materials Science and Engineering, UC San Diego, CA 92093, USA
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Lan F, Liu J, Narsinh KH, Hu S, Han L, Lee AS, Karow M, Nguyen PK, Nag D, Calos MP, Robbins RC, Wu JC. Safe genetic modification of cardiac stem cells using a site-specific integration technique. Circulation 2012; 126:S20-8. [PMID: 22965984 PMCID: PMC3481839 DOI: 10.1161/circulationaha.111.084913] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Human cardiac progenitor cells (hCPCs) are a promising cell source for regenerative repair after myocardial infarction. Exploitation of their full therapeutic potential may require stable genetic modification of the cells ex vivo. Safe genetic engineering of stem cells, using facile methods for site-specific integration of transgenes into known genomic contexts, would significantly enhance the overall safety and efficacy of cellular therapy in a variety of clinical contexts. METHODS AND RESULTS We used the phiC31 site-specific recombinase to achieve targeted integration of a triple fusion reporter gene into a known chromosomal context in hCPCs and human endothelial cells. Stable expression of the reporter gene from its unique chromosomal integration site resulted in no discernible genomic instability or adverse changes in cell phenotype. Namely, phiC31-modified hCPCs were unchanged in their differentiation propensity, cellular proliferative rate, and global gene expression profile when compared with unaltered control hCPCs. Expression of the triple fusion reporter gene enabled multimodal assessment of cell fate in vitro and in vivo using fluorescence microscopy, bioluminescence imaging, and positron emission tomography. Intramyocardial transplantation of genetically modified hCPCs resulted in significant improvement in myocardial function 2 weeks after cell delivery, as assessed by echocardiography (P=0.002) and MRI (P=0.001). We also demonstrated the feasibility and therapeutic efficacy of genetically modifying differentiated human endothelial cells, which enhanced hind limb perfusion (P<0.05 at day 7 and 14 after transplantation) on laser Doppler imaging. CONCLUSIONS The phiC31 integrase genomic modification system is a safe, efficient tool to enable site-specific integration of reporter transgenes in progenitor and differentiated cell types.
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Affiliation(s)
- Feng Lan
- Department of Medicine, Division of Cardiology, Stanford School of Medicine, Stanford, California, USA
- Department of Radiology, Stanford School of Medicine, Stanford, California, USA
| | - Junwei Liu
- Department of Medicine, Division of Cardiology, Stanford School of Medicine, Stanford, California, USA
- Department of Radiology, Stanford School of Medicine, Stanford, California, USA
| | - Kazim H. Narsinh
- Department of Medicine, Division of Cardiology, Stanford School of Medicine, Stanford, California, USA
- Department of Radiology, Stanford School of Medicine, Stanford, California, USA
| | - Shijun Hu
- Department of Medicine, Division of Cardiology, Stanford School of Medicine, Stanford, California, USA
- Department of Radiology, Stanford School of Medicine, Stanford, California, USA
| | - Leng Han
- Department of Medicine, Division of Cardiology, Stanford School of Medicine, Stanford, California, USA
- Department of Radiology, Stanford School of Medicine, Stanford, California, USA
| | - Andrew S. Lee
- Department of Medicine, Division of Cardiology, Stanford School of Medicine, Stanford, California, USA
- Department of Radiology, Stanford School of Medicine, Stanford, California, USA
| | - Marisa Karow
- Department of Genetics, Stanford School of Medicine, Stanford, California, USA
| | - Patricia K. Nguyen
- Department of Medicine, Division of Cardiology, Stanford School of Medicine, Stanford, California, USA
- Department of Radiology, Stanford School of Medicine, Stanford, California, USA
| | - Divya Nag
- Department of Medicine, Division of Cardiology, Stanford School of Medicine, Stanford, California, USA
- Department of Radiology, Stanford School of Medicine, Stanford, California, USA
| | - Michele P. Calos
- Department of Genetics, Stanford School of Medicine, Stanford, California, USA
| | - Robert C. Robbins
- Department of Cardiothoracic Surgery, Stanford School of Medicine, Stanford, California, USA
- Stanford Cardiovascular Institute, Stanford School of Medicine, Stanford, California, USA
| | - Joseph C. Wu
- Department of Medicine, Division of Cardiology, Stanford School of Medicine, Stanford, California, USA
- Department of Radiology, Stanford School of Medicine, Stanford, California, USA
- Stanford Cardiovascular Institute, Stanford School of Medicine, Stanford, California, USA
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford School of Medicine, Stanford, California, USA
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Gu M, Nguyen PK, Lee AS, Xu D, Hu S, Plews JR, Han L, Huber BC, Lee WH, Gong Y, de Almeida PE, Lyons J, Ikeno F, Pacharinsak C, Connolly AJ, Gambhir SS, Robbins RC, Longaker MT, Wu JC. Microfluidic single-cell analysis shows that porcine induced pluripotent stem cell-derived endothelial cells improve myocardial function by paracrine activation. Circ Res 2012; 111:882-93. [PMID: 22821929 DOI: 10.1161/circresaha.112.269001] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [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: 01/12/2023]
Abstract
RATIONALE Induced pluripotent stem cells (iPSCs) hold great promise for the development of patient-specific therapies for cardiovascular disease. However, clinical translation will require preclinical optimization and validation of large-animal iPSC models. OBJECTIVE To successfully derive endothelial cells from porcine iPSCs and demonstrate their potential utility for the treatment of myocardial ischemia. METHODS AND RESULTS Porcine adipose stromal cells were reprogrammed to generate porcine iPSCs (piPSCs). Immunohistochemistry, quantitative PCR, microarray hybridization, and angiogenic assays confirmed that piPSC-derived endothelial cells (piPSC-ECs) shared similar morphological and functional properties as endothelial cells isolated from the autologous pig aorta. To demonstrate their therapeutic potential, piPSC-ECs were transplanted into mice with myocardial infarction. Compared with control, animals transplanted with piPSC-ECs showed significant functional improvement measured by echocardiography (fractional shortening at week 4: 27.2±1.3% versus 22.3±1.1%; P<0.001) and MRI (ejection fraction at week 4: 45.8±1.3% versus 42.3±0.9%; P<0.05). Quantitative protein assays and microfluidic single-cell PCR profiling showed that piPSC-ECs released proangiogenic and antiapoptotic factors in the ischemic microenvironment, which promoted neovascularization and cardiomyocyte survival, respectively. Release of paracrine factors varied significantly among subpopulations of transplanted cells, suggesting that transplantation of specific cell populations may result in greater functional recovery. CONCLUSIONS In summary, this is the first study to successfully differentiate piPSCs-ECs from piPSCs and demonstrate that transplantation of piPSC-ECs improved cardiac function after myocardial infarction via paracrine activation. Further development of these large animal iPSC models will yield significant insights into their therapeutic potential and accelerate the clinical translation of autologous iPSC-based therapy.
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Affiliation(s)
- Mingxia Gu
- Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, CA 94305, USA
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Liu J, Narsinh KH, Lan F, Wang L, Nguyen PK, Hu S, Lee A, Han L, Gong Y, Huang M, Nag D, Rosenberg J, Chouldechova A, Robbins RC, Wu JC. Early stem cell engraftment predicts late cardiac functional recovery: preclinical insights from molecular imaging. Circ Cardiovasc Imaging 2012; 5:481-90. [PMID: 22565608 DOI: 10.1161/circimaging.111.969329] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [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: 12/16/2022]
Abstract
BACKGROUND Human cardiac progenitor cells have demonstrated great potential for myocardial repair in small and large animals, but robust methods for longitudinal assessment of their engraftment in humans is not yet readily available. In this study, we sought to optimize and evaluate the use of positron emission tomography (PET) reporter gene imaging for monitoring human cardiac progenitor cell (hCPC) transplantation in a mouse model of myocardial infarction. METHODS AND RESULTS hCPCs were isolated and expanded from human myocardial samples and stably transduced with herpes simplex virus thymidine kinase (TK) PET reporter gene. Thymidine kinase-expressing hCPCs were characterized in vitro and transplanted into murine myocardial infarction models (n=57). Cardiac echocardiographic, magnetic resonance imaging and pressure-volume loop analyses revealed improvement in left ventricular contractile function 2 weeks after transplant (hCPC versus phosphate-buffered saline, P<0.03). Noninvasive PET imaging was used to track hCPC fate over a 4-week time period, demonstrating a substantial decline in surviving cells. Importantly, early cell engraftment as assessed by PET was found to predict subsequent functional improvement, implying a "dose-effect" relationship. We isolated the transplanted cells from recipient myocardium by laser capture microdissection for in vivo transcriptome analysis. Our results provide direct evidence that hCPCs augment cardiac function after their transplantation into ischemic myocardium through paracrine secretion of growth factors. CONCLUSIONS PET reporter gene imaging can provide important diagnostic and prognostic information regarding the ultimate success of hCPC treatment for myocardial infarction.
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Affiliation(s)
- Junwei Liu
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA
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Abstract
Stem cells have been touted as the holy grail of medical therapy, with promises to regenerate cardiac tissue, but it appears the jury is still out on this novel therapy. Using advanced imaging technology, scientists have discovered that these cells do not survive nor engraft long-term. In addition, only marginal benefit has been observed in large-animal studies and human trials. However, all is not lost. Further application of advanced imaging technology will help scientists unravel the mysteries of stem cell therapy and address the clinical hurdles facing its routine implementation. In this review, we will discuss how advanced imaging technology will help investigators better define the optimal delivery method, improve survival and engraftment, and evaluate efficacy and safety. Insights gained from this review may direct the development of future preclinical investigations and clinical trials.
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Affiliation(s)
- Patricia K Nguyen
- Department of Medicine, Division of Cardiology, Molecular Imaging Program at Stanford, CA 94305, USA
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Hu S, Huang M, Nguyen PK, Gong Y, Li Z, Jia F, Lan F, Liu J, Nag D, Robbins RC, Wu JC. Novel microRNA prosurvival cocktail for improving engraftment and function of cardiac progenitor cell transplantation. Circulation 2011; 124:S27-34. [PMID: 21911815 DOI: 10.1161/circulationaha.111.017954] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.1] [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: 02/06/2023]
Abstract
BACKGROUND Although stem cell therapy has provided a promising treatment for myocardial infarction, the low survival of the transplanted cells in the infarcted myocardium is possibly a primary reason for failure of long-term improvement. Therefore, the development of novel prosurvival strategies to boost stem cell survival will be of significant benefit to this field. METHODS AND RESULTS Cardiac progenitor cells (CPCs) were isolated from transgenic mice, which constitutively express firefly luciferase and green fluorescent protein. The CPCs were transduced with individual lentivirus carrying the precursor of miR-21, miR-24, and miR-221, a cocktail of these 3 microRNA precursors, or green fluorescent protein as a control. After challenge in serum free medium, CPCs treated with the 3 microRNA cocktail showed significantly higher viability compared with untreated CPCs. After intramuscular and intramyocardial injections, in vivo bioluminescence imaging showed that microRNA cocktail-treated CPCs survived significantly longer after transplantation. After left anterior descending artery ligation, microRNA cocktail-treated CPCs boost the therapeutic efficacy in terms of functional recovery. Histological analysis confirmed increased myocardial wall thickness and CPC engraftment in the myocardium with the microRNA cocktail. Finally, we used bioinformatics analysis and experimental validation assays to show that Bim, a critical apoptotic activator, is an important target gene of the microRNA cocktail, which collectively can bind to the 3'UTR region of Bim and suppress its expression. CONCLUSIONS We have demonstrated that a microRNA prosurvival cocktail (miR-21, miR-24, and miR-221) can improve the engraftment of transplanted cardiac progenitor cells and therapeutic efficacy for treatment of ischemic heart disease.
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Affiliation(s)
- Shijun Hu
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA 94305-5454, USA
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