Dare to dream? Cell-based therapies for heart failure after DREAM-HF: Review and roadmap for future clinical study

Clinical trials of cell-based therapies for heart failure have resulted in significant strides forward in our understanding of the potential the failing heart has for regeneration and repair. Yet, two decades on, the need for novel cell-based therapies for heart failure has never been greater. The DREAM-HF trial, which was presented as a late-breaking trial at the American Heart Association Scientific Sessions 2021 did not meet the primary heart failure outcome, but did show a large, clinically significant reduction in major adverse cardiovascular events (MACE) in patients receiving cells, an effect that was most pronounced in patients with evidence of maladaptive inflammation. These results represent an important step forward in our understanding of how cell-based therapies can exert beneficial effects in patients with heart failure and should serve as a guide for future clinical efforts. In light of the results of DREAM-HF, this review serves to provide an understanding of the current state of cell-based therapies for heart failure, as well as to highlight major knowledge gaps and suggest guiding principles for clinical trials of cell therapy going forward. Using the knowledge gained from DREAM-HF along with the trials that preceded it, the potential for breakthrough cell-based therapies for heart failure in the coming decade is immense.

Biomaterials-based Approaches for Cardiac Regeneration

Cardiovascular disease is a prevalent cause of mortality and morbidity, largely due to the limited ability of cardiomyocytes to proliferate. Existing therapies for cardiac regeneration include cell-based therapies and bioactive molecules. However, delivery remains one of the major challenges impeding such therapies from having significant clinical impact. Recent advancements in biomaterials-based approaches for cardiac regeneration have shown promise in improving cardiac function, promoting angiogenesis, and reducing adverse immune response in both human clinical trials and animal studies. These advances in therapeutic delivery via extracellular vesicles, cardiac patches, and hydrogels have the potential to enable clinical impact of cardiac regeneration therapies.

The limited ability of cardiomyocytes to proliferate is a major cause of mortality and morbidity in cardiovascular diseases. There exist therapies for cardiac regeneration that are cell-based as well as that involve bioactive molecules. However, delivery remains one of the major challenges impeding such therapies from having clinical impact. Recent advancements in biomaterials-based approaches for cardiac regeneration have shown promise in clinical trials and animal studies in improving cardiac function, promoting angiogenesis, and reducing adverse immune response. This review will focus on current clinical studies of three contemporary biomaterials-based approaches for cardiac regeneration (extracellular vesicles, injectable hydrogels, and cardiac patches), remaining challenges and shortcomings to be overcome, and future directions for the use of biomaterials to promote cardiac regeneration.

Intravascular Stem Cell Bioreactor for Prevention of Adverse Remodeling After Myocardial Infarction

Background Prevention of adverse remodeling after myocardial infarction (MI) is an important goal of stem cell therapy. Clinical trial results vary, however, and poor cell retention and survival after delivery likely limit the opportunity to exert beneficial effects. To overcome these limitations, we built an implantable intravascular bioreactor (IBR) designed to protect contained cells from washout, dilution, and immune attack while allowing sustained release of beneficial paracrine factors. Methods and Results IBRs were constructed using semipermeable membrane adhered to a clinical-grade catheter shaft. Mesenchymal stem cell (MSC) viability in and paracrine factor release from IBRs were assessed in vitro and IBR biocompatibility and immune protection confirmed in vivo. In a porcine anterior MI model, IBRs containing 25 million allogeneic MSCs (IBR-MSCs) were compared with IBRs containing media alone (IBR-Placebo; n=8 per group) with adverse remodeling assessed by magnetic resonance imaging. Four weeks after MI, IBR-MSCs had no significant change in end-diastolic volume (+0.33±4.32 mL; P=0.89), end-systolic volume (+2.14±4.13 mL; P=0.21), and left ventricular ejection fraction (-2.27±2.94; P=0.33) while IBR-Placebo had significant increases in end-diastolic volume (+10.37±3.84 mL; P=0.01) and ESV (+11.35±2.88 mL; P=0.01), and a significant decrease in left ventricular ejection fraction (-5.78±1.70; P=0.025). Eight weeks after MI, adherent pericarditis was present in 0 of 8 IBR-MSCs versus 4 of 8 IBR-Placebo (P=0.02), suggesting an anti-inflammatory effect. In a separate study, 25 million allogeneic pig MSCs directly injected in the peri-infarct zone 3 days after MI (n=6) showed no significant benefit in adverse remodeling at 4 weeks compared with IBR-MSCs. Conclusions MSCs deployed inside an implantable, removable, and potentially rechargeable bioreactor in a large animal model remain viable, are immunoprotected, and attenuate adverse remodeling 4 weeks after MI.

The CardiAMP Heart Failure trial: A randomized controlled pivotal trial of high-dose autologous bone marrow mononuclear cells using the CardiAMP cell therapy system in patients with post-myocardial infarction heart failure: Trial rationale and study design

BACKGROUND

Heart failure following myocardial infarction is a common, disabling, and deadly condition. Direct injection of autologous bone marrow mononuclear cells into the myocardium may result in improved functional recovery, relieve symptoms, and improve other cardiovascular outcomes.

METHODS

CardiAMP-HF is a randomized, double-blind, sham-controlled, pivotal trial designed to investigate the safety and efficacy of autologous bone marrow mononuclear cells treatment for patients with medically refractory and symptomatic ischemic cardiomyopathy. The primary end point is change in 6-minute walk distance adjusted for major adverse cardiovascular events at 12 months following treatment. Particularly novel aspects of this trial include a cell potency assay to screen subjects who have bone marrow cell characteristics that suggest a favorable response to treatment, a point-of-care treatment method, a high target dose of 200 million cells, and an efficient transcatheter intramyocardial delivery method that is associated with high cell retention.

CONCLUSIONS

This novel approach may lead to a new treatment for those with ischemic heart disease suffering from medically refractory heart failure.

Usefulness of a Noninvasive Device to Identify Elevated Left Ventricular Filling Pressure Using Finger Photoplethysmography During a Valsalva Maneuver

The high rate of re-hospitalization for heart failure might be reduced by improving noninvasive techniques for identifying elevated left ventricular (LV) filling pressure. We previously showed that changes in a finger photoplethysmography (PPG) waveform during the Valsalva maneuver (VM) reflect invasively measured LV end-diastolic pressure (LVEDP). We have since developed a hand-held device that analyzes PPG while guiding the expiratory effort of a VM. Here we assessed the sensitivity and specificity of this device for identifying elevated LVEDP in patients. We tested 82 participants (28 women), aged 40 to 85 years, before a clinically indicated left heart catheterization. Each performed a VM between 18 and 25 mm Hg for 10 seconds into a pressure transducer. PPG was recorded continuously before and during the VM. LVEDP was measured during the catheterization. An equation for calculating LVEDP was derived using (1) ratio of signal amplitudes: minimum during VM to average at baseline, (2) ratio of peak-to-peak time intervals: minimum during VM to average at baseline, and (3) mean blood pressure. Calculated and measured LVEDP were compared. The range of measured LVEDP was 4 to 35 mm Hg. Calculated LVEDP correlated with measured LVEDP (p <0.0001, r = 0.56). A calculated LVEDP >20 mm Hg had a 70% sensitivity and 86% specificity for identifying measured LVEDP >20 mm Hg (area under receiver-operating characteristic curve 0.83). In conclusion, a hand-held device for assessing LV filling pressure had high specificity and good sensitivity for identifying LVEDP >20 mm Hg, a clinically meaningful threshold in heart failure.

Plasmonic phased array feeder enabling ultra-fast beam steering at millimeter waves

In this paper, we demonstrate an integrated microwave phoneeded for beamtonics phased array antenna feeder at 60 GHz with a record-low footprint. Our design is based on ultra-compact plasmonic phase modulators (active area <2.5µm²) that not only provide small size but also ultra-fast tuning speed. In our design, the integrated circuit footprint is in fact only limited by the contact pads of the electrodes and by the optical feeding waveguides. Using the high speed of the plasmonic modulators, we demonstrate beam steering with less than 1 ns reconfiguration time, i.e. the beam direction is reconfigured in-between 1 GBd transmitted symbols.

Patients without ST elevation after return of spontaneous circulation may benefit from emergent percutaneous intervention: A systematic review and meta-analysis

INTRODUCTION

The American Heart Association recommends that post-arrest patients with evidence of ST elevation myocardial infarction (STEMI) on electrocardiogram (ECG) be emergently taken to the catheterization lab for percutaneous coronary intervention (PCI). However, recommendations regarding the utility of emergent PCI for patients without ST elevation are less specific. This review examined the literature on the utility of PCI in post-arrest patients without ST elevation compared to patients with STEMI.

METHODS

A systematic review of the English language literature was performed for all years to March 1, 2015 to examine the hypothesis that a percentage of post-cardiac arrest patients without ST elevation will benefit from emergent PCI as defined by evidence of an acute culprit coronary lesion.

RESULTS

Out of 1067 articles reviewed, 11 articles were identified that allowed for analysis of data to examine our study hypothesis. These studies show that patients presenting post cardiac arrest with STEMI are thirteen times more likely to be emergently taken to the catheterization lab than patients without STEMI; OR 13.8 (95% CI 4.9-39.0). Most importantly, the cumulative data show that when taken to the catheterization lab as much as 32.2% of patients without ST elevation had an acute culprit lesion requiring intervention, compared to 71.9% of patients with STEMI; OR 0.15 (95% CI 0.06-0.34).

CONCLUSION

The results of this systematic review demonstrate that nearly one third of patients who have been successfully resuscitated from cardiopulmonary arrest without ST elevation on ECG have an acute lesion that would benefit from emergent percutaneous coronary intervention.

Stem cell impregnated nanofiber stent sleeve for on-stent production and intravascular delivery of paracrine factors

Stem cell therapies for atherosclerotic diseases are promising, but benefits remain modest with present cell delivery devices in part due to cell washout and immune attack. Many stem cell effects are believed mediated by paracrine factors (PFs) secreted by the stem cells which potentiate tissue repair via activation and enhancement of intrinsic host repair mechanisms We therefore sought to create an "intravascular paracrine factor factory" by harnessing stem cells on a stent using a nanofiber (NF) stent sleeve, and thus providing a sheltered milieu for cells to continuously produce PFs on-stent. The NF sleeve acts as a substrate on which stem cells grow, and as a semi-permeable barrier that protects cells from washout and host immune response while allowing free outward passage of PFs. NF stent sleeves were created by covering stents with electrospun poly-lactic-co-glycolic acid nanofibers and were then uniformly coated with mesenchymal stem cells (MSCs). NF sleeves blocked cell passage but did not hamper MSC attachment or proliferation, and did not alter MSC morphology or surface markers. NF sleeve MSCs continued to secrete PFs that were biologically active and successfully induced tubulogenesis in human endothelial cells. NF stent sleeves seeded with allogeneic MSCs implanted in pigs remained patent at 7 days without thrombotic occlusion or immune rejection. Our results demonstrate the feasibility of creating an intravascular PF factory using a stem cell impregnated NF stent sleeve, and pave the way for animal studies to assess the efficacy of local PF production to treat ischemic artery disease.

Fused X-ray and MR imaging guidance of intrapericardial delivery of microencapsulated human mesenchymal stem cells in immunocompetent swine

PURPOSE

To assess intrapericardial delivery of microencapsulated, xenogeneic human mesenchymal stem cells (hMSCs) by using x-ray fused with magnetic resonance (MR) imaging (x-ray/MR imaging) guidance as a potential treatment for ischemic cardiovascular disease in an immunocompetent swine model.

MATERIALS AND METHODS

All animal experiments were approved by the institutional animal care and use committee. Stem cell microencapsulation was performed by using a modified alginate-poly-l-lysine-alginate encapsulation method to include 10% (wt/vol) barium sulfate to create barium-alginate microcapsules (BaCaps) that contained hMSCs. With x-ray/MR imaging guidance, eight female pigs (approximately 25 kg) were randomized to receive either BaCaps with hMSCs, empty BaCaps, naked hMSCs, or saline by using a percutaneous subxiphoid approach and were compared with animals that received empty BaCaps (n = 1) or BaCaps with hMSCs (n = 2) by using standard fluoroscopic delivery only. MR images and C-arm computed tomographic (CT) images were acquired before injection and 1 week after delivery. Animals were sacrificed immediately or at 1 week for histopathologic validation. Cardiac function between baseline and 1 week after delivery was evaluated by using a paired Student t test.

RESULTS

hMSCs remained highly viable (94.8% ± 6) 2 days after encapsulation in vitro. With x-ray/MR imaging, successful intrapericardial access and delivery were achieved in all animals. BaCaps were visible fluoroscopically and at C-arm CT immediately and 1 week after delivery. Whereas BaCaps were free floating immediately after delivery, they consolidated into a pseudoepicardial tissue patch at 1 week, with hMSCs remaining highly viable within BaCaps; naked hMSCs were poorly retained. Follow-up imaging 1 week after x-ray/MR imaging-guided intrapericardial delivery showed no evidence of pericardial adhesion and/or effusion or adverse effect on cardiac function. In contradistinction, BaCaps delivery with x-ray fluoroscopy without x-ray/MR imaging (n = 3) resulted in pericardial adhesions and poor hMSC viability after 1 week.

CONCLUSION

Intrapericardial delivery of BaCaps with hMSCs leads to high cell retention and survival. With x-ray/MR imaging guidance, intrapericardial delivery can be performed safely in the absence of preexisting pericardial effusion to provide a novel route for cardiac cellular regenerative therapy.

Does transendocardial injection of mesenchymal stem cells improve myocardial function locally or globally?: An analysis from the Percutaneous Stem Cell Injection Delivery Effects on Neomyogenesis (POSEIDON) randomized trial

RATIONALE

Transendocardial stem cell injection (TESI) with mesenchymal stem cells improves remodeling in chronic ischemic cardiomyopathy, but the effect of the injection site remains unknown.

OBJECTIVE

To address whether TESI exerts its effects at the site of injection only or also in remote areas, we hypothesized that segmental myocardial scar and segmental ejection fraction improve to a greater extent in injected than in noninjected segments.

METHODS AND RESULTS

Biplane ventriculographic and endocardial tracings were recorded. TESI was guided to 10 sites in infarct-border zones. Sites were mapped according to the 17-myocardial segment model. As a result, 510 segments were analyzed in 30 patients before and 13 months after TESI. Segmental early enhancement defect (a measure of scar size) was reduced by TESI in both injected (-43.7 ± 4.4%; n=95; P<0.01) and noninjected segments (-25.1 ± 7.8%; n=148; P<0.001; between-group comparison P<0.05). Conversely, segmental ejection fraction (a measure of contractile performance) improved in injected scar segments (19.9 ± 3.3-26.3 ± 3.5%; P=0.003) but not in noninjected scar segments (21.3 ± 2.6-23.5 ± 3.2%; P=0.20; between-group comparison P<0.05). Furthermore, segmental ejection fraction in injected scar segments improved to a greater degree in patients with baseline segmental ejection fraction <20% (12.1 ± 1.2-19.9 ± 2.7%; n=18; P=0.003), versus <20% (31.7 ± 3.4-35.5 ± 3.3%; n=12; P=0.33, between-group comparison P<0.0001).

CONCLUSIONS

These findings illustrate a dichotomy in regional responses to TESI. Although scar size reduction was evident in all scar segments, scar size reduction and ventricular functional responses preferentially occurred at the sites of TESI versus non-TESI sites. Furthermore, improvement was greatest when segmental left ventricular dysfunction was severe.

Intracoronary cardiosphere-derived cells after myocardial infarction: evidence of therapeutic regeneration in the final 1-year results of the CADUCEUS trial (CArdiosphere-Derived aUtologous stem CElls to reverse ventricUlar dySfunction)

OBJECTIVES

This study sought to report full 1-year results, detailed magnetic resonance imaging analysis, and determinants of efficacy in the prospective, randomized, controlled CADUCEUS (CArdiosphere-Derived aUtologous stem CElls to reverse ventricUlar dySfunction) trial.

BACKGROUND

Cardiosphere-derived cells (CDCs) exerted regenerative effects at 6 months in the CADUCEUS trial. Complete results at the final 1-year endpoint are unknown.

METHODS

Autologous CDCs (12.5 to 25 × 10(6)) grown from endomyocardial biopsy specimens were infused via the intracoronary route in 17 patients with left ventricular dysfunction 1.5 to 3 months after myocardial infarction (MI) (plus 1 infused off-protocol 14 months post-MI). Eight patients were followed as routine-care control patients.

RESULTS

In 13.4 months of follow-up, safety endpoints were equivalent between groups. At 1 year, magnetic resonance imaging revealed that CDC-treated patients had smaller scar size compared with control patients. Scar mass decreased and viable mass increased in CDC-treated patients but not in control patients. The single patient infused 14 months post-MI responded similarly. CDC therapy led to improved regional function of infarcted segments compared with control patients. Scar shrinkage correlated with an increase in viability and with improvement in regional function. Scar reduction correlated with baseline scar size but not with a history of temporally remote MI or time from MI to infusion. The changes in left ventricular ejection fraction in CDC-treated subjects were consistent with the natural relationship between scar size and ejection fraction post-MI.

CONCLUSIONS

Intracoronary administration of autologous CDCs did not raise significant safety concerns. Preliminary indications of bioactivity include decreased scar size, increased viable myocardium, and improved regional function of infarcted myocardium at 1 year post-treatment. These results, which are consistent with therapeutic regeneration, merit further investigation in future trials. (CArdiosphere-Derived aUtologous stem CElls to reverse ventricUlar dySfunction [CADUCEUS]; NCT00893360).

Comparison of allogeneic vs autologous bone marrow–derived mesenchymal stem cells delivered by transendocardial injection in patients with ischemic cardiomyopathy: the POSEIDON randomized trial

CONTEXT

Mesenchymal stem cells (MSCs) are under evaluation as a therapy for ischemic cardiomyopathy (ICM). Both autologous and allogeneic MSC therapies are possible; however, their safety and efficacy have not been compared.

OBJECTIVE

To test whether allogeneic MSCs are as safe and effective as autologous MSCs in patients with left ventricular (LV) dysfunction due to ICM.

DESIGN, SETTING, AND PATIENTS

A phase 1/2 randomized comparison (POSEIDON study) in a US tertiary-care referral hospital of allogeneic and autologous MSCs in 30 patients with LV dysfunction due to ICM between April 2, 2010, and September 14, 2011, with 13-month follow-up.

INTERVENTION

Twenty million, 100 million, or 200 million cells (5 patients in each cell type per dose level) were delivered by transendocardial stem cell injection into 10 LV sites.

MAIN OUTCOME MEASURES

Thirty-day postcatheterization incidence of predefined treatment-emergent serious adverse events (SAEs). Efficacy assessments included 6-minute walk test, exercise peak VO2, Minnesota Living with Heart Failure Questionnaire (MLHFQ), New York Heart Association class, LV volumes, ejection fraction (EF), early enhancement defect (EED; infarct size), and sphericity index.

RESULTS

Within 30 days, 1 patient in each group (treatment-emergent SAE rate, 6.7%) was hospitalized for heart failure, less than the prespecified stopping event rate of 25%. The 1-year incidence of SAEs was 33.3% (n = 5) in the allogeneic group and 53.3% (n = 8) in the autologous group (P = .46). At 1 year, there were no ventricular arrhythmia SAEs observed among allogeneic recipients compared with 4 patients (26.7%) in the autologous group (P = .10). Relative to baseline, autologous but not allogeneic MSC therapy was associated with an improvement in the 6-minute walk test and the MLHFQ score, but neither improved exercise VO2 max. Allogeneic and autologous MSCs reduced mean EED by −33.21% (95% CI, −43.61% to −22.81%; P < .001) and sphericity index but did not increase EF. Allogeneic MSCs reduced LV end-diastolic volumes. Low-dose concentration MSCs (20 million cells) produced greatest reductions in LV volumes and increased EF. Allogeneic MSCs did not stimulate significant donor-specific alloimmune reactions.

CONCLUSIONS

In this early-stage study of patients with ICM, transendocardial injection of allogeneic and autologous MSCs without a placebo control were both associated with low rates of treatment-emergent SAEs, including immunologic reactions. In aggregate, MSC injection favorably affected patient functional capacity, quality of life, and ventricular remodeling.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT01087996.

Intracoronary cardiosphere-derived cells for heart regeneration after myocardial infarction (CADUCEUS): a prospective, randomised phase 1 trial

BACKGROUND

Cardiosphere-derived cells (CDCs) reduce scarring after myocardial infarction, increase viable myocardium, and boost cardiac function in preclinical models. We aimed to assess safety of such an approach in patients with left ventricular dysfunction after myocardial infarction.

METHODS

In the prospective, randomised CArdiosphere-Derived aUtologous stem CElls to reverse ventricUlar dySfunction (CADUCEUS) trial, we enrolled patients 2-4 weeks after myocardial infarction (with left ventricular ejection fraction of 25-45%) at two medical centres in the USA. An independent data coordinating centre randomly allocated patients in a 2:1 ratio to receive CDCs or standard care. For patients assigned to receive CDCs, autologous cells grown from endomyocardial biopsy specimens were infused into the infarct-related artery 1·5-3 months after myocardial infarction. The primary endpoint was proportion of patients at 6 months who died due to ventricular tachycardia, ventricular fibrillation, or sudden unexpected death, or had myocardial infarction after cell infusion, new cardiac tumour formation on MRI, or a major adverse cardiac event (MACE; composite of death and hospital admission for heart failure or non-fatal recurrent myocardial infarction). We also assessed preliminary efficacy endpoints on MRI by 6 months. Data analysers were masked to group assignment. This study is registered with ClinicalTrials.gov, NCT00893360.

FINDINGS

Between May 5, 2009, and Dec 16, 2010, we randomly allocated 31 eligible participants of whom 25 were included in a per-protocol analysis (17 to CDC group and eight to standard of care). Mean baseline left ventricular ejection fraction (LVEF) was 39% (SD 12) and scar occupied 24% (10) of left ventricular mass. Biopsy samples yielded prescribed cell doses within 36 days (SD 6). No complications were reported within 24 h of CDC infusion. By 6 months, no patients had died, developed cardiac tumours, or MACE in either group. Four patients (24%) in the CDC group had serious adverse events compared with one control (13%; p=1·00). Compared with controls at 6 months, MRI analysis of patients treated with CDCs showed reductions in scar mass (p=0·001), increases in viable heart mass (p=0·01) and regional contractility (p=0·02), and regional systolic wall thickening (p=0·015). However, changes in end-diastolic volume, end-systolic volume, and LVEF did not differ between groups by 6 months.

INTERPRETATION

We show intracoronary infusion of autologous CDCs after myocardial infarction is safe, warranting the expansion of such therapy to phase 2 study. The unprecedented increases we noted in viable myocardium, which are consistent with therapeutic regeneration, merit further assessment of clinical outcomes.

FUNDING

US National Heart, Lung and Blood Institute and Cedars-Sinai Board of Governors Heart Stem Cell Center.

Finger photoplethysmography during the Valsalva maneuver reflects left ventricular filling pressure

It is often challenging to assess cardiac filling pressure clinically. An improved system for detecting or ruling out elevated cardiac filling pressure may help reduce hospitalizations for heart failure. The blood pressure response to the Valsalva maneuver reflects left heart filling pressure, but its underuse clinically may be due in part to lack of continuous blood pressure recording along with lack of standardization of expiratory effort. In this study, we tested whether Valsalva-induced changes in the pulse amplitude of finger photoplethysmography (PPG), a technology already widely available in medical settings, correlate with invasively measured left ventricular end-diastolic pressure (LVEDP). We tested 33 subjects before clinically scheduled cardiac catheterizations. A finger photoplethysmography waveform was recorded during a Valsalva effort of 20 mmHg expiratory pressure sustained for 10 s, an effort most patients can achieve. Pulse amplitude ratio (PAR) was calculated as the PPG waveform amplitude just before release of expiratory effort divided by the waveform amplitude at baseline. PAR was well correlated with LVEDP (r = 0.68; P < 0.0001). For identifying LVEDP > 15 mmHG, PAR > 0.4 was 85% sensitive [95% confidence interval (95CI): 54-97%] and 80% specific (95CI: 56-93%). In conclusion, finger PPG, a technology already ubiquitous in medical centers, may be useful for assessing clinically meaningful categories of left heart filling pressure, using simple analysis of the waveform after a Valsalva maneuver effort that most patients can achieve.

Subacute stent thrombosis owing to complete clopidogrel resistance successfully managed with prasugrel

This report describes a case of an acute anterior myocardial infarction secondary to subacute stent thrombosis of a drug-eluting stent within the proximal segment of the left anterior descending artery (LAD) 5 days after percutaneous transluminal coronary angioplasty and stenting (PCI). The patient was initially managed with conventional dual-antiplatelet therapy (aspirin and clopidogrel) and was subsequently found to have complete absence of adenosine diphosphate (ADP) receptor P2Y12 receptor inhibition. Following additional PCI of the LAD and substitution of clopidogrel for the thienopyridine prasugrel, therapeutic platelet inhibition was achieved without recurrence of stent thrombosis.

Engraftment, differentiation, and functional benefits of autologous cardiosphere-derived cells in porcine ischemic cardiomyopathy

BACKGROUND

Cardiosphere-derived cells (CDCs) isolated from human endomyocardial biopsies reduce infarct size and improve cardiac function in mice. Safety and efficacy testing in large animals is necessary for clinical translation.

METHODS AND RESULTS

Mesenchymal stem cells, which resemble CDCs in size and thrombogenicity, have been associated with infarction after intracoronary infusion. To maximize CDC engraftment while avoiding infarction, we optimized the infusion protocol in 19 healthy pigs. A modified cocktail of CDCs in calcium-free PBS, 100 U/mL of heparin, and 250 microg/mL of nitroglycerin eliminated infusion-related infarction. Subsequent infusion experiments in 17 pigs with postinfarct left ventricular dysfunction showed CDC doses > or =10(7) but <2.5 x 10(7) result in new myocardial tissue formation without infarction. In a pivotal randomized study, 7 infarcted pigs received 300,000 CDCs/kg (approximately 10(7) total) and 7 received placebo (vehicle alone). Cardiac magnetic resonance imaging 8 weeks later showed CDC treatment decreased relative infarct size (19.2% to 14.2% of left ventricle infarcted, P=0.01), whereas placebo did not (17.7% to 15.3%, P=0.22). End-diastolic volume increased in placebo, but not in CDC-treated animals. Hemodynamically, the rate of pressure change (dP/dt) maximum and dP/dt minimum were significantly better with CDC infusion. There was no difference between groups in the ability to induce ventricular tachycardia, nor was there any tumor or ectopic tissue formation.

CONCLUSIONS

Intracoronary delivery of CDCs in a preclinical model of postinfarct left ventricular dysfunction results in formation of new cardiac tissue, reduces relative infarct size, attenuates adverse remodeling, and improves hemodynamics. The evidence of efficacy without obvious safety concerns at 8 weeks of follow-up motivates human studies in patients after myocardial infarction and in chronic ischemic cardiomyopathy.

Mycotic Aortocoronary Saphenous Vein Graft Aneurysm Presenting With Unstable Angina Pectoris

We report the case of a 60-year-old man with a history of coronary bypass surgery 20 years prior who had a fever, chest pain, and a mediastinal mass develop after a complicated postoperative course of abdominal aortic aneurysm resection. A mycotic aneurysm of the saphenous vein graft to his left anterior descending coronary artery was diagnosed based on blood culture results and visualization of the aneurysm before resection. A summary of the saphenous vein graft aneurysm and pseudoaneurysm cause, diagnosis, and management is detailed.

High levels of extra-pair paternity in an isolated, low-density, island population of tree swallows (Tachycineta bicolor)

Molecular genetic studies have suggested that apparently nonbreeding males ('floaters') may account for a significant proportion of extra-pair paternity (EPP) in avian populations. Attempts to determine the influence of breeding density on EPP are therefore confounded by the presence of a subpopulation of floaters whose numbers are difficult to estimate. To study EPP in a tree swallow (Tachycineta bicolor) population with few floaters, we chose a nestbox grid on an island with an excess of available breeding sites and very few floaters. We obtained DNA samples from 13 complete families and performed DNA profiling on them using four microsatellite loci. For comparison, we also obtained a sample of 58 extra-pair young (EPY) from a mainland population typed at five microsatellite loci. Paternity assignments among resident males in both populations were made using the microsatellite profiles and a likelihood-based statistical method. Of the 67 island nestlings typed, we found 37 (55%) nestlings from 11 (85%) different nests that were EPY. The proportion of nestlings that were EPY and the proportion of broods containing EPY did not differ significantly between island and mainland populations studied previously. There was no significant difference between island and mainland populations in the proportion of extra-pair paternities assigned among neighbouring resident males. Male breeding density does not appear to affect the ability of female tree swallows to obtain extra-pair fertilizations, at least over the range of densities studied so far. The rate of EPP has remained remarkably consistent over many years, studies and populations implying an important role of active female choice in determining EPP.

Tedisamil in a chronic canine model of atrial flutter

Tedisamil inhibits several cardiac potassium channels including Ito, Ikr, and the adenosine triphosphate (ATP)-sensitive potassium channel (I(KATP)), which may be important in the initiation and maintenance of atrial arrhythmias. We herein report the efficacy of tedisamil in terminating and protecting against the reinduction of atrial flutter (AFL) in a conscious canine model. Sustained AFL (> 15 min) was induced in eight of 10 mongrel dogs by programmed atrial stimulation (PAS) 2-41 days after producing a surgical barrier to conduction in the right atrium. At the time of surgery, an epicardial electrode was attached to the right atrial appendage for pacing and recording. Normal saline, 1 ml/kg, was infused after 15 min of AFL as placebo. Tedisamil (1.0 mg/kg) was given intravenously after 30 min of sustained AFL while recording surface ECGs and atrial electrograms. Conversion to sinus rhythm was achieved in 10 of 10 trials (eight dogs) in a mean time of 20.5 s (SD, +/- 11.8 s). Tedisamil had a negative chronotropic effect lasting > or =2 h and was protective against the reinduction of AFL. In five dogs, PAS was able to induce AFL in only two of seven trials 2 h after drug infusion. The corrected QT interval (QTc) was lengthened for the first 15 min after tedisamil administration (mean, +/- 39.3 ms; p < 0.05), but thereafter returned to baseline. The QRS interval was not altered by tedisamil. Saline alone, given after 15 min of sustained AFL, converted AFL in one of 11 trials (eight dogs) but did not alter the RR interval, QTc, or QRS interval compared with values measured during AFL. No significant adverse effects of tedisamil were observed. The results indicate that tedisamil is effective in interrupting and/or preventing reinduction of canine AFL, possibly by prolonging atrial refractoriness through inhibition of one or more potassium ion repolarizing currents in atrial muscle. Further studies are required to address the exact mechanism by which tedisamil exerts its antiarrhythmic effect.

Effect of time on neonatal immune response to dietary selenium and fat

The effect of dietary selenium (0.03 mg/kg and 0.31 mg/kg), and fat (5% and 20% corn oil) on antibody formation in the neonatal rat was studied at two different time periods using four diets. The latter were fed to dams throughout pregnancy and lactation and to their pups starting at day 18. A week later, pups received intraperitoneal injections of the test antigen, fluorescein-bovine serum albumin in complete Freund's adjuvant (150 micrograms per 30 g body wt.). On days 7 or 9 post-injection, the pups were sacrificed. The antibody titer, as determined by the quenching of fluorescein by the test sera, and by ELISA, almost doubled from day 7 to day 9 (p < 0.05). There was no significant difference in antibody titers between dietary groups except at day 9 post-injection. Using ELISA, pairwise comparisons indicated that addition of 0.3 mg/kg Se to high fat diet was associated with low antibody titer (p < 0.05).

Solar ultraviolet spectroradiometry in New Zealand: instrumentation and sample results from 1990

In 1988 the New Zealand Department of Scientific and Industrial Research initiated a program to characterize the spectrum of solar ultraviolet radiation reaching the ground in New Zealand and to identify the extent and causes of its variability. Routine measurements began at Lauder (45 degrees S 170 degrees E) in December 1989. The instrumentation, measurement strategy, and calibration procedures are discussed and uncertainties in the measurements are analyzed. With the present system useful measurements at 1-nm resolution are limited to irradiances greater than 10(-3) microW cm(-2) nm(-1), which corresponds to a lower limit in wavelength in the region 290-295 nm (depending on the Sun angle and ozone amount). This is a useful lower limit for many applications of relevance to the biosphere. Results from the first year of operation are presented and discussed.

Effect of dietary alpha-linolenic acid on growth, metastasis, fatty acid profile and prostaglandin production of two murine mammary adenocarcinomas

The purpose of this study was to determine whether dietary (n-3) fatty acids would affect mammary tumor growth and metastasis. Weanling female BALB/c mice were fed diets that contained 10% corn oil (CO), linseed oil (LO) or a fish oil-corn oil mix (FO) for 3-8 wk prior to receiving subcutaneous injections of one of two syngeneic mammary tumor cell types (410 and 410.4). Tumor growth was assessed by monitoring mean tumor diameter and tumor weight upon removal. Feeding LO, but not FO, reduced the growth (p less than 0.05) of 410.4 mammary tumors compared with growth in those fed CO. Metastasis data paralleled the tumor growth rate. Feeding LO and FO enhanced (p less than 0.005) incorporation of (n-3) fatty acids into tumors. Tumor prostaglandin E (PGE) production was reduced (p less than 0.005) by LO and FO, compared with CO. FO feeding reduced 410.4 tumor PGE synthesis more (p less than 0.05) than LO feeding, yet tumor growth was only inhibited by LO. These data suggest an inhibitory effect of dietary linolenic acid [i.e., 18:3 (n-3)] on mammary tumor growth and metastasis. However, this effect did not directly correlate with diet-induced changes in PGE synthesis.

Modulation of eicosanoid production and cell-mediated cytotoxicity by dietary alpha-linolenic acid in BALB/c mice

The effects of dietary alpha-linolenic acid (18:3n-3) on fatty acid composition, eicosanoid production, and cell-mediated cytotoxic activity of immune cells before and after challenge with virus or poly I-C from BALB/c mice were studied. Weanling BALB/c mice were fed purified diets containing either 10%-by-weight corn oil or linseed oil providing a ratio of 18:3n-3 to 18:2n-6 of 1/32 or 2/1, respectively, for 6-10 weeks. Fatty acid analysis of splenocyte phospholipids showed an appreciable increase in the percentage of n-3, and a decrease in n-6, fatty acids in splenocytes from mice fed the linseed oil diet. Splenocyte prostaglandin E and peritoneal exudate cell leukotriene C production was significantly lower in the linseed oil-fed mice. In general, cell-mediated cytotoxic activity was similar for immune cells from linseed oil and corn oil-fed mice. However, 6 days after the viral challenge, splenocyte cell-mediated cytotoxic activity was significantly higher in linseed oil mice. This higher activity was associated with nonspecific cytotoxicity rather than that of viral-specific cytotoxic T-lymphocytes. Cell yields from the spleen and peritoneum were frequently significantly higher in linseed oil mice. Interactions between dietary 18:3n-3, eicosanoid production, and immune cell proliferation and/or migration are discussed. In summary, feeding mice a diet rich in 18:3n-3 elevates immune cell n-3 fatty acid content, reduces eicosanoid synthesis and, to a limited extent, enhances the cell-mediated cytotoxic response to a viral challenge.

Rapid autoxidation of fish oil in diets without added antioxidants

Feeding of purified diets containing fish oil without added antioxidant leads to rapid autoxidation of the oil and the possibility of artifactual results due to the feeding of autoxidation products. Purified diets containing menhaden oil without any added antioxidant deteriorate quickly. Peroxide value of the diet is elevated 5- to 6-fold within 24 h and 12-fold within 48 h when exposed to air at room temperature. Addition of 0.02% t-butylhydroquinone to the fish oil prevents this deterioration for at least 72 h. Determination of fatty acid composition is not a sensitive indicator of diet integrity. Supplementation of fish oil diets with vitamin E to help protect against in vivo peroxidation is discussed.

Lymphocyte activation, cell-mediated cytotoxicity and their relationship to dietary fat-enhanced mammary tumorigenesis in C3H/OUJ mice

The effects of dietary soybean oil (SBO) concentration (5 vs. 20% by weight) on mammary tumorigenesis, mitogen-induced blastogenesis, cell-mediated cytotoxicity and serum and lymphocyte fatty acid composition were studied in C3H/OUJ female mice. Weanling mice fed 20% SBO for 9 mo had a higher incidence (89 vs. 65%) and greater average size (2.9 vs. 1.9 g) of mammary tumor virus type S breast tumors than mice fed 5% SBO. The response of isolated splenocytes to the T-cell mitogens concanavalin A and phytohemagglutinin was 20-25% lower in mice fed 20% SBO than in mice fed 5% SBO for 20 wk. There was no effect of SBO concentration on the splenocyte response to lipopolysaccharide E55:B5, a B-cell mitogen, or to pokeweed mitogen, and B- and T-cell mitogen. Cell-mediated cytotoxicity to allogenic P815 tumor cells was 20% lower in mice fed 20% SBO than in mice fed 5% SBO for 12 wk. The lower cell-mediated immunity associated with 20% SBO was not due to changes in the fatty acid composition of the two major splenocyte membrane phospholipids, phosphatidylcholine and phosphatidylethanolamine. However, serum levels of linoleic acid were higher in mice fed 20% SBO. Raising dietary SBO from 5 to 20% by weight was associated with increased mammary tumorigenesis, reduced T-cell blastogenesis and lower cell-mediated cytotoxicity.

The influence of dietary essential fatty acids on rat immunocompetent cell prostaglandin synthesis and mitogen-induced blastogenesis

Sprague-Dawley rats were fed diets including 10% corn oil (CO), 10% hydrogenated coconut oil (HCO) or 10% linseed oil (LO), and immune cell populations isolated from peripheral blood and spleen were examined for alterations in prostaglandin E (PGE) synthesizing capacity and mitogen-induced blastogenesis. Culture conditions were optimized by incubating the cells in serum obtained from animals fed the same diet. The fatty acid profiles of these sera reflected the composition of the dietary fat ingested. Both the LO and HCO diet treatments resulted in significantly lower PG-synthesizing capacity by both unstimulated and phytohemagglutinin (PHA)-stimulated peripheral blood mononuclear cells or splenocytes when compared to the CO group. Mitogen-induced [3H]thymidine uptake by splenocytes from rats fed the HCO diet was twofold higher than responses observed in cells from animals fed the LO or CO diets. The results suggest that mitogenesis is not influenced by the diet-induced change in immune cell PGE2 synthesizing capacity. Enhanced [3H]thymidine incorporation was associated with a greater degree of saturation of dietary fat.

Effect of culture in vitro with eicosatetraenoic (20:4(n-6) ) and eicosapentaenoic (20:5(n-3) ) acids on fatty acid composition, prostaglandin synthesis and chemiluminescence of rat peritoneal macrophages

Rat peritoneal macrophages were cultured in either eicosatetraenoic acid (20:4(n-6) ) or eicosapentaenoic acid (20:5(n-3) ) and the effects on phospholipid fatty acids, prostaglandin synthesizing capacity and the ability of the macrophages to show chemiluminescence were examined. Chemiluminescence is an activity resulting from the synthesis of reactive oxygen species. It has been reported that prostaglandins inhibit this activity. The fatty acid profile of the four major phospholipids reflected the fatty acid component of the medium. Macrophages cultured in 20:4(n-6) synthesized twice the prostaglandin produced by controls and those cultured in 20:5(n-3) synthesized 10% that of controls and 5% that of 20:4(n-6)-cultured cells. Macrophages cultured with 20:4(n-6) for 12 h showed half the chemiluminescence of those cultured with 20:5(n-3), while those cultured with 20:4(n-6) for 24 h showed 10% the chemiluminescence of 20:5(n-3)-cultured cells. Addition of the prostaglandin synthase inhibitor, indomethacin, had no effect on chemiluminescence.

Alterations in cerebral and microvascular prostaglandin synthesis by manipulation of dietary essential fatty acids

Sprague-Dawley rats were fed one of three purified diets--10% corn oil, 10% hydrogenated coconut oil, or 10% linseed oil--through two generations. At 60-80 days of age the animals were sacrificed. The fatty acyl composition of phosphatidylcholine, phosphatidylethanolamine, plasmalogen phosphatidylethanolamine, and combined phosphatidylinositol/phosphatidylserine from cerebral cortex and isolated cerebral microvessels was determined. Brain slice prostaglandin F2 alpha or microvascular prostacyclin synthesis was also measured. Major changes were noted in the fatty acid profiles, most dramatically in the phosphatidylethanolamine and ethanolamine plasmalogen fractions, with an active rise in docosahexaenoic acid resulting from linseed oil feeding. A depression in prostaglandin F2 alpha synthesis was seen in brain slices of hydrogenated coconut oil- and linseed oil-fed rats. Such a depression was also observed in microvascular prostaglandin synthesis at basal and stimulated levels but not in control incubations. The potential importance of these findings to cerebral microcirculation and hemostasis is discussed.

Humoral immunity in essential fatty acid-deficient rats and mice: effect of route of injection of antigen

Weanling male Lewis Mai F rats and A/J mice were fed semi-purified diets either adequate or deficient in essential fatty acids (EFA) for 50-60 days. After death livers were excised, the lipids were extracted, and the fatty acid profile was determined. Groups of rats and mice were immunized by injection with sheep red blood cells (sRBC) either i.v. or i.p. One group of rats received an injection of sRBC plus Bordetella pertussis organisms. The plaque-forming cell response (PFC) of all groups was determined. Samples of mouse spleens were analyzed for prostaglandin F2 alpha. EFA-deficient rat and mice liver fatty acid profiles showed elevated levels of omega 7 and omega 9 fatty acids and decreased omega 6 fatty acids. The fatty acid profiles of mice differed quantitatively from the rats. As determined by the ratios of 18:0 to 18:2 omega 6 and 18:2 omega 6 to 20:4 omega 6 mice showed a higher delta 9 and a lower delta 6 desaturase activity. When the antigen was injected i.v. the EFA-deficient animals of both species showed an increased PFC response compared to controls, but when it was injected i.p. there was no difference between dietary groups. The PFC response in rats receiving B. pertussis increased dramatically but the difference between dietary groups was abrogated. As had been previously shown in rats the increase in PFC response in the mice immunized by the i.v. route correlated with a decreased synthesis of PGF2 alpha by the spleen.

Dietary alpha-linolenic acid and prostaglandin synthesis: a time course study

A purified diet containing 10% linseed oil as the fat source was fed to rats over a 56-day period. After the 56th day the rats were fed the same basal diet but containing 10% corn oil in place of the linseed oil. Rats were killed and blood and liver samples were taken from four to six rats on 14 days of the feeding trial. Serum and liver fatty acid profiles were determined. The platelet prostaglandin E2 (PGE2) released in serum as a result of blood coagulation for 1 h at 37 degrees C was determined. Liver homogenates were incubated and PGF2 alpha synthesizing capacity was assayed. Both serum and liver fatty acid profiles reflected the high linolenic content of the linseed oil. There was a progressive increase in fatty acids of the omega 3 series and a decrease in the omega 6 series. Notably the PG-2 series precursor, arachidonic acid (20:4 omega 6) was decreased and the precursor of the PG-3 series timnodonic acid (20:5 omega 3) was increased. These changes were reversed when corn oil was fed. PGE2 content of serum and PGF2 alpha synthesis by liver homogenates progressively decreased as the 20:4 omega 6 levels fell and the 20:5 omega 3 levels increased. PG synthesis was quickly increased in both when corn oil diets were fed. This study has implications for dietary manipulation of PG synthesis by blood components and may provide a basis for manipulation of PG synthesis in systems in which they are regulatory.

The effect of dietary alpha-linolenic acid in the rat on fatty acid profiles of immunocompetent cell populations

Analysis of diet-induced fatty acid changes in the major phospholipids of various immune cell populations has not been previously documented, particularly modifications induced by dietary alpha-linolenic acid. Rats were fed purified diets containing either 10% corn oil (CO), 10% linseed oil (LO) or 10% soybean oil-linseed mixture (SL) for 8 weeks. The alpha-linolenic to linoleic acid ratios of the diets were 1:32, 1:1 and 3:1, respectively. Fatty acid analysis of cell populations isolated from he spleen, thymus, thoracic cavity and peripheral blood phospholipids showed increases in omega 3 fatty acids accompanied by decreases in the omega 6 fatty acids when diets high in alpha-linolenic to linoleic acid ratios were fed. The extent of change observed was dependent on the magnitude of the alpha-linolenic to linoleic acid ratio. Both magnitude of change and the specific fatty acids altered varied with the cell population examined.

Modulation of prostaglandin synthesis in rat peritoneal macrophages with omega-3 fatty acids

In view of the findings that omega 3 fatty acids inhibit the synthesis of prostaglandins (PG) from arachidonic acid (20:4 omega 6) and that among immunologically active cells, the macrophage is a major producer of PG, we undertook a study of the effect of dietary alpha-linolenic acid (18:3 omega 3) on PG synthesis in the macrophage. Rats were fed purified diets containing either 10% corn oil (CO) or linseed oil (LO), providing either a low (1/32) or high (3.5/1) ratio of 18:3 omega 3 to 18:2 omega 6, respectively, for 6 weeks. Fatty acid analysis of macrophage phospholipids showed that there was an appreciable increase in the percentage of omega 3 fatty acids and a decrease in the omega 6 fatty acids in macrophages from rats fed the LO diet. The changes in fatty acid composition were associated with a significant decrease in the synthesis of prostaglandin E (PGE) by macrophages from rats fed the LO diet. Macrophages from rats fed the 2 dietary oils did not differ in their ability to degrade PG, thus the difference in PG production appeared to be a consequence of decreased synthesis only. The dietarily induced changes in PGE synthesis were readily overcome in vitro by culturing macrophages with complexes of fat-free bovine serum albumin and either 20:4 omega 6 or 20:5 omega 3.

Sera fatty acid effects on cultured rat splenocytes

Rats were fed either a stock diet or purified diets containing either 10% by weight corn oil or linseed oil for 8 weeks. Splenocytes from rats on the stock ration were cultured for 48 hours in media containing either serum from the rats fed stock diet, corn oil or linseed oil, or fetal bovine serum (FBS). Populations were cultured without stimulation and with stimulation by leucogglutinin (PHA), and the production of prostaglandin F2 alpha by the cells was determined. The serum from the corn oil-fed rats differed markedly in composition from that of the linseed oil-fed rats notably in the higher level of arachidonic acid (20:4 omega 6) and lower level of timnodonic acid (20:5 omega 3). FBS also had a lower level of 20:4 omega 6. These changes were reflected in the fatty acid composition of the spleen choline glycerophosphatide. PGF2 alpha production was significantly depressed in the medium from linseed oil-fed rats compared to the corn oil group. This effect was due to the competition of 20:5 omega 3 for the cyclooxygenase. Viability of cells was better in rat serum than in FBS. The study shows that when studying functions in cultured cells obtained from rats fed different dietary fats the dietary effect will be abrogated or modified by use of FBS in the medium.

Essential fatty acid deficiency, prostaglandin synthesis and humoral immunity in Lewis rats

Essential fatty acid (EFA) deficiency is known to alter the immune response in several experimental systems. To further evaluate the effects of EFAs on immunity Lewis rats were fed diets either adequate or deficient in EFAs for 70-80 days. EFA-adequate rats responded to an i.v. injection of 5 X 10(8) sheep erythrocytes with a sharp, short-lived rise in splenic levels of PGE and PGF within 2 minutes after injection. EFA deficiency resulted in a diminution of this PG response. PG production in liver homogenates was also depressed in EFA-deficient liver. An i.v. injection of sheep erythrocytes resulted in a humoral response against this antigen, measured as hemolytic plaque-forming cells in the spleen. EFA deficiency, as well as pretreatment of EFA-adequate rats with indomethacin, an inhibitor of PG synthesis, resulted in a stimulation of the plaque-forming cell response over that observed in control, EFA-adequate rats. The alterations in immune response resulting from changes in PG synthetic capacity may be important in the etiology of certain immunodeficiency syndromes such as the lupus-erythematosus-like autoimmune disease in NZB/W mice.

Modulation of tissue prostaglandin synthesizing capacity by increased ratios of dietary alpha-linolenic acid to linoleic acid

Semipurified diets containing ratios of alpha-linolenic acid (18:3 omega 3) to linoleic acid (18:2 omega 6) of 1/32, 1/7, 1/1, and 3.5/1 in the form of corn oil, soybean oil, soybean/linseed oil mix and linseed oil were fed to rats for 2 months. The first 3 diets were fed to another group of rats for 4 months and to a group through the second generation. Fatty acid analysis of liver and spleen ethanolamine glycerophosphatide revealed that, as the level of 18:3 omega 3 in the diet increased, the elongated, desaturated metabolites of the omega 6 series decreased and the omega 3 series increased. Noteworthy was the depression in the amount of the precursor of the 2-series prostaglandins (PG) as the omega 3 levels increased. Synthesis of PG by liver of rats fed 2 or 4 months markedly decreased, but at 2 months in thymus and spleen, it showed a trend toward decreasing only. Brain slices showed no decrease in PGF2 alpha synthesis after 4 months, but did decrease significantly after feeding the diets to the second generation. Synthesis of PGE2 by spleen homogenate from the second generation also significantly decreased. The replacement of omega 6 series fatty acids by omega 3 series is explained by the effective competition of 18:3 omega 3 over 18:2 omega 6 for the delta 6 desaturase. Depressions in PG synthesis by high dietary 18:3 omega 3 is explained by the competitive inhibition of the PG synthetase complex by 20:5 omega 3 as well as by the decreased levels of 20:4 omega 6.

Incidence and severity of experimental allergic encephalomyelitis and cerebral prostaglandin synthesis in essential fatty acid deficient and aspirin-treated rats

Experimental allergic encephalomyelitis (EAE) was induced in rats of the Lewis strain fed diets adequate or deficient in essential fatty acids (EFA). After induction of the disease, the diets were supplemented with aspirin (3.75 g/kg diet), and the effects of the drug on the course of EAE and on the synthesis of prostaglandin F (PGF) by brain slices from diseased animals and their Freund controls were examined. Aspirin supplementation delayed the onset of EAE in both dietary groups. EFA-deficient rats experienced an incidence and severity of the disease similar to that of aspirin-free, EFA-deficiet rats, while the EFA-adequate group showed a greater severity but not an increased incidence, compared to aspirin-free controls. Aspirin treatment led to an increased PGF production by brain slices from rats on either diet and not subjected to an immunochallenge. When the diet was deficient in EFA, challenge with antigen plus adjuvant or adjuvant alone tended to decrease PGF synthesis by brain slices, and when the diet was adequate in EFA, immunochallenge caused a marked depression on PGF synthesis. It was concluded that the PG synthetase inhibitor aspirin can alter the course of EAE in the rat, providing further evidence that PGs or related metabolites may be involved in the immune response in this disease.

Cerebral prostaglandin synthesis during the dietary and pathological stresses of essential fatty acid deficiency and experimental allergic encephalomyelitis

Rats of the Lewis strain were fed diets adequate or deficient in essential fatty acids (EFA). At 70-80 days of age experimental allergic encephalomyelitis (EAE) was induced using adjuvants containing either Mycobacterium butyricum or Mycobacterium tuberculois H37Ra. When the former Mycobacterium was used, the incidence of EAE was greater in the EFA-deficient than in EFA-adequate controls; but when the rats challenged with M. tuberculosis, the incidence of the disease was the same in both dietary groups. Brain slices from EFA-deficient rats had a marginally depressed synthesis of prostaglandin F (PGF) compared to that of controls. Immunochallenge with adjuvant alone or adjuvant plus antigen tended to depress further PGF synthesis by brain slices from EFA-deficient rats and significantly depressed synthesis by slices from rats receiving adequate EFA. Whether or not rats were paralyzed had no effect on PGF synthesis when the diet was adequate in EFA, but a significant difference was seen in the EFA-deficient group. The results indicate a possible role for PGF synthesis in the degree of susceptibility of the rats to EAE under different dietary regimens.