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Marar TT, Martinez ND, Maroney SA, Siebert AE, Wu J, Stalker TJ, Tomaiuolo M, Delacroix S, Simari RD, Mast AE, Brass LF. The contribution of TFPIα to the hemostatic response to injury in mice. J Thromb Haemost 2021; 19:2182-2192. [PMID: 34160126 PMCID: PMC8571650 DOI: 10.1111/jth.15430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/27/2020] [Revised: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Tissue factor pathway inhibitor (TFPI) is an essential regulator of coagulation, limiting thrombin generation and preventing thrombosis. In humans and mice, TFPIα is the sole isoform present in platelets. OBJECTIVE Here, we asked whether TFPIα, because of its release from platelets at sites of injury, has a unique role in limiting the hemostatic response. METHODS TFPIα-mutant (TfpiΔα/Δα ) mice were generated by introducing a stop codon in the C-terminus. Platelet accumulation, platelet activation, and fibrin accumulation were measured following penetrating injuries in the jugular vein and cremaster muscle arterioles, and imaged by fluorescence and scanning electron microscopy. Time to bleeding cessation was recorded in the jugular vein studies. RESULTS TfpiΔα/Δα mice were viable and fertile. Plasma TFPI levels were normal in the TfpiΔα/Δα mice, no TFPI protein or activity was present in their platelets and thrombin-antithrombin complex levels were indistinguishable from Tfpi+/+ littermates. There was a small, but statistically significant reduction in the time to bleeding cessation following jugular vein puncture injury in the TfpiΔα/Δα mice, but no measurable changes in platelet or fibrin accumulation or in hemostatic plug architecture following injury of the micro- or macrovasculature. CONCLUSION Loss of TFPIα expression does not produce a global prothrombotic state in mice. Platelet TFPIα is expected to be released or displayed in a focal manner at the site of injury, potentially accumulating to high concentrations in the narrow gaps between platelets. If so, the data from the vascular injury models studied here indicate this is not essential for a normal hemostatic response in mice.
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Affiliation(s)
- Tanya T. Marar
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | - Jie Wu
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Timothy J. Stalker
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Maurizio Tomaiuolo
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sinny Delacroix
- Department of Medicine, University of Adelaide, Adelaide, Australia
| | - Robert D. Simari
- Department of Cardiovascular Medicine, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Alan E. Mast
- Versiti Blood Research Institute, Milwaukee, WI, USA
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Lawrence F. Brass
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Froehlich H, Simari RD, Boilson BA. Differential phenotype and behavior in culture of CD34 positive cells from peripheral blood and adipose tissue. Heliyon 2021; 7:e07779. [PMID: 34458617 PMCID: PMC8377488 DOI: 10.1016/j.heliyon.2021.e07779] [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: 02/11/2021] [Revised: 04/14/2021] [Accepted: 08/10/2021] [Indexed: 01/31/2023] Open
Abstract
The localization and quantification of endothelial progenitor cells (EPCs) are controversial. Circulating CD34 + cells in blood have been identified as EPCs and as biomarkers of cardiovascular disease. We discuss in this paper the current data describing differential phenotype and behavior in vitro of CD34 positive cells from the circulation and adipose tissue (AT). We also describe in brief our own findings from CD34 + cells isolated from leukopheresis cones derived from healthy platelet donors and from patients undergoing bariatric surgery. We conclude that CD34 + cells in blood and in AT are different in antigenic profile and behavior in culture. The findings described assert that CD34 + cells detected in blood previously identified as biomarkers of cardiovascular disease are predominantly HPCs rather than EPCs, and that true CD34 + EPCs can be readily identified and extracted from AT, supportive of the current evidence which suggests EPCs are resident in the tissue vasculature.
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Affiliation(s)
- Harald Froehlich
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.,Department of Internal Medicine and Emergency Medicine, LKH Graz II, Graz, Austria
| | - Robert D Simari
- Department of Cardiovascular Medicine, University of Kansas School of Medicine, USA
| | - Barry A Boilson
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
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Bolli R, Mitrani RD, Hare JM, Pepine CJ, Perin EC, Willerson JT, Traverse JH, Henry TD, Yang PC, Murphy MP, March KL, Schulman IH, Ikram S, Lee DP, O’Brien C, Lima JA, Ostovaneh MR, Ambale-Venkatesh B, Lewis G, Khan A, Bacallao K, Valasaki K, Longsomboon B, Gee AP, Richman S, Taylor DA, Lai D, Sayre SL, Bettencourt J, Vojvodic RW, Cohen ML, Simpson L, Aguilar D, Loghin C, Moyé L, Ebert RF, Davis BR, Simari RD. A Phase II study of autologous mesenchymal stromal cells and c-kit positive cardiac cells, alone or in combination, in patients with ischaemic heart failure: the CCTRN CONCERT-HF trial. Eur J Heart Fail 2021; 23:661-674. [PMID: 33811444 PMCID: PMC8357352 DOI: 10.1002/ejhf.2178] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [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: 12/04/2020] [Revised: 03/19/2021] [Accepted: 03/23/2021] [Indexed: 12/21/2022] Open
Abstract
AIMS CONCERT-HF is an NHLBI-sponsored, double-blind, placebo-controlled, Phase II trial designed to determine whether treatment with autologous bone marrow-derived mesenchymal stromal cells (MSCs) and c-kit positive cardiac cells (CPCs), given alone or in combination, is feasible, safe, and beneficial in patients with heart failure (HF) caused by ischaemic cardiomyopathy. METHODS AND RESULTS Patients were randomized (1:1:1:1) to transendocardial injection of MSCs combined with CPCs, MSCs alone, CPCs alone, or placebo, and followed for 12 months. Seven centres enrolled 125 participants with left ventricular ejection fraction of 28.6 ± 6.1% and scar size 19.4 ± 5.8%, in New York Heart Association class II or III. The proportion of major adverse cardiac events (MACE) was significantly decreased by CPCs alone (-22% vs. placebo, P = 0.043). Quality of life (Minnesota Living with Heart Failure Questionnaire score) was significantly improved by MSCs alone (P = 0.050) and MSCs + CPCs (P = 0.023) vs. placebo. Left ventricular ejection fraction, left ventricular volumes, scar size, 6-min walking distance, and peak oxygen consumption did not differ significantly among groups. CONCLUSIONS This is the first multicentre trial assessing CPCs and a combination of two cell types from different tissues in HF patients. The results show that treatment is safe and feasible. Even with maximal guideline-directed therapy, both CPCs and MSCs were associated with improved clinical outcomes (MACE and quality of life, respectively) in ischaemic HF without affecting left ventricular function or structure, suggesting possible systemic or paracrine cellular mechanisms. Combining MSCs with CPCs was associated with improvement in both these outcomes. These results suggest potential important beneficial effects of CPCs and MSCs and support further investigation in HF patients.
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Affiliation(s)
- Roberto Bolli
- University of Louisville, School of Medicine, Louisville, KY, USA
| | - Raul D. Mitrani
- University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Joshua M. Hare
- University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Carl J. Pepine
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Emerson C. Perin
- Texas Heart Institute, CHI St. Luke’s Health Baylor College of Medicine Medical Center, Houston, TX, USA
| | - James T. Willerson
- Texas Heart Institute, CHI St. Luke’s Health Baylor College of Medicine Medical Center, Houston, TX, USA
| | - Jay H. Traverse
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, and University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Timothy D. Henry
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH, USA
| | | | | | - Keith L. March
- University of Florida College of Medicine, Gainesville, FL, USA
| | | | - Sohail Ikram
- University of Louisville, School of Medicine, Louisville, KY, USA
| | - David P. Lee
- Stanford University School of Medicine, Stanford, CA, USA
| | - Connor O’Brien
- Stanford University School of Medicine, Stanford, CA, USA
| | - Joao A. Lima
- Johns Hopkins University, Cardiovascular Imaging, Baltimore, MD, USA
| | | | | | - Gregory Lewis
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Aisha Khan
- University of Miami, Miller School of Medicine, Interdisciplinary Stem Cell Institute, Miami, FL, USA
| | - Ketty Bacallao
- University of Miami, Miller School of Medicine, Interdisciplinary Stem Cell Institute, Miami, FL, USA
| | - Krystalenia Valasaki
- University of Miami, Miller School of Medicine, Interdisciplinary Stem Cell Institute, Miami, FL, USA
| | - Bangon Longsomboon
- University of Miami, Miller School of Medicine, Interdisciplinary Stem Cell Institute, Miami, FL, USA
| | - Adrian P. Gee
- Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Sara Richman
- Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Doris A. Taylor
- Texas Heart Institute, CHI St. Luke’s Health Baylor College of Medicine Medical Center, Houston, TX, USA
| | - Dejian Lai
- UTHealth University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Shelly L. Sayre
- UTHealth University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Judy Bettencourt
- UTHealth University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Rachel W. Vojvodic
- UTHealth University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Michelle L. Cohen
- UTHealth University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Lara Simpson
- UTHealth University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - David Aguilar
- UTHealth University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
- UTHealth University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA
| | - Catalin Loghin
- UTHealth University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA
| | - Lem Moyé
- UTHealth University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Ray F. Ebert
- NIH, National Heart, Lung and Blood Institute, Bethesda, MD, USA
| | - Barry R. Davis
- UTHealth University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
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Abstract
BACKGROUND In 2000, a landmark study showed that women who graduated from U.S. medical schools from 1979 through 1997 were less likely than their male counterparts to be promoted to upper faculty ranks in academic medical centers. It is unclear whether these differences persist. METHODS We merged data from the Association of American Medical Colleges on all medical school graduates from 1979 through 2013 with faculty data through 2018, and we compared the percentages of women who would be expected to be promoted on the basis of the proportion of women in the graduating class with the actual percentages of women who were promoted. We calculated Kaplan-Meier curves and used adjusted Cox proportional-hazards models to examine the differences between the early cohorts (1979-1997) and the late cohorts (1998-2013). RESULTS The sample included 559,098 graduates from 134 U.S. medical schools. In most of the cohorts, fewer women than expected were promoted to the rank of associate or full professor or appointed to the post of department chair. Findings were similar across basic science and clinical departments. In analyses that included all the cohorts, after adjustment for graduation year, race or ethnic group, and department type, women assistant professors were less likely than their male counterparts to be promoted to associate professor (hazard ratio, 0.76; 95% confidence interval [CI], 0.74 to 0.78). Similar sex disparities existed in promotions to full professor (hazard ratio, 0.77; 95% CI, 0.74 to 0.81) and appointments to department chair (hazard ratio, 0.46; 95% CI, 0.39 to 0.54). These sex differences in promotions and appointments did not diminish over time and were not smaller in the later cohorts than in the earlier cohorts. The sex differences were even larger in the later cohorts with respect to promotion to full professor. CONCLUSIONS Over a 35-year period, women physicians in academic medical centers were less likely than men to be promoted to the rank of associate or full professor or to be appointed to department chair, and there was no apparent narrowing in the gap over time. (Funded by the University of Kansas Medical Center Joy McCann Professorship for Women in Medicine and the American Association of University Women.).
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Affiliation(s)
- Kimber P Richter
- From the Departments of Population Health (K.P.R., E.C., C.A.B.), Biostatistics and Data Science (L.C., J.A.W.), Otolaryngology and Head and Neck Surgery (D.D.), Pediatrics (P.S.), Anesthesiology (G.H.S.), and Cardiovascular Medicine (R.D.S.), University of Kansas School of Medicine, Kansas City
| | - Lauren Clark
- From the Departments of Population Health (K.P.R., E.C., C.A.B.), Biostatistics and Data Science (L.C., J.A.W.), Otolaryngology and Head and Neck Surgery (D.D.), Pediatrics (P.S.), Anesthesiology (G.H.S.), and Cardiovascular Medicine (R.D.S.), University of Kansas School of Medicine, Kansas City
| | - Jo A Wick
- From the Departments of Population Health (K.P.R., E.C., C.A.B.), Biostatistics and Data Science (L.C., J.A.W.), Otolaryngology and Head and Neck Surgery (D.D.), Pediatrics (P.S.), Anesthesiology (G.H.S.), and Cardiovascular Medicine (R.D.S.), University of Kansas School of Medicine, Kansas City
| | - Erica Cruvinel
- From the Departments of Population Health (K.P.R., E.C., C.A.B.), Biostatistics and Data Science (L.C., J.A.W.), Otolaryngology and Head and Neck Surgery (D.D.), Pediatrics (P.S.), Anesthesiology (G.H.S.), and Cardiovascular Medicine (R.D.S.), University of Kansas School of Medicine, Kansas City
| | - Dianne Durham
- From the Departments of Population Health (K.P.R., E.C., C.A.B.), Biostatistics and Data Science (L.C., J.A.W.), Otolaryngology and Head and Neck Surgery (D.D.), Pediatrics (P.S.), Anesthesiology (G.H.S.), and Cardiovascular Medicine (R.D.S.), University of Kansas School of Medicine, Kansas City
| | - Pamela Shaw
- From the Departments of Population Health (K.P.R., E.C., C.A.B.), Biostatistics and Data Science (L.C., J.A.W.), Otolaryngology and Head and Neck Surgery (D.D.), Pediatrics (P.S.), Anesthesiology (G.H.S.), and Cardiovascular Medicine (R.D.S.), University of Kansas School of Medicine, Kansas City
| | - Grace H Shih
- From the Departments of Population Health (K.P.R., E.C., C.A.B.), Biostatistics and Data Science (L.C., J.A.W.), Otolaryngology and Head and Neck Surgery (D.D.), Pediatrics (P.S.), Anesthesiology (G.H.S.), and Cardiovascular Medicine (R.D.S.), University of Kansas School of Medicine, Kansas City
| | - Christie A Befort
- From the Departments of Population Health (K.P.R., E.C., C.A.B.), Biostatistics and Data Science (L.C., J.A.W.), Otolaryngology and Head and Neck Surgery (D.D.), Pediatrics (P.S.), Anesthesiology (G.H.S.), and Cardiovascular Medicine (R.D.S.), University of Kansas School of Medicine, Kansas City
| | - Robert D Simari
- From the Departments of Population Health (K.P.R., E.C., C.A.B.), Biostatistics and Data Science (L.C., J.A.W.), Otolaryngology and Head and Neck Surgery (D.D.), Pediatrics (P.S.), Anesthesiology (G.H.S.), and Cardiovascular Medicine (R.D.S.), University of Kansas School of Medicine, Kansas City
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5
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Bolli R, Perin EC, Willerson JT, Yang PC, Traverse JH, Henry TD, Pepine CJ, Mitrani RD, Hare JM, Murphy MP, March KL, Ikram S, Lee DP, O’Brien C, Durand JB, Miller K, Lima JA, Ostovaneh MR, Ambale-Venkatesh B, Gee AP, Richman S, Taylor DA, Sayre SL, Bettencourt J, Vojvodic RW, Cohen ML, Simpson LM, Lai D, Aguilar D, Loghin C, Moyé L, Ebert RF, Davis BR, Simari RD. Allogeneic Mesenchymal Cell Therapy in Anthracycline-Induced Cardiomyopathy Heart Failure Patients: The CCTRN SENECA Trial. JACC CardioOncol 2020; 2:581-595. [PMID: 33403362 PMCID: PMC7781291 DOI: 10.1016/j.jaccao.2020.09.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Anthracycline-induced cardiomyopathy (AIC) may be irreversible with a poor prognosis, disproportionately affecting women and young adults. Administration of allogeneic bone marrow-derived mesenchymal stromal cells (allo-MSCs) is a promising approach to heart failure (HF) treatment. OBJECTIVES SENECA (Stem Cell Injection in Cancer Survivors) was a phase 1 study of allo-MSCs in AIC. METHODS Cancer survivors with chronic AIC (mean age 56.6 years; 68% women; NT-proBNP 1,426 pg/ml; 6 enrolled in an open-label, lead-in phase and 31 subjects randomized 1:1) received 1 × 108 allo-MSCs or vehicle transendocardially. Primary objectives were safety and feasibility. Secondary efficacy measures included cardiac function and structure measured by cardiac magnetic resonance imaging (CMR), functional capacity, quality of life (Minnesota Living with Heart Failure Questionnaire), and biomarkers. RESULTS A total of 97% of subjects underwent successful study product injections; all allo-MSC-assigned subjects received the target dose of cells. Follow-up visits were well-attended (92%) with successful collection of endpoints in 94% at the 1-year visit. Although 58% of subjects had non-CMR compatible devices, CMR endpoints were successfully collected in 84% of subjects imaged at 1 year. No new tumors were reported. There were no significant differences between allo-MSC and vehicle groups with regard to clinical outcomes. Secondary measures included 6-min walk test (p = 0.056) and Minnesota Living with Heart Failure Questionnaire score (p = 0.048), which tended to favor the allo-MSC group. CONCLUSIONS In this first-in-human study of cell therapy in patients with AIC, transendocardial administration of allo-MSCs appears safe and feasible, and CMR was successfully performed in the majority of the HF patients with devices. This study lays the groundwork for phase 2 trials aimed at assessing efficacy of cell therapy in patients with AIC.
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Affiliation(s)
- Roberto Bolli
- Department of Medicine, Division of Cardiovascular Medicine, University of Louisville, School of Medicine, Louisville, Kentucky, USA
| | - Emerson C. Perin
- Division of Cardiology Research, Texas Heart Institute, CHI St. Luke’s Health Baylor College of Medicine Medical Center, Houston, Texas, USA
| | - James T. Willerson
- Division of Cardiology Research, Texas Heart Institute, CHI St. Luke’s Health Baylor College of Medicine Medical Center, Houston, Texas, USA
| | - Phillip C. Yang
- Department of Medicine and Cardiovascular Institute, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Jay H. Traverse
- Department of Medicine, Cardiovascular Division, Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, and University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Timothy D. Henry
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio, USA
| | - Carl J. Pepine
- Department of Medicine, Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Raul D. Mitrani
- Department of Medicine, Cardiovascular Division, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Joshua M. Hare
- Department of Molecular and Cellular Pharmacology, Division of Cardiology, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Michael P. Murphy
- Department of Surgery, Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Keith L. March
- Department of Medicine, Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Sohail Ikram
- Department of Medicine, Division of Cardiovascular Medicine, University of Louisville, School of Medicine, Louisville, Kentucky, USA
| | - David P. Lee
- Department of Medicine and Cardiovascular Institute, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Connor O’Brien
- Department of Medicine and Cardiovascular Institute, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Jean-Bernard Durand
- Department of Cardiology, Division of Internal Medicine, M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Kathy Miller
- Department of Medicine, Division of Hematology/Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Joao A. Lima
- Department of Medicine, Cardiology Division, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mohammad R. Ostovaneh
- Department of Medicine, Cardiology Division, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Adrian P. Gee
- Department of Pediatrics, Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas, USA
| | - Sara Richman
- Department of Pediatrics, Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas, USA
| | - Doris A. Taylor
- Department of Regenerative Medicine Research, Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston, Texas, USA
| | - Shelly L. Sayre
- Department of Biostatistics & Data Science, UTHealth University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Judy Bettencourt
- Department of Biostatistics & Data Science, UTHealth University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Rachel W. Vojvodic
- Department of Biostatistics & Data Science, UTHealth University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Michelle L. Cohen
- Department of Biostatistics & Data Science, UTHealth University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Lara M. Simpson
- Department of Biostatistics & Data Science, UTHealth University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Dejian Lai
- Department of Biostatistics & Data Science, UTHealth University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - David Aguilar
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Catalin Loghin
- Department of Medicine, Division of Cardiovascular Medicine, UTHealth University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas, USA
| | - Lem Moyé
- Department of Biostatistics & Data Science, UTHealth University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Ray F. Ebert
- Division of Cardiovascular Sciences, Basic & Early Translational Research Program, National Institutes of Health, National Heart, Lung, and Blood Institute, Washington, DC, USA
| | - Barry R. Davis
- Department of Biostatistics & Data Science, UTHealth University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA,Address for correspondence: Dr. Barry R. Davis, UTHealth School of Public Health, 1200 Pressler, W-916, Houston, Texas 77584. @UTexasSPH
| | - Robert D. Simari
- Division of Cardiovascular Diseases, University of Kansas School of Medicine, Kansas City, Kansas, USA
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Wang X, Chacon LI, Derakhshandeh R, Rodriguez HJ, Han DD, Kostyushev DS, Henry TD, Traverse JH, Moyé L, Simari RD, Taylor DA, Springer ML. Impaired therapeutic efficacy of bone marrow cells from post-myocardial infarction patients in the TIME and LateTIME clinical trials. PLoS One 2020; 15:e0237401. [PMID: 32841277 PMCID: PMC7446972 DOI: 10.1371/journal.pone.0237401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/25/2020] [Indexed: 01/07/2023] Open
Abstract
Implantation of bone marrow-derived cells (BMCs) into mouse hearts post-myocardial infarction (MI) limits cardiac functional decline. However, clinical trials of post-MI BMC therapy have yielded conflicting results. While most laboratory experiments use healthy BMC donor mice, clinical trials use post-MI autologous BMCs. Post-MI mouse BMCs are therapeutically impaired, due to inflammatory changes in BMC composition. Thus, therapeutic efficacy of the BMCs progressively worsens after MI but recovers as donor inflammatory response resolves. The availability of post-MI patient BM mononuclear cells (MNCs) from the TIME and LateTIME clinical trials enabled us to test if human post-MI MNCs undergo a similar period of impaired efficacy. We hypothesized that MNCs from TIME trial patients would be less therapeutic than healthy human donor MNCs when implanted into post-MI mouse hearts, and that therapeutic properties would be restored in MNCs from LateTIME trial patients. Post-MI SCID mice received MNCs from healthy donors, TIME patients, or LateTIME patients. Cardiac function improved considerably in the healthy donor group, but neither the TIME nor LateTIME group showed therapeutic effect. Conclusion: post-MI human MNCs lack therapeutic benefits possessed by healthy MNCs, which may partially explain why BMC clinical trials have been less successful than mouse studies.
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Affiliation(s)
- Xiaoyin Wang
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA, United States of America
| | | | - Ronak Derakhshandeh
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA, United States of America
| | - Hilda J. Rodriguez
- Division of Cardiology, University of California, San Francisco, San Francisco, CA, United States of America
- Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, San Francisco, CA, United States of America
| | - Daniel D. Han
- Division of Cardiology, University of California, San Francisco, San Francisco, CA, United States of America
| | - Dmitry S. Kostyushev
- Division of Cardiology, University of California, San Francisco, San Francisco, CA, United States of America
| | - Timothy D. Henry
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, OH, United States of America
| | - Jay H. Traverse
- Minneapolis Heart Institute Foundation, Minneapolis, MN, United States of America
| | - Lem Moyé
- University of Texas Health School of Public Health, Houston, TX, United States of America
| | - Robert D. Simari
- Kansas University Medical Center, Kansas City, KS, United States of America
| | - Doris A. Taylor
- Texas Heart Institute, Houston, TX, United States of America
| | - Matthew L. Springer
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA, United States of America
- Division of Cardiology, University of California, San Francisco, San Francisco, CA, United States of America
- Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, San Francisco, CA, United States of America
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Bonaminio GA, Walling A, Beacham TD, Murphy WR, Huyett KM, Simari RD. Impacts of an Alumni Association-Institutional Partnership to Invest in Educational Innovation. Med Sci Educ 2020; 30:505-511. [PMID: 34457694 PMCID: PMC8368678 DOI: 10.1007/s40670-019-00842-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
An 8-year small grants program funded by an alumni association has awarded $814,356 to 50 principal investigators for educational research. The 63 projects principally concerned simulation, educational tools and techniques, interprofessional education, and pilot projects for curricular reform. Awardees identify career growth and institutional advancement of education as major outcomes. Four publications, 63 posters/presentations, nationally disseminated educational materials, and external grants have been generated. Other outcomes include a second small grants program and travel funding for educational scholarship. The alumni association has made additional investment of over $1.8 million in educational development and has been nationally recognized for its collaborative philanthropy.
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Affiliation(s)
- Giulia A. Bonaminio
- Office of Medical Education, University of Kansas School of Medicine, 3901 Rainbow Blvd. Mailstop 1055, Kansas City, KS 66160 USA
| | - Anne Walling
- Family and Community Medicine-Wichita, University of Kansas School of Medicine-Wichita, 1010 North Kansas, Wichita, KS 67214-3199 USA
| | - Teresa D. Beacham
- Office of Medical Education, University of Kansas School of Medicine, 3901 Rainbow Blvd. Mailstop 1055, Kansas City, KS 66160 USA
| | - William Rory Murphy
- Psychiatric Associates, 4601 W 109th Street Suite 208, Overland Park, KS 66211 USA
| | - Kimberly M. Huyett
- Institute for Community Engagement, Kansas University Medical Center, 3901 Rainbow Blvd. Mailstop: 3056, Kanas City, KS 66160 USA
| | - Robert D. Simari
- Office of the Executive Vice Chancellor, Kansas University Medical Center, 3901 Rainbow Blvd. Mailstop: 2015, Kansas City, KS 66160 USA
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Fernández-Avilés F, Sanz-Ruiz R, Climent AM, Badimon L, Bolli R, Charron D, Fuster V, Janssens S, Kastrup J, Kim HS, Lüscher TF, Martin JF, Menasché P, Pinto FJ, Simari RD, Stone GW, Terzic A, Willerson JT, Wu JC. Global Overview of the Transnational Alliance for Regenerative Therapies in Cardiovascular Syndromes (TACTICS) Recommendations: A Comprehensive Series of Challenges and Priorities of Cardiovascular Regenerative Medicine. Circ Res 2019; 122:199-201. [PMID: 29348246 DOI: 10.1161/circresaha.117.312099] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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)
- Francisco Fernández-Avilés
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain (F.F.-A., R.S.-R., A.M.C.); CIBERCV, ISCIII, Madrid, Spain (F.F.-A., R.S.-R., A.M.C., L.B., V.F.); Cardiovascular Research Center (ICCC), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (L.B.); Institute of Molecular Cardiology, Diabetes and Obesity Center, University of Louisville School of Medicine, KY (R.B.); LabEx TRANSPLANTEX, Paris, France (D.C.); HLA and Médecine Jean Dausset Laboratory Network, Hôpital Saint-Louis AP-HP, Université Paris Diderot, France (D.C.); Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain (V.F.); Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (V.F.); Department of Cardiovascular Sciences, KU Leuven, Belgium (S.J.); Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark (J.K.); National Research Laboratory for Stem Cell Niche, Center for Medical Innovation, Seoul National University Hospital, Seoul, Korea (H.-S.K.); Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Korea (H.-S.K.); Department of Cardiology, Royal Brompton and Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, England (T.F.L); University College of London, England (J.F.M.); Department of Cardiovascular Surgery Hôpital Européen Georges Pompidou, Paris, France (P.M.); Université Paris Descartes, Sorbonne Paris Cité, France (P.M.); Serviço de Cardiologia, Hospital Universitário de Santa Maria, CAML, Centro Cardiovascular da Universidade de Lisboa, Universidade de Lisboa, Portugal (F.J.P.); School of Medicine, University of Kansas, Lawrence (R.D.S.); Center for Clinical Trials, Cardiovascular Research Foundation, New York, NY (G.W.S.); Center for Clinical Trials, NewYork-Presbyterian Hospital, Columbia University Medical Center (G.W.S.); Center for Regenerative Medicine (A.T.), Department of Cardiovascular Diseases (A.T.), and Department of Molecular Pharmacology and Experimental Therapeutics (A.T.), Mayo Clinic, Rochester, NY; Department of Regenerative Medicine Research, Texas Heart Institute, Houston (J.T.W.); and Division of Cardiovascular Medicine, Department of Medicine, Stanford Cardiovascular Institute (J.C.W.) and Department of Radiology (J.C.W.), Stanford University School of Medicine, CA.
| | - Ricardo Sanz-Ruiz
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain (F.F.-A., R.S.-R., A.M.C.); CIBERCV, ISCIII, Madrid, Spain (F.F.-A., R.S.-R., A.M.C., L.B., V.F.); Cardiovascular Research Center (ICCC), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (L.B.); Institute of Molecular Cardiology, Diabetes and Obesity Center, University of Louisville School of Medicine, KY (R.B.); LabEx TRANSPLANTEX, Paris, France (D.C.); HLA and Médecine Jean Dausset Laboratory Network, Hôpital Saint-Louis AP-HP, Université Paris Diderot, France (D.C.); Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain (V.F.); Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (V.F.); Department of Cardiovascular Sciences, KU Leuven, Belgium (S.J.); Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark (J.K.); National Research Laboratory for Stem Cell Niche, Center for Medical Innovation, Seoul National University Hospital, Seoul, Korea (H.-S.K.); Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Korea (H.-S.K.); Department of Cardiology, Royal Brompton and Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, England (T.F.L); University College of London, England (J.F.M.); Department of Cardiovascular Surgery Hôpital Européen Georges Pompidou, Paris, France (P.M.); Université Paris Descartes, Sorbonne Paris Cité, France (P.M.); Serviço de Cardiologia, Hospital Universitário de Santa Maria, CAML, Centro Cardiovascular da Universidade de Lisboa, Universidade de Lisboa, Portugal (F.J.P.); School of Medicine, University of Kansas, Lawrence (R.D.S.); Center for Clinical Trials, Cardiovascular Research Foundation, New York, NY (G.W.S.); Center for Clinical Trials, NewYork-Presbyterian Hospital, Columbia University Medical Center (G.W.S.); Center for Regenerative Medicine (A.T.), Department of Cardiovascular Diseases (A.T.), and Department of Molecular Pharmacology and Experimental Therapeutics (A.T.), Mayo Clinic, Rochester, NY; Department of Regenerative Medicine Research, Texas Heart Institute, Houston (J.T.W.); and Division of Cardiovascular Medicine, Department of Medicine, Stanford Cardiovascular Institute (J.C.W.) and Department of Radiology (J.C.W.), Stanford University School of Medicine, CA
| | - Andreu M Climent
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain (F.F.-A., R.S.-R., A.M.C.); CIBERCV, ISCIII, Madrid, Spain (F.F.-A., R.S.-R., A.M.C., L.B., V.F.); Cardiovascular Research Center (ICCC), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (L.B.); Institute of Molecular Cardiology, Diabetes and Obesity Center, University of Louisville School of Medicine, KY (R.B.); LabEx TRANSPLANTEX, Paris, France (D.C.); HLA and Médecine Jean Dausset Laboratory Network, Hôpital Saint-Louis AP-HP, Université Paris Diderot, France (D.C.); Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain (V.F.); Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (V.F.); Department of Cardiovascular Sciences, KU Leuven, Belgium (S.J.); Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark (J.K.); National Research Laboratory for Stem Cell Niche, Center for Medical Innovation, Seoul National University Hospital, Seoul, Korea (H.-S.K.); Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Korea (H.-S.K.); Department of Cardiology, Royal Brompton and Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, England (T.F.L); University College of London, England (J.F.M.); Department of Cardiovascular Surgery Hôpital Européen Georges Pompidou, Paris, France (P.M.); Université Paris Descartes, Sorbonne Paris Cité, France (P.M.); Serviço de Cardiologia, Hospital Universitário de Santa Maria, CAML, Centro Cardiovascular da Universidade de Lisboa, Universidade de Lisboa, Portugal (F.J.P.); School of Medicine, University of Kansas, Lawrence (R.D.S.); Center for Clinical Trials, Cardiovascular Research Foundation, New York, NY (G.W.S.); Center for Clinical Trials, NewYork-Presbyterian Hospital, Columbia University Medical Center (G.W.S.); Center for Regenerative Medicine (A.T.), Department of Cardiovascular Diseases (A.T.), and Department of Molecular Pharmacology and Experimental Therapeutics (A.T.), Mayo Clinic, Rochester, NY; Department of Regenerative Medicine Research, Texas Heart Institute, Houston (J.T.W.); and Division of Cardiovascular Medicine, Department of Medicine, Stanford Cardiovascular Institute (J.C.W.) and Department of Radiology (J.C.W.), Stanford University School of Medicine, CA
| | - Lina Badimon
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain (F.F.-A., R.S.-R., A.M.C.); CIBERCV, ISCIII, Madrid, Spain (F.F.-A., R.S.-R., A.M.C., L.B., V.F.); Cardiovascular Research Center (ICCC), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (L.B.); Institute of Molecular Cardiology, Diabetes and Obesity Center, University of Louisville School of Medicine, KY (R.B.); LabEx TRANSPLANTEX, Paris, France (D.C.); HLA and Médecine Jean Dausset Laboratory Network, Hôpital Saint-Louis AP-HP, Université Paris Diderot, France (D.C.); Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain (V.F.); Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (V.F.); Department of Cardiovascular Sciences, KU Leuven, Belgium (S.J.); Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark (J.K.); National Research Laboratory for Stem Cell Niche, Center for Medical Innovation, Seoul National University Hospital, Seoul, Korea (H.-S.K.); Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Korea (H.-S.K.); Department of Cardiology, Royal Brompton and Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, England (T.F.L); University College of London, England (J.F.M.); Department of Cardiovascular Surgery Hôpital Européen Georges Pompidou, Paris, France (P.M.); Université Paris Descartes, Sorbonne Paris Cité, France (P.M.); Serviço de Cardiologia, Hospital Universitário de Santa Maria, CAML, Centro Cardiovascular da Universidade de Lisboa, Universidade de Lisboa, Portugal (F.J.P.); School of Medicine, University of Kansas, Lawrence (R.D.S.); Center for Clinical Trials, Cardiovascular Research Foundation, New York, NY (G.W.S.); Center for Clinical Trials, NewYork-Presbyterian Hospital, Columbia University Medical Center (G.W.S.); Center for Regenerative Medicine (A.T.), Department of Cardiovascular Diseases (A.T.), and Department of Molecular Pharmacology and Experimental Therapeutics (A.T.), Mayo Clinic, Rochester, NY; Department of Regenerative Medicine Research, Texas Heart Institute, Houston (J.T.W.); and Division of Cardiovascular Medicine, Department of Medicine, Stanford Cardiovascular Institute (J.C.W.) and Department of Radiology (J.C.W.), Stanford University School of Medicine, CA
| | - Roberto Bolli
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain (F.F.-A., R.S.-R., A.M.C.); CIBERCV, ISCIII, Madrid, Spain (F.F.-A., R.S.-R., A.M.C., L.B., V.F.); Cardiovascular Research Center (ICCC), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (L.B.); Institute of Molecular Cardiology, Diabetes and Obesity Center, University of Louisville School of Medicine, KY (R.B.); LabEx TRANSPLANTEX, Paris, France (D.C.); HLA and Médecine Jean Dausset Laboratory Network, Hôpital Saint-Louis AP-HP, Université Paris Diderot, France (D.C.); Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain (V.F.); Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (V.F.); Department of Cardiovascular Sciences, KU Leuven, Belgium (S.J.); Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark (J.K.); National Research Laboratory for Stem Cell Niche, Center for Medical Innovation, Seoul National University Hospital, Seoul, Korea (H.-S.K.); Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Korea (H.-S.K.); Department of Cardiology, Royal Brompton and Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, England (T.F.L); University College of London, England (J.F.M.); Department of Cardiovascular Surgery Hôpital Européen Georges Pompidou, Paris, France (P.M.); Université Paris Descartes, Sorbonne Paris Cité, France (P.M.); Serviço de Cardiologia, Hospital Universitário de Santa Maria, CAML, Centro Cardiovascular da Universidade de Lisboa, Universidade de Lisboa, Portugal (F.J.P.); School of Medicine, University of Kansas, Lawrence (R.D.S.); Center for Clinical Trials, Cardiovascular Research Foundation, New York, NY (G.W.S.); Center for Clinical Trials, NewYork-Presbyterian Hospital, Columbia University Medical Center (G.W.S.); Center for Regenerative Medicine (A.T.), Department of Cardiovascular Diseases (A.T.), and Department of Molecular Pharmacology and Experimental Therapeutics (A.T.), Mayo Clinic, Rochester, NY; Department of Regenerative Medicine Research, Texas Heart Institute, Houston (J.T.W.); and Division of Cardiovascular Medicine, Department of Medicine, Stanford Cardiovascular Institute (J.C.W.) and Department of Radiology (J.C.W.), Stanford University School of Medicine, CA
| | - Dominique Charron
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain (F.F.-A., R.S.-R., A.M.C.); CIBERCV, ISCIII, Madrid, Spain (F.F.-A., R.S.-R., A.M.C., L.B., V.F.); Cardiovascular Research Center (ICCC), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (L.B.); Institute of Molecular Cardiology, Diabetes and Obesity Center, University of Louisville School of Medicine, KY (R.B.); LabEx TRANSPLANTEX, Paris, France (D.C.); HLA and Médecine Jean Dausset Laboratory Network, Hôpital Saint-Louis AP-HP, Université Paris Diderot, France (D.C.); Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain (V.F.); Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (V.F.); Department of Cardiovascular Sciences, KU Leuven, Belgium (S.J.); Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark (J.K.); National Research Laboratory for Stem Cell Niche, Center for Medical Innovation, Seoul National University Hospital, Seoul, Korea (H.-S.K.); Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Korea (H.-S.K.); Department of Cardiology, Royal Brompton and Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, England (T.F.L); University College of London, England (J.F.M.); Department of Cardiovascular Surgery Hôpital Européen Georges Pompidou, Paris, France (P.M.); Université Paris Descartes, Sorbonne Paris Cité, France (P.M.); Serviço de Cardiologia, Hospital Universitário de Santa Maria, CAML, Centro Cardiovascular da Universidade de Lisboa, Universidade de Lisboa, Portugal (F.J.P.); School of Medicine, University of Kansas, Lawrence (R.D.S.); Center for Clinical Trials, Cardiovascular Research Foundation, New York, NY (G.W.S.); Center for Clinical Trials, NewYork-Presbyterian Hospital, Columbia University Medical Center (G.W.S.); Center for Regenerative Medicine (A.T.), Department of Cardiovascular Diseases (A.T.), and Department of Molecular Pharmacology and Experimental Therapeutics (A.T.), Mayo Clinic, Rochester, NY; Department of Regenerative Medicine Research, Texas Heart Institute, Houston (J.T.W.); and Division of Cardiovascular Medicine, Department of Medicine, Stanford Cardiovascular Institute (J.C.W.) and Department of Radiology (J.C.W.), Stanford University School of Medicine, CA
| | - Valentin Fuster
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain (F.F.-A., R.S.-R., A.M.C.); CIBERCV, ISCIII, Madrid, Spain (F.F.-A., R.S.-R., A.M.C., L.B., V.F.); Cardiovascular Research Center (ICCC), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (L.B.); Institute of Molecular Cardiology, Diabetes and Obesity Center, University of Louisville School of Medicine, KY (R.B.); LabEx TRANSPLANTEX, Paris, France (D.C.); HLA and Médecine Jean Dausset Laboratory Network, Hôpital Saint-Louis AP-HP, Université Paris Diderot, France (D.C.); Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain (V.F.); Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (V.F.); Department of Cardiovascular Sciences, KU Leuven, Belgium (S.J.); Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark (J.K.); National Research Laboratory for Stem Cell Niche, Center for Medical Innovation, Seoul National University Hospital, Seoul, Korea (H.-S.K.); Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Korea (H.-S.K.); Department of Cardiology, Royal Brompton and Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, England (T.F.L); University College of London, England (J.F.M.); Department of Cardiovascular Surgery Hôpital Européen Georges Pompidou, Paris, France (P.M.); Université Paris Descartes, Sorbonne Paris Cité, France (P.M.); Serviço de Cardiologia, Hospital Universitário de Santa Maria, CAML, Centro Cardiovascular da Universidade de Lisboa, Universidade de Lisboa, Portugal (F.J.P.); School of Medicine, University of Kansas, Lawrence (R.D.S.); Center for Clinical Trials, Cardiovascular Research Foundation, New York, NY (G.W.S.); Center for Clinical Trials, NewYork-Presbyterian Hospital, Columbia University Medical Center (G.W.S.); Center for Regenerative Medicine (A.T.), Department of Cardiovascular Diseases (A.T.), and Department of Molecular Pharmacology and Experimental Therapeutics (A.T.), Mayo Clinic, Rochester, NY; Department of Regenerative Medicine Research, Texas Heart Institute, Houston (J.T.W.); and Division of Cardiovascular Medicine, Department of Medicine, Stanford Cardiovascular Institute (J.C.W.) and Department of Radiology (J.C.W.), Stanford University School of Medicine, CA
| | - Stefan Janssens
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain (F.F.-A., R.S.-R., A.M.C.); CIBERCV, ISCIII, Madrid, Spain (F.F.-A., R.S.-R., A.M.C., L.B., V.F.); Cardiovascular Research Center (ICCC), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (L.B.); Institute of Molecular Cardiology, Diabetes and Obesity Center, University of Louisville School of Medicine, KY (R.B.); LabEx TRANSPLANTEX, Paris, France (D.C.); HLA and Médecine Jean Dausset Laboratory Network, Hôpital Saint-Louis AP-HP, Université Paris Diderot, France (D.C.); Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain (V.F.); Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (V.F.); Department of Cardiovascular Sciences, KU Leuven, Belgium (S.J.); Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark (J.K.); National Research Laboratory for Stem Cell Niche, Center for Medical Innovation, Seoul National University Hospital, Seoul, Korea (H.-S.K.); Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Korea (H.-S.K.); Department of Cardiology, Royal Brompton and Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, England (T.F.L); University College of London, England (J.F.M.); Department of Cardiovascular Surgery Hôpital Européen Georges Pompidou, Paris, France (P.M.); Université Paris Descartes, Sorbonne Paris Cité, France (P.M.); Serviço de Cardiologia, Hospital Universitário de Santa Maria, CAML, Centro Cardiovascular da Universidade de Lisboa, Universidade de Lisboa, Portugal (F.J.P.); School of Medicine, University of Kansas, Lawrence (R.D.S.); Center for Clinical Trials, Cardiovascular Research Foundation, New York, NY (G.W.S.); Center for Clinical Trials, NewYork-Presbyterian Hospital, Columbia University Medical Center (G.W.S.); Center for Regenerative Medicine (A.T.), Department of Cardiovascular Diseases (A.T.), and Department of Molecular Pharmacology and Experimental Therapeutics (A.T.), Mayo Clinic, Rochester, NY; Department of Regenerative Medicine Research, Texas Heart Institute, Houston (J.T.W.); and Division of Cardiovascular Medicine, Department of Medicine, Stanford Cardiovascular Institute (J.C.W.) and Department of Radiology (J.C.W.), Stanford University School of Medicine, CA
| | - Jens Kastrup
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain (F.F.-A., R.S.-R., A.M.C.); CIBERCV, ISCIII, Madrid, Spain (F.F.-A., R.S.-R., A.M.C., L.B., V.F.); Cardiovascular Research Center (ICCC), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (L.B.); Institute of Molecular Cardiology, Diabetes and Obesity Center, University of Louisville School of Medicine, KY (R.B.); LabEx TRANSPLANTEX, Paris, France (D.C.); HLA and Médecine Jean Dausset Laboratory Network, Hôpital Saint-Louis AP-HP, Université Paris Diderot, France (D.C.); Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain (V.F.); Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (V.F.); Department of Cardiovascular Sciences, KU Leuven, Belgium (S.J.); Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark (J.K.); National Research Laboratory for Stem Cell Niche, Center for Medical Innovation, Seoul National University Hospital, Seoul, Korea (H.-S.K.); Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Korea (H.-S.K.); Department of Cardiology, Royal Brompton and Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, England (T.F.L); University College of London, England (J.F.M.); Department of Cardiovascular Surgery Hôpital Européen Georges Pompidou, Paris, France (P.M.); Université Paris Descartes, Sorbonne Paris Cité, France (P.M.); Serviço de Cardiologia, Hospital Universitário de Santa Maria, CAML, Centro Cardiovascular da Universidade de Lisboa, Universidade de Lisboa, Portugal (F.J.P.); School of Medicine, University of Kansas, Lawrence (R.D.S.); Center for Clinical Trials, Cardiovascular Research Foundation, New York, NY (G.W.S.); Center for Clinical Trials, NewYork-Presbyterian Hospital, Columbia University Medical Center (G.W.S.); Center for Regenerative Medicine (A.T.), Department of Cardiovascular Diseases (A.T.), and Department of Molecular Pharmacology and Experimental Therapeutics (A.T.), Mayo Clinic, Rochester, NY; Department of Regenerative Medicine Research, Texas Heart Institute, Houston (J.T.W.); and Division of Cardiovascular Medicine, Department of Medicine, Stanford Cardiovascular Institute (J.C.W.) and Department of Radiology (J.C.W.), Stanford University School of Medicine, CA
| | - Hyo-Soo Kim
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain (F.F.-A., R.S.-R., A.M.C.); CIBERCV, ISCIII, Madrid, Spain (F.F.-A., R.S.-R., A.M.C., L.B., V.F.); Cardiovascular Research Center (ICCC), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (L.B.); Institute of Molecular Cardiology, Diabetes and Obesity Center, University of Louisville School of Medicine, KY (R.B.); LabEx TRANSPLANTEX, Paris, France (D.C.); HLA and Médecine Jean Dausset Laboratory Network, Hôpital Saint-Louis AP-HP, Université Paris Diderot, France (D.C.); Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain (V.F.); Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (V.F.); Department of Cardiovascular Sciences, KU Leuven, Belgium (S.J.); Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark (J.K.); National Research Laboratory for Stem Cell Niche, Center for Medical Innovation, Seoul National University Hospital, Seoul, Korea (H.-S.K.); Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Korea (H.-S.K.); Department of Cardiology, Royal Brompton and Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, England (T.F.L); University College of London, England (J.F.M.); Department of Cardiovascular Surgery Hôpital Européen Georges Pompidou, Paris, France (P.M.); Université Paris Descartes, Sorbonne Paris Cité, France (P.M.); Serviço de Cardiologia, Hospital Universitário de Santa Maria, CAML, Centro Cardiovascular da Universidade de Lisboa, Universidade de Lisboa, Portugal (F.J.P.); School of Medicine, University of Kansas, Lawrence (R.D.S.); Center for Clinical Trials, Cardiovascular Research Foundation, New York, NY (G.W.S.); Center for Clinical Trials, NewYork-Presbyterian Hospital, Columbia University Medical Center (G.W.S.); Center for Regenerative Medicine (A.T.), Department of Cardiovascular Diseases (A.T.), and Department of Molecular Pharmacology and Experimental Therapeutics (A.T.), Mayo Clinic, Rochester, NY; Department of Regenerative Medicine Research, Texas Heart Institute, Houston (J.T.W.); and Division of Cardiovascular Medicine, Department of Medicine, Stanford Cardiovascular Institute (J.C.W.) and Department of Radiology (J.C.W.), Stanford University School of Medicine, CA
| | - Thomas F Lüscher
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain (F.F.-A., R.S.-R., A.M.C.); CIBERCV, ISCIII, Madrid, Spain (F.F.-A., R.S.-R., A.M.C., L.B., V.F.); Cardiovascular Research Center (ICCC), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (L.B.); Institute of Molecular Cardiology, Diabetes and Obesity Center, University of Louisville School of Medicine, KY (R.B.); LabEx TRANSPLANTEX, Paris, France (D.C.); HLA and Médecine Jean Dausset Laboratory Network, Hôpital Saint-Louis AP-HP, Université Paris Diderot, France (D.C.); Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain (V.F.); Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (V.F.); Department of Cardiovascular Sciences, KU Leuven, Belgium (S.J.); Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark (J.K.); National Research Laboratory for Stem Cell Niche, Center for Medical Innovation, Seoul National University Hospital, Seoul, Korea (H.-S.K.); Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Korea (H.-S.K.); Department of Cardiology, Royal Brompton and Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, England (T.F.L); University College of London, England (J.F.M.); Department of Cardiovascular Surgery Hôpital Européen Georges Pompidou, Paris, France (P.M.); Université Paris Descartes, Sorbonne Paris Cité, France (P.M.); Serviço de Cardiologia, Hospital Universitário de Santa Maria, CAML, Centro Cardiovascular da Universidade de Lisboa, Universidade de Lisboa, Portugal (F.J.P.); School of Medicine, University of Kansas, Lawrence (R.D.S.); Center for Clinical Trials, Cardiovascular Research Foundation, New York, NY (G.W.S.); Center for Clinical Trials, NewYork-Presbyterian Hospital, Columbia University Medical Center (G.W.S.); Center for Regenerative Medicine (A.T.), Department of Cardiovascular Diseases (A.T.), and Department of Molecular Pharmacology and Experimental Therapeutics (A.T.), Mayo Clinic, Rochester, NY; Department of Regenerative Medicine Research, Texas Heart Institute, Houston (J.T.W.); and Division of Cardiovascular Medicine, Department of Medicine, Stanford Cardiovascular Institute (J.C.W.) and Department of Radiology (J.C.W.), Stanford University School of Medicine, CA
| | - John F Martin
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain (F.F.-A., R.S.-R., A.M.C.); CIBERCV, ISCIII, Madrid, Spain (F.F.-A., R.S.-R., A.M.C., L.B., V.F.); Cardiovascular Research Center (ICCC), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (L.B.); Institute of Molecular Cardiology, Diabetes and Obesity Center, University of Louisville School of Medicine, KY (R.B.); LabEx TRANSPLANTEX, Paris, France (D.C.); HLA and Médecine Jean Dausset Laboratory Network, Hôpital Saint-Louis AP-HP, Université Paris Diderot, France (D.C.); Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain (V.F.); Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (V.F.); Department of Cardiovascular Sciences, KU Leuven, Belgium (S.J.); Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark (J.K.); National Research Laboratory for Stem Cell Niche, Center for Medical Innovation, Seoul National University Hospital, Seoul, Korea (H.-S.K.); Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Korea (H.-S.K.); Department of Cardiology, Royal Brompton and Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, England (T.F.L); University College of London, England (J.F.M.); Department of Cardiovascular Surgery Hôpital Européen Georges Pompidou, Paris, France (P.M.); Université Paris Descartes, Sorbonne Paris Cité, France (P.M.); Serviço de Cardiologia, Hospital Universitário de Santa Maria, CAML, Centro Cardiovascular da Universidade de Lisboa, Universidade de Lisboa, Portugal (F.J.P.); School of Medicine, University of Kansas, Lawrence (R.D.S.); Center for Clinical Trials, Cardiovascular Research Foundation, New York, NY (G.W.S.); Center for Clinical Trials, NewYork-Presbyterian Hospital, Columbia University Medical Center (G.W.S.); Center for Regenerative Medicine (A.T.), Department of Cardiovascular Diseases (A.T.), and Department of Molecular Pharmacology and Experimental Therapeutics (A.T.), Mayo Clinic, Rochester, NY; Department of Regenerative Medicine Research, Texas Heart Institute, Houston (J.T.W.); and Division of Cardiovascular Medicine, Department of Medicine, Stanford Cardiovascular Institute (J.C.W.) and Department of Radiology (J.C.W.), Stanford University School of Medicine, CA
| | - Philippe Menasché
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain (F.F.-A., R.S.-R., A.M.C.); CIBERCV, ISCIII, Madrid, Spain (F.F.-A., R.S.-R., A.M.C., L.B., V.F.); Cardiovascular Research Center (ICCC), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (L.B.); Institute of Molecular Cardiology, Diabetes and Obesity Center, University of Louisville School of Medicine, KY (R.B.); LabEx TRANSPLANTEX, Paris, France (D.C.); HLA and Médecine Jean Dausset Laboratory Network, Hôpital Saint-Louis AP-HP, Université Paris Diderot, France (D.C.); Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain (V.F.); Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (V.F.); Department of Cardiovascular Sciences, KU Leuven, Belgium (S.J.); Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark (J.K.); National Research Laboratory for Stem Cell Niche, Center for Medical Innovation, Seoul National University Hospital, Seoul, Korea (H.-S.K.); Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Korea (H.-S.K.); Department of Cardiology, Royal Brompton and Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, England (T.F.L); University College of London, England (J.F.M.); Department of Cardiovascular Surgery Hôpital Européen Georges Pompidou, Paris, France (P.M.); Université Paris Descartes, Sorbonne Paris Cité, France (P.M.); Serviço de Cardiologia, Hospital Universitário de Santa Maria, CAML, Centro Cardiovascular da Universidade de Lisboa, Universidade de Lisboa, Portugal (F.J.P.); School of Medicine, University of Kansas, Lawrence (R.D.S.); Center for Clinical Trials, Cardiovascular Research Foundation, New York, NY (G.W.S.); Center for Clinical Trials, NewYork-Presbyterian Hospital, Columbia University Medical Center (G.W.S.); Center for Regenerative Medicine (A.T.), Department of Cardiovascular Diseases (A.T.), and Department of Molecular Pharmacology and Experimental Therapeutics (A.T.), Mayo Clinic, Rochester, NY; Department of Regenerative Medicine Research, Texas Heart Institute, Houston (J.T.W.); and Division of Cardiovascular Medicine, Department of Medicine, Stanford Cardiovascular Institute (J.C.W.) and Department of Radiology (J.C.W.), Stanford University School of Medicine, CA
| | - Fausto J Pinto
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain (F.F.-A., R.S.-R., A.M.C.); CIBERCV, ISCIII, Madrid, Spain (F.F.-A., R.S.-R., A.M.C., L.B., V.F.); Cardiovascular Research Center (ICCC), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (L.B.); Institute of Molecular Cardiology, Diabetes and Obesity Center, University of Louisville School of Medicine, KY (R.B.); LabEx TRANSPLANTEX, Paris, France (D.C.); HLA and Médecine Jean Dausset Laboratory Network, Hôpital Saint-Louis AP-HP, Université Paris Diderot, France (D.C.); Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain (V.F.); Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (V.F.); Department of Cardiovascular Sciences, KU Leuven, Belgium (S.J.); Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark (J.K.); National Research Laboratory for Stem Cell Niche, Center for Medical Innovation, Seoul National University Hospital, Seoul, Korea (H.-S.K.); Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Korea (H.-S.K.); Department of Cardiology, Royal Brompton and Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, England (T.F.L); University College of London, England (J.F.M.); Department of Cardiovascular Surgery Hôpital Européen Georges Pompidou, Paris, France (P.M.); Université Paris Descartes, Sorbonne Paris Cité, France (P.M.); Serviço de Cardiologia, Hospital Universitário de Santa Maria, CAML, Centro Cardiovascular da Universidade de Lisboa, Universidade de Lisboa, Portugal (F.J.P.); School of Medicine, University of Kansas, Lawrence (R.D.S.); Center for Clinical Trials, Cardiovascular Research Foundation, New York, NY (G.W.S.); Center for Clinical Trials, NewYork-Presbyterian Hospital, Columbia University Medical Center (G.W.S.); Center for Regenerative Medicine (A.T.), Department of Cardiovascular Diseases (A.T.), and Department of Molecular Pharmacology and Experimental Therapeutics (A.T.), Mayo Clinic, Rochester, NY; Department of Regenerative Medicine Research, Texas Heart Institute, Houston (J.T.W.); and Division of Cardiovascular Medicine, Department of Medicine, Stanford Cardiovascular Institute (J.C.W.) and Department of Radiology (J.C.W.), Stanford University School of Medicine, CA
| | - Robert D Simari
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain (F.F.-A., R.S.-R., A.M.C.); CIBERCV, ISCIII, Madrid, Spain (F.F.-A., R.S.-R., A.M.C., L.B., V.F.); Cardiovascular Research Center (ICCC), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (L.B.); Institute of Molecular Cardiology, Diabetes and Obesity Center, University of Louisville School of Medicine, KY (R.B.); LabEx TRANSPLANTEX, Paris, France (D.C.); HLA and Médecine Jean Dausset Laboratory Network, Hôpital Saint-Louis AP-HP, Université Paris Diderot, France (D.C.); Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain (V.F.); Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (V.F.); Department of Cardiovascular Sciences, KU Leuven, Belgium (S.J.); Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark (J.K.); National Research Laboratory for Stem Cell Niche, Center for Medical Innovation, Seoul National University Hospital, Seoul, Korea (H.-S.K.); Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Korea (H.-S.K.); Department of Cardiology, Royal Brompton and Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, England (T.F.L); University College of London, England (J.F.M.); Department of Cardiovascular Surgery Hôpital Européen Georges Pompidou, Paris, France (P.M.); Université Paris Descartes, Sorbonne Paris Cité, France (P.M.); Serviço de Cardiologia, Hospital Universitário de Santa Maria, CAML, Centro Cardiovascular da Universidade de Lisboa, Universidade de Lisboa, Portugal (F.J.P.); School of Medicine, University of Kansas, Lawrence (R.D.S.); Center for Clinical Trials, Cardiovascular Research Foundation, New York, NY (G.W.S.); Center for Clinical Trials, NewYork-Presbyterian Hospital, Columbia University Medical Center (G.W.S.); Center for Regenerative Medicine (A.T.), Department of Cardiovascular Diseases (A.T.), and Department of Molecular Pharmacology and Experimental Therapeutics (A.T.), Mayo Clinic, Rochester, NY; Department of Regenerative Medicine Research, Texas Heart Institute, Houston (J.T.W.); and Division of Cardiovascular Medicine, Department of Medicine, Stanford Cardiovascular Institute (J.C.W.) and Department of Radiology (J.C.W.), Stanford University School of Medicine, CA
| | - Gregg W Stone
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain (F.F.-A., R.S.-R., A.M.C.); CIBERCV, ISCIII, Madrid, Spain (F.F.-A., R.S.-R., A.M.C., L.B., V.F.); Cardiovascular Research Center (ICCC), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (L.B.); Institute of Molecular Cardiology, Diabetes and Obesity Center, University of Louisville School of Medicine, KY (R.B.); LabEx TRANSPLANTEX, Paris, France (D.C.); HLA and Médecine Jean Dausset Laboratory Network, Hôpital Saint-Louis AP-HP, Université Paris Diderot, France (D.C.); Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain (V.F.); Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (V.F.); Department of Cardiovascular Sciences, KU Leuven, Belgium (S.J.); Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark (J.K.); National Research Laboratory for Stem Cell Niche, Center for Medical Innovation, Seoul National University Hospital, Seoul, Korea (H.-S.K.); Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Korea (H.-S.K.); Department of Cardiology, Royal Brompton and Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, England (T.F.L); University College of London, England (J.F.M.); Department of Cardiovascular Surgery Hôpital Européen Georges Pompidou, Paris, France (P.M.); Université Paris Descartes, Sorbonne Paris Cité, France (P.M.); Serviço de Cardiologia, Hospital Universitário de Santa Maria, CAML, Centro Cardiovascular da Universidade de Lisboa, Universidade de Lisboa, Portugal (F.J.P.); School of Medicine, University of Kansas, Lawrence (R.D.S.); Center for Clinical Trials, Cardiovascular Research Foundation, New York, NY (G.W.S.); Center for Clinical Trials, NewYork-Presbyterian Hospital, Columbia University Medical Center (G.W.S.); Center for Regenerative Medicine (A.T.), Department of Cardiovascular Diseases (A.T.), and Department of Molecular Pharmacology and Experimental Therapeutics (A.T.), Mayo Clinic, Rochester, NY; Department of Regenerative Medicine Research, Texas Heart Institute, Houston (J.T.W.); and Division of Cardiovascular Medicine, Department of Medicine, Stanford Cardiovascular Institute (J.C.W.) and Department of Radiology (J.C.W.), Stanford University School of Medicine, CA
| | - Andre Terzic
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain (F.F.-A., R.S.-R., A.M.C.); CIBERCV, ISCIII, Madrid, Spain (F.F.-A., R.S.-R., A.M.C., L.B., V.F.); Cardiovascular Research Center (ICCC), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (L.B.); Institute of Molecular Cardiology, Diabetes and Obesity Center, University of Louisville School of Medicine, KY (R.B.); LabEx TRANSPLANTEX, Paris, France (D.C.); HLA and Médecine Jean Dausset Laboratory Network, Hôpital Saint-Louis AP-HP, Université Paris Diderot, France (D.C.); Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain (V.F.); Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (V.F.); Department of Cardiovascular Sciences, KU Leuven, Belgium (S.J.); Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark (J.K.); National Research Laboratory for Stem Cell Niche, Center for Medical Innovation, Seoul National University Hospital, Seoul, Korea (H.-S.K.); Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Korea (H.-S.K.); Department of Cardiology, Royal Brompton and Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, England (T.F.L); University College of London, England (J.F.M.); Department of Cardiovascular Surgery Hôpital Européen Georges Pompidou, Paris, France (P.M.); Université Paris Descartes, Sorbonne Paris Cité, France (P.M.); Serviço de Cardiologia, Hospital Universitário de Santa Maria, CAML, Centro Cardiovascular da Universidade de Lisboa, Universidade de Lisboa, Portugal (F.J.P.); School of Medicine, University of Kansas, Lawrence (R.D.S.); Center for Clinical Trials, Cardiovascular Research Foundation, New York, NY (G.W.S.); Center for Clinical Trials, NewYork-Presbyterian Hospital, Columbia University Medical Center (G.W.S.); Center for Regenerative Medicine (A.T.), Department of Cardiovascular Diseases (A.T.), and Department of Molecular Pharmacology and Experimental Therapeutics (A.T.), Mayo Clinic, Rochester, NY; Department of Regenerative Medicine Research, Texas Heart Institute, Houston (J.T.W.); and Division of Cardiovascular Medicine, Department of Medicine, Stanford Cardiovascular Institute (J.C.W.) and Department of Radiology (J.C.W.), Stanford University School of Medicine, CA
| | - James T Willerson
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain (F.F.-A., R.S.-R., A.M.C.); CIBERCV, ISCIII, Madrid, Spain (F.F.-A., R.S.-R., A.M.C., L.B., V.F.); Cardiovascular Research Center (ICCC), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (L.B.); Institute of Molecular Cardiology, Diabetes and Obesity Center, University of Louisville School of Medicine, KY (R.B.); LabEx TRANSPLANTEX, Paris, France (D.C.); HLA and Médecine Jean Dausset Laboratory Network, Hôpital Saint-Louis AP-HP, Université Paris Diderot, France (D.C.); Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain (V.F.); Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (V.F.); Department of Cardiovascular Sciences, KU Leuven, Belgium (S.J.); Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark (J.K.); National Research Laboratory for Stem Cell Niche, Center for Medical Innovation, Seoul National University Hospital, Seoul, Korea (H.-S.K.); Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Korea (H.-S.K.); Department of Cardiology, Royal Brompton and Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, England (T.F.L); University College of London, England (J.F.M.); Department of Cardiovascular Surgery Hôpital Européen Georges Pompidou, Paris, France (P.M.); Université Paris Descartes, Sorbonne Paris Cité, France (P.M.); Serviço de Cardiologia, Hospital Universitário de Santa Maria, CAML, Centro Cardiovascular da Universidade de Lisboa, Universidade de Lisboa, Portugal (F.J.P.); School of Medicine, University of Kansas, Lawrence (R.D.S.); Center for Clinical Trials, Cardiovascular Research Foundation, New York, NY (G.W.S.); Center for Clinical Trials, NewYork-Presbyterian Hospital, Columbia University Medical Center (G.W.S.); Center for Regenerative Medicine (A.T.), Department of Cardiovascular Diseases (A.T.), and Department of Molecular Pharmacology and Experimental Therapeutics (A.T.), Mayo Clinic, Rochester, NY; Department of Regenerative Medicine Research, Texas Heart Institute, Houston (J.T.W.); and Division of Cardiovascular Medicine, Department of Medicine, Stanford Cardiovascular Institute (J.C.W.) and Department of Radiology (J.C.W.), Stanford University School of Medicine, CA
| | - Joseph C Wu
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain (F.F.-A., R.S.-R., A.M.C.); CIBERCV, ISCIII, Madrid, Spain (F.F.-A., R.S.-R., A.M.C., L.B., V.F.); Cardiovascular Research Center (ICCC), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (L.B.); Institute of Molecular Cardiology, Diabetes and Obesity Center, University of Louisville School of Medicine, KY (R.B.); LabEx TRANSPLANTEX, Paris, France (D.C.); HLA and Médecine Jean Dausset Laboratory Network, Hôpital Saint-Louis AP-HP, Université Paris Diderot, France (D.C.); Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain (V.F.); Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (V.F.); Department of Cardiovascular Sciences, KU Leuven, Belgium (S.J.); Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark (J.K.); National Research Laboratory for Stem Cell Niche, Center for Medical Innovation, Seoul National University Hospital, Seoul, Korea (H.-S.K.); Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Korea (H.-S.K.); Department of Cardiology, Royal Brompton and Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, England (T.F.L); University College of London, England (J.F.M.); Department of Cardiovascular Surgery Hôpital Européen Georges Pompidou, Paris, France (P.M.); Université Paris Descartes, Sorbonne Paris Cité, France (P.M.); Serviço de Cardiologia, Hospital Universitário de Santa Maria, CAML, Centro Cardiovascular da Universidade de Lisboa, Universidade de Lisboa, Portugal (F.J.P.); School of Medicine, University of Kansas, Lawrence (R.D.S.); Center for Clinical Trials, Cardiovascular Research Foundation, New York, NY (G.W.S.); Center for Clinical Trials, NewYork-Presbyterian Hospital, Columbia University Medical Center (G.W.S.); Center for Regenerative Medicine (A.T.), Department of Cardiovascular Diseases (A.T.), and Department of Molecular Pharmacology and Experimental Therapeutics (A.T.), Mayo Clinic, Rochester, NY; Department of Regenerative Medicine Research, Texas Heart Institute, Houston (J.T.W.); and Division of Cardiovascular Medicine, Department of Medicine, Stanford Cardiovascular Institute (J.C.W.) and Department of Radiology (J.C.W.), Stanford University School of Medicine, CA
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Barohn RJ, Weir SJ, Simari RD. Progress in Drug Discovery in Academia and Persistent Challenges of "the Valley of Death". Mayo Clin Proc 2019; 94:391-393. [PMID: 30832788 DOI: 10.1016/j.mayocp.2019.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 01/21/2019] [Indexed: 11/25/2022]
Affiliation(s)
| | - Scott J Weir
- University of Kansas Medical Center, Kansas City, KS
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Puranik AS, Leaf IA, Jensen MA, Hedayat AF, Saad A, Kim KW, Saadalla AM, Woollard JR, Kashyap S, Textor SC, Grande JP, Lerman A, Simari RD, Randolph GJ, Duffield JS, Lerman LO. Kidney-resident macrophages promote a proangiogenic environment in the normal and chronically ischemic mouse kidney. Sci Rep 2018; 8:13948. [PMID: 30224726 PMCID: PMC6141464 DOI: 10.1038/s41598-018-31887-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [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: 03/26/2018] [Accepted: 08/28/2018] [Indexed: 12/24/2022] Open
Abstract
Renal artery stenosis (RAS) caused by narrowing of arteries is characterized by microvascular damage. Macrophages are implicated in repair and injury, but the specific populations responsible for these divergent roles have not been identified. Here, we characterized murine kidney F4/80+CD64+ macrophages in three transcriptionally unique populations. Using fate-mapping and parabiosis studies, we demonstrate that CD11b/cint are long-lived kidney-resident (KRM) while CD11chiMϕ, CD11cloMϕ are monocyte-derived macrophages. In a murine model of RAS, KRM self-renewed, while CD11chiMϕ and CD11cloMϕ increased significantly, which was associated with loss of peritubular capillaries. Replacing the native KRM with monocyte-derived KRM using liposomal clodronate and bone marrow transplantation followed by RAS, amplified loss of peritubular capillaries. To further elucidate the nature of interactions between KRM and peritubular endothelial cells, we performed RNA-sequencing on flow-sorted macrophages from Sham and RAS kidneys. KRM showed a prominent activation pattern in RAS with significant enrichment in reparative pathways, like angiogenesis and wound healing. In culture, KRM increased proliferation of renal peritubular endothelial cells implying direct pro-angiogenic properties. Human homologs of KRM identified as CD11bintCD11cintCD68+ increased in post-stenotic kidney biopsies from RAS patients compared to healthy human kidneys, and inversely correlated to kidney function. Thus, KRM may play protective roles in stenotic kidney injury through expansion and upregulation of pro-angiogenic pathways.
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Affiliation(s)
- Amrutesh S Puranik
- The Divisions of Nephrology & Hypertension, Mayo Clinic, Rochester, MN, USA
- Colton Center for Autoimmunity, New York University School of Medicine, New York, NY, USA
| | | | | | - Ahmad F Hedayat
- The Divisions of Nephrology & Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Ahmad Saad
- The Divisions of Nephrology & Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Ki-Wook Kim
- Department of Pathology, Washington University School of Medicine, Saint Louis, MO, USA
| | | | - John R Woollard
- The Divisions of Nephrology & Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Sonu Kashyap
- Departments of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Joseph P Grande
- Departments of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN, USA
| | - Amir Lerman
- Departments of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Robert D Simari
- University of Kansas, School of Medicine, Kansas City, KS, USA
| | - Gwendalyn J Randolph
- Department of Pathology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Jeremy S Duffield
- University of Washington, Seattle, WA, USA
- Vertex Pharmaceuticals, Boston, MA, USA
| | - Lilach O Lerman
- The Divisions of Nephrology & Hypertension, Mayo Clinic, Rochester, MN, USA.
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Bolli R, Hare JM, Henry TD, Lenneman CG, March KL, Miller K, Pepine CJ, Perin EC, Traverse JH, Willerson JT, Yang PC, Gee AP, Lima JA, Moyé L, Vojvodic RW, Sayre SL, Bettencourt J, Cohen M, Ebert RF, Simari RD. Rationale and Design of the SENECA (StEm cell iNjECtion in cAncer survivors) Trial. Am Heart J 2018; 201:54-62. [PMID: 29910056 PMCID: PMC7282462 DOI: 10.1016/j.ahj.2018.02.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 02/07/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVES SENECA (StEm cell iNjECtion in cAncer survivors) is a phase I, randomized, double-blind, placebo-controlled study to evaluate the safety and feasibility of delivering allogeneic mesenchymal stromal cells (allo-MSCs) transendocardially in subjects with anthracycline-induced cardiomyopathy (AIC). BACKGROUND AIC is an incurable and often fatal syndrome, with a prognosis worse than that of ischemic or nonischemic cardiomyopathy. Recently, cell therapy with MSCs has emerged as a promising new approach to repair damaged myocardium. METHODS The study population is 36 cancer survivors with a diagnosis of AIC, left ventricular (LV) ejection fraction ≤40%, and symptoms of heart failure (NYHA class II-III) on optimally-tolerated medical therapy. Subjects must be clinically free of cancer for at least two years with a ≤ 30% estimated five-year risk of recurrence. The first six subjects participated in an open-label, lead-in phase and received 100 million allo-MSCs; the remaining 30 will be randomized 1:1 to receive allo-MSCs or vehicle via 20 transendocardial injections. Efficacy measures (obtained at baseline, 6 months, and 12 months) include MRI evaluation of LV function, LV volumes, fibrosis, and scar burden; assessment of exercise tolerance (six-minute walk test) and quality of life (Minnesota Living with Heart Failure Questionnaire); clinical outcomes (MACE and cumulative days alive and out of hospital); and biomarkers of heart failure (NT-proBNP). CONCLUSIONS This is the first clinical trial using direct cardiac injection of cells for the treatment of AIC. If administration of allo-MSCs is found feasible and safe, SENECA will pave the way for larger phase II/III studies with therapeutic efficacy as the primary outcome.
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Affiliation(s)
| | - Joshua M Hare
- University of Miami Miller School of Medicine, Miami, Florida
| | | | | | - Keith L March
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Kathy Miller
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Carl J Pepine
- University of Florida School of Medicine, Gainesville, Florida
| | | | - Jay H Traverse
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN
| | | | - Phillip C Yang
- Stanford University School of Medicine, Stanford, California
| | | | | | - Lem Moyé
- UT Health School of Public Health, Houston, TX.
| | | | | | | | | | - Ray F Ebert
- NIH, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Robert D Simari
- University of Kansas School of Medicine, Kansas City, Kansas
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Bolli R, Hare JM, March KL, Pepine CJ, Willerson JT, Perin EC, Yang PC, Henry TD, Traverse JH, Mitrani RD, Khan A, Hernandez-Schulman I, Taylor DA, DiFede DL, Lima JAC, Chugh A, Loughran J, Vojvodic RW, Sayre SL, Bettencourt J, Cohen M, Moyé L, Ebert RF, Simari RD. Rationale and Design of the CONCERT-HF Trial (Combination of Mesenchymal and c-kit + Cardiac Stem Cells As Regenerative Therapy for Heart Failure). Circ Res 2018; 122:1703-1715. [PMID: 29703749 DOI: 10.1161/circresaha.118.312978] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/16/2018] [Accepted: 04/25/2018] [Indexed: 12/15/2022]
Abstract
RATIONALE Autologous bone marrow mesenchymal stem cells (MSCs) and c-kit+ cardiac progenitor cells (CPCs) are 2 promising cell types being evaluated for patients with heart failure (HF) secondary to ischemic cardiomyopathy. No information is available in humans about the relative efficacy of MSCs and CPCs and whether their combination is more efficacious than either cell type alone. OBJECTIVE CONCERT-HF (Combination of Mesenchymal and c-kit+ Cardiac Stem Cells As Regenerative Therapy for Heart Failure) is a phase II trial aimed at elucidating these issues by assessing the feasibility, safety, and efficacy of transendocardial administration of autologous MSCs and CPCs, alone and in combination, in patients with HF caused by chronic ischemic cardiomyopathy (coronary artery disease and old myocardial infarction). METHODS AND RESULTS Using a randomized, double-blinded, placebo-controlled, multicenter, multitreatment, and adaptive design, CONCERT-HF examines whether administration of MSCs alone, CPCs alone, or MSCs+CPCs in this population alleviates left ventricular remodeling and dysfunction, reduces scar size, improves quality of life, or augments functional capacity. The 4-arm design enables comparisons of MSCs alone with CPCs alone and with their combination. CONCERT-HF consists of 162 patients, 18 in a safety lead-in phase (stage 1) and 144 in the main trial (stage 2). Stage 1 is complete, and stage 2 is currently randomizing patients from 7 centers across the United States. CONCLUSIONS CONCERT-HF will provide important insights into the potential therapeutic utility of MSCs and CPCs, given alone and in combination, for patients with HF secondary to ischemic cardiomyopathy. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT02501811.
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Affiliation(s)
- Roberto Bolli
- From the Division of Cardiovascular Medicine, University of Louisville, KY (R.B., J.L.)
| | - Joshua M Hare
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, FL (J.M.H., A.K., R.D.M., I.H.-S.)
| | - Keith L March
- Division of Cardiovascular Medicine, UFHealth at University of Florida, Gainesville (K.L.M., C.J.P.)
| | - Carl J Pepine
- Division of Cardiovascular Medicine, UFHealth at University of Florida, Gainesville (K.L.M., C.J.P.)
| | - James T Willerson
- Texas Heart Institute, CHI St. Luke's Health, Houston (J.T.W., E.C.P., D.A.T.)
| | - Emerson C Perin
- Texas Heart Institute, CHI St. Luke's Health, Houston (J.T.W., E.C.P., D.A.T.)
| | - Phillip C Yang
- Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.)
| | - Timothy D Henry
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.)
| | - Jay H Traverse
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.H.T.)
| | - Raul D Mitrani
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, FL (J.M.H., A.K., R.D.M., I.H.-S.)
| | - Aisha Khan
- From the Division of Cardiovascular Medicine, University of Louisville, KY (R.B., J.L.)
| | - Ivonne Hernandez-Schulman
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, FL (J.M.H., A.K., R.D.M., I.H.-S.)
| | - Doris A Taylor
- Texas Heart Institute, CHI St. Luke's Health, Houston (J.T.W., E.C.P., D.A.T.)
| | | | - João A C Lima
- Division of Cardiology, Johns Hopkins University, Baltimore, MD (J.A.C.L.)
| | - Atul Chugh
- Franciscan Saint Francis Health, Indianapolis, IN (A.C.)
| | - John Loughran
- From the Division of Cardiovascular Medicine, University of Louisville, KY (R.B., J.L.)
| | - Rachel W Vojvodic
- Coordinating Center for Clinical Trials, UT Health School of Public Health, Houston, TX (R.W.V., S.L.S., J.B., M.C., L.M.)
| | - Shelly L Sayre
- Coordinating Center for Clinical Trials, UT Health School of Public Health, Houston, TX (R.W.V., S.L.S., J.B., M.C., L.M.)
| | - Judy Bettencourt
- Coordinating Center for Clinical Trials, UT Health School of Public Health, Houston, TX (R.W.V., S.L.S., J.B., M.C., L.M.)
| | - Michelle Cohen
- Coordinating Center for Clinical Trials, UT Health School of Public Health, Houston, TX (R.W.V., S.L.S., J.B., M.C., L.M.)
| | - Lem Moyé
- Coordinating Center for Clinical Trials, UT Health School of Public Health, Houston, TX (R.W.V., S.L.S., J.B., M.C., L.M.)
| | - Ray F Ebert
- NIH, National Heart, Lung, and Blood Institute, Division of Cardiovascular Sciences, Bethesda, MD (R.F.E.)
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Tefft BJ, Uthamaraj S, Harbuzariu A, Harburn JJ, Witt TA, Newman B, Psaltis PJ, Hlinomaz O, Holmes DR, Gulati R, Simari RD, Dragomir-Daescu D, Sandhu GS. Nanoparticle-Mediated Cell Capture Enables Rapid Endothelialization of a Novel Bare Metal Stent. Tissue Eng Part A 2018; 24:1157-1166. [PMID: 29431053 DOI: 10.1089/ten.tea.2017.0404] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Incomplete endothelialization of intracoronary stents has been associated with stent thrombosis and recurrent symptoms, whereas prolonged use of dual antiplatelet therapy increases bleeding-related adverse events. Facilitated endothelialization has the potential to improve clinical outcomes in patients who are unable to tolerate dual antiplatelet therapy. The objective of this study was to demonstrate the feasibility of magnetic cell capture to rapidly endothelialize intracoronary stents in a large animal model. A novel stent was developed from a magnetizable duplex stainless steel (2205 SS). Polylactic-co-glycolic acid and magnetite (Fe3O4) were used to synthesize biodegradable superparamagnetic iron oxide nanoparticles, and these were used to label autologous blood outgrowth endothelial cells. Magnetic 2205 SS and nonmagnetic 316L SS control stents were implanted in the coronary arteries of pigs (n = 11), followed by intracoronary delivery of magnetically labeled cells to 2205 SS stents. In this study, we show extensive endothelialization of magnetic 2205 SS stents (median 98.4% cell coverage) within 3 days, whereas the control 316L SS stents exhibited significantly less coverage (median 48.9% cell coverage, p < 0.0001). This demonstrates the ability of intracoronary delivery of magnetic nanoparticle labeled autologous endothelial cells to improve endothelialization of magnetized coronary stents within 3 days of implantation.
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Affiliation(s)
- Brandon J Tefft
- 1 Department of Cardiovascular Medicine, Mayo Clinic , Rochester, Minnesota
| | | | - Adriana Harbuzariu
- 1 Department of Cardiovascular Medicine, Mayo Clinic , Rochester, Minnesota
| | - J Jonathan Harburn
- 3 School of Pharmacy & Institute of Cellular Medicine, Newcastle University , Newcastle-upon-Tyne, United Kingdom
| | - Tyra A Witt
- 1 Department of Cardiovascular Medicine, Mayo Clinic , Rochester, Minnesota
| | - Brant Newman
- 2 Division of Engineering, Mayo Clinic , Rochester, Minnesota
| | - Peter J Psaltis
- 4 Vascular Research Centre, South Australian Health and Medical Research Institute , Adelaide, Australia .,5 School of Medicine, University of Adelaide , Adelaide, Australia
| | - Ota Hlinomaz
- 6 Department of Cardioangiology, St. Anne's University Hospital , Brno, Czech Republic
| | - David R Holmes
- 1 Department of Cardiovascular Medicine, Mayo Clinic , Rochester, Minnesota
| | - Rajiv Gulati
- 1 Department of Cardiovascular Medicine, Mayo Clinic , Rochester, Minnesota
| | - Robert D Simari
- 1 Department of Cardiovascular Medicine, Mayo Clinic , Rochester, Minnesota
| | - Dan Dragomir-Daescu
- 7 Department of Physiology and Biomedical Engineering, Mayo Clinic , Rochester, Minnesota
| | - Gurpreet S Sandhu
- 1 Department of Cardiovascular Medicine, Mayo Clinic , Rochester, Minnesota
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15
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Traverse JH, Henry TD, Pepine CJ, Willerson JT, Chugh A, Yang PC, Zhao DXM, Ellis SG, Forder JR, Perin EC, Penn MS, Hatzopoulos AK, Chambers JC, Baran KW, Raveendran G, Gee AP, Taylor DA, Moyé L, Ebert RF, Simari RD. TIME Trial: Effect of Timing of Stem Cell Delivery Following ST-Elevation Myocardial Infarction on the Recovery of Global and Regional Left Ventricular Function: Final 2-Year Analysis. Circ Res 2017; 122:479-488. [PMID: 29208679 DOI: 10.1161/circresaha.117.311466] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 11/29/2017] [Accepted: 12/01/2017] [Indexed: 02/07/2023]
Abstract
RATIONALE The TIME trial (Timing in Myocardial Infarction Evaluation) was the first cell therapy trial sufficiently powered to determine if timing of cell delivery after ST-segment-elevation myocardial infarction affects recovery of left ventricular (LV) function. OBJECTIVE To report the 2-year clinical and cardiac magnetic resonance imaging results and their modification by microvascular obstruction. METHODS AND RESULTS TIME was a randomized, double-blind, placebo-controlled trial comparing 150 million bone marrow mononuclear cells versus placebo in 120 patients with anterior ST-segment-elevation myocardial infarctions resulting in LV dysfunction. Primary end points included changes in global (LV ejection fraction) and regional (infarct and border zone) function. Secondary end points included changes in LV volumes, infarct size, and major adverse cardiac events. Here, we analyzed the continued trajectory of these measures out to 2 years and the influence of microvascular obstruction present at baseline on these long-term outcomes. At 2 years (n=85), LV ejection fraction was similar in the bone marrow mononuclear cells (48.7%) and placebo groups (51.6%) with no difference in regional LV function. Infarct size and LV mass decreased ≥30% in each group at 6 months and declined gradually to 2 years. LV volumes increased ≈10% at 6 months and remained stable to 2 years. Microvascular obstruction was present in 48 patients at baseline and was associated with significantly larger infarct size (56.5 versus 36.2 g), greater adverse LV remodeling, and marked reduction in LV ejection fraction recovery (0.2% versus 6.2%). CONCLUSIONS In one of the longest serial cardiac magnetic resonance imaging analyses of patients with large anterior ST-segment-elevation myocardial infarctions, bone marrow mononuclear cells administration did not improve recovery of LV function over 2 years. Microvascular obstruction was associated with reduced recovery of LV function, greater adverse LV remodeling, and more device implantations. The use of cardiac magnetic resonance imaging leads to greater dropout of patients over time because of device implantation in patients with more severe LV dysfunction resulting in overestimation of clinical stability of the cohort. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00684021.
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Affiliation(s)
- Jay H Traverse
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Timothy D Henry
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Carl J Pepine
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - James T Willerson
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Atul Chugh
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Phillip C Yang
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - David X M Zhao
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Stephen G Ellis
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - John R Forder
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Emerson C Perin
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Marc S Penn
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Antonis K Hatzopoulos
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Jeffrey C Chambers
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Kenneth W Baran
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Ganesh Raveendran
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Adrian P Gee
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Doris A Taylor
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Lem Moyé
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.).
| | - Ray F Ebert
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
| | - Robert D Simari
- From the Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (J.H.T., T.D.H.); Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.H.T., G.R.); Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (T.D.H.); Department of Medicine, College of Medicine, University of Florida, Gainesville (C.J.P., J.R.F.); Stem Cell Center (J.T.W., E.C.P.), and Regenerative Medicine Research (D.A.T.), Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston; Franciscan Saint Francis Health, Indianapolis, IN (A.C.); Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (P.C.Y.); Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC (D.X.M.Z.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.G.E.); Summa Health Heart and Vascular Institute, Akron, OH (M.S.P.); Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN (A.K.H.); Metropolitan Heart and Vascular Institute, Mercy Hospital, Coon Rapids, MN (J.C.C.); United Heart and Vascular Clinic (K.W.B.); Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX (A.P.G.); Coordinating Center for Clinical Trials, UTHealth School of Public Health, Houston, TX (L.M.); National Heart Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine (R.D.S.)
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Fernández-Avilés F, Sanz-Ruiz R, Climent AM, Badimon L, Bolli R, Charron D, Fuster V, Janssens S, Kastrup J, Kim HS, Lüscher TF, Martin JF, Menasché P, Simari RD, Stone GW, Terzic A, Willerson JT, Wu JC. Global position paper on cardiovascular regenerative medicine. Eur Heart J 2017; 38:2532-2546. [PMID: 28575280 PMCID: PMC5837698 DOI: 10.1093/eurheartj/ehx248] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/13/2017] [Accepted: 04/20/2017] [Indexed: 12/11/2022] Open
Affiliation(s)
- Francisco Fernández-Avilés
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
- CIBERCV, ISCIII, Madrid, Spain
| | - Ricardo Sanz-Ruiz
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
- CIBERCV, ISCIII, Madrid, Spain
| | - Andreu M Climent
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
- CIBERCV, ISCIII, Madrid, Spain
| | - Lina Badimon
- CIBERCV, ISCIII, Madrid, Spain
- Cardiovascular Research Center (CSIC-ICCC), Hospital de la Santa Creu i Sant Pau (HSCSP), Barcelona, Spain
| | - Roberto Bolli
- Institute of Molecular Cardiology, Diabetes and Obesity Center, University of Louisville School of Medicine, Louisville, Kentucky
| | - Dominique Charron
- LabEx TRANSPLANTEX; HLA & Médecine "Jean Dausset" Laboratory Network, Hôpital Saint-Louis AP-HP, Université Paris Diderot, 75013, France
| | - Valentin Fuster
- CIBERCV, ISCIII, Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of medicine at Mount Sinai, New York, NY, USA
| | - Stefan Janssens
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Jens Kastrup
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Hyo-Soo Kim
- National Research Laboratory for Stem Cell Niche, Center for Medical Innovation, Seoul National University Hospital, Seoul, Korea; Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
| | - Thomas F Lüscher
- Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland; Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | | | - Philippe Menasché
- Department of Cardiovascular Surgery Hôpital Européen Georges Pompidou; Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Robert D Simari
- School of Medicine, University of Kansas, 3901 Rainbow Boulevard, Kansas City, KS, USA
| | - Gregg W Stone
- Center for Clinical Trials, Cardiovascular Research Foundation, New York, New York; Center for Clinical Trials, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Andre Terzic
- Center for Regenerative Medicine, Department of Cardiovascular Diseases, Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, NY, USA
| | - James T Willerson
- Department of Regenerative Medicine Research, Texas Heart Institute, Houston, TX, USA
| | - Joseph C Wu
- Stanford Cardiovascular Institute, Division of Cardiovascular Medicine, Department of Medicine and Department of Radiology, Stanford University School of Medicine, CA, USA
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Helder MRK, Stoyles NJ, Tefft BJ, Hennessy RS, Hennessy RRC, Dyer R, Witt T, Simari RD, Lerman A. Xenoantigenicity of porcine decellularized valves. J Cardiothorac Surg 2017; 12:56. [PMID: 28716099 PMCID: PMC5514525 DOI: 10.1186/s13019-017-0621-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 07/12/2017] [Indexed: 11/11/2022] Open
Abstract
Background The xenoantigenicity of porcine bioprosthetic valves is implicated as an etiology leading to calcification and subsequent valve failure. Decellularization of porcine valves theoretically could erase the antigenicity of the tissue leading to more durable prosthetic valves, but the effectiveness of decellularization protocols in regard to completely removing antigens has yet to be verified. Our hypothesis was that decellularization would remove the more abundant α-gal antigens but not remove all the non α-gal antigens, which could mount a response. Methods Porcine aortic valves were decellularized with 1% sodium dodecyl sulfate for 4 days. Decellularized cusps were evaluated for α-gal epitopes by ELISA. To test for non α-gal antigens, valves were implanted into sheep. Serum was obtained from the sheep preoperatively and 1 week, 1 month, and 2 months postoperatively. This serum was utilized for anti-porcine antibody staining and for quantification of anti-pig IgM and IgG antibodies and complement. Results Decellularized porcine cusps had 2.8 ± 2.0% relative α-gal epitope as compared to fresh porcine aortic valve cusps and was not statistically significantly different (p = 0.4) from the human aortic valve cusp which had a 2.0 ± 0.4% relative concentration. Anti-pig IgM and IgG increased postoperatively from baseline levels. Preoperatively anti-pig IgM was 27.7 ± 1.7 μg/mL and it increased to 71.9 ± 12.1 μg/mL average of all time points postoperatively (p = 0.04). Preoperatively anti-pig IgG in sheep serum was 44.9 ± 1.5 μg/mL and it increased to 72.6 ± 6.0 μg/mL average of all time points postoperatively (p = 0.01). There was a statistically significant difference (p = 0.00007) in the serum C1q concentration before valve implantation (2.5 ± 0.2 IU/mL) and at averaged time points after valve implantation (5.3 ± 0.3 IU/mL). Conclusions Decellularization with 1% sodium dodecyl sulfate does not fully eliminate non α-gal antigens; however, significant reduction in α-gal presence on decellularized cusps was observed. Clinical implications of the non α-gal antigenic response are yet to be determined. As such, evaluation of any novel decellularized xenografts must include rigorous antigen testing prior to human trials. Electronic supplementary material The online version of this article (doi:10.1186/s13019-017-0621-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Nicholas J Stoyles
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Brandon J Tefft
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Ryan S Hennessy
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Rebecca R C Hennessy
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Roy Dyer
- Divisions of Immunochemical Core Lab, Mayo Clinic, Rochester, MN, USA
| | - Tyra Witt
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Robert D Simari
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Amir Lerman
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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Abstract
The field of cell therapy for cardiovascular disease has progressed at an uneven rate and will likely follow the translational paths of other biologic therapies. The field will require novel public-private partnerships to guide it to its ultimate applications.
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Affiliation(s)
- Robert D Simari
- From the Department of Internal Medicine, University of Kansas School of Medicine, Kansas University Medical Center, Kansas City, KS.
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Perin EC, Murphy MP, March KL, Bolli R, Loughran J, Yang PC, Leeper NJ, Dalman RL, Alexander J, Henry TD, Traverse JH, Pepine CJ, Anderson RD, Berceli S, Willerson JT, Muthupillai R, Gahremanpour A, Raveendran G, Velasquez O, Hare JM, Hernandez Schulman I, Kasi VS, Hiatt WR, Ambale-Venkatesh B, Lima JA, Taylor DA, Resende M, Gee AP, Durett AG, Bloom J, Richman S, G'Sell P, Williams S, Khan F, Gyang Ross E, Santoso MR, Goldman J, Leach D, Handberg E, Cheong B, Piece N, DiFede D, Bruhn-Ding B, Caldwell E, Bettencourt J, Lai D, Piller L, Simpson L, Cohen M, Sayre SL, Vojvodic RW, Moyé L, Ebert RF, Simari RD, Hirsch AT. Evaluation of Cell Therapy on Exercise Performance and Limb Perfusion in Peripheral Artery Disease: The CCTRN PACE Trial (Patients With Intermittent Claudication Injected With ALDH Bright Cells). Circulation 2017; 135:1417-1428. [PMID: 28209728 DOI: 10.1161/circulationaha.116.025707] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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: 09/29/2016] [Accepted: 02/09/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Atherosclerotic peripheral artery disease affects 8% to 12% of Americans >65 years of age and is associated with a major decline in functional status, increased myocardial infarction and stroke rates, and increased risk of ischemic amputation. Current treatment strategies for claudication have limitations. PACE (Patients With Intermittent Claudication Injected With ALDH Bright Cells) is a National Heart, Lung, and Blood Institute-sponsored, randomized, double-blind, placebo-controlled, phase 2 exploratory clinical trial designed to assess the safety and efficacy of autologous bone marrow-derived aldehyde dehydrogenase bright (ALDHbr) cells in patients with peripheral artery disease and to explore associated claudication physiological mechanisms. METHODS All participants, randomized 1:1 to receive ALDHbr cells or placebo, underwent bone marrow aspiration and isolation of ALDHbr cells, followed by 10 injections into the thigh and calf of the index leg. The coprimary end points were change from baseline to 6 months in peak walking time (PWT), collateral count, peak hyperemic popliteal flow, and capillary perfusion measured by magnetic resonance imaging, as well as safety. RESULTS A total of 82 patients with claudication and infrainguinal peripheral artery disease were randomized at 9 sites, of whom 78 had analyzable data (57 male, 21 female patients; mean age, 66±9 years). The mean±SEM differences in the change over 6 months between study groups for PWT (0.9±0.8 minutes; 95% confidence interval [CI] -0.6 to 2.5; P=0.238), collateral count (0.9±0.6 arteries; 95% CI, -0.2 to 2.1; P=0.116), peak hyperemic popliteal flow (0.0±0.4 mL/s; 95% CI, -0.8 to 0.8; P=0.978), and capillary perfusion (-0.2±0.6%; 95% CI, -1.3 to 0.9; P=0.752) were not significant. In addition, there were no significant differences for the secondary end points, including quality-of-life measures. There were no adverse safety outcomes. Correlative relationships between magnetic resonance imaging measures and PWT were not significant. A post hoc exploratory analysis suggested that ALDHbr cell administration might be associated with an increase in the number of collateral arteries (1.5±0.7; 95% CI, 0.1-2.9; P=0.047) in participants with completely occluded femoral arteries. CONCLUSIONS ALDHbr cell administration did not improve PWT or magnetic resonance outcomes, and the changes in PWT were not associated with the anatomic or physiological magnetic resonance imaging end points. Future peripheral artery disease cell therapy investigational trial design may be informed by new anatomic and perfusion insights. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01774097.
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Affiliation(s)
- Emerson C Perin
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Michael P Murphy
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Keith L March
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Roberto Bolli
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - John Loughran
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Phillip C Yang
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Nicholas J Leeper
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Ronald L Dalman
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Jason Alexander
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Timothy D Henry
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Jay H Traverse
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Carl J Pepine
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - R David Anderson
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Scott Berceli
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - James T Willerson
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Raja Muthupillai
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Amir Gahremanpour
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Ganesh Raveendran
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Omaida Velasquez
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Joshua M Hare
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Ivonne Hernandez Schulman
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Vijaykumar S Kasi
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - William R Hiatt
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Bharath Ambale-Venkatesh
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - João A Lima
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Doris A Taylor
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Micheline Resende
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Adrian P Gee
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - April G Durett
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Jeanette Bloom
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Sara Richman
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Patricia G'Sell
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Shari Williams
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Fouzia Khan
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Elsie Gyang Ross
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Michelle R Santoso
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - JoAnne Goldman
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Dana Leach
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Eileen Handberg
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Benjamin Cheong
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Nichole Piece
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Darcy DiFede
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Barb Bruhn-Ding
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Emily Caldwell
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Judy Bettencourt
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Dejian Lai
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Linda Piller
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Lara Simpson
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Michelle Cohen
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Shelly L Sayre
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Rachel W Vojvodic
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Lem Moyé
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.).
| | - Ray F Ebert
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Robert D Simari
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
| | - Alan T Hirsch
- From Texas Heart Institute (E.C.P., J.T.W., A.G., D.A.T., M.R., B.C., N.P.), CHI St. Luke's Health (R.M.), Houston; Indiana University School of Medicine, Indianapolis (M.P.M., K.L.M., P.G.); University of Louisville, KY (R.B., J.L., S.W.); Stanford University School of Medicine, CA (P.C.Y., N.J.L., R.L.D., F.K., E.G.R., M.R.S.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.A., J.H.T., J.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A., S.B., D.L., E.H.); University of Minnesota Medical School, Minneapolis (G.R., B.B.-D., E.C., A.T.H.); University of Miami Miller School of Medicine, FL (O.V., J.M.H., I.H.S., D.D.); Orlando Health, FL (V.S.K.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Johns Hopkins University, Baltimore, MD (B.A.- V., J.A.L.); Baylor College of Medicine, Houston, TX (A.P.G., A.G.D., J. Bloom, S.R.); University of Texas School of Public Health, Houston (J. Bettencourt, D.L., L.P., L.S., M.C., S.L.S., R.W.V., L.M.); National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); and University of Kansas School of Medicine, Kansas City (R.D.S.)
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Bhatnagar A, Bolli R, Johnstone BH, Traverse JH, Henry TD, Pepine CJ, Willerson JT, Perin EC, Ellis SG, Zhao DXM, Yang PC, Cooke JP, Schutt RC, Trachtenberg BH, Orozco A, Resende M, Ebert RF, Sayre SL, Simari RD, Moyé L, Cogle CR, Taylor DA. Bone marrow cell characteristics associated with patient profile and cardiac performance outcomes in the LateTIME-Cardiovascular Cell Therapy Research Network (CCTRN) trial. Am Heart J 2016; 179:142-50. [PMID: 27595689 DOI: 10.1016/j.ahj.2016.06.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 06/25/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although several preclinical studies have shown that bone marrow cell (BMC) transplantation promotes cardiac recovery after myocardial infarction, clinical trials with unfractionated bone marrow have shown variable improvements in cardiac function. METHODS To determine whether in a population of post-myocardial infarction patients, functional recovery after BM transplant is associated with specific BMC subpopulation, we examined the association between BMCs with left ventricular (LV) function in the LateTIME-CCTRN trial. RESULTS In this population, we found that older individuals had higher numbers of BM CD133(+) and CD3(+) cells. Bone marrow from individuals with high body mass index had lower CD45(dim)/CD11b(dim) levels, whereas those with hypertension and higher C-reactive protein levels had higher numbers of CD133(+) cells. Smoking was associated with higher levels of CD133(+)/CD34(+)/VEGFR2(+) cells and lower levels of CD3(+) cells. Adjusted multivariate analysis indicated that CD11b(dim) cells were negatively associated with changes in LV ejection fraction and wall motion in both the infarct and border zones. Change in LV ejection fraction was positively associated with CD133(+), CD34(+), and CD45(+)/CXCR4(dim) cells as well as faster BMC growth rates in endothelial colony forming assays. CONCLUSIONS In the LateTIME population, BM composition varied with patient characteristics and treatment. Irrespective of cell therapy, recovery of LV function was greater in patients with greater BM abundance of CD133(+) and CD34(+) cells and worse in those with higher levels of CD11b(dim) cells. Bone marrow phenotype might predict clinical response before BMC therapy and administration of selected BM constituents could potentially improve outcomes of other future clinical trials.
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Affiliation(s)
| | | | | | - Jay H Traverse
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN
| | | | - Carl J Pepine
- University of Florida College of Medicine, Gainesville, FL
| | - James T Willerson
- Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston, TX
| | - Emerson C Perin
- Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston, TX
| | | | | | | | - John P Cooke
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Robert C Schutt
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | | | - Aaron Orozco
- Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston, TX
| | - Micheline Resende
- Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston, TX
| | - Ray F Ebert
- National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Shelly L Sayre
- University of Texas School of Public Health, Houston, TX
| | | | - Lem Moyé
- University of Texas School of Public Health, Houston, TX.
| | | | - Doris A Taylor
- Texas Heart Institute, CHI St. Luke's Health Baylor College of Medicine Medical Center, Houston, TX
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21
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Golpanian S, Schulman IH, Ebert RF, Heldman AW, DiFede DL, Yang PC, Wu JC, Bolli R, Perin EC, Moyé L, Simari RD, Wolf A, Hare JM. Concise Review: Review and Perspective of Cell Dosage and Routes of Administration From Preclinical and Clinical Studies of Stem Cell Therapy for Heart Disease. Stem Cells Transl Med 2015; 5:186-91. [PMID: 26683870 PMCID: PMC4729551 DOI: 10.5966/sctm.2015-0101] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 09/14/2015] [Indexed: 02/06/2023] Open
Abstract
An important stage in the development of any new therapeutic agent is establishment of the optimal dosage and route of administration. Inconsistent findings have been reported regarding the relationship between the cell dose and clinical benefit. The present study summarizes the data regarding the optimal cell dosage and route of administration from studies of stem cell therapy for heart disease and offers a perspective on future directions. An important stage in the development of any new therapeutic agent is establishment of the optimal dosage and route of administration. This can be particularly challenging when the treatment is a biologic agent that might exert its therapeutic effects via complex or poorly understood mechanisms. Multiple preclinical and clinical studies have shown paradoxical results, with inconsistent findings regarding the relationship between the cell dose and clinical benefit. Such phenomena can, at least in part, be attributed to variations in cell dosing or concentration and the route of administration (ROA). Although clinical trials of cell-based therapy for cardiovascular disease began more than a decade ago, specification of the optimal dosage and ROA has not been established. The present review summarizes what has been learned regarding the optimal cell dosage and ROA from preclinical and clinical studies of stem cell therapy for heart disease and offers a perspective on future directions. Significance Preclinical and clinical studies on cell-based therapy for cardiovascular disease have shown inconsistent results, in part because of variations in study-specific dosages and/or routes of administration (ROA). Future preclinical studies and smaller clinical trials implementing cell-dose and ROA comparisons are warranted before proceeding to pivotal trials.
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Affiliation(s)
- Samuel Golpanian
- Interdisciplinary Stem Cell Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Ivonne H Schulman
- Interdisciplinary Stem Cell Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Ray F Ebert
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Alan W Heldman
- Interdisciplinary Stem Cell Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Darcy L DiFede
- Interdisciplinary Stem Cell Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Phillip C Yang
- School of Medicine, Stanford University, Stanford, California, USA
| | - Joseph C Wu
- School of Medicine, Stanford University, Stanford, California, USA
| | - Roberto Bolli
- School of Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Emerson C Perin
- Texas Heart Institute, CHI St. Luke's Health, Baylor College of Medicine Medical Center, Houston, Texas, USA
| | - Lem Moyé
- School of Public Health, University of Texas Health Science Center, Houston, Texas, USA
| | - Robert D Simari
- School of Medicine, University of Kansas, Kansas City, Kansas, USA
| | - Ariel Wolf
- Interdisciplinary Stem Cell Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Joshua M Hare
- Interdisciplinary Stem Cell Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida, USA
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22
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Taylor DA, Perin EC, Willerson JT, Zierold C, Resende M, Carlson M, Nestor B, Wise E, Orozco A, Pepine CJ, Henry TD, Ellis SG, Zhao DXM, Traverse JH, Cooke JP, Schutt RC, Bhatnagar A, Grant MB, Lai D, Johnstone BH, Sayre SL, Moyé L, Ebert RF, Bolli R, Simari RD, Cogle CR. Identification of Bone Marrow Cell Subpopulations Associated With Improved Functional Outcomes in Patients With Chronic Left Ventricular Dysfunction: An Embedded Cohort Evaluation of the FOCUS-CCTRN Trial. Cell Transplant 2015; 25:1675-1687. [PMID: 26590374 DOI: 10.3727/096368915x689901] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
In the current study, we sought to identify bone marrow-derived mononuclear cell (BM-MNC) subpopulations associated with a combined improvement in left ventricular ejection fraction (LVEF), left ventricular end-systolic volume (LVESV), and maximal oxygen consumption (VO2 max) in patients with chronic ischemic cardiomyopathy 6 months after receiving transendocardial injections of autologous BM-MNCs or placebo. For this prospectively planned analysis, we conducted an embedded cohort study comprising 78 patients from the FOCUS-Cardiovascular Cell Therapy Research Network (CCTRN) trial. Baseline BM-MNC immunophenotypes and progenitor cell activity were determined by flow cytometry and colony-forming assays, respectively. Previously stable patients who demonstrated improvement in LVEF, LVESV, and VO2 max during the 6-month course of the FOCUS-CCTRN study (group 1, n = 17) were compared to those who showed no change or worsened in one to three of these endpoints (group 2, n = 61) and to a subset of patients from group 2 who declined in all three functional endpoints (group 2A, n = 11). Group 1 had higher frequencies of B-cell and CXCR4+ BM-MNC subpopulations at study baseline than group 2 or 2A. Furthermore, patients in group 1 had fewer endothelial colony-forming cells and monocytes/macrophages in their bone marrow than those in group 2A. To our knowledge, this is the first study to show that in patients with ischemic cardiomyopathy, certain bone marrow-derived cell subsets are associated with improvement in LVEF, LVESV, and VO2 max at 6 months. These results suggest that the presence of both progenitor and immune cell populations in the bone marrow may influence the natural history of chronic ischemic cardiomyopathy-even in stable patients. Thus, it may be important to consider the bone marrow composition and associated regenerative capacity of patients when assigning them to treatment groups and evaluating the results of cell therapy trials.
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Affiliation(s)
- Doris A Taylor
- Texas Heart Institute, CHI St. Luke's Health, Houston, TX, USA
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23
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Helder MRK, Hennessy RS, Spoon DB, Tefft BJ, Witt TA, Marler RJ, Pislaru SV, Simari RD, Stulak JM, Lerman A. Low-Dose Gamma Irradiation of Decellularized Heart Valves Results in Tissue Injury In Vitro and In Vivo. Ann Thorac Surg 2015; 101:667-74. [PMID: 26453425 DOI: 10.1016/j.athoracsur.2015.07.080] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 07/13/2015] [Accepted: 07/28/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Decellularized heart valves are emerging as a potential alternative to current bioprostheses for valve replacement. Whereas techniques of decellularization have been thoroughly examined, terminal sterilization techniques have not received the same scrutiny. METHODS This study evaluated low-dose gamma irradiation as a sterilization method for decellularized heart valves. Incubation of valves and transmission electron microscopy evaluation after different doses of gamma irradiation were used to determine the optimal dose of gamma irradiation. Quantitative evaluation of mechanical properties was done by tensile mechanical testing of isolated cusps. Sterilized decellularized heart valves were tested in a sheep model (n = 3 [1 at 1,500 Gy and 2 at 3,000 Gy]) of pulmonary valve replacement. RESULTS Valves sterilized with gamma radiation between 1,000 Gy and 3,000 Gy were found to be optimal with in vitro testing. However, in vivo testing showed deteriorating valve function within 2 months. On explant, the valve with 1,500 Gy gamma irradiation showed signs of endocarditis with neutrophils on hematoxylin and eosin staining, and positive gram stain resembling streptococcus infection. The 3,000 Gy valves had no evidence of infection, but the hematoxylin and eosin staining showed evidence of wound remodeling with macrophages and fibroblasts. Tensile strength testing showed decreased strength (0 Gy: 2.53 ± 0.98 MPa, 1,500 Gy: 2.03 ± 1.23 MPa, and 3,000 Gy: 1.26 ± 0.90 MPa) with increasing levels of irradiation. CONCLUSIONS Low-dose gamma irradiation does not maintain the mechanical integrity of valves, and the balance between sterilization and damage may not be able to be achieved with gamma irradiation. Other methods of terminal sterilization must be pursued and evaluated.
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Affiliation(s)
| | - Ryan S Hennessy
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Daniel B Spoon
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Brandon J Tefft
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Tyra A Witt
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | | | - Sorin V Pislaru
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Robert D Simari
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - John M Stulak
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Amir Lerman
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
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24
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Abstract
The fibrosa layer of a cardiac aortic valve is composed mostly of a dense network of type I collagen fibers oriented in circumferential direction. This main layer bears the tensile load and responds to the high stress on a leaflet. The inner fibrosa layer is also the site of pathophysiologic changes that result in valvular dysfunction, including stenosis and regurgitation. In vitro studies of these changes are limited by the absence of a substrate that mimics the circumferentially oriented structure of the fibrosa layer. In heart valve tissue engineering, generation of this layer is challenging. This study aimed to develop an artificial fibrosa layer of a native aortic leaflet. A unique morphologically biomimicked, pliable, but standalone substrate with circumferentially oriented nanofibers was fabricated by electrospinning on a novel collector designed for this study. The substrate had low-bulk tensile stiffness and ultimate strength; thus, cultured valvular interstitial cells (VICs) showed a fibroblast phenotype that is generally observed in a healthy aortic leaflet. Furthermore, gene and protein expression and morphology of VICs in substrates were close to those in the fibrosa layer of a native aortic leaflet. This artificial fibrosa layer can be useful for in vitro studies of valvular dysfunctions.
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Affiliation(s)
- Soumen Jana
- Division of Cardiovascular Diseases, Mayo Clinic , 200 First Street SW, Rochester, Minnesota 55905, United States
| | - Amir Lerman
- Division of Cardiovascular Diseases, Mayo Clinic , 200 First Street SW, Rochester, Minnesota 55905, United States
| | - Robert D Simari
- School of Medicine, University of Kansas , 3901 Rainbow Boulevard, Kansas City, Kansas 66160, United States
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25
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Abstract
The vasculature plays an indispensible role in organ development and maintenance of tissue homeostasis, such that disturbances to it impact greatly on developmental and postnatal health. Although cell turnover in healthy blood vessels is low, it increases considerably under pathological conditions. The principle sources for this phenomenon have long been considered to be the recruitment of cells from the peripheral circulation and the re-entry of mature cells in the vessel wall back into cell cycle. However, recent discoveries have also uncovered the presence of a range of multipotent and lineage-restricted progenitor cells in the mural layers of postnatal blood vessels, possessing high proliferative capacity and potential to generate endothelial, smooth muscle, hematopoietic or mesenchymal cell progeny. In particular, the tunica adventitia has emerged as a progenitor-rich compartment with niche-like characteristics that support and regulate vascular wall progenitor cells. Preliminary data indicate the involvement of some of these vascular wall progenitor cells in vascular disease states, adding weight to the notion that the adventitia is integral to vascular wall pathogenesis, and raising potential implications for clinical therapies. This review discusses the current body of evidence for the existence of vascular wall progenitor cell subpopulations from development to adulthood and addresses the gains made and significant challenges that lie ahead in trying to accurately delineate their identities, origins, regulatory pathways, and relevance to normal vascular structure and function, as well as disease.
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Affiliation(s)
- Peter J Psaltis
- From the Department of Medicine, University of Adelaide and Heart Health Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia (P.J.P.); Monash Cardiovascular Research Centre, Monash University, Clayton, Victoria, Australia (P.J.P.); and Department of Internal Medicine, University of Kansas School of Medicine (R.D.S.)
| | - Robert D Simari
- From the Department of Medicine, University of Adelaide and Heart Health Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia (P.J.P.); Monash Cardiovascular Research Centre, Monash University, Clayton, Victoria, Australia (P.J.P.); and Department of Internal Medicine, University of Kansas School of Medicine (R.D.S.).
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26
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Simonetto DA, Yang HY, Yin M, de Assuncao TM, Kwon JH, Hilsher M, Pan S, Yang L, Bi Y, Beyder A, Cao S, Simari RD, Ehman R, Kamath PS, Shah VH. Chronic passive venous congestion drives hepatic fibrogenesis via sinusoidal thrombosis and mechanical forces. Hepatology 2015; 61:648-59. [PMID: 25142214 PMCID: PMC4303520 DOI: 10.1002/hep.27387] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [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: 05/12/2014] [Accepted: 08/19/2014] [Indexed: 02/06/2023]
Abstract
UNLABELLED Chronic passive hepatic congestion (congestive hepatopathy) leads to hepatic fibrosis; however, the mechanisms involved in this process are not well understood. We developed a murine experimental model of congestive hepatopathy through partial ligation of the inferior vena cava (pIVCL). C57BL/6 and transgenic mice overexpressing tissue factor pathway inhibitor (SM22α-TFPI) were subjected to pIVCL or sham. Liver and blood samples were collected and analyzed in immunohistochemical, morphometric, real-time polymerase chain reaction, and western blot assays. Hepatic fibrosis and portal pressure were significantly increased after pIVCL concurrent with hepatic stellate cell (HSC) activation. Liver stiffness, as assessed by magnetic resonance elastography, correlated with portal pressure and preceded fibrosis in our model. Hepatic sinusoidal thrombosis as evidenced by fibrin deposition was demonstrated both in mice after pIVCL as well as in humans with congestive hepatopathy. Warfarin treatment and TFPI overexpression both had a protective effect on fibrosis development and HSC activation after pIVCL. In vitro studies show that congestion stimulates HSC fibronectin (FN) fibril assembly through direct effects of thrombi as well as by virtue of mechanical strain. Pretreatment with either Mab13 or Cytochalasin-D, to inhibit β-integrin or actin polymerization, respectively, significantly reduced fibrin and stretch-induced FN fibril assembly. CONCLUSION Chronic hepatic congestion leads to sinusoidal thrombosis and strain, which in turn promote hepatic fibrosis. These studies mechanistically link congestive hepatopathy to hepatic fibrosis.
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Affiliation(s)
| | - Hui-yin Yang
- Gastroenterology Research Unit, Mayo Clinic, Rochester, MN
,Chinese PLA General Hospital & Chinese PLA Medical School; Integrative Medical Center of the 302 Military Hospital, Beijing, People’s Republic of China
| | - Meng Yin
- Department of Radiology, Mayo Clinic, Rochester, MN
| | | | - Jung Hee Kwon
- Gastroenterology Research Unit, Mayo Clinic, Rochester, MN
| | - Moira Hilsher
- Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Shuchong Pan
- Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
| | - Liu Yang
- Gastroenterology Research Unit, Mayo Clinic, Rochester, MN
| | - Yan Bi
- Gastroenterology Research Unit, Mayo Clinic, Rochester, MN
| | - Arthur Beyder
- Gastroenterology Research Unit, Mayo Clinic, Rochester, MN
| | - Sheng Cao
- Gastroenterology Research Unit, Mayo Clinic, Rochester, MN
| | - Robert D Simari
- Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
| | | | | | - Vijay H Shah
- Gastroenterology Research Unit, Mayo Clinic, Rochester, MN
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Collin J, Gössl M, Matsuo Y, Cilluffo RR, Flammer AJ, Loeffler D, Lennon RJ, Simari RD, Spoon DB, Erbel R, Lerman LO, Khosla S, Lerman A. Osteogenic monocytes within the coronary circulation and their association with plaque vulnerability in patients with early atherosclerosis. Int J Cardiol 2014; 181:57-64. [PMID: 25482280 DOI: 10.1016/j.ijcard.2014.11.156] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 09/08/2014] [Accepted: 11/23/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This study tests the hypothesis that circulating mononuclear cells expressing osteocalcin (OCN) and bone alkaline phosphatase (BAP) are associated with distinct plaque tissue components in patients with early coronary atherosclerosis. BACKGROUND Plaque characteristics implying vulnerability develop at the earliest stage of coronary atherosclerosis. Increasing evidence indicates that cells from the myeloid lineage might serve as important mediators of destabilization. Plaque burden and its components were assessed regarding their relationship to monocytes carrying both pro-inflammatory (CD14) and osteogenic surface markers OCN and BAP. METHODS Twenty-three patients with angiographically non-obstructive coronary artery disease underwent coronary endothelial function assessment and virtual histology-intravascular ultrasound of the left coronary artery. Plaque composition was characterized in the total segment (TS) and in the target lesion (TL) containing the highest amount of plaque burden. Blood samples were collected simultaneously from the aorta and the coronary sinus. Circulating cell counts were then identified from each sample and a gradient across the coronary circulation was determined. RESULTS Circulating CD14+/BAP+/OCN+ monocytes correlate with the extent of necrotic core and calcification (r=0.53, p=0.010; r=0.55, p=0.006, respectively). Importantly, coronary retention of CD14+/OCN+ cells also correlates with the amount of necrotic core and calcification (r=0.61, p=0.003; r=0.61, p=0.003) respectively. CONCLUSIONS Our study links CD14+/BAP+/OCN+ monocytes to the pathologic remodeling of the coronary circulation and therefore associates these cells with plaque destabilization in patients with early coronary atherosclerosis.
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Affiliation(s)
- Julia Collin
- Department of Cardiology, West-German Heart-Center - University Hospital Essen, Essen, Germany; Department of Internal Medicine, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Mario Gössl
- Department of Cardiology, Dean Clinic - Dean St. Mary's Outpatient Hospital Center, Madison, WI, USA
| | - Yoshiki Matsuo
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Rebecca R Cilluffo
- Divison of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, College of Medicine, Rochester, MN, USA
| | - Andreas J Flammer
- Department of Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - Darrell Loeffler
- Divison of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, College of Medicine, Rochester, MN, USA
| | - Ryan J Lennon
- Division of Biomedical Statistics and Informatics, Mayo Clinic, College of Medicine, Rochester, MN, USA
| | - Robert D Simari
- Department of Internal Medicine, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Daniel B Spoon
- Divison of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, College of Medicine, Rochester, MN, USA
| | - Raimund Erbel
- Department of Cardiology, West-German Heart-Center - University Hospital Essen, Essen, Germany
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, College of Medicine, Rochester, MN, USA
| | - Sundeep Khosla
- Division of Endocrinology, Mayo Clinic, College of Medicine, Rochester, MN, USA
| | - Amir Lerman
- Divison of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, College of Medicine, Rochester, MN, USA.
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Pan S, Chen HH, Correia C, Dai H, Witt TA, Kleppe LS, Burnett JC, Simari RD. Cell surface protein disulfide isomerase regulates natriuretic peptide generation of cyclic guanosine monophosphate. PLoS One 2014; 9:e112986. [PMID: 25419565 PMCID: PMC4242536 DOI: 10.1371/journal.pone.0112986] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 10/21/2014] [Indexed: 12/21/2022] Open
Abstract
Rationale The family of natriuretic peptides (NPs), including atrial natriuretic peptide (ANP), B-type natriuretic peptide (BNP), and C-type natriuretic peptide (CNP), exert important and diverse actions for cardiovascular and renal homeostasis. The autocrine and paracrine functions of the NPs are primarily mediated through the cellular membrane bound guanylyl cyclase-linked receptors GC-A (NPR-A) and GC-B (NPR-B). As the ligands and receptors each contain disulfide bonds, a regulatory role for the cell surface protein disulfide isomerase (PDI) was investigated. Objective We utilized complementary in vitro and in vivo models to determine the potential role of PDI in regulating the ability of the NPs to generate its second messenger, cyclic guanosine monophosphate. Methods and Results Inhibition of PDI attenuated the ability of ANP, BNP and CNP to generate cGMP in human mesangial cells (HMCs), human umbilical vein endothelial cells (HUVECs), and human aortic smooth muscle cells (HASMCs), each of which were shown to express PDI. In LLC-PK1 cells, where PDI expression was undetectable by immunoblotting, PDI inhibition had a minimal effect on cGMP generation. Addition of PDI to cultured LLC-PK1 cells increased intracellular cGMP generation mediated by ANP. Inhibition of PDI in vivo attenuated NP-mediated generation of cGMP by ANP. Surface Plasmon Resonance demonstrated modest and differential binding of the natriuretic peptides with immobilized PDI in a cell free system. However, PDI was shown to co-localize on the surface of cells with GC-A and GC-B by co-immunoprecpitation and immunohistochemistry. Conclusion These data demonstrate for the first time that cell surface PDI expression and function regulate the capacity of natriuretic peptides to generate cGMP through interaction with their receptors.
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Affiliation(s)
- Shuchong Pan
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States of America
| | - Horng H. Chen
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States of America
| | - Cristina Correia
- Division of Oncology Research, Mayo Clinic, Rochester, MN, United States of America
| | - Haiming Dai
- Division of Oncology Research, Mayo Clinic, Rochester, MN, United States of America
| | - Tyra A. Witt
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States of America
| | - Laurel S. Kleppe
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States of America
| | - John C. Burnett
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States of America
| | - Robert D. Simari
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States of America
- * E-mail:
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Schutt RC, Trachtenberg BH, Cooke JP, Traverse JH, Henry TD, Pepine CJ, Willerson JT, Perin EC, Ellis SG, Zhao DXM, Bhatnagar A, Johnstone BH, Lai D, Resende M, Ebert RF, Wu JC, Sayre SL, Orozco A, Zierold C, Simari RD, Moyé L, Cogle CR, Taylor DA. Bone marrow characteristics associated with changes in infarct size after STEMI: a biorepository evaluation from the CCTRN TIME trial. Circ Res 2014; 116:99-107. [PMID: 25406300 DOI: 10.1161/circresaha.116.304710] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [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] [Indexed: 12/15/2022]
Abstract
RATIONALE Despite significant interest in bone marrow mononuclear cell (BMC) therapy for ischemic heart disease, current techniques have resulted in only modest benefits. However, selected patients have shown improvements after autologous BMC therapy, but the contributing factors are unclear. OBJECTIVE The purpose of this study was to identify BMC characteristics associated with a reduction in infarct size after ST-segment-elevation-myocardial infarction. METHODS AND RESULTS This prospective study comprised patients consecutively enrolled in the CCTRN TIME (Cardiovascular Cell Therapy Research Network Timing in Myocardial Infarction Evaluation) trial who agreed to have their BMCs stored and analyzed at the CCTRN Biorepository. Change in infarct size between baseline (3 days after percutaneous coronary intervention) and 6-month follow-up was measured by cardiac MRI. Infarct-size measurements and BMC phenotype and function data were obtained for 101 patients (mean age, 56.5 years; mean screening ejection fraction, 37%; mean baseline cardiac MRI ejection fraction, 45%). At 6 months, 75 patients (74.3%) showed a reduction in infarct size (mean change, -21.0±17.6%). Multiple regression analysis indicated that infarct size reduction was greater in patients who had a larger percentage of CD31(+) BMCs (P=0.046) and in those with faster BMC growth rates in colony-forming unit Hill and endothelial-colony forming cell functional assays (P=0.033 and P=0.032, respectively). CONCLUSIONS This study identified BMC characteristics associated with a better clinical outcome in patients with segment-elevation-myocardial infarction and highlighted the importance of endothelial precursor activity in regenerating infarcted myocardium. Furthermore, it suggests that for these patients with segment-elevation-myocardial infarction, myocardial repair was more dependent on baseline BMC characteristics than on whether the patient underwent intracoronary BMC transplantation. CLINICAL TRIAL REGISTRATION INFORMATION URL http://www.clinicaltrials.gov. Unique identifier: NCT00684021.
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Affiliation(s)
- Robert C Schutt
- From the Houston Methodist DeBakey Heart and Vascular Center (R.C.S., B.H.T., J.P.C.) and Houston Methodist Research Institute (R.C.S., B.H.T., J.P.C.), TX; Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.H.T.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida College of Medicine, Gainesville (C.J.P., C.R.C.); Texas Heart Institute, CHI St. Luke's Health, Houston (J.T.W., E.C.P., M.R., A.O., D.A.T.); University of Minnesota School of Medicine, Minneapolis (C.Z.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest, School of Medicine, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (A.B.); Indiana University School of Medicine, Indianapolis (B.H.J.); The University of Texas Health Science Center, School of Public Health, Houston (D.L., S.L.S., L.M.); National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); Stanford University, School of Medicine, CA (J.C.W.); and Kansas University Medical Center, School of Medicine, Kansas City (R.D.S.)
| | - Barry H Trachtenberg
- From the Houston Methodist DeBakey Heart and Vascular Center (R.C.S., B.H.T., J.P.C.) and Houston Methodist Research Institute (R.C.S., B.H.T., J.P.C.), TX; Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.H.T.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida College of Medicine, Gainesville (C.J.P., C.R.C.); Texas Heart Institute, CHI St. Luke's Health, Houston (J.T.W., E.C.P., M.R., A.O., D.A.T.); University of Minnesota School of Medicine, Minneapolis (C.Z.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest, School of Medicine, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (A.B.); Indiana University School of Medicine, Indianapolis (B.H.J.); The University of Texas Health Science Center, School of Public Health, Houston (D.L., S.L.S., L.M.); National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); Stanford University, School of Medicine, CA (J.C.W.); and Kansas University Medical Center, School of Medicine, Kansas City (R.D.S.)
| | - John P Cooke
- From the Houston Methodist DeBakey Heart and Vascular Center (R.C.S., B.H.T., J.P.C.) and Houston Methodist Research Institute (R.C.S., B.H.T., J.P.C.), TX; Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.H.T.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida College of Medicine, Gainesville (C.J.P., C.R.C.); Texas Heart Institute, CHI St. Luke's Health, Houston (J.T.W., E.C.P., M.R., A.O., D.A.T.); University of Minnesota School of Medicine, Minneapolis (C.Z.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest, School of Medicine, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (A.B.); Indiana University School of Medicine, Indianapolis (B.H.J.); The University of Texas Health Science Center, School of Public Health, Houston (D.L., S.L.S., L.M.); National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); Stanford University, School of Medicine, CA (J.C.W.); and Kansas University Medical Center, School of Medicine, Kansas City (R.D.S.)
| | - Jay H Traverse
- From the Houston Methodist DeBakey Heart and Vascular Center (R.C.S., B.H.T., J.P.C.) and Houston Methodist Research Institute (R.C.S., B.H.T., J.P.C.), TX; Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.H.T.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida College of Medicine, Gainesville (C.J.P., C.R.C.); Texas Heart Institute, CHI St. Luke's Health, Houston (J.T.W., E.C.P., M.R., A.O., D.A.T.); University of Minnesota School of Medicine, Minneapolis (C.Z.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest, School of Medicine, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (A.B.); Indiana University School of Medicine, Indianapolis (B.H.J.); The University of Texas Health Science Center, School of Public Health, Houston (D.L., S.L.S., L.M.); National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); Stanford University, School of Medicine, CA (J.C.W.); and Kansas University Medical Center, School of Medicine, Kansas City (R.D.S.)
| | - Timothy D Henry
- From the Houston Methodist DeBakey Heart and Vascular Center (R.C.S., B.H.T., J.P.C.) and Houston Methodist Research Institute (R.C.S., B.H.T., J.P.C.), TX; Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.H.T.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida College of Medicine, Gainesville (C.J.P., C.R.C.); Texas Heart Institute, CHI St. Luke's Health, Houston (J.T.W., E.C.P., M.R., A.O., D.A.T.); University of Minnesota School of Medicine, Minneapolis (C.Z.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest, School of Medicine, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (A.B.); Indiana University School of Medicine, Indianapolis (B.H.J.); The University of Texas Health Science Center, School of Public Health, Houston (D.L., S.L.S., L.M.); National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); Stanford University, School of Medicine, CA (J.C.W.); and Kansas University Medical Center, School of Medicine, Kansas City (R.D.S.)
| | - Carl J Pepine
- From the Houston Methodist DeBakey Heart and Vascular Center (R.C.S., B.H.T., J.P.C.) and Houston Methodist Research Institute (R.C.S., B.H.T., J.P.C.), TX; Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.H.T.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida College of Medicine, Gainesville (C.J.P., C.R.C.); Texas Heart Institute, CHI St. Luke's Health, Houston (J.T.W., E.C.P., M.R., A.O., D.A.T.); University of Minnesota School of Medicine, Minneapolis (C.Z.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest, School of Medicine, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (A.B.); Indiana University School of Medicine, Indianapolis (B.H.J.); The University of Texas Health Science Center, School of Public Health, Houston (D.L., S.L.S., L.M.); National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); Stanford University, School of Medicine, CA (J.C.W.); and Kansas University Medical Center, School of Medicine, Kansas City (R.D.S.)
| | - James T Willerson
- From the Houston Methodist DeBakey Heart and Vascular Center (R.C.S., B.H.T., J.P.C.) and Houston Methodist Research Institute (R.C.S., B.H.T., J.P.C.), TX; Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.H.T.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida College of Medicine, Gainesville (C.J.P., C.R.C.); Texas Heart Institute, CHI St. Luke's Health, Houston (J.T.W., E.C.P., M.R., A.O., D.A.T.); University of Minnesota School of Medicine, Minneapolis (C.Z.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest, School of Medicine, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (A.B.); Indiana University School of Medicine, Indianapolis (B.H.J.); The University of Texas Health Science Center, School of Public Health, Houston (D.L., S.L.S., L.M.); National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); Stanford University, School of Medicine, CA (J.C.W.); and Kansas University Medical Center, School of Medicine, Kansas City (R.D.S.)
| | - Emerson C Perin
- From the Houston Methodist DeBakey Heart and Vascular Center (R.C.S., B.H.T., J.P.C.) and Houston Methodist Research Institute (R.C.S., B.H.T., J.P.C.), TX; Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.H.T.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida College of Medicine, Gainesville (C.J.P., C.R.C.); Texas Heart Institute, CHI St. Luke's Health, Houston (J.T.W., E.C.P., M.R., A.O., D.A.T.); University of Minnesota School of Medicine, Minneapolis (C.Z.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest, School of Medicine, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (A.B.); Indiana University School of Medicine, Indianapolis (B.H.J.); The University of Texas Health Science Center, School of Public Health, Houston (D.L., S.L.S., L.M.); National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); Stanford University, School of Medicine, CA (J.C.W.); and Kansas University Medical Center, School of Medicine, Kansas City (R.D.S.)
| | - Stephen G Ellis
- From the Houston Methodist DeBakey Heart and Vascular Center (R.C.S., B.H.T., J.P.C.) and Houston Methodist Research Institute (R.C.S., B.H.T., J.P.C.), TX; Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.H.T.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida College of Medicine, Gainesville (C.J.P., C.R.C.); Texas Heart Institute, CHI St. Luke's Health, Houston (J.T.W., E.C.P., M.R., A.O., D.A.T.); University of Minnesota School of Medicine, Minneapolis (C.Z.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest, School of Medicine, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (A.B.); Indiana University School of Medicine, Indianapolis (B.H.J.); The University of Texas Health Science Center, School of Public Health, Houston (D.L., S.L.S., L.M.); National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); Stanford University, School of Medicine, CA (J.C.W.); and Kansas University Medical Center, School of Medicine, Kansas City (R.D.S.)
| | - David X M Zhao
- From the Houston Methodist DeBakey Heart and Vascular Center (R.C.S., B.H.T., J.P.C.) and Houston Methodist Research Institute (R.C.S., B.H.T., J.P.C.), TX; Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.H.T.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida College of Medicine, Gainesville (C.J.P., C.R.C.); Texas Heart Institute, CHI St. Luke's Health, Houston (J.T.W., E.C.P., M.R., A.O., D.A.T.); University of Minnesota School of Medicine, Minneapolis (C.Z.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest, School of Medicine, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (A.B.); Indiana University School of Medicine, Indianapolis (B.H.J.); The University of Texas Health Science Center, School of Public Health, Houston (D.L., S.L.S., L.M.); National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); Stanford University, School of Medicine, CA (J.C.W.); and Kansas University Medical Center, School of Medicine, Kansas City (R.D.S.)
| | - Aruni Bhatnagar
- From the Houston Methodist DeBakey Heart and Vascular Center (R.C.S., B.H.T., J.P.C.) and Houston Methodist Research Institute (R.C.S., B.H.T., J.P.C.), TX; Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.H.T.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida College of Medicine, Gainesville (C.J.P., C.R.C.); Texas Heart Institute, CHI St. Luke's Health, Houston (J.T.W., E.C.P., M.R., A.O., D.A.T.); University of Minnesota School of Medicine, Minneapolis (C.Z.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest, School of Medicine, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (A.B.); Indiana University School of Medicine, Indianapolis (B.H.J.); The University of Texas Health Science Center, School of Public Health, Houston (D.L., S.L.S., L.M.); National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); Stanford University, School of Medicine, CA (J.C.W.); and Kansas University Medical Center, School of Medicine, Kansas City (R.D.S.)
| | - Brian H Johnstone
- From the Houston Methodist DeBakey Heart and Vascular Center (R.C.S., B.H.T., J.P.C.) and Houston Methodist Research Institute (R.C.S., B.H.T., J.P.C.), TX; Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.H.T.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida College of Medicine, Gainesville (C.J.P., C.R.C.); Texas Heart Institute, CHI St. Luke's Health, Houston (J.T.W., E.C.P., M.R., A.O., D.A.T.); University of Minnesota School of Medicine, Minneapolis (C.Z.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest, School of Medicine, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (A.B.); Indiana University School of Medicine, Indianapolis (B.H.J.); The University of Texas Health Science Center, School of Public Health, Houston (D.L., S.L.S., L.M.); National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); Stanford University, School of Medicine, CA (J.C.W.); and Kansas University Medical Center, School of Medicine, Kansas City (R.D.S.)
| | - Dejian Lai
- From the Houston Methodist DeBakey Heart and Vascular Center (R.C.S., B.H.T., J.P.C.) and Houston Methodist Research Institute (R.C.S., B.H.T., J.P.C.), TX; Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.H.T.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida College of Medicine, Gainesville (C.J.P., C.R.C.); Texas Heart Institute, CHI St. Luke's Health, Houston (J.T.W., E.C.P., M.R., A.O., D.A.T.); University of Minnesota School of Medicine, Minneapolis (C.Z.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest, School of Medicine, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (A.B.); Indiana University School of Medicine, Indianapolis (B.H.J.); The University of Texas Health Science Center, School of Public Health, Houston (D.L., S.L.S., L.M.); National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); Stanford University, School of Medicine, CA (J.C.W.); and Kansas University Medical Center, School of Medicine, Kansas City (R.D.S.)
| | - Micheline Resende
- From the Houston Methodist DeBakey Heart and Vascular Center (R.C.S., B.H.T., J.P.C.) and Houston Methodist Research Institute (R.C.S., B.H.T., J.P.C.), TX; Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.H.T.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida College of Medicine, Gainesville (C.J.P., C.R.C.); Texas Heart Institute, CHI St. Luke's Health, Houston (J.T.W., E.C.P., M.R., A.O., D.A.T.); University of Minnesota School of Medicine, Minneapolis (C.Z.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest, School of Medicine, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (A.B.); Indiana University School of Medicine, Indianapolis (B.H.J.); The University of Texas Health Science Center, School of Public Health, Houston (D.L., S.L.S., L.M.); National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); Stanford University, School of Medicine, CA (J.C.W.); and Kansas University Medical Center, School of Medicine, Kansas City (R.D.S.)
| | - Ray F Ebert
- From the Houston Methodist DeBakey Heart and Vascular Center (R.C.S., B.H.T., J.P.C.) and Houston Methodist Research Institute (R.C.S., B.H.T., J.P.C.), TX; Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.H.T.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida College of Medicine, Gainesville (C.J.P., C.R.C.); Texas Heart Institute, CHI St. Luke's Health, Houston (J.T.W., E.C.P., M.R., A.O., D.A.T.); University of Minnesota School of Medicine, Minneapolis (C.Z.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest, School of Medicine, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (A.B.); Indiana University School of Medicine, Indianapolis (B.H.J.); The University of Texas Health Science Center, School of Public Health, Houston (D.L., S.L.S., L.M.); National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); Stanford University, School of Medicine, CA (J.C.W.); and Kansas University Medical Center, School of Medicine, Kansas City (R.D.S.)
| | - Joseph C Wu
- From the Houston Methodist DeBakey Heart and Vascular Center (R.C.S., B.H.T., J.P.C.) and Houston Methodist Research Institute (R.C.S., B.H.T., J.P.C.), TX; Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.H.T.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida College of Medicine, Gainesville (C.J.P., C.R.C.); Texas Heart Institute, CHI St. Luke's Health, Houston (J.T.W., E.C.P., M.R., A.O., D.A.T.); University of Minnesota School of Medicine, Minneapolis (C.Z.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest, School of Medicine, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (A.B.); Indiana University School of Medicine, Indianapolis (B.H.J.); The University of Texas Health Science Center, School of Public Health, Houston (D.L., S.L.S., L.M.); National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); Stanford University, School of Medicine, CA (J.C.W.); and Kansas University Medical Center, School of Medicine, Kansas City (R.D.S.)
| | - Shelly L Sayre
- From the Houston Methodist DeBakey Heart and Vascular Center (R.C.S., B.H.T., J.P.C.) and Houston Methodist Research Institute (R.C.S., B.H.T., J.P.C.), TX; Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.H.T.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida College of Medicine, Gainesville (C.J.P., C.R.C.); Texas Heart Institute, CHI St. Luke's Health, Houston (J.T.W., E.C.P., M.R., A.O., D.A.T.); University of Minnesota School of Medicine, Minneapolis (C.Z.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest, School of Medicine, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (A.B.); Indiana University School of Medicine, Indianapolis (B.H.J.); The University of Texas Health Science Center, School of Public Health, Houston (D.L., S.L.S., L.M.); National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); Stanford University, School of Medicine, CA (J.C.W.); and Kansas University Medical Center, School of Medicine, Kansas City (R.D.S.)
| | - Aaron Orozco
- From the Houston Methodist DeBakey Heart and Vascular Center (R.C.S., B.H.T., J.P.C.) and Houston Methodist Research Institute (R.C.S., B.H.T., J.P.C.), TX; Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.H.T.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida College of Medicine, Gainesville (C.J.P., C.R.C.); Texas Heart Institute, CHI St. Luke's Health, Houston (J.T.W., E.C.P., M.R., A.O., D.A.T.); University of Minnesota School of Medicine, Minneapolis (C.Z.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest, School of Medicine, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (A.B.); Indiana University School of Medicine, Indianapolis (B.H.J.); The University of Texas Health Science Center, School of Public Health, Houston (D.L., S.L.S., L.M.); National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); Stanford University, School of Medicine, CA (J.C.W.); and Kansas University Medical Center, School of Medicine, Kansas City (R.D.S.)
| | - Claudia Zierold
- From the Houston Methodist DeBakey Heart and Vascular Center (R.C.S., B.H.T., J.P.C.) and Houston Methodist Research Institute (R.C.S., B.H.T., J.P.C.), TX; Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.H.T.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida College of Medicine, Gainesville (C.J.P., C.R.C.); Texas Heart Institute, CHI St. Luke's Health, Houston (J.T.W., E.C.P., M.R., A.O., D.A.T.); University of Minnesota School of Medicine, Minneapolis (C.Z.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest, School of Medicine, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (A.B.); Indiana University School of Medicine, Indianapolis (B.H.J.); The University of Texas Health Science Center, School of Public Health, Houston (D.L., S.L.S., L.M.); National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); Stanford University, School of Medicine, CA (J.C.W.); and Kansas University Medical Center, School of Medicine, Kansas City (R.D.S.)
| | - Robert D Simari
- From the Houston Methodist DeBakey Heart and Vascular Center (R.C.S., B.H.T., J.P.C.) and Houston Methodist Research Institute (R.C.S., B.H.T., J.P.C.), TX; Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.H.T.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida College of Medicine, Gainesville (C.J.P., C.R.C.); Texas Heart Institute, CHI St. Luke's Health, Houston (J.T.W., E.C.P., M.R., A.O., D.A.T.); University of Minnesota School of Medicine, Minneapolis (C.Z.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest, School of Medicine, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (A.B.); Indiana University School of Medicine, Indianapolis (B.H.J.); The University of Texas Health Science Center, School of Public Health, Houston (D.L., S.L.S., L.M.); National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); Stanford University, School of Medicine, CA (J.C.W.); and Kansas University Medical Center, School of Medicine, Kansas City (R.D.S.)
| | - Lem Moyé
- From the Houston Methodist DeBakey Heart and Vascular Center (R.C.S., B.H.T., J.P.C.) and Houston Methodist Research Institute (R.C.S., B.H.T., J.P.C.), TX; Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.H.T.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida College of Medicine, Gainesville (C.J.P., C.R.C.); Texas Heart Institute, CHI St. Luke's Health, Houston (J.T.W., E.C.P., M.R., A.O., D.A.T.); University of Minnesota School of Medicine, Minneapolis (C.Z.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest, School of Medicine, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (A.B.); Indiana University School of Medicine, Indianapolis (B.H.J.); The University of Texas Health Science Center, School of Public Health, Houston (D.L., S.L.S., L.M.); National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); Stanford University, School of Medicine, CA (J.C.W.); and Kansas University Medical Center, School of Medicine, Kansas City (R.D.S.).
| | - Christopher R Cogle
- From the Houston Methodist DeBakey Heart and Vascular Center (R.C.S., B.H.T., J.P.C.) and Houston Methodist Research Institute (R.C.S., B.H.T., J.P.C.), TX; Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.H.T.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida College of Medicine, Gainesville (C.J.P., C.R.C.); Texas Heart Institute, CHI St. Luke's Health, Houston (J.T.W., E.C.P., M.R., A.O., D.A.T.); University of Minnesota School of Medicine, Minneapolis (C.Z.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest, School of Medicine, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (A.B.); Indiana University School of Medicine, Indianapolis (B.H.J.); The University of Texas Health Science Center, School of Public Health, Houston (D.L., S.L.S., L.M.); National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); Stanford University, School of Medicine, CA (J.C.W.); and Kansas University Medical Center, School of Medicine, Kansas City (R.D.S.)
| | - Doris A Taylor
- From the Houston Methodist DeBakey Heart and Vascular Center (R.C.S., B.H.T., J.P.C.) and Houston Methodist Research Institute (R.C.S., B.H.T., J.P.C.), TX; Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (J.H.T.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Florida College of Medicine, Gainesville (C.J.P., C.R.C.); Texas Heart Institute, CHI St. Luke's Health, Houston (J.T.W., E.C.P., M.R., A.O., D.A.T.); University of Minnesota School of Medicine, Minneapolis (C.Z.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest, School of Medicine, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (A.B.); Indiana University School of Medicine, Indianapolis (B.H.J.); The University of Texas Health Science Center, School of Public Health, Houston (D.L., S.L.S., L.M.); National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.); Stanford University, School of Medicine, CA (J.C.W.); and Kansas University Medical Center, School of Medicine, Kansas City (R.D.S.)
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Cogle CR, Wise E, Meacham AM, Zierold C, Traverse JH, Henry TD, Perin EC, Willerson JT, Ellis SG, Carlson M, Zhao DXM, Bolli R, Cooke JP, Anwaruddin S, Bhatnagar A, da Graca Cabreira-Hansen M, Grant MB, Lai D, Moyé L, Ebert RF, Olson RE, Sayre SL, Schulman IH, Bosse RC, Scott EW, Simari RD, Pepine CJ, Taylor DA. Detailed analysis of bone marrow from patients with ischemic heart disease and left ventricular dysfunction: BM CD34, CD11b, and clonogenic capacity as biomarkers for clinical outcomes. Circ Res 2014; 115:867-74. [PMID: 25136078 DOI: 10.1161/circresaha.115.304353] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
RATIONALE Bone marrow (BM) cell therapy for ischemic heart disease (IHD) has shown mixed results. Before the full potency of BM cell therapy can be realized, it is essential to understand the BM niche after acute myocardial infarction (AMI). OBJECTIVE To study the BM composition in patients with IHD and severe left ventricular (LV) dysfunction. METHODS AND RESULTS BM from 280 patients with IHD and LV dysfunction were analyzed for cell subsets by flow cytometry and colony assays. BM CD34(+) cell percentage was decreased 7 days after AMI (mean of 1.9% versus 2.3%-2.7% in other cohorts; P<0.05). BM-derived endothelial colonies were significantly decreased (P<0.05). Increased BM CD11b(+) cells associated with worse LV ejection fraction (LVEF) after AMI (P<0.05). Increased BM CD34(+) percentage associated with greater improvement in LVEF (+9.9% versus +2.3%; P=0.03, for patients with AMI and +6.6% versus -0.02%; P=0.021 for patients with chronic IHD). In addition, decreased BM CD34(+) percentage in patients with chronic IHD correlated with decrement in LVEF (-2.9% versus +0.7%; P=0.0355). CONCLUSIONS In this study, we show a heterogeneous mixture of BM cell subsets, decreased endothelial colony capacity, a CD34+ cell nadir 7 days after AMI, a negative correlation between CD11b percentage and postinfarct LVEF, and positive correlation of CD34 percentage with change in LVEF after cell therapy. These results serve as a possible basis for the small clinical improvement seen in autologous BM cell therapy trials and support selection of potent cell subsets and reversal of comorbid BM impairment. CLINICAL TRIAL REGISTRATIONS URL http://www.clinicaltrials.gov. Unique identifiers: NCT00684021, NCT00684060, and NCT00824005.
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Affiliation(s)
- Christopher R Cogle
- From the University of Florida College of Medicine, Gainesville (C.R.C., E.W., A.M.M., M.B.G., R.C.B., E.W.S., C.J.P.); University of Minnesota School of Medicine, Minneapolis (C.Z., M.C.); Minneapolis Heart Institute Foundation at Abbott, MN (J.H.T., T.D.H., R.E.O.); Texas Heart Institute, Houston (E.C.P., J.T.W., M.d.G.C.-H., D.A.T.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest Baptist Health, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (R.B., A.B.); Houston Methodist Research Institute, TX (J.P.C.); University of Pennsylvania School of Medicine, Philadelphia (S.A.); University of Texas School of Public Health, Houston (D.L., L.M., S.L.S.); National Heart, Lung and Blood Institute, Bethesda, MD (R.F.E.); University of Miami School of Medicine, FL (I.H.S.), and Mayo Clinic College of Medicine, Rochester, MN (R.D.S.)
| | - Elizabeth Wise
- From the University of Florida College of Medicine, Gainesville (C.R.C., E.W., A.M.M., M.B.G., R.C.B., E.W.S., C.J.P.); University of Minnesota School of Medicine, Minneapolis (C.Z., M.C.); Minneapolis Heart Institute Foundation at Abbott, MN (J.H.T., T.D.H., R.E.O.); Texas Heart Institute, Houston (E.C.P., J.T.W., M.d.G.C.-H., D.A.T.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest Baptist Health, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (R.B., A.B.); Houston Methodist Research Institute, TX (J.P.C.); University of Pennsylvania School of Medicine, Philadelphia (S.A.); University of Texas School of Public Health, Houston (D.L., L.M., S.L.S.); National Heart, Lung and Blood Institute, Bethesda, MD (R.F.E.); University of Miami School of Medicine, FL (I.H.S.), and Mayo Clinic College of Medicine, Rochester, MN (R.D.S.)
| | - Amy M Meacham
- From the University of Florida College of Medicine, Gainesville (C.R.C., E.W., A.M.M., M.B.G., R.C.B., E.W.S., C.J.P.); University of Minnesota School of Medicine, Minneapolis (C.Z., M.C.); Minneapolis Heart Institute Foundation at Abbott, MN (J.H.T., T.D.H., R.E.O.); Texas Heart Institute, Houston (E.C.P., J.T.W., M.d.G.C.-H., D.A.T.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest Baptist Health, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (R.B., A.B.); Houston Methodist Research Institute, TX (J.P.C.); University of Pennsylvania School of Medicine, Philadelphia (S.A.); University of Texas School of Public Health, Houston (D.L., L.M., S.L.S.); National Heart, Lung and Blood Institute, Bethesda, MD (R.F.E.); University of Miami School of Medicine, FL (I.H.S.), and Mayo Clinic College of Medicine, Rochester, MN (R.D.S.)
| | - Claudia Zierold
- From the University of Florida College of Medicine, Gainesville (C.R.C., E.W., A.M.M., M.B.G., R.C.B., E.W.S., C.J.P.); University of Minnesota School of Medicine, Minneapolis (C.Z., M.C.); Minneapolis Heart Institute Foundation at Abbott, MN (J.H.T., T.D.H., R.E.O.); Texas Heart Institute, Houston (E.C.P., J.T.W., M.d.G.C.-H., D.A.T.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest Baptist Health, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (R.B., A.B.); Houston Methodist Research Institute, TX (J.P.C.); University of Pennsylvania School of Medicine, Philadelphia (S.A.); University of Texas School of Public Health, Houston (D.L., L.M., S.L.S.); National Heart, Lung and Blood Institute, Bethesda, MD (R.F.E.); University of Miami School of Medicine, FL (I.H.S.), and Mayo Clinic College of Medicine, Rochester, MN (R.D.S.)
| | - Jay H Traverse
- From the University of Florida College of Medicine, Gainesville (C.R.C., E.W., A.M.M., M.B.G., R.C.B., E.W.S., C.J.P.); University of Minnesota School of Medicine, Minneapolis (C.Z., M.C.); Minneapolis Heart Institute Foundation at Abbott, MN (J.H.T., T.D.H., R.E.O.); Texas Heart Institute, Houston (E.C.P., J.T.W., M.d.G.C.-H., D.A.T.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest Baptist Health, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (R.B., A.B.); Houston Methodist Research Institute, TX (J.P.C.); University of Pennsylvania School of Medicine, Philadelphia (S.A.); University of Texas School of Public Health, Houston (D.L., L.M., S.L.S.); National Heart, Lung and Blood Institute, Bethesda, MD (R.F.E.); University of Miami School of Medicine, FL (I.H.S.), and Mayo Clinic College of Medicine, Rochester, MN (R.D.S.)
| | - Timothy D Henry
- From the University of Florida College of Medicine, Gainesville (C.R.C., E.W., A.M.M., M.B.G., R.C.B., E.W.S., C.J.P.); University of Minnesota School of Medicine, Minneapolis (C.Z., M.C.); Minneapolis Heart Institute Foundation at Abbott, MN (J.H.T., T.D.H., R.E.O.); Texas Heart Institute, Houston (E.C.P., J.T.W., M.d.G.C.-H., D.A.T.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest Baptist Health, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (R.B., A.B.); Houston Methodist Research Institute, TX (J.P.C.); University of Pennsylvania School of Medicine, Philadelphia (S.A.); University of Texas School of Public Health, Houston (D.L., L.M., S.L.S.); National Heart, Lung and Blood Institute, Bethesda, MD (R.F.E.); University of Miami School of Medicine, FL (I.H.S.), and Mayo Clinic College of Medicine, Rochester, MN (R.D.S.)
| | - Emerson C Perin
- From the University of Florida College of Medicine, Gainesville (C.R.C., E.W., A.M.M., M.B.G., R.C.B., E.W.S., C.J.P.); University of Minnesota School of Medicine, Minneapolis (C.Z., M.C.); Minneapolis Heart Institute Foundation at Abbott, MN (J.H.T., T.D.H., R.E.O.); Texas Heart Institute, Houston (E.C.P., J.T.W., M.d.G.C.-H., D.A.T.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest Baptist Health, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (R.B., A.B.); Houston Methodist Research Institute, TX (J.P.C.); University of Pennsylvania School of Medicine, Philadelphia (S.A.); University of Texas School of Public Health, Houston (D.L., L.M., S.L.S.); National Heart, Lung and Blood Institute, Bethesda, MD (R.F.E.); University of Miami School of Medicine, FL (I.H.S.), and Mayo Clinic College of Medicine, Rochester, MN (R.D.S.)
| | - James T Willerson
- From the University of Florida College of Medicine, Gainesville (C.R.C., E.W., A.M.M., M.B.G., R.C.B., E.W.S., C.J.P.); University of Minnesota School of Medicine, Minneapolis (C.Z., M.C.); Minneapolis Heart Institute Foundation at Abbott, MN (J.H.T., T.D.H., R.E.O.); Texas Heart Institute, Houston (E.C.P., J.T.W., M.d.G.C.-H., D.A.T.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest Baptist Health, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (R.B., A.B.); Houston Methodist Research Institute, TX (J.P.C.); University of Pennsylvania School of Medicine, Philadelphia (S.A.); University of Texas School of Public Health, Houston (D.L., L.M., S.L.S.); National Heart, Lung and Blood Institute, Bethesda, MD (R.F.E.); University of Miami School of Medicine, FL (I.H.S.), and Mayo Clinic College of Medicine, Rochester, MN (R.D.S.)
| | - Stephen G Ellis
- From the University of Florida College of Medicine, Gainesville (C.R.C., E.W., A.M.M., M.B.G., R.C.B., E.W.S., C.J.P.); University of Minnesota School of Medicine, Minneapolis (C.Z., M.C.); Minneapolis Heart Institute Foundation at Abbott, MN (J.H.T., T.D.H., R.E.O.); Texas Heart Institute, Houston (E.C.P., J.T.W., M.d.G.C.-H., D.A.T.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest Baptist Health, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (R.B., A.B.); Houston Methodist Research Institute, TX (J.P.C.); University of Pennsylvania School of Medicine, Philadelphia (S.A.); University of Texas School of Public Health, Houston (D.L., L.M., S.L.S.); National Heart, Lung and Blood Institute, Bethesda, MD (R.F.E.); University of Miami School of Medicine, FL (I.H.S.), and Mayo Clinic College of Medicine, Rochester, MN (R.D.S.)
| | - Marjorie Carlson
- From the University of Florida College of Medicine, Gainesville (C.R.C., E.W., A.M.M., M.B.G., R.C.B., E.W.S., C.J.P.); University of Minnesota School of Medicine, Minneapolis (C.Z., M.C.); Minneapolis Heart Institute Foundation at Abbott, MN (J.H.T., T.D.H., R.E.O.); Texas Heart Institute, Houston (E.C.P., J.T.W., M.d.G.C.-H., D.A.T.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest Baptist Health, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (R.B., A.B.); Houston Methodist Research Institute, TX (J.P.C.); University of Pennsylvania School of Medicine, Philadelphia (S.A.); University of Texas School of Public Health, Houston (D.L., L.M., S.L.S.); National Heart, Lung and Blood Institute, Bethesda, MD (R.F.E.); University of Miami School of Medicine, FL (I.H.S.), and Mayo Clinic College of Medicine, Rochester, MN (R.D.S.)
| | - David X M Zhao
- From the University of Florida College of Medicine, Gainesville (C.R.C., E.W., A.M.M., M.B.G., R.C.B., E.W.S., C.J.P.); University of Minnesota School of Medicine, Minneapolis (C.Z., M.C.); Minneapolis Heart Institute Foundation at Abbott, MN (J.H.T., T.D.H., R.E.O.); Texas Heart Institute, Houston (E.C.P., J.T.W., M.d.G.C.-H., D.A.T.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest Baptist Health, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (R.B., A.B.); Houston Methodist Research Institute, TX (J.P.C.); University of Pennsylvania School of Medicine, Philadelphia (S.A.); University of Texas School of Public Health, Houston (D.L., L.M., S.L.S.); National Heart, Lung and Blood Institute, Bethesda, MD (R.F.E.); University of Miami School of Medicine, FL (I.H.S.), and Mayo Clinic College of Medicine, Rochester, MN (R.D.S.)
| | - Roberto Bolli
- From the University of Florida College of Medicine, Gainesville (C.R.C., E.W., A.M.M., M.B.G., R.C.B., E.W.S., C.J.P.); University of Minnesota School of Medicine, Minneapolis (C.Z., M.C.); Minneapolis Heart Institute Foundation at Abbott, MN (J.H.T., T.D.H., R.E.O.); Texas Heart Institute, Houston (E.C.P., J.T.W., M.d.G.C.-H., D.A.T.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest Baptist Health, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (R.B., A.B.); Houston Methodist Research Institute, TX (J.P.C.); University of Pennsylvania School of Medicine, Philadelphia (S.A.); University of Texas School of Public Health, Houston (D.L., L.M., S.L.S.); National Heart, Lung and Blood Institute, Bethesda, MD (R.F.E.); University of Miami School of Medicine, FL (I.H.S.), and Mayo Clinic College of Medicine, Rochester, MN (R.D.S.)
| | - John P Cooke
- From the University of Florida College of Medicine, Gainesville (C.R.C., E.W., A.M.M., M.B.G., R.C.B., E.W.S., C.J.P.); University of Minnesota School of Medicine, Minneapolis (C.Z., M.C.); Minneapolis Heart Institute Foundation at Abbott, MN (J.H.T., T.D.H., R.E.O.); Texas Heart Institute, Houston (E.C.P., J.T.W., M.d.G.C.-H., D.A.T.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest Baptist Health, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (R.B., A.B.); Houston Methodist Research Institute, TX (J.P.C.); University of Pennsylvania School of Medicine, Philadelphia (S.A.); University of Texas School of Public Health, Houston (D.L., L.M., S.L.S.); National Heart, Lung and Blood Institute, Bethesda, MD (R.F.E.); University of Miami School of Medicine, FL (I.H.S.), and Mayo Clinic College of Medicine, Rochester, MN (R.D.S.)
| | - Saif Anwaruddin
- From the University of Florida College of Medicine, Gainesville (C.R.C., E.W., A.M.M., M.B.G., R.C.B., E.W.S., C.J.P.); University of Minnesota School of Medicine, Minneapolis (C.Z., M.C.); Minneapolis Heart Institute Foundation at Abbott, MN (J.H.T., T.D.H., R.E.O.); Texas Heart Institute, Houston (E.C.P., J.T.W., M.d.G.C.-H., D.A.T.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest Baptist Health, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (R.B., A.B.); Houston Methodist Research Institute, TX (J.P.C.); University of Pennsylvania School of Medicine, Philadelphia (S.A.); University of Texas School of Public Health, Houston (D.L., L.M., S.L.S.); National Heart, Lung and Blood Institute, Bethesda, MD (R.F.E.); University of Miami School of Medicine, FL (I.H.S.), and Mayo Clinic College of Medicine, Rochester, MN (R.D.S.)
| | - Aruni Bhatnagar
- From the University of Florida College of Medicine, Gainesville (C.R.C., E.W., A.M.M., M.B.G., R.C.B., E.W.S., C.J.P.); University of Minnesota School of Medicine, Minneapolis (C.Z., M.C.); Minneapolis Heart Institute Foundation at Abbott, MN (J.H.T., T.D.H., R.E.O.); Texas Heart Institute, Houston (E.C.P., J.T.W., M.d.G.C.-H., D.A.T.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest Baptist Health, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (R.B., A.B.); Houston Methodist Research Institute, TX (J.P.C.); University of Pennsylvania School of Medicine, Philadelphia (S.A.); University of Texas School of Public Health, Houston (D.L., L.M., S.L.S.); National Heart, Lung and Blood Institute, Bethesda, MD (R.F.E.); University of Miami School of Medicine, FL (I.H.S.), and Mayo Clinic College of Medicine, Rochester, MN (R.D.S.)
| | - Maria da Graca Cabreira-Hansen
- From the University of Florida College of Medicine, Gainesville (C.R.C., E.W., A.M.M., M.B.G., R.C.B., E.W.S., C.J.P.); University of Minnesota School of Medicine, Minneapolis (C.Z., M.C.); Minneapolis Heart Institute Foundation at Abbott, MN (J.H.T., T.D.H., R.E.O.); Texas Heart Institute, Houston (E.C.P., J.T.W., M.d.G.C.-H., D.A.T.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest Baptist Health, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (R.B., A.B.); Houston Methodist Research Institute, TX (J.P.C.); University of Pennsylvania School of Medicine, Philadelphia (S.A.); University of Texas School of Public Health, Houston (D.L., L.M., S.L.S.); National Heart, Lung and Blood Institute, Bethesda, MD (R.F.E.); University of Miami School of Medicine, FL (I.H.S.), and Mayo Clinic College of Medicine, Rochester, MN (R.D.S.)
| | - Maria B Grant
- From the University of Florida College of Medicine, Gainesville (C.R.C., E.W., A.M.M., M.B.G., R.C.B., E.W.S., C.J.P.); University of Minnesota School of Medicine, Minneapolis (C.Z., M.C.); Minneapolis Heart Institute Foundation at Abbott, MN (J.H.T., T.D.H., R.E.O.); Texas Heart Institute, Houston (E.C.P., J.T.W., M.d.G.C.-H., D.A.T.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest Baptist Health, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (R.B., A.B.); Houston Methodist Research Institute, TX (J.P.C.); University of Pennsylvania School of Medicine, Philadelphia (S.A.); University of Texas School of Public Health, Houston (D.L., L.M., S.L.S.); National Heart, Lung and Blood Institute, Bethesda, MD (R.F.E.); University of Miami School of Medicine, FL (I.H.S.), and Mayo Clinic College of Medicine, Rochester, MN (R.D.S.)
| | - Dejian Lai
- From the University of Florida College of Medicine, Gainesville (C.R.C., E.W., A.M.M., M.B.G., R.C.B., E.W.S., C.J.P.); University of Minnesota School of Medicine, Minneapolis (C.Z., M.C.); Minneapolis Heart Institute Foundation at Abbott, MN (J.H.T., T.D.H., R.E.O.); Texas Heart Institute, Houston (E.C.P., J.T.W., M.d.G.C.-H., D.A.T.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest Baptist Health, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (R.B., A.B.); Houston Methodist Research Institute, TX (J.P.C.); University of Pennsylvania School of Medicine, Philadelphia (S.A.); University of Texas School of Public Health, Houston (D.L., L.M., S.L.S.); National Heart, Lung and Blood Institute, Bethesda, MD (R.F.E.); University of Miami School of Medicine, FL (I.H.S.), and Mayo Clinic College of Medicine, Rochester, MN (R.D.S.)
| | - Lem Moyé
- From the University of Florida College of Medicine, Gainesville (C.R.C., E.W., A.M.M., M.B.G., R.C.B., E.W.S., C.J.P.); University of Minnesota School of Medicine, Minneapolis (C.Z., M.C.); Minneapolis Heart Institute Foundation at Abbott, MN (J.H.T., T.D.H., R.E.O.); Texas Heart Institute, Houston (E.C.P., J.T.W., M.d.G.C.-H., D.A.T.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest Baptist Health, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (R.B., A.B.); Houston Methodist Research Institute, TX (J.P.C.); University of Pennsylvania School of Medicine, Philadelphia (S.A.); University of Texas School of Public Health, Houston (D.L., L.M., S.L.S.); National Heart, Lung and Blood Institute, Bethesda, MD (R.F.E.); University of Miami School of Medicine, FL (I.H.S.), and Mayo Clinic College of Medicine, Rochester, MN (R.D.S.).
| | - Ray F Ebert
- From the University of Florida College of Medicine, Gainesville (C.R.C., E.W., A.M.M., M.B.G., R.C.B., E.W.S., C.J.P.); University of Minnesota School of Medicine, Minneapolis (C.Z., M.C.); Minneapolis Heart Institute Foundation at Abbott, MN (J.H.T., T.D.H., R.E.O.); Texas Heart Institute, Houston (E.C.P., J.T.W., M.d.G.C.-H., D.A.T.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest Baptist Health, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (R.B., A.B.); Houston Methodist Research Institute, TX (J.P.C.); University of Pennsylvania School of Medicine, Philadelphia (S.A.); University of Texas School of Public Health, Houston (D.L., L.M., S.L.S.); National Heart, Lung and Blood Institute, Bethesda, MD (R.F.E.); University of Miami School of Medicine, FL (I.H.S.), and Mayo Clinic College of Medicine, Rochester, MN (R.D.S.)
| | - Rachel E Olson
- From the University of Florida College of Medicine, Gainesville (C.R.C., E.W., A.M.M., M.B.G., R.C.B., E.W.S., C.J.P.); University of Minnesota School of Medicine, Minneapolis (C.Z., M.C.); Minneapolis Heart Institute Foundation at Abbott, MN (J.H.T., T.D.H., R.E.O.); Texas Heart Institute, Houston (E.C.P., J.T.W., M.d.G.C.-H., D.A.T.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest Baptist Health, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (R.B., A.B.); Houston Methodist Research Institute, TX (J.P.C.); University of Pennsylvania School of Medicine, Philadelphia (S.A.); University of Texas School of Public Health, Houston (D.L., L.M., S.L.S.); National Heart, Lung and Blood Institute, Bethesda, MD (R.F.E.); University of Miami School of Medicine, FL (I.H.S.), and Mayo Clinic College of Medicine, Rochester, MN (R.D.S.)
| | - Shelly L Sayre
- From the University of Florida College of Medicine, Gainesville (C.R.C., E.W., A.M.M., M.B.G., R.C.B., E.W.S., C.J.P.); University of Minnesota School of Medicine, Minneapolis (C.Z., M.C.); Minneapolis Heart Institute Foundation at Abbott, MN (J.H.T., T.D.H., R.E.O.); Texas Heart Institute, Houston (E.C.P., J.T.W., M.d.G.C.-H., D.A.T.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest Baptist Health, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (R.B., A.B.); Houston Methodist Research Institute, TX (J.P.C.); University of Pennsylvania School of Medicine, Philadelphia (S.A.); University of Texas School of Public Health, Houston (D.L., L.M., S.L.S.); National Heart, Lung and Blood Institute, Bethesda, MD (R.F.E.); University of Miami School of Medicine, FL (I.H.S.), and Mayo Clinic College of Medicine, Rochester, MN (R.D.S.)
| | - Ivonne H Schulman
- From the University of Florida College of Medicine, Gainesville (C.R.C., E.W., A.M.M., M.B.G., R.C.B., E.W.S., C.J.P.); University of Minnesota School of Medicine, Minneapolis (C.Z., M.C.); Minneapolis Heart Institute Foundation at Abbott, MN (J.H.T., T.D.H., R.E.O.); Texas Heart Institute, Houston (E.C.P., J.T.W., M.d.G.C.-H., D.A.T.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest Baptist Health, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (R.B., A.B.); Houston Methodist Research Institute, TX (J.P.C.); University of Pennsylvania School of Medicine, Philadelphia (S.A.); University of Texas School of Public Health, Houston (D.L., L.M., S.L.S.); National Heart, Lung and Blood Institute, Bethesda, MD (R.F.E.); University of Miami School of Medicine, FL (I.H.S.), and Mayo Clinic College of Medicine, Rochester, MN (R.D.S.)
| | - Raphael C Bosse
- From the University of Florida College of Medicine, Gainesville (C.R.C., E.W., A.M.M., M.B.G., R.C.B., E.W.S., C.J.P.); University of Minnesota School of Medicine, Minneapolis (C.Z., M.C.); Minneapolis Heart Institute Foundation at Abbott, MN (J.H.T., T.D.H., R.E.O.); Texas Heart Institute, Houston (E.C.P., J.T.W., M.d.G.C.-H., D.A.T.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest Baptist Health, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (R.B., A.B.); Houston Methodist Research Institute, TX (J.P.C.); University of Pennsylvania School of Medicine, Philadelphia (S.A.); University of Texas School of Public Health, Houston (D.L., L.M., S.L.S.); National Heart, Lung and Blood Institute, Bethesda, MD (R.F.E.); University of Miami School of Medicine, FL (I.H.S.), and Mayo Clinic College of Medicine, Rochester, MN (R.D.S.)
| | - Edward W Scott
- From the University of Florida College of Medicine, Gainesville (C.R.C., E.W., A.M.M., M.B.G., R.C.B., E.W.S., C.J.P.); University of Minnesota School of Medicine, Minneapolis (C.Z., M.C.); Minneapolis Heart Institute Foundation at Abbott, MN (J.H.T., T.D.H., R.E.O.); Texas Heart Institute, Houston (E.C.P., J.T.W., M.d.G.C.-H., D.A.T.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest Baptist Health, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (R.B., A.B.); Houston Methodist Research Institute, TX (J.P.C.); University of Pennsylvania School of Medicine, Philadelphia (S.A.); University of Texas School of Public Health, Houston (D.L., L.M., S.L.S.); National Heart, Lung and Blood Institute, Bethesda, MD (R.F.E.); University of Miami School of Medicine, FL (I.H.S.), and Mayo Clinic College of Medicine, Rochester, MN (R.D.S.)
| | - Robert D Simari
- From the University of Florida College of Medicine, Gainesville (C.R.C., E.W., A.M.M., M.B.G., R.C.B., E.W.S., C.J.P.); University of Minnesota School of Medicine, Minneapolis (C.Z., M.C.); Minneapolis Heart Institute Foundation at Abbott, MN (J.H.T., T.D.H., R.E.O.); Texas Heart Institute, Houston (E.C.P., J.T.W., M.d.G.C.-H., D.A.T.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest Baptist Health, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (R.B., A.B.); Houston Methodist Research Institute, TX (J.P.C.); University of Pennsylvania School of Medicine, Philadelphia (S.A.); University of Texas School of Public Health, Houston (D.L., L.M., S.L.S.); National Heart, Lung and Blood Institute, Bethesda, MD (R.F.E.); University of Miami School of Medicine, FL (I.H.S.), and Mayo Clinic College of Medicine, Rochester, MN (R.D.S.)
| | - Carl J Pepine
- From the University of Florida College of Medicine, Gainesville (C.R.C., E.W., A.M.M., M.B.G., R.C.B., E.W.S., C.J.P.); University of Minnesota School of Medicine, Minneapolis (C.Z., M.C.); Minneapolis Heart Institute Foundation at Abbott, MN (J.H.T., T.D.H., R.E.O.); Texas Heart Institute, Houston (E.C.P., J.T.W., M.d.G.C.-H., D.A.T.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest Baptist Health, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (R.B., A.B.); Houston Methodist Research Institute, TX (J.P.C.); University of Pennsylvania School of Medicine, Philadelphia (S.A.); University of Texas School of Public Health, Houston (D.L., L.M., S.L.S.); National Heart, Lung and Blood Institute, Bethesda, MD (R.F.E.); University of Miami School of Medicine, FL (I.H.S.), and Mayo Clinic College of Medicine, Rochester, MN (R.D.S.)
| | - Doris A Taylor
- From the University of Florida College of Medicine, Gainesville (C.R.C., E.W., A.M.M., M.B.G., R.C.B., E.W.S., C.J.P.); University of Minnesota School of Medicine, Minneapolis (C.Z., M.C.); Minneapolis Heart Institute Foundation at Abbott, MN (J.H.T., T.D.H., R.E.O.); Texas Heart Institute, Houston (E.C.P., J.T.W., M.d.G.C.-H., D.A.T.); Cleveland Clinic Foundation, OH (S.G.E.); Wake Forest Baptist Health, Winston-Salem, NC (D.X.M.Z.); University of Louisville, School of Medicine, KY (R.B., A.B.); Houston Methodist Research Institute, TX (J.P.C.); University of Pennsylvania School of Medicine, Philadelphia (S.A.); University of Texas School of Public Health, Houston (D.L., L.M., S.L.S.); National Heart, Lung and Blood Institute, Bethesda, MD (R.F.E.); University of Miami School of Medicine, FL (I.H.S.), and Mayo Clinic College of Medicine, Rochester, MN (R.D.S.)
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Jana S, Tefft BJ, Spoon DB, Simari RD. Scaffolds for tissue engineering of cardiac valves. Acta Biomater 2014; 10:2877-93. [PMID: 24675108 DOI: 10.1016/j.actbio.2014.03.014] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [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: 11/27/2013] [Revised: 02/25/2014] [Accepted: 03/12/2014] [Indexed: 01/09/2023]
Abstract
Tissue engineered heart valves offer a promising alternative for the replacement of diseased heart valves avoiding the limitations faced with currently available bioprosthetic and mechanical heart valves. In the paradigm of tissue engineering, a three-dimensional platform - the so-called scaffold - is essential for cell proliferation, growth and differentiation, as well as the ultimate generation of a functional tissue. A foundation for success in heart valve tissue engineering is a recapitulation of the complex design and diverse mechanical properties of a native valve. This article reviews technological details of the scaffolds that have been applied to date in heart valve tissue engineering research.
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Affiliation(s)
- S Jana
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - B J Tefft
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - D B Spoon
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - R D Simari
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Simari RD, Pepine CJ, Traverse JH, Henry TD, Bolli R, Spoon DB, Yeh E, Hare JM, Schulman IH, Anderson RD, Lambert C, Sayre SL, Taylor DA, Ebert RF, Moyé LA. Bone marrow mononuclear cell therapy for acute myocardial infarction: a perspective from the cardiovascular cell therapy research network. Circ Res 2014; 114:1564-8. [PMID: 24812350 DOI: 10.1161/circresaha.114.303720] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To understand the role of bone marrow mononuclear cells in the treatment of acute myocardial infarction, this overview offers a retrospective examination of strengths and limitations of 3 contemporaneous trials with attention to critical design features and provides an analysis of the combined data set and implications for future directions in cell therapy for acute myocardial infarction.
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Affiliation(s)
- Robert D Simari
- From Mayo Clinic, Rochester, MN (R.D.S., D.B.S.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A.); Minneapolis Heart Institute at Abbott Northwestern Hospital, University of Minnesota School of Medicine (J.H.T.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Louisville School of Medicine, KY (R.B.); The University of Texas MD Anderson Cancer Center, Houston (E.Y.); University of Miami Miller School of Medicine, FL (J.M.H., I.H.S.); Florida Hospital Tampa Pepin Heart Institute (C.L.); University of Texas Health Science Center School of Public Health, Houston (S.L.S., L.A.M.); Texas Heart Institute, Houston (D.A.T.); and National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.)
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Simari RD, Pepine CJ, Traverse JH, Henry TD, Bolli R, Spoon DB, Yeh E, Hare JM, Schulman IH, Anderson RD, Lambert C, Sayre SL, Taylor DA, Ebert RF, Moyé LA. Bone marrow mononuclear cell therapy for acute myocardial infarction: a perspective from the cardiovascular cell therapy research network. Circ Res 2014. [PMID: 24812350 DOI: 10.1161/circre saha.114.303720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 12/26/2022]
Abstract
To understand the role of bone marrow mononuclear cells in the treatment of acute myocardial infarction, this overview offers a retrospective examination of strengths and limitations of 3 contemporaneous trials with attention to critical design features and provides an analysis of the combined data set and implications for future directions in cell therapy for acute myocardial infarction.
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Affiliation(s)
- Robert D Simari
- From Mayo Clinic, Rochester, MN (R.D.S., D.B.S.); University of Florida School of Medicine, Gainesville (C.J.P., R.D.A.); Minneapolis Heart Institute at Abbott Northwestern Hospital, University of Minnesota School of Medicine (J.H.T.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); University of Louisville School of Medicine, KY (R.B.); The University of Texas MD Anderson Cancer Center, Houston (E.Y.); University of Miami Miller School of Medicine, FL (J.M.H., I.H.S.); Florida Hospital Tampa Pepin Heart Institute (C.L.); University of Texas Health Science Center School of Public Health, Houston (S.L.S., L.A.M.); Texas Heart Institute, Houston (D.A.T.); and National Heart, Lung, and Blood Institute, Bethesda, MD (R.F.E.)
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Psaltis PJ, Puranik AS, Spoon DB, Chue CD, Hoffman SJ, Witt TA, Delacroix S, Kleppe LS, Mueske CS, Pan S, Gulati R, Simari RD. Characterization of a resident population of adventitial macrophage progenitor cells in postnatal vasculature. Circ Res 2014; 115:364-75. [PMID: 24906644 DOI: 10.1161/circresaha.115.303299] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
RATIONALE Macrophages regulate blood vessel structure and function in health and disease. The origins of tissue macrophages are diverse, with evidence for local production and circulatory renewal. OBJECTIVE We identified a vascular adventitial population containing macrophage progenitor cells and investigated their origins and fate. METHODS AND RESULTS Single-cell disaggregates from adult C57BL/6 mice were prepared from different tissues and tested for their capacity to form hematopoietic colony-forming units. Aorta showed a unique predilection for generating macrophage colony-forming units. Aortic macrophage colony-forming unit progenitors coexpressed stem cell antigen-1 and CD45 and were adventitially located, where they were the predominant source of proliferating cells in the aortic wall. Aortic Sca-1(+)CD45(+) cells were transcriptionally and phenotypically distinct from neighboring cells lacking stem cell antigen-1 or CD45 and contained a proliferative (Ki67(+)) Lin(-)c-Kit(+)CD135(-)CD115(+)CX3CR1(+)Ly6C(+)CD11b(-) subpopulation, consistent with the immunophenotypic profile of macrophage progenitors. Adoptive transfer studies revealed that Sca-1(+)CD45(+) adventitial macrophage progenitor cells were not replenished via the circulation from bone marrow or spleen, nor was their prevalence diminished by depletion of monocytes or macrophages by liposomal clodronate treatment or genetic deficiency of macrophage colony-stimulating factor. Rather adventitial macrophage progenitor cells were upregulated in hyperlipidemic ApoE(-/-) and LDL-R(-/-) mice, with adventitial transfer experiments demonstrating their durable contribution to macrophage progeny particularly in the adventitia, and to a lesser extent the atheroma, of atherosclerotic carotid arteries. CONCLUSIONS The discovery and characterization of resident vascular adventitial macrophage progenitor cells provides new insight into adventitial biology and its participation in atherosclerosis and provokes consideration of the broader existence of local macrophage progenitors in other tissues.
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Affiliation(s)
- Peter J Psaltis
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (P.J.P., A.S.P., D.B.S., C.D.C., S.J.H., T.A.W., S.D., L.S.K., C.S.M., S.P., R.G., R.D.S.); Monash Cardiovascular Research Centre, Monash University, Clayton, Victoria, Australia (P.J.P.); Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia (P.J.P., S.D.); and Kansas University Medical Center, The University of Kansas, Kansas City (R.D.S)
| | - Amrutesh S Puranik
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (P.J.P., A.S.P., D.B.S., C.D.C., S.J.H., T.A.W., S.D., L.S.K., C.S.M., S.P., R.G., R.D.S.); Monash Cardiovascular Research Centre, Monash University, Clayton, Victoria, Australia (P.J.P.); Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia (P.J.P., S.D.); and Kansas University Medical Center, The University of Kansas, Kansas City (R.D.S)
| | - Daniel B Spoon
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (P.J.P., A.S.P., D.B.S., C.D.C., S.J.H., T.A.W., S.D., L.S.K., C.S.M., S.P., R.G., R.D.S.); Monash Cardiovascular Research Centre, Monash University, Clayton, Victoria, Australia (P.J.P.); Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia (P.J.P., S.D.); and Kansas University Medical Center, The University of Kansas, Kansas City (R.D.S)
| | - Colin D Chue
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (P.J.P., A.S.P., D.B.S., C.D.C., S.J.H., T.A.W., S.D., L.S.K., C.S.M., S.P., R.G., R.D.S.); Monash Cardiovascular Research Centre, Monash University, Clayton, Victoria, Australia (P.J.P.); Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia (P.J.P., S.D.); and Kansas University Medical Center, The University of Kansas, Kansas City (R.D.S)
| | - Scott J Hoffman
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (P.J.P., A.S.P., D.B.S., C.D.C., S.J.H., T.A.W., S.D., L.S.K., C.S.M., S.P., R.G., R.D.S.); Monash Cardiovascular Research Centre, Monash University, Clayton, Victoria, Australia (P.J.P.); Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia (P.J.P., S.D.); and Kansas University Medical Center, The University of Kansas, Kansas City (R.D.S)
| | - Tyra A Witt
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (P.J.P., A.S.P., D.B.S., C.D.C., S.J.H., T.A.W., S.D., L.S.K., C.S.M., S.P., R.G., R.D.S.); Monash Cardiovascular Research Centre, Monash University, Clayton, Victoria, Australia (P.J.P.); Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia (P.J.P., S.D.); and Kansas University Medical Center, The University of Kansas, Kansas City (R.D.S)
| | - Sinny Delacroix
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (P.J.P., A.S.P., D.B.S., C.D.C., S.J.H., T.A.W., S.D., L.S.K., C.S.M., S.P., R.G., R.D.S.); Monash Cardiovascular Research Centre, Monash University, Clayton, Victoria, Australia (P.J.P.); Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia (P.J.P., S.D.); and Kansas University Medical Center, The University of Kansas, Kansas City (R.D.S)
| | - Laurel S Kleppe
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (P.J.P., A.S.P., D.B.S., C.D.C., S.J.H., T.A.W., S.D., L.S.K., C.S.M., S.P., R.G., R.D.S.); Monash Cardiovascular Research Centre, Monash University, Clayton, Victoria, Australia (P.J.P.); Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia (P.J.P., S.D.); and Kansas University Medical Center, The University of Kansas, Kansas City (R.D.S)
| | - Cheryl S Mueske
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (P.J.P., A.S.P., D.B.S., C.D.C., S.J.H., T.A.W., S.D., L.S.K., C.S.M., S.P., R.G., R.D.S.); Monash Cardiovascular Research Centre, Monash University, Clayton, Victoria, Australia (P.J.P.); Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia (P.J.P., S.D.); and Kansas University Medical Center, The University of Kansas, Kansas City (R.D.S)
| | - Shuchong Pan
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (P.J.P., A.S.P., D.B.S., C.D.C., S.J.H., T.A.W., S.D., L.S.K., C.S.M., S.P., R.G., R.D.S.); Monash Cardiovascular Research Centre, Monash University, Clayton, Victoria, Australia (P.J.P.); Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia (P.J.P., S.D.); and Kansas University Medical Center, The University of Kansas, Kansas City (R.D.S)
| | - Rajiv Gulati
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (P.J.P., A.S.P., D.B.S., C.D.C., S.J.H., T.A.W., S.D., L.S.K., C.S.M., S.P., R.G., R.D.S.); Monash Cardiovascular Research Centre, Monash University, Clayton, Victoria, Australia (P.J.P.); Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia (P.J.P., S.D.); and Kansas University Medical Center, The University of Kansas, Kansas City (R.D.S)
| | - Robert D Simari
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (P.J.P., A.S.P., D.B.S., C.D.C., S.J.H., T.A.W., S.D., L.S.K., C.S.M., S.P., R.G., R.D.S.); Monash Cardiovascular Research Centre, Monash University, Clayton, Victoria, Australia (P.J.P.); Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia (P.J.P., S.D.); and Kansas University Medical Center, The University of Kansas, Kansas City (R.D.S).
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Spoon DB, Psaltis PJ, Singh M, Holmes DR, Gersh BJ, Rihal CS, Lennon RJ, Moussa ID, Simari RD, Gulati R. Trends in cause of death after percutaneous coronary intervention. Circulation 2014; 129:1286-94. [PMID: 24515993 DOI: 10.1161/circulationaha.113.006518] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND The impact of changing demographics on causes of long-term death after percutaneous coronary intervention (PCI) remains incompletely defined. METHODS AND RESULTS We evaluated trends in cause-specific long-term mortality after index PCI performed at a single center from 1991 to 2008. Deaths were ascertained by scheduled prospective surveillance. Cause was determined via telephone interviews, medical records, autopsy reports, and death certificates. Competing-risks analysis of cause-specific mortality was performed using 3 time periods of PCI (1991-1996, 1997-2002, and 2003-2008). Final follow-up was December 31, 2012. A total of 19 077 patients survived index PCI hospitalization, of whom 6988 subsequently died (37%, 4.48 per 100 person-years). Cause was determined in 6857 (98.1%). Across 3 time periods, there was a 33% decline in cardiac deaths at 5 years after PCI (incidence: 9.8%, 7.4%, and 6.6%) but a 57% increase in noncardiac deaths (7.1%, 8.5%, and 11.2%). Only 36.8% of deaths in the recent era were cardiac. Similar trends were observed regardless of age, extent of coronary disease, or PCI indication. After adjustment for baseline variables, there was a 50% temporal decline in cardiac mortality but no change in noncardiac mortality. The decline in cardiac mortality was driven by fewer deaths from myocardial infarction/sudden death (P<0.001) but not heart failure (P=0.85). The increase in noncardiac mortality was primarily attributable to cancer and chronic diseases (P<0.001). CONCLUSIONS This study found a marked temporal switch from predominantly cardiac to predominantly noncardiac causes of death after PCI over 2 decades. The decline in cardiac mortality was independent of changes in baseline clinical characteristics. These findings have implications for patient care and clinical trial design.
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Affiliation(s)
- Daniel B Spoon
- Divisions of Cardiovascular Diseases (D.B.S., P.J.P., M.S., D.R.H., B.J.G., C.S.R., R.D.S., R.G.) and Biomedical Statistics and Informatics (R.J.L.), Mayo Clinic, Rochester, MN; and Division of Cardiovascular Diseases (I.D.M.), Mayo Clinic, Jacksonville, FL
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Henry TD, Traverse JH, Pepine CJ, Willerson JT, Ellis S, Zhao DX, Simpson L, Perin E, Penn M, Baran KW, Chambers J, Lambert C, Raveendran G, Simon D, Gee AP, Forder JR, Taylor DA, Cogle CR, Olson RE, Smith D, Geither C, Skarlatos SI, Moye LA, Simari RD. TCT-823 Results from LateTIME: A Randomized, Placebo Controlled Trial of Intracoronary Stem Cell Delivery Two to Three Weeks Following Acute Myocardial Infarction from the Cardiovascular Cell Therapy Research Network. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.1576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Delewi R, Hirsch A, Tijssen JG, Schächinger V, Wojakowski W, Roncalli J, Aakhus S, Erbs S, Assmus B, Tendera M, Goekmen Turan R, Corti R, Henry T, Lemarchand P, Lunde K, Cao F, Huikuri HV, Sürder D, Simari RD, Janssens S, Wollert KC, Plewka M, Grajek S, Traverse JH, Zijlstra F, Piek JJ. Impact of intracoronary bone marrow cell therapy on left ventricular function in the setting of ST-segment elevation myocardial infarction: a collaborative meta-analysis. Eur Heart J 2013; 35:989-98. [PMID: 24026778 DOI: 10.1093/eurheartj/eht372] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [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: 12/23/2022] Open
Abstract
AIMS The objective of the present analysis was to systematically examine the effect of intracoronary bone marrow cell (BMC) therapy on left ventricular (LV) function after ST-segment elevation myocardial infarction in various subgroups of patients by performing a collaborative meta-analysis of randomized controlled trials. METHODS AND RESULTS We identified all randomized controlled trials comparing intracoronary BMC infusion as treatment for ST-segment elevation myocardial infarction. We contacted the principal investigator for each participating trial to provide summary data with regard to different pre-specified subgroups [age, diabetes mellitus, time from symptoms to percutaneous coronary intervention, infarct-related artery, LV end-diastolic volume index (EDVI), LV ejection fraction (EF), infarct size, presence of microvascular obstruction, timing of cell infusion, and injected cell number] and three different endpoints [change in LVEF, LVEDVI, and LV end-systolic volume index (ESVI)]. Data from 16 studies were combined including 1641 patients (984 cell therapy, 657 controls). The absolute improvement in LVEF was greater among BMC-treated patients compared with controls: [2.55% increase, 95% confidence interval (CI) 1.83-3.26, P < 0.001]. Cell therapy significantly reduced LVEDVI and LVESVI (-3.17 mL/m², 95% CI: -4.86 to -1.47, P < 0.001; -2.60 mL/m², 95% CI -3.84 to -1.35, P < 0.001, respectively). Treatment benefit in terms of LVEF improvement was more pronounced in younger patients (age <55, 3.38%, 95% CI: 2.36-4.39) compared with older patients (age ≥ 55 years, 1.77%, 95% CI: 0.80-2.74, P = 0.03). This heterogeneity in treatment effect was also observed with respect to the reduction in LVEDVI and LVESVI. Moreover, patients with baseline LVEF <40% derived more benefit from intracoronary BMC therapy. LVEF improvement was 5.30%, 95% CI: 4.27-6.33 in patients with LVEF <40% compared with 1.45%, 95% CI: 0.60 to 2.31 in LVEF ≥ 40%, P < 0.001. No clear interaction was observed between other subgroups and outcomes. CONCLUSION Intracoronary BMC infusion is associated with improvement of LV function and remodelling in patients after ST-segment elevation myocardial infarction. Younger patients and patients with a more severely depressed LVEF at baseline derived most benefit from this adjunctive therapy.
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Affiliation(s)
- Ronak Delewi
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
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Wan SH, McKie PM, Schirger JA, Cataliotti A, Simari RD, Redfield MM, Burnett JC, Chen HH. Novel Protein Therapeutics for Human Preclinical Diastolic Dysfunction (Stage B Heart Failure): Chronic SQ BNP Administration. J Card Fail 2013. [DOI: 10.1016/j.cardfail.2013.06.212] [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: 11/29/2022]
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Hare JM, Bolli R, Cooke JP, Gordon DJ, Henry TD, Perin EC, March KL, Murphy MP, Pepine CJ, Simari RD, Skarlatos SI, Traverse JH, Willerson JT, Szady AD, Taylor DA, Vojvodic RW, Yang PC, Moyé LA. Phase II clinical research design in cardiology: learning the right lessons too well: observations and recommendations from the Cardiovascular Cell Therapy Research Network (CCTRN). Circulation 2013; 127:1630-5. [PMID: 23588961 DOI: 10.1161/circulationaha.112.000779] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Joshua M Hare
- University of Texas School of Public Health, 1200 Herman Pressler W-848, Houston, TX 77030, USA
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Psaltis PJ, Peterson KM, Xu R, Franchi F, Witt T, Chen IY, Lerman A, Simari RD, Gambhir SS, Rodriguez-Porcel M. Noninvasive monitoring of oxidative stress in transplanted mesenchymal stromal cells. JACC Cardiovasc Imaging 2013; 6:795-802. [PMID: 23643284 DOI: 10.1016/j.jcmg.2012.11.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 11/01/2012] [Accepted: 11/09/2012] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The goal of this study was to validate a pathway-specific reporter gene that could be used to noninvasively image the oxidative status of progenitor cells. BACKGROUND In cell therapy studies, reporter gene imaging plays a valuable role in the assessment of cell fate in living subjects. After myocardial injury, noxious stimuli in the host tissue confer oxidative stress to transplanted cells that may influence their survival and reparative function. METHODS Rat mesenchymal stromal cells (MSCs) were studied for phenotypic evidence of increased oxidative stress under in vitro stress. On the basis of their up-regulation of the pro-oxidant enzyme p67(phox) subunit of nicotinamide adenine dinucleotide phosphate (NAD[P]H oxidase p67(phox)), an oxidative stress sensor was constructed, comprising the firefly luciferase (Fluc) reporter gene driven by the NAD(P)H p67(phox) promoter. MSCs cotransfected with NAD(P)H p67(phox)-Fluc and a cell viability reporter gene (cytomegalovirus-Renilla luciferase) were studied under in vitro and in vivo pro-oxidant conditions. RESULTS After in vitro validation of the sensor during low-serum culture, transfected MSCs were transplanted into a rat model of myocardial ischemia/reperfusion (IR) and monitored by using bioluminescence imaging. Compared with sham controls (no IR), cardiac Fluc intensity was significantly higher in IR rats (3.5-fold at 6 h, 2.6-fold at 24 h, 5.4-fold at 48 h; p < 0.01), indicating increased cellular oxidative stress. This finding was corroborated by ex vivo luminometry after correcting for Renilla luciferase activity as a measure of viable MSC number (Fluc:Renilla luciferase ratio 0.011 ± 0.003 for sham vs. 0.026 ± 0.004 for IR at 48 h; p < 0.05). Furthermore, in IR animals that received MSCs preconditioned with an antioxidant agent (tempol), Fluc signal was strongly attenuated, substantiating the specificity of the oxidative stress sensor. CONCLUSIONS Pathway-specific reporter gene imaging allows assessment of changes in the oxidative status of MSCs after delivery to ischemic myocardium, providing a template to monitor key biological interactions between transplanted cells and their host environment in living subjects.
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Affiliation(s)
- Peter J Psaltis
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Eirin A, Zhu XY, Li Z, Ebrahimi B, Zhang X, Tang H, Korsmo MJ, Chade AR, Grande JP, Ward CJ, Simari RD, Lerman A, Textor SC, Lerman LO. Endothelial outgrowth cells shift macrophage phenotype and improve kidney viability in swine renal artery stenosis. Arterioscler Thromb Vasc Biol 2013; 33:1006-13. [PMID: 23430615 DOI: 10.1161/atvbaha.113.301164] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Endothelial outgrowth cells (EOC) decrease inflammation and improve endothelial repair. Inflammation aggravates kidney injury in renal artery stenosis (RAS), and may account for its persistence upon revascularization. We hypothesized that EOC would decrease inflammatory (M1) macrophages and improve renal recovery in RAS. APPROACH AND RESULTS Pigs with 10 weeks of RAS were studied 4 weeks after percutaneous transluminal renal angioplasty (PTRA+stenting) or sham, with or without adjunct intrarenal delivery of autologous EOC (10×10(6)), and compared with similarly treated normal controls (n=7 each). Single-kidney function, microvascular and tissue remodeling, inflammation, oxidative stress, and fibrosis were evaluated. Four weeks after PTRA, EOC were engrafted in injected RAS-kidneys. Stenotic-kidney glomerular filtration rate was restored in RAS+EOC, RAS+PTRA, and RAS+PTRA+EOC pigs, whereas stenotic-kidney blood flow and angiogenesis were improved and fibrosis attenuated only in EOC-treated pigs. Furthermore, EOC increased cell proliferation and decreased the ratio of M1 (inflammatory)/M2 (reparative) macrophages, as well as circulating levels and stenotic-kidney release of inflammatory cytokines. Cultured-EOC released microvesicles in vitro and induced phenotypic switch (M1-to-M2) in cultured monocytes, which was inhibited by vascular endothelial growth factor blockade. Finally, a single intrarenal injection of rh-vascular endothelial growth factor (0.05 μg/kg) in 7 additional RAS pigs also restored M1/M2 ratio 4 weeks later. CONCLUSIONS Intrarenal infusion of EOC after PTRA induced a vascular endothelial growth factor-mediated attenuation in macrophages inflammatory phenotype, preserved microvascular architecture and function, and decreased inflammation and fibrosis in the stenotic kidney, suggesting a novel mechanism and therapeutic potential for adjunctive EOC delivery in experimental RAS to improve PTRA outcomes.
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Affiliation(s)
- Alfonso Eirin
- Division of Nephrology and Hypertension, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
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Wang D, Warner GM, Yin P, Knudsen BE, Cheng J, Butters KA, Lien KR, Gray CE, Garovic VD, Lerman LO, Textor SC, Nath KA, Simari RD, Grande JP. Inhibition of p38 MAPK attenuates renal atrophy and fibrosis in a murine renal artery stenosis model. Am J Physiol Renal Physiol 2013; 304:F938-47. [PMID: 23364805 DOI: 10.1152/ajprenal.00706.2012] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Renal artery stenosis (RAS) is an important cause of chronic renal dysfunction. Recent studies have underscored a critical role for CCL2 (MCP-1)-mediated inflammation in the progression of chronic renal damage in RAS and other chronic renal diseases. In vitro studies have implicated p38 MAPK as a critical intermediate for the production of CCL2. However, a potential role of p38 signaling in the development and progression of chronic renal disease in RAS has not been previously defined. We sought to test the hypothesis that inhibition of p38 MAPK ameliorates chronic renal injury in mice with RAS. We established a murine RAS model by placing a cuff on the right renal artery and treated mice with the p38 inhibitor SB203580 or vehicle for 2 wk. In mice treated with vehicle, the cuffed kidney developed interstitial fibrosis, tubular atrophy, and interstitial inflammation. In mice treated with SB203580, the RAS-induced renal atrophy was reduced (70% vs. 39%, P < 0.05). SB203580 also reduced interstitial inflammation and extracellular matrix deposition but had no effect on the development of hypertension. SB203580 partially blocked the induction of CCL2, CCL7 (MCP-3), CC chemokine receptor 2 (CCR2), and collagen 4 mRNA expression in the cuffed kidneys. In vitro, blockade of p38 hindered both TNF-α and TGF-β-induced CCL2 upregulation. Based on these observations, we conclude that p38 MAPK plays a critical role in the induction of CCL2/CCL7/CCR2 system and the development of interstitial inflammation in RAS.
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Affiliation(s)
- Diping Wang
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
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Traverse JH, Henry TD, Pepine CJ, Willerson JT, Zhao DX, Ellis SG, Forder JR, Anderson RD, Hatzopoulos AK, Penn MS, Perin EC, Chambers J, Baran KW, Raveendran G, Lambert C, Lerman A, Simon DI, Vaughan DE, Lai D, Gee AP, Taylor DA, Cogle CR, Thomas JD, Olson RE, Bowman S, Francescon J, Geither C, Handberg E, Kappenman C, Westbrook L, Piller LB, Simpson LM, Baraniuk S, Loghin C, Aguilar D, Richman S, Zierold C, Spoon DB, Bettencourt J, Sayre SL, Vojvodic RW, Skarlatos SI, Gordon DJ, Ebert RF, Kwak M, Moyé LA, Simari RD. Effect of the use and timing of bone marrow mononuclear cell delivery on left ventricular function after acute myocardial infarction: the TIME randomized trial. JAMA 2012; 308:2380-9. [PMID: 23129008 PMCID: PMC3652242 DOI: 10.1001/jama.2012.28726] [Citation(s) in RCA: 323] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
CONTEXT While the delivery of cell therapy after ST-segment elevation myocardial infarction (STEMI) has been evaluated in previous clinical trials, the influence of the timing of cell delivery on the effect on left ventricular function has not been analyzed. OBJECTIVES To determine the effect of intracoronary autologous bone marrow mononuclear cell (BMC) delivery after STEMI on recovery of global and regional left ventricular function and whether timing of BMC delivery (3 days vs 7 days after reperfusion) influences this effect. DESIGN, SETTING, AND PATIENTS A randomized, 2 × 2 factorial, double-blind, placebo-controlled trial, Timing In Myocardial infarction Evaluation (TIME) enrolled 120 patients with left ventricular dysfunction (left ventricular ejection fraction [LVEF] ≤ 45%) after successful primary percutaneous coronary intervention (PCI) of anterior STEMI between July 17, 2008, and November 15, 2011, as part of the Cardiovascular Cell Therapy Research Network sponsored by the National Heart, Lung, and Blood Institute. INTERVENTIONS Intracoronary infusion of 150 × 106 BMCs or placebo (randomized 2:1) within 12 hours of aspiration and cell processing administered at day 3 or day 7 (randomized 1:1) after treatment with PCI. MAIN OUTCOME MEASURES The primary end points were change in global (LVEF) and regional (wall motion) left ventricular function in infarct and border zones at 6 months measured by cardiac magnetic resonance imaging and change in left ventricular function as affected by timing of treatment on day 3 vs day 7. The secondary end points included major adverse cardiovascular events as well as changes in left ventricular volumes and infarct size. RESULTS The mean (SD) patient age was 56.9 (10.9) years and 87.5% of participants were male. At 6 months, there was no significant increase in LVEF for the BMC group (45.2% [95% CI, 42.8% to 47.6%] to 48.3% [95% CI, 45.3% to 51.3%) vs the placebo group (44.5% [95% CI, 41.0% to 48.0%] to 47.8% [95% CI, 43.4% to 52.2%]) (P = .96). There was no significant treatment effect on regional left ventricular function observed in either infarct or border zones. There were no significant differences in change in global left ventricular function for patients treated at day 3 (−0.9% [95% CI, −6.6% to 4.9%], P = .76) or day 7 (1.1% [95% CI, −4.7% to 6.9%], P = .70). The timing of treatment had no significant effect on regional left ventricular function recovery. Major adverse events were rare among all treatment groups. CONCLUSION Among patients with STEMI treated with primary PCI, the administration of intracoronary BMCs at either 3 days or 7 days after the event had no significant effect on recovery of global or regional left ventricular function compared with placebo. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00684021.
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Flammer AJ, Gössl M, Li J, Matsuo Y, Reriani M, Loeffler D, Simari RD, Lerman LO, Khosla S, Lerman A. Patients with an HbA1c in the prediabetic and diabetic range have higher numbers of circulating cells with osteogenic and endothelial progenitor cell markers. J Clin Endocrinol Metab 2012; 97:4761-8. [PMID: 23015657 PMCID: PMC3513527 DOI: 10.1210/jc.2012-2642] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
CONTEXT Vascular calcification, an important feature of diabetic vasculopathy, is an active process potentially mediated by endothelial progenitor cells (EPCs) coexpressing the osteoblastic marker osteocalcin (OCN). OBJECTIVE In this study we tested the hypothesis that cells expressing these markers are associated with the presence of elevated glycated hemoglobin (HbA1c). DESIGN, SETTING, AND PATIENTS This was a cross-sectional comparison. Patients (n = 133, aged 57.4 ± 15.7 yr) were divided into two groups according to the presence of an HbA1c in a (pre-)diabetic (>5.6) or normal range at the time of blood sampling. METHODS Using flow cytometry of peripheral blood mononuclear cells (MNCs), cells positive for OCN, the EPC markers (CD34/KDR and CD133(+)/CD34(-)/KDR(+)) and OCN(+) EPCs were counted. RESULTS Patients with elevated HbA1c compared with those with normal HbA1c had a significantly higher percentage of circulating OCN(+) MNCs [4.6 (interquartile range 2.68-7.81%) vs. 3.12 (0.99-7.81%), P = 0.035], higher numbers of OCN(+)/CD133(+)/CD34(-)/KDR(+) cells [20 (9-74) vs. 8 (0-19) counts per 100,000 gated events, P < 0.001] and a higher fraction of CD133(+)/CD34(-)/KDR(+) and CD34/KDR cells coexpressing OCN (23.7 ± 24.3 vs. 40.5 ± 34.6%, P = 0.002 and 37.1 ± 39.5 vs. 59.7 ± 37.7%, P = 0.002, respectively). The association between circulating OCN(+)/CD133(+)/CD34(-)/KDR(+) cells and an HbA1c in the (pre-) diabetic range remained strong, even after adjusting for differences in obesity and cardiovascular risk factors, disease, and medications in a multivariate model [odds ratio 1.72 (1.21-2.61), P =0.002]. CONCLUSION This study demonstrated that patients with HbA1c in the (pre-)diabetic range have a significant increase in OCN(+) MNCs, and OCN(+)/CD133(+)/CD34(-)/KDR(+) cells, in particular. Whether these cells increase vascular calcification in (pre-)diabetes warrants further studies.
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Affiliation(s)
- Andreas J Flammer
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
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Affiliation(s)
- Ethany L Cullen
- Department of Radiology, Mayo Clinic, Rochester, MN 55902, USA.
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Rodriguez-Porcel M, Kronenberg MW, Henry TD, Traverse JH, Pepine CJ, Ellis SG, Willerson JT, Moyé LA, Simari RD. Cell tracking and the development of cell-based therapies: a view from the Cardiovascular Cell Therapy Research Network. JACC Cardiovasc Imaging 2012; 5:559-65. [PMID: 22595165 DOI: 10.1016/j.jcmg.2011.12.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 12/13/2011] [Accepted: 12/15/2011] [Indexed: 12/12/2022]
Abstract
Cell-based therapies are being developed for myocardial infarction (MI) and its consequences (e.g., heart failure) as well as refractory angina and critical limb ischemia. The promising results obtained in preclinical studies led to the translation of this strategy to clinical studies. To date, the initial results have been mixed: some studies showed benefit, whereas in others, no benefit was observed. There is a growing consensus among the scientific community that a better understanding of the fate of transplanted cells (e.g., cell homing and viability over time) will be critical for the long-term success of these strategies and that future studies should include an assessment of cell homing, engraftment, and fate as an integral part of the trial design. In this review, different imaging methods and technologies are discussed within the framework of the physiological answers that the imaging strategies can provide, with a special focus on the inherent regulatory issues.
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Flammer AJ, Gössl M, Widmer RJ, Reriani M, Lennon R, Loeffler D, Shonyo S, Simari RD, Lerman LO, Khosla S, Lerman A. Osteocalcin positive CD133+/CD34-/KDR+ progenitor cells as an independent marker for unstable atherosclerosis. Eur Heart J 2012; 33:2963-9. [PMID: 22855739 DOI: 10.1093/eurheartj/ehs234] [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: 12/19/2022] Open
Abstract
AIMS For the characterization of endothelial progenitor cells (EPCs), commonly the markers CD34 and KDR have been used. CD133+/CD34-/KDR+ cells may represent more immature 'early' progenitors. In patients with coronary artery disease (CAD), a large fraction of EPCs carry the osteoblastic marker osteocalcin (OCN), which may mediate vascular calcification and abnormal repair. The aim of this study was to evaluate the expression of OCN+ 'early' EPCs in patients with risk factors (RFs) and a history of stable (history of stenting/coronary artery bypass grafting) or unstable CAD (myocardial infarction). METHODS AND RESULTS Medical history and blood samples from 282 patients (age 58 ± 16 years) with CAD or at least one RF (mean 2.5 ± 1.5) were analysed. For the analysis of EPC markers (CD133, CD34, KDR) and OCN, the flow cytometry of peripheral blood mononuclear cells was performed. Circulating OCN+/CD133+/CD34-/KDR+ cells (median counts [interquartile range] per 100 000 events) were 15 [4-41] in patients with RF (n = 199), 26 [1-136] in those with a history of stable (n = 57), and 246 [105-308] in those with a history of unstable CAD (n = 26; P < 0.001). The association with unstable CAD remained highly significant even after multivariate adjusting for RFs and the different characteristics of the groups. Osteocalcin positive 'early' EPCs trend to predict further events [HR for each doubling of the cell number: 1.20 (95% CI: 1.00-1.46), P = 0.06]. CONCLUSION Circulating OCN+ 'early' EPCs are strongly associated with unstable CAD. Therefore, this particular subset of EPCs could mediate abnormal vascular repair and may help identifying patients with a more unstable phenotype of atherosclerosis.
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Affiliation(s)
- Andreas J Flammer
- Division of Cardiovascular Diseases, Mayo Clinic and College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
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Tweet MS, Hayes SN, Pitta SR, Simari RD, Lerman A, Lennon RJ, Gersh BJ, Khambatta S, Best PJM, Rihal CS, Gulati R. Clinical features, management, and prognosis of spontaneous coronary artery dissection. Circulation 2012; 126:579-88. [PMID: 22800851 DOI: 10.1161/circulationaha.112.105718] [Citation(s) in RCA: 590] [Impact Index Per Article: 49.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) is an acute coronary event of uncertain origin. Clinical features and prognosis remain insufficiently characterized. METHODS AND RESULTS A retrospective single-center cohort study identified 87 patients with angiographically confirmed SCAD. Incidence, clinical characteristics, treatment modalities, in-hospital outcomes, and long-term risk of SCAD recurrence or major adverse cardiac events were evaluated. Mean age was 42.6 years; 82% were female. Extreme exertion at SCAD onset was more frequent in men (7 of 16 versus 2 of 71; P<0.001), and postpartum status was observed in 13 of 71 women (18%). Presentation was ST-elevation myocardial infarction in 49%. Multivessel SCAD was found in 23%. Initial conservative management (31 of 87) and coronary artery bypass grafting (7 of 87) were associated with an uncomplicated in-hospital course, whereas percutaneous coronary intervention was complicated by technical failure in 15 of 43 patients (35%) and 1 death. During a median follow-up of 47 months (interquartile range, 18-106 months), SCAD recurred in 15 patients, all female. Estimated 10-year rate of major adverse cardiac events (death, heart failure, myocardial infarction, and SCAD recurrence) was 47%. Fibromuscular dysplasia of the iliac artery was identified incidentally in 8 of 16 femoral angiograms (50%) undertaken before closure device placement and in the carotid arteries of 2 others with carotid dissection. CONCLUSIONS SCAD affects a young, predominantly female population, frequently presenting as ST-elevation myocardial infarction. Although in-hospital mortality is low regardless of initial treatment, percutaneous coronary intervention is associated with high rates of complication. Risks of SCAD recurrence and major adverse cardiac events in the long term emphasize the need for close follow-up. Fibromuscular dysplasia is a novel association and potentially causative factor.
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Affiliation(s)
- Marysia S Tweet
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA
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