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Bunker-Alberts M, Scheftz E, Molga H, Gatto A, Fisher E, Khalafalla FG. Street medicine: An interprofessional elective to address the unhoused population crisis. Curr Pharm Teach Learn 2024; 16:270-280. [PMID: 38184484 DOI: 10.1016/j.cptl.2023.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 12/05/2023] [Accepted: 12/22/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND AND PURPOSE The homelessness crisis continues to escalate nationwide, yet many healthcare providers are not adequately prepared to provide care for unhoused patients. An interprofessional Street Medicine elective was developed to address identified knowledge gaps in the unhoused population healthcare needs. EDUCATIONAL ACTIVITY AND SETTING The course comprised didactic and clinical elements focused on empathetic communication, resource utilization, and medical management for unhoused patients. Course learning outcomes were evaluated via thematic analysis of students' post-course reflective essays. Additionally, students completed a voluntary survey to evaluate course effectiveness in preparing students for healthcare in the unhoused population and to identify areas for course improvement. FINDINGS Thirty students completed the course (17 osteopathic medical, five pharmacy, eight joint physician assistant/public health). All enrolled students submitted mandatory post-course reflections and 57% completed the voluntary survey. Thematic analysis of reflections indicated that the course content challenged biases toward unhoused populations, equipped students with new perspectives on the unique healthcare needs for unhoused patients, and provided interprofessional approaches to address these needs. Voluntary survey results demonstrated students' preparedness to provide effective care for local unhoused patients without bias or stigma. Most students reported they were likely to incorporate the knowledge/skills acquired from the course in their future clinical practice and were satisfied with the course content and organization. SUMMARY The Street Medicine elective provided a structured interprofessional curricular opportunity on specialized care for unhoused individuals. This course can be adapted by other healthcare professional programs to empower students to address the growing homelessness crisis.
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Affiliation(s)
- Michele Bunker-Alberts
- Touro University California, College of Education and Health Sciences, School of Nursing, 1310 Club Drive, Vallejo, CA 94592, United States.
| | - Erin Scheftz
- Touro University California, College of Osteopathic Medicine, 1310 Club Drive, Vallejo, CA 94592, United States.
| | - Heidi Molga
- Touro University California, College of Osteopathic Medicine, 1310 Club Drive, Vallejo, CA 94592, United States.
| | - Andrew Gatto
- Touro University California, College of Osteopathic Medicine, 1310 Club Drive, Vallejo, CA 94592, United States.
| | - Emily Fisher
- One Love Vallejo Mobile Health, 949 Amador Street, Vallejo, CA 94589, United States.
| | - Farid G Khalafalla
- Touro University California, College of Education and Health Sciences, 1310 Club Drive, Vallejo, CA 94592, United States.
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Majerczyk D, Behnen EM, Weldon DJ, Kanbar R, Hardy YM, Matsuda SK, Hardinger KL, Khalafalla FG. Racial, Ethnic, and Sex Diversity Trends in Health Professions Programs From Applicants to Graduates. JAMA Netw Open 2023; 6:e2347817. [PMID: 38153738 PMCID: PMC10755626 DOI: 10.1001/jamanetworkopen.2023.47817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/01/2023] [Indexed: 12/29/2023] Open
Abstract
Importance Diversity is an essential element of an effective health care system. A key to developing a diverse workforce is establishing a diverse student population in health professions programs. Objective To examine the diversity of students in Doctor of Medicine (MD), Doctor of Osteopathic Medicine (DO), Doctor of Dental Surgery (DDS), Doctor of Dental Medicine (DMD), and Doctor of Pharmacy (PharmD) programs with emphasis on the trends of underrepresented minoritized groups (American Indian or Alaska Native, Black or African American, Hispanic or Latino, and Native Hawaiian or Other Pacific Islander) and sex relative to the overall age-adjusted US population. Design, Setting, and Participants This cross-sectional study used deidentified, self-reported data from 2003 to 2019 from the Association of American Medical Colleges, American Association of Colleges of Osteopathic Medicine, American Dental Education Association, American Dental Association, and American Association of Colleges of Pharmacy. Data analysis was performed from 2003 to 2004 and from 2018 to 2019. Exposures Data on the race, ethnicity, and sex of applicants, matriculants, and degrees conferred by health professions programs were collected and compared with the age-adjusted population in the US Census (aged 20-34 years) over time. Main Outcomes and Measures The main outcomes were trends in the proportions of underrepresented minoritized groups and sex diversity among applicants, matriculants, and degrees conferred relative to the overall age-adjusted US population. Trends were measured using the representation quotient, which is defined as the ratio of the proportion of each subgroup to the total population of applicants, matriculants, or graduates relative to the proportion for that subgroup within the US Census population of similar age. Regression analysis was used to evaluate the trend over time. Results A total of 594 352 applicants were analyzed across the examined programs. From 2003 to 2019, the proportions of individuals from underrepresented groups increased for DDS and DMD (applicants, from 1003 of 8176 to 1962 of 11 298 [5.1%]; matriculants, from 510 of 4528 to 966 of 6163 [4.2%]; degrees awarded, from 484 of 4350 to 878 of 6340 [2.7%]), PharmD (applicants, from 9045 of 71 966 to 11 653 of 50 482 [9.0%]; matriculants, from 5979 of 42 627 to 10 129 to 62 504 [6.3%]; degrees awarded, from 922 of 7770 to 2190 of 14 800 [3.0%]), and DO (applicants, from 740 of 6814 to 3478 of 21 090 [5.4%]; degrees awarded, 199 of 2713 to 582 of 6703 [1.4%]) programs, but decreased for MD programs (applicants, from 6066 of 34 791 to 7889 of 52 777 [-2.3%]; matriculants, 2506 of 16 541 to 2952 of 21 622 [-2.4%]; degrees awarded, from 2167 of 15 829 to 2349 of 19 937 [-0.1%]). Compared with age-adjusted US Census data, all programs had more Asian students and fewer male, American Indian or Alaska Native, Black or African American, Hispanic or Latino, and Native Hawaiian or Other Pacific Islander students (representation quotient <1). Conclusions and Relevance In this cross-sectional study, most of the health professions in the study saw increases in underrepresented minority applicants, matriculants, and degrees conferred from 2003 to 2019; however, all programs were below the age-adjusted US Census data. The increased racial, ethnic, and sex diversity in the programs illustrates progress, but additional strategies are needed to achieve a more representative health care workforce.
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Affiliation(s)
- Daniel Majerczyk
- Department of Family Medicine, Loyola Medicine–MacNeal Family Medicine Residency Program, Berwyn, Illinois
- College of Science, Health and Pharmacy, Roosevelt University, Schaumburg, Illinois
- Harvard Graduate School of Education, Harvard University, Cambridge, Massachusetts
| | - Erin M. Behnen
- College of Pharmacy, Belmont University, Nashville, Tennessee
| | - David J. Weldon
- School of Pharmacy, William Carey University, Biloxi, Mississippi
| | - Roy Kanbar
- School of Pharmacy, Lebanese American University, Byblos, Lebanon
| | - Yolanda M. Hardy
- Lloyd L. Gregory School of Pharmacy, Palm Beach Atlantic University, West Palm Beach, Florida
| | | | | | - Farid G. Khalafalla
- College of Education and Health Sciences, Touro University California, Vallejo
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Khalafalla FG, Eichmann KK, VanGarsse A, Ofstad W. Nutrition and Lifestyle Coaching: An Interprofessional Course for Pharmacy, Medical, and Dietetic Students. Cureus 2023; 15:e48302. [PMID: 38058349 PMCID: PMC10697130 DOI: 10.7759/cureus.48302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2023] [Indexed: 12/08/2023] Open
Abstract
Background Poor nutrition and lifestyle choices are major contributors to the development and progression of various chronic diseases. Enhancing patients' awareness of healthy nutrition and lifestyle habits by interprofessional healthcare teams can play a significant role in tackling many chronic diseases, particularly in underserved communities with inequitable access to healthcare and educational opportunities. However, healthcare professionals are not adequately prepared to provide effective, culturally competent nutrition and lifestyle coaching due to a lack of emphasis on these topics in the curricula of many healthcare professional programs. Objective This study introduces a virtual, interprofessional, team-based elective course to address the curricular gap in nutrition education among healthcare professional programs. Methods Quantitative and qualitative pre-/post-surveys were utilized to evaluate course impact on student's knowledge, confidence in coaching families, and interprofessional competencies. Quantitative pre-/post-training scores were analyzed by a two-tailed, Mann-Whitney test, where P < 0.05 indicated a significant difference. Additionally, student learning outcomes were assessed using readiness assurance tests and application exercises, along with end-of-course presentations and mock interviews. Results Pre-/post-course assessments (n = 16) demonstrated significant improvement in students' confidence in coaching families (20%; P = 0.01) and knowledge of coaching curriculum (87%; P < 0.001). Improvement in different interprofessional competencies ranged between 15% (P = 0.002) and 46% (P < 0.001). Course material/activities, facilitation, impact on learning new knowledge/skills/mindset, and application in future practice were applauded by 81-94% of students. Conclusion Positive outcomes of this course encourage future offerings and systematic incorporation of similar training in healthcare professional programs to prepare clinicians capable of transforming lives through interprofessional, patient-centered nutrition and lifestyle coaching.
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Affiliation(s)
- Farid G Khalafalla
- Preclinical Basic Sciences, Touro University California, College of Education and Health Sciences, Vallejo, USA
| | - Kelly K Eichmann
- Career and Technical Education, Clovis Unified School District, Clovis, USA
| | - Anne VanGarsse
- Pediatrics, University of California Riverside, School of Medicine, Riverside, USA
| | - William Ofstad
- Pharmacy Practice, West Coast University, School of Pharmacy, Los Angeles, USA
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Khalafalla FG, Alqaysi R. Blending team-based learning and game-based learning in pharmacy education. Curr Pharm Teach Learn 2021; 13:992-997. [PMID: 34294265 DOI: 10.1016/j.cptl.2021.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 01/13/2021] [Accepted: 06/09/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND PURPOSE Team-based learning (TBL) and game-based learning (GBL) are evidence-based active learning pedagogies. This study reports a learning experience that harnesses TBL and GBL benefits by blending both pedagogies (referred herein as TGL) in the facilitation of an immunology module for pharmacy students. The manuscript presents the rationale for using TGL, a description of the TGL process, student outcomes and satisfaction with the learning experience, and TGL applicability in different topics/disciplines. EDUCATIONAL ACTIVITY AND SETTING Sixty-five students were divided into 12 teams. Pre-class foundational readiness material was posted one week before class. Student readiness was assessed via individual and team readiness assurance tests (iRAT/tRAT) mapped to learning objectives, with immediate instructor-mediated debrief. Then student teams worked toward solving clinical applications using evidence-based clinical information databases, e.g., UpToDate, Lexicomp. Finally, students were engaged in a competitive online game designed to review topic's key concepts and evaluate student knowledge individually post-learning experience. FINDINGS TGL process fulfilled learning outcomes, indicated by successful student performance in module-related assessments: iRAT = 92.5% ± 1.2; tRAT = 98.3% ± 1.1; educational game = 71.5% ± 3.6; block exam = 82.1% ± 5.3. Student survey indicated that >90% of students are satisfied with readiness material, alignment of activities with learning outcomes, engagement in active learning, gaining new relevant knowledge/skills/mindset, and merging TBL with GBL. SUMMARY Combining GBL with TBL allowed assessing student performance individually after the learning experience, an element that is not part of canonical TBL structure, to ensure students are prepared for high-stake/board exams. TGL can be applied in diverse topics/disciplines and is generalizable to small and large cohorts.
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Affiliation(s)
- Farid G Khalafalla
- California Health Sciences University, College of Pharmacy, United States; A.T. Still University, Kirksville College of Osteopathic Medicine, United States.
| | - Rafal Alqaysi
- California Health Sciences University, College of Pharmacy, United States.
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Li Y, Duche A, Sayer MR, Roosan D, Khalafalla FG, Ostrom RS, Totonchy J, Roosan MR. SARS-CoV-2 early infection signature identified potential key infection mechanisms and drug targets. BMC Genomics 2021; 22:125. [PMID: 33602138 PMCID: PMC7889713 DOI: 10.1186/s12864-021-07433-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/05/2021] [Indexed: 12/15/2022] Open
Abstract
Background The ongoing COVID-19 outbreak has caused devastating mortality and posed a significant threat to public health worldwide. Despite the severity of this illness and 2.3 million worldwide deaths, the disease mechanism is mostly unknown. Previous studies that characterized differential gene expression due to SARS-CoV-2 infection lacked robust validation. Although vaccines are now available, effective treatment options are still out of reach. Results To characterize the transcriptional activity of SARS-CoV-2 infection, a gene signature consisting of 25 genes was generated using a publicly available RNA-Sequencing (RNA-Seq) dataset of cultured cells infected with SARS-CoV-2. The signature estimated infection level accurately in bronchoalveolar lavage fluid (BALF) cells and peripheral blood mononuclear cells (PBMCs) from healthy and infected patients (mean 0.001 vs. 0.958; P < 0.0001). These signature genes were investigated in their ability to distinguish the severity of SARS-CoV-2 infection in a single-cell RNA-Sequencing dataset. TNFAIP3, PPP1R15A, NFKBIA, and IFIT2 had shown bimodal gene expression in various immune cells from severely infected patients compared to healthy or moderate infection cases. Finally, this signature was assessed using the publicly available ConnectivityMap database to identify potential disease mechanisms and drug repurposing candidates. Pharmacological classes of tricyclic antidepressants, SRC-inhibitors, HDAC inhibitors, MEK inhibitors, and drugs such as atorvastatin, ibuprofen, and ketoconazole showed strong negative associations (connectivity score < − 90), highlighting the need for further evaluation of these candidates for their efficacy in treating SARS-CoV-2 infection. Conclusions Thus, using the 25-gene SARS-CoV-2 infection signature, the SARS-CoV-2 infection status was captured in BALF cells, PBMCs and postmortem lung biopsies. In addition, candidate SARS-CoV-2 therapies with known safety profiles were identified. The signature genes could potentially also be used to characterize the COVID-19 disease severity in patients’ expression profiles of BALF cells. Supplementary Information The online version contains supplementary material available at 10.1186/s12864-021-07433-4.
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Affiliation(s)
- Yue Li
- School of Pharmacy, Chapman University, Irvine, CA, 92618, USA
| | - Ashley Duche
- School of Pharmacy, Chapman University, Irvine, CA, 92618, USA
| | - Michael R Sayer
- School of Pharmacy, Chapman University, Irvine, CA, 92618, USA
| | - Don Roosan
- College of Pharmacy, Western University of Health Sciences, Pomona, CA, 91766, USA
| | - Farid G Khalafalla
- College of Pharmacy, California Health Sciences University, Clovis, CA, 93612, USA
| | | | | | - Moom R Roosan
- School of Pharmacy, Chapman University, Irvine, CA, 92618, USA.
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Ebeid DE, Khalafalla FG, Broughton KM, Monsanto MM, Esquer CY, Sacchi V, Hariharan N, Korski KI, Moshref M, Emathinger J, Cottage CT, Quijada PJ, Nguyen JH, Alvarez R, Völkers M, Konstandin MH, Wang BJ, Firouzi F, Navarrete JM, Gude NA, Goumans MJ, Sussman MA. Pim1 maintains telomere length in mouse cardiomyocytes by inhibiting TGFβ signalling. Cardiovasc Res 2021; 117:201-211. [PMID: 32176281 PMCID: PMC7797214 DOI: 10.1093/cvr/cvaa066] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 07/30/2019] [Accepted: 03/13/2019] [Indexed: 12/26/2022] Open
Abstract
AIMS Telomere attrition in cardiomyocytes is associated with decreased contractility, cellular senescence, and up-regulation of proapoptotic transcription factors. Pim1 is a cardioprotective kinase that antagonizes the aging phenotype of cardiomyocytes and delays cellular senescence by maintaining telomere length, but the mechanism remains unknown. Another pathway responsible for regulating telomere length is the transforming growth factor beta (TGFβ) signalling pathway where inhibiting TGFβ signalling maintains telomere length. The relationship between Pim1 and TGFβ has not been explored. This study delineates the mechanism of telomere length regulation by the interplay between Pim1 and components of TGFβ signalling pathways in proliferating A549 cells and post-mitotic cardiomyocytes. METHODS AND RESULTS Telomere length was maintained by lentiviral-mediated overexpression of PIM1 and inhibition of TGFβ signalling in A549 cells. Telomere length maintenance was further demonstrated in isolated cardiomyocytes from mice with cardiac-specific overexpression of PIM1 and by pharmacological inhibition of TGFβ signalling. Mechanistically, Pim1 inhibited phosphorylation of Smad2, preventing its translocation into the nucleus and repressing expression of TGFβ pathway genes. CONCLUSION Pim1 maintains telomere lengths in cardiomyocytes by inhibiting phosphorylation of the TGFβ pathway downstream effectors Smad2 and Smad3, which prevents repression of telomerase reverse transcriptase. Findings from this study demonstrate a novel mechanism of telomere length maintenance and provide a potential target for preserving cardiac function.
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Affiliation(s)
- David E Ebeid
- Department of Biology, San Diego State University, North Life Sciences, 426, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - Farid G Khalafalla
- Department of Biology, San Diego State University, North Life Sciences, 426, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - Kathleen M Broughton
- Department of Biology, San Diego State University, North Life Sciences, 426, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - Megan M Monsanto
- Department of Biology, San Diego State University, North Life Sciences, 426, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - Carolina Y Esquer
- Department of Biology, San Diego State University, North Life Sciences, 426, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - Veronica Sacchi
- Department of Biology, San Diego State University, North Life Sciences, 426, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - Nirmala Hariharan
- Department of Biology, San Diego State University, North Life Sciences, 426, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - Kelli I Korski
- Department of Biology, San Diego State University, North Life Sciences, 426, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - Maryam Moshref
- Department of Biology, San Diego State University, North Life Sciences, 426, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - Jacqueline Emathinger
- Department of Biology, San Diego State University, North Life Sciences, 426, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - Christopher T Cottage
- Department of Biology, San Diego State University, North Life Sciences, 426, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - Pearl J Quijada
- Department of Biology, San Diego State University, North Life Sciences, 426, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - Jonathan H Nguyen
- Department of Biology, San Diego State University, North Life Sciences, 426, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - Roberto Alvarez
- Department of Biology, San Diego State University, North Life Sciences, 426, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - Mirko Völkers
- Department of Biology, San Diego State University, North Life Sciences, 426, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - Mathias H Konstandin
- Department of Biology, San Diego State University, North Life Sciences, 426, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - Bingyan J Wang
- Department of Biology, San Diego State University, North Life Sciences, 426, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - Fareheh Firouzi
- Department of Biology, San Diego State University, North Life Sciences, 426, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - Julian M Navarrete
- Department of Biology, San Diego State University, North Life Sciences, 426, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - Natalie A Gude
- Department of Biology, San Diego State University, North Life Sciences, 426, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - Marie-Jose Goumans
- Department of Biology, San Diego State University, North Life Sciences, 426, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - Mark A Sussman
- Department of Biology, San Diego State University, North Life Sciences, 426, 5500 Campanile Drive, San Diego, CA 92182, USA
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Khalafalla FG, Covarrubias K, Fesperman M, Eichmann K, VanGarsse A, Ofstad W. Enhancing nutrition and lifestyle education for healthcare professional students through an interprofessional, team-based training program. Curr Pharm Teach Learn 2020; 12:1484-1490. [PMID: 33092779 DOI: 10.1016/j.cptl.2020.07.017] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 07/01/2020] [Accepted: 07/15/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND PURPOSE Nutrition and lifestyle modifications are effective interventions in tackling many chronic diseases, including cardiovascular diseases. However, healthcare professionals are not sufficiently trained in nutrition and lifestyle education. To address this gap, we established an interprofessional, team-based framework to train healthcare professional students on healthy nutrition and culturally competent dietary coaching and motivational interviewing. EDUCATIONAL ACTIVITY AND SETTING Twelve doctor of pharmacy students from California Health Sciences University and three dietetic students from California State University, Fresno enrolled in this training program. Three pre-/post-surveys and one post-reflection worksheet were utilized to assess progress in student learning, including knowledge about obesity, confidence in coaching/mentoring families, perception of healthy nutrition, dietary habits, and interprofessional collaborative competencies. FINDINGS Quantitative data and reflection worksheet thematic analysis revealed improvement in learner outcomes in the majority of the assessed areas. Students' knowledge about obesity and mentoring skills improved by 32%, knowledge about program curriculum improved by 167%, dietary habits improved by 28% and interprofessional competencies improved by 9%-34%. Thematic analysis of interprofessional educational reflection worksheets indicated positive reaction to the program, enhanced interprofessional outcomes, and potential application of acquired knowledge and skills on family and future patients. SUMMARY Success of this interprofessional, team-based study encourages expanding the program to enroll more students from various healthcare specialties, including medical and nursing. This framework can be easily adapted by other healthcare programs to prepare healthcare providers to work interprofessionally and effectively include basic nutrition and lifestyle recommendations in disease management and preventive care.
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Affiliation(s)
- Farid G Khalafalla
- California Health Sciences University, College of Pharmacy, Department of Pharmaceutical and Biomedical Sciences, 120 N Clovis Ave, Clovis, CA 93612 United States.
| | - Kenya Covarrubias
- California Health Sciences University, College of Pharmacy, 120 N Clovis Ave, Clovis, CA 93612 United States.
| | - Madison Fesperman
- California Health Sciences University, College of Pharmacy, 120 N Clovis Ave, Clovis, CA 93612 United States.
| | - Kelly Eichmann
- Registered Dietitian, Clovis Unified School District, 1450 Herndon Ave, Clovis, CA 93611, National University, 20 E River Park Pl W, Fresno, CA 93720 United States
| | - Anne VanGarsse
- California Health Sciences University, College of Osteopathic Medicine, 2500 Alluvial Ave, Clovis, CA 93611 United States.
| | - William Ofstad
- California Health Sciences University, College of Pharmacy, Department of Clinical Sciences, 120 N Clovis Ave, Clovis, CA 93612 United States.
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Korski KI, Kubli DA, Wang BJ, Khalafalla FG, Monsanto MM, Firouzi F, Echeagaray OH, Kim T, Adamson RM, Dembitsky WP, Gustafsson ÅB, Sussman MA. Hypoxia Prevents Mitochondrial Dysfunction and Senescence in Human c-Kit + Cardiac Progenitor Cells. Stem Cells 2019; 37:555-567. [PMID: 30629785 DOI: 10.1002/stem.2970] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 12/10/2018] [Accepted: 12/17/2018] [Indexed: 12/21/2022]
Abstract
Senescence-associated dysfunction deleteriously affects biological activities of human c-Kit+ cardiac progenitor cells (hCPCs), particularly under conditions of in vitro culture. In comparison, preservation of self-renewal and decreases in mitochondrial reactive oxygen species (ROS) are characteristics of murine CPCs in vivo that reside within hypoxic niches. Recapitulating hypoxic niche oxygen tension conditions of ∼1% O2 in vitro for expansion of hCPCs rather than typical normoxic cell culture conditions (21% O2 ) could provide significant improvement of functional and biological activities of hCPCs. hCPCs were isolated and expanded under permanent hypoxic (hCPC-1%) or normoxic (hCPC-21%) conditions from left ventricular tissue explants collected during left ventricular assist device implantation. hCPC-1% exhibit increased self-renewal and suppression of senescence characteristics relative to hCPC-21%. Oxidative stress contributed to higher susceptibility to apoptosis, as well as decreased mitochondrial function in hCPC-21%. Hypoxia prevented accumulation of dysfunctional mitochondria, supporting higher oxygen consumption rates and mitochondrial membrane potential. Mitochondrial ROS was an upstream mediator of senescence since treatment of hCPC-1% with mitochondrial inhibitor antimycin A recapitulated mitochondrial dysfunction and senescence observed in hCPC-21%. NAD+ /NADH ratio and autophagic flux, which are key factors for mitochondrial function, were higher in hCPC-1%, but hCPC-21% were highly dependent on BNIP3/NIX-mediated mitophagy to maintain mitochondrial function. Overall, results demonstrate that supraphysiological oxygen tension during in vitro expansion initiates a downward spiral of oxidative stress, mitochondrial dysfunction, and cellular energy imbalance culminating in early proliferation arrest of hCPCs. Senescence is inhibited by preventing ROS through hypoxic culture of hCPCs. Stem Cells 2019;37:555-567.
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Affiliation(s)
- Kelli I Korski
- Department of Biology and Integrated Regenerative Research Institute, San Diego State University, San Diego, California, USA
| | - Dieter A Kubli
- Department of Biology and Integrated Regenerative Research Institute, San Diego State University, San Diego, California, USA
| | - Bingyan J Wang
- Department of Biology and Integrated Regenerative Research Institute, San Diego State University, San Diego, California, USA
| | - Farid G Khalafalla
- Department of Biology and Integrated Regenerative Research Institute, San Diego State University, San Diego, California, USA
| | - Megan M Monsanto
- Department of Biology and Integrated Regenerative Research Institute, San Diego State University, San Diego, California, USA
| | - Fareheh Firouzi
- Department of Biology and Integrated Regenerative Research Institute, San Diego State University, San Diego, California, USA
| | - Oscar H Echeagaray
- Department of Biology and Integrated Regenerative Research Institute, San Diego State University, San Diego, California, USA
| | - Taeyong Kim
- Department of Biology and Integrated Regenerative Research Institute, San Diego State University, San Diego, California, USA
| | - Robert M Adamson
- Division of Cardiology, Sharp Hospital, San Diego, California, USA
| | | | - Åsa B Gustafsson
- The Skaggs School of Pharmacy and Pharmaceutical Sciences, Department of Pharmacology, University of California San Diego, La Jolla, California, USA
| | - Mark A Sussman
- Department of Biology and Integrated Regenerative Research Institute, San Diego State University, San Diego, California, USA
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Affiliation(s)
- Farid G Khalafalla
- San Diego Heart Research Institute, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA
| | - Mark A Sussman
- San Diego Heart Research Institute, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA
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Gude NA, Firouzi F, Broughton KM, Ilves K, Nguyen KP, Payne CR, Sacchi V, Monsanto MM, Casillas AR, Khalafalla FG, Wang BJ, Ebeid DE, Alvarez R, Dembitsky WP, Bailey BA, van Berlo J, Sussman MA. Cardiac c-Kit Biology Revealed by Inducible Transgenesis. Circ Res 2018; 123:57-72. [PMID: 29636378 DOI: 10.1161/circresaha.117.311828] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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] [Received: 08/02/2017] [Revised: 03/24/2018] [Accepted: 04/09/2018] [Indexed: 12/24/2022]
Abstract
RATIONALE Biological significance of c-Kit as a cardiac stem cell marker and role(s) of c-Kit+ cells in myocardial development or response to pathological injury remain unresolved because of varied and discrepant findings. Alternative experimental models are required to contextualize and reconcile discordant published observations of cardiac c-Kit myocardial biology and provide meaningful insights regarding clinical relevance of c-Kit signaling for translational cell therapy. OBJECTIVE The main objectives of this study are as follows: demonstrating c-Kit myocardial biology through combined studies of both human and murine cardiac cells; advancing understanding of c-Kit myocardial biology through creation and characterization of a novel, inducible transgenic c-Kit reporter mouse model that overcomes limitations inherent to knock-in reporter models; and providing perspective to reconcile disparate viewpoints on c-Kit biology in the myocardium. METHODS AND RESULTS In vitro studies confirm a critical role for c-Kit signaling in both cardiomyocytes and cardiac stem cells. Activation of c-Kit receptor promotes cell survival and proliferation in stem cells and cardiomyocytes of either human or murine origin. For creation of the mouse model, the cloned mouse c-Kit promoter drives Histone2B-EGFP (enhanced green fluorescent protein; H2BEGFP) expression in a doxycycline-inducible transgenic reporter line. The combination of c-Kit transgenesis coupled to H2BEGFP readout provides sensitive, specific, inducible, and persistent tracking of c-Kit promoter activation. Tagging efficiency for EGFP+/c-Kit+ cells is similar between our transgenic versus a c-Kit knock-in mouse line, but frequency of c-Kit+ cells in cardiac tissue from the knock-in model is 55% lower than that from our transgenic line. The c-Kit transgenic reporter model reveals intimate association of c-Kit expression with adult myocardial biology. Both cardiac stem cells and a subpopulation of cardiomyocytes express c-Kit in uninjured adult heart, upregulating c-Kit expression in response to pathological stress. CONCLUSIONS c-Kit myocardial biology is more complex and varied than previously appreciated or documented, demonstrating validity in multiple points of coexisting yet heretofore seemingly irreconcilable published findings.
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Affiliation(s)
- Natalie A Gude
- From the SDSU Heart Institute, Department of Biology (N.A.G., F.F., K.M.B., K.I., K.P.N., C.R.P., V.S., M.M.M., A.R.C., F.G.K., B.J.W., D.E.E., R.A., M.A.S.)
| | - Fareheh Firouzi
- From the SDSU Heart Institute, Department of Biology (N.A.G., F.F., K.M.B., K.I., K.P.N., C.R.P., V.S., M.M.M., A.R.C., F.G.K., B.J.W., D.E.E., R.A., M.A.S.)
| | - Kathleen M Broughton
- From the SDSU Heart Institute, Department of Biology (N.A.G., F.F., K.M.B., K.I., K.P.N., C.R.P., V.S., M.M.M., A.R.C., F.G.K., B.J.W., D.E.E., R.A., M.A.S.)
| | - Kelli Ilves
- From the SDSU Heart Institute, Department of Biology (N.A.G., F.F., K.M.B., K.I., K.P.N., C.R.P., V.S., M.M.M., A.R.C., F.G.K., B.J.W., D.E.E., R.A., M.A.S.)
| | - Kristine P Nguyen
- From the SDSU Heart Institute, Department of Biology (N.A.G., F.F., K.M.B., K.I., K.P.N., C.R.P., V.S., M.M.M., A.R.C., F.G.K., B.J.W., D.E.E., R.A., M.A.S.)
| | - Christina R Payne
- From the SDSU Heart Institute, Department of Biology (N.A.G., F.F., K.M.B., K.I., K.P.N., C.R.P., V.S., M.M.M., A.R.C., F.G.K., B.J.W., D.E.E., R.A., M.A.S.)
| | - Veronica Sacchi
- From the SDSU Heart Institute, Department of Biology (N.A.G., F.F., K.M.B., K.I., K.P.N., C.R.P., V.S., M.M.M., A.R.C., F.G.K., B.J.W., D.E.E., R.A., M.A.S.)
| | - Megan M Monsanto
- From the SDSU Heart Institute, Department of Biology (N.A.G., F.F., K.M.B., K.I., K.P.N., C.R.P., V.S., M.M.M., A.R.C., F.G.K., B.J.W., D.E.E., R.A., M.A.S.)
| | - Alexandria R Casillas
- From the SDSU Heart Institute, Department of Biology (N.A.G., F.F., K.M.B., K.I., K.P.N., C.R.P., V.S., M.M.M., A.R.C., F.G.K., B.J.W., D.E.E., R.A., M.A.S.)
| | - Farid G Khalafalla
- From the SDSU Heart Institute, Department of Biology (N.A.G., F.F., K.M.B., K.I., K.P.N., C.R.P., V.S., M.M.M., A.R.C., F.G.K., B.J.W., D.E.E., R.A., M.A.S.)
| | - Bingyan J Wang
- From the SDSU Heart Institute, Department of Biology (N.A.G., F.F., K.M.B., K.I., K.P.N., C.R.P., V.S., M.M.M., A.R.C., F.G.K., B.J.W., D.E.E., R.A., M.A.S.)
| | - David E Ebeid
- From the SDSU Heart Institute, Department of Biology (N.A.G., F.F., K.M.B., K.I., K.P.N., C.R.P., V.S., M.M.M., A.R.C., F.G.K., B.J.W., D.E.E., R.A., M.A.S.)
| | - Roberto Alvarez
- From the SDSU Heart Institute, Department of Biology (N.A.G., F.F., K.M.B., K.I., K.P.N., C.R.P., V.S., M.M.M., A.R.C., F.G.K., B.J.W., D.E.E., R.A., M.A.S.)
| | - Walter P Dembitsky
- San Diego State University, CA; Sharp Memorial Hospital, San Diego, CA (W.P.D.)
| | | | - Jop van Berlo
- Department of Medicine, University of Minnesota, Minneapolis (J.v.B.)
| | - Mark A Sussman
- From the SDSU Heart Institute, Department of Biology (N.A.G., F.F., K.M.B., K.I., K.P.N., C.R.P., V.S., M.M.M., A.R.C., F.G.K., B.J.W., D.E.E., R.A., M.A.S.)
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11
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Khalafalla FG, Kayani W, Kassab A, Ilves K, Monsanto MM, Alvarez R, Chavarria M, Norman B, Dembitsky WP, Sussman MA. Empowering human cardiac progenitor cells by P2Y 14 nucleotide receptor overexpression. J Physiol 2017; 595:7135-7148. [PMID: 28980705 DOI: 10.1113/jp274980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 09/27/2017] [Indexed: 01/10/2023] Open
Abstract
KEY POINTS Autologous cardiac progenitor cell (CPC) therapy is a promising approach for treatment of heart failure (HF). There is an unmet need to identify inherent deficits in aged/diseased human CPCs (hCPCs) derived from HF patients in the attempts to augment their regenerative capacity prior to use in the clinical setting. Here we report significant functional correlations between phenotypic properties of hCPCs isolated from cardiac biopsies of HF patients, clinical parameters of patients and expression of the P2Y14 purinergic receptor (P2Y14 R), a crucial detector for extracellular UDP-sugars released during injury/stress. P2Y14 R is downregulated in hCPCs derived from HF patients with lower ejection fraction or diagnosed with diabetes. Augmenting P2Y14 R expression levels in aged/diseased hCPCs antagonizes senescence and improves functional responses. This study introduces purinergic signalling modulation as a potential strategy to rejuvenate and improve phenotypic characteristics of aged/functionally compromised hCPCs prior to transplantation in HF patients. ABSTRACT Autologous cardiac progenitor cell therapy is a promising alternative approach to current inefficient therapies for heart failure (HF). However, ex vivo expansion and pharmacological/genetic modification of human cardiac progenitor cells (hCPCs) are necessary interventions to rejuvenate aged/diseased cells and improve their regenerative capacities. This study was designed to assess the potential of improving hCPC functional capacity by targeting the P2Y14 purinergic receptor (P2Y14 R), which has been previously reported to induce regenerative and anti-senescence responses in a variety of experimental models. c-Kit+ hCPCs were isolated from cardiac biopsies of multiple HF patients undergoing left ventricular assist device implantation surgery. Significant correlations existed between the expression of P2Y14 R in hCPCs and clinical parameters of HF patients. P2Y14 R was downregulated in hCPCs derived from patients with a relatively lower ejection fraction and patients diagnosed with diabetes. hCPC lines with lower P2Y14 R expression did not respond to P2Y14 R agonist UDP-glucose (UDP-Glu) while hCPCs with higher P2Y14 R expression showed enhanced proliferation in response to UDP-Glu stimulation. Mechanistically, UDP-Glu stimulation enhanced the activation of canonical growth signalling pathways ERK1/2 and AKT. Restoring P2Y14 R expression levels in functionally compromised hCPCs via lentiviral-mediated overexpression improved proliferation, migration and survival under stress stimuli. Additionally, P2Y14 R overexpression reversed senescence-associated morphology and reduced levels of molecular markers of senescence p16INK4a , p53, p21 and mitochondrial reactive oxygen species. Findings from this study unveil novel biological roles of the UDP-sugar receptor P2Y14 in hCPCs and suggest purinergic signalling modulation as a promising strategy to improve phenotypic properties of functionally impaired hCPCs.
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Affiliation(s)
- Farid G Khalafalla
- San Diego Heart Research Institute, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA
| | - Waqas Kayani
- San Diego Heart Research Institute, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA
| | - Arwa Kassab
- San Diego Heart Research Institute, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA
| | - Kelli Ilves
- San Diego Heart Research Institute, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA
| | - Megan M Monsanto
- San Diego Heart Research Institute, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA
| | - Roberto Alvarez
- San Diego Heart Research Institute, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA
| | - Monica Chavarria
- San Diego Heart Research Institute, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA
| | - Benjamin Norman
- San Diego Heart Research Institute, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA
| | | | - Mark A Sussman
- San Diego Heart Research Institute, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA
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12
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Khalafalla FG, Greene S, Khan H, Ilves K, Monsanto MM, Alvarez R, Chavarria M, Nguyen J, Norman B, Dembitsky WP, Sussman MA. P2Y 2 Nucleotide Receptor Prompts Human Cardiac Progenitor Cell Activation by Modulating Hippo Signaling. Circ Res 2017; 121:1224-1236. [PMID: 28923792 DOI: 10.1161/circresaha.117.310812] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 09/08/2017] [Accepted: 09/15/2017] [Indexed: 12/31/2022]
Abstract
RATIONALE Autologous stem cell therapy using human c-Kit+ cardiac progenitor cells (hCPCs) is a promising therapeutic approach for treatment of heart failure (HF). However, hCPCs derived from aged patients with HF with genetic predispositions and comorbidities of chronic diseases exhibit poor proliferative and migratory capabilities, which impair overall reparative potential for injured myocardium. Therefore, empowering functionally compromised hCPCs with proregenerative molecules ex vivo is crucial for improving the therapeutic outcome in patients with HF. OBJECTIVE To improve hCPC proliferation and migration responses that are critical for regeneration by targeting proregenerative P2Y2 nucleotide receptor (P2Y2R) activated by extracellular ATP and UTP molecules released following injury/stress. METHODS AND RESULTS c-Kit+ hCPCs were isolated from cardiac tissue of patients with HF undergoing left ventricular assist device implantation surgery. Correlations between P2 nucleotide receptor expression and hCPC growth kinetics revealed downregulation of select P2 receptors, including P2Y2R, in slow-growing hCPCs compared with fast growers. hCPC proliferation and migration significantly improved by overexpressing or stimulating P2Y2R. Mechanistically, P2Y2R-induced proliferation and migration were dependent on activation of YAP (yes-associated protein)-the downstream effector of Hippo signaling pathway. CONCLUSIONS Proliferation and migration of functionally impaired hCPCs are enhanced by P2Y2R-mediated YAP activation, revealing a novel link between extracellular nucleotides released during injury/stress and Hippo signaling-a central regulator of cardiac regeneration. Functional correlations exist between hCPC phenotypic properties and P2 purinergic receptor expression. Lack of P2Y2R and other crucial purinergic stress detectors could compromise hCPC responsiveness to presence of extracellular stress signals. These findings set the stage for subsequent studies to assess purinergic signaling modulation as a potential strategy to improve therapeutic outcome for use of hCPCs in patients with HF.
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Affiliation(s)
- Farid G Khalafalla
- From the SDSU Heart Research Institute, San Diego State University, CA (F.G.K., S.G., H.K., K.I., M.M.M., R.A., M.C., J.N., B.N., M.A.S.); and Sharp Memorial Hospital, San Diego, CA (W.P.D.)
| | - Steven Greene
- From the SDSU Heart Research Institute, San Diego State University, CA (F.G.K., S.G., H.K., K.I., M.M.M., R.A., M.C., J.N., B.N., M.A.S.); and Sharp Memorial Hospital, San Diego, CA (W.P.D.)
| | - Hashim Khan
- From the SDSU Heart Research Institute, San Diego State University, CA (F.G.K., S.G., H.K., K.I., M.M.M., R.A., M.C., J.N., B.N., M.A.S.); and Sharp Memorial Hospital, San Diego, CA (W.P.D.)
| | - Kelli Ilves
- From the SDSU Heart Research Institute, San Diego State University, CA (F.G.K., S.G., H.K., K.I., M.M.M., R.A., M.C., J.N., B.N., M.A.S.); and Sharp Memorial Hospital, San Diego, CA (W.P.D.)
| | - Megan M Monsanto
- From the SDSU Heart Research Institute, San Diego State University, CA (F.G.K., S.G., H.K., K.I., M.M.M., R.A., M.C., J.N., B.N., M.A.S.); and Sharp Memorial Hospital, San Diego, CA (W.P.D.)
| | - Roberto Alvarez
- From the SDSU Heart Research Institute, San Diego State University, CA (F.G.K., S.G., H.K., K.I., M.M.M., R.A., M.C., J.N., B.N., M.A.S.); and Sharp Memorial Hospital, San Diego, CA (W.P.D.)
| | - Monica Chavarria
- From the SDSU Heart Research Institute, San Diego State University, CA (F.G.K., S.G., H.K., K.I., M.M.M., R.A., M.C., J.N., B.N., M.A.S.); and Sharp Memorial Hospital, San Diego, CA (W.P.D.)
| | - Jonathan Nguyen
- From the SDSU Heart Research Institute, San Diego State University, CA (F.G.K., S.G., H.K., K.I., M.M.M., R.A., M.C., J.N., B.N., M.A.S.); and Sharp Memorial Hospital, San Diego, CA (W.P.D.)
| | - Benjamin Norman
- From the SDSU Heart Research Institute, San Diego State University, CA (F.G.K., S.G., H.K., K.I., M.M.M., R.A., M.C., J.N., B.N., M.A.S.); and Sharp Memorial Hospital, San Diego, CA (W.P.D.)
| | - Walter P Dembitsky
- From the SDSU Heart Research Institute, San Diego State University, CA (F.G.K., S.G., H.K., K.I., M.M.M., R.A., M.C., J.N., B.N., M.A.S.); and Sharp Memorial Hospital, San Diego, CA (W.P.D.)
| | - Mark A Sussman
- From the SDSU Heart Research Institute, San Diego State University, CA (F.G.K., S.G., H.K., K.I., M.M.M., R.A., M.C., J.N., B.N., M.A.S.); and Sharp Memorial Hospital, San Diego, CA (W.P.D.).
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13
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Khalafalla FG, Kayani W, Kassab A, Ilves K, Alvarez RJ, Chavarria M, Norman B, Sussman MA. Abstract 25: P2Y14 Purinergic Receptor Overexpression: Letting Blind Cardiac Progenitor Cells ’See’ Again. Circ Res 2017. [DOI: 10.1161/res.121.suppl_1.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Heart failure (HF) is a leading cause of death due to limited regenerative capacity of adult mammalian heart following injury. Autologous stem cell therapy holds promise for promoting cardiac regeneration. However, stem cells derived from aged/diseased organs exhibit poor growth and survival capabilities. Empowering cardiac progenitor cells (CPC) with prosurvival genes has been attempted. Nonetheless, the molecular mechanisms by which stem cells initially detect stress signals to stimulate appropriate regenerative responses are poorly understood. This study aims to explore the physiological responses mediated by purinergic receptors, which represent a major detector for extracellular nucleotides released during injury/stress, with a focus on P2Y
14
nucleotide receptor (P2Y
14
R) activated by extracellular UDP-conjugated sugars. P2Y
14
R mediates proliferation of keratinocytes and chemotaxis of neutrophils and hematopoietic stem cells (HSCs). In addition, P2Y
14
R enhances HSC resistance to stress-induced senescence and maintains regenerative capacity after injury. However, the physiological roles of P2Y
14
R in CPCs are largely unknown. Preliminary data show striking correlations between P2Y
14
R expression in human CPCs derived from HF patients (hCPCs) and patients’ ejection fraction (EF), where low EF corresponds to low P2Y
14
R expression hCPCs. Moreover, hCPCs with relatively slower growth kinetics and enhanced senescence exhibit dramatic decreases in P2Y
14
R expression compared to fast-growing hCPCs. P2Y
14
R overexpression improves hCPC proliferation, migration, survival under stress stimuli and reverses senescent-associated phenotypes. Furthermore, P2Y
14
R-overexpressing hCPCs show remarkable upregulation in the expression of paracrine factors critical for cardiac repair. Preliminary studies will be extended
in vivo
to assess whether P2Y
14
R overexpression in hCPCs improves their reparative potential for injured mouse myocardium. Overall, this study introduces a novel interventional molecular approach to improve the therapeutic outcome of hCPCs by enhancing their capability to detect stress-induced extracellular nucleotides and initiate proper regenerative responses through augmenting P2Y
14
R expression.
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14
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Khalafalla FG, Khan MW. Inflammation and Epithelial-Mesenchymal Transition in Pancreatic Ductal Adenocarcinoma: Fighting Against Multiple Opponents. Cancer Growth Metastasis 2017; 10:1179064417709287. [PMID: 28579826 PMCID: PMC5436837 DOI: 10.1177/1179064417709287] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 04/06/2017] [Indexed: 12/11/2022]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is the most common type of pancreatic cancer and one of the most lethal human cancers. Inflammation is a critical component in PDAC initiation and progression. Inflammation also contributes to the aggressiveness of PDAC indirectly via induction of epithelial-mesenchymal transition (EMT), altogether leading to enhanced resistance to chemotherapy and poor survival rates. This review gives an overview of the key pro-inflammatory signaling pathways involved in PDAC pathogenesis and discusses the role of inflammation in induction of EMT and development of chemoresistance in patients with PDAC.
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Monsanto MM, White KS, Kim T, Wang BJ, Fisher K, Ilves K, Khalafalla FG, Casillas A, Broughton K, Mohsin S, Dembitsky WP, Sussman MA. Concurrent Isolation of 3 Distinct Cardiac Stem Cell Populations From a Single Human Heart Biopsy. Circ Res 2017; 121:113-124. [PMID: 28446444 DOI: 10.1161/circresaha.116.310494] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [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: 12/16/2016] [Revised: 04/19/2017] [Accepted: 04/25/2017] [Indexed: 12/26/2022]
Abstract
RATIONALE The relative actions and synergism between distinct myocardial-derived stem cell populations remain obscure. Ongoing debates on optimal cell population(s) for treatment of heart failure prompted implementation of a protocol for isolation of multiple stem cell populations from a single myocardial tissue sample to develop new insights for achieving myocardial regeneration. OBJECTIVE Establish a robust cardiac stem cell isolation and culture protocol to consistently generate 3 distinct stem cell populations from a single human heart biopsy. METHODS AND RESULTS Isolation of 3 endogenous cardiac stem cell populations was performed from human heart samples routinely discarded during implantation of a left ventricular assist device. Tissue explants were mechanically minced into 1 mm3 pieces to minimize time exposure to collagenase digestion and preserve cell viability. Centrifugation removes large cardiomyocytes and tissue debris producing a single cell suspension that is sorted using magnetic-activated cell sorting technology. Initial sorting is based on tyrosine-protein kinase Kit (c-Kit) expression that enriches for 2 c-Kit+ cell populations yielding a mixture of cardiac progenitor cells and endothelial progenitor cells. Flowthrough c-Kit- mesenchymal stem cells are positively selected by surface expression of markers CD90 and CD105. After 1 week of culture, the c-Kit+ population is further enriched by selection for a CD133+ endothelial progenitor cell population. Persistence of respective cell surface markers in vitro is confirmed both by flow cytometry and immunocytochemistry. CONCLUSIONS Three distinct cardiac cell populations with individualized phenotypic properties consistent with cardiac progenitor cells, endothelial progenitor cells, and mesenchymal stem cells can be successfully concurrently isolated and expanded from a single tissue sample derived from human heart failure patients.
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Affiliation(s)
- Megan M Monsanto
- From the San Diego Heart Research Institute, San Diego State University, CA (M.M.M., K.S.W., T.K., B.J.W., K.F., K.I., F.G.K., A.C., K.B., S.M., M.A.S.); and Sharp Memorial Hospital, San Diego, CA (W.P.D.)
| | - Kevin S White
- From the San Diego Heart Research Institute, San Diego State University, CA (M.M.M., K.S.W., T.K., B.J.W., K.F., K.I., F.G.K., A.C., K.B., S.M., M.A.S.); and Sharp Memorial Hospital, San Diego, CA (W.P.D.)
| | - Taeyong Kim
- From the San Diego Heart Research Institute, San Diego State University, CA (M.M.M., K.S.W., T.K., B.J.W., K.F., K.I., F.G.K., A.C., K.B., S.M., M.A.S.); and Sharp Memorial Hospital, San Diego, CA (W.P.D.)
| | - Bingyan J Wang
- From the San Diego Heart Research Institute, San Diego State University, CA (M.M.M., K.S.W., T.K., B.J.W., K.F., K.I., F.G.K., A.C., K.B., S.M., M.A.S.); and Sharp Memorial Hospital, San Diego, CA (W.P.D.)
| | - Kristina Fisher
- From the San Diego Heart Research Institute, San Diego State University, CA (M.M.M., K.S.W., T.K., B.J.W., K.F., K.I., F.G.K., A.C., K.B., S.M., M.A.S.); and Sharp Memorial Hospital, San Diego, CA (W.P.D.)
| | - Kelli Ilves
- From the San Diego Heart Research Institute, San Diego State University, CA (M.M.M., K.S.W., T.K., B.J.W., K.F., K.I., F.G.K., A.C., K.B., S.M., M.A.S.); and Sharp Memorial Hospital, San Diego, CA (W.P.D.)
| | - Farid G Khalafalla
- From the San Diego Heart Research Institute, San Diego State University, CA (M.M.M., K.S.W., T.K., B.J.W., K.F., K.I., F.G.K., A.C., K.B., S.M., M.A.S.); and Sharp Memorial Hospital, San Diego, CA (W.P.D.)
| | - Alexandria Casillas
- From the San Diego Heart Research Institute, San Diego State University, CA (M.M.M., K.S.W., T.K., B.J.W., K.F., K.I., F.G.K., A.C., K.B., S.M., M.A.S.); and Sharp Memorial Hospital, San Diego, CA (W.P.D.)
| | - Kathleen Broughton
- From the San Diego Heart Research Institute, San Diego State University, CA (M.M.M., K.S.W., T.K., B.J.W., K.F., K.I., F.G.K., A.C., K.B., S.M., M.A.S.); and Sharp Memorial Hospital, San Diego, CA (W.P.D.)
| | - Sadia Mohsin
- From the San Diego Heart Research Institute, San Diego State University, CA (M.M.M., K.S.W., T.K., B.J.W., K.F., K.I., F.G.K., A.C., K.B., S.M., M.A.S.); and Sharp Memorial Hospital, San Diego, CA (W.P.D.)
| | - Walter P Dembitsky
- From the San Diego Heart Research Institute, San Diego State University, CA (M.M.M., K.S.W., T.K., B.J.W., K.F., K.I., F.G.K., A.C., K.B., S.M., M.A.S.); and Sharp Memorial Hospital, San Diego, CA (W.P.D.)
| | - Mark A Sussman
- From the San Diego Heart Research Institute, San Diego State University, CA (M.M.M., K.S.W., T.K., B.J.W., K.F., K.I., F.G.K., A.C., K.B., S.M., M.A.S.); and Sharp Memorial Hospital, San Diego, CA (W.P.D.).
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16
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Doroudgar S, Quijada P, Konstandin M, Ilves K, Broughton K, Khalafalla FG, Casillas A, Nguyen K, Gude N, Toko H, Ornelas L, Thuerauf DJ, Glembotski CC, Sussman MA, Völkers M. S100A4 protects the myocardium against ischemic stress. J Mol Cell Cardiol 2016; 100:54-63. [PMID: 27721024 DOI: 10.1016/j.yjmcc.2016.10.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 09/13/2016] [Accepted: 10/04/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Myocardial infarction is followed by cardiac dysfunction, cellular death, and ventricular remodeling, including tissue fibrosis. S100A4 protein plays multiple roles in cellular survival, and tissue fibrosis, but the relative role of the S100A4 in the myocardium after myocardial infarction is unknown. This study aims to investigate the role of S100A4 in myocardial remodeling and cardiac function following infarct damage. METHODS AND RESULTS S100A4 expression is low in the adult myocardium, but significantly increased following myocardial infarction. Deletion of S100A4 increased cardiac damage after myocardial infarction, whereas cardiac myocyte-specific overexpression of S100A4 protected the infarcted myocardium. Decreased cardiac function in S100A4 Knockout mice was accompanied with increased cardiac remodeling, fibrosis, and diminished capillary density in the remote myocardium. Loss of S100A4 caused increased apoptotic cell death both in vitro and in vivo in part mediated by decreased VEGF expression. Conversely, S100A4 overexpression protected cells against apoptosis in vitro and in vivo. Increased pro-survival AKT-signaling explained reduced apoptosis in S100A4 overexpressing cells. CONCLUSION S100A4 expression protects cardiac myocytes against myocardial ischemia and is required for stabilization of cardiac function after MI.
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Affiliation(s)
- Shirin Doroudgar
- The San Diego State Heart Institute and Department of Biology, San Diego State University, San Diego, CA 92182, USA; University Hospital Heidelberg, Internal Medicine III, Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany
| | - Pearl Quijada
- The San Diego State Heart Institute and Department of Biology, San Diego State University, San Diego, CA 92182, USA
| | - Mathias Konstandin
- The San Diego State Heart Institute and Department of Biology, San Diego State University, San Diego, CA 92182, USA; University Hospital Heidelberg, Internal Medicine III, Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany
| | - Kelli Ilves
- The San Diego State Heart Institute and Department of Biology, San Diego State University, San Diego, CA 92182, USA
| | - Kathleen Broughton
- The San Diego State Heart Institute and Department of Biology, San Diego State University, San Diego, CA 92182, USA
| | - Farid G Khalafalla
- The San Diego State Heart Institute and Department of Biology, San Diego State University, San Diego, CA 92182, USA
| | - Alexandria Casillas
- The San Diego State Heart Institute and Department of Biology, San Diego State University, San Diego, CA 92182, USA
| | - Kristine Nguyen
- The San Diego State Heart Institute and Department of Biology, San Diego State University, San Diego, CA 92182, USA
| | - Natalie Gude
- The San Diego State Heart Institute and Department of Biology, San Diego State University, San Diego, CA 92182, USA
| | - Haruhiro Toko
- The San Diego State Heart Institute and Department of Biology, San Diego State University, San Diego, CA 92182, USA
| | - Luis Ornelas
- The San Diego State Heart Institute and Department of Biology, San Diego State University, San Diego, CA 92182, USA
| | - Donna J Thuerauf
- The San Diego State Heart Institute and Department of Biology, San Diego State University, San Diego, CA 92182, USA
| | - Christopher C Glembotski
- The San Diego State Heart Institute and Department of Biology, San Diego State University, San Diego, CA 92182, USA
| | - Mark A Sussman
- The San Diego State Heart Institute and Department of Biology, San Diego State University, San Diego, CA 92182, USA
| | - Mirko Völkers
- The San Diego State Heart Institute and Department of Biology, San Diego State University, San Diego, CA 92182, USA; University Hospital Heidelberg, Internal Medicine III, Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany.
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