Release of plasmid DNA from intravascular stents coated with ultrathin multilayered polyelectrolyte films

Materials that permit control over the release of DNA from the surfaces of topologically complex implantable devices, such as intravascular stents, could contribute to the development of new approaches to the localized delivery of DNA. We report the fabrication of ultrathin, multilayered polyelectrolyte films that permit both the immobilization and controlled release of plasmid DNA from the surfaces of stainless steel intravascular stents. Our approach makes use of an aqueous-based, layer-by-layer method for the assembly of nanostructured thin films consisting of alternating layers of plasmid DNA and a hydrolytically degradable polyamine. Characterization of coated stents using scanning electron microscopy (SEM) demonstrated that stents were coated uniformly with an ultrathin film ca. 120 nm thick that adhered conformally to the surfaces of stent struts. These ultrathin films did not crack, peel, or delaminate substantially from the surface after exposure to a range of mechanical challenges representative of those encountered during stent deployment (e.g., balloon expansion). Stents coated with eight bilayers of degradable polyamine and a plasmid encoding enhanced green fluorescent protein (EGFP) sustained the release of DNA into solution for up to four days when incubated in phosphate buffered saline at 37 degrees C, and coated stents were capable of mediating the expression of EGFP in a mammalian cell line without the aid of additional transfection agents. The approach reported here could, with further development, contribute to the development of localized gene-based approaches to the treatment of cardiovascular diseases or related conditions.

Transplantation of embryonic stem cells into the infarcted mouse heart: formation of multiple cell types

Initial studies have suggested that transplantation of embryonic stem (ES) cells following myocardial infarction (MI) in animal models is beneficial; however, the mechanism of benefit is largely unknown. The present study investigated the fate of mouse ES cells transplanted post-MI to determine if the ES cells give rise to the range of major cell types present in the native myocardium. MI was produced by coronary artery ligation in C57BL/6 mice. Two different mouse ES cell lines, expressing eGFP and beta-galactosidase, respectively, were tested. Post-MI intramyocardial injection of 3 x 10(4) ES cells was compared to injection of media alone. Histochemistry and immunofluorescence were used to track the transplanted ES cells and identify the resulting cell types. Echocardiography assessed the cardiac size and function in a blinded fashion. Two weeks post-MI, engraftment of the transplanted ES cells was demonstrated by eGFP or beta-galactosidase-positive cells in the infarct region without evidence for tumor formation. Co-immunolabeling demonstrated that the transplanted ES cells had become cardiomyocytes, vascular smooth muscle, and endothelial cells. Echocardiographic analysis showed that ES cell transplantation resulted in reduced post-MI remodeling of the heart and improved cardiac function. In conclusion, transplanted mouse ES cells can regenerate infarcted myocardium in part by becoming cardiomyocytes, vascular smooth muscle, and endothelial cells that result in an improvement in cardiac structure and function. Therefore, ES cells hold promise for myocardial cellular therapy.

Age-related changes in cardiac structure and function in Fischer 344 x Brown Norway hybrid rats

The effects of aging on cardiovascular function and cardiac structure were determined in a rat model recommended for gerontological studies. A cross-sectional analysis assessed cardiac changes in male Fischer 344 x Brown Norway F1 hybrid rats (FBN) from adulthood to the very aged (n = 6 per 12-, 18-, 21-, 24-, 27-, 30-, 33-, 36-, and 39-mo-old group). Rats underwent echocardiographic and hemodynamic analyses to determine standard values for left ventricular (LV) mass, LV wall thickness, LV chamber diameter, heart rate, LV fractional shortening, mitral inflow velocity, LV relaxation time, and aortic/LV pressures. Histological analyses were used to assess LV fibrotic infiltration and cardiomyocyte volume density over time. Aged rats had an increased LV mass-to-body weight ratio and deteriorated systolic function. LV systolic pressure declined with age. Histological analysis demonstrated a gradual increase in fibrosis and a decrease in cardiomyocyte volume density with age. We conclude that, although significant physiological and morphological changes occurred in heart function and structure between 12 and 39 mo of age, these changes did not likely contribute to mortality. We report reference values for cardiac function and structure in adult FBN male rats through very old age at 3-mo intervals.

Distinct mouse coronary anatomy and myocardial infarction consequent to ligation

This study describes the coronary anatomy of C57BL/6 mice and the functional impact of that anatomy on myocardial infarctions induced by ligation of the left coronary artery. In contrast to humans, a distinct septal coronary artery was observed in all mice arising either from a separate ostium from the right sinus of Valsalva or as a branch of the right coronary artery. Ligation of the left coronary artery at the site of its emergence from under the left atrium resulted in reproducible large myocardial infarctions involving the anterolateral, posterior, and apical regions of the heart as evidenced by histology and echocardiography. Interestingly, the septum was spared from infarction as predicted by the presence of the distinct septal branch found in mice. Thus, the distinct mouse coronary artery anatomy results in different regionality of infarction compared with man and large laboratory animals, and this may affect on the associated pathological remodeling of the heart.

BACKGROUND

The objective of this study was to describe the coronary anatomy of C57BL/6 mice and determine the functional impact of that anatomy on myocardial infarctions induced by ligation of the left coronary artery.

METHODS

C57BL/6 mice were used to visualize mouse coronary anatomy and to generate myocardial infarction. Mouse coronary artery visualization was performed on isolated hearts using injection of Silastic sealant into the aortic arch. After left thoracotomy myocardial infarction was produced by ligating the left coronary artery at the site of the vessels' emergence past the tip of the left atrium. Echocardiography was performed to analyze heart function, and histology was performed to delineate myocardial infarction.

RESULTS

The different septal coronary artery was observed in all mice arising either from a separate ostium from the right sinus of Valsalva or as a branch of the right coronary artery. The mouse left coronary artery passed obliquely across the left ventricular free wall similar to the ramus intermedius coronary artery variant in man. Ligation of the left coronary artery as it emerged from under the left atrium resulted in reproducible large infarctions involving the anterolateral, posterior, and apical regions of the heart as demonstrated by histology and echocardiography. Notably, the septum was spared from infarction as predicted by the presence of the distinct septal coronary artery found in mice.

CONCLUSIONS

Mouse coronary anatomy is distinct compared to man or large laboratory animals, and myocardial infarctions resulting from ligation of the mouse left coronary artery spare the septum, which may affect the pathological remodeling of the heart.

Hypertrophic cardiomyopathy in cardiac myosin binding protein-C knockout mice

Familial hypertrophic cardiomyopathy (FHC) is an inherited autosomal dominant disease caused by mutations in sarcomeric proteins. Among these, mutations that affect myosin binding protein-C (MyBP-C), an abundant component of the thick filaments, account for 20% to 30% of all mutations linked to FHC. However, the mechanisms by which MyBP-C mutations cause disease and the function of MyBP-C are not well understood. Therefore, to assess deficits due to elimination of MyBP-C, we used gene targeting to produce a knockout mouse that lacks MyBP-C in the heart. Knockout mice were produced by deletion of exons 3 to 10 from the endogenous cardiac (c) MyBP-C gene in murine embryonic stem (ES) cells and subsequent breeding of chimeric founder mice to obtain mice heterozygous (+/-) and homozygous (-/-) for the knockout allele. Wild-type (+/+), cMyBP-C(+/-), and cMyBP-C(-/-) mice were born in accordance with Mendelian inheritance ratios, survived into adulthood, and were fertile. Western blot analyses confirmed that cMyBP-C was absent in hearts of homozygous knockout mice. Whereas cMyBP-C(+/-) mice were indistinguishable from wild-type littermates, cMyBP-C(-/-) mice exhibited significant cardiac hypertrophy. Cardiac function, assessed using 2-dimensionally guided M-mode echocardiography, showed significantly depressed indices of diastolic and systolic function only in cMyBP-C(-/-) mice. Ca2+ sensitivity of tension, measured in single skinned myocytes, was reduced in cMyBP-C(-/-) but not cMyBP-C(+/-) mice. These results establish that cMyBP-C is not essential for cardiac development but that the absence of cMyBP-C results in profound cardiac hypertrophy and impaired contractile function.

Age- and gender-related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds

BACKGROUND AND PURPOSE

The interpretation of patient scores on clinical tests of physical mobility is limited by a lack of data describing the range of performance among people without disabilities. The purpose of this study was to provide data for 4 common clinical tests in a sample of community-dwelling older adults.

SUBJECTS

Ninety-six community-dwelling elderly people (61-89 years of age) with independent functioning performed 4 clinical tests.

METHODS

Data were collected on the Six-Minute Walk Test (6MW), Berg Balance Scale (BBS), and Timed Up & Go Test (TUG) and during comfortable- and fast-speed walking (CGS and FGS). Intraclass correlation coefficients (ICCs) were used to determine the test-retest reliability for the 6MW, TUG, CGS, and FGS measurements. Data were analyzed by gender and age (60-69, 70-79, and 80-89 years) cohorts, similar to previous studies. Means, standard deviations, and 95% confidence intervals for each measurement were calculated for each cohort.

RESULTS

The 6MW, TUG, CGS, and FGS measurements showed high test-retest reliability (ICC [2,1]=.95-.97). Mean test scores showed a trend of age-related declines for the 6MW, BBS, TUG, CGS, and FGS for both male and female subjects.

DISCUSSION AND CONCLUSION

Preliminary descriptive data suggest that physical therapists should use age-related data when interpreting patient data obtained for the 6MW, BBS, TUG, CGS and FGS. Further data on these clinical tests with larger sample sizes are needed to serve as a reference for patient comparisons.

The role of glucose metabolism in a pig heart model of short-term hibernation

Previously, we reported, alterations in glucose metabolism in a 4 day model of chronic coronary stenosis similar to those described in patients with hibernating hearts. The purpose of this study was 2 fold: (1) to identify whether an acute model of mild, sustained ischemia could effect similar changes, and (2) to determine the effects of pharmacological inhibition of glycolysis. In the first group, extracorporeally perfused, intact pig hearts were subjected to 85 min of a 40% reduction in left anterior descending (LAD) coronary arterial blood flow. A second group was subjected to the same protocol, except after 40 min of LAD regional ischemia, iodoacetate (IAA) was administered to block glycolysis. Ischemia reduced MVO2 by 10% in both groups with a further 20% reduction noted following IAA treatment. Regional systolic shortening was reduced nearly 50% by ischemia and decreased an additional 40% following treatment with IAA. Glycolysis was increased by over 700% with ischemia in the first group. IAA caused a 3 fold reduction in glycolysis as compared to the preceding ischemic period and inhibited lactate production. Fatty acid metabolism was significantly reduced by ischemia in the first group, but was not reduced in the IAA group. Activity of creatine kinase associated with myofibrils was reduced and may have contributed to the contractile dysfunction. In conclusion, this acute model of short-term hibernation demonstrates several metabolic changes previously reported in chronic hibernation and may prove useful in determining mechanisms of substrate utilization in simulated conditions of chronic coronary stenosis and hibernation.

Effect of repetitive stunning on myocardial metabolism in pig hearts

Recent animal and clinical studies have suggested that chronic hibernation, a condition of depressed mechanical function and enhanced glycolysis in viable but downregulated myocardium, may result from chronic repetitive ischemia and reperfusion. The present study was conducted to test whether similar trends could be reproduced in an acute animal preparation of repetitive stunning. Eight intact pig hearts were extracorporeally perfused for 115 min and subjected to four cycles of ischemia [60% decrease in anterior descending flow for 5 min each, interspersed with 15 min of aerobic reperfusion]. Each bout of ischemia caused a progressive decline in regional systolic shortening such that systolic shortening was 37% lower at end-reperfusion (P < 0.05 vs. initial conditions). Regional myocardial O2 consumption was reduced during ischemia but was not significantly lower at end-reperfusion compared with that under initial conditions. Fatty acid oxidation was unchanged at any point during the trials. Although glucose utilization was increased by an average of 264% during the four ischemic periods, it was not significantly or progressively increased during the reperfusion periods. Therefore, although this acute stunning protocol depressed mechanical function, it did not cumulatively increase glycolysis during reperfusion. This absence of accelerated glycolysis is at variance with the metabolic findings reported in clinical hibernation and raises concerns regarding this protocol in animal studies designed to simulate short-term hibernation.

Decreased myocardial glucose uptake during ischemia in diabetic swine

The purpose of the study was to assess myocardial glucose uptake in nondiabetic (n = 5) and streptozotocin-diabetic (n = 6) Yucatan miniature swine under matched hyperglycemic and hypoinsulinemic conditions. Fasting conscious diabetic swine had significantly higher plasma glucose levels (20.9 +/- 2.6 v 5.2 +/- 0.3 mmol/L) and lower insulin levels (6 +/- 1 v 14 +/- 4 microU/mL) than nondiabetic animals. Myocardial glucose uptake was measured in open-chest anesthetized animals under aerobic and ischemic conditions 12 weeks after streptozotocin treatment. Coronary blood flow was controlled by an extracorporeal perfusion circuit. Ischemia was induced by reducing left anterior descending (LAD) coronary artery blood flow by 60% for 40 minutes. Animals were treated with somatostatin to suppress insulin secretion, and nondiabetic swine received intravenous (IV) glucose to match the hyperglycemia in the diabetic animals. The rate of glucose uptake by the myocardium was not statistically different under aerobic conditions, but was significantly lower in diabetic swine during ischemia (0.20 +/- 0.08 v 0.63 +/- 0.14 micromol x g(-1) x min(-1), P < .01). Myocardial glucose transporter (GLUT4) protein concentration was decreased by 31% in diabetic swine. In conclusion, 12 weeks of streptozotocin diabetes in swine caused a significant decrease in myocardial GLUT4 protein and a decrease in myocardial glucose uptake during ischemia.

Effects of moderate repetitive ischemia on myocardial substrate utilization

The purpose of this report was to directly measure the influence of antecedent ischemia or repetitive ischemia on subsequent rates of intermediary metabolism, specifically exogenous glucose utilization and fatty acid oxidation, with the use of myocardial equilibrium labeling with [U-14C]palmitate and [5-3H]glucose. Twenty-one intact, working, extracorporeally perfused pig hearts were prepared and divided into three groups. These groups included 7 control hearts and 14 comparison hearts, which were exposed to either one cycle (cycle 1, n = 7) or four cycles (cycle 4, n = 7) of brief (5-10 min), moderate (70% decrease in flow below aerobic values) precursory ischemia to the left anterior descending (LAD) circulation followed by aerobic reperfusion. All groups then underwent a 40 min sustained LAD ischemia (60% decrease in flow below aerobic levels) and 40 min aerobic reperfusion. Treatment with one cycle of transient ischemia did not significantly modify the pattern of glycolytic flux from control values during sustained ischemia (over a ninefold increase in average control and cycle 1 values above aerobic levels). However, repetitive ischemia in cycle 4 hearts demonstrably attenuated glycolytic flux during the same interval (-45% from control hearts, P < 0.046). Glucose utilization rapidly returned to near-aerobic values in all three groups during reperfusion but was again appreciably lower (P < 0.004 from control values) in cycle 4 hearts. Fatty acid oxidation averaged 12.3 +/- 1.2 mumol.h-1.g dry wt-1 in all three groups during sustained ischemia and 21.3 +/- 2.0 mumol.h-1.g dry wt-1 during reperfusion (not significant among groups for either perfusion interval).(ABSTRACT TRUNCATED AT 250 WORDS)

Ischemia produces an increase in ammonia output in swine myocardium

We have recently reported that ischemia causes myocardial ammonia production which is not due to amino acid breakdown. The purpose of this study was to identify the remaining possible sources of ammonia production. The prospects were either deamination of AMP to inosine monophosphate (IMP), or adenosine to inosine. Eight intact extracorporally perfused pig hearts were rendered regionally ischemic by reducing the left anterior descending coronary artery blood flow by 60% for 40 minutes. Adjacent myocardium supplied by the circumflex artery was held aerobic throughout the study. Myocardial oxygen consumption and regional systolic shortening in the left anterior descending perfusion bed fell by 50 and 32%, respectively. Myocardial ammonia production increased significantly (p = 0.008) and tissue ammonia concentration was 55% greater in the ischemic left anterior descending bed than in the aerobic circumflex bed (p = 0.003). Compared to the circumflex bed, ATP and creatine phosphate concentrations in the left anterior descending bed were decreased by 41 and 53%, respectively. There were no significant increases in AMP or IMP levels, however there were dramatic increases of 525 and 397% in adenosine and inosine levels in the ischemic tissue. Thus, myocardial ammonia production was stimulated by ischemia without an increase in IMP levels. Combined with the fact that adenylate deaminase levels in the swine myocardium are normally low, this leads to the likely conclusion that source of the increased myocardial ammonia production during ischemia is deamination of adenosine, not IMP formation from AMP.

Myocardial glucose transporters and glycolytic metabolism during ischemia in hyperglycemic diabetic swine

We assessed the effects of 4 weeks of streptozocin-induced diabetes on regional myocardial glycolytic metabolism during ischemia in anesthetized open-chest domestic swine. Diabetic animals were hyperglycemic (12.0 +/- 2.1 v 6.6 +/- .5 mmol/L), and had lower fasting insulin levels (27 +/- 8 v 79 +/- 19 pmol/L). Myocardial glycolytic metabolism was studied with coronary flow controlled by an extracorporeal perfusion circuit. Left anterior descending coronary artery (LAD) flow was decreased by 50% for 45 minutes and left circumflex (CFX) flow was constant. Myocardial glucose uptake and extraction were measured with D-[6-3H]-2-deoxyglucose (DG) and myocardial blood flow was measured with microspheres. The rate of glucose conversion to lactate and lactate uptake and output were assessed with a continuous infusion of [6-14C]glucose and [U-13C]lactate into the coronary perfusion circuit. Both diabetic and nondiabetic animals had sharp decreases in subendocardial blood flow during ischemia (from 1.21 +/- .10 to 0.43 +/- .08 mL.g-1.min-1 in the nondiabetic group, and from 1.30 +/- .15 to 0.55 +/- .11 in the diabetic group). Diabetes had no significant effect on myocardial glucose uptake or glucose conversion to lactate under either well-perfused or ischemic conditions. Forty-five minutes of ischemia resulted in significant glycogen depletion in the subendocardium in both nondiabetic and diabetic animals, with no differences between the two groups. Glycolytic metabolism is not impaired in hyperglycemic diabetic swine after 1 month of the disease when compared with that in normoglycemic nondiabetic animals. The myocardial content of the insulin-regulatable glucose transporter (GLUT 4) was measured in left ventricular biopsies.(ABSTRACT TRUNCATED AT 250 WORDS)

Alanine, glutamate, and ammonia exchanges in acutely ischemic swine myocardium

Coronary artery disease causes an increase in glutamate uptake and alanine output by the heart. We assessed the effects of acute myocardial ischemia on alanine and glutamate exchange and ammonia production in 10 anesthetized open-chest domestic swine (46.9 +/- 0.7 kg). Coronary blood flow was controlled through an extracorporal perfusion circuit. After a nonischemic control period (aerobic) the blood flow in the left anterior descending coronary artery was reduced by 60%. Arterial and anterior interventricular venous samples where drawn before and during 35 min of ischemia. Subendocardial blood flow, measured using radiolabeled microspheres, decreased from 1.27 +/- 0.16 to 0.25 +/- 0.09 (ml/g)/min, and left-ventricular wall-thickening fell to 47% of aerobic values. Ischemia resulted in a significant increase in the rate of glucose uptake (p less than 0.05) and a switch to net lactate production (p less than 0.01). Ischemia did not affect the rates of alanine output (-0.9 +/- 1.0 vs. -0.3 +/- 0.3 mumol/min) or glutamate uptake (-0.4 +/- 1.1 vs. 0.3 +/- 0.6 mumol/min), but did increase the venous-arterial difference for ammonia (-4.1 +/- 4.1 to 52.7 +/- 5.5 microM, p less than 0.0001) and the ammonia output (-0.33 +/- 0.24 to 1.34 +/- 0.14 mumol/min, p less than 0.0001). In conclusion, acute ischemia did not stimulate greater alanine output or glutamate uptake. However, acute ischemia did cause an increase in anaerobic glycolysis rate and ammonia output, which reflects a profound disruption in myocardial energy metabolism.

Acute myocardial ischemia causes a transmural gradient in glucose extraction but not glucose uptake

We assessed the relationship between myocardial glucose metabolism and blood flow during ischemia in eight open-chest swine. Coronary flow was controlled by an extracorporeal perfusion circuit. Left anterior descending coronary arterial (LAD) flow was reduced by 60%, while left circumflex flow was normally perfused. The rate of glucose uptake (Rg) was measured with a coronary infusion of 2-deoxy-D-[14C]glucose and myocardial blood flow with radiolabeled microspheres. Myocardial biopsies were taken after 50 min of ischemia. Regional arterial-venous glucose difference was calculated as Rg per myocardial blood flow. Subendocardial blood flow decreased from 1.27 +/- 0.19 to 0.25 +/- 0.11 ml.g-1.min-1 (P less than 0.0001). The subendocardial arterial-venous glucose difference was greater in the LAD bed (1.38 +/- 0.35 mumol/ml) than the left circumflex coronary arterial perfusion bed (0.10 +/- 03; P less than 0.01); however, there was no statistically significant difference in the rate of glucose uptake between the two beds. Subendocardial glycogen concentration in the LAD perfusion bed was reduced to 26% of circumflex bed values. In conclusion, acute ischemia stimulated a dramatic increase in glucose extraction; however, this did not compensate for the decrease in blood flow, and thus the rate of glucose uptake did not increase significantly. The high rate of glycolysis is primarily supported by accelerated net glycogen breakdown rather than increased glucose uptake.

Antibodies to donor B lymphocytes and autoantibodies in renal transplantation

A positive CDC B-lymphocyte XM is not deleterious to long-term graft outcome. A positive unfractionated CDC XM is not a contraindication to transplantation if the positive crossmatch is due entirely to anti-B-lymphocyte antibody. B-lymphocyte autoantibodies are common in hemodialysis patients, but may account for only a minority of positive B-lymphocyte XMs.