Static frictional resistance with the slide low-friction elastomeric ligature system

AIM

This ex-vivo study compared the static frictional resistance of a low-friction ligation system against a conventional elastomeric module, and studied the effect of storage in a simulated oral environment on the static frictional resistance of both ligation systems.

METHODS

Eighty stainless steel brackets were tested by sliding along straight lengths of 0.018 inch round and 0.019 x 0.025 inch rectangular stainless steel wires ligated with either conventional elastomerics or the Slide system (Leone, Florence, Italy). During the tests the brackets and wires were lubricated with artificial saliva. A specially constructed jig assembly was used to hold the bracket and archwire securely. The jig was clamped in an Instron universal load testing machine. Crosshead speed was controlled via a microcomputer connected to the Instron machine. The static frictional forces at 0 degree bracket/wire angulation were measured for both systems, fresh from the pack and after storage in artificial saliva at 37 degrees C for 24 hours.

RESULTS

The results of this investigation demonstrated that the Slide ligatures produced significantly lower static frictional resistance than conventional elastomeric modules in the fresh condition and after 24 hours of storage in a simulated oral environment (p < 0.001). Storage for 24 hours in artificial saliva had no effect on the static frictional resistance of conventional elastomeric modules and the Slide system (p = 0.525).

CONCLUSIONS

The claim by the manufacturer that the Slide system produces lower frictional resistance than conventional elastomeric modules is upheld.

O-GlcNAc signaling attenuates ER stress-induced cardiomyocyte death

We previously demonstrated that the O-linked beta-N-acetylglucosamine (O-GlcNAc) posttranslational modification confers cardioprotection at least partially through mitochondrial-dependent mechanisms, but it remained unclear if O-GlcNAc signaling interfered with other mechanisms of cell death. Because ischemia/hypoxia causes endoplasmic reticulum (ER) stress, we ascertained whether O-GlcNAc signaling could attenuate ER stress-induced cell death per se. Before induction of ER stress (with tunicamycin or brefeldin A), we adenovirally overexpressed O-GlcNAc transferase (AdOGT) or pharmacologically inhibited O-GlcNAcase [via O-(2-acetamido-2-deoxy-d-glucopyranosylidene) amino-N-phenylcarbamate] to augment O-GlcNAc levels or adenovirally overexpressed O-GlcNAcase to reduce O-GlcNAc levels. AdOGT significantly (P < 0.05) attenuated the activation of the maladaptive arm of the unfolded protein response [according to C/EBP homologous protein (CHOP) activation] and cardiomyocyte death (reflected by percent propidium iodide positivity). Moreover, pharmacological inhibition of O-GlcNAcase significantly (P < 0.05) mitigated ER stress-induced CHOP activation and cardiac myocyte death. Interestingly, overexpression of GCA did not alter ER stress markers but exacerbated brefeldin A-induced cardiomyocyte death. We conclude that enhanced O-GlcNAc signaling represents a partially proadaptive response to reduce ER stress-induced cell death. These results provide new insights into a possible interaction between O-GlcNAc signaling and ER stress and may partially explain a mechanism of O-GlcNAc-mediated cardioprotection.

Comparison of fluoridated apatites with pure hydroxyapatite as potential biomimetic alternatives to enamel for laboratory-based bond strength studies

AIM

To investigate whether fluoridated apatites have a shear bond strength which more closely equates to that of natural enamel than pure hydroxyapatite, making them potentially useful as biomimetic alternatives to natural enamel for ex vivo laboratory bonding studies.

METHODS

Discs of pure hydroxyapatite, pure fluorapatite and a 1:1 mixture of hydroxyapatite-fluorapatite were produced by cold uni-axial pressing. The discs were sintered at 1300 degrees C, embedded in epoxy resin, ground and polished. X-ray diffraction technique was used to analyse the purity of the apatites. Scanning electron microscopy was employed to investigate the etch patterns of the apatite specimens. Ninely-six upper left central incisor brackets were bonded to each of the three groups of discs. Shear bond strengths were determined by debonding the brackets using a loaded metal jig in an Instron Universal Testing Machine. The sites of bond failure were recorded using the Adhesive Remnant Index. One-way analysis of variance (ANOVA) and Bonferroni post-hoc comparisons were used to determine statistical differences between the mean shear bond strengths of the three specimen groups.

RESULTS

The mean shear bond strength of pure hydroxyapatite (20.44 MPa; SD: 8.03; 95% CI: 18.81, 22.07) was significantly higher than those of fluorapatite (13.13 MPa; SD: 6.76; 95% CI: 11.76, 14.50) and hydroxyapatitefluorapatite (13.62 MPa; SD: 7.03; 95% CI: 12.19, 15.04) (p < 0.001). There was no statistically significant difference in shear bond strengths between fluorapatite and hydroxyapatite-fluorapatite (p > 0.99), and both were below the normal range ascribed to enamel (15-20 MPa). More than 90 per cent of the fluorapatite and the hydroxyapatite-fluorapatite specimens demonstrated bond failure at the substrate-adhesive interface, while only one-third of the hydroxyapatite specimens exhibited bond failure at that interface.

CONCLUSION

Pure fluorapatite and hydroxyapatite-fluorapatite specimens offer no advantage over pure hydroxyapatite as a suitable artificial substrate for ex vivo bond strength testing.

Unique hexosaminidase reduces metabolic survival signal and sensitizes cardiac myocytes to hypoxia/reoxygenation injury

Metabolic signaling through the posttranslational linkage of N-acetylglucosamine (O-GlcNAc) to cellular proteins represents a unique signaling paradigm operative during lethal cellular stress and a pathway that we and others have recently shown to exert cytoprotective effects in vitro and in vivo. Accordingly, the present work addresses the contribution of the hexosaminidase responsible for removing O-GlcNAc (ie, O-GlcNAcase) from proteins. We used pharmacological inhibition, viral overexpression, and RNA interference of O-GlcNAcase in isolated cardiac myocytes to establish its role during acute hypoxia/reoxygenation. Elevated O-GlcNAcase expression significantly reduced O-GlcNAc levels and augmented posthypoxic cell death. Conversely, short interfering RNA directed against, or pharmacological inhibition of, O-GlcNAcase significantly augmented O-GlcNAc levels and reduced posthypoxic cell death. On the mechanistic front, we evaluated posthypoxic mitochondrial membrane potential and found that repression of O-GlcNAcase activity improves, whereas augmentation impairs, mitochondrial membrane potential recovery. Similar beneficial effects on posthypoxic calcium overload were also evident. Such changes were evident without significant alteration in expression of the major putative components of the mitochondrial permeability transition pore (ie, voltage-dependent anion channel, adenine nucleotide translocase, cyclophilin D). The present results provide definitive evidence that O-GlcNAcase antagonizes posthypoxic cardiac myocyte survival. Moreover, such results support a renewed approach to the contribution of metabolism and metabolic signaling to the determination of cell fate.

New insights into metabolic signaling and cell survival: the role of beta-O-linkage of N-acetylglucosamine

The involvement of glucose in fundamental metabolic pathways represents a core element of biology. Late in the 20th century, a unique glucose-derived signal was discovered, which appeared to be involved in a variety of cellular processes, including mitosis, transcription, insulin signaling, stress responses, and potentially, Alzheimer's disease, and diabetes. By definition, this glucose-fed signaling system was a post-translational modification to proteins. However, unlike classical cotranslational N-glycosylation occurring in the endoplasmic reticulum and Golgi apparatus, this process occurs elsewhere throughout the cell in a highly dynamic fashion, similar to the quintessential post-translational modification, phosphorylation. This more recently described post-translational modification, the beta-O-linkage of N-acetylglucosamine (i.e., O-GlcNAc) to nucleocytoplasmic proteins, represents an under-investigated area of biology. This signaling system operates in all of the tissues examined and seems to have persisted throughout all multicellular eukaryotes. Thus, it comes with little surprise that O-GlcNAc signaling is an integral system and viable target for biomedical investigation. This system may be a boundless source for insight into a variety of diseases and yield numerous opportunities for drug design. This Perspective will address recent insights into O-GlcNAc signaling in the cardiovascular system as a paradigm for its involvement in other biological systems.

An ex vivo laboratory study to determine the static frictional resistance of a variable ligation orthodontic bracket system

OBJECTIVE

To determine the effects of static frictional resistance on varying the ligation technique in a Delta Force bracket system (Ortho Organizers Ltd, Hampton, UK) and using increasing degrees of bracket/archwire angulation to simulate binding.

DESIGN

An ex vivo laboratory investigation using the Instron Universal Testing Machine (Instron Ltd, High Wycombe, UK) to generate sliding forces on an archwire through the Delta Force bracket. The system was lubricated with Saliva Orthana artificial saliva (Nycomed Ltd, Buckinghamshire, UK).

SETTING

Biomaterials Laboratory, Eastman Dental Institute, London, UK.

MATERIALS AND METHOD

Ninety Delta Force brackets were tested against 0.018-inch stainless steel wire. Three modes of ligation were tested with three different angulations: 0, 5 and 10 degrees to simulate increasing levels of binding.

RESULTS

The average static frictional resistance went from 0.20 N, at 0 degrees angulation and minimum ligation, to 2.37 N with 10 degrees angulation and maximum ligation. Results revealed that the ligation pattern was found to be highly statistically significant (P<0.001) in influencing frictional force. The binding angle showed a trend of increasing frictional force with increasing bracket/archwire angulation. Repeatability testing showed no evidence of bias (P=0.171).

CONCLUSIONS

These results suggest that the Delta Force variable ligation system does in fact enable friction to be varied, which may have implications in clinical application.

Post-transcriptional gene silencing of KChIP2 and Navbeta1 in neonatal rat cardiac myocytes reveals a functional association between Na and Ito currents

The Ca(2+)-independent transient outward potassium current (I(to)) encoded by the Kv4 family of potassium channels, is central to normal repolarization of cardiac myocytes. KChIPs are a group of Ca(2+)-binding accessory subunits that modulate Kv4-encoded currents. However, the biophysical effects of KChIP2 on Kv4 currents raise questions about the role that KChIP2 plays in forming the native I(to). Previous heterologous expression studies demonstrated that the Na channel beta1 subunit modulates the gating properties of Kv4.3 to closely recapitulate native I(to) suggesting that Na(v)beta1 may modulate the function of Kv4-encoded channels in native cardiomyocytes. Therefore we hypothesized the existence of a structural or functional complex between subunits of I(to) and I(Na). In co-immunoprecipitation of proteins from neonatal rat ventricular myocardium (NRVM), Na(v)beta1 was pulled-down by Kv4.x antibodies suggesting a structural association between subunits that comprise I(to) and I(Na). Remarkably, post-transcriptional gene silencing of KChIP2 in NRVM, using small interfering RNAs specific to KChIP2, suppressed both cardiac I(to) and I(Na) consistent with a functional coupling of these channels. KChIP2 silencing suppressed Na channel alpha and beta1 subunit mRNA levels, leaving Kv4.x mRNAs unaltered, but reducing levels of immunoreactive proteins. Post-transcriptional gene silencing of Na(v)beta1 reduced its protein expression. Silencing of Na(v)beta1 also reduced mRNA and protein levels of its alpha-subunit, Na(v)1.5. Surprisingly, silencing of Na(v)beta1 also produced a reduction in KChIP2 mRNA and protein as well as Kv4.x proteins resulting in remarkably decreased I(Na) and I(to). These data are consistent with a novel structural and functional association of I(Na) and I(to) in NRVMs.

Cardiac phosphatase-deficient 6-phosphofructo-2-kinase/fructose-2,6-bisphosphatase increases glycolysis, hypertrophy, and myocyte resistance to hypoxia

During ischemia and heart failure, there is an increase in cardiac glycolysis. To understand if this is beneficial or detrimental to the heart, we chronically elevated glycolysis by cardiac-specific overexpression of phosphatase-deficient 6-phosphofructo-2-kinase/fructose-2,6-bisphosphatase (PFK-2) in transgenic mice. PFK-2 controls the level of fructose-2,6-bisphosphate (Fru-2,6-P2), an important regulator of phosphofructokinase and glycolysis. Transgenic mice had over a threefold elevation in levels of Fru-2,6-P2. Cardiac metabolites upstream of phosphofructokinase were significantly reduced, as would be expected by the activation of phosphofructokinase. In perfused hearts, the transgene caused a significant increase in glycolysis that was less sensitive to inhibition by palmitate. Conversely, oxidation of palmitate was reduced by close to 50%. The elevation in glycolysis made isolated cardiomyocytes highly resistant to contractile inhibition by hypoxia, but in vivo the transgene had no effect on ischemia-reperfusion injury. Transgenic hearts exhibited pathology: the heart weight-to-body weight ratio was increased 17%, cardiomyocyte length was greater, and cardiac fibrosis was increased. However, the transgene did not change insulin sensitivity. These results show that the elevation in glycolysis provides acute benefits against hypoxia, but the chronic increase in glycolysis or reduction in fatty acid oxidation interferes with normal cardiac metabolism, which may be detrimental to the heart.

Non-canonical glycosyltransferase modulates post-hypoxic cardiac myocyte death and mitochondrial permeability transition

O-linked beta-N-acetylglucosamine (O-GlcNAc) is a dynamic, inducible, and reversible post-translational modification of nuclear and cytoplasmic proteins on Ser/Thr amino acid residues. In addition to its putative role as a nutrient sensor, we have recently shown pharmacologic elevation of O-GlcNAc levels positively affected myocyte survival during oxidant stress. However, no rigorous assessment of the contribution of O-GlcNAc transferase has been performed, particularly in the post-hypoxic setting. Therefore, we hypothesized that pharmacological or genetic manipulation of O-GlcNAc transferase (OGT), the enzyme that adds O-GlcNAc to proteins, would affect cardiac myocyte survival following hypoxia/reoxygenation (H/R). Adenoviral overexpression of OGT (AdOGT) in cardiac myocytes augmented O-GlcNAc levels and reduced post-hypoxic damage. Conversely, pharmacologic inhibition of OGT significantly attenuated O-GlcNAc levels, exacerbated post-hypoxic cardiac myocyte death, and sensitized myocytes to mitochondrial membrane potential collapse. Both genetic deletion of OGT using a cre-lox approach and translational silencing via RNAi also resulted in significant reductions in OGT protein and O-GlcNAc levels, and, exacerbated post-hypoxic cardiac myocyte death. Inhibition of OGT reduced O-GlcNAc levels on voltage dependent anion channel (VDAC) in isolated mitochondria and sensitized to calcium-induced mitochondrial permeability transition pore (mPTP) formation, indicating that mPTP may be an important target of O-GlcNAc signaling and confirming the aforementioned mitochondrial membrane potential results. These data demonstrate that OGT exerts pro-survival actions during hypoxia-reoxygenation in cardiac myocytes, particularly at the level of mitochondria.

Comparison of hydroxyapatite and dental enamel for testing shear bond strengths

AIMS

To investigate the feasibility of using artificial hydroxyapatite as a future biomimetic laboratory substitute for human enamel in orthodontic bond strength testing by comparing the shear bond strengths and nature of failure of brackets bonded to samples of hydroxyapatite and enamel.

METHOD

One hundred and fifty hydroxyapatite discs were prepared by compression at 20 tons and fired in a furnace at 1300 degrees C. One hundred and five enamel samples were prepared from the buccal and palatal/lingual surfaces of healthy premolars extracted for orthodontic purposes. Orthodontic brackets were bonded to each sample and these were subjected to shear bond strength testing using a custom-made jig mounted in an Instron Universal Testing Machine. The force value at bond failure was obtained, together with the nature of failure which was assessed using the Adhesive Remnant Index.

RESULTS

The mean shear bond strength for the enamel samples was 16.62 MPa (95 per cent CI: 15.26, 17.98) and for the hydroxyapatite samples 20.83 MPa (95 per cent CI: 19.68, 21.98). The difference between the two samples was statistically significant (p < 0.001). When the nature of failure was assessed with the ARI Index, 83 per cent of the enamel samples scored 2 or 3, while 49 per cent of the hydroxyapatite samples scored 0 or 1.

CONCLUSIONS

Hydroxyapatite was an effective biomimetic substrate for bond strength testing with a mean shear bond strength value (20.83 MPa) at the upper end of the normal range attributed to enamel (15-20 MPa). Although the difference between the shear bond strengths for hydroxyapatite and enamel was statistically significant, hydroxyapatite could be used as an alternative to enamel for comparative laboratory studies until a closer alternative is found. This would eliminate the need for extracted teeth to be collected. However, it should be used with caution for quantitative studies where true bond strengths are to be investigated.

Cardioprotection by N-acetylglucosamine linkage to cellular proteins

BACKGROUND

The modification of proteins with O-linked beta-N-acetylglucosamine (O-GlcNAc) represents a key posttranslational modification that modulates cellular function. Previous data suggest that O-GlcNAc may act as an intracellular metabolic or stress sensor, linking glucose metabolism to cellular function. Considering this, we hypothesized that augmentation of O-GlcNAc levels represents an endogenously recruitable mechanism of cardioprotection.

METHODS AND RESULTS

In mouse hearts subjected to in vivo ischemic preconditioning, O-GlcNAc levels were significantly elevated. Pharmacological augmentation of O-GlcNAc levels in vivo was sufficient to reduce myocardial infarct size. We investigated the influence of O-GlcNAc levels on cardiac injury at the cellular level. Lethal oxidant stress of cardiac myocytes produced a time-dependent loss of cellular O-GlcNAc levels. This pathological response was largely reversible by pharmacological augmentation of O-GlcNAc levels and was associated with improved cardiac myocyte survival. The diminution of O-GlcNAc levels occurred synchronously with the loss of mitochondrial membrane potential in isolated cardiac myocytes. Pharmacological enhancement of O-GlcNAc levels attenuated the loss of mitochondrial membrane potential. Proteomic analysis identified voltage-dependent anion channel as a potential target of O-GlcNAc modification. Mitochondria isolated from adult mouse hearts with elevated O-GlcNAc levels had more O-GlcNAc-modified voltage-dependent anion channel and were more resistant to calcium-induced swelling than cardiac mitochondria from vehicle mice.

CONCLUSIONS

O-GlcNAc signaling represents a unique endogenously recruitable mechanism of cardioprotection that may involve direct modification of mitochondrial proteins critical for survival such as voltage-dependent anion channel.

Static frictional resistances of polycrystalline ceramic brackets with conventional slots, glazed slots and metal slot inserts

AIMS

To compare the static frictional resistance of ceramic brackets with a conventional slot (Allure), a glazed slot (Mystique) and a metal slot insert (Clarity).

METHOD

Twenty five brackets of each type, with slot size 0.022 x 0.028 inch and Roth prescription were tested by sliding against straight lengths of 0.019 x 0.025 inch rectangular stainless steel wire. During the tests the brackets and wire were lubricated with artificial saliva. Static frictional forces at three different simulated binding angulations (0, 5 and 10 degrees) were measured for each type of bracket.

RESULTS

At each of the angulations tested, the Clarity brackets produced the lowest static frictional resistance. At 0 degree angulation (below the critical angle for binding) the Allure brackets produced the greatest friction. The difference in friction between the Clarity and Mystique brackets was not statistically significant. As the angulations were increased to 5 degrees the Allure brackets again produced the greatest frictional resistance, although this was not significantly higher than the Mystique brackets. The Mystique brackets produced the greatest frictional resistance at 10 degrees, but again there was no statistical difference from the Allure brackets.

CONCLUSIONS

A glazed slot ceramic bracket demonstrates low frictional resistance at non-binding angulations and compares favourably with a metal slot ceramic bracket. Increasing angulations through 5 to 10 degrees of simulated binding results in high levels of static frictional resistance such that the bracket behaves more like a conventional polycrystalline ceramic bracket.

Low-dose simvastatin improves survival and ventricular function via eNOS in congestive heart failure

3-Hydroxy-3-methylglutaryl coenzyme A reductase inhibitors increase endothelial nitric oxide synthase (eNOS) activity by multiple mechanisms. We previously reported that genetic overexpression of eNOS improves survival and cardiac function in congestive heart failure (CHF). In the present study, we tested the hypothesis that low-dose treatment with an 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor exerts beneficial effects on survival and/or cardiac function in a murine model of CHF. Mice were subjected to permanent ligation of the left coronary artery and randomized to receive either saline vehicle or simvastatin (0.25 mg/kg) 2 h after myocardial infarction and daily (0.25 mg/kg) for 7 days, followed by 21 days of administration every other day for a total duration of 28 days. Myocardial infarct size was not reduced by simvastatin therapy ( P = not significant between groups). Simvastatin treatment did significantly ( P < 0.05) improve survival (45%) compared with vehicle treatment (25%). In addition, simvastatin treatment significantly improved ( P < 0.01) left ventricular function and significantly ( P < 0.01) abrogated cardiac hypertrophy and pulmonary edema compared with vehicle treatment. The protective effects of simvastatin were abrogated by delayed initiation of treatment or genetic ablation of eNOS. In conclusion, low-dose simvastatin therapy significantly improves survival and cardiac function and reduces both cardiac hypertrophy and pulmonary edema via an eNOS-dependent mechanism in a murine model of CHF.

The ubiquitous role of nitric oxide in cardioprotection

In recent years, major advances have been made toward understanding the role of nitric oxide (NO) in the ischemic biology of the heart. It is now clear that NO, either endogenous or exogenous, represents one of the most important defenses against myocardial ischemia-reperfusion injury. The purpose of this review is to provide an update on the cardioprotective actions of NO, with particular emphasis on the function of the inducible isoform of NO synthase (iNOS) and on the role of mitochondria in NO-mediated protection. This essay underscores some of the more prominent areas of ischemic biology that relate to NO, such as ischemic preconditioning, pharmacological cardioprotection, and gene therapy. The hypothesis that the late phase of preconditioning is mediated by increased iNOS activity resulting in enhanced NO bioavailability, first proposed by our group, is now widely accepted and can be regarded as a proven hypothesis. Likewise, the burgeoning field of postconditioning may share such a requirement for NO. Various drugs (e.g. statins, ACE inhibitors, angiotensin-receptor blockers, etc.) also produce salubrious effects in experimental models of myocardial infarction via their enhancement of NO bioavailability. Thus, NO appears to be a common mediator of the protection afforded by a wide array of seemingly unrelated pharmacological and nonpharmacological interventions, underscoring its fundamental role as a ubiquitous defense of the heart against ischemia and reperfusion. This review challenges the conventional wisdom that iNOS is deleterious during myocardial ischemia-reperfusion and instead proposes the concept that iNOS, when expressed in cardiac myocytes, is a profoundly protective protein. We also emphasize the emerging importance of the mitochondrial actions of NO. Although the precise molecular events remain to be defined, we propose that NO interacts with components of the electron transport chain and/or the mitochondrial permeability transition pore to limit post-ischemic myocardial damage, and that this action potentially provides a fundamental molecular explanation for the mechanism of NO-mediated cardioprotection.

Deficiency of iNOS does not attenuate severe congestive heart failure in mice

Inducible nitric oxide synthase (iNOS) has been implicated in the pathophysiology of congestive heart failure (CHF). Given the extensive evidence supporting this concept, we hypothesized that iNOS deficiency (iNOS−/−) would attenuate the severity of CHF in mice. Mice were subjected to permanent occlusion [myocardial infarction (MI)] of the proximal left anterior descending coronary artery to produce CHF. Cardiac function was assessed in vivo using echocardiography and ultraminiature ventricular pressure catheters. Sham wild-type ( n = 17), sham iNOS−/− ( n = 8), MI wild-type ( n = 56), and MI iNOS−/− ( n = 48) mice were subjected to MI (or sham MI) and followed for 1 mo. Deficiency of iNOS did not alter survival during CHF compared with wild type (35% vs. 32%, P = not significant). Furthermore, fractional shortening and cardiac output were not significantly different between wild-type (9.6 ± 2.0% and 441 ± 20 μl·min−1·g−1) and iNOS−/− (9.8 ± 1.3% and 471 ± 26 μl·min−1·g−1) mice. The extent of cardiac hypertrophy and pulmonary edema was also similar between wild-type and iNOS−/− mice. None of the indexes demonstrated any significant differences between iNOS−/− and wild-type mice subjected to MI. These findings indicate that deficiency of iNOS does not significantly affect severe CHF in mice after MI.

Functional integration of electrically active cardiac derivatives from genetically engineered human embryonic stem cells with quiescent recipient ventricular cardiomyocytes: insights into the development of cell-based pacemakers

BACKGROUND

Human embryonic stem cells (hESCs) derived from blastocysts can propagate indefinitely in culture while maintaining pluripotency, including the ability to differentiate into cardiomyocytes (CMs); therefore, hESCs may provide an unlimited source of human CMs for cell-based therapies. Although CMs can be derived from hESCs ex vivo, it remains uncertain whether a functional syncytium can be formed between donor and recipient cells after engraftment.

METHODS AND RESULTS

Using a combination of electrophysiological and imaging techniques, here we demonstrate that electrically active, donor CMs derived from hESCs that had been stably genetically engineered by a recombinant lentivirus can functionally integrate with otherwise-quiescent, recipient, ventricular CMs to induce rhythmic electrical and contractile activities in vitro. The integrated syncytium was responsive to the beta-adrenergic agonist isoproterenol as well as to other pharmacological agents such as lidocaine and ZD7288. Similarly, a functional hESC-derived pacemaker could be implanted in the left ventricle in vivo. Detailed optical mapping of the epicardial surface of guinea pig hearts transplanted with hESC-derived CMs confirmed the successful spread of membrane depolarization from the site of injection to the surrounding myocardium.

CONCLUSIONS

We conclude that electrically active, hESC-derived CMs are capable of actively pacing quiescent, recipient, ventricular CMs in vitro and ventricular myocardium in vivo. Our results may lead to an alternative or a supplemental method for correcting defects in cardiac impulse generation, such as cell-based pacemakers.