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Ebeling M, Mühlichen M, Talbäck M, Rau R, Goedel A, Klüsener S. Disease incidence and not case fatality drives the rural disadvantage in myocardial-infarction-related mortality in Germany. Prev Med 2024; 179:107833. [PMID: 38145875 DOI: 10.1016/j.ypmed.2023.107833] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/11/2023] [Accepted: 12/20/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE Demographic and infrastructural developments might compromise medical care provision in rural regions, particularly for acute health conditions. Studying the case of myocardial infarction (MI), we investigated how MI-related mortality at ages 65+ varies between rural and urban regions in Germany and to what extent differences are driven by varying case fatality and disease incidence. METHODS The study relies on data containing all hospitalizations, cause-specific deaths and population counts for the total German population between years 2012-2018 and ages 65+. MI-related mortality, MI incidence and case fatality are compared between urban and rural regions in a population-wide analysis. The impacts of changing incidence and case fatality on rural-urban MI-related mortality differences are assessed using a counterfactual approach. RESULTS Rural regions in Germany show systematically higher MI-related death rates and MI incidence at ages 65+ compared to urban regions. Higher mortality is primarily the result of higher MI incidence in rural regions, while case fatality is largely similar. The rural excess in MI-related death rates would be nullified and 1 out of 6 MI-related deaths in rural regions could be prevented if rural regions in Germany would have at least the median MI incidence of urban regions. CONCLUSIONS MI incidence and not case fatality drives the rural disadvantage in MI-related mortality in Germany. Higher MI incidence points towards potential regional variation in the effectiveness of disease prevention. The findings highlight that improving disease prevention at the patient level carries larger opportunities for reducing regional MI-related mortality inequalities in Germany.
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Affiliation(s)
- Marcus Ebeling
- Max Planck Institute for Demographic Research, Rostock, Germany; Karolinska Institute, Stockholm, Sweden; Federal Institute for Population Research (BiB), Wiesbaden, Germany.
| | | | | | - Roland Rau
- Max Planck Institute for Demographic Research, Rostock, Germany; University of Rostock, Rostock, Germany
| | - Alexander Goedel
- Karolinska Institute, Stockholm, Sweden; Technical University of Munich, Munich, Germany
| | - Sebastian Klüsener
- Federal Institute for Population Research (BiB), Wiesbaden, Germany; University of Cologne, Cologne, Germany; Vytautas Magnus University, Kaunas, Lithuania
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2
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Meier AB, Zawada D, De Angelis MT, Martens LD, Santamaria G, Zengerle S, Nowak-Imialek M, Kornherr J, Zhang F, Tian Q, Wolf CM, Kupatt C, Sahara M, Lipp P, Theis FJ, Gagneur J, Goedel A, Laugwitz KL, Dorn T, Moretti A. Epicardioid single-cell genomics uncovers principles of human epicardium biology in heart development and disease. Nat Biotechnol 2023; 41:1787-1800. [PMID: 37012447 PMCID: PMC10713454 DOI: 10.1038/s41587-023-01718-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 02/22/2023] [Indexed: 04/05/2023]
Abstract
The epicardium, the mesothelial envelope of the vertebrate heart, is the source of multiple cardiac cell lineages during embryonic development and provides signals that are essential to myocardial growth and repair. Here we generate self-organizing human pluripotent stem cell-derived epicardioids that display retinoic acid-dependent morphological, molecular and functional patterning of the epicardium and myocardium typical of the left ventricular wall. By combining lineage tracing, single-cell transcriptomics and chromatin accessibility profiling, we describe the specification and differentiation process of different cell lineages in epicardioids and draw comparisons to human fetal development at the transcriptional and morphological levels. We then use epicardioids to investigate the functional cross-talk between cardiac cell types, gaining new insights into the role of IGF2/IGF1R and NRP2 signaling in human cardiogenesis. Finally, we show that epicardioids mimic the multicellular pathogenesis of congenital or stress-induced hypertrophy and fibrotic remodeling. As such, epicardioids offer a unique testing ground of epicardial activity in heart development, disease and regeneration.
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Affiliation(s)
- Anna B Meier
- First Department of Medicine, Cardiology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
- Regenerative Medicine in Cardiovascular Diseases, First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich, Germany
| | - Dorota Zawada
- First Department of Medicine, Cardiology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
- Regenerative Medicine in Cardiovascular Diseases, First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich, Germany
| | - Maria Teresa De Angelis
- First Department of Medicine, Cardiology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
- Regenerative Medicine in Cardiovascular Diseases, First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich, Germany
- Department of Experimental and Clinical Medicine, University 'Magna Graecia', Catanzaro, Italy
| | - Laura D Martens
- School of Computation, Information and Technology, Technical University of Munich, Garching, Germany
- Computational Health Center, Helmholtz Center Munich, Neuherberg, Germany
- Helmholtz Association-Munich School for Data Science (MUDS), Munich, Germany
| | - Gianluca Santamaria
- First Department of Medicine, Cardiology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
- Regenerative Medicine in Cardiovascular Diseases, First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich, Germany
- Department of Experimental and Clinical Medicine, University 'Magna Graecia', Catanzaro, Italy
| | - Sophie Zengerle
- First Department of Medicine, Cardiology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
- Regenerative Medicine in Cardiovascular Diseases, First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich, Germany
| | - Monika Nowak-Imialek
- First Department of Medicine, Cardiology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
- Regenerative Medicine in Cardiovascular Diseases, First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich, Germany
| | - Jessica Kornherr
- First Department of Medicine, Cardiology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
- Regenerative Medicine in Cardiovascular Diseases, First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich, Germany
| | - Fangfang Zhang
- First Department of Medicine, Cardiology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
- Regenerative Medicine in Cardiovascular Diseases, First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich, Germany
| | - Qinghai Tian
- Center for Molecular Signaling (PZMS), Institute for Molecular Cell Biology, Research Center for Molecular Imaging and Screening, Medical Faculty, Saarland University, Homburg, Germany
| | - Cordula M Wolf
- German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich, Germany
- Department of Congenital Heart Defects and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, School of Medicine and Health, Munich, Germany
| | - Christian Kupatt
- First Department of Medicine, Cardiology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
- Regenerative Medicine in Cardiovascular Diseases, First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
| | - Makoto Sahara
- Department of Cell and Molecular Biology, Karolinska Institute, Stockholm, Sweden
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Peter Lipp
- Center for Molecular Signaling (PZMS), Institute for Molecular Cell Biology, Research Center for Molecular Imaging and Screening, Medical Faculty, Saarland University, Homburg, Germany
| | - Fabian J Theis
- School of Computation, Information and Technology, Technical University of Munich, Garching, Germany
- Computational Health Center, Helmholtz Center Munich, Neuherberg, Germany
| | - Julien Gagneur
- School of Computation, Information and Technology, Technical University of Munich, Garching, Germany
- Computational Health Center, Helmholtz Center Munich, Neuherberg, Germany
- Institute of Human Genetics, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexander Goedel
- First Department of Medicine, Cardiology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
- Regenerative Medicine in Cardiovascular Diseases, First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
- Department of Cell and Molecular Biology, Karolinska Institute, Stockholm, Sweden
| | - Karl-Ludwig Laugwitz
- First Department of Medicine, Cardiology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
- Regenerative Medicine in Cardiovascular Diseases, First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
| | - Tatjana Dorn
- First Department of Medicine, Cardiology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
- Regenerative Medicine in Cardiovascular Diseases, First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich, Germany
| | - Alessandra Moretti
- First Department of Medicine, Cardiology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany.
- Regenerative Medicine in Cardiovascular Diseases, First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany.
- German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich, Germany.
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
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3
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Zawada D, Kornherr J, Meier AB, Santamaria G, Dorn T, Nowak-Imialek M, Ortmann D, Zhang F, Lachmann M, Dreßen M, Ortiz M, Mascetti VL, Harmer SC, Nobles M, Tinker A, De Angelis MT, Pedersen RA, Grote P, Laugwitz KL, Moretti A, Goedel A. Retinoic acid signaling modulation guides in vitro specification of human heart field-specific progenitor pools. Nat Commun 2023; 14:1722. [PMID: 37012244 PMCID: PMC10070453 DOI: 10.1038/s41467-023-36764-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 02/15/2023] [Indexed: 04/05/2023] Open
Abstract
Cardiogenesis relies on the precise spatiotemporal coordination of multiple progenitor populations. Understanding the specification and differentiation of these distinct progenitor pools during human embryonic development is crucial for advancing our knowledge of congenital cardiac malformations and designing new regenerative therapies. By combining genetic labelling, single-cell transcriptomics, and ex vivo human-mouse embryonic chimeras we uncovered that modulation of retinoic acid signaling instructs human pluripotent stem cells to form heart field-specific progenitors with distinct fate potentials. In addition to the classical first and second heart fields, we observed the appearance of juxta-cardiac field progenitors giving rise to both myocardial and epicardial cells. Applying these findings to stem-cell based disease modelling we identified specific transcriptional dysregulation in first and second heart field progenitors derived from stem cells of patients with hypoplastic left heart syndrome. This highlights the suitability of our in vitro differentiation platform for studying human cardiac development and disease.
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Affiliation(s)
- Dorota Zawada
- First Department of Medicine, Cardiology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich, Germany
- Regenerative Medicine in Cardiovascular Diseases, First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
| | - Jessica Kornherr
- First Department of Medicine, Cardiology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich, Germany
- Regenerative Medicine in Cardiovascular Diseases, First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
| | - Anna B Meier
- First Department of Medicine, Cardiology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich, Germany
- Regenerative Medicine in Cardiovascular Diseases, First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
| | - Gianluca Santamaria
- First Department of Medicine, Cardiology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich, Germany
- Regenerative Medicine in Cardiovascular Diseases, First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
- Department of Experimental and Clinical Medicine, University "Magna Graecia", Catanzaro, Italy
| | - Tatjana Dorn
- First Department of Medicine, Cardiology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich, Germany
- Regenerative Medicine in Cardiovascular Diseases, First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
| | - Monika Nowak-Imialek
- First Department of Medicine, Cardiology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich, Germany
- Regenerative Medicine in Cardiovascular Diseases, First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
| | - Daniel Ortmann
- Department of Surgery, University of Cambridge, Cambridge, UK
- Wellcome-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, University of Cambridge, Cambridge, UK
| | - Fangfang Zhang
- First Department of Medicine, Cardiology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich, Germany
- Regenerative Medicine in Cardiovascular Diseases, First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
| | - Mark Lachmann
- First Department of Medicine, Cardiology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich, Germany
| | - Martina Dreßen
- German Heart Center Munich, Department of Cardiovascular Surgery, Institute Insure - Technical University of Munich, School of Medicine and Health, Munich, Germany
| | | | - Victoria L Mascetti
- Bristol Heart Institute, Bristol Medical School, Translational Health Sciences, Bristol, UK
| | - Stephen C Harmer
- School of Physiology, Pharmacology and Neuroscience, Faculty of Life Sciences, University of Bristol, Bristol, UK
| | - Muriel Nobles
- Clinical Pharmacology & Precision Medicine, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Andrew Tinker
- Clinical Pharmacology & Precision Medicine, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Maria Teresa De Angelis
- First Department of Medicine, Cardiology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich, Germany
- Department of Experimental and Clinical Medicine, University "Magna Graecia", Catanzaro, Italy
| | - Roger A Pedersen
- Department of Obstetrics and Gynecology, Stanford School of Medicine, Stanford University, Stanford, USA
| | - Phillip Grote
- Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy, Frankfurt am Main, Germany
- Institute of Cardiovascular Regeneration, Centre for Molecular Medicine, Goethe University, Frankfurt am Main, Germany
| | - Karl-Ludwig Laugwitz
- First Department of Medicine, Cardiology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany.
- German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich, Germany.
| | - Alessandra Moretti
- First Department of Medicine, Cardiology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany.
- German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich, Germany.
- Regenerative Medicine in Cardiovascular Diseases, First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany.
- Department of Surgery, Yale University School of Medicine, New Haven, USA.
| | - Alexander Goedel
- First Department of Medicine, Cardiology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany.
- Department of Cell and Molecular Biology, Karolinska Institute, Stockholm, Sweden.
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4
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Zheng Y, Yan RZ, Sun S, Kobayashi M, Xiang L, Yang R, Goedel A, Kang Y, Xue X, Esfahani SN, Liu Y, Resto Irizarry AM, Wu W, Li Y, Ji W, Niu Y, Chien KR, Li T, Shioda T, Fu J. Single-cell analysis of embryoids reveals lineage diversification roadmaps of early human development. Cell Stem Cell 2022; 29:1402-1419.e8. [PMID: 36055194 PMCID: PMC9499422 DOI: 10.1016/j.stem.2022.08.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 06/08/2022] [Accepted: 08/11/2022] [Indexed: 01/03/2023]
Abstract
Despite its clinical and fundamental importance, our understanding of early human development remains limited. Stem cell-derived, embryo-like structures (or embryoids) allowing studies of early development without using natural embryos can potentially help fill the knowledge gap of human development. Herein, transcriptome at the single-cell level of a human embryoid model was profiled at different time points. Molecular maps of lineage diversifications from the pluripotent human epiblast toward the amniotic ectoderm, primitive streak/mesoderm, and primordial germ cells were constructed and compared with in vivo primate data. The comparative transcriptome analyses reveal a critical role of NODAL signaling in human mesoderm and primordial germ cell specification, which is further functionally validated. Through comparative transcriptome analyses and validations with human blastocysts and in vitro cultured cynomolgus embryos, we further proposed stringent criteria for distinguishing between human blastocyst trophectoderm and early amniotic ectoderm cells.
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Affiliation(s)
- Yi Zheng
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Robin Zhexuan Yan
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Shiyu Sun
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Mutsumi Kobayashi
- Massachusetts General Hospital Center for Cancer Research, Charlestown, MA 02129, USA
| | - Lifeng Xiang
- Department of Reproductive Medicine, the First People's Hospital of Yunnan Province, Kunming, China
| | - Ran Yang
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm 171 77, Sweden
| | - Alexander Goedel
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm 171 77, Sweden
| | - Yu Kang
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming, China
| | - Xufeng Xue
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Sajedeh Nasr Esfahani
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Yue Liu
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | | | - Weisheng Wu
- BRCF Bioinformatics Core, University of Michigan, Ann Arbor, MI 48109, USA
| | - Yunxiu Li
- Department of Reproductive Medicine, the First People's Hospital of Yunnan Province, Kunming, China
| | - Weizhi Ji
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming, China
| | - Yuyu Niu
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming, China
| | - Kenneth R Chien
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm 171 77, Sweden
| | - Tianqing Li
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming, China
| | - Toshihiro Shioda
- Massachusetts General Hospital Center for Cancer Research, Charlestown, MA 02129, USA; Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Jianping Fu
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; Department of Cell and Developmental Biology, University of Michigan Medical School, Ann Arbor, MI 48109, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA.
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5
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Eroglu E, Yen CYT, Tsoi YL, Witman N, Elewa A, Joven Araus A, Wang H, Szattler T, Umeano CH, Sohlmér J, Goedel A, Simon A, Chien KR. Epicardium-derived cells organize through tight junctions to replenish cardiac muscle in salamanders. Nat Cell Biol 2022; 24:645-658. [PMID: 35550612 PMCID: PMC9106584 DOI: 10.1038/s41556-022-00902-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 03/21/2022] [Indexed: 12/13/2022]
Abstract
The contribution of the epicardium, the outermost layer of the heart, to cardiac regeneration has remained controversial due to a lack of suitable analytical tools. By combining genetic marker-independent lineage-tracing strategies with transcriptional profiling and loss-of-function methods, we report here that the epicardium of the highly regenerative salamander species Pleurodeles waltl has an intrinsic capacity to differentiate into cardiomyocytes. Following cryoinjury, CLDN6+ epicardium-derived cells appear at the lesion site, organize into honeycomb-like structures connected via focal tight junctions and undergo transcriptional reprogramming that results in concomitant differentiation into de novo cardiomyocytes. Ablation of CLDN6+ differentiation intermediates as well as disruption of their tight junctions impairs cardiac regeneration. Salamanders constitute the evolutionarily closest species to mammals with an extensive ability to regenerate heart muscle and our results highlight the epicardium and tight junctions as key targets in efforts to promote cardiac regeneration.
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Affiliation(s)
- Elif Eroglu
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden.
| | - Christopher Y T Yen
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
| | - Yat-Long Tsoi
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
| | - Nevin Witman
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ahmed Elewa
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
- Department of Genetics, Microbiology and Statistics, Faculty of Biology, University of Barcelona, Barcelona, Spain
| | - Alberto Joven Araus
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
| | - Heng Wang
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
- College of Animal Sciences and Technology, Huazhong Agricultural University, Wuhan, China
| | - Tamara Szattler
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
| | - Chimezie H Umeano
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
- Department of Molecular Medicine and Gene Therapy, Lunds Universitet, Lund, Sweden
| | - Jesper Sohlmér
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
| | - Alexander Goedel
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
- Klinik und Poliklinik für Innere Medizin I, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - András Simon
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden.
| | - Kenneth R Chien
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden.
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
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6
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Goedel A, Lanner F. A peek into the black box of human embryology. Nature 2021; 600:223-224. [PMID: 34789887 DOI: 10.1038/d41586-021-03381-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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7
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Fomin A, Gärtner A, Cyganek L, Tiburcy M, Tuleta I, Wellers L, Folsche L, Hobbach AJ, von Frieling-Salewsky M, Unger A, Hucke A, Koser F, Kassner A, Sielemann K, Streckfuß-Bömeke K, Hasenfuss G, Goedel A, Laugwitz KL, Moretti A, Gummert JF, Dos Remedios CG, Reinecke H, Knöll R, van Heesch S, Hubner N, Zimmermann WH, Milting H, Linke WA. Truncated titin proteins and titin haploinsufficiency are targets for functional recovery in human cardiomyopathy due to TTN mutations. Sci Transl Med 2021; 13:eabd3079. [PMID: 34731013 DOI: 10.1126/scitranslmed.abd3079] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Andrey Fomin
- Clinic for Cardiology and Pneumology, University Medical Center, 37075 Göttingen, Germany.,German Centre for Cardiovascular Research, 10785 Berlin, partner site Göttingen, Germany
| | - Anna Gärtner
- Erich and Hanna Klessmann Institute, Heart and Diabetes Centre NRW, University Hospital of the Ruhr-University Bochum, 32545 Bad Oeynhausen, Germany
| | - Lukas Cyganek
- Clinic for Cardiology and Pneumology, University Medical Center, 37075 Göttingen, Germany.,German Centre for Cardiovascular Research, 10785 Berlin, partner site Göttingen, Germany.,Stem Cell Unit, University Medical Center, 37075 Göttingen, Germany.,Institute of Pharmacology and Toxicology, University Medical Center, 37075 Göttingen, Germany
| | - Malte Tiburcy
- German Centre for Cardiovascular Research, 10785 Berlin, partner site Göttingen, Germany.,Institute of Pharmacology and Toxicology, University Medical Center, 37075 Göttingen, Germany
| | - Izabela Tuleta
- Department of Cardiology I, Coronary, Peripheral Vascular Disease and Heart Failure, 48149 University Hospital Münster, Münster, Germany
| | - Luisa Wellers
- Institute of Physiology II, University of Münster, 48149 Münster, Germany
| | - Lina Folsche
- Institute of Physiology II, University of Münster, 48149 Münster, Germany
| | - Anastasia J Hobbach
- Department of Cardiology I, Coronary, Peripheral Vascular Disease and Heart Failure, 48149 University Hospital Münster, Münster, Germany
| | | | - Andreas Unger
- Institute of Physiology II, University of Münster, 48149 Münster, Germany
| | - Anna Hucke
- Institute of Physiology II, University of Münster, 48149 Münster, Germany
| | - Franziska Koser
- Institute of Physiology II, University of Münster, 48149 Münster, Germany
| | - Astrid Kassner
- Erich and Hanna Klessmann Institute, Heart and Diabetes Centre NRW, University Hospital of the Ruhr-University Bochum, 32545 Bad Oeynhausen, Germany
| | - Katharina Sielemann
- Erich and Hanna Klessmann Institute, Heart and Diabetes Centre NRW, University Hospital of the Ruhr-University Bochum, 32545 Bad Oeynhausen, Germany
| | - Katrin Streckfuß-Bömeke
- Clinic for Cardiology and Pneumology, University Medical Center, 37075 Göttingen, Germany.,German Centre for Cardiovascular Research, 10785 Berlin, partner site Göttingen, Germany
| | - Gerd Hasenfuss
- Clinic for Cardiology and Pneumology, University Medical Center, 37075 Göttingen, Germany.,German Centre for Cardiovascular Research, 10785 Berlin, partner site Göttingen, Germany
| | - Alexander Goedel
- First Medical Department, Cardiology, Technical University of Munich, 81675 Munich, Germany.,German Centre for Cardiovascular Research, 10785 Berlin, partner site Munich, Germany.,Department of Cell and Molecular Biology, Karolinska Institute, S-17177 Stockholm, Sweden
| | - Karl-Ludwig Laugwitz
- First Medical Department, Cardiology, Technical University of Munich, 81675 Munich, Germany.,German Centre for Cardiovascular Research, 10785 Berlin, partner site Munich, Germany.,Munich Heart Alliance, 80802 Munich, Germany
| | - Alessandra Moretti
- First Medical Department, Cardiology, Technical University of Munich, 81675 Munich, Germany.,German Centre for Cardiovascular Research, 10785 Berlin, partner site Munich, Germany.,Munich Heart Alliance, 80802 Munich, Germany
| | - Jan F Gummert
- Erich and Hanna Klessmann Institute, Heart and Diabetes Centre NRW, University Hospital of the Ruhr-University Bochum, 32545 Bad Oeynhausen, Germany.,Department of Cardio-Thoracic Surgery, Heart and Diabetes Centre NRW, University Hospital of the Ruhr-University Bochum, 32545 Bad Oeynhausen, Germany
| | | | - Holger Reinecke
- Department of Cardiology I, Coronary, Peripheral Vascular Disease and Heart Failure, 48149 University Hospital Münster, Münster, Germany
| | - Ralph Knöll
- Department of Medicine, Integrated Cardio Metabolic Centre (ICMC), Heart and Vascular Theme, Karolinska Institute, S-17177 Stockholm, Sweden.,Bioscience Cardiovascular, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, 43183 Gothenburg, Sweden
| | - Sebastiaan van Heesch
- Cardiovascular and Metabolic Sciences, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, 13125 Berlin, Germany.,German Centre for Cardiovascular Research, 10785 Berlin, partner site Berlin, Germany.,Princess Máxima Center for Pediatric Oncology, 3584 CT Utrecht, Netherlands
| | - Norbert Hubner
- Cardiovascular and Metabolic Sciences, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, 13125 Berlin, Germany.,German Centre for Cardiovascular Research, 10785 Berlin, partner site Berlin, Germany.,Charité-Universitätsmedizin, 10117 Berlin, Germany.,Berlin Institute of Health, 10178 Berlin, Germany
| | - Wolfram H Zimmermann
- German Centre for Cardiovascular Research, 10785 Berlin, partner site Göttingen, Germany.,Institute of Pharmacology and Toxicology, University Medical Center, 37075 Göttingen, Germany.,Cluster of Excellence "Multiscale Bioimaging: From Molecular Machines to Networks of Excitable Cells," University of Göttingen, 37073 Göttingen, Germany
| | - Hendrik Milting
- Erich and Hanna Klessmann Institute, Heart and Diabetes Centre NRW, University Hospital of the Ruhr-University Bochum, 32545 Bad Oeynhausen, Germany
| | - Wolfgang A Linke
- Clinic for Cardiology and Pneumology, University Medical Center, 37075 Göttingen, Germany.,German Centre for Cardiovascular Research, 10785 Berlin, partner site Göttingen, Germany.,Institute of Physiology II, University of Münster, 48149 Münster, Germany
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8
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Krane M, Dreßen M, Santamaria G, My I, Schneider CM, Dorn T, Laue S, Mastantuono E, Berutti R, Rawat H, Gilsbach R, Schneider P, Lahm H, Schwarz S, Doppler SA, Paige S, Puluca N, Doll S, Neb I, Brade T, Zhang Z, Abou-Ajram C, Northoff B, Holdt LM, Sudhop S, Sahara M, Goedel A, Dendorfer A, Tjong FVY, Rijlaarsdam ME, Cleuziou J, Lang N, Kupatt C, Bezzina C, Lange R, Bowles NE, Mann M, Gelb BD, Crotti L, Hein L, Meitinger T, Wu S, Sinnecker D, Gruber PJ, Laugwitz KL, Moretti A. Sequential Defects in Cardiac Lineage Commitment and Maturation Cause Hypoplastic Left Heart Syndrome. Circulation 2021; 144:1409-1428. [PMID: 34694888 PMCID: PMC8542085 DOI: 10.1161/circulationaha.121.056198] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Complex molecular programs in specific cell lineages govern human heart development. Hypoplastic left heart syndrome (HLHS) is the most common and severe manifestation within the spectrum of left ventricular outflow tract obstruction defects occurring in association with ventricular hypoplasia. The pathogenesis of HLHS is unknown, but hemodynamic disturbances are assumed to play a prominent role. METHODS To identify perturbations in gene programs controlling ventricular muscle lineage development in HLHS, we performed whole-exome sequencing of 87 HLHS parent-offspring trios, nuclear transcriptomics of cardiomyocytes from ventricles of 4 patients with HLHS and 15 controls at different stages of heart development, single cell RNA sequencing, and 3D modeling in induced pluripotent stem cells from 3 patients with HLHS and 3 controls. RESULTS Gene set enrichment and protein network analyses of damaging de novo mutations and dysregulated genes from ventricles of patients with HLHS suggested alterations in specific gene programs and cellular processes critical during fetal ventricular cardiogenesis, including cell cycle and cardiomyocyte maturation. Single-cell and 3D modeling with induced pluripotent stem cells demonstrated intrinsic defects in the cell cycle/unfolded protein response/autophagy hub resulting in disrupted differentiation of early cardiac progenitor lineages leading to defective cardiomyocyte subtype differentiation/maturation in HLHS. Premature cell cycle exit of ventricular cardiomyocytes from patients with HLHS prevented normal tissue responses to developmental signals for growth, leading to multinucleation/polyploidy, accumulation of DNA damage, and exacerbated apoptosis, all potential drivers of left ventricular hypoplasia in absence of hemodynamic cues. CONCLUSIONS Our results highlight that despite genetic heterogeneity in HLHS, many mutations converge on sequential cellular processes primarily driving cardiac myogenesis, suggesting novel therapeutic approaches.
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Affiliation(s)
- Markus Krane
- Department of Cardiovascular Surgery, Institute Insure (M.K., M.D., H.L., S.A.D., N.P., I.N., Z.Z., C.A.-A., R.L.),Klinikum rechts der Isar, School of Medicine & Health, Technical University of Munich, Germany.,DZHK (German Centre for Cardiovascular Research)-partner site Munich Heart Alliance, Germany (M.K., A.D., C.K., R.L., T.M., D.S., K.-L.L., A.M.)
| | - Martina Dreßen
- Department of Cardiovascular Surgery, Institute Insure (M.K., M.D., H.L., S.A.D., N.P., I.N., Z.Z., C.A.-A., R.L.),Klinikum rechts der Isar, School of Medicine & Health, Technical University of Munich, Germany
| | - Gianluca Santamaria
- Department of Internal Medicine I, Cardiology (G.S., I.M., C.M.S., T.D., S.L., E.M., H.R., T.B., A.G., C.K., D.S., K.-L.L., A.M.), Klinikum rechts der Isar, School of Medicine & Health, Technical University of Munich, Germany
| | - Ilaria My
- Department of Internal Medicine I, Cardiology (G.S., I.M., C.M.S., T.D., S.L., E.M., H.R., T.B., A.G., C.K., D.S., K.-L.L., A.M.), Klinikum rechts der Isar, School of Medicine & Health, Technical University of Munich, Germany
| | - Christine M Schneider
- Department of Internal Medicine I, Cardiology (G.S., I.M., C.M.S., T.D., S.L., E.M., H.R., T.B., A.G., C.K., D.S., K.-L.L., A.M.), Klinikum rechts der Isar, School of Medicine & Health, Technical University of Munich, Germany
| | - Tatjana Dorn
- Department of Internal Medicine I, Cardiology (G.S., I.M., C.M.S., T.D., S.L., E.M., H.R., T.B., A.G., C.K., D.S., K.-L.L., A.M.), Klinikum rechts der Isar, School of Medicine & Health, Technical University of Munich, Germany
| | - Svenja Laue
- Department of Internal Medicine I, Cardiology (G.S., I.M., C.M.S., T.D., S.L., E.M., H.R., T.B., A.G., C.K., D.S., K.-L.L., A.M.), Klinikum rechts der Isar, School of Medicine & Health, Technical University of Munich, Germany
| | - Elisa Mastantuono
- German Heart Center Munich, and Institute of Human Genetics (E.M., R.B., T.M.), Klinikum rechts der Isar, School of Medicine & Health, Technical University of Munich, Germany.,Department of Internal Medicine I, Cardiology (G.S., I.M., C.M.S., T.D., S.L., E.M., H.R., T.B., A.G., C.K., D.S., K.-L.L., A.M.), Klinikum rechts der Isar, School of Medicine & Health, Technical University of Munich, Germany.,Helmholtz Zentrum München, Neuherberg, Germany (E.M., R.B., T.M.)
| | - Riccardo Berutti
- German Heart Center Munich, and Institute of Human Genetics (E.M., R.B., T.M.), Klinikum rechts der Isar, School of Medicine & Health, Technical University of Munich, Germany.,Helmholtz Zentrum München, Neuherberg, Germany (E.M., R.B., T.M.)
| | - Hilansi Rawat
- Department of Internal Medicine I, Cardiology (G.S., I.M., C.M.S., T.D., S.L., E.M., H.R., T.B., A.G., C.K., D.S., K.-L.L., A.M.), Klinikum rechts der Isar, School of Medicine & Health, Technical University of Munich, Germany
| | - Ralf Gilsbach
- Institute of Experimental and Clinical Pharmacology and Toxicology (R.G., P.S., L.H.), University of Freiburg, Germany.,Institute for Cardiovascular Physiology, Goethe University, Frankfurt am Main, Germany (R.G.).,DZHK (German Centre for Cardiovascular Research)-partner site RheinMain, Frankfurt am Main, Germany (R.G.)
| | - Pedro Schneider
- Institute of Experimental and Clinical Pharmacology and Toxicology (R.G., P.S., L.H.), University of Freiburg, Germany
| | - Harald Lahm
- Department of Cardiovascular Surgery, Institute Insure (M.K., M.D., H.L., S.A.D., N.P., I.N., Z.Z., C.A.-A., R.L.),Klinikum rechts der Isar, School of Medicine & Health, Technical University of Munich, Germany
| | - Sascha Schwarz
- Center for Applied Tissue Engineering and Regenerative Medicine (CANTER), Munich University of Applied Sciences, Germany (S. Schwarz, S. Sudhop)
| | - Stefanie A Doppler
- Department of Cardiovascular Surgery, Institute Insure (M.K., M.D., H.L., S.A.D., N.P., I.N., Z.Z., C.A.-A., R.L.),Klinikum rechts der Isar, School of Medicine & Health, Technical University of Munich, Germany
| | - Sharon Paige
- Cardiovascular Institute, Stanford University School of Medicine, CA (S.P., S.W.)
| | - Nazan Puluca
- Department of Cardiovascular Surgery, Institute Insure (M.K., M.D., H.L., S.A.D., N.P., I.N., Z.Z., C.A.-A., R.L.),Klinikum rechts der Isar, School of Medicine & Health, Technical University of Munich, Germany
| | - Sophia Doll
- Proteomics and Signal Transduction, Max-Planck Institute of Biochemistry, Martinsried, Germany (S.D., M.M.)
| | - Irina Neb
- Department of Cardiovascular Surgery, Institute Insure (M.K., M.D., H.L., S.A.D., N.P., I.N., Z.Z., C.A.-A., R.L.),Klinikum rechts der Isar, School of Medicine & Health, Technical University of Munich, Germany
| | - Thomas Brade
- Department of Internal Medicine I, Cardiology (G.S., I.M., C.M.S., T.D., S.L., E.M., H.R., T.B., A.G., C.K., D.S., K.-L.L., A.M.), Klinikum rechts der Isar, School of Medicine & Health, Technical University of Munich, Germany
| | - Zhong Zhang
- Department of Cardiovascular Surgery, Institute Insure (M.K., M.D., H.L., S.A.D., N.P., I.N., Z.Z., C.A.-A., R.L.),Klinikum rechts der Isar, School of Medicine & Health, Technical University of Munich, Germany
| | - Claudia Abou-Ajram
- Department of Cardiovascular Surgery, Institute Insure (M.K., M.D., H.L., S.A.D., N.P., I.N., Z.Z., C.A.-A., R.L.),Klinikum rechts der Isar, School of Medicine & Health, Technical University of Munich, Germany
| | - Bernd Northoff
- Institute of Laboratory Medicine (B.N., L.M.H.), University Hospital, LMU Munich, Germany
| | - Lesca M Holdt
- Institute of Laboratory Medicine (B.N., L.M.H.), University Hospital, LMU Munich, Germany
| | - Stefanie Sudhop
- Center for Applied Tissue Engineering and Regenerative Medicine (CANTER), Munich University of Applied Sciences, Germany (S. Schwarz, S. Sudhop)
| | - Makoto Sahara
- Department of Cell and Molecular Biology, Karolinska Institute, Stockholm, Sweden (M.S.)
| | - Alexander Goedel
- Department of Internal Medicine I, Cardiology (G.S., I.M., C.M.S., T.D., S.L., E.M., H.R., T.B., A.G., C.K., D.S., K.-L.L., A.M.), Klinikum rechts der Isar, School of Medicine & Health, Technical University of Munich, Germany
| | - Andreas Dendorfer
- DZHK (German Centre for Cardiovascular Research)-partner site Munich Heart Alliance, Germany (M.K., A.D., C.K., R.L., T.M., D.S., K.-L.L., A.M.).,Walter-Brendel-Centre of Experimental Medicine (A.D.), University Hospital, LMU Munich, Germany
| | - Fleur V Y Tjong
- Heart Centre, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, The Netherlands (F.V.Y.T., C.B.)
| | - Maria E Rijlaarsdam
- Department of Pediatric Cardiology, Leiden University Medical Center, The Netherlands (M.E.R.)
| | - Julie Cleuziou
- Department of Congenital and Paediatric Heart Surgery, Institute Insure (J.C.), Klinikum rechts der Isar, School of Medicine & Health, Technical University of Munich, Germany
| | - Nora Lang
- Department of Paediatric Cardiology and Congenital Heart Defects (N.L.), Klinikum rechts der Isar, School of Medicine & Health, Technical University of Munich, Germany
| | - Christian Kupatt
- Department of Internal Medicine I, Cardiology (G.S., I.M., C.M.S., T.D., S.L., E.M., H.R., T.B., A.G., C.K., D.S., K.-L.L., A.M.), Klinikum rechts der Isar, School of Medicine & Health, Technical University of Munich, Germany.,DZHK (German Centre for Cardiovascular Research)-partner site Munich Heart Alliance, Germany (M.K., A.D., C.K., R.L., T.M., D.S., K.-L.L., A.M.)
| | - Connie Bezzina
- Heart Centre, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, The Netherlands (F.V.Y.T., C.B.)
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, Institute Insure (M.K., M.D., H.L., S.A.D., N.P., I.N., Z.Z., C.A.-A., R.L.),Klinikum rechts der Isar, School of Medicine & Health, Technical University of Munich, Germany.,DZHK (German Centre for Cardiovascular Research)-partner site Munich Heart Alliance, Germany (M.K., A.D., C.K., R.L., T.M., D.S., K.-L.L., A.M.)
| | - Neil E Bowles
- Department of Pediatrics (Division of Cardiology), University of Utah School of Medicine, Salt Lake City (N.E.B.)
| | - Matthias Mann
- Proteomics and Signal Transduction, Max-Planck Institute of Biochemistry, Martinsried, Germany (S.D., M.M.)
| | - Bruce D Gelb
- The Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York (B.D.G.)
| | - Lia Crotti
- Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, Istituto Auxologico Italiano, IRCCS, Milan, Italy (L.C.).,Cardiomyopathies Unit, Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy (L.C.).,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (L.C.)
| | - Lutz Hein
- Institute of Experimental and Clinical Pharmacology and Toxicology (R.G., P.S., L.H.), University of Freiburg, Germany.,BIOSS, Center for Biological Signaling Studies (L.H.), University of Freiburg, Germany
| | - Thomas Meitinger
- German Heart Center Munich, and Institute of Human Genetics (E.M., R.B., T.M.), Klinikum rechts der Isar, School of Medicine & Health, Technical University of Munich, Germany.,DZHK (German Centre for Cardiovascular Research)-partner site Munich Heart Alliance, Germany (M.K., A.D., C.K., R.L., T.M., D.S., K.-L.L., A.M.).,Helmholtz Zentrum München, Neuherberg, Germany (E.M., R.B., T.M.)
| | - Sean Wu
- Cardiovascular Institute, Stanford University School of Medicine, CA (S.P., S.W.)
| | - Daniel Sinnecker
- Department of Internal Medicine I, Cardiology (G.S., I.M., C.M.S., T.D., S.L., E.M., H.R., T.B., A.G., C.K., D.S., K.-L.L., A.M.), Klinikum rechts der Isar, School of Medicine & Health, Technical University of Munich, Germany.,DZHK (German Centre for Cardiovascular Research)-partner site Munich Heart Alliance, Germany (M.K., A.D., C.K., R.L., T.M., D.S., K.-L.L., A.M.)
| | - Peter J Gruber
- Department of Surgery, Yale University, New Haven, CT (P.J.G.)
| | - Karl-Ludwig Laugwitz
- Department of Internal Medicine I, Cardiology (G.S., I.M., C.M.S., T.D., S.L., E.M., H.R., T.B., A.G., C.K., D.S., K.-L.L., A.M.), Klinikum rechts der Isar, School of Medicine & Health, Technical University of Munich, Germany.,DZHK (German Centre for Cardiovascular Research)-partner site Munich Heart Alliance, Germany (M.K., A.D., C.K., R.L., T.M., D.S., K.-L.L., A.M.)
| | - Alessandra Moretti
- Department of Internal Medicine I, Cardiology (G.S., I.M., C.M.S., T.D., S.L., E.M., H.R., T.B., A.G., C.K., D.S., K.-L.L., A.M.), Klinikum rechts der Isar, School of Medicine & Health, Technical University of Munich, Germany.,DZHK (German Centre for Cardiovascular Research)-partner site Munich Heart Alliance, Germany (M.K., A.D., C.K., R.L., T.M., D.S., K.-L.L., A.M.)
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9
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Lahu S, Bristot P, Gewalt S, Goedel A, Giacoppo D, Schüpke S, Schunkert H, Kastrati A, Sarafoff N. Meta-Analysis of Short vs. Prolonged Dual Antiplatelet Therapy after Drug-Eluting Stent Implantation and Role of Continuation with either Aspirin or a P2Y 12 Inhibitor Thereafter. J Atheroscler Thromb 2021; 29:1001-1019. [PMID: 34248087 PMCID: PMC9252616 DOI: 10.5551/jat.63000] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM The optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation is an ongoing debate and novel data has emerged. The aim of this meta-analysis was to assess outcomes of short vs. control DAPT duration. In addition, the role of single antiplatelet therapy (SAPT) after DAPT with either aspirin or P2Y12 monotherapy was analyzed. METHODS The authors searched MEDLINE and Cochrane databases and proceedings of international meetings for randomized controlled trials (RCT) comparing ≤ 3 months with ≥ 6 months DAPT after DES implantation. The primary and co-primary outcomes of interest were definite or probable stent thrombosis (ST) and bleeding. In addition, we performed an analysis on studies who continued with either aspirin or P2Y12 monotherapy after DAPT. RESULTS 9 RCTs comprising 41,864 patients were included and we analyzed a short DAPT duration of median 1.5 months vs. 12.1 months in the control group. The risk for ST was similar with short vs. control DAPT duration (0.5 vs. 0.5%; hazard ratio 1.17[95% CI 0.89-1.54]; p=0.26). Bleeding was significantly reduced with short vs. control DAPT duration (1.9 vs. 3.0%; 0.65[0.54-0.77]; p<0.0001). ST was not different between short vs. control DAPT duration in the analysis of the 4 RCTs who continued with aspirin after DAPT and the 5 P2Y12 RCTs, respectively, and no heterogeneity was detected (p=0.861). Bleeding was also reduced with short vs. control DAPT in both the aspirin (1.2 vs. 1.7%; 0.71[0.51-0.99]; p=0.04) and P2Y12 inhibitor studies (2.1 vs. 3.4%; 0.62[0.47-0.80]; p=0.0003) and no heterogeneity was detected (p=0.515). CONCLUSIONS Our meta-analysis shows that short DAPT ≤ 3 months followed by SAPT reduces bleeding and is not associated with an increase in ST. The results were consistent within the aspirin and P2Y12 SAPT studies.
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Affiliation(s)
- Shqipdona Lahu
- Klinik fuer Herz- und Kreislauferkrankungen, Deutsches Herzzentrum Munich
| | - Peter Bristot
- Klinik fuer Herz- und Kreislauferkrankungen, Deutsches Herzzentrum Munich
| | - Senta Gewalt
- Klinik fuer Herz- und Kreislauferkrankungen, Deutsches Herzzentrum Munich
| | - Alexander Goedel
- Klinik und Poliklinik fuer Innere Medizin I, Klinikum rechts der Isar, Technische Universitaet Munich
| | - Daniele Giacoppo
- Klinik fuer Herz- und Kreislauferkrankungen, Deutsches Herzzentrum Munich
| | - Stefanie Schüpke
- Klinik fuer Herz- und Kreislauferkrankungen, Deutsches Herzzentrum Munich
| | - Heribert Schunkert
- Klinik fuer Herz- und Kreislauferkrankungen, Deutsches Herzzentrum Munich.,Deutsches Zentrum fuer Herz- und Kreislauferkrankungen (DZHK), Partner Site Munich Heart Alliance, Munich
| | - Adnan Kastrati
- Klinik fuer Herz- und Kreislauferkrankungen, Deutsches Herzzentrum Munich.,Deutsches Zentrum fuer Herz- und Kreislauferkrankungen (DZHK), Partner Site Munich Heart Alliance, Munich
| | - Nikolaus Sarafoff
- Klinik fuer Herz- und Kreislauferkrankungen, Deutsches Herzzentrum Munich
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10
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Von Olshausen G, Bourke T, Schwieler J, Drca N, Bastani H, Tapanainen J, Saluveer O, Benson L, Goedel A, Kenneback G, Insulander P, Jensen-Urstad M, Braunschweig F. Long-term outcome of patients with invasive electrophysiology procedure related cardiac tamponade. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0411] [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: 11/13/2022] Open
Abstract
Abstract
Aims
Iatrogenic cardiac tamponades are a rare but dreaded complication of invasive electrophysiology procedures (EPs). Their long-term impact on clinical outcomes is unknown. This study analyzed the risk of death or serious cardiovascular events in patients suffering from EP related cardiac tamponade requiring pericardiocentesis during long-term follow-up.
Methods and results
Out of 19997 invasive EPs at our university hospital between January 1998 and September 2018, all patients with EP related periprocedural cardiac tamponade were identified (n=60) and matched (1:3 ratio) to a control group (n=180). After a follow-up of 5 years, the composite primary end point - death from any cause, acute myocardial infarction, TIA/stroke and hospitalization for heart failure – occurred in significantly more patients in the tamponade than in the control group (12 patients (20.0%) vs 19 patients (10.6%); Hazard ratio (HR) 2.53 (95% CI, 1.15–5.58); p=0.021). This was mainly driven by a higher incidence of TIA/stroke in the tamponade than in the control group (HR 3.75 (95% CI, 1.01–13.97); p=0.049). Death from any cause, acute myocardial infarction and hospitalization for heart failure did not show a significant difference between the groups. Hospitalization for pericarditis occurred in significantly more patients in the tamponade than in the control group (HR 36.0 (95% CI, 4.68–276.86); p=0.001).
Conclusion
Patients with EP related cardiac tamponade are at higher risk for cerebrovascular events during the first two weeks and hospitalization for pericarditis during the first months after index procedure. Despite the increased risk for early complications tamponade patients have a good long-term prognosis without increased risk for mortality or other serious cardiovascular events.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): German Research Foundation
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Affiliation(s)
| | - T Bourke
- Karolinska University Hospital, Stockholm, Sweden
| | - J Schwieler
- Karolinska University Hospital, Stockholm, Sweden
| | - N Drca
- Karolinska University Hospital, Stockholm, Sweden
| | - H Bastani
- Karolinska University Hospital, Stockholm, Sweden
| | - J Tapanainen
- Karolinska University Hospital, Stockholm, Sweden
| | - O Saluveer
- Karolinska University Hospital, Stockholm, Sweden
| | - L Benson
- Karolinska Institutet, Stockholm, Sweden
| | - A Goedel
- Karolinska Institutet, Stockholm, Sweden
| | - G Kenneback
- Karolinska University Hospital, Stockholm, Sweden
| | - P Insulander
- Karolinska University Hospital, Stockholm, Sweden
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11
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von Olshausen G, Bourke T, Schwieler J, Drca N, Bastani H, Tapanainen J, Saluveer O, Benson L, Goedel A, Kennebäck G, Insulander P, Jensen-Urstad M, Braunschweig F. Long-term outcome of patients with invasive electrophysiology procedure-related cardiac tamponade. Europace 2020; 22:1547-1557. [PMID: 32772100 DOI: 10.1093/europace/euaa155] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/18/2020] [Indexed: 12/29/2022] Open
Abstract
AIMS Iatrogenic cardiac tamponades are a rare but dreaded complication of invasive electrophysiology procedures (EPs). Their long-term impact on clinical outcomes is unknown. This study analysed the risk of death or serious cardiovascular events in patients suffering from EP-related cardiac tamponade requiring pericardiocentesis during long-term follow-up. METHODS AND RESULTS Out of 19 997 invasive EPs at the Karolinska University Hospital between January 1998 and September 2018, all patients with EP-related periprocedural cardiac tamponade were identified (n = 60) and matched (1:3 ratio) to a control group (n = 180). After a follow-up of 5 years, the composite primary endpoint - death from any cause, acute myocardial infarction, transitory ischaemic attack (TIA)/stroke, and hospitalization for heart failure - occurred in significantly more patients in the tamponade than in the control group [12 patients (20.0%) vs. 19 patients (10.6%); hazard ratio (HR) 2.53 (95% confidence interval, CI 1.15-5.58); P = 0.021]. This was mainly driven by a higher incidence of TIA/stroke in the tamponade than in the control group [HR 3.75 (95% CI 1.01-13.97); P = 0.049]. Death from any cause, acute myocardial infarction, and hospitalization for heart failure did not show a significant difference between the groups. Hospitalization for pericarditis occurred in significantly more patients in the tamponade than in the control group [HR 36.0 (95% CI 4.68-276.86); P = 0.001]. CONCLUSION Patients with EP-related cardiac tamponade are at higher risk for cerebrovascular events during the first 2 weeks and hospitalization for pericarditis during the first months after index procedure. Despite the increased risk for early complications tamponade patients have a good long-term prognosis without increased risk for mortality or other serious cardiovascular events.
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Affiliation(s)
- Gesa von Olshausen
- Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Tara Bourke
- Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Jonas Schwieler
- Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Nikola Drca
- Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Hamid Bastani
- Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Jari Tapanainen
- Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Ott Saluveer
- Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Lina Benson
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Alexander Goedel
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
| | - Göran Kennebäck
- Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Per Insulander
- Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Mats Jensen-Urstad
- Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Frieder Braunschweig
- Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
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12
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Abstract
The advent of pluripotent stem cell biology and facile genetic manipulation via CRISPR technology has ushered in a new era of human disease models for drug discovery and development. While these precision "super models" hold great promise for tailoring personalized therapy, their full potential and in vivo validation have remained elusive.
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Affiliation(s)
- Alexander Goedel
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
| | | | - Makoto Sahara
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Yale University School of Medicine, New Haven, CN, USA
| | - Kenneth R Chien
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden.,Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
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13
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Goedel A, Fiedler KA, Mehilli J, Bernlochner I, von Olshausen G, Mayer K, Schüpke S, Hoppmann P, Sibbing D, Maeng M, Massberg S, Schunkert H, Laugwitz KL, Kastrati A, Sarafoff N. Enhanced platelet inhibition by clopidogrel and risk of bleeding in patients requiring oral anticoagulation after drug-eluting stent implantation. EUROINTERVENTION 2019; 15:700-706. [PMID: 30834895 DOI: 10.4244/eij-d-18-00995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/23/2022]
Abstract
AIMS Clopidogrel is the P2Y12 inhibitor of choice in patients who undergo PCI and have an indication for oral anticoagulation (OAC). Prediction of the bleeding risk is of major interest in this population. The aim of this analysis was to investigate whether an enhanced platelet inhibition by clopidogrel measured by platelet function testing (PFT) with the Multiplate Analyzer is associated with an increased bleeding risk in patients on triple antithrombotic therapy. METHODS AND RESULTS This investigation was performed in a cohort of 524 patients from the randomised ISAR-TRIPLE trial; 458 (87.4%) had PFT results available in the first 24 hours after PCI. Patients belonging to the lowest quintile according to PFT were considered as enhanced responders to clopidogrel. The primary endpoint was major bleeding according to TIMI criteria at nine months. The median of ADP-induced platelet aggregation in the whole population was 163 AU*min (107-241). Patients in the lowest quintile had values below 93 AU*min. These enhanced responders (92 patients) had a significantly higher risk of TIMI major bleeding (hazard ratio [HR] 3.13, 95% confidence interval [CI]: 1.38-7.09, p=0.01) and overall mortality (HR 3.42, 95% CI: 1.55-7.52, p=0.004) compared with the remaining patients (366 patients). No significant difference was observed for the secondary combined ischaemic endpoint (HR 1.27, 95% CI: 0.47-3.47, p=0.64). CONCLUSIONS Enhanced platelet inhibition delivered by clopidogrel is associated with an increased risk for major bleeding and death in patients on OAC who undergo PCI. These results support the use of PFT to identify patients with an increased risk for bleeding.
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Affiliation(s)
- Alexander Goedel
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
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14
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Goedel A, Müller S, Schwerdtfeger C, Zink A, Noe S, Bongiovanni D, Haller B, Spinner CD, Bernlochner I. Influence of antiretroviral therapy and cardiovascular disease on the immature platelet fraction in patients living with HIV. Platelets 2019; 31:756-762. [PMID: 31608753 DOI: 10.1080/09537104.2019.1678114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Cardiovascular disease is an important contributor to morbidity and mortality in people living with HIV . The immature platelet fraction (IPF) is increased in HIV-negative patients with cardiovascular disease and evidence suggests that an enlarged IPF is associated with adverse cardiovascular events. In this multi-center observational study, we aimed to investigate how the IPF in people living with HIV is influenced by antiretroviral therapy and cardiovascular disease. Subjects without cardiovascular disease that received antiretroviral therapy showed a smaller IPF accompanied by lower D-dimer and C-reactive protein (CRP) levels compared to therapy-naïve subjects (mean IPF: 2.9% vs. 3.9%, p = .016; median D-dimer: 252 µg/L vs. 623 µg/L, p < .001; median CRP: 0.2 mg/dL vs. 0.5 mg/dL, p = .004). No significant differences for the IPF, D-dimer or CRP were found between subjects on antiretroviral therapy with documented cardiovascular disease and therapy-naïve subjects. In conclusion, we observed a reduction in the IPF among subjects on therapy only in the absence of cardiovascular disease. In contrast, subjects receiving therapy that had documented cardiovascular disease showed an IPF comparable to therapy-naïve subjects. Future studies are needed to investigate if an enlarged IPF may serve as a biomarker in predicting adverse cardiovascular events in people living with HIV.
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Affiliation(s)
- A Goedel
- Department of Medicine I, Technical University of Munich, School of Medicine, University Hospital Klinikum rechts der Isar , Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance , Munich, Germany
| | - S Müller
- Department of Medicine II, Technical University of Munich, School of Medicine, University Hospital Klinikum rechts der Isar , Munich, Germany
| | - C Schwerdtfeger
- Department of Medicine II, Technical University of Munich, School of Medicine, University Hospital Klinikum rechts der Isar , Munich, Germany.,DZIF (German Center for Infection Research), partner site Munich , Munich, Germany
| | - A Zink
- Department of Dermatology and Allergology, Technical University of Munich, School of Medicine, University Hospital Klinikum rechts der Isar , Munich, Germany
| | - S Noe
- Medizinisches Versorgungszentrum am Karlsplatz, HIV Clinical Care and Research Center , Munich, Germany
| | - D Bongiovanni
- Department of Medicine I, Technical University of Munich, School of Medicine, University Hospital Klinikum rechts der Isar , Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance , Munich, Germany
| | - B Haller
- School of Medicine, Institute for Medical Informatics, Statistics and Epidemiology, Technical University of Munich , Munich, Germany
| | - C D Spinner
- Department of Medicine II, Technical University of Munich, School of Medicine, University Hospital Klinikum rechts der Isar , Munich, Germany.,DZIF (German Center for Infection Research), partner site Munich , Munich, Germany
| | - I Bernlochner
- Department of Medicine I, Technical University of Munich, School of Medicine, University Hospital Klinikum rechts der Isar , Munich, Germany
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15
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Kossmann H, Rischpler C, Hanus F, Nekolla SG, Kunze KP, Götze K, Goedel A, Sager H, Kastrati A, Sinnecker D, Kupatt C, Ibrahim T, Schwaiger M, Laugwitz KL, Dirschinger RJ. Monocyte-platelet aggregates affect local inflammation in patients with acute myocardial infarction. Int J Cardiol 2019; 287:7-12. [PMID: 31003796 DOI: 10.1016/j.ijcard.2019.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 04/01/2019] [Indexed: 01/12/2023]
Abstract
The local inflammatory response following acute myocardial infarction (AMI) is increasingly being recognized as a central factor determining infarct healing. Myocardial inflammation can be visualized in patients using fasting 18F-FDG PET/MRI. Although this novel biosignal correlates with long-term functional outcome, the corresponding cellular substrate is not well understood. Here we present a retrospective analysis of 29 patients with AMI who underwent revascularization, suggesting a connection between post infarction myocardial fasting 18F-FDG uptake, monocyte platelet aggregates (MPA), and P2Y12 inhibition. In detail, patients with high MPA percentages of CD14highCD16+ and CD14lowCD16+ monocytes had significantly higher local 18F-FDG uptake (SUVmean) in the infarcted myocardium than patients with low MPA (p < 0.05). Furthermore, there was an association of high MPA percentage in all monocyte subpopulations with deteriorating ΔLV-EF after 6 months (p < 0.01), which was confirmed in an extended analysis with additional 29 patients without PET/MRI data available. In this analysis, administration of Ticagrelor was associated with lower MPA percentage of CD14high monocyte subpopulations than Clopidogrel (p < 0.01) or Prasugrel (p < 0.05). Taken together, the findings from this analysis suggest that platelet aggregability may affect monocyte extravasation into the infarcted myocardium and influence long-term functional outcome. P2Y12 inhibition may intervene in this pathophysiologic process. Prospective studies are needed to further examine this important relationship.
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Affiliation(s)
- Hans Kossmann
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Christoph Rischpler
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Franziska Hanus
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Stephan G Nekolla
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Karl P Kunze
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Katharina Götze
- Klinik und Poliklinik für Innere Medizin III, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Alexander Goedel
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Hendrik Sager
- Deutsches Herzzentrum, Technische Universität München, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum, Technische Universität München, Munich, Germany
| | - Daniel Sinnecker
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Christian Kupatt
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Tareq Ibrahim
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Markus Schwaiger
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Karl-Ludwig Laugwitz
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Ralf J Dirschinger
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
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16
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Chen Z, Xian W, Bellin M, Dorn T, Tian Q, Goedel A, Dreizehnter L, Schneider CM, Ward-van Oostwaard D, Ng JKM, Hinkel R, Pane LS, Mummery CL, Lipp P, Moretti A, Laugwitz KL, Sinnecker D. Subtype-specific promoter-driven action potential imaging for precise disease modelling and drug testing in hiPSC-derived cardiomyocytes. Eur Heart J 2019; 38:292-301. [PMID: 28182242 PMCID: PMC5381588 DOI: 10.1093/eurheartj/ehw189] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 03/18/2016] [Accepted: 04/19/2016] [Indexed: 12/30/2022] Open
Affiliation(s)
- Zhifen Chen
- I. Department of Medicine (Cardiology), Klinikum rechts der Isar, Technische Universität München, Munich 81675, Germany
| | - Wenying Xian
- Institute for Molecular Cell Biology, Medical Faculty, University Homburg/Saar, Universität des Saarlandes, Homburg/Saar 66421, Germany
| | - Milena Bellin
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden 2333, The Netherlands
| | - Tatjana Dorn
- I. Department of Medicine (Cardiology), Klinikum rechts der Isar, Technische Universität München, Munich 81675, Germany
| | - Qinghai Tian
- Institute for Molecular Cell Biology, Medical Faculty, University Homburg/Saar, Universität des Saarlandes, Homburg/Saar 66421, Germany
| | - Alexander Goedel
- I. Department of Medicine (Cardiology), Klinikum rechts der Isar, Technische Universität München, Munich 81675, Germany
| | - Lisa Dreizehnter
- I. Department of Medicine (Cardiology), Klinikum rechts der Isar, Technische Universität München, Munich 81675, Germany
| | - Christine M Schneider
- I. Department of Medicine (Cardiology), Klinikum rechts der Isar, Technische Universität München, Munich 81675, Germany
| | - Dorien Ward-van Oostwaard
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden 2333, The Netherlands
| | - Judy King Man Ng
- I. Department of Medicine (Cardiology), Klinikum rechts der Isar, Technische Universität München, Munich 81675, Germany
| | | | - Luna Simona Pane
- I. Department of Medicine (Cardiology), Klinikum rechts der Isar, Technische Universität München, Munich 81675, Germany
| | - Christine L Mummery
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden 2333, The Netherlands
| | - Peter Lipp
- Institute for Molecular Cell Biology, Medical Faculty, University Homburg/Saar, Universität des Saarlandes, Homburg/Saar 66421, Germany
| | | | | | - Daniel Sinnecker
- I. Department of Medicine (Cardiology), Klinikum rechts der Isar, Technische Universität München, Munich 81675, Germany
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17
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Goedel A, Sarafoff N. Finding the right balance. Int J Cardiol 2018; 273:90-91. [PMID: 30274748 DOI: 10.1016/j.ijcard.2018.09.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 09/24/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Alexander Goedel
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Nikolaus Sarafoff
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians Universität, Munich, Germany.
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18
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Goedel A, Zawada DM, Zhang F, Chen Z, Moretti A, Sinnecker D. Subtype-specific Optical Action Potential Recordings in Human Induced Pluripotent Stem Cell-derived Ventricular Cardiomyocytes. J Vis Exp 2018. [PMID: 30320759 DOI: 10.3791/58134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Cardiomyocytes generated from human induced pluripotent stem cells (iPSC-CMs) are an emerging tool in cardiovascular research. Rather than being a homogenous population of cells, the iPSC-CMs generated by current differentiation protocols represent a mixture of cells with ventricular-, atrial-, and nodal-like phenotypes, which complicates phenotypic analyses. Here, a method to optically record action potentials specifically from ventricular-like iPSC-CMs is presented. This is achieved by lentiviral transduction with a construct in which a genetically-encoded voltage indicator is under the control of a ventricular-specific promoter element. When iPSC-CMs are transduced with this construct, the voltage sensor is expressed exclusively in ventricular-like cells, enabling subtype-specific optical membrane potential recordings using time-lapse fluorescence microscopy.
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Affiliation(s)
- Alexander Goedel
- Medical Department I, University Hospital Klinikum rechts der Isar, Technical University of Munich; German Centre for Cardiovascular Research (DZHK), Munich Heart Alliance
| | - Dorota M Zawada
- Medical Department I, University Hospital Klinikum rechts der Isar, Technical University of Munich
| | - Fangfang Zhang
- Medical Department I, University Hospital Klinikum rechts der Isar, Technical University of Munich
| | - Zhifen Chen
- Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Alessandra Moretti
- Medical Department I, University Hospital Klinikum rechts der Isar, Technical University of Munich; German Centre for Cardiovascular Research (DZHK), Munich Heart Alliance
| | - Daniel Sinnecker
- Medical Department I, University Hospital Klinikum rechts der Isar, Technical University of Munich; German Centre for Cardiovascular Research (DZHK), Munich Heart Alliance;
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19
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My I, Laue S, Dressen M, Schmidt F, Brade T, Dorn T, Goedel A, Lahm H, Lickert H, Krane M, Moretti A, Laugwitz KL. P1848Primary cilium-autophagy-cell cycle axis defects impair cardiac progenitor specification in hypoplastic left heart syndrome. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- I My
- Hospital Rechts der Isar, Molecular Cardiology, first department of medicine, TU, Munich, Germany
| | - S Laue
- Hospital Rechts der Isar, Molecular Cardiology, first department of medicine, TU, Munich, Germany
| | - M Dressen
- Deutsches Herzzentrum Technische Universitat, Department of cardiovascular surgery, division of experimental surgery, Munich, Germany
| | - F Schmidt
- Helmholtz Center Munich - German Research Center for Environment and Health, Institute of diabetes and regeneration research, Munich, Germany
| | - T Brade
- Hospital Rechts der Isar, Molecular Cardiology, first department of medicine, TU, Munich, Germany
| | - T Dorn
- Hospital Rechts der Isar, Molecular Cardiology, first department of medicine, TU, Munich, Germany
| | - A Goedel
- Hospital Rechts der Isar, Molecular Cardiology, first department of medicine, TU, Munich, Germany
| | - H Lahm
- Deutsches Herzzentrum Technische Universitat, Department of cardiovascular surgery, division of experimental surgery, Munich, Germany
| | - H Lickert
- Helmholtz Center Munich - German Research Center for Environment and Health, Institute of diabetes and regeneration research, Munich, Germany
| | - M Krane
- Deutsches Herzzentrum Technische Universitat, Department of cardiovascular surgery, division of experimental surgery, Munich, Germany
| | - A Moretti
- Hospital Rechts der Isar, Molecular Cardiology, first department of medicine, TU, Munich, Germany
| | - K.-L Laugwitz
- Hospital Rechts der Isar, Molecular Cardiology, first department of medicine, TU, Munich, Germany
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20
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Dorn T, Kornherr J, Parrotta EI, Zawada D, Ayetey H, Santamaria G, Iop L, Mastantuono E, Sinnecker D, Goedel A, Dirschinger RJ, My I, Laue S, Bozoglu T, Baarlink C, Ziegler T, Graf E, Hinkel R, Cuda G, Kääb S, Grace AA, Grosse R, Kupatt C, Meitinger T, Smith AG, Laugwitz KL, Moretti A. Interplay of cell-cell contacts and RhoA/MRTF-A signaling regulates cardiomyocyte identity. EMBO J 2018; 37:e98133. [PMID: 29764980 PMCID: PMC6003642 DOI: 10.15252/embj.201798133] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 03/29/2018] [Accepted: 04/04/2018] [Indexed: 12/13/2022] Open
Abstract
Cell-cell and cell-matrix interactions guide organ development and homeostasis by controlling lineage specification and maintenance, but the underlying molecular principles are largely unknown. Here, we show that in human developing cardiomyocytes cell-cell contacts at the intercalated disk connect to remodeling of the actin cytoskeleton by regulating the RhoA-ROCK signaling to maintain an active MRTF/SRF transcriptional program essential for cardiomyocyte identity. Genetic perturbation of this mechanosensory pathway activates an ectopic fat gene program during cardiomyocyte differentiation, which ultimately primes the cells to switch to the brown/beige adipocyte lineage in response to adipogenesis-inducing signals. We also demonstrate by in vivo fate mapping and clonal analysis of cardiac progenitors that cardiac fat and a subset of cardiac muscle arise from a common precursor expressing Isl1 and Wt1 during heart development, suggesting related mechanisms of determination between the two lineages.
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Affiliation(s)
- Tatjana Dorn
- Klinik und Poliklinik Innere Medizin I, Klinikum rechts der Isar - Technical University of Munich, Munich, Germany
| | - Jessica Kornherr
- Klinik und Poliklinik Innere Medizin I, Klinikum rechts der Isar - Technical University of Munich, Munich, Germany
| | - Elvira I Parrotta
- Klinik und Poliklinik Innere Medizin I, Klinikum rechts der Isar - Technical University of Munich, Munich, Germany
- Department of Experimental and Clinical Medicine, Medical School, University of Magna Grecia, Catanzaro, Italy
| | - Dorota Zawada
- Klinik und Poliklinik Innere Medizin I, Klinikum rechts der Isar - Technical University of Munich, Munich, Germany
| | - Harold Ayetey
- Wellcome Trust - Medical Research Council Stem Cell Institute, University of Cambridge, Cambridge, UK
- Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Gianluca Santamaria
- Department of Experimental and Clinical Medicine, Medical School, University of Magna Grecia, Catanzaro, Italy
| | - Laura Iop
- Klinik und Poliklinik Innere Medizin I, Klinikum rechts der Isar - Technical University of Munich, Munich, Germany
| | - Elisa Mastantuono
- Institute of Human Genetics, Klinikum rechts der Isar - Technical University of Munich, Munich, Germany
| | - Daniel Sinnecker
- Klinik und Poliklinik Innere Medizin I, Klinikum rechts der Isar - Technical University of Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research) - partner site Munich Heart Alliance, Munich, Germany
| | - Alexander Goedel
- Klinik und Poliklinik Innere Medizin I, Klinikum rechts der Isar - Technical University of Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research) - partner site Munich Heart Alliance, Munich, Germany
| | - Ralf J Dirschinger
- Klinik und Poliklinik Innere Medizin I, Klinikum rechts der Isar - Technical University of Munich, Munich, Germany
| | - Ilaria My
- Klinik und Poliklinik Innere Medizin I, Klinikum rechts der Isar - Technical University of Munich, Munich, Germany
| | - Svenja Laue
- Klinik und Poliklinik Innere Medizin I, Klinikum rechts der Isar - Technical University of Munich, Munich, Germany
| | - Tarik Bozoglu
- Klinik und Poliklinik Innere Medizin I, Klinikum rechts der Isar - Technical University of Munich, Munich, Germany
| | | | - Tilman Ziegler
- Klinik und Poliklinik Innere Medizin I, Klinikum rechts der Isar - Technical University of Munich, Munich, Germany
| | - Elisabeth Graf
- Institute of Human Genetics, Klinikum rechts der Isar - Technical University of Munich, Munich, Germany
| | - Rabea Hinkel
- Klinik und Poliklinik Innere Medizin I, Klinikum rechts der Isar - Technical University of Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research) - partner site Munich Heart Alliance, Munich, Germany
- IPEK Institute for Cardiovascular Prevention, Klinikum der Universität München - Ludwig-Maximillians-Universität, Munich, Germany
| | - Giovanni Cuda
- Department of Experimental and Clinical Medicine, Medical School, University of Magna Grecia, Catanzaro, Italy
| | - Stefan Kääb
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München - Ludwig-Maximillians-Universität, Munich, Germany
| | - Andrew A Grace
- Papworth Hospital NHS Foundation Trust, Cambridge, UK
- Department of Biochemistry, University of Cambridge, Cambridge, UK
| | - Robert Grosse
- Pharmacology Institute, Philipps University Marburg, Marburg, Germany
| | - Christian Kupatt
- Klinik und Poliklinik Innere Medizin I, Klinikum rechts der Isar - Technical University of Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research) - partner site Munich Heart Alliance, Munich, Germany
| | - Thomas Meitinger
- Institute of Human Genetics, Klinikum rechts der Isar - Technical University of Munich, Munich, Germany
| | - Austin G Smith
- Wellcome Trust - Medical Research Council Stem Cell Institute, University of Cambridge, Cambridge, UK
- Department of Biochemistry, University of Cambridge, Cambridge, UK
| | - Karl-Ludwig Laugwitz
- Klinik und Poliklinik Innere Medizin I, Klinikum rechts der Isar - Technical University of Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research) - partner site Munich Heart Alliance, Munich, Germany
| | - Alessandra Moretti
- Klinik und Poliklinik Innere Medizin I, Klinikum rechts der Isar - Technical University of Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research) - partner site Munich Heart Alliance, Munich, Germany
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21
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Sinnecker D, Chen Z, Goedel A, My I, Dreizehnter L, Moretti A, Laugwitz KL. P2561All-optical imaging of membrane potential and calcium signalling in patient-specific hiPSC-derived cardiomyocytes. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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22
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Gramlich M, Pane LS, Zhou Q, Chen Z, Murgia M, Schötterl S, Goedel A, Metzger K, Brade T, Parrotta E, Schaller M, Gerull B, Thierfelder L, Aartsma-Rus A, Labeit S, Atherton JJ, McGaughran J, Harvey RP, Sinnecker D, Mann M, Laugwitz KL, Gawaz MP, Moretti A. Antisense-mediated exon skipping: a therapeutic strategy for titin-based dilated cardiomyopathy. EMBO Mol Med 2016; 7:562-76. [PMID: 25759365 PMCID: PMC4492817 DOI: 10.15252/emmm.201505047] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Frameshift mutations in the TTN gene encoding titin are a major cause for inherited forms of dilated cardiomyopathy (DCM), a heart disease characterized by ventricular dilatation, systolic dysfunction, and progressive heart failure. To date, there are no specific treatment options for DCM patients but heart transplantation. Here, we show the beneficial potential of reframing titin transcripts by antisense oligonucleotide (AON)-mediated exon skipping in human and murine models of DCM carrying a previously identified autosomal-dominant frameshift mutation in titin exon 326. Correction of TTN reading frame in patient-specific cardiomyocytes derived from induced pluripotent stem cells rescued defective myofibril assembly and stability and normalized the sarcomeric protein expression. AON treatment in Ttn knock-in mice improved sarcomere formation and contractile performance in homozygous embryos and prevented the development of the DCM phenotype in heterozygous animals. These results demonstrate that disruption of the titin reading frame due to a truncating DCM mutation can be restored by exon skipping in both patient cardiomyocytes in vitro and mouse heart in vivo, indicating RNA-based strategies as a potential treatment option for DCM.
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Affiliation(s)
- Michael Gramlich
- Department of Cardiology and Cardiovascular Diseases, Eberhard Karls University, Tübingen, Germany Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
| | - Luna Simona Pane
- I. Medical Department - Cardiology, Klinikum rechts der Isar - Technische Universität München, Munich, Germany
| | - Qifeng Zhou
- Department of Cardiology and Cardiovascular Diseases, Eberhard Karls University, Tübingen, Germany
| | - Zhifen Chen
- I. Medical Department - Cardiology, Klinikum rechts der Isar - Technische Universität München, Munich, Germany
| | - Marta Murgia
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany Department of Biomedical Sciences, University of Padova, Padua, Italy
| | - Sonja Schötterl
- Department of Cardiology and Cardiovascular Diseases, Eberhard Karls University, Tübingen, Germany
| | - Alexander Goedel
- I. Medical Department - Cardiology, Klinikum rechts der Isar - Technische Universität München, Munich, Germany
| | - Katja Metzger
- Department of Cardiology and Cardiovascular Diseases, Eberhard Karls University, Tübingen, Germany
| | - Thomas Brade
- I. Medical Department - Cardiology, Klinikum rechts der Isar - Technische Universität München, Munich, Germany
| | - Elvira Parrotta
- I. Medical Department - Cardiology, Klinikum rechts der Isar - Technische Universität München, Munich, Germany Department of Experimental and Clinical Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Martin Schaller
- Department of Dermatology, Eberhard Karls University, Tübingen, Germany
| | - Brenda Gerull
- Libin Cardiovascular Institute of Alberta and University of Calgary, Calgary, AB, Canada
| | | | - Annemieke Aartsma-Rus
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Siegfried Labeit
- Institute for Integrative Pathophysiology, Universitätsmedizin Mannheim, Mannheim, Germany
| | - John J Atherton
- Department of Cardiology, Royal Brisbane and Women's Hospital and University of Queensland School of Medicine, Brisbane, Australia
| | - Julie McGaughran
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia
| | - Richard P Harvey
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia St Vincent's Clinical School, University of New South Wales, Kensington, NSW, Australia
| | - Daniel Sinnecker
- I. Medical Department - Cardiology, Klinikum rechts der Isar - Technische Universität München, Munich, Germany
| | - Matthias Mann
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Karl-Ludwig Laugwitz
- I. Medical Department - Cardiology, Klinikum rechts der Isar - Technische Universität München, Munich, Germany DZHK (German Centre for Cardiovascular Research) - partner site Munich Heart Alliance, Munich, Germany
| | - Meinrad Paul Gawaz
- Department of Cardiology and Cardiovascular Diseases, Eberhard Karls University, Tübingen, Germany
| | - Alessandra Moretti
- I. Medical Department - Cardiology, Klinikum rechts der Isar - Technische Universität München, Munich, Germany DZHK (German Centre for Cardiovascular Research) - partner site Munich Heart Alliance, Munich, Germany
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23
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Dorn T, Goedel A, Lam JT, Haas J, Tian Q, Herrmann F, Bundschu K, Dobreva G, Schiemann M, Dirschinger R, Guo Y, Kühl SJ, Sinnecker D, Lipp P, Laugwitz KL, Kühl M, Moretti A. Direct nkx2-5 transcriptional repression of isl1 controls cardiomyocyte subtype identity. Stem Cells 2016; 33:1113-29. [PMID: 25524439 PMCID: PMC6750130 DOI: 10.1002/stem.1923] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [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: 04/30/2014] [Revised: 10/29/2014] [Accepted: 11/08/2014] [Indexed: 12/31/2022]
Abstract
During cardiogenesis, most myocytes arise from cardiac progenitors expressing the transcription factors Isl1 and Nkx2-5. Here, we show that a direct repression of Isl1 by Nkx2-5 is necessary for proper development of the ventricular myocardial lineage. Overexpression of Nkx2-5 in mouse embryonic stem cells (ESCs) delayed specification of cardiac progenitors and inhibited expression of Isl1 and its downstream targets in Isl1(+) precursors. Embryos deficient for Nkx2-5 in the Isl1(+) lineage failed to downregulate Isl1 protein in cardiomyocytes of the heart tube. We demonstrated that Nkx2-5 directly binds to an Isl1 enhancer and represses Isl1 transcriptional activity. Furthermore, we showed that overexpression of Isl1 does not prevent cardiac differentiation of ESCs and in Xenopus laevis embryos. Instead, it leads to enhanced specification of cardiac progenitors, earlier cardiac differentiation, and increased cardiomyocyte number. Functional and molecular characterization of Isl1-overexpressing cardiomyocytes revealed higher beating frequencies in both ESC-derived contracting areas and Xenopus Isl1-gain-of-function hearts, which associated with upregulation of nodal-specific genes and downregulation of transcripts of working myocardium. Immunocytochemistry of cardiomyocyte lineage-specific markers demonstrated a reduction of ventricular cells and an increase of cells expressing the pacemaker channel Hcn4. Finally, optical action potential imaging of single cardiomyocytes combined with pharmacological approaches proved that Isl1 overexpression in ESCs resulted in normally electrophysiologically functional cells, highly enriched in the nodal subtype at the expense of the ventricular lineage. Our findings provide an Isl1/Nkx2-5-mediated mechanism that coordinately regulates the specification of cardiac progenitors toward the different myocardial lineages and ensures proper acquisition of myocyte subtype identity.
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Affiliation(s)
- Tatjana Dorn
- I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
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24
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Bernlochner I, Goedel A, Plischke C, Schüpke S, Haller B, Schulz C, Mayer K, Morath T, Braun S, Schunkert H, Siess W, Kastrati A, Laugwitz KL. Impact of immature platelets on platelet response to ticagrelor and prasugrel in patients with acute coronary syndrome. Eur Heart J 2015. [DOI: 10.1093/eurheartj/ehv326] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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25
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Orban M, Goedel A, Haas J, Sandrock-Lang K, Gärtner F, Jung CB, Zieger B, Parrotta E, Kurnik K, Sinnecker D, Wanner G, Laugwitz KL, Massberg S, Moretti A. Functional comparison of induced pluripotent stem cell- and blood-derived GPIIbIIIa deficient platelets. PLoS One 2015; 10:e0115978. [PMID: 25607928 PMCID: PMC4301811 DOI: 10.1371/journal.pone.0115978] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 11/28/2014] [Indexed: 12/16/2022] Open
Abstract
Human induced pluripotent stem cells (hiPSCs) represent a versatile tool to model genetic diseases and are a potential source for cell transfusion therapies. However, it remains elusive to which extent patient-specific hiPSC-derived cells functionally resemble their native counterparts. Here, we generated a hiPSC model of the primary platelet disease Glanzmann thrombasthenia (GT), characterized by dysfunction of the integrin receptor GPIIbIIIa, and compared side-by-side healthy and diseased hiPSC-derived platelets with peripheral blood platelets. Both GT-hiPSC-derived platelets and their peripheral blood equivalents showed absence of membrane expression of GPIIbIIIa, a reduction of PAC-1 binding, surface spreading and adherence to fibrinogen. We demonstrated that GT-hiPSC-derived platelets recapitulate molecular and functional aspects of the disease and show comparable behavior to their native counterparts encouraging the further use of hiPSC-based disease models as well as the transition towards a clinical application.
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Affiliation(s)
- Mathias Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximillians-Universität, Munich, Germany
| | - Alexander Goedel
- I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Jessica Haas
- I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Kirstin Sandrock-Lang
- Department of Pediatrics and Adolescent Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Florian Gärtner
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximillians-Universität, Munich, Germany
| | - Christian Billy Jung
- I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Barbara Zieger
- Department of Pediatrics and Adolescent Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Elvira Parrotta
- I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany; Department of Experimental and Clinical Medicine, University of Magna Graecia, Medical School, Catanzaro, Italy
| | - Karin Kurnik
- Paediatric Haemophilia Centre, Dr. von Hauner Children's Hospital, Ludwig-Maximillians-Universität, Munich, Germany
| | - Daniel Sinnecker
- I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Gerhard Wanner
- Ultrastructural Research, Department Biology I, Biozentrum, Ludwig-Maximillians-Universität, Planegg-Martinsried, Germany
| | - Karl-Ludwig Laugwitz
- I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research)-partner site Munich Heart Alliance, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximillians-Universität, Munich, Germany; DZHK (German Centre for Cardiovascular Research)-partner site Munich Heart Alliance, Munich, Germany
| | - Alessandra Moretti
- I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research)-partner site Munich Heart Alliance, Munich, Germany
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26
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Affiliation(s)
- Alexander Goedel
- I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Strasse 22, Munich 81675, Germany DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Alexander Hoellein
- III. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Christoph Rischpler
- Klinik für Nuklearmedizin, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Katharina Götze
- III. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
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27
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Goedel A, Orban M, Haas J, Gaertner F, Sandrock K, Zieger B, Kurnik K, Moretti A, Laugwitz KL, Massberg S. In vitro generation of hiPSC-derived megakaryocytes and platelets from a patient with Glanzmann thrombasthenia. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht311.5867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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28
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Abstract
Induced pluripotent stem cells offer the possibility to generate patient-specific stem cell lines from individuals affected by inherited disorders. Cardiomyocytes differentiated from such patient-specific induced pluripotent stem cells lines have been used to study the pathophysiology of arrhythmogenic heart diseases, such as the long-QT syndrome or catecholaminergic polymorphic ventricular tachycardia. Testing for unwanted drug side effects or tailoring medical treatment to the specific needs of individual patients with arrhythmogenic disorders may become future applications of this emerging technology.
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Affiliation(s)
- Daniel Sinnecker
- Klinikum rechts der Isar, Technische Universität München, I. Medizinische Klinik, Kardiologie, Munich, Germany
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29
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Sinnecker D, Goedel A, Dorn T, Dirschinger RJ, Moretti A, Laugwitz KL. Modeling long-QT syndromes with iPS cells. J Cardiovasc Transl Res 2012; 6:31-6. [PMID: 23076501 DOI: 10.1007/s12265-012-9416-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [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: 08/06/2012] [Accepted: 10/10/2012] [Indexed: 11/25/2022]
Abstract
The generation of induced pluripotent stem cells (iPSC) from human somatic cells bears the possibility to generate patient-specific stem cell lines which can serve as a theoretically unlimited source of somatic cells carrying the genotype of the patients. Different types of the long-QT syndrome have been studied by analyzing the phenotype of cardiomyocytes generated from patient-specific iPSC lines. Major aspects of the pathophysiology of long-QT syndrome, like prolonged action potentials, arrhythmia, and the effects of pro- and antiarrhythmic drugs could be recapitulated in these cells. In the future, patient-specific iPSC-derived cardiomyocytes might be used to screen for new drugs, to avoid unwanted drug side effects, and to deepen our understanding on the pathophysiology of long-QT syndromes.
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Affiliation(s)
- Daniel Sinnecker
- I. Medizinische Klinik Kardiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675, Munich, Germany.
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30
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Dirschinger RJ, Goedel A, Moretti A, Laugwitz KL, Sinnecker D. Recapitulating long-QT syndrome using induced pluripotent stem cell technology. Pediatr Cardiol 2012; 33:950-8. [PMID: 22411718 DOI: 10.1007/s00246-012-0286-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Accepted: 02/28/2012] [Indexed: 10/28/2022]
Abstract
The generation of patient-specific stem cells by reprogramming somatic cells to induced pluripotent stem cells (iPSC) provides the basis for a promising new type of in vitro disease models. Patient-specific iPSC derived from individuals with hereditary disorders can be differentiated into somatic cells in vitro, thus allowing the pathophysiology of the diseases to be studied on a cellular level. Different types of long-QT syndrome have been successfully modeled using this approach, demonstrating that the iPSC-derived patient-specific cardiomyocytes recapitulated key features of the disease in vitro. This approach will likely serve to model other monogenetic or polygenetic cardiovascular disorders in the future. Moreover, test platforms based on patient-specific iPSC could be used to test the potential of drug candidates to induce QT-interval prolongation or other unwanted side effects, screen for novel cardiovascular drugs, or to tailor medical therapy to the specific needs of a single patient.
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Affiliation(s)
- Ralf J Dirschinger
- Medizinische Klinik-Kardiologie, Klinikum rechts der Isar-Technische Universität München, Ismaninger Straße 22, 81675, München, Germany
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31
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Jung CB, Moretti A, Mederos y Schnitzler M, Iop L, Storch U, Bellin M, Dorn T, Ruppenthal S, Pfeiffer S, Goedel A, Dirschinger RJ, Seyfarth M, Lam JT, Sinnecker D, Gudermann T, Lipp P, Laugwitz KL. Dantrolene rescues arrhythmogenic RYR2 defect in a patient-specific stem cell model of catecholaminergic polymorphic ventricular tachycardia. EMBO Mol Med 2012; 4:180-91. [PMID: 22174035 PMCID: PMC3376852 DOI: 10.1002/emmm.201100194] [Citation(s) in RCA: 263] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 12/01/2011] [Accepted: 12/05/2011] [Indexed: 12/23/2022] Open
Abstract
Coordinated release of calcium (Ca2+) from the sarcoplasmic reticulum (SR) through cardiac ryanodine receptor (RYR2) channels is essential for cardiomyocyte function. In catecholaminergic polymorphic ventricular tachycardia (CPVT), an inherited disease characterized by stress-induced ventricular arrhythmias in young patients with structurally normal hearts, autosomal dominant mutations in RYR2 or recessive mutations in calsequestrin lead to aberrant diastolic Ca2+ release from the SR causing arrhythmogenic delayed after depolarizations (DADs). Here, we report the generation of induced pluripotent stem cells (iPSCs) from a CPVT patient carrying a novel RYR2 S406L mutation. In patient iPSC-derived cardiomyocytes, catecholaminergic stress led to elevated diastolic Ca2+ concentrations, a reduced SR Ca2+ content and an increased susceptibility to DADs and arrhythmia as compared to control myocytes. This was due to increased frequency and duration of elementary Ca2+ release events (Ca2+ sparks). Dantrolene, a drug effective on malignant hyperthermia, restored normal Ca2+ spark properties and rescued the arrhythmogenic phenotype. This suggests defective inter-domain interactions within the RYR2 channel as the pathomechanism of the S406L mutation. Our work provides a new in vitro model to study the pathogenesis of human cardiac arrhythmias and develop novel therapies for CPVT.
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Affiliation(s)
- Christian B Jung
- Klinikum rechts der Isar, Technische Universität München, I. Medizinische Klinik, Kardiologie, München, Germany
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32
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Sinnecker D, Dirschinger RJ, Goedel A, Moretti A, Lipp P, Laugwitz KL. Induced pluripotent stem cells in cardiovascular research. Rev Physiol Biochem Pharmacol 2012; 163:1-26. [PMID: 22447279 DOI: 10.1007/112_2012_6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The discovery that somatic cells can be reprogrammed to induced pluripotent stem cells (iPSC) by overexpression of a combination of transcription factors bears the potential to spawn a wealth of new applications in both preclinical and clinical cardiovascular research. Disease modeling, which is accomplished by deriving iPSC lines from patients affected by heritable diseases and then studying the pathophysiology of the diseases in somatic cells differentiated from these patient-specific iPSC lines, is the so far most advanced of these applications. Long-QT syndrome and catecholaminergic polymorphic ventricular tachycardia are two heart rhythm disorders that have been already successfully modeled by several groups using this approach, which will likely serve to model other mono- or polygenetic cardiovascular disorders in the future. Test systems based on cells derived from iPSC might prove beneficial to screen for novel cardiovascular drugs or unwanted drug side effects and to individualize medical therapy. The application of iPSC for cell therapy of cardiovascular disorders, albeit promising, will only become feasible if the problem of biological safety of these cells will be mastered.
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Affiliation(s)
- Daniel Sinnecker
- Klinikum rechts der Isar - Technische Universität München, I. Medizinische Klinik - Kardiologie, Ismaninger Strasse 22, 81675, Munich, Germany.
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33
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Moretti A, Bellin M, Welling A, Jung CB, Lam JT, Bott-Flügel L, Dorn T, Goedel A, Höhnke C, Hofmann F, Seyfarth M, Sinnecker D, Schömig A, Laugwitz KL. Patient-specific induced pluripotent stem-cell models for long-QT syndrome. N Engl J Med 2010; 363:1397-409. [PMID: 20660394 DOI: 10.1056/nejmoa0908679] [Citation(s) in RCA: 894] [Impact Index Per Article: 63.9] [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] [Indexed: 12/26/2022]
Abstract
BACKGROUND Long-QT syndromes are heritable diseases associated with prolongation of the QT interval on an electrocardiogram and a high risk of sudden cardiac death due to ventricular tachyarrhythmia. In long-QT syndrome type 1, mutations occur in the KCNQ1 gene, which encodes the repolarizing potassium channel mediating the delayed rectifier I(Ks) current. METHODS We screened a family affected by long-QT syndrome type 1 and identified an autosomal dominant missense mutation (R190Q) in the KCNQ1 gene. We obtained dermal fibroblasts from two family members and two healthy controls and infected them with retroviral vectors encoding the human transcription factors OCT3/4, SOX2, KLF4, and c-MYC to generate pluripotent stem cells. With the use of a specific protocol, these cells were then directed to differentiate into cardiac myocytes. RESULTS Induced pluripotent stem cells maintained the disease genotype of long-QT syndrome type 1 and generated functional myocytes. Individual cells showed a “ventricular,” “atrial,” or “nodal” phenotype, as evidenced by the expression of cell-type–specific markers and as seen in recordings of the action potentials in single cells. The duration of the action potential was markedly prolonged in “ventricular” and “atrial” cells derived from patients with long-QT syndrome type 1, as compared with cells from control subjects. Further characterization of the role of the R190Q–KCNQ1 mutation in the pathogenesis of long-QT syndrome type 1 revealed a dominant negative trafficking defect associated with a 70 to 80% reduction in I(Ks) current and altered channel activation and deactivation properties. Moreover, we showed that myocytes derived from patients with long-QT syndrome type 1 had an increased susceptibility to catecholamine-induced tachyarrhythmia and that beta-blockade attenuated this phenotype. CONCLUSIONS We generated patient-specific pluripotent stem cells from members of a family affected by long-QT syndrome type 1 and induced them to differentiate into functional cardiac myocytes. The patient-derived cells recapitulated the electrophysiological features of the disorder. (Funded by the European Research Council and others.)
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Affiliation(s)
- Alessandra Moretti
- Cardiology Division, First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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