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Atchaneeyasakul K, Valasaki K, Silvera R, Khan A, Yavagal D. Optimal technique for canine mesenchymal stem cells labeling with novel SPIO, MIRB™: for MRI detection of transplanted stem cells canine stroke model. Neurol Res 2024; 46:326-329. [PMID: 38468486 DOI: 10.1080/01616412.2024.2303879] [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] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 01/07/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Cell-based therapy has emerged as a promising avenue for post-stroke recovery. A significant challenge lies in tracking the distribution and engraftment of transplanted cells within the target cerebral tissue. To address this, we turn to the potential of Brain MRI detection of mesenchymal stem cells (MSCs), achieved by labeling these cells with superparamagnetic iron oxide (SPIO). This is the first report of a technique to label canine MSCs using a commercially available SPIO, Molday ION Rhodamine B (MIRB), to optimize both viability and labeling efficacy for transplantation purposes." METHOD Canine MSCs were incubated with addition of different MIRB concentration from 0, 10, 20, 30 μg Fe/ml. The cellular uptake of MIRB was confirmed through the analysis of fluorescent images and flow cytometry. The morphological characteristics of MSCs were assessed via microscopic visualization. Cellular viability was evaluated using both a cellometer and flow cytometry. RESULT Fluorescent microscopic images of all MIRB incubated MSCs groups show >70% labeled cells with homogenous signal intensity. Notably, the morphology of MSCs remained unaltered in the 10 μg Fe/ml group compared to the control group. Furthermore, among the labeled groups, the 10 μg Fe/ml concentration exhibited the highest viability when assessed using two different flow cytometry methods (95.3%, p < 0.05). CONCLUSION This study successfully labels canine MSCs with MIRB. The optimal concentration of 10 μg Fe/ml demonstrates optimal viability, labeling efficacy, and preserved cellular morphology.
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Affiliation(s)
| | - Krystalenia Valasaki
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Risset Silvera
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Aisha Khan
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dileep Yavagal
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA
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2
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Benny M, Courchia B, Shrager S, Sharma M, Chen P, Duara J, Valasaki K, Bellio MA, Damianos A, Huang J, Zambrano R, Schmidt A, Wu S, Velazquez OC, Hare JM, Khan A, Young KC. OUP accepted manuscript. Stem Cells Transl Med 2022; 11:189-199. [PMID: 35298658 PMCID: PMC8929420 DOI: 10.1093/stcltm/szab011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/17/2021] [Indexed: 11/13/2022] Open
Abstract
Bronchopulmonary dysplasia (BPD) is a life-threatening condition in preterm infants with few effective therapies. Mesenchymal stem or stromal cells (MSCs) are a promising therapeutic strategy for BPD. The ideal MSC source for BPD prevention is however unknown. The objective of this study was to compare the regenerative effects of MSC obtained from bone marrow (BM) and umbilical cord tissue (UCT) in an experimental BPD model. In vitro, UCT-MSC demonstrated greater proliferation and expression of anti-inflammatory cytokines as compared to BM-MSC. Lung epithelial cells incubated with UCT-MSC conditioned media (CM) had better-wound healing following scratch injury. UCT-MSC CM and BM-MSC CM had similar pro-angiogenic effects on hyperoxia-exposed pulmonary microvascular endothelial cells. In vivo, newborn rats exposed to normoxia or hyperoxia (85% O2) from postnatal day (P) 1 to 21 were given intra-tracheal (IT) BM or UCT-MSC (1 × 106 cells/50 μL), or placebo (PL) on P3. Hyperoxia PL-treated rats had marked alveolar simplification, reduced lung vascular density, pulmonary vascular remodeling, and lung inflammation. In contrast, administration of both BM-MSC and UCT-MSC significantly improved alveolar structure, lung angiogenesis, pulmonary vascular remodeling, and lung inflammation. UCT-MSC hyperoxia-exposed rats however had greater improvement in some morphometric measures of alveolarization and less lung macrophage infiltration as compared to the BM-MSC-treated group. Together, these findings suggest that BM-MSC and UCT-MSC have significant lung regenerative effects in experimental BPD but UCT-MSC suppresses lung macrophage infiltration and promotes lung epithelial cell healing to a greater degree.
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Affiliation(s)
- Merline Benny
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA
- Batchelor Children’s Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Benjamin Courchia
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA
- Batchelor Children’s Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sebastian Shrager
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA
- Batchelor Children’s Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mayank Sharma
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA
- Batchelor Children’s Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Pingping Chen
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA
- Batchelor Children’s Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joanne Duara
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA
- Batchelor Children’s Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Krystalenia Valasaki
- The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michael A Bellio
- The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Andreas Damianos
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA
- Batchelor Children’s Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jian Huang
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA
- Batchelor Children’s Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ronald Zambrano
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA
- Batchelor Children’s Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Augusto Schmidt
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA
- Batchelor Children’s Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Shu Wu
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA
- Batchelor Children’s Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Omaida C Velazquez
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joshua M Hare
- The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Aisha Khan
- The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Karen C Young
- Corresponding author: Karen C. Young, MD, Batchelor Children’s Research Institute, University of Miami Miller School of Medicine, 1580 NW 10th Avenue, RM-345, Miami, FL 33136, USA. Tel: 305-243-4531;
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3
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Rieger AC, Tompkins BA, Natsumeda M, Florea V, Banerjee MN, Rodriguez J, Rosado M, Porras V, Valasaki K, Takeuchi LM, Collon K, Desai S, Bellio MA, Khan A, Kashikar ND, Landin AM, Hardin DV, Rodriguez DA, Balkan W, Hare JM, Schulman IH. OUP accepted manuscript. Stem Cells Transl Med 2022; 11:59-72. [PMID: 35641169 PMCID: PMC8895493 DOI: 10.1093/stcltm/szab004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 08/29/2021] [Indexed: 11/28/2022] Open
Abstract
Background Left ventricular hypertrophy and heart failure with preserved ejection fraction (HFpEF) are primary manifestations of the cardiorenal syndrome in patients with chronic kidney disease (CKD). Therapies that improve morbidity and mortality in HFpEF are lacking. Cell-based therapies promote cardiac repair in ischemic and non-ischemic cardiomyopathies. We hypothesized that cell-based therapy ameliorates CKD-induced HFpEF. Methods and Results Yorkshire pigs (n = 26) underwent 5/6 embolization-mediated nephrectomy. CKD was confirmed by increased creatinine and decreased glomerular filtration rate (GFR). Mean arterial pressure (MAP) was not different between groups from baseline to 4 weeks. HFpEF was evident at 4 weeks by increased LV mass, relative wall thickening, end-diastolic pressure, and end-diastolic pressure-volume relationship, with no change in ejection fraction (EF). Four weeks post-embolization, allogeneic (allo) bone marrow-derived mesenchymal stem cells (MSC; 1 × 107 cells), allo-kidney-derived stem cells (KSC; 1 × 107 cells), allo-cell combination therapy (ACCT; MSC + KSC; 1:1 ratio; total = 1 × 107 cells), or placebo (Plasma-Lyte) was delivered via intra-renal artery. Eight weeks post-treatment, there was a significant increase in MAP in the placebo group (21.89 ± 6.05 mmHg) compared to the ACCT group. GFR significantly improved in the ACCT group. EF, relative wall thickness, and LV mass did not differ between groups at 12 weeks. EDPVR improved in the ACCT group, indicating decreased ventricular stiffness. Conclusions Intra-renal artery allogeneic cell therapy was safe in a CKD swine model manifesting the characteristics of HFpEF. The beneficial effect on renal function and ventricular compliance in the ACCT group supports further research of cell therapy for cardiorenal syndrome.
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Affiliation(s)
- Angela C Rieger
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Bryon A Tompkins
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Makoto Natsumeda
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Victoria Florea
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Monisha N Banerjee
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jose Rodriguez
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Marcos Rosado
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Valeria Porras
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Krystalenia Valasaki
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lauro M Takeuchi
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kevin Collon
- Department of Orthopedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Sohil Desai
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michael A Bellio
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Aisha Khan
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Ana Marie Landin
- Cell Therapy and Vaccine Lab, Moffitt Cancer Center, Tampa, FL, USA
| | - Darrell V Hardin
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Daniel A Rodriguez
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Wayne Balkan
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joshua M Hare
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ivonne Hernandez Schulman
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Katz Family Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
- Corresponding author: Ivonne H. Schulman, MD, Program Director, Translational and Clinical Studies of Acute Kidney Injury, Division of Kidney, Urologic and Hematologic Diseases (KUH), National Institutes of Health (NIH), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Two Democracy Plaza, Room #6077, 6707 Democracy Blvd, Bethesda, MD 20892-5458, USA. Tel: 301-435-3350; Mobile: 301-385-5744; Fax: 301-480-3510, ,
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4
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Florea V, Rieger AC, Natsumeda M, Tompkins BA, Banerjee MN, Schulman IH, Premer C, Khan A, Valasaki K, Heidecker B, Mantero A, Balkan W, Mitrani RD, Hare JM. The impact of patient sex on the response to intramyocardial mesenchymal stem cell administration in patients with non-ischaemic dilated cardiomyopathy. Cardiovasc Res 2021; 116:2131-2141. [PMID: 32053144 DOI: 10.1093/cvr/cvaa004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 10/31/2019] [Accepted: 02/05/2020] [Indexed: 12/11/2022] Open
Abstract
AIMS Sex differences impact the occurrence, presentation, prognosis, and response to therapy in heart disease. Particularly, the phenotypic presentation of patients with non-ischaemic dilated cardiomyopathy (NIDCM) differs between men and women. However, whether the response to mesenchymal stem cell (MSC) therapy is influenced by sex remains unknown. We hypothesize that males and females with NIDCM respond similarly to MSC therapy. METHODS AND RESULTS Male (n = 24) and female (n = 10) patients from the POSEIDON-DCM trial who received MSCs via transendocardial injections were evaluated over 12 months. Endothelial function was measured at baseline and 3 months post-transendocardial stem cell injection (TESI). At baseline, ejection fraction (EF) was lower (P = 0.004) and end-diastolic volume (EDV; P = 0.0002) and end-systolic volume (ESV; P = 0.0002) were higher in males vs. females. In contrast, baseline demographic characteristics, Minnesota Living with Heart Failure Questionnaire (MLHFQ), and 6-min walk test (6MWT) were similar between groups. EF improved in males by 6.2 units (P = 0.04) and in females by 8.6 units (P = 0.04; males vs. females, P = 0.57). EDV and ESV were unchanged over time. The MLHFQ score, New York Heart Association (NYHA) class, endothelial progenitor cell-colony forming units, and serum tumour necrosis factor alpha improved similarly in both groups. CONCLUSION Despite major differences in phenotypic presentation of NIDCM in males and females, this study is the first of its kind to demonstrate that MSC therapy improves a variety of parameters in NIDCM irrespective of patient sex. These findings have important clinical and pathophysiologic implications regarding the impact of sex on responses to cell-based therapy for NIDCM.
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Affiliation(s)
- Victoria Florea
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Biomedical Research Building - 9th Floor 1501 NW 10th Ave, Miami, FL 33136, USA
| | - Angela C Rieger
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Biomedical Research Building - 9th Floor 1501 NW 10th Ave, Miami, FL 33136, USA
| | - Makoto Natsumeda
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Biomedical Research Building - 9th Floor 1501 NW 10th Ave, Miami, FL 33136, USA
| | - Bryon A Tompkins
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Biomedical Research Building - 9th Floor 1501 NW 10th Ave, Miami, FL 33136, USA.,Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Monisha N Banerjee
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Biomedical Research Building - 9th Floor 1501 NW 10th Ave, Miami, FL 33136, USA.,Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ivonne H Schulman
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Biomedical Research Building - 9th Floor 1501 NW 10th Ave, Miami, FL 33136, USA.,Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Courtney Premer
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Biomedical Research Building - 9th Floor 1501 NW 10th Ave, Miami, FL 33136, USA
| | - Aisha Khan
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Biomedical Research Building - 9th Floor 1501 NW 10th Ave, Miami, FL 33136, USA
| | - Krystalenia Valasaki
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Biomedical Research Building - 9th Floor 1501 NW 10th Ave, Miami, FL 33136, USA
| | - Bettina Heidecker
- Department of Cardiology, Charite Berlin University of Medicine, Berlin, Germany
| | - Alejandro Mantero
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Wayne Balkan
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Biomedical Research Building - 9th Floor 1501 NW 10th Ave, Miami, FL 33136, USA.,Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Raul D Mitrani
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Biomedical Research Building - 9th Floor 1501 NW 10th Ave, Miami, FL 33136, USA.,Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joshua M Hare
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Biomedical Research Building - 9th Floor 1501 NW 10th Ave, Miami, FL 33136, USA.,Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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5
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Khan A, Bellio MA, Schulman IH, Levi AD, Longsomboon B, Brooks A, Valasaki K, DiFede DL, Pujol MV, Yavagal DR, Bates KE, Si MS, Kaushal S, Green BA, Anderson KD, Guest JD, Burks SS, Silvera R, Santamaria AJ, Lalwani A, Dietrich WD, Hare JM. The Interdisciplinary Stem Cell Institute's Use of Food and Drug Administration-Expanded Access Guidelines to Provide Experimental Cell Therapy to Patients With Rare Serious Diseases. Front Cell Dev Biol 2021; 9:675738. [PMID: 34169074 PMCID: PMC8217825 DOI: 10.3389/fcell.2021.675738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/04/2021] [Indexed: 11/15/2022] Open
Abstract
The U.S. Food and Drug Administration (FDA) provides guidance for expanded access to experimental therapies, which in turn plays an important role in the Twenty-first Century Cures Act mandate to advance cell-based therapy. In cases of incurable diseases where there is a lack of alternative treatment options, many patients seek access to cell-based therapies for the possibility of treatment responses demonstrated in clinical trials. Here, we describe the use of the FDA’s expanded access to investigational new drug (IND) to address rare and emergency conditions that include stiff-person syndrome, spinal cord injury, traumatic brain stem injury, complex congenital heart disease, ischemic stroke, and peripheral nerve injury. We have administered both allogeneic bone marrow-derived mesenchymal stem cell (MSC) and autologous Schwann cell (SC) therapy to patients upon emergency request using Single Patient Expanded Access (SPEA) INDs approved by the FDA. In this report, we present our experience with 10 completed SPEA protocols.
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Affiliation(s)
- Aisha Khan
- Leonard M. Miller School of Medicine, The Interdisciplinary Stem Cell Institute, University of Miami, Miami, FL, United States.,The Miami Project to Cure Paralysis, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Michael A Bellio
- Leonard M. Miller School of Medicine, The Interdisciplinary Stem Cell Institute, University of Miami, Miami, FL, United States
| | - Ivonne H Schulman
- Leonard M. Miller School of Medicine, The Interdisciplinary Stem Cell Institute, University of Miami, Miami, FL, United States.,Katz Family Division of Nephrology and Hypertension, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Allan D Levi
- The Miami Project to Cure Paralysis, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States.,The Department of Neurological Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Bangon Longsomboon
- Leonard M. Miller School of Medicine, The Interdisciplinary Stem Cell Institute, University of Miami, Miami, FL, United States
| | - Adriana Brooks
- Leonard M. Miller School of Medicine, The Interdisciplinary Stem Cell Institute, University of Miami, Miami, FL, United States.,The Miami Project to Cure Paralysis, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Krystalenia Valasaki
- Leonard M. Miller School of Medicine, The Interdisciplinary Stem Cell Institute, University of Miami, Miami, FL, United States
| | - Darcy L DiFede
- Leonard M. Miller School of Medicine, The Interdisciplinary Stem Cell Institute, University of Miami, Miami, FL, United States
| | - Marietsy V Pujol
- Leonard M. Miller School of Medicine, The Interdisciplinary Stem Cell Institute, University of Miami, Miami, FL, United States
| | - Dileep R Yavagal
- Leonard M. Miller School of Medicine, The Interdisciplinary Stem Cell Institute, University of Miami, Miami, FL, United States.,The Department of Clinical Neurology and Neurosurgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Karen E Bates
- The Department of Clinical Neurology and Neurosurgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Ming-Sing Si
- Section of Pediatric Cardiovascular Surgery, Department of Cardiac Surgery, Michigan Medicine, C.S. Mott Children's Hospital, Ann Arbor, MI, United States
| | - Sunjay Kaushal
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Barth A Green
- The Miami Project to Cure Paralysis, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States.,The Department of Neurological Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | | | - James D Guest
- The Miami Project to Cure Paralysis, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States.,The Department of Neurological Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Stephen Shelby Burks
- The Department of Neurological Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Risset Silvera
- Leonard M. Miller School of Medicine, The Interdisciplinary Stem Cell Institute, University of Miami, Miami, FL, United States.,The Miami Project to Cure Paralysis, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Andrea J Santamaria
- The Miami Project to Cure Paralysis, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Anil Lalwani
- Medtronic ST Neurosurgery, Louisville, CO, United States
| | - W Dalton Dietrich
- The Miami Project to Cure Paralysis, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States.,The Department of Neurological Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Joshua M Hare
- Leonard M. Miller School of Medicine, The Interdisciplinary Stem Cell Institute, University of Miami, Miami, FL, United States.,Division of Cardiology, Department of Medicine, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
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6
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Bolli R, Mitrani RD, Hare JM, Pepine CJ, Perin EC, Willerson JT, Traverse JH, Henry TD, Yang PC, Murphy MP, March KL, Schulman IH, Ikram S, Lee DP, O’Brien C, Lima JA, Ostovaneh MR, Ambale-Venkatesh B, Lewis G, Khan A, Bacallao K, Valasaki K, Longsomboon B, Gee AP, Richman S, Taylor DA, Lai D, Sayre SL, Bettencourt J, Vojvodic RW, Cohen ML, Simpson L, Aguilar D, Loghin C, Moyé L, Ebert RF, Davis BR, Simari RD. A Phase II study of autologous mesenchymal stromal cells and c-kit positive cardiac cells, alone or in combination, in patients with ischaemic heart failure: the CCTRN CONCERT-HF trial. Eur J Heart Fail 2021; 23:661-674. [PMID: 33811444 PMCID: PMC8357352 DOI: 10.1002/ejhf.2178] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/19/2021] [Accepted: 03/23/2021] [Indexed: 12/21/2022] Open
Abstract
AIMS CONCERT-HF is an NHLBI-sponsored, double-blind, placebo-controlled, Phase II trial designed to determine whether treatment with autologous bone marrow-derived mesenchymal stromal cells (MSCs) and c-kit positive cardiac cells (CPCs), given alone or in combination, is feasible, safe, and beneficial in patients with heart failure (HF) caused by ischaemic cardiomyopathy. METHODS AND RESULTS Patients were randomized (1:1:1:1) to transendocardial injection of MSCs combined with CPCs, MSCs alone, CPCs alone, or placebo, and followed for 12 months. Seven centres enrolled 125 participants with left ventricular ejection fraction of 28.6 ± 6.1% and scar size 19.4 ± 5.8%, in New York Heart Association class II or III. The proportion of major adverse cardiac events (MACE) was significantly decreased by CPCs alone (-22% vs. placebo, P = 0.043). Quality of life (Minnesota Living with Heart Failure Questionnaire score) was significantly improved by MSCs alone (P = 0.050) and MSCs + CPCs (P = 0.023) vs. placebo. Left ventricular ejection fraction, left ventricular volumes, scar size, 6-min walking distance, and peak oxygen consumption did not differ significantly among groups. CONCLUSIONS This is the first multicentre trial assessing CPCs and a combination of two cell types from different tissues in HF patients. The results show that treatment is safe and feasible. Even with maximal guideline-directed therapy, both CPCs and MSCs were associated with improved clinical outcomes (MACE and quality of life, respectively) in ischaemic HF without affecting left ventricular function or structure, suggesting possible systemic or paracrine cellular mechanisms. Combining MSCs with CPCs was associated with improvement in both these outcomes. These results suggest potential important beneficial effects of CPCs and MSCs and support further investigation in HF patients.
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Affiliation(s)
- Roberto Bolli
- University of Louisville, School of Medicine, Louisville, KY, USA
| | - Raul D. Mitrani
- University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Joshua M. Hare
- University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Carl J. Pepine
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Emerson C. Perin
- Texas Heart Institute, CHI St. Luke’s Health Baylor College of Medicine Medical Center, Houston, TX, USA
| | - James T. Willerson
- Texas Heart Institute, CHI St. Luke’s Health Baylor College of Medicine Medical Center, Houston, TX, USA
| | - Jay H. Traverse
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, and University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Timothy D. Henry
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH, USA
| | | | | | - Keith L. March
- University of Florida College of Medicine, Gainesville, FL, USA
| | | | - Sohail Ikram
- University of Louisville, School of Medicine, Louisville, KY, USA
| | - David P. Lee
- Stanford University School of Medicine, Stanford, CA, USA
| | - Connor O’Brien
- Stanford University School of Medicine, Stanford, CA, USA
| | - Joao A. Lima
- Johns Hopkins University, Cardiovascular Imaging, Baltimore, MD, USA
| | | | | | - Gregory Lewis
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Aisha Khan
- University of Miami, Miller School of Medicine, Interdisciplinary Stem Cell Institute, Miami, FL, USA
| | - Ketty Bacallao
- University of Miami, Miller School of Medicine, Interdisciplinary Stem Cell Institute, Miami, FL, USA
| | - Krystalenia Valasaki
- University of Miami, Miller School of Medicine, Interdisciplinary Stem Cell Institute, Miami, FL, USA
| | - Bangon Longsomboon
- University of Miami, Miller School of Medicine, Interdisciplinary Stem Cell Institute, Miami, FL, USA
| | - Adrian P. Gee
- Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Sara Richman
- Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Doris A. Taylor
- Texas Heart Institute, CHI St. Luke’s Health Baylor College of Medicine Medical Center, Houston, TX, USA
| | - Dejian Lai
- UTHealth University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Shelly L. Sayre
- UTHealth University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Judy Bettencourt
- UTHealth University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Rachel W. Vojvodic
- UTHealth University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Michelle L. Cohen
- UTHealth University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Lara Simpson
- UTHealth University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - David Aguilar
- UTHealth University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
- UTHealth University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA
| | - Catalin Loghin
- UTHealth University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA
| | - Lem Moyé
- UTHealth University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Ray F. Ebert
- NIH, National Heart, Lung and Blood Institute, Bethesda, MD, USA
| | - Barry R. Davis
- UTHealth University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
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7
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Hatzistergos KE, Durante MA, Valasaki K, Wanschel ACBA, Harbour JW, Hare JM. A novel cardiomyogenic role for Isl1 + neural crest cells in the inflow tract. Sci Adv 2020; 6:6/49/eaba9950. [PMID: 33268364 PMCID: PMC7821887 DOI: 10.1126/sciadv.aba9950] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 10/20/2020] [Indexed: 06/12/2023]
Abstract
The degree to which populations of cardiac progenitors (CPCs) persist in the postnatal heart remains a controversial issue in cardiobiology. To address this question, we conducted a spatiotemporally resolved analysis of CPC deployment dynamics, tracking cells expressing the pan-CPC gene Isl1 Most CPCs undergo programmed silencing during early cardiogenesis through proteasome-mediated and PRC2 (Polycomb group repressive complex 2)-mediated Isl1 repression, selectively in the outflow tract. A notable exception is a domain of cardiac neural crest cells (CNCs) in the inflow tract. These "dorsal CNCs" are regulated through a Wnt/β-catenin/Isl1 feedback loop and generate a limited number of trabecular cardiomyocytes that undergo multiple clonal divisions during compaction, to eventually produce ~10% of the biventricular myocardium. After birth, CNCs continue to generate cardiomyocytes that, however, exhibit diminished clonal amplification dynamics. Thus, although the postnatal heart sustains cardiomyocyte-producing CNCs, their regenerative potential is likely diminished by the loss of trabeculation-like proliferative properties.
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Affiliation(s)
- Konstantinos E Hatzistergos
- Aristotle University of Thessaloniki, Faculty of Sciences, School of Biology, Department of Genetics, Development and Molecular Biology, Thessaloniki 54124, Greece.
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Cell Biology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Michael A Durante
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Krystalenia Valasaki
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Amarylis C B A Wanschel
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - J William Harbour
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Joshua M Hare
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL 33136, USA
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8
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Hatzistergos KE, Jiang Z, Valasaki K, Takeuchi LM, Balkan W, Atluri P, Saur D, Seidler B, Tsinoremas N, DiFede DL, Hare JM. Simulated Microgravity Impairs Cardiac Autonomic Neurogenesis from Neural Crest Cells. Stem Cells Dev 2018; 27:819-830. [PMID: 29336212 DOI: 10.1089/scd.2017.0265] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Microgravity-induced alterations in the autonomic nervous system (ANS) contribute to derangements in both the mechanical and electrophysiological function of the cardiovascular system, leading to severe symptoms in humans following space travel. Because the ANS forms embryonically from neural crest (NC) progenitors, we hypothesized that microgravity can impair NC-derived cardiac structures. Accordingly, we conducted in vitro simulated microgravity experiments employing NC genetic lineage tracing in mice with cKitCreERT2/+, Isl1nLacZ, and Wnt1-Cre reporter alleles. Inducible fate mapping in adult mouse hearts and pluripotent stem cells (iPSCs) demonstrated reduced cKitCreERT2/+-mediated labeling of both NC-derived cardiomyocytes and autonomic neurons (P < 0.0005 vs. controls). Whole transcriptome analysis, suggested that this effect was associated with repressed cardiac NC- and upregulated mesoderm-related gene expression profiles, coupled with abnormal bone morphogenetic protein (BMP)/transforming growth factor beta (TGF-β) and Wnt/β-catenin signaling. To separate the manifestations of simulated microgravity on NC versus mesodermal-cardiac derivatives, we conducted Isl1nLacZ lineage analyses, which indicated an approximately 3-fold expansion (P < 0.05) in mesoderm-derived Isl-1+ pacemaker sinoatrial nodal cells; and an approximately 3-fold reduction (P < 0.05) in cardiac NC-derived ANS cells, including sympathetic nerves and Isl-1+ cardiac ganglia. Finally, NC-specific fate mapping with a Wnt1-Cre reporter iPSC model of murine NC development confirmed that simulated microgravity directly impacted the in vitro development of cardiac NC progenitors and their contribution to the sympathetic and parasympathetic innervation of the iPSC-derived myocardium. Altogether, these findings reveal an important role for gravity in the development of NCs and their postnatal derivatives, and have important therapeutic implications for human space exploration, providing insights into cellular and molecular mechanisms of microgravity-induced cardiomyopathies/channelopathies.
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Affiliation(s)
| | - Zhijie Jiang
- 2 Center for Computational Sciences, University of Miami , Miller School of Medicine, Miami, Florida
| | | | - Lauro M Takeuchi
- 1 Interdisciplinary Stem Cell Institute, University of Miami , Miami, Florida
| | - Wayne Balkan
- 1 Interdisciplinary Stem Cell Institute, University of Miami , Miami, Florida
| | - Preethi Atluri
- 1 Interdisciplinary Stem Cell Institute, University of Miami , Miami, Florida
| | - Dieter Saur
- 3 Department of Medicine II, Klinikum rechts der Isar, Technische Universität München , München, Germany .,4 German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK) , Heidelberg, Germany
| | - Barbara Seidler
- 3 Department of Medicine II, Klinikum rechts der Isar, Technische Universität München , München, Germany .,4 German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK) , Heidelberg, Germany
| | - Nicholas Tsinoremas
- 2 Center for Computational Sciences, University of Miami , Miller School of Medicine, Miami, Florida
| | - Darcy L DiFede
- 1 Interdisciplinary Stem Cell Institute, University of Miami , Miami, Florida
| | - Joshua M Hare
- 1 Interdisciplinary Stem Cell Institute, University of Miami , Miami, Florida
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9
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Tompkins BA, DiFede DL, Khan A, Landin AM, Schulman IH, Pujol MV, Heldman AW, Miki R, Goldschmidt-Clermont PJ, Goldstein BJ, Mushtaq M, Levis-Dusseau S, Byrnes JJ, Lowery M, Natsumeda M, Delgado C, Saltzman R, Vidro-Casiano M, Da Fonseca M, Golpanian S, Premer C, Medina A, Valasaki K, Florea V, Anderson E, El-Khorazaty J, Mendizabal A, Green G, Oliva AA, Hare JM. Allogeneic Mesenchymal Stem Cells Ameliorate Aging Frailty: A Phase II Randomized, Double-Blind, Placebo-Controlled Clinical Trial. J Gerontol A Biol Sci Med Sci 2017; 72:1513-1522. [PMID: 28977399 PMCID: PMC5861900 DOI: 10.1093/gerona/glx137] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 07/17/2017] [Indexed: 12/31/2022] Open
Abstract
Background Aging frailty, characterized by decreased physical and immunological functioning, is associated with stem cell depletion. Human allogeneic mesenchymal stem cells (allo-hMSCs) exert immunomodulatory effects and promote tissue repair. Methods This is a randomized, double-blinded, dose-finding study of intravenous allo-hMSCs (100 or 200-million [M]) vs placebo delivered to patients (n = 30, mean age 75.5 ± 7.3) with frailty. The primary endpoint was incidence of treatment-emergent serious adverse events (TE-SAEs) at 1-month postinfusion. Secondary endpoints included physical performance, patient-reported outcomes, and immune markers of frailty measured at 6 months postinfusion. Results No therapy-related TE-SAEs occurred at 1 month. Physical performance improved preferentially in the 100M-group; immunologic improvement occurred in both the 100M- and 200M-groups. The 6-minute walk test, short physical performance exam, and forced expiratory volume in 1 second improved in the 100M-group (p = .01), not in the 200M- or placebo groups. The female sexual quality of life questionnaire improved in the 100M-group (p = .03). Serum TNF-α levels decreased in the 100M-group (p = .03). B cell intracellular TNF-α improved in both the 100M- (p < .0001) and 200M-groups (p = .002) as well as between groups compared to placebo (p = .003 and p = .039, respectively). Early and late activated T-cells were also reduced by MSC therapy. Conclusion Intravenous allo-hMSCs were safe in individuals with aging frailty. Treated groups had remarkable improvements in physical performance measures and inflammatory biomarkers, both of which characterize the frailty syndrome. Given the excellent safety and efficacy profiles demonstrated in this study, larger clinical trials are warranted to establish the efficacy of hMSCs in this multisystem disorder. Clinical Trial Registration www.clinicaltrials.gov: CRATUS (#NCT02065245).
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Affiliation(s)
- Bryon A Tompkins
- The Interdisciplinary Stem Cell Institute.,Department of Surgery
| | - Darcy L DiFede
- The Interdisciplinary Stem Cell Institute.,Longeveron LLC, Miami, Florida
| | - Aisha Khan
- The Interdisciplinary Stem Cell Institute
| | | | - Ivonne Hernandez Schulman
- The Interdisciplinary Stem Cell Institute.,Department of Medicine, University of Miami Miller School of Medicine, Florida
| | | | | | - Roberto Miki
- Department of Medicine, University of Miami Miller School of Medicine, Florida
| | | | | | - Muzammil Mushtaq
- Department of Medicine, University of Miami Miller School of Medicine, Florida
| | | | - John J Byrnes
- Department of Medicine, University of Miami Miller School of Medicine, Florida
| | - Maureen Lowery
- Department of Medicine, University of Miami Miller School of Medicine, Florida
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Joshua M Hare
- The Interdisciplinary Stem Cell Institute.,Department of Medicine, University of Miami Miller School of Medicine, Florida
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10
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Golpanian S, DiFede DL, Khan A, Schulman IH, Landin AM, Tompkins BA, Heldman AW, Miki R, Goldstein BJ, Mushtaq M, Levis-Dusseau S, Byrnes JJ, Lowery M, Natsumeda M, Delgado C, Saltzman R, Vidro-Casiano M, Pujol MV, Da Fonseca M, Oliva AA, Green G, Premer C, Medina A, Valasaki K, Florea V, Anderson E, El-Khorazaty J, Mendizabal A, Goldschmidt-Clermont PJ, Hare JM. Allogeneic Human Mesenchymal Stem Cell Infusions for Aging Frailty. J Gerontol A Biol Sci Med Sci 2017; 72:1505-1512. [PMID: 28444181 PMCID: PMC5861970 DOI: 10.1093/gerona/glx056] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 07/19/2017] [Indexed: 11/13/2022] Open
Abstract
Background Impaired endogenous stem cell repair capacity is hypothesized to be a biologic basis of frailty. Therapies that restore regenerative capacity may therefore be beneficial. This Phase 1 study evaluated the safety and potential efficacy of intravenous, allogeneic, human mesenchymal stem cell (allo-hMSC)-based therapy in patients with aging frailty. Methods In this nonrandomized, dose-escalation study, patients received a single intravenous infusion of allo-hMSCs: 20-million (n = 5), 100-million (n = 5), or 200-million cells (n = 5). The primary endpoint was incidence of any treatment-emergent serious adverse events measured at 1 month postinfusion. The secondary endpoints were functional efficacy domains and inflammatory biomarkers, measured at 3 and 6 months, respectively. Results There were no treatment-emergent serious adverse events at 1-month postinfusion or significant donor-specific immune reactions during the first 6 months. There was one death at 258 days postinfusion in the 200-million group. In all treatment groups, 6-minute walk distance increased at 3 months (p = .02) and 6 months (p = .001) and TNF-α levels decreased at 6 months (p < .0001). Overall, the 100-million dose showed the best improvement in all parameters, with the exception of TNF-α, which showed an improvement in both the 100- and 200-million groups (p = .0001 and p = .0001, respectively). The 100-million cell-dose group also showed significant improvements in the physical component of the SF-36 quality of life assessment at all time points relative to baseline. Conclusions Allo-hMSCs are safe and immunologically tolerated in aging frailty patients. Improvements in functional and immunologic status suggest that ongoing clinical development of cell-based therapy is warranted for frailty.
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Affiliation(s)
- Samuel Golpanian
- The Interdisciplinary Stem Cell Institute.,Department of Surgery, University of Miami Miller School of Medicine, Florida
| | | | - Aisha Khan
- The Interdisciplinary Stem Cell Institute
| | - Ivonne Hernandez Schulman
- The Interdisciplinary Stem Cell Institute.,Department of Medicine, University of Miami Miller School of Medicine, Florida
| | - Ana Marie Landin
- The Interdisciplinary Stem Cell Institute.,Longeveron LLC, Miami, Florida
| | - Bryon A Tompkins
- The Interdisciplinary Stem Cell Institute.,Department of Surgery, University of Miami Miller School of Medicine, Florida
| | | | - Roberto Miki
- Department of Medicine, University of Miami Miller School of Medicine, Florida
| | - Bradley J Goldstein
- The Interdisciplinary Stem Cell Institute.,Department of Surgery, University of Miami Miller School of Medicine, Florida
| | - Muzammil Mushtaq
- Department of Medicine, University of Miami Miller School of Medicine, Florida
| | | | - John J Byrnes
- Department of Medicine, University of Miami Miller School of Medicine, Florida
| | - Maureen Lowery
- Department of Medicine, University of Miami Miller School of Medicine, Florida
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Joshua M Hare
- The Interdisciplinary Stem Cell Institute.,Department of Medicine, University of Miami Miller School of Medicine, Florida
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11
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Florea V, Rieger AC, DiFede DL, El-Khorazaty J, Natsumeda M, Banerjee MN, Tompkins BA, Khan A, Schulman IH, Landin AM, Mushtaq M, Golpanian S, Lowery MH, Byrnes JJ, Hendel RC, Cohen MG, Valasaki K, Pujol MV, Ghersin E, Miki R, Delgado C, Abuzeid F, Vidro-Casiano M, Saltzman RG, DaFonseca D, Caceres LV, Ramdas KN, Mendizabal A, Heldman AW, Mitrani RD, Hare JM. Dose Comparison Study of Allogeneic Mesenchymal Stem Cells in Patients With Ischemic Cardiomyopathy (The TRIDENT Study). Circ Res 2017; 121:1279-1290. [PMID: 28923793 DOI: 10.1161/circresaha.117.311827] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 09/12/2017] [Accepted: 09/14/2017] [Indexed: 12/31/2022]
Abstract
RATIONALE Cell dose and concentration play crucial roles in phenotypic responses to cell-based therapy for heart failure. OBJECTIVE To compare the safety and efficacy of 2 doses of allogeneic bone marrow-derived human mesenchymal stem cells identically delivered in patients with ischemic cardiomyopathy. METHODS AND RESULTS Thirty patients with ischemic cardiomyopathy received in a blinded manner either 20 million (n=15) or 100 million (n=15) allogeneic human mesenchymal stem cells via transendocardial injection (0.5 cc per injection × 10 injections per patient). Patients were followed for 12 months for safety and efficacy end points. There were no treatment-emergent serious adverse events at 30 days or treatment-related serious adverse events at 12 months. The Major Adverse Cardiac Event rate was 20.0% (95% confidence interval [CI], 6.9% to 50.0%) in 20 million and 13.3% (95% CI, 3.5% to 43.6%) in 100 million (P=0.58). Worsening heart failure rehospitalization was 20.0% (95% CI, 6.9% to 50.0%) in 20 million and 7.1% (95% CI, 1.0% to 40.9%) in 100 million (P=0.27). Whereas scar size reduced to a similar degree in both groups: 20 million by -6.4 g (interquartile range, -13.5 to -3.4 g; P=0.001) and 100 million by -6.1 g (interquartile range, -8.1 to -4.6 g; P=0.0002), the ejection fraction improved only with 100 million by 3.7 U (interquartile range, 1.1 to 6.1; P=0.04). New York Heart Association class improved at 12 months in 35.7% (95% CI, 12.7% to 64.9%) in 20 million and 42.9% (95% CI, 17.7% to 71.1%) in 100 million. Importantly, proBNP (pro-brain natriuretic peptide) increased at 12 months in 20 million by 0.32 log pg/mL (95% CI, 0.02 to 0.62; P=0.039), but not in 100 million (-0.07 log pg/mL; 95% CI, -0.36 to 0.23; P=0.65; between group P=0.07). CONCLUSIONS Although both cell doses reduced scar size, only the 100 million dose increased ejection fraction. This study highlights the crucial role of cell dose in the responses to cell therapy. Determining optimal dose and delivery is essential to advance the field, decipher mechanism(s) of action and enhance planning of pivotal Phase III trials. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT02013674.
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Affiliation(s)
- Victoria Florea
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Angela C Rieger
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Darcy L DiFede
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Jill El-Khorazaty
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Makoto Natsumeda
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Monisha N Banerjee
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Bryon A Tompkins
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Aisha Khan
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Ivonne H Schulman
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Ana Marie Landin
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Muzammil Mushtaq
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Samuel Golpanian
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Maureen H Lowery
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - John J Byrnes
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Robert C Hendel
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Mauricio G Cohen
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Krystalenia Valasaki
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Marietsy V Pujol
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Eduard Ghersin
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Roberto Miki
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Cindy Delgado
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Fouad Abuzeid
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Mayra Vidro-Casiano
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Russell G Saltzman
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Daniel DaFonseca
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Lina V Caceres
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Kevin N Ramdas
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Adam Mendizabal
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Alan W Heldman
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Raul D Mitrani
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.)
| | - Joshua M Hare
- From the Interdisciplinary Stem Cell Institute (V.F., A.C.R., M.N., M.N.B., B.A.T., A.K., I.H.S., A.M.L., S.G., K.V., M.V.P., C.D., F.A., M.V.-C., R.G.S., D.D., L.V.C., K.N.R., A.W.H., R.D.M., J.M.H.), Department of Surgery (M.N.B., B.A.T., S.G.), Katz Family Division of Nephrology and Hypertension (I.H.S.), Department of Medicine (M.M., M.H.L., J.J.B., R.C.H., M.G.C., R.M., R.D.M., J.M.H.), and Department of Radiology (E.G.), University of Miami Miller School of Medicine, FL; The Emmes Corporation, Rockville, MD (J.E.-K., A.M.); and Longeveron LLC, Miami, FL (D.L.D.).
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Hatzistergos KE, Vedenko A, Valasaki K, Balkan W, Hare JM. Abstract 137: Ghrhr is a Cell-surface Marker of Human Pluripotent Stem Cell-derived Cardiomyogenic Precursors. Circ Res 2017. [DOI: 10.1161/res.121.suppl_1.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
A major roadblock for generating human pluripotent stem cell (hPSCs) derivatives highly enriched in cardiomyogenic precursors (CPCs), has been the lack of CPC-specific cell surface markers.
Hypothesis:
Based on observations that adult CPCs are responsive to growth hormone-releasing hormone (GHRH) signaling, we hypothesized that the GHRH receptor (GHRHR) is a specific cell-surface marker for hPSC-derived CPCs.
Methods:
We performed temporal analysis of GHRHR expression in an
in-vitro
model of human cardiogenesis using induced hPSCs (hiPSCs) and
SOX10::GFP
embryonic hPSCs (hESCs)
;
and mouse (
in-vivo
) cardiogenesis in wild-type (WT),
MEF2c-AHF-Cre, Wnt1-Cre2
and
cKit-CreERT2/+
reporter mice.
Results:
Gene expression and confocal immunofluorescence analyses during chemically-defined, stage-specific, cardiac lineage differentiation indicated that GHRHR is not expressed in undifferentiated hiPSCs or during specification into primitive streak-like Brachyury
+
or Mesp1
+
precardiac cells; but is induced in cardiogenic mesoderm-like cells, at the stage of commitment into NKX2.5
+
and/or ISL1
+
CPCs (
p
=0.001) and persists in Troponin-T
+
cardiomyocytes. Similarly, experiments modeling cardiac neural crest (CNC) with
SOX10::GFP
hESCs indicated that GHRHR is not expressed by GFP
+
CNCs but is induced following differentiation into NKX2.5
+
and/or ISL1
+
derivatives. Importantly, stimulation with 1μm recombinant GHRH during days 5-7 of hiPSCs differentiation increased
NKX2.5
expression 2.5-fold, an effect that was abolished by exposure to 1μM Somatostatin, a GHRH antagonist (
p
=0.0009). Last, in vivo analyses in WT
, MEF2c-AHF-Cre, Wnt1-Cre2
and
cKit-CreERT2/+
reporter embryonic and postnatal hearts corroborated that GHRHR specifically marks NKX2.5
+
mesoderm- and CNC-lineage descendants in vivo, whereas GHRHR is not expressed by
Wnt1-Cre2
and
cKit-CreERT2/+
CNCs descendants that are Nkx2.5
–
.
Conclusions:
Together these findings indicate that GHRHR is universally expressed by NKX2.5
+
/ISL1
+
CPCs and cardiomyocytes of both mesoderm and CNC origin. Therefore, GHRHR appears to be a valuable cell-surface marker for the selection and enrichment of CPCs from hPSCs for biomedical and regenerative medicine applications.
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13
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Hare JM, DiFede DL, Rieger AC, Florea V, Landin AM, El-Khorazaty J, Khan A, Mushtaq M, Lowery MH, Byrnes JJ, Hendel RC, Cohen MG, Alfonso CE, Valasaki K, Pujol MV, Golpanian S, Ghersin E, Fishman JE, Pattany P, Gomes SA, Delgado C, Miki R, Abuzeid F, Vidro-Casiano M, Premer C, Medina A, Porras V, Hatzistergos KE, Anderson E, Mendizabal A, Mitrani R, Heldman AW. Randomized Comparison of Allogeneic Versus Autologous Mesenchymal Stem Cells for Nonischemic Dilated Cardiomyopathy: POSEIDON-DCM Trial. J Am Coll Cardiol 2016; 69:526-537. [PMID: 27856208 DOI: 10.1016/j.jacc.2016.11.009] [Citation(s) in RCA: 235] [Impact Index Per Article: 29.4] [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: 10/11/2016] [Revised: 10/26/2016] [Accepted: 11/01/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although human mesenchymal stem cells (hMSCs) have been tested in ischemic cardiomyopathy, few studies exist in chronic nonischemic dilated cardiomyopathy (NIDCM). OBJECTIVES The authors conducted a randomized comparison of safety and efficacy of autologous (auto) versus allogeneic (allo) bone marrow-derived hMSCs in NIDCM. METHODS Thirty-seven patients were randomized to either allo- or auto-hMSCs in a 1:1 ratio. Patients were recruited between December 2011 and July 2015 at the University of Miami Hospital. Patients received hMSCs (100 million) by transendocardial stem cell injection in 10 left ventricular sites. Treated patients were evaluated at baseline, 30 days, and 3-, 6-, and 12-months for safety (serious adverse events [SAE]), and efficacy endpoints: ejection fraction, Minnesota Living with Heart Failure Questionnaire, 6-min walk test, major adverse cardiac events, and immune biomarkers. RESULTS There were no 30-day treatment-emergent SAEs. Twelve-month SAE incidence was 28.2% with allo-hMSCs versus 63.5% with auto-hMSCs (p = 0.1004 for the comparison). One allo-hMSC patient developed an elevated (>80) donor-specific calculated panel reactive antibody level. The ejection fraction increased in allo-hMSC patients by 8.0 percentage points (p = 0.004) compared with 5.4 with auto-hMSCs (p = 0.116; allo vs. auto p = 0.4887). The 6-min walk test increased with allo-hMSCs by 37.0 m (p = 0.04), but not auto-hMSCs at 7.3 m (p = 0.71; auto vs. allo p = 0.0168). MLHFQ score decreased in allo-hMSC (p = 0.0022) and auto-hMSC patients (p = 0.463; auto vs. allo p = 0.172). The major adverse cardiac event rate was lower, too, in the allo group (p = 0.0186 vs. auto). Tumor necrosis factor-α decreased (p = 0.0001 for each), to a greater extent with allo-hMSCs versus auto-hMSCs at 6 months (p = 0.05). CONCLUSIONS These findings demonstrated safety and clinically meaningful efficacy of allo-hMSC versus auto-hMSC in NIDCM patients. Pivotal trials of allo-hMSCs are warranted based on these results. (Percutaneous Stem Cell Injection Delivery Effects on Neomyogenesis in Dilated Cardiomyopathy [PoseidonDCM]; NCT01392625).
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Affiliation(s)
- Joshua M Hare
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, Florida; Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida.
| | - Darcy L DiFede
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Angela C Rieger
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Victoria Florea
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Ana M Landin
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Aisha Khan
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Muzammil Mushtaq
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Maureen H Lowery
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - John J Byrnes
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Robert C Hendel
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Mauricio G Cohen
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Carlos E Alfonso
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Krystalenia Valasaki
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Marietsy V Pujol
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Samuel Golpanian
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Eduard Ghersin
- Department of Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Joel E Fishman
- Department of Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Pradip Pattany
- Department of Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Samirah A Gomes
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Cindy Delgado
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Roberto Miki
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Fouad Abuzeid
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Mayra Vidro-Casiano
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Courtney Premer
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Audrey Medina
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Valeria Porras
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, Florida
| | | | | | | | - Raul Mitrani
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Alan W Heldman
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
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14
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Sammour I, Somashekar S, Huang J, Batlahally S, Breton M, Valasaki K, Khan A, Wu S, Young KC. The Effect of Gender on Mesenchymal Stem Cell (MSC) Efficacy in Neonatal Hyperoxia-Induced Lung Injury. PLoS One 2016; 11:e0164269. [PMID: 27711256 PMCID: PMC5053475 DOI: 10.1371/journal.pone.0164269] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 09/22/2016] [Indexed: 12/28/2022] Open
Abstract
Background Mesenchymal stem cells (MSC) improve alveolar and vascular structures in experimental models of bronchopulmonary dysplasia (BPD). Female MSC secrete more anti-inflammatory and pro-angiogenic factors as compared to male MSC. Whether the therapeutic efficacy of MSC in attenuating lung injury in an experimental model of BPD is influenced by the sex of the donor MSC or recipient is unknown. Here we tested the hypothesis that female MSC would have greater lung regenerative properties than male MSC in experimental BPD and this benefit would be more evident in males. Objective To determine whether intra-tracheal (IT) administration of female MSC to neonatal rats with experimental BPD has more beneficial reparative effects as compared to IT male MSC. Methods Newborn Sprague-Dawley rats exposed to normoxia (RA) or hyperoxia (85% O2) from postnatal day (P) 2- P21 were randomly assigned to receive male or female IT bone marrow (BM)-derived green fluorescent protein (GFP+) MSC (1 x 106 cells/50 μl), or Placebo on P7. Pulmonary hypertension (PH), vascular remodeling, alveolarization, and angiogenesis were assessed at P21. PH was determined by measuring right ventricular systolic pressure (RVSP) and pulmonary vascular remodeling was evaluated by quantifying the percentage of muscularized peripheral pulmonary vessels. Alveolarization was evaluated by measuring mean linear intercept (MLI) and radial alveolar count (RAC). Angiogenesis was determined by measuring vascular density. Data are expressed as mean ± SD, and analyzed by ANOVA. Results There were no significant differences in the RA groups. Exposure to hyperoxia resulted in a decrease in vascular density and RAC, with a significant increase in MLI, RVSP, and the percentage of partially and fully muscularized pulmonary arterioles. Administration of both male and female MSC significantly improved vascular density, alveolarization, RVSP, percent of muscularized vessels and alveolarization. Interestingly, the improvement in PH and vascular remodeling was more robust in the hyperoxic rodents who received MSC from female donors. In keeping with our hypothesis, male animals receiving female MSC, had a greater improvement in vascular remodeling. This was accompanied by a more significant decrease in lung pro-inflammatory markers and a larger increase in anti-inflammatory and pro-angiogenic markers in male rodents that received female MSC. There were no significant differences in MSC engraftment among groups. Conclusions Female BM-derived MSC have greater therapeutic efficacy than male MSC in reducing neonatal hyperoxia-induced lung inflammation and vascular remodeling. Furthermore, the beneficial effects of female MSC were more pronounced in male animals. Together, these findings suggest that female MSC maybe the most potent BM-derived MSC population for lung repair in severe BPD complicated by PH.
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Affiliation(s)
- Ibrahim Sammour
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States of America
- Batchelor Children’s Research Institute, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Santhosh Somashekar
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States of America
- Batchelor Children’s Research Institute, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Jian Huang
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States of America
- Batchelor Children’s Research Institute, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Sunil Batlahally
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Matthew Breton
- The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Krystalenia Valasaki
- The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Aisha Khan
- The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Shu Wu
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States of America
- Batchelor Children’s Research Institute, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Karen C. Young
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States of America
- Batchelor Children’s Research Institute, University of Miami Miller School of Medicine, Miami, FL, United States of America
- The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, United States of America
- * E-mail:
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15
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Bellio MA, Rodrigues CO, Landin AM, Hatzistergos KE, Kuznetsov J, Florea V, Valasaki K, Khan A, Hare JM, Schulman IH. Physiological and hypoxic oxygen concentration differentially regulates human c-Kit+ cardiac stem cell proliferation and migration. Am J Physiol Heart Circ Physiol 2016; 311:H1509-H1519. [PMID: 27694215 DOI: 10.1152/ajpheart.00449.2016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 09/24/2016] [Indexed: 02/07/2023]
Abstract
Cardiac stem cells (CSCs) are being evaluated for their efficacy in the treatment of heart failure. However, numerous factors impair the exogenously delivered cells' regenerative capabilities. Hypoxia is one stress that contributes to inadequate tissue repair. Here, we tested the hypothesis that hypoxia impairs cell proliferation, survival, and migration of human CSCs relative to physiological and room air oxygen concentrations. Human endomyocardial biopsy-derived CSCs were isolated, selected for c-Kit expression, and expanded in vitro at room air (21% O2). To assess the effect on proliferation, survival, and migration, CSCs were transferred to physiological (5%) or hypoxic (0.5%) O2 concentrations. Physiological O2 levels increased proliferation (P < 0.05) but did not affect survival of CSCs. Although similar growth rates were observed in room air and hypoxia, a significant reduction of β-galactosidase activity (-4,203 fluorescent units, P < 0.05), p16 protein expression (0.58-fold, P < 0.001), and mitochondrial content (0.18-fold, P < 0.001) in hypoxia suggests that transition from high (21%) to low (0.5%) O2 reduces senescence and promotes quiescence. Furthermore, physiological O2 levels increased migration (P < 0.05) compared with room air and hypoxia, and treatment with mesenchymal stem cell-conditioned media rescued CSC migration under hypoxia to levels comparable to physiological O2 migration (2-fold, P < 0.05 relative to CSC media control). Our finding that physiological O2 concentration is optimal for in vitro parameters of CSC biology suggests that standard room air may diminish cell regenerative potential. This study provides novel insights into the modulatory effects of O2 concentration on CSC biology and has important implications for refining stem cell therapies.
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Affiliation(s)
- Michael A Bellio
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, Florida; and
| | - Claudia O Rodrigues
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, Florida; and
| | - Ana Marie Landin
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, Florida; and
| | | | - Jeffim Kuznetsov
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, Florida; and
| | - Victoria Florea
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, Florida; and
| | - Krystalenia Valasaki
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, Florida; and
| | - Aisha Khan
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, Florida; and
| | - Joshua M Hare
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, Florida; and
| | - Ivonne Hernandez Schulman
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, Florida; and .,Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, Florida
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16
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Hatzistergos KE, Saur D, Seidler B, Balkan W, Breton M, Valasaki K, Takeuchi LM, Landin AM, Khan A, Hare JM. Stimulatory Effects of Mesenchymal Stem Cells on cKit+ Cardiac Stem Cells Are Mediated by SDF1/CXCR4 and SCF/cKit Signaling Pathways. Circ Res 2016; 119:921-30. [PMID: 27481956 DOI: 10.1161/circresaha.116.309281] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 07/29/2016] [Indexed: 01/13/2023]
Abstract
RATIONALE Culture-expanded cells originating from cardiac tissue that express the cell surface receptor cKit are undergoing clinical testing as a cell source for heart failure and congenital heart disease. Although accumulating data support that mesenchymal stem cells (MSCs) enhance the efficacy of cardiac cKit(+) cells (CSCs), the underlying mechanism for this synergistic effect remains incompletely understood. OBJECTIVE To test the hypothesis that MSCs stimulate endogenous CSCs to proliferate, migrate, and differentiate via the SDF1/CXCR4 and stem cell factor/cKit pathways. METHODS AND RESULTS Using genetic lineage-tracing approaches, we show that in the postnatal murine heart, cKit(+) cells proliferate, migrate, and form cardiomyocytes, but not endothelial cells. CSCs exhibit marked chemotactic and proliferative responses when cocultured with MSCs but not with cardiac stromal cells. Antagonism of the CXCR4 pathway with AMD3100 (an SDF1/CXCR4 antagonist) inhibited MSC-induced CSC chemotaxis but stimulated CSC cardiomyogenesis (P<0.0001). Furthermore, MSCs enhanced CSC proliferation via the stem cell factor/cKit and SDF1/CXCR4 pathways (P<0.0001). CONCLUSIONS Together these findings show that MSCs exhibit profound, yet differential, effects on CSC migration, proliferation, and differentiation and suggest a mechanism underlying the improved cardiac regeneration associated with combination therapy using CSCs and MSCs. These findings have important therapeutic implications for cell-based therapy strategies that use mixtures of CSCs and MSCs.
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Affiliation(s)
- Konstantinos E Hatzistergos
- From the Interdisciplinary Stem Cell Institute, University of Miami, Miller School of Medicine, FL (K.E.H., W.B., M.B., K.V., L.M.T., A.M.L., A.K., J.M.H.); Department of Medicine II, Klinikum Rechts der Isar, Technische Universität München, Germany (D.S., B.S.); and German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany (D.S., B.S.)
| | - Dieter Saur
- From the Interdisciplinary Stem Cell Institute, University of Miami, Miller School of Medicine, FL (K.E.H., W.B., M.B., K.V., L.M.T., A.M.L., A.K., J.M.H.); Department of Medicine II, Klinikum Rechts der Isar, Technische Universität München, Germany (D.S., B.S.); and German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany (D.S., B.S.)
| | - Barbara Seidler
- From the Interdisciplinary Stem Cell Institute, University of Miami, Miller School of Medicine, FL (K.E.H., W.B., M.B., K.V., L.M.T., A.M.L., A.K., J.M.H.); Department of Medicine II, Klinikum Rechts der Isar, Technische Universität München, Germany (D.S., B.S.); and German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany (D.S., B.S.)
| | - Wayne Balkan
- From the Interdisciplinary Stem Cell Institute, University of Miami, Miller School of Medicine, FL (K.E.H., W.B., M.B., K.V., L.M.T., A.M.L., A.K., J.M.H.); Department of Medicine II, Klinikum Rechts der Isar, Technische Universität München, Germany (D.S., B.S.); and German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany (D.S., B.S.)
| | - Matthew Breton
- From the Interdisciplinary Stem Cell Institute, University of Miami, Miller School of Medicine, FL (K.E.H., W.B., M.B., K.V., L.M.T., A.M.L., A.K., J.M.H.); Department of Medicine II, Klinikum Rechts der Isar, Technische Universität München, Germany (D.S., B.S.); and German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany (D.S., B.S.)
| | - Krystalenia Valasaki
- From the Interdisciplinary Stem Cell Institute, University of Miami, Miller School of Medicine, FL (K.E.H., W.B., M.B., K.V., L.M.T., A.M.L., A.K., J.M.H.); Department of Medicine II, Klinikum Rechts der Isar, Technische Universität München, Germany (D.S., B.S.); and German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany (D.S., B.S.)
| | - Lauro M Takeuchi
- From the Interdisciplinary Stem Cell Institute, University of Miami, Miller School of Medicine, FL (K.E.H., W.B., M.B., K.V., L.M.T., A.M.L., A.K., J.M.H.); Department of Medicine II, Klinikum Rechts der Isar, Technische Universität München, Germany (D.S., B.S.); and German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany (D.S., B.S.)
| | - Ana Marie Landin
- From the Interdisciplinary Stem Cell Institute, University of Miami, Miller School of Medicine, FL (K.E.H., W.B., M.B., K.V., L.M.T., A.M.L., A.K., J.M.H.); Department of Medicine II, Klinikum Rechts der Isar, Technische Universität München, Germany (D.S., B.S.); and German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany (D.S., B.S.)
| | - Aisha Khan
- From the Interdisciplinary Stem Cell Institute, University of Miami, Miller School of Medicine, FL (K.E.H., W.B., M.B., K.V., L.M.T., A.M.L., A.K., J.M.H.); Department of Medicine II, Klinikum Rechts der Isar, Technische Universität München, Germany (D.S., B.S.); and German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany (D.S., B.S.)
| | - Joshua M Hare
- From the Interdisciplinary Stem Cell Institute, University of Miami, Miller School of Medicine, FL (K.E.H., W.B., M.B., K.V., L.M.T., A.M.L., A.K., J.M.H.); Department of Medicine II, Klinikum Rechts der Isar, Technische Universität München, Germany (D.S., B.S.); and German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany (D.S., B.S.).
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17
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Florea V, Sanina C, Difede D, Valasaki K, Khan A, Hare J. Abstract 355: Heart Failure Impairs Bone Marrow Mesenchymal Stem Cell Renewing Capacity and Migration. Circ Res 2016. [DOI: 10.1161/res.119.suppl_1.355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Clinical trials have shown a sustained beneficial effect of bone marrow mesenchymal stem cells (MSCs) as a therapy for acute and chronic heart failure (HF). Clinical grade cell manufacturing of autologous and allogeneic MSCs is becoming a standard procedure. This study investigates the differences of bone marrow MSC isolation and expansion in favorable in vitro conditions. We compared MSC production from both healthy young donors and chronic HF patients.
Methods:
We analyzed MSC manufacturing records from five clinical trials: TAC-HFT (Ischemic cardiomyopathy (CMP), patient and donors), POSEIDON (Ischemic CMP, donors), POSEIDON DCM (Dilated CMP, donors), TRIDENT (Ischemic CMP, donors), and CRATUS (Frailty, donors).
Results:
All cells expressed CD105, CD90 and lacked hematopoietic marker CD45. The age of healthy donors (25.5 ± 0.7 y.o., N=24) and HF patients (56.1 ± 2.5, y.o., N=23), was significantly different (P<0.0001). Collectively, the number of mononuclear cells (MNCs) isolated from bone marrow (volume range 58-125ml) didn’t differ between the groups. However, plated MNCs from healthy adults generated more MSCs than MNCs from HF patients (p0: 5.9x10^6±0.5x10^6, N=23 vs 3.8x10^6±0.4x10^6, N=24, respectively, P=0.003 and p1: 15.4x10^6±2.5x10^6, N=23 vs 10.8x10^6±1.1x10^6, N=24, respectively, P=0.036). No correlation was found between stem cell growth and age (35 to 78y.o.). Left ventricular ejection fraction (LVEF) in patients with HF had a direct correlation with MSC growth rate (P=0.03), particularly, in patients with severely depressed LVEF (<30%), which had a tendency to generate less MSCs overall. Moreover, MSCs from HF patients demonstrated less migration compared to MSCs from healthy donors at 6, 10 and 24 hours (h) relative to baseline (6 h: 9.5±3.0% vs 30.7±2.1%; 10 h: 19.9±13.7% vs 53.1±2.5% and 24 h: 41.5±15.8% vs 88.9±1.6%, N=4, respectively. P=0.03).
Conclusions:
Despite equivalent numbers of MNCs, healthy young donors generate significantly more MSCs than HF patients, due to increased growth rate and higher number of resident stromal bone marrow stem cells. MSC migration was impaired in HF patients compared to healthy donors. HF appears to be an independent factor for MSC renewal capacity and culture phenotype.
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18
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Hatzistergos KE, Valasaki K, Jiang Z, Takeuchi LM, Balkan W, Saur D, Seidler B, DiFede DL, Hare JM. Abstract 323: Loss of Gravity Impairs Cardiac Neural Crest Cell Lineage Development and Function. Circ Res 2016. [DOI: 10.1161/res.119.suppl_1.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
A multitude of structural, haemodynamic and electromechanical cardiovascular disorders have been observed in humans following space-travel. These abnormalities are thought to emerge from transient alterations in autonomic nervous system (ANS). However, since the ANS is cardiac neural crest (CNC)-derived, whether microgravity-induced cardiomyopathies reflect CNC dysfunction, is unknown.
Hypothesis:
Impairment of CNCs underlies microgravity-induced cardiomyopathies.
Methods:
Myocardial explants from adult
cKit
CreERT2/+
;IRG
mice (n=5/group), as well as
cKit
CreERT2/+
;IRG-
derived (iPSC
Kit-Cre
; n=6/group) and
Wnt1-Cre;tdTomato
-derived (iPSC
Wnt1-Cre
; n=18/group) induced pluripotent stem cells, were cultured under static (SC) or simulated microgravity conditions (rotary cell-culture system; RCCS).
Results:
CNC lineage-tracing in cardiac explants illustrated that, compared to SC, RCCS abolished the pool of
cKit
+
CNCs in adult hearts, indicated by quantitation of
cKit
CreERT2
-
mediated EGFP expression (
p
<0.05). Cardiogenesis modeling experiments with iPSC
Kit-Cre
yielded fewer beating EBs (
p
=0.0005), and ~10-fold reduction in EGFP
+
cardiomyocytes (
p
=0.01), in RCCS
vs
. SC. Microarray analyses suggested that RCCS-mediated alterations in BMP and Wnt/β-catenin pathways, downregulated ANS and CNC-related gene programs, and enhanced vasculogenic differentiation without affecting the expression of cardiac mesoderm-related genes. Differences were verified by quantitative PCR. Modeling CNC development in iPSC
Wnt1-Cre
further confirmed an RCCS-mediated dramatic impairment in development and function of CNCs, indicated by quantitation of tdTomato expression in day-10 and day-21 beating embryoid bodies (
p
<0.0001). Intriguingly, the effect of RCCS in CNCs could be only partially rescued upon transfer to SC.
Conclusions:
Together these data indicate that microgravity negatively regulates the development and function of CNCs, thus partly explaining the cellular and molecular mechanisms of microgravity-induced cardiomyopathies. Moreover, these findings are expected to have important implications in space exploration, since they suggest an essential role for gravity in vertebrate development.
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19
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Sanina C, Florea V, Difede D, Valasaki K, Khan A, Hare J. HEART FAILURE AFFECTS BONE MARROW MESENCHYMAL STEM RENEWING CAPACITY. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)31452-8] [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: 11/27/2022]
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20
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Valasaki K, Staikou A, Theodorou LG, Charamopoulou V, Zacharaki P, Papamichael EM. Purification and kinetics of two novel thermophilic extracellular proteases from Lactobacillus helveticus, from kefir with possible biotechnological interest. Bioresour Technol 2008; 99:5804-5813. [PMID: 18032033 DOI: 10.1016/j.biortech.2007.10.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2007] [Revised: 10/02/2007] [Accepted: 10/03/2007] [Indexed: 05/25/2023]
Abstract
Two thermophilic extracellular proteases, designated Lmm-protease-Lh ( approximately 29 kDa) and Hmm-protease-Lh ( approximately 62 kDa), were purified from the Lactobacillus helveticus from kefir, and found active in media containing dithiothreitol; the activity of Lmm-protease-Lh was increased significantly in media containing also EDTAK(2). Both novel proteases maintained full activity at 60 degrees C after 1-h incubation at 10 degrees C as well as at 80 degrees C, showing optimum k(cat)/K(m) values at pH 7.00 and 60 degrees C. Only irreversible inhibitors specific for cysteine proteinases strongly inhibited the activity of both novel enzymes, while they remained unaffected by irreversible inhibitors specific for serine proteinases. Both enzymes hydrolyzed the substrate Suc-FR-pNA via Michaelis-Menten kinetics; conversely, the substrate Cbz-FR-pNA was hydrolyzed by Lmm-protease-Lh via Michaelis-Menten kinetics and by Hmm-protease-Lh via substrate inhibition kinetics. Valuable rate constants and activation energies were estimated from the temperature-(k(cat)/K(m)) profiles of both enzymes, and useful results were obtained from the effect of different metallic ions on their Michaelis-Menten parameters.
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Affiliation(s)
- Krystalenia Valasaki
- University of Ioannina, Department of Chemistry, Sector of Organic Chemistry and Biochemistry, Laboratory of Enzymology, Ioannina 45110, Greece
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21
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Theodorou LG, Perisynakis A, Valasaki K, Drainas C, Papamichael EM. Proton Inventories Constitute Reliable Tools in Investigating Enzymatic Mechanisms: Application on a Novel Thermo-stable Extracellular Protease from a Halo-Alkalophilic Bacillus sp. J Biochem 2007; 142:293-300. [PMID: 17646182 DOI: 10.1093/jb/mvm132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A novel protease designated protease-A-17N-1, was purified from the halo-alkalophilic Bacillus sp. 17N-1, and found active in media containing dithiothreitol and EDTAK(2). This enzyme maintained significant activity from pH 6.00 to 9.00, showed optimum k(cat)/K(m) value at pH 7.50 and 33 degrees C. It was observed that only specific inhibitors of cysteine proteinases inhibited its activity. The pH-(k(cat)/K(m)) profile of protease-A-17N-1 was described by three pK(a)s in the acid limb, and one in the alkaline limb. Both are more likely due t3o the protonic dissociation of an acidic residue, and the development and subsequent deprotonation of an ion-pair, respectively, in its catalytic site, characteristic for cysteine proteinases. Moreover, both the obtained estimates of rate constant k(1) and the ratio k(2)/k(-1) at 25 degrees C, from the temperature-(k(cat)/K(m)) profile of protease-A-17N-1, were found similar to those estimated from the proton inventories of the same parameter, verifying the reliability of the latter methodology. Besides, the bowed-downward proton inventories of k(cat)/K(m), as well as the large inverse SIE observed for this parameter, in combination with its dependence versus temperature, were showed unambiguously that k(cat)/K(m) = k(1). Such results suggest that the novel enzyme is more likely to be a cysteine proteinase functioning via a general acid-base mechanism.
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