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O’Brien CG, Ozen MO, Ikeda G, Vaskova E, Jung JH, Bayardo N, Santoso MR, Shi L, Wahlquist C, Jiang Z, Jung Y, Zeng Y, Egan E, Sinclair R, Gee A, Witteles R, Mercola M, Svensson KJ, Demirci U, Yang PC. Mitochondria-Rich Extracellular Vesicles Rescue Patient-Specific Cardiomyocytes From Doxorubicin Injury: Insights Into the SENECA Trial. JACC CardioOncol 2021; 3:428-440. [PMID: 34604804 PMCID: PMC8463733 DOI: 10.1016/j.jaccao.2021.05.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 04/29/2021] [Accepted: 05/11/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Anthracycline-induced cardiomyopathy (AIC) is a significant source of morbidity and mortality in cancer survivors. The role of mesenchymal stem cells (MSCs) in treating AIC was evaluated in the SENECA trial, a Phase 1 National Heart, Lung, and Blood Institute-sponsored study, but the mechanisms underpinning efficacy in human tissue need clarification. OBJECTIVES The purpose of this study was to perform an in vitro clinical trial evaluating the efficacy and putative mechanisms of SENECA trial-specific MSCs in treating doxorubicin (DOX) injury, using patient-specific induced pluripotent stem cell-derived cardiomyocytes (iCMs) generated from SENECA patients. METHODS Patient-specific iCMs were injured with 1 μmol/L DOX for 24 hours, treated with extracellular vesicles (EVs) from MSCs by either coculture or direct incubation and then assessed for viability and markers of improved cellular physiology. MSC-derived EVs were separated into large extracellular vesicles (L-EVs) (>200 nm) and small EVs (<220nm) using a novel filtration system. RESULTS iCMs cocultured with MSCs in a transwell system demonstrated improved iCM viability and attenuated apoptosis. L-EVs but not small EVs recapitulated this therapeutic effect. L-EVs were found to be enriched in mitochondria, which were shown to be taken up by iCMs. iCMs treated with L-EVs demonstrated improved contractility, reactive oxygen species production, ATP production, and mitochondrial biogenesis. Inhibiting L-EV mitochondrial function with 1-methyl-4-phenylpyridinium attenuated efficacy. CONCLUSIONS L-EV-mediated mitochondrial transfer mitigates DOX injury in patient-specific iCMs. Although SENECA was not designed to test MSC efficacy, consistent tendencies toward a positive effect were observed across endpoints. Our results suggest a mechanism by which MSCs may improve cardiovascular performance in AIC independent of regeneration, which could inform future trial design evaluating the therapeutic potential of MSCs.
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Key Words
- AIC, anthracycline induced cardiomyopathy
- DOX, doxorubicin
- DZR, dexrazoxane
- EV, extracellular vesicle
- L-EV, large extracellular vesicle
- MPP+, 1-methyl-4-phenylpyrindinium
- MSC, mesenchymal stem cell
- MSC-EV, mesenchymal stem cell derived extracellular vesicle
- MTDR, MitoTracker Deep Red
- MTG, MitoTracker Green
- RBC, red blood cell
- ROS, reactive oxygen species
- S-EV, small extracellular vesicle
- anthracycline
- cardiomyopathy
- heart failure
- iCM, induced cardiomyocyte
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Affiliation(s)
- Connor G. O’Brien
- Department of Medicine, Division of Cardiology, University California San Francisco School of Medicine, San Francisco, California, USA
| | - Mehmet Ozgun Ozen
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA
- Bio-Acoustic MEMS in Medicine BAMM Laboratory, Canary Center at Stanford for Cancer Early Detection, Department of Radiology, Stanford School of Medicine, Stanford University, Palo Alto, California, USA
| | - Gentaro Ikeda
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Evgeniya Vaskova
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Ji Hye Jung
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Nathan Bayardo
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Michelle Rai Santoso
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Liye Shi
- Department of Geriatric Cardiovascular Medicine, First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Christine Wahlquist
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Zewen Jiang
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, California, USA
| | - Yunshin Jung
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, California, USA
| | - Yitian Zeng
- Department of Materials Science and Engineering, Stanford University, Stanford, California, USA
| | - Elizabeth Egan
- Department of Pediatrics (Infectious Diseases), Stanford University School of Medicine, Stanford, California, USA
| | - Robert Sinclair
- Department of Materials Science and Engineering, Stanford University, Stanford, California, USA
| | - Adrian Gee
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, USA
| | - Ronald Witteles
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Mark Mercola
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Katrin J. Svensson
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, California, USA
| | - Utkan Demirci
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA
- Bio-Acoustic MEMS in Medicine BAMM Laboratory, Canary Center at Stanford for Cancer Early Detection, Department of Radiology, Stanford School of Medicine, Stanford University, Palo Alto, California, USA
- Department of Electrical Engineering (by courtesy), Stanford, California, USA
| | - Phillip C. Yang
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
- Address for correspondence: Dr Phillip C. Yang, Division of Cardiovascular Medicine, Department of Medicine, Stanford University, 240 Pasteur Drive, BMI 3053, Stanford, California 94304, USA.
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