Differential regulation of the HIF-1α/apoptosis axis by miR-126-5p in cardiac cells during ischemia/reperfusion injury.

<i>Circulation Research</i> Thematic Synopsis

The recognition that myocyte mitosis occurs in the fetal, neonatal, adult, and hypertrophied heart and that a pool of primitive, undifferentiated cells is present in the myocardium has put forward a different view of the biology of the heart. The new paradigm suggests that myocyte formation is preserved during postnatal life, in adulthood or senescence, pointing to a remarkable growth reserve of the heart throughout the course of life of the organism. This article reviews a large body of novel information, which has been obtained in the last 2 decades, in favor of the notion that the mammalian heart has the inherent ability to continuously replace its parenchymal cells and that this unexpected characteristic has important implications in understanding myocardial homeostasis, cardiac aging, and tissue repair. The paradigm that the heart is a postmitotic organ incapable of regenerating parenchymal cells was established in the 1970s, and this dogma has profoundly conditioned basic and clinical research in cardiology for the last 3 decades. On the basis of this paradigm, cardiomyocytes undergo cellular hypertrophy1,2 but cannot be replaced either by entry into the cell cycle of a subpopulation of nonterminally differentiated myocytes or by activation of a pool of primitive cells that become committed to the myocyte lineage. The only response of cardiomyocytes to stress is hypertrophy and/or death. Therefore, a tremendous effort was made to identify the molecular mechanisms of myocyte hypertrophy and their genetic control. A sophisticated knowledge of various signaling pathways has been achieved, and our understanding of the biology of hypertrophic myocyte growth has advanced markedly.3 An array of new technologies has been introduced that has led to a scientific revolution in terms of questions, approaches, and interpretation of experimental results. Despite this enormous progress in our understanding of basic mechanisms of hypertrophy, however, very little …

Heart failure, a common consequence of ischemic heart disease, is a major cause of morbidity and mortality in the world.1–3 Pharmacological treatment with β-blockers and inhibitors of the renin–angiotensin–aldosterone system has improved the clinical outcomes in patients with heart failure.4–7 Likewise, mechanical unloading with left ventricular assist devices and resynchronization therapy have led to partial reversal of cardiac structural and molecular remodeling and symptomatic improvement.8–10 Despite these remarkable advances, however, mortality and morbidity of patients with heart failure, with or without reduced ejection fraction remains high.1,2 Moreover, heart transplantation, while an effective option, is available only for a selected number of patients and is not without considerable negative consequences.11 Furthermore, gene therapy still remains in early investigational stages and not yet ready for clinical applications.12 The high residual mortality and morbidity of patients with heart failure might be inherent to the shortcomings of the current therapeutic approaches, as none directly targets the underlying causal problem in heart failure, that is, loss of or intrinsically dysfunctional myocytes. Consequently, novel therapeutic approaches are necessary to further improve the clinical outcomes in patients with heart failure. The heart is considered, by and large, a terminally differentiated organ with a limited intrinsic regenerative capacity that alone is insufficient to compensate for the pathological loss of cardiac myocytes during the postnatal period.13–15 The discovery of cardiac progenitor cells (CPCs) in the heart more than a decade ago along with the recent data showing that the existing myocytes undergo a gradual turnover have raised the potentials for regenerative cardiac repair.16,17 Likewise, the discovery of mesenchymal stem cells (MSCs), which was thought to have the potential to differentiate to cardiac myocytes, but yet to proven, or enhance …

<i>Circulation Research</i> Thematic Synopsis

Mesp1 Acts as a Master Regulator of Multipotent Cardiovascular Progenitor Specification

### Endothelial Progenitor Cells and Postnatal Vasculogenesis: Experimental Evidence The option of performing full-scale endothelial cell transplantation to optimize local neovascularization is daunting if even feasible. An alternative, attractive strategy is designed to exploit the conceptual notion that endothelial cells and hematopoietic stem cells were ultimately derived from a common precursor, the putative hemangioblast. Hematopoietic stem cells had been shown previously to be present in circulating blood, in quantities sufficient to permit their harvesting and readministration for autologous, in lieu of bone marrow, transplantation. The related descendants, endothelial progenitor cells, can be detected in the peripheral circulation.1,2 Initially, Flk-1 and a second antigen, CD34, shared by angioblasts and hematopoietic stem cells were used to isolate putative angioblasts from the leukocyte fraction of peripheral blood.1 Meanwhile, endothelial progenitor cells were isolated from human umbilical cord blood,3 bone marrow–derived mononuclear cells,4 and CD34+ or CD133+ hematopoietic stem cells1,5 and were successfully ex vivo expanded with the use of human peripheral blood mononuclear cells.6 These cells differentiated into endothelial cells, as shown by expression of various endothelial proteins (KDR, von Willebrand factor, endothelial nitric oxide synthase, VE-cadherin, CD146) and uptake of Dil-acetylated LDL and binding of lectin.1,7 In animal models of ischemia, heterologous, homologous, and autologous endothelial progenitor cells were shown to incorporate into sites of active neovascularization in ischemic and tumor tissue. Blood flow recovery and capillary density were markedly improved, and the rate of limb loss was significantly reduced after transplantation of human peripheral blood–derived endothelial progenitor cells8,9 or bone marrow mononuclear cells.10 Likewise, infusion of peripheral blood–derived endothelial progenitor cells,11 bone marrow mononuclear cells,12 or purified CD34+ cells13 improved neovascularization and myocardial function after infarction. Isolated CD34+ cells also increased impaired blood flow in diabetic mice.14 These findings provide evidence that exogenously …

Diabetes mellitus (DM) is characterized by fasting hyperglycaemia and a high risk of atherothrombotic disorders affecting the coronary, cerebral and peripheral arterial trees. The risk of myocardial infarction (MI) is 3-5 fold higher in Type 2 DM and a DM subject with no history of MI has the same risk as a non-DM subject with a past history of MI. In total around 70% of deaths are vascular with poorer outcomes to both acute events and cardiological interventions. It was proposed that clustering of vascular risk factors (hyperinsulinaemia, dysglycaemia, dyslipidaemia and hypertension) around insulin resistance (IR) accounted for the increase in risk with Type 2 DM. The importance of this became apparent with the recognition that risk clustering occurs in normoglycaemic and impaired glucose tolerance (IGT) subjects with IR, in total around 25% of the population in addition to long-standing Type 1 subjects with renal disease. Evidence indicates that thrombotic risk clustering also occurs in association with IR, suppression of fibrinolysis due to elevated concentrations of the fibrinolytic inhibitor, plasminogen activator inhibitor-1 (PAI-1) is invariable with IR and there is evidence that this is regulated by the effects of triglyceride on the PAI-1 gene promoter. Other studies indicated that prothrombotic risk (coagulation factors VII, XII and fibrinogen) also associates with the IR syndrome. The development of endothelial cell dysfunction with suppression of nitric oxide and prostacyclin synthesis, combined with platelet resistance to the anti-aggregatory effects of these hormones leads to loss of control over platelet activation. In addition, hyperglycaemia and glycation have marked effects on fibrin structure function, generating a clot which has a denser structure, resistant to fibrinolysis. The combination of increased circulating coagulation zymogens, inhibition of fibrinolysis, changes in fibrin structure/function and alterations in platelet reactivity creates a thrombotic risk clustering which underpins the development of cardiovascular disease.

We have previously demonstrated in acute myocardial infarctions that human umbilical cord blood mononuclear cells (HUCBCs), which contain hematopoietic, endothelial, and mesenchymal stem cells, reduce acute myocardial infarction size by ≥50% and preserve LV contractility. We hypothesize that the beneficial effects of HUCBCs are due to secretion of biologically active factors that activate in cardiac endothelial cells and myocytes the cell survival protein Akt. We determined by protein microarrays the growth factors and anti-inflammatory cytokines secreted by HUCBCs into culture media during 12 h of hypoxia (1% O2). We then determined by Western blots the effects of cell-free media from hypoxic-conditioned HUCBCs (HUCM) on activation of the cell survival protein Akt in human coronary artery endothelial cells and cardiac myocytes in culture during 24 h of 1% O2. We also determined in separate experiments endothelial cell and myocyte apoptosis by caspase-3 and Annexin V. In the present experiments, HUCBCs secreted multiple growth factors, anti-inflammatory cytokines, and inhibitors of metalloproteinase during normoxia and hypoxia. Human cord blood cells increased the concentration in culture media of angiopoietin, hepatocyte growth factor, interleukin-4, insulin-like growth factor, placental growth factor, vascular endothelial cell growth factor, angiogenin, and stem cell factor by 100 to >10,000% during 12 h of 1% O2 (p<0.001). HUCM, which contained these biological factors, significantly increased Akt phosphorylation/activation in coronary artery endothelial cells and cardiac myocytes subjected to 24 h of 1% O2 by more than 60% (p<0.05) and increased the antiapoptotic protein Bcl-2 expression by 34-50% in comparison with endothelial cells and myocytes treated without HUCM in 1% O2(p<0.05). HUCM also significantly decreased caspase-3 activity and decreased hypoxic endothelial cell and cardiac myocyte apoptosis by more than 40% in comparison with cells cultured without HUCM (p<0.05). Inhibition of Akt activation in endothelial cells and myocytes by the sensitive and specific antagonist API-1 during 24 h of hypoxia nearly completely prevented the beneficial effects of HUCM on inhibiting caspase-3 activity and apoptosis. We conclude that HUCBCs secrete biologically active factors during hypoxia that activate survival proteins in endothelial cells and myocytes that significantly limit apoptosis.

The current issue of Circulation reports 2 apparently conflicting studies1,2 pertaining to the highly controversial issue of transdifferentiation of bone marrow–derived cells into cardiomyocytes. The study by Iwasaki et al1 entailed intramyocardial injections of human CD34+ progenitors 20 minutes after the creation of a myocardial infarction in sex-mismatched, immunodeficient athymic mice. The results, assessed 28 days after transplantation, demonstrate a dose-dependent improvement in regional and global left ventricular function, a limitation of remodeling, and an increase in capillary density. These functional benefits are associated with a cardiac differentiation of the engrafted CD34+ cells demonstrated by a double immunofluorescent staining for human- and cardiac-specific markers. Expression of cardiac genes unraveled by real-time polymerase chain reaction is also taken as additional evidence for the cardiomyocytic conversion of the CD34+ progenitor cells, although this conclusion is compounded by the concomitant observation of fusion events between human and mouse cells demonstrated by fluorescent hybridization in situ, using probes specific for these 2 species. Differentiation of the CD34+ progenitors into smooth muscle and endothelial cells is also reported on the basis of similar double-staining immunofluorescent patterns. In contrast, the second article, by Gruh et al,2 does not demonstrate any conversion of human endothelial progenitor cells cocultured with neonatal rat cardiomyocytes. This study has carefully deciphered the potential causes of artifacts that may arise from the use of flow cytometry and conventional 2-dimensional immunofluorescence microscopy and lead to misinterpretations of phenotypic changes incurred by transplanted cells. Indeed, even 3-dimensional confocal microscopy failed to provide a conclusive interpretation for approximately 12% of the double-stained cells (ie, those expressing markers of both endothelial and cardiac lineages), thereby highlighting the caution with which these putative transdifferentiation events should be analyzed. Failure of additional real-time polymerase chain reaction to detect cardiac transcription factors …

Intracoronary delivery of c-kit-positive human cardiac stem cells (hCSCs) is a promising approach to repair the infarcted heart, but it is severely limited by the poor survival of donor cells. Cobalt protoporphyrin (CoPP), a well known heme oxygenase 1 inducer, has been used to promote endogenous CO generation and protect against ischemia/reperfusion injury. Therefore, we determined whether preconditioning hCSCs with CoPP promotes CSC survival. c-kit-positive, lineage-negative hCSCs were isolated from human heart biopsies. Lactate dehydrogenase release assays demonstrated that preconditioning CSCs with CoPP markedly enhanced cell survival after oxidative stress induced by H(2)O(2), concomitant with up-regulation of heme oxygenase 1, COX-2, and anti-apoptotic proteins (BCL2, BCL2-A1, and MCL-1) and increased phosphorylation of NRF2. Apoptotic cytometric assays showed that pretreatment of CSCs with CoPP enhanced the cells' resistance to apoptosis induced by oxidative stress. Conversely, knocking down HO-1, COX-2, or NRF2 by shRNA gene silencing abrogated the cytoprotective effects of CoPP. Further, preconditioning CSCs with CoPP led to a global increase in release of cytokines, such as EGF, FGFs, colony-stimulating factors, and chemokine ligand. Conditioned medium from cells pretreated with CoPP conferred naive CSCs remarkable resistance to apoptosis, demonstrating that cytokines released by preconditioned cells play a key role in the anti-apoptotic effects of CoPP. Preconditioning CSCs with CoPP also induced an increase in the phosphorylation of Erk1/2, which are known to modulate multiple pro-survival genes. These results potentially provide a simple and effective strategy to enhance survival of CSCs after transplantation and, therefore, their efficacy in repairing infarcted myocardium.

Functional erythropoietin receptor is undetectable in endothelial, cardiac, neuronal, and renal cells

### 21998 #### Enhanced Myocardial Repair with CardioChimeras Pearl J Quijada, Jonathan D Cubillo, Claudio Staub, Mark A Sussman; San Diego State Univ, San Diego, CA Dual stem cell transplantation of c-kit positive cardiac progenitor cells (CPCs) and mesenchymal stem cells (MSCs) after infarction support modest improvements in cardiac function, however there are currently no reports substantiating a single stem cell type supporting both direct and indirect mechanisms of myocardial repair. Therefore we created a CardioChimera, a stem/progenitor cell formed by fusion between CPCs and MSCs, resulting in a unique progeny superior to either individual precursor. CardioChimeras were purified after cell fusion with Hemagglutinating virus of Japan and expanded clonally based on dual expression of fluorescent proteins mCherry and eGFP from CPCs and MSCs respectively. CardioChimeras are mono-nucleated, have comparable growth kinetics to parental CPCs and MSCs and display increased cellular size unrelated to cell cycle arrest and/or senescence. CardioChimeras have increased expression of cardiomyogenic lineage markers cardiac troponin T (2.5-fold), smooth muscle 22 (9.3-fold), and CD31 (10.7-fold) concomitantly associated with decreased c-kit protein expression (50%) relative to parent CPCs. Lineage commitment of CardioChimeras is bolstered by dexamethasone treatment measured by mRNA levels of cardiogenic genes and increases in active mitochondria (2.2-fold) after labeling with MitoTracker. Induction of apoptosis is blunted in cardiomyocytes co-cultured with CardioChimeras compared to co-culturing with CPCs and MSCs alone, or combination of non-fused parent cells. CardioChimeras enhance cardiomyocyte growth similar to parent MSCs owing to an increased propensity to secrete pro-growth factors. Collectively, CardioChimeras represent an adaptable cell therapy combining the beneficial properties of CPCs to undergo cardiac specific commitment as well as MSCs that foster an improved microenvironment with protective paracrine secretion. Clinically, CardioChimeras merge the application of distinct cell types into a single entity for increased engraftment, mitigation of inflammation and blunting the progression of heart failure by promoting myocardial regeneration. …

von Willebrand factor: a marker of endothelial damage?

<i>Circulation Research</i> “In This Issue” Anthology

Sphingosine Kinase-1 Associates with Integrin α Vβ 3 to Mediate Endothelial Cell Survival