Combined transplantation of skeletal myoblasts and angiopoietic progenitor cells reduces infarct size and apoptosis and improves cardiac function in chronic.

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Combined transplantation of skeletal myoblasts and angiopoietic progenitor cells reduces infarct size and apoptosis and improves cardiac function in chronic ischemic heart failure Nikolaos Bonaros, MD, Rauend Rauf, MD, Dominik Wolf, MD, Eva Margreiter, PhD, Alexandar Tzankov, MD, Bernhard Schlechta, MD, Alfred Kocher, MD, Harald Ott, MD, Thomas Schachner, MD, Steffen Hering, PhD, Johannes Bonatti, MD, Guenther Laufer, MD The Journal of Thoracic and Cardiovascular Surgery Volume 132, Issue 6, Pages 1321-1328.e2 (December 2006) DOI: 10.1016/j.jtcvs.2006.07.023 Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Transplanted skeletal myoblasts and AC-133+ angiopoietic progenitors survive in chronic ischemic myocardium. A, Fluorescent staining of YFP-labeled skeletal myoblasts (green) in the infarct area detected 4 weeks after cell injection (40× magnification). B, Immunohistochemical staining of skeletal myoblasts by My-32 antibody confirms fluorescence-based cell detection in the infarct scar (40× magnification). C, Immunofluorescent staining of My-32 (red) showing stable myotube formation in the scar (cell nuclei stained blue) (100× magnification). D, Fluorescent staining of DiI-labeled AC-133+ cells (red) in the border zone 4 weeks after cell transplantation (40× magnification). E, Fluorescent staining of skeletal myoblasts (green) and AC-133+ cells (red) in the infarct area 4 weeks after combined cell transplantation of skeletal myoblasts and AC-133+ cells in the scar and border zone, respectively (100× magnification). The Journal of Thoracic and Cardiovascular Surgery 2006 132, 1321-1328.e2DOI: (10.1016/j.jtcvs.2006.07.023) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Combined transplantation of skeletal myoblasts and AC-133+ progenitors reverses left ventricular dilatation (A) and improves left ventricular function (B), as assessed by transthoracic echocardiography 4 weeks after cell transplantation (results expressed as mean ± standard deviation). M-Mode echocardiography, i., 2 days after myocardial infarction; ii., 4 weeks after double-cell therapy. Animals received Roswell Park Memorial Institute injections in the scar and peri-infarct rim (control), homologous skeletal myoblasts in the scar (SM), human-derived AC-133+ cells in the peri-infarct rim (SC), homologous skeletal myoblasts and human-derived AC-133+ cells (Comb) in the scar and peri-infarct rim, respectively. Note anterior wall hypokinesia and left ventricular dilatation after myocardial infarction (arrow). Both findings are partially reversed 4 weeks after combined cell therapy (arrow). The Journal of Thoracic and Cardiovascular Surgery 2006 132, 1321-1328.e2DOI: (10.1016/j.jtcvs.2006.07.023) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Combined transplantation of skeletal myoblasts and angiopoietic progenitors prevents myocardial fibrosis and results in reduced myocardial scar, as assessed by Masson’s Trichrome staining 8 weeks after myocardial infarction. A, Scar area of a control animal 4 weeks after injection of culture medium (40× magnification). B, Scar area of an animal after myocardial infarction and 4 weeks after skeletal myoblasts transplantation (40× magnification). C, Quantification of myocardial fibrosis 4 weeks after injection of culture medium (control), homologous skeletal myoblasts (SM), human-derived AC-133+ cells (SC), or combination of homologous skeletal myoblasts and human-derived AC-133+ cells. The Journal of Thoracic and Cardiovascular Surgery 2006 132, 1321-1328.e2DOI: (10.1016/j.jtcvs.2006.07.023) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Double-cell therapy with skeletal myoblasts and AC-133+ cells attenuates apoptosis in the border zone and distal area, as assessed by TUNEL staining. TUNEL staining of the border zone 4 weeks after injections of (A) culture medium and (B) combination of homologous skeletal myoblasts and human-derived AC-133+ cells (brown and blue nuclei indicating apoptotic and non-apoptotic cells, respectively). Quantification of apoptotic index, calculated as the ratio of apoptotic cardiomyocytes in the total myocardial cell population in the border zone (C) and distal area (D). Results are expressed as mean ± standard deviation. The Journal of Thoracic and Cardiovascular Surgery 2006 132, 1321-1328.e2DOI: (10.1016/j.jtcvs.2006.07.023) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Degree of neovascularization in the peri-infarct area of chronic infarcted myocardium after injection of (A) culture medium and (B) combination of skeletal myoblasts and AC-133+ cells. Quantification of capillary density in the border zone (C) and scar (D) 4 weeks after cell transplantation. The Journal of Thoracic and Cardiovascular Surgery 2006 132, 1321-1328.e2DOI: (10.1016/j.jtcvs.2006.07.023) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figures E1 and E2 M-Mode echocardiography before myocardial infarction (E1) and 4 weeks after cell monotherapy (E2). Note anterior wall movement and normal dimensions of the left ventricle before myocardial infarction (arrow, Figure E1) and 4 weeks after cell monotherapy (arrow, Figure E2). The Journal of Thoracic and Cardiovascular Surgery 2006 132, 1321-1328.e2DOI: (10.1016/j.jtcvs.2006.07.023) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figures E3 and E4 Double-cell therapy with skeletal myoblasts and AC-133+ cells attenuates apoptosis in the border zone and distal area, as assessed by TUNEL staining. TUNEL staining of the border zone 4 weeks after injections of homologous skeletal myoblasts (E3) and human-derived AC-133+ cells (E4) (brown and blue nuclei indicating apoptotic and non-apoptotic cells, respectively). The Journal of Thoracic and Cardiovascular Surgery 2006 132, 1321-1328.e2DOI: (10.1016/j.jtcvs.2006.07.023) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figures E5 and E6 Degree of neovascularization in the peri-infarct area of chronic infarcted myocardium after injection of skeletal myoblasts (E5) and AC-133+ cells (E6) as assessed by means of CD34 staining of endothelial cells. The Journal of Thoracic and Cardiovascular Surgery 2006 132, 1321-1328.e2DOI: (10.1016/j.jtcvs.2006.07.023) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions