title: Is the myofibrillarlytic myocyte a forme fruste apoptotic myocyte?
abstract: BACKGROUND
  Myofibrillarlytic (MFL) cells are commonly observed in subendocardial myocardium in myocardial infarction. Because ischemic damage to myocytes is also known to induce apoptosis, we evaluated the prevalence of apoptosis in MFL cells in nine ischemic cardiomyopathic hearts explanted during transplantation.
  
  
  METHODS
  Myocytes with partial or complete clearing of cytoplasm, observed commonly in the subendocardium, were recognized as MFL cells. Prevalence of apoptosis was defined by TUNEL and ISOL staining and further characterized by immunohistochemical staining for caspase-3, Bcl2, BCL-X(L), Bax, proliferating cell nuclear antigen (PCNA), and Ki67.
  
  
  RESULTS
  Of 4131 MFL cells examined, 1305 (32%) possessed nuclei in a given histologic section; 1140 (88%) of the nucleated myocardial cells were TUNEL positive. Of 842 cells with normal appearance, 257 (31%) cells demonstrated nuclei in the given histologic section. TUNEL staining was observed in 5 (1.9%) in these control areas. All MFL cells stained positive for caspase 3. The antiapoptotic proteins, Bcl2 and BCL-X(L), demonstrated intense upregulation within and surrounding MFL cells, whereas pro-apoptotic protein Bax expression was only seen at control level. The MFL cells had Ki67 negative and PCNA positive nuclei.
  
  
  CONCLUSIONS
  The present study demonstrates that the majority of MFL cells are apoptotic and are associated with upregulation of caspase 3. Simultaneous upregulation of Bcl2 represents a survival effort in these myocytes. This is consistent with the review of the literature that MFL cells are viable, persist in myocardium for long time and may be functionally reversible. Evidence for concurrent apoptosis and survival instinct represent a conceptual paradox and suggests that myocytes undergoing apoptosis should be amenable to reconstitution of function.
authors.affiliation: Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Navneet
authors.initials: N
authors.lastname: Narula
authors.forename: Jagat
authors.initials: J
authors.lastname: Narula
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Zhang
authors.forename: Nezam
authors.initials: N
authors.lastname: Haider
authors.forename: Puthiyaveettil N
authors.initials: PN
authors.lastname: Raghunath
authors.forename: Robin
authors.initials: R
authors.lastname: Brittin
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Gorman
authors.forename: Robert C
authors.initials: RC
authors.lastname: Gorman
authors.forename: John E
authors.initials: JE
authors.lastname: Tomaszewski
mesh_terms: D017209:Apoptosis; D053148:Caspase 3; D020169:Caspases / Q000032:analysis; D006801:Humans; D007150:Immunohistochemistry; D020287:In Situ Nick-End Labeling; D019394:Ki-67 Antigen / Q000032:analysis; D017202:Myocardial Ischemia / Q000473:pathology*; D032383:Myocytes, Cardiac / Q000737:chemistry / Q000473:pathology*; D018809:Proliferating Cell Nuclear Antigen / Q000032:analysis; D051020:bcl-X Protein / Q000032:analysis
chemical_list: C494811:BCL2L1 protein, human; D019394:Ki-67 Antigen; D018809:Proliferating Cell Nuclear Antigen; D051020:bcl-X Protein; C505407:CASP3 protein, human; D053148:Caspase 3; D020169:Caspases