title: Neoangiogenesis after combined transplantation of skeletal myoblasts and angiopoietic progenitors leads to increased cell engraftment and lower apoptosis rates in ischemic heart failure.
abstract: OBJECTIVE
  We previously reported that combined transplantation of skeletal myoblasts and AC-133+ cells leads to improved left ventricular function, reduced infarct size and myocardial apoptosis in a model of chronic ischemia. The aim of this study is to elucidate on the possible mechanisms and to assess new implications in increasing cell therapy efficacy in chronic ischemia.
  
  
  METHODS
  Heart failure was induced by LAD-ligation in nude rats. (a) Homologous skeletal myoblasts (SM), (b) human derived AC-133+ cells (SC), (c) combination of both cells (Comb) and (d) culture medium (CM) were injected in the infarct and peri-infarct area, respectively, four weeks after infarction. Cell engraftment was detected by fluorescence microscopy and confirmed by immunohistochemical techniques. Cardiac gene expression levels of VEFG-A, cardiac troponin, ACTA2, SDF-1, TGF-beta-1, were assessed by RT-PCR.
  
  
  RESULTS
  Both cell types were detected in the injection areas four weeks after cell transplantation. Double cell therapy led to increased cell engraftment (SM: 52+/-13/mm(2), SC: 45+/-8 in the combination group vs. SM: 31+/-9 and 23+/-7 in the monotherapy groups, P=0.007). This effect was confirmed using PCR. Apoptotic index among engrafted cells was significantly lower in the Comb group (Comb: 0.53+/-0.12 for myoblasts and 0.34+/-0.09 for SC, vs. SM: 0.76+/-0.19 and SC: 0.63+/-0.16, P=0.013). Expression of cardiac troponin was higher in the combination group in the peri-infarct area. Evaluation of capillary density revealed increased angiogenesis in the combination group (Comb: 12.3+/-2.3, SM: 5.2+/-1.2, SC: 8.3+/-1.8, P=0.002). Neoangiogenesis was associated with higher levels of VEGF-A and TGF-beta in the injection areas as detected by RT-PCR. The higher SDF-1 expression in the injected areas implies an increased secretion of chemoattractants by the injected cells, which suggests that the effect of combined cell transplantation is mainly associated with paracrine mechanisms.
  
  
  CONCLUSIONS
  The mechanism of functional improvement after combined transplantation of skeletal myoblasts and AC-133+ progenitors in ischemic heart failure is mainly associated with increased angiogenesis based on paracrine factors, which leads to improved survival and lower apoptosis rates of the injected cells.
authors.affiliation: Department of Cardiac Surgery, Innsbruck Medical University, Anichstrasse 35, A-6020, Innsbruck, Austria. Nikolaos.bonaros@i-med.ac.at
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Bonaros
authors.forename: Rauend
authors.initials: R
authors.lastname: Rauf
authors.forename: Ernst
authors.initials: E
authors.lastname: Werner
authors.forename: Bernhard
authors.initials: B
authors.lastname: Schlechta
authors.forename: Eva
authors.initials: E
authors.lastname: Rohde
authors.forename: Alfred
authors.initials: A
authors.lastname: Kocher
authors.forename: Johannes
authors.initials: J
authors.lastname: Bonatti
authors.forename: Guenther
authors.initials: G
authors.lastname: Laufer
mesh_terms: D000071916:AC133 Antigen; D000185:Actinin / Q000378:metabolism; D000818:Animals; D015703:Antigens, CD / Q000032:analysis; D017209:Apoptosis; D002470:Cell Survival; D002478:Cells, Cultured; D054377:Chemokine CXCL12 / Q000378:metabolism; D004195:Disease Models, Animal; D042783:Endothelial Cells / Q000276:immunology / Q000637:transplantation*; D006023:Glycoproteins / Q000032:analysis; D006333:Heart Failure / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D032448:Myoblasts, Skeletal / Q000637:transplantation*; D009203:Myocardial Infarction / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D017202:Myocardial Ischemia / Q000150:complications* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D009206:Myocardium / Q000378:metabolism / Q000473:pathology*; D018919:Neovascularization, Physiologic; D019899:Paracrine Communication; D010455:Peptides / Q000032:analysis; D012333:RNA, Messenger / Q000378:metabolism; D051381:Rats; D011916:Rats, Inbred F344; D011923:Rats, Nude; D033581:Stem Cell Transplantation; D013997:Time Factors; D053773:Transforming Growth Factor beta1 / Q000378:metabolism; D020107:Troponin T / Q000378:metabolism; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism
chemical_list: D000071916:AC133 Antigen; C498530:Actn2 protein, rat; D015703:Antigens, CD; D054377:Chemokine CXCL12; D006023:Glycoproteins; D010455:Peptides; D012333:RNA, Messenger; D053773:Transforming Growth Factor beta1; D020107:Troponin T; D042461:Vascular Endothelial Growth Factor A; D000185:Actinin