title: Embryonic stem cell therapy of heart failure in genetic cardiomyopathy.
abstract: Pathogenic causes underlying nonischemic cardiomyopathies are increasingly being resolved, yet repair therapies for these commonly heritable forms of heart failure are lacking. A case in point is human dilated cardiomyopathy 10 (CMD10; Online Mendelian Inheritance in Man #608569), a progressive organ dysfunction syndrome refractory to conventional therapies and linked to mutations in cardiac ATP-sensitive K(+) (K(ATP)) channel subunits. Embryonic stem cell therapy demonstrates benefit in ischemic heart disease, but the reparative capacity of this allogeneic regenerative cell source has not been tested in inherited cardiomyopathy. Here, in a Kir6.2-knockout model lacking functional K(ATP) channels, we recapitulated under the imposed stress of pressure overload the gene-environment substrate of CMD10. Salient features of the human malignant heart failure phenotype were reproduced, including compromised contractility, ventricular dilatation, and poor survival. Embryonic stem cells were delivered through the epicardial route into the left ventricular wall of cardiomyopathic stressed Kir6.2-null mutants. At 1 month of therapy, transplantation of 200,000 cells per heart achieved teratoma-free reversal of systolic dysfunction and electrical synchronization and halted maladaptive remodeling, thereby preventing end-stage organ failure. Tracked using the lacZ reporter transgene, stem cells engrafted into host heart. Beyond formation of cardiac tissue positive for Kir6.2, transplantation induced cell cycle activation and halved fibrotic zones, normalizing sarcomeric and gap junction organization within remuscularized hearts. Improved systemic function induced by stem cell therapy translated into increased stamina, absence of anasarca, and benefit to overall survivorship. Embryonic stem cells thus achieve functional repair in nonischemic genetic cardiomyopathy, expanding indications to the therapy of heritable heart failure. Disclosure of potential conflicts of interest is found at the end of this article.
authors.affiliation: Department of Medicine, Division of Cardiovascular Diseases, Marriott Heart Disease Research Program, Mayo Clinic, Rochester, Minnesota, USA. 55905, USA. terzic.andre@mayo.edu
authors.forename: Satsuki
authors.initials: S
authors.lastname: Yamada
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Nelson
authors.forename: Ruben J
authors.initials: RJ
authors.lastname: Crespo-Diaz
authors.forename: Carmen
authors.initials: C
authors.lastname: Perez-Terzic
authors.forename: Xiao-Ke
authors.initials: XK
authors.lastname: Liu
authors.forename: Takashi
authors.initials: T
authors.lastname: Miki
authors.forename: Susumu
authors.initials: S
authors.lastname: Seino
authors.forename: Atta
authors.initials: A
authors.lastname: Behfar
authors.forename: Andre
authors.initials: A
authors.lastname: Terzic
mesh_terms: D000818:Animals; D006332:Cardiomegaly / Q000503:physiopathology / Q000628:therapy; D009202:Cardiomyopathies / Q000150:complications* / Q000235:genetics* / Q000503:physiopathology; D064987:Cell- and Tissue-Based Therapy; D053595:Embryonic Stem Cells / Q000166:cytology* / Q000378:metabolism; D020022:Genetic Predisposition to Disease; D006329:Heart Conduction System / Q000503:physiopathology; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D006334:Heart Function Tests; D006801:Humans; D054086:KATP Channels / Q000172:deficiency; D051379:Mice; D008810:Mice, Inbred C57BL; D018345:Mice, Knockout; D009200:Myocardial Contraction / Q000502:physiology; D009206:Myocardium / Q000473:pathology / Q000648:ultrastructure; D033581:Stem Cell Transplantation; D013312:Stress, Physiological; D016896:Treatment Outcome; D020257:Ventricular Remodeling / Q000502:physiology; D014945:Wound Healing
chemical_list: D054086:KATP Channels