title: Injectable collagen implant improves survival, cardiac remodeling, and function in the early period after myocarditis in rats.
abstract: OBJECTIVE
  Despite clear evidence of immune system involvement in the pathogenesis of myocarditis, the treatment of myocarditis remains nonspecific and supportive. We sought to test the hypothesis that injection of a collagen-based implant into the inflamed myocardium would stabilize the left ventricular (LV) wall and prevent adverse remodeling and dysfunction.
  
  
  RESULTS
  Autoimmune myocarditis was induced in 42 male Lewis rats. Development of myocarditis was evaluated and confirmed by serial echocardiography and cardiac magnetic resonance scans, LV wall thickening, global and regional LV wall motion abnormalities, and in some cases pericardial effusion. Sick animals were randomized to either injectable collagen implantation or saline injection into the anterior inflamed myocardium 14 days after immunization. Significantly, injectable collagen implantation improved 31-day survival compared with controls (85.7% vs 50%; P = .03). Furthermore, although injectable collagen significantly attenuated LV systolic and diastolic dilatation and preserved LV geometry and function, control animals developed significant LV dilatation and dysfunction. These favorable effects on LV remodeling were confirmed by postmortem morphometry. Significantly, the injectable collagen implant attenuated cardiomyocyte hypertrophy and infiltration of macrophages and lymphocytes into the myocardium.
  
  
  CONCLUSIONS
  The present study shows, for the first time, that injectable collagen biomaterial improves survival and attenuates cardiac inflammation, cardiomyocyte hypertrophy, LV remodeling, and dysfunction in the early period after myocarditis in rats. Our findings suggest a new biomaterial-based strategy to ameliorate the devastating effects of myocarditis.
authors.affiliation: Tamman Cardiovascular Research Institute, Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, Israel Regenerative Medicine Stem Cells and Tissue Engineering Center, Sheba Medical Center, Tel-Hashomer, Israel Neufeld Cardiac Research Institute, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Shunit
authors.initials: S
authors.lastname: Rinkevich-Shop
authors.affiliation: Tamman Cardiovascular Research Institute, Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, Israel Regenerative Medicine Stem Cells and Tissue Engineering Center, Sheba Medical Center, Tel-Hashomer, Israel Neufeld Cardiac Research Institute, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Natalie
authors.initials: N
authors.lastname: Landa-Rouben
authors.affiliation: Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA Department of Radiology, University of Virginia, Charlottesville, VA, USA.
authors.forename: Frederick H
authors.initials: FH
authors.lastname: Epstein
authors.affiliation: Tamman Cardiovascular Research Institute, Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, Israel Regenerative Medicine Stem Cells and Tissue Engineering Center, Sheba Medical Center, Tel-Hashomer, Israel Neufeld Cardiac Research Institute, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Radka
authors.initials: R
authors.lastname: Holbova
authors.affiliation: Tamman Cardiovascular Research Institute, Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, Israel Regenerative Medicine Stem Cells and Tissue Engineering Center, Sheba Medical Center, Tel-Hashomer, Israel Neufeld Cardiac Research Institute, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Micha S
authors.initials: MS
authors.lastname: Feinberg
authors.affiliation: Diagnostic Imaging Department, Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Orly
authors.initials: O
authors.lastname: Goitein
authors.affiliation: Diagnostic Imaging Department, Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Tammar
authors.initials: T
authors.lastname: Kushnir
authors.affiliation: Diagnostic Imaging Department, Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Eli
authors.initials: E
authors.lastname: Konen
authors.affiliation: Tamman Cardiovascular Research Institute, Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, Israel Regenerative Medicine Stem Cells and Tissue Engineering Center, Sheba Medical Center, Tel-Hashomer, Israel Neufeld Cardiac Research Institute, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel leorj@post.tau.ac.il.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Leor
mesh_terms: D000818:Animals; D003094:Collagen / Q000494:pharmacology*; D004195:Disease Models, Animal; D004452:Echocardiography; D006321:Heart / Q000187:drug effects; D007267:Injections; D008297:Male; D009205:Myocarditis / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D009206:Myocardium; D011897:Random Allocation; D051381:Rats; D011917:Rats, Inbred Lew; D016896:Treatment Outcome
chemical_list: C549013:dermicol-P35 27G; D003094:Collagen
keywords: animal model; cardiac remodeling; collagen implant; injectable biomaterials/scaffold; myocarditis