title: Intra-renal delivery of mesenchymal stem cells attenuates myocardial injury after reversal of hypertension in porcine renovascular disease.
abstract: BACKGROUND
  Percutaneous transluminal renal angioplasty (PTRA) fails to fully improve cardiac injury and dysfunction in patients with renovascular hypertension (RVH). Mesenchymal stem cells (MSCs) restore renal function, but their potential for attenuating cardiac injury after reversal of RVH has not been explored. We hypothesized that replenishment of MSCs during PTRA would improve cardiac function and oxygenation, and decrease myocardial injury in porcine RVH.
  
  
  METHODS
  Pigs were studied after 16 weeks of RVH, RVH treated 4 weeks earlier with PTRA with or without adjunct intra-renal delivery of MSC (10^6 cells), and controls. Cardiac structure, function (fast-computed tomography (CT)), and myocardial oxygenation (Blood-Oxygen-Level-Dependent- magnetic resonance imaging) were assessed in-vivo. Myocardial microvascular density (micro-CT) and myocardial injury were evaluated ex-vivo. Kidney venous and systemic blood levels of inflammatory markers were measured and their renal release calculated.
  
  
  RESULTS
  PTRA normalized blood pressure, yet stenotic-kidney glomerular filtration rate, similarly blunted in RVH and RVH + PTRA, normalized only in PTRA + MSC-treated pigs. PTRA attenuated left ventricular remodeling, whereas myocardial oxygenation, subendocardial microvascular density, and diastolic function remained decreased in RVH + PTRA, but normalized in RVH + PTRA-MSC. Circulating isoprostane levels and renal release of inflammatory cytokines increased in RVH and RVH + PTRA, but normalized in RVH + PTRA-MSC, as did myocardial oxidative stress, inflammation, collagen deposition, and fibrosis.
  
  
  CONCLUSIONS
  Intra-renal MSC delivery during PTRA preserved stenotic-kidney function, reduced systemic oxidative stress and inflammation, and thereby improved cardiac function, oxygenation, and myocardial injury four weeks after revascularization, suggesting a therapeutic potential for adjunctive MSC delivery to preserve cardiac function and structure after reversal of experimental RVH.
authors.affiliation: Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA. eirinmassat.alfonso@mayo.edu.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Eirin
authors.affiliation: Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA. zhu.xiangyang@mayo.edu.
authors.forename: Xiang-Yang
authors.initials: XY
authors.lastname: Zhu
authors.affiliation: Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA. ferguson.christopher@mayo.edu.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Ferguson
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA. riester.scott@mayo.edu.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Riester
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA. vanWijnen.andre@mayo.edu.
authors.forename: Andre J
authors.initials: AJ
authors.lastname: van Wijnen
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA. lerman.amir@mayo.edu.
authors.forename: Amir
authors.initials: A
authors.lastname: Lerman
authors.affiliation: Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA. lerman.lilach@mayo.edu.|Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA. lerman.lilach@mayo.edu.
authors.forename: Lilach O
authors.initials: LO
authors.lastname: Lerman
mesh_terms: D017130:Angioplasty; D000818:Animals; D001794:Blood Pressure; D003094:Collagen / Q000378:metabolism; D016207:Cytokines / Q000378:metabolism; D005260:Female; D005355:Fibrosis; D005919:Glomerular Filtration Rate; D006321:Heart / Q000000981:diagnostic imaging; D006335:Heart Injuries / Q000473:pathology; D006439:Hemodynamics; D006978:Hypertension, Renovascular / Q000628:therapy*; D007249:Inflammation; D028421:Isoprostanes / Q000097:blood; D007668:Kidney / Q000166:cytology / Q000502:physiology*; D045164:Mesenchymal Stem Cell Transplantation; D059630:Mesenchymal Stem Cells / Q000166:cytology* / Q000378:metabolism; D055806:Microvessels / Q000502:physiology; D009206:Myocardium / Q000378:metabolism; D018384:Oxidative Stress; D013552:Swine; D014057:Tomography, X-Ray Computed
chemical_list: D016207:Cytokines; D028421:Isoprostanes; D003094:Collagen