title: An autologous platelet-rich plasma hydrogel compound restores left ventricular structure, function and ameliorates adverse remodeling in a minimally invasive large animal myocardial restoration model: a translational approach: Vu and Pal "Myocardial Repair: PRP, Hydrogel and Supplements".
abstract: OBJECTIVE
  Cell-based myocardial restoration has not penetrated broad clinical practice yet due to poor cell retention and survival rates. In this study, we attempt a translational, large-scale restorative but minimally invasive approach in the pig, aiming at both structurally stabilizing the left ventricular (LV) wall and enhancing function following ischemic injury.
  
  
  RESULTS
  A myocardial infarction (MI) was created by permanent ligation of left circumflex coronary artery through a small lateral thoracotomy. Thirty-six Yorkshire pigs were randomized to receive transthoracic intramyocardial injection into both infarct and border zone areas with different compounds: 1) Hyaluronic acid-based hydrogel; 2) autologous platelet-rich plasma (PRP); 3) ascorbic acid-enriched hydrogel (50 mg/L), combined with IV ibuprofen (25 mg/kg) and allopurinol (25 mg/kg) (cocktail group); 4) PRP and cocktail (full-compound); or 5) saline (control). The latter two groups received daily oral ibuprofen (25 mg/kg) for 7 days and allopurinol (25 mg/kg) for 30 days, postoperatively. Hemodynamic and echocardiographic studies were carried out at baseline, immediately after infarction and at end-point. Eight weeks after MI, the full-compound group had better LV fractional area change, ejection fraction and smaller LV dimensions than the control group. Also, dp/dtmax was significantly higher in the full-compound group when the heart rate increased from 100 bpm to 160bpm in stress tests. Blood vessel density was higher in the full-compound group, compared to the other treatment groups.
  
  
  CONCLUSIONS
  A combination of PRP, anti-oxidant and anti-inflammatory factors with intramyocardial injection of hydrogel has the potential to structurally and functionally improve the injured heart muscle while attenuating adverse cardiac remodeling after acute myocardial infarction.
authors: Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors: Thang Duc
authors: TD
authors: Vu
authors: Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors: Shripad N
authors: SN
authors: Pal
authors: Department of Anesthesia, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors: Lian-Kah
authors: LK
authors: Ti
authors: Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Cardiovascular Research Institute, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors: Eliana C
authors: EC
authors: Martinez
authors: Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors: Abdul Jalil
authors: AJ
authors: Rufaihah
authors: Cardiovascular Research Institute, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors: Lieng H
authors: LH
authors: Ling
authors: Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiac, Thoracic and Vascular Surgery, National University Health System, Singapore.
authors: Chuen-Neng
authors: CN
authors: Lee
authors: Cardiovascular Research Institute, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors: Arthur Mark
authors: AM
authors: Richards
authors: Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiac, Thoracic and Vascular Surgery, National University Health System, Singapore. Electronic address: surtk@nus.edu.sg.
authors: Theo
authors: T
authors: Kofidis
mesh_terms: D000818:Animals; D002921:Cicatrix / Q000473:pathology; D003094:Collagen / Q000378:metabolism; D003971:Diastole / Q000187:drug effects; D005260:Female; D006352:Heart Ventricles / Q000187:drug effects / Q000473:pathology* / Q000503:physiopathology; D020136:Hydrogel, Polyethylene Glycol Dimethacrylate / Q000494:pharmacology*; D007267:Injections; D009200:Myocardial Contraction / Q000187:drug effects; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D009206:Myocardium / Q000473:pathology; D018919:Neovascularization, Physiologic / Q000187:drug effects; D053657:Platelet-Rich Plasma / Q000378:metabolism*; D034421:Sus scrofa; D057170:Translational Research, Biomedical; D014182:Transplantation, Autologous; D014463:Ultrasonography; D016277:Ventricular Function, Left / Q000187:drug effects*; D020257:Ventricular Remodeling / Q000187:drug effects*
chemical_list: D020136:Hydrogel, Polyethylene Glycol Dimethacrylate; D003094:Collagen
keywords: Antioxidants; Heart failure; Hyaluronic acid-based hydrogels; Left ventricular restoration; Myocardial infarction; Platelet-rich plasma