European Society of Cardiology Congress DONOR AGE NEGATIVELY INFLUENCES THE CYTOPROTECTIVE PARACRINE EFFECTS EXERTED BY HUMAN MESENCHYMAL STEM CELLS

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1 European Society of Cardiology Congress 28 Aug - 01 Sep 2009, Stockholm - Sweden DONOR AGE NEGATIVELY INFLUENCES THE CYTOPROTECTIVE PARACRINE EFFECTS EXERTED BY HUMAN MESENCHYMAL STEM CELLS Massimiliano Gnecchi, MD, PhD The authors have no financial disclosures to declare Fondazione IRCCS Policlinico San Matteo University of Pavia, Italy

2 Gnecchi M et al. in Heart Development and Regeneration Edited by Rosenthal and Harvey Elsevier 2010

3 Background (Trans)-differentiation or cell fusion (Trans)-differentiation Cardiomyocyte VSMC Endothelial cell Myocyte regeneration Vasculogenesis PARACRINE MECHANISMS

4 Background PARACRINE FACTORS Myocardial protection Cardiac metabolism Cardiomyocytes Endothelial cells Smooth muscle Fibroblasts Cardiac stem cells Cardiac regeneration Neovascularization Cardiomyocyte contractility Cardiac remodeling Gnecchi M et al. in Paracrine Mechanism in Adult Stem Cell Signaling and Therapy Circ. Res. 2008;103:

5 Background PARACRINE FACTORS Myocardial protection Cardiac metabolism Cardiomyocytes Endothelial cells Smooth muscle Fibroblasts Cardiac stem cells Cardiac regeneration Neovascularization Cardiomyocyte contractility Cardiac remodeling Gnecchi M et al. in Paracrine Mechanism in Adult Stem Cell Signaling and Therapy Circ. Res. 2008;103:

6 Background It is unknown if donor age influences the production of soluble paracrine factors in adult bone-marrow derived mesenchymal stem cells (MSC) Since cardiovascular diseases occur more often in elderly patients, it would be of pivotal importance to determine if MSC-mediated paracrine mechanisms are preserved in those subjects In particular, it would be relevant to establish MSC isolated from elderly patients mediate myocardial protection

7 Goals 1. To compare the cytoprotective effects exerted by fetal MSC (F-MSC) vs adult MSC from young (< 65 ymsc) and elderly ( 65 omsc) patients 2. To identify pathways involved in MSC-mediated cardiac protection

8 Fetal MSC FISH analysis for the Y chromosome AMSC p1-5x Fetal MSC p1

9 FACS analysis CD Fetal MSC CD105 CD73 CD90 CD Adult MSC CD HLA-ABC CD45 CD34 HLA-ABC CD45 CD CD14 CD133 CD HLA-DR CD CD CD133 CD HLA-DR CD80

10 MSC F-MSC Differentiation potential Gene expression PPAR 2 PPAR 2 F-MSC Osteopontin Cathepsin K BSP GAPDH ADFP GAPDH MSC Osteopontin Cathepsin K BSP GAPDH ADFP GAPDH Ostecytes Adipocytes Ostecytes Adipocytes Alkaline Phosphatase Cytochemistry Von Kossa Oil Red-O

11 In vitro experiments F-MSC or ymsc or omsc H9c2 Conditioned medium (CM): F-MSC, ymsc and omsc grown in serum free medium (36 hrs) Rat neonatal cardiomyocytes (H9c2 cells) were exposed to 6 hrs of hypoxia followed by 18 hrs of reoxygenation in the presence of CM or CTRL-M

12 % Cell viability Cell viability MTS assay * * p<0.001 vs CTRL-M and omsc p<0.01 vs CTRL-M and omsc CTRL-M F-MSC CM ymsc CM omsc CM 6 hrs hypoxia + 18 hrs reoxygenation

13 % TUNEL + nuclei TUNEL staining *p<0.001 vs CTRL-M and omsc p<0.01 vs CTRL-M and omsc * CTRL-M F-MSC CM ymsc CM omsc CM HOECHST TUNEL + MERGED

14 Caspase-3 activation (relative units) Cleaved Caspase * p<0.001 vs normoxia p<0.01 vs CTRL-M, ymsc and omsc p<0.01 vs omsc * * CTRL CTRL-M F-MSC CM ymsc CM omsc CM Cleaved Caspase-3 Actin Basal normoxia 6 hrs hypoxia + 18 hrs reoxygenation

15 Pathway activation RT-PCR Western Blot CTRL-M F-MSC omsc ymsc Bcl2 STAT3 GAPDH Bak1 TNF-α FasL Anti-apoptotic Pro-apoptotic p-erk p-akt p-jnk p-p38 CTRL-M F-MSC omsc ymsc Anti-apoptotic Pro-apoptotic

16 In vivo experiment Male Sprague-Dawley RATS T0 30 min 40 min 72 hours Coronary Ligation SHAM animals: ligature left loose and no injection Reperfusion Saline C-CM F-MSC C-CM 5 injections in the infarct border zone omsc C-CM CM Sacrifice and heart collection TUNEL staining and Western Blot experiments

17 TUNEL staining PBS F-MSC C-CM omsc C-CM - 62% * - 11% ns Western Blot PBS F-MSC omsc p-erk p-akt Anti-apoptotic p-jnk p-p38 Pro-apoptotic

18 Conclusions Human MSC can mediate cardiomyocyte protection through the release of soluble cytoprotective factors Donor age negatively influences the paracrine cytoprotective properties of adult MSC Autologous MSC therapy for ischemic heart diseases may be less effective in elderly patients The CM from fetal MSC exerts powerful cytoprotective effects against hypoxia/reoxygenation (namely ischemia/reperfusion) damage via inhibition of proapoptotic and activation of anti-apoptotic signaling pathways

19 Acknowledgements Collaborators Fondazione IRCCS San Matteo, Pavia Peter J. Schwartz Laura Calvillo Gianluca Viarengo Cesare Perotti Roberto Bassani Marianna Roccio Irene D Ambruoso Laboratory of Experimental Cardiology for Cell and Molecular Therapy Fondazione IRCCS San Matteo, Pavia Patrizia Danieli Elisabetta Cervio Chiara Ciuffreda Federica Pisano Giuseppe Malpasso Manuela Mura Contact: m.gnecchi@unipv.it

20 Relative expression (GAPDH) 1 F-MSC n=7 ybm-msc n=9 obm-msc n=5 Cytoprotective factors * p<0.05 vs F-MSC ** p<0.01 vs F-MSC p<0.05 vs F-MSC * ** * ** * EPO PDGF IGF-1 VEGF FGF2 TB4 Sfrp2 HGF BMP2 TGF