MicroRNA as a Biological Drug and Recovery of Myocardial Infarction. Exosome

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1 MicroRNA as a Biological Drug and Recovery of Myocardial Infarction Exosome Jianyi (Jay) Zhang, MD, PhD Professor of Medicine, of Engineering University of Alabama - Birmingham UAB 1

2 Rebuilding the Failing Heart with Cell Therapy Road Blocks to Overcome 1. Low engraftment rate 2. Increased arrhythmic potential 3. Potential Mechanisms of Actions 2

3 Roadblock 1: Low engraftment rate Strategies: hipsc - HLA I/II KO to generate Universal Cell Lines In collaboration with Townes lab at UAB Local Delivery : Myocardial Tissue Equivalent Patch using hipsc- tri lineage Cardiac Cells 3

4 Roadblocks 2: Arrhythmias: Microenvironment of graft and recipient heart Strategies: Deciphering the mechanisms of arrhythmias Ectopic center or reentry? Ca2+ and Action potential propagation passing the interface: Optical mapping and micro impedance hipsc Gap Junction Protein Over Expression:Cx43 4

5 Roadblock 3 Unknown Potential Mechanisms of Actions Strategy 3: Local Delivery : Myocardial Tissue Equivalent Patch using hipsc- tri lineage Cardiac Cells The potential mechanisms of actions from the perspective of the regulations in myocardial perfusion, metabolism and function in the in vivo heart 5

9 hipsc-cm TE graft 4 weeks after transplantation (A) (C) Interface Patch Host (D) Interface (F) Interface Patch HNA DAPI Patch ctnt Ki67 PCs DAPI Wendel J et al 2015 SCTM

10 Significant Angiogenesis Support the CM Grafts (week 4) (A) (B) Patch Patch IB4 DAPI (C) Interface H &E Wendel J et al

11 Fabrication human cardiac muscle patch CM cluster Fabrication of hipsc-cm Patch Zhang L Circ 2014

12 hipsc Derived tri- Lineage Cardiovascular Cells for Postinfarction LV Remodeling Fabrication of Larger and Thicker Human Myocardial Tissue Equivalent UAB

million hipsc-smcs. After 7 days in culure, the hcmp beats regularly at rate of 100 beat/min.

13 Fabrication of Larger and Ticker Myocardial Tissue Equivalent (MTE) Figure 2. Left, Fibrin hcmp patch (2 cm x 4 cm) containing 10 million hipsc-cms, 5 million hipsc-ecs, and 5 million hipsc-smcs. After 7 days in culure, the hcmp beats regularly at rate of 100 beat/min. Right, Two rectangle fibrin hcmp were sutured on the surface of a pig heart that exposed to 60 minutes of no flow ischemia reperfusion

14 Electrical pacing of human cardiac MTE patch

15 Optical mapping of V m in cardiac patch Conduction velocity = 15.1 cm/s APD 50 = 306 ms APD 80 = 353 ms

16 APD (ms) CV (cm/s) Rate dependence of APD and conduction velocity APD50 APD CL (ms) CL (ms)

17 RH237 GCaMP6 Activation Time (ms) Dual mapping of ventricle and implanted patch. A 10 ms 20 ms 30 ms 5 mm 40 ms 50 ms 60 ms B C Ventricle CV = 60.5 cm/s 5 mm Patch CV = 29.2 cm/s

18 CM Maturation in vivo hctnt DAPI Merged Day 1 hctnt DAPI Merged Day 28

19 Completely Noninvasive Cardiac MR Spectroscopy at 7T/65CM Magnet

20 Patching the Heart: Myocardial Repair from Within or Outside Working hypothesis MSCs hesc/ips -VCs hipsc- VCs + CMs Infarct size reduction DE MRI TUNEL ctnt BrdU CPC Perfusion and Chamber function Perfusion Cine CD31 SMA Metabolism UAB

21 Acknowledgements: Zhang lab Collaborators : Tranquillo, Garry, UMN Kamp, Ge, UW-Madison Townes, Rogers, Fast, Walcott; UAB Bursac, Duke NIH Grants : NIH RO1s HL67828, HL 95077, HL114120, UO1 HL

22 Acknowledgements: Zhang lab Ø Cardiac Repair using Stem Cells Ø Myocardial energetics 31 P MR spectroscopy Collaborators : Tranquillo, Garry, UMN Kamp, Ge, UW-Madison Townes, Rogers, Fast; UAB NIH Grants : NIH RO1s HL67828, HL 95077, HL114120, 22 UO1 HL100407

23 A Non-human Primates Study Hypoxia Preconditioning Cardiac Function Evaluation N-MSCs NHP Model (N=49) Intramyocardial Injection HP-MSCs Cell Tracing Cell Survival PET IH CD4 CD8 Cardiac Metabolism Electromechanical Stability (PES) Telemetry Immune Modulation Molecular Mechanism Arrhythmia detection Circres JAN 2016

24 Potential Mechanisms of Actions Strategy 3: Local Delivery : Myocardial Tissue Equivalent Patch using hipsc- tri lineage Cardiac Cells 24

25 Arteriole density (mm -2 ) Resistance vessel density (week-4) CD31 SMA ctnt MI Patch p<0.05 p<0.05 MI Patch Cell P+Cell

26 BZ myocardial energetics In vivo 31 P MR spectroscopy * * # Unidirectional ATP utilization rate: ATP ADP + Pi * * # Xiong Q et al Circulation. 2013

27 BZ myocardial Wall stress, Flux ATP Pi contractile function Normal MI CELL -BZ -BZ -BZ -BZ Laplace law: wall stress (P) LVSP radius 2 thickness

28 Over stretched myocytes in failing hearts Murakami Y et al Circ 1999

29 31 P spectra were acquired with a 3D ultra-short TE chemical shift imaging (UTE-CSI) sequence in a normal adult mongrel dog acquired on a Magnetom 7T scanner 29

Peak Force Generated (mn) Force (mn) Fabrication of a Myocardial Tissue

gel 7 days 7 days F-actin ctni DAPI 3.5 Twitch Force Generation 9.5 9 8.

5 6 CX43 ctnt DAPI 1.5 1 0.5 0 1 2 3 4 Stimulation Frequency (Hz) 5.

6 6.4 6.2 6 3 H z 5.5 0 1000 2000 3000 4000 5000 6000 9 8.8 8.6 8.4 8.

30 Peak Force Generated (mn) Force (mn) Fabrication of a Myocardial Tissue Equivalent Disaggregated neonatal rat cardiac cells seeded into fibrin gel 7 days 7 days F-actin ctni DAPI 3.5 Twitch Force Generation H z H z CX43 ctnt DAPI Stimulation Frequency (Hz) H z H z Time (ms)

31 Myocardial Tissue Equivalent Patch Study Groups: 1) Sham, (n=5) 2) MI, (n=6) : Ligation Only 3) TE CM-, (n=5): MI+ tissue equivalent constructed without CMs 4) TE CM+, (n=7): MI + tissue equivalent containing CMs Week 1 and 4 follow up with ECHO Wendel J TE 2014

32 Percent of LV anterior wall Engraftment of Tissue Equivalent to the Host Myocardium noncm Host Infarct Size ctnt F-actin DAPI Host Myocardium Patch noncm 20um Sham * 20 0 CM patch * noncm patch MI only CM Host Interface Graft F-actin Host Myocardium Patch CM 100um (D) 50um

33 Center for Magnet Resonance Research 9.4T-65cm magnet 7T-90cm magnet Aa b c d e f

34 [ADP] K x [(PCr) /(ATP)] -1 k [PCr] [ADP] [ATP] [Cr]

Proteins downregulated in MI Proteins up-regulated in MI Normal MI MI+iPSC -VC

35 Proteins downregulated in MI Proteins up-regulated in MI Normal MI MI+iPSC -VC Myocardial Differential Protein Expression Profile Changes in response to Cell Patch Therapy AA C Regulation of metabolic process B Cytoskeleton organization Regulation of cell morphogenesis Fig. 6. Number of proteins identified from heart tissue Electron transport chain homogenate using gene ontology annotation ATP Synthesis coupled for cell electron transport compartment analysis.

36 Recipient myocardial protein expression profile changes

37 Identify the grafted hipsc-cms (week-4) GFP DAPI ctnt DAPI Merged Phase contrast

38 Cell transplantation reduced apoptosis (day-3) TUNEL + ctni ctni DAPI Merged MI Patch only P + Cell

39 c-kit + CV PC density (cm -2 ) Cell transplantation activated c-kit + CV progenitor cell (week-4) c-kit DAPI * MI c-kit ctnt DAPI Patch Cell MI Patch Cell 0 MI Patch Cell

40 Summary The preliminary results suggest the capacity of a fibrinbased cardiac tissue equivalent to engraft 4 weeks after transplantation, which is accompanied by a reduction of infarct size, and improvement of LV chamber function. The mechanisms of the reduced infarct size are not clear, but are likely related to the cytokine related protective effect. The optimized synergetic effects of the cytokine signaling pathways are depend upon communications between myocytes and non-cm cardiac cells.

41 Identify the grafted hipsc-smcs (week-4) GFP DAPI SMA DAPI GFP SMA ctni DAPI Bright field

42 Identify the grafted hipsc-ecs (week-4) hcd31 DAPI GFP ctnt DAPI hcd31 ctni DAPI Bright field 42

43 Angiogeic profile of EC and SMC conditioned medium EC SMC CM Growth factor, cytokine Angiogenin Angiopoietin Angiopoietin IL PDGF-BB VEGF Chemokine TGF-beta Growth regulated protein IL MCP RANTES MCP Inhibitor of metalloproteinases TIMP TIMP Angiogeic inhibitor Angiostatin Endostatin Protease MMP Plasminogen activator u PAR Angiogeic receptor VEGF R VEGF R

44 Aims To develop an efficient hipsc-cm selection protocol To examine the efficiency of a patch and microspheres based enhanced delivery of hipsc - 3 lineage cardiovascular cells for myocardial repair using an immuno-suppressed porcine model of postinfarction LV remodeling: - engraftment rate, - vascular density and myocardial perfusion, - myocardial protection and apoptosis - tracking the endogenous CV PCs with BrdU Using novel NMR technology to examine the myocardial bioenergetics and ATP turnover rate in the in vivo hearts with or without cell transplantation The electrophysiology stability was examined by loop recorder and recipient myocardial differential protein expression profile by proteomics

45 3D Porous PEGylated Fibrin patch for enhanced delivery of hipsc 3-lineage cardiac cells PEG GM Zhang, G Tissue Engineering 2007

46 Gelatin microsphere for IGF delivery

47 Percentage Percentage Cell engraftment rate (week-4) 15% 50% 10% 8.97±1.8% 40% 30% 26.76% 33.44% 39.80% 5% 20% 10% 0% Total cell engraftment rate 0% hipsc-cms hipsc-ecs hipsc-smcs Quantitative PCR (qpcr) for human Y chromosome Dual immunostaining

9/23/2017. Prof. Steven S. Saliterman. Department of Biomedical Engineering, University of Minnesota

9/23/2017. Prof. Steven S. Saliterman. Department of Biomedical Engineering, University of Minnesota Department of Biomedical Engineering, University of Minnesota http://saliterman.umn.edu/ Murphy, S. V., and A. Atala. "3d Bioprinting of Tissues and Organs." Nature Biotechnology 32, no. 8 (Aug 2014):