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
Gnecchi M et al. in Heart Development and Regeneration Edited by Rosenthal and Harvey Elsevier 2010
Background (Trans)-differentiation or cell fusion (Trans)-differentiation Cardiomyocyte VSMC Endothelial cell Myocyte regeneration Vasculogenesis PARACRINE MECHANISMS
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;103:1204-1219
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;103:1204-1219
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
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
Fetal MSC FISH analysis for the Y chromosome AMSC p1-5x Fetal MSC p1
FACS analysis CD90 0 50 0 50 100 0 100 200 0 50 100 0 100 200 100 0 50 100 0 100 200 0 25 50 Fetal MSC CD105 CD73 CD90 CD105 0 50 100 0 50 100 0 50 100 0 100 200 0 30 60 0 50 100 0 75 150 0 25 50 Adult MSC CD73 10 0 10 1 10 2 10 3 10 4 HLA-ABC 0 50 100 CD45 CD34 HLA-ABC CD45 CD34 10 0 10 1 10 2 10 3 10 4 CD14 CD133 CD31 10 0 10 1 10 2 10 3 0 100 200 0 100 200 HLA-DR 0 100 200 CD80 10 4 0 50 100 CD14 0 50 100 CD133 CD31 10 0 10 1 10 2 10 3 104 HLA-DR CD80
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
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
% Cell viability Cell viability MTS assay 100 80 * * p<0.001 vs CTRL-M and omsc p<0.01 vs CTRL-M and omsc 60 40 20 0 CTRL-M F-MSC CM ymsc CM omsc CM 6 hrs hypoxia + 18 hrs reoxygenation
% TUNEL + nuclei TUNEL staining 40 30 *p<0.001 vs CTRL-M and omsc p<0.01 vs CTRL-M and omsc 20 10 0 * CTRL-M F-MSC CM ymsc CM omsc CM HOECHST 33258 TUNEL + MERGED
Caspase-3 activation (relative units) Cleaved Caspase-3 3.5 3.0 * p<0.001 vs normoxia p<0.01 vs CTRL-M, ymsc and omsc p<0.01 vs omsc 2.5 2.0 1.5 * * 1.0 0.5 0 CTRL CTRL-M F-MSC CM ymsc CM omsc CM Cleaved Caspase-3 Actin Basal normoxia 6 hrs hypoxia + 18 hrs reoxygenation
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
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
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
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
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
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 0.8 0.6 0.4 * 0.2 0 ** * ** * EPO PDGF IGF-1 VEGF FGF2 TB4 Sfrp2 HGF BMP2 TGF