Improvement of cardiac function in the failing rat heart after transfer of skeletal myoblasts engineered to overexpress placental growth factor Matthias.

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Improvement of cardiac function in the failing rat heart after transfer of skeletal myoblasts engineered to overexpress placental growth factor Matthias Gmeiner, MD, Daniel Zimpfer, MD, Johannes Holfeld, MD, Gernot Seebacher, MD, Dietmar Abraham, PhD, Michael Grimm, MD, Seyedhossein Aharinejad, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 141, Issue 5, Pages 1238-1245 (May 2011) DOI: 10.1016/j.jtcvs.2010.10.054 Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Left ventricular function. Only group treated with myoblasts transfected with placental growth factor (MB-PlGF) showed improved fractional shortening (FS) significantly with time, whereas in group treated with unmodified myoblasts (MB) and control group, fractional shortening values on days 52 and 86 were not significantly different from values on day 21. In all infarct groups, fractional shortening was lower than in sham groups. Fractional shortening on day 86 in group with transfected myoblasts was higher than fractional shortening on day 86 in group with unmodified myoblasts (P < .05) and control group (P < .01). Asterisk indicates significant difference from sham group (P < .05). Dagger indicates significant differences on days 21 and 52 versus day 86 (P < .05). The Journal of Thoracic and Cardiovascular Surgery 2011 141, 1238-1245DOI: (10.1016/j.jtcvs.2010.10.054) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Cardiac remodeling in infarcted hearts. Representative histologic images (A) and quantitative morphometric analysis (B and C). B, Mean proportion of fibrotic tissue to normal left ventricular (LV) myocardium is decreased in unmodified myoblast group (MB) and in placental growth factor–transfected myoblast group (MB-PlGF) relative to control group. Asterisk indicates significant difference from control group (P < .05). C, Left ventricular infarct wall thickness is increased in transfected myoblast group relative to unmodified myoblast and control groups. Asterisk indicates significant difference from sham group. Dagger indicates significant differences from unmodified myoblast and control groups (P < .05). The Journal of Thoracic and Cardiovascular Surgery 2011 141, 1238-1245DOI: (10.1016/j.jtcvs.2010.10.054) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Fluorescent autologous myoblasts. A, Localization of myoblasts labeled with 1,1′-dioctadecyl-3,3,3′,3′-tetramethylindocarbocyanine perchlorate, both unmodified (MB) and overexpressing placental growth factor (MB-PlGF) 86 days after myocardial infarction. B, Representative white-light images (left), fluorescent 1,1′-dioctadecyl-3,3,3′,3′-tetramethylindocarbocyanine perchlorate (DiIC18) signals (center), and merged images (right) showing cellular localization (red) in infarcted area of heart (asterisk). LV, Left ventricle; RV, right ventricle. Atria are removed. B, Representative red-channel fluorescence images of 1,1′-dioctadecyl-3,3,3′,3′-tetramethylindocarbocyanine perchlorate signal merged with corresponding section counterstained with 4,6-diamidino-2-phenylindole in border zone of unmodified (MB) and transfected (MB-PlGF) myoblast groups. Bar represents 50 μm. HE, Hematoxylin–eosin. C, Analyses revealed significantly more grafted fluorescent myoblasts labeled with 1,1′-dioctadecyl-3,3,3′,3′-tetramethylindocarbocyanine perchlorate (DiI) in transfected myoblast group (MB-PlGF) relative to unmodified myoblast (MB) group in tissue lysates. Asterisk indicates significant difference from unmodified myoblast group (P < .05). The Journal of Thoracic and Cardiovascular Surgery 2011 141, 1238-1245DOI: (10.1016/j.jtcvs.2010.10.054) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Analysis of angiogenesis. Representative sections stained for von Willebrand factor (vWF) in (A) unmodified myoblasts (MB) and (B) placental growth factor–transfected myoblasts (MB-PlGF). Representative sections stained for α-smooth muscle actin (α SMA) in unmodified myoblast (C, E) and transfected myoblast (D, F) groups. Quantification of von Willebrand factor–positive (vWF+, G) or α-smooth muscle actin–positive (α SMA+, H) vessels 86 days after infarction (count per high-power field, HPF) showing increased vessel density in transfected myoblast group. Asterisk indicates significant difference from control and unmodified myoblast groups (G, H, P < .01). Bar represents 50 μm (A, B, E, F) or 100 μm (C, D). I, Changes in placental growth factor (PlGF) messenger RNA (mRNA) levels after transfection of myoblasts with placental growth factor plasmids in vitro relative to controls. Asterisk indicates significant difference from control (P < .001). Quantification of messenger RNA (mRNA) levels of vascular endothelial growth factor A (VEGF-A, J), placental growth factor (PlGF, K), fms-like tyrosine kinase (Flt-1, L), and kinase insert domain receptor (KDR, M), and protein levels of vascular endothelial growth factor A (VEGF-A, N) and placental growth factor (PlGF, O) 86 days after myocardial infarction. Asterisk indicates significant difference from sham, control, and unmodified myoblast groups in J (P < .05). Asterisk indicates significant difference from sham group and dagger indicates significant difference from control and unmodified myoblast groups in L (P < .05). Asterisk indicates significant difference from sham, control, and unmodified myoblast groups in M (P < .05). Asterisk indicates significant difference from sham group in O (P < .05). LC, Loading control; SP, specific protein. The Journal of Thoracic and Cardiovascular Surgery 2011 141, 1238-1245DOI: (10.1016/j.jtcvs.2010.10.054) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Matrix metalloproteinase (MMP) and tissue inhibitor of matrix metalloproteinase (TIMP) protein expressions in sham, control, unmodified myoblast (MB), and transfected myoblast groups (MB-PlGF). Asterisk indicates significant difference from sham group (P < .05 for control and unmodified myoblast groups, P < .001 for transfected myoblast group) and dagger indicates significant difference from control and unmodified myoblast groups (P < .001 for control and P < .05 for unmodified myoblasts) in A. Asterisk indicates significant difference from sham, control, and unmodified myoblast groups (P < .0001) in B. Asterisk indicates significant difference from sham group (P < .01 for control and unmodified myoblast groups, P < .05 for transfected myoblast group) and dagger indicates significant difference from control and unmodified myoblast groups (P < .05) in C. Asterisk indicates significant difference from sham group (P < .01 for control group, P < .001 for unmodified myoblast group, and P < .05 for transfected myoblast group) and dagger indicates significant difference from control and unmodified myoblast groups (P < .05) in D. Asterisk indicates significant difference from sham and control groups (P < .05 for unmodified myoblast group vs sham and control groups, P < .001 for transfected myoblast group vs sham and control groups) in E. Asterisk indicates significant difference from control group (P < .001) in F. LC, Loading control; SP, specific protein. The Journal of Thoracic and Cardiovascular Surgery 2011 141, 1238-1245DOI: (10.1016/j.jtcvs.2010.10.054) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions