Cardiac allograft vasculopathy (CAV) limits survival after heart transplantation. CAV is caused by damage to the allograft endothelium, resulting in occlusive intimal lesions. Administration of ex vivo cultured early endothelial progenitor cells (eEPCs) enhances endothelial repair and inhibits intimal hyperplasia. However, engraftment rates of eEPCs remain low. We examined changes in eEPC adhesion molecule expression during ex vivo cultivation, and how these changes affect their ability to adhere. Compared to their parent cell population (freshly isolated peripheral blood mononuclear cells, PBMCs), eEPCs had decreased expression of integrins necessary to form firm adhesions with endothelial cells. Despite this eEPCs showed an enhanced ability to adhere under static conditions compared to PBMCs. However, under conditions of physiological flow, eEPC rolling adhesion was reduced compared to PBMCs. We hypothesize that low eEPC retention rates observed in vivo may be due to impaired eEPC rolling resulting from ex vivo culture.

Cardiac allograft vasculopathy (CAV) limits survival after heart transplantation. CAV is caused by damage to the allograft endothelium, resulting in occlusive intimal lesions. Administration of ex vivo cultured early endothelial progenitor cells (eEPCs) enhances endothelial repair and inhibits intimal hyperplasia. However, engraftment rates of eEPCs remain low. We examined changes in eEPC adhesion molecule expression during ex vivo cultivation, and how these changes affect their ability to adhere. Compared to their parent cell population (freshly isolated peripheral blood mononuclear cells, PBMCs), eEPCs had decreased expression of integrins necessary to form firm adhesions with endothelial cells. Despite this eEPCs showed an enhanced ability to adhere under static conditions compared to PBMCs. However, under conditions of physiological flow, eEPC rolling adhesion was reduced compared to PBMCs. We hypothesize that low eEPC retention rates observed in vivo may be due to impaired eEPC rolling resulting from ex vivo culture.

Endothelial Progenitor Cells (EPCs) were first identified from human blood samples as a population of circulating mononuclear cells capable of displaying a mature endothelial cell phenotype in culture. Subsequent studies have established that EPCs arise from the bone marrow (BM) and incorporate into the endothelium at sites of blood vessel growth, suggesting a potential role for these cells in neovascularization. Furthermore, a decline in EPC count has been correlated to multiple vascular pathologies, indicating that EPC number could serve as a biomarker of cardiovascular disease. Unfortunately, due to the variability in techniques used for EPC isolation and identification, considerable heterogeneity exists within the population of cells commonly defined as EPCs. In order for the clinical potential of EPCs to be fully realized, thorough characterization of the BM-derived cell populations involved in neovascularization is required. The objective of our study was to determine the functional significance of circulating EPCs in postnatal vascular growth and repair. Two separate strategies were employed to achieve this objective. In the first, we attempted to generate a novel mouse model where the pool of bone marrow-derived endothelial precursors was drastically reduced or eliminated. Our overall approach was to deliver a "suicide" gene, under control of an endothelial cell-specific promoter, to bone marrow cells for use in bone marrow transplantation (BMT) experiments. Mice receiving BMTs would therefore lack the ability to deliver viable BM-derived EPCs to sites of neovascularization. Our central hypothesis for this study was that a reduction in EPC viability would hinder endogenous vascular repair mechanisms, thereby exacerbating cardiovascular disease. In the second strategy, we attempted to identify novel progenitor cell populations based on the transcriptional regulation of pro-angiogenic genes. Our overall approach was to transduce BM with a retrovirus containing a fluorescent reporter gene under control of pro-angiogenic promoters for use in transplantation experiments. Our central hypothesis for this study was that unique populations of BM-derived cells could be identified by expression of the fluorescent reporter gene directed by the Vascular Endothelial Growth Factor (VEGF), endothelial Nitric Oxide Synthase (eNOS) and Vascular Endothelial (VE) Cadherin promoters. The BMT strategy utilized to address our first hypothesis was unsuccessful due to the use of a truncated form of the pro-apoptotic Bax as our suicide gene target. A plasmid encoding GFP fused to the truncated Bax fragment (ΔN-Bax, consisting of amino acids 112-192 of the full length protein) was used in transfection experiments to assess ΔN-Bax function. The GFP:ΔN-Bax fusion protein formed distinct extranuclear aggregates (presumably due to mitochondrial translocation) but did not induce apoptosis in transfected cells. The ΔN-Bax fragment also did not induce cell death when targeted to endothelial cells with retoviral-mediated gene delivery or in a transgenic mouse setting. To address our second hypothesis, we generated retroviral vectors containing the fluorescent tdTomato reporter under control of the VEGF, eNOS and VE Cadherin promoters. Significant fluorescence was detected in cultured endothelial cells and ex vivo-expanded BM cells. Following transplantation of transduced BM cells into lethally irradiated recipient mice, we were able to identify circulating populations of tdTomato-positive cells using flow cytometry. With these results we have identified novel subpopulations of circulating BM-derived cells which may play a significant role in post-natal neovascularization in mice. Therefore, results acquired from these studies could lead to improved cell therapy techniques for treatment of vascular disease.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第19620号 / 医博第4127号 / 新制||医||1015(附属図書館) / 32656 / 京都大学大学院医学研究科医学専攻 / (主査)教授 武藤 学, 教授 森田 智視, 教授 山下 潤 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Increasingly, cell-based therapy with autologous progenitor populations, such as endothelial progenitor cells (EPC), are being utilized for treatment of vascular diseases. However, both the number and functional capacity are diminished when cells are derived from patients with established risk factors for coronary artery disease (CAD). Herein, we report that inhibition of glycogen synthase kinase 3 (GSK) can improve both the number and function of endothelial progenitor cells in patients with CAD or diabetes mellitus (DM) leading to greater therapeutic benefit. Specifically, use of various small molecule inhibitors of GSK (GSKi) results in a 4-fold increased number of EPCs. Moreover, GSKi treatment improves the functional profile of EPCs through reductions in apoptosis, improvements in cell adhesion through up-regulation of very-late antigen-4 (VLA-4), and by increasing paracrine efficacy by increasing vascular endothelial growth factor (VEGF)secretion. Therapeutic improvement was confirmed in vivo by increased reendothelialization(RE) and reductions of neointima (NI) formation achieved when GSKi-treated cells were administered following vascular injury to CD-1 nude mice. Because cell-based therapy is technically challenging, we also tested a strategy of local delivery of GSKi at the site of arterial injury through GSKi-eluting stents. In vitro, GSKi elution increased EPC attachment to stent struts. In vivo, GSKi-eluting stents deployed in rabbit carotid arteries resulted in systemic mobilization of EPCs, improved local RE, and important reductions in in-stent NI formation. Finally, we tested the ability of GSKi to improve EPC-mediated arterial repair in patients with DM. As in patients with CAD, GSKi treatment improved EPC yield and diminished in vitro apoptosis. Utilizing a proteomics approach, we identified Cathepsin B (catB) as a differentially regulated protein necessary for reductions in apoptosis. Indeed, antagonism of catB prevented GSKi improvements in GSKi treated EPC mediated arterial repair in a xenotransplant wire injury model. Thus, our data demonstrates that GSKi treatment results in improvements in EPC number and function in vitro and in vivo resulting in enhanced arterial repair following mechanical injury. Accordingly, GSK antagonism is an effective cell enhancement strategy for autologous cell-based therapy with EPCs from high risk patients such as CAD or DM.

Increasingly, cell-based therapy with autologous progenitor populations, such as endothelial progenitor cells (EPC), are being utilized for treatment of vascular diseases. However, both the number and functional capacity are diminished when cells are derived from patients with established risk factors for coronary artery disease (CAD). Herein, we report that inhibition of glycogen synthase kinase 3 (GSK) can improve both the number and function of endothelial progenitor cells in patients with CAD or diabetes mellitus (DM) leading to greater therapeutic benefit. Specifically, use of various small molecule inhibitors of GSK (GSKi) results in a 4-fold increased number of EPCs. Moreover, GSKi treatment improves the functional profile of EPCs through reductions in apoptosis, improvements in cell adhesion through up-regulation of very-late antigen-4 (VLA-4), and by increasing paracrine efficacy by increasing vascular endothelial growth factor (VEGF)secretion. Therapeutic improvement was confirmed in vivo by increased reendothelialization(RE) and reductions of neointima (NI) formation achieved when GSKi-treated cells were administered following vascular injury to CD-1 nude mice. Because cell-based therapy is technically challenging, we also tested a strategy of local delivery of GSKi at the site of arterial injury through GSKi-eluting stents. In vitro, GSKi elution increased EPC attachment to stent struts. In vivo, GSKi-eluting stents deployed in rabbit carotid arteries resulted in systemic mobilization of EPCs, improved local RE, and important reductions in in-stent NI formation. Finally, we tested the ability of GSKi to improve EPC-mediated arterial repair in patients with DM. As in patients with CAD, GSKi treatment improved EPC yield and diminished in vitro apoptosis. Utilizing a proteomics approach, we identified Cathepsin B (catB) as a differentially regulated protein necessary for reductions in apoptosis. Indeed, antagonism of catB prevented GSKi improvements in GSKi treated EPC mediated arterial repair in a xenotransplant wire injury model. Thus, our data demonstrates that GSKi treatment results in improvements in EPC number and function in vitro and in vivo resulting in enhanced arterial repair following mechanical injury. Accordingly, GSK antagonism is an effective cell enhancement strategy for autologous cell-based therapy with EPCs from high risk patients such as CAD or DM.

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Stem cell therapy may present an effective treatment for metastatic brain cancer and glioblastoma. Here we posit the critical role of a leaky blood-brain barrier (BBB) as a key element for the development of brain metastases, specifically melanoma. By reviewing the immunological and inflammatory responses associated with BBB damage secondary to tumoral activity, we identify the involvement of this pathological process in the growth and formation of metastatic brain cancers. Likewise, we evaluate the hypothesis of regenerating impaired endothelial cells of the BBB and alleviating the damaged neurovascular unit to attenuate brain metastasis, using the endothelial progenitor cell (EPC) phenotype of bone marrow-derived mesenchymal stem cells. Specifically, there is a need to evaluate the efficacy for stem cell therapy to repair disruptions in the BBB and reduce inflammation in the brain, thereby causing attenuation of metastatic brain cancers. To establish the viability of stem cell therapy for the prevention and treatment of metastatic brain tumors, it is crucial to demonstrate BBB repair through augmentation of vasculogenesis and angiogenesis. BBB disruption is strongly linked to metastatic melanoma, worsens neuroinflammation during metastasis, and negatively influences the prognosis of metastatic brain cancer. Using stem cell therapy to interrupt inflammation secondary to this leaky BBB represents a paradigm-shifting approach for brain cancer treatment. In this review article, we critically assess the advantages and disadvantages of using stem cell therapy for brain metastases and glioblastoma. / National Institutes of Health / Revisión por pares

L’angioplastie coronaire est la première forme de revascularisation coronaire. Elle présente cependant 2 limites qui restreignent encore son utilisation : la thrombose et la resténose de stent. La thrombose de stent est un événement précoce associé à une mortalité élevée. Les plaquettes y jouent un rôle déterminant. Le développement de tests fonctionnels plaquettaires permettant d’analyser le niveau de réactivité plaquettaire sous traitement a permis de mettre en évidence les limites de celui-ci sur le plan biologique. Nous avons démontré l’impact clinique de l’utilisation de ces tests dans la prédiction et la réduction du risque de thrombose de stent chez des patients traités par angioplastie coronaire. La resténose est quant à elle une complication tardive de l’angioplastie coronaire avec implantation d’un stent non-actif. Sa physiopathologie repose sur des mécanismes de lésion et de régénération endothéliale. Des marqueurs endothéliaux circulants ont récemment été développés. Nous avons montré qu’ils pouvaient permettre d’évaluer la lésion et la régénération endothéliale induite par une angioplastie coronaire. Les cellules endothéliales circulantes s’élèvent transitoirement après l’angioplastie et ce de façon variable en fonction de la réactivité plaquettaire sous traitement démontrant les interactions étroites entre ces différents acteurs. Dans le même temps, on observe une mobilisation de progéniteurs d’origine médullaire suite à l’angioplastie. Nos travaux suggèrent un rôle clé de la régénération endothéliale dans la cicatrisation vasculaire après angioplastie. En effet, il apparait que la proportion de progéniteurs de profil de différenciation endothélial en réponse à l’angioplastie coronaire détermine la survenue d’une resténose intra-stent. Ces données ouvrent la voie à une meilleure compréhension des mécanismes physiopathologie menant à la resténose mais aussi à des perspectives thérapeutiques intéressantes. / Percutaneous coronary intervention is the most commonly used revascularization technique. However it has 2 main complications limiting its widespread: stent thrombosis and in stent restenosis. Stent thrombosis is an early event associated with a high mortality rate. Platelets are key in its physiopathology. The availability of platelet function tests allowing to determine platelet reactivity levels under therapy showed a variable ant platelet effect following aspirin and clopidogrel intake. We further demonstrated that tailoring anti platelet therapy according to platelet function tests results decrease the rate of stent thrombosis following PCI without increasing bleedings. In stent-restenosis is a late complication of PCI with bare metal stents. The pathophysiology of in-stent restenosis is dependent on the lesion and regeneration of the endothelium. Circulating endothelial biomarkers have recently been developed. We have demonstrated that this marker allow to evaluate the lesion and regeneration of the endothelium following PCI. We evidenced a transient increase in circulating endothelial cells following PCI which is dependent on the level of platelet reactivity inhibition demonstrating the interaction between platelets and the endothelium. At the same time, PCI induces mobilization of progenitor cells which is detectable early after the intervention. Our work suggests that these progenitor cells have a key role in endothelial regeneration after PCI. We evidenced for the first time that the proportion of endothelial progenitor cells among progenitor cells mobilized after PCI determine the occurrence of in stent restenosis. Altogether these data give critical inside into vascular regeneration after PCI in human and on the mechanisms associated with in stent restenosis thus providing new potential therapeutic target.