Current therapies for the treatment of myocardial infarction and heart failure include medical, surgical, mechanical assist, and transplantation. These therapies have been based on the dogma that ventricular myocytes themselves are terminally differentiated and, therefore, cannot regenerate. This concept has been recently challenged with stem cell therapy. A potential problem is the ability of cardiac tissue to mobilize, recruit, and transdifferentiate adult stem cells from other tissues. We believe that there is a unique failure of the damaged myocardium to provide the appropriate molecular signals for stem cells engraftment related to age. Our hypothesis is that the overexpression of IL-10 in the aged population reduces cardiac cellular proliferation subsequent to myocardial injury. This hypothesis is supported by aging models, where elevated levels of IL-10 are associated with reduced healing response to noncardiac tissue injury. We demonstrated an increased cardiac gene expression of IL-10 that may be associated with a reduced proliferative response in the border regions of the infarcted myocardium that are proportional with age. In conclusion, myocardial infarction and heart failure has presented a significant challenge for the clinician to provide reparative therapies. The use of therapeutics to modulate IL-10 and, thereby, optimizing regenerative processes in the injured myocardium may provide a unique means for the cardiac patient.

Myocardium lacks the ability to regenerate following injury. This is in contrast to skeletal muscle (SKM), in which capacity for tissue repair is attributed to the presence of satellite cells. It was hypothesized that SKM satellite cells multiplied in vitro could be used to repair injured heart muscle. Fourteen dogs underwent explantation of the anterior tibialis muscle. Satellite cells were multiplied in vitro and their nuclei were labelled with tritiated thymidine 24 h prior to implantation. The same dogs were then subjected successfully to a myocardial injury by the application of a cryoprobe. The cells were suspended in serum-free growth medium and autotransplanted within the damaged muscle. Medium without cells was injected into an adjacent site to serve as a control. Endpoints comprised histology using standard stains as well as Masson trichrome (specific for connective tissue), and radioautography. In five dogs, satellite cell isolation, culture, and implantation were technically satisfactory. In three implanted dogs, specimens were taken within 6-8 wk. There were persistence of the implantation channels in the experimental sites when compared to the controls. Macroscopically, muscle tissue completely surrounded by scar tissue could be seen. Masson trichrome staining showed homogeneous scar in the control site, but not in the test site where a patch of muscle fibres containing intercalated discs (characteristic of myocardial tissue) was observed. In two other dogs, specimens were taken at 14 wk postimplantation. Muscle tissue could not be found. These preliminary results could be consistent with the hypothesis that SKM satellite cells can form neo-myocardium within an appropriate environment. Our specimens failed to demonstrate the presence of myocyte nuclei. It is therefore further hypothesized that in the late postoperative period, the muscle regenerate failed to survive.

Acute myocardial infarction (AMI) triggers the mobilization of stem/progenitor cells from bone marrow (BMSPCs) into peripheral blood (PB). The underlying mechanisms orchestrating this mobilization and subsequent homing of BMSPCs to the myocardium are poorly understood. While the role of traditional chemokines in the mobilization and homing of hematopoietic stem cell (HSCs) to BM niches is undisputed, their role in directing BMSPCs to the highly proteolytic environment of the ischemic myocardium is debatable and other redundant mechanism may exist. Based on our observation that bioactive lipids, such as sphingosine-1 phosphate (S1P) and ceramide-1 phosphate (C1P), play an important role in regulating trafficking of HSCs; we explored if they also direct trafficking of BMSPCs in the setting of myocardial ischemia. While BMSPCs expressed S1P receptors regardless of the source, the expression of S1P receptor 1 (S1PR1) and receptor 3 (S1PR3), which are responsible for migration and chemotaxis, was elevated in BMSPCs in naïve BM cells and was reduced following mobilization. This expression correlated to differential response of BMSPCs to S1P in chemotaxis assays. By employing flow cytometry analyses, we observed an increase in circulating PB CD34+, CD133+ and CXCR4+ lineage negative (Lin-)/CD45- cells that are enriched in non-HSCs (P < 0.05 vs. controls). This corroborated our mass spectrometry studies showing a temporal increase in S1P and C1P plasma levels. At the same time, plasma obtained in the early phases following AMI strongly chemoattracted human BM-derived CD34+/Lin- and CXCR4+/Lin- cells in Transwell chemotaxis assays in an S1P dependent fashion. We examined other mechanisms that may contribute to the homing of BMSPCs to the infarcted myocardium due to the reduction of S1PRs upon mobilization. We observed that hypoxia induced higher expression of cathelicidins in cardiac tissues. Indeed, PB cells isolated from patients with AMI migrated more efficiently to low, yet physiological, gradient of SDF-1 in Transwell migration assays compared to SDF-1 alone. Together, these observations suggest that while elevated S1P plasma levels early in the course of AMI may trigger mobilization of non-HSCs into PB, cathelicidins appear to play an important role in their homing to ischemic and damaged myocardium.

La transplantation demeure le traitement de choix de l’insuffisance cardiaque (IC) et ce malgré les récents progrès des techniques de support d’assistance mécanique. Une amélioration considérable de la prévention et du traitement du rejet aigu a été réalisée ces 20 dernières années. Cependant, le succès à long terme des transplantations d’organes a été peu modifié : il est toujours compromis par la survenue d'une dysfonction chronique du greffon. Ainsi, l'avenir des transplantés cardiaques demeure sombre et représente un fardeau médical avec un impact socioéconomique important. Toutefois, la recherche a récemment mis en avant l'énorme potentiel de régénération des cellules souches (CS) et représenterait une nouvelle avenue thérapeutique pour les patients souffrant d’IC. Une meilleure compréhension des processus biologiques des CS et de leur interaction avec le cœur transplanté, permettrait d’exploiter pleinement leur potentiel de réparation cardiaque. Le but de cette thèse est d’explorer les différents aspects du traitement de l’IC en 2020. Les hypothèses proposées dans cette thèse sont les suivantes : (1) les excellents résultats obtenus (>20 ans de survie) chez près d’1/3 des patients greffés lors de la 1ère décade de notre expérience à ICM serait difficile à obtenir de nos jours à la vue de l’évolution d’une population plus malade et plus âgée; (2) le cœur artificiel total (CAT) temporaire Syncardia permet d’amener des patients en insuffisance cardiaque terminale à la greffe de façon satisfaisante; (3) la thérapie cellulaire, plus spécifiquement les CS d’origine adipeuse (ASC) sous forme sphéroïdes, permet de diminuer l’impact de la vasculopathie du greffon cardiaque; et (4) l’effet paracrine des ASC permet une diminution de l’inflammation dans un modèle expérimental de péritonite chez le rat. / Transplantation remains the preferred treatment for heart failure (HF) despite recent advances in mechanical support devices. A considerable improvement in the prevention and treatment of acute rejection has been achieved over the past 20 years. However, the long-term survival of organ transplants has not been changed: it is still compromised by the occurrence of chronic graft dysfunction. Thus, the future of cardiac transplant patients remains bleak and represents a medical burden with a significant socio-economic impact. However, research has recently highlighted the potential for regeneration of stem cells (SC) and would represent a new therapeutic avenue for patients with HF. A better understanding of the biological processes of SC and their interaction with the transplanted heart would allow them to fully exploit their cardiac repair potential. The aim of this thesis is to explore the various aspects of the treatment of HF in 2020. The hypotheses proposed in this thesis are as follows: (1) the excellent results obtained (> 20 years of survival) in almost 1/3 of the patients transplanted during the 1st decade of our experience at ICM would be difficult to obtain from our days at the sight of the evolution of a sicker and older population; (2) the temporary Syncardia total artificial heart (CAT) allows patients with end-stage heart failure to be transplanted satisfactorily; (3) cell therapy, more specifically CS of adipose origin (ASC) cultured as spheroid, reduce the impact of cardiac allograft vasculopathy (CAV); and (4) the paracrine effect of ASCs reduces inflammation in a rat experimental model of peritonitis.

La cardiomyopathie ischémique et l’insuffisance cardiaque (IC) sont deux des principales causes de morbidité et de mortalité dans les pays industrialisés. L’IC représente la condition finale résultant de plusieurs pathologies affectant le myocarde. Au Canada, plus de 400 000 personnes souffrent d’IC. Malgré la grande variété de traitements disponibles pour prendre en charge ces patients à haut risque de mortalité, l’évolution et le pronostic clinique de cette population demeurent sombres. Les thérapies de régénération par transplantation cellulaire représentent de nouvelles approches pour traiter les patients souffrant d’IC. L’impact de cette approche cellulaire et les mécanismes qui sous-tendent l’application de ce nouveau mode de traitement demeurent obscurs. Les hypothèses proposées dans cette thèse sont les suivantes : 1) l’évolution à long terme des patients qui se présentent en IC grave est nettement défavorable malgré les techniques actuelles de revascularisation chirurgicale à cœur battant; 2) la thérapie cellulaire et, plus spécifiquement, l’injection intracoronaire précoce de milieu de culture cellulaire, permet d’améliorer la récupération fonctionnelle du ventricule gauche suite à un infarctus aigu du myocarde; et 3) la mobilisation de l’axe cœur-moelle osseuse constitue un mécanisme de réponse important lors de la survenue d’un événement ischémique chronique affectant le myocarde. / Congestive heart failure (CHF) remains a leading cause of mortality in the developed world. There are more than 400,000 diagnosed cases of this pathology in Canada. Despite the numerous treatment options available for patients presenting with left ventricular dysfunction, the evolution of this population is still dismal. Stem cell transplantation is a potential approach to repopulate the injured myocardium, to treat heart failure, and to restore cardiac function. However, the exact mechanisms underlying the beneficial effects of this approach remain to be elucidated. The hypotheses of this thesis are the following: 1) the long-term evolution of patients undergoing coronary artery bypass graft surgery is still poor, even when considering the use of new innovative surgical strategies such as off-pump coronary revascularization; 2) the intracoronary injection of concentrated biologically active factors secreted by stem cells can achieve early protection of the ischemic myocardium and preserve heart function; and 3) the bone marrow/heart interaction in a critical axis is involved in chronic myocardial repair following persistent ischemic injury.

La cardiomyopathie ischémique et l’insuffisance cardiaque (IC) sont deux des principales causes de morbidité et de mortalité dans les pays industrialisés. L’IC représente la condition finale résultant de plusieurs pathologies affectant le myocarde. Au Canada, plus de 400 000 personnes souffrent d’IC. Malgré la grande variété de traitements disponibles pour prendre en charge ces patients à haut risque de mortalité, l’évolution et le pronostic clinique de cette population demeurent sombres. Les thérapies de régénération par transplantation cellulaire représentent de nouvelles approches pour traiter les patients souffrant d’IC. L’impact de cette approche cellulaire et les mécanismes qui sous-tendent l’application de ce nouveau mode de traitement demeurent obscurs. Les hypothèses proposées dans cette thèse sont les suivantes : 1) l’évolution à long terme des patients qui se présentent en IC grave est nettement défavorable malgré les techniques actuelles de revascularisation chirurgicale à cœur battant; 2) la thérapie cellulaire et, plus spécifiquement, l’injection intracoronaire précoce de milieu de culture cellulaire, permet d’améliorer la récupération fonctionnelle du ventricule gauche suite à un infarctus aigu du myocarde; et 3) la mobilisation de l’axe cœur-moelle osseuse constitue un mécanisme de réponse important lors de la survenue d’un événement ischémique chronique affectant le myocarde. / Congestive heart failure (CHF) remains a leading cause of mortality in the developed world. There are more than 400,000 diagnosed cases of this pathology in Canada. Despite the numerous treatment options available for patients presenting with left ventricular dysfunction, the evolution of this population is still dismal. Stem cell transplantation is a potential approach to repopulate the injured myocardium, to treat heart failure, and to restore cardiac function. However, the exact mechanisms underlying the beneficial effects of this approach remain to be elucidated. The hypotheses of this thesis are the following: 1) the long-term evolution of patients undergoing coronary artery bypass graft surgery is still poor, even when considering the use of new innovative surgical strategies such as off-pump coronary revascularization; 2) the intracoronary injection of concentrated biologically active factors secreted by stem cells can achieve early protection of the ischemic myocardium and preserve heart function; and 3) the bone marrow/heart interaction in a critical axis is involved in chronic myocardial repair following persistent ischemic injury.