A dearth of literature exists surrounding the sport of Body Building. Anecdotally, when preparing for a competition, most elite body builders in South Africa will go through two totally different phases of training and dieting. The first phase is the bulking- or weight-gaining phase. During this phase, a structured diet with high carbohydrate component and moderate to high fat content will be followed for several months. During the weight-gaining phase, Androgenic-Anabolic Steroid (AAS) substances are used in moderately high doses compared to the pre-contest period. The second phase of training and dieting, is called the pre-contest preparation phase. This is a very intense phase of high volume training that usually starts about 16-13 weeks from the time of the competition. During this phase, extremely strict, structured diets are followed, with each meal being weighed. During the pre-contest phase, a multitude of chemical substances are used to enhance the desired physique â this strategy of using combinations of different classes of drugs, is called âstackingâ. This will be the period with the highest AAS substance milligram usage per week. Very little current information on the profile of these athletes is available to the South African Medical Community, especially the Sports Medicine Community. There exists only a small body of knowledge in the literature on the dosing protocols abused by these athletes and the side effects they incur. Little is known of the usage of high dose AAS amongst the elite, competitive South African Body Building population and the possible side effects. A rare opportunity was presented to the author to study a group of elite level body builders during the 2010 competitive season. Obtaining participants for this cohort was difficult as these athletes form part of a very secluded group of sportsmen. Though the present cohort was disadvantaged in small cohort size, the opportunity to study such a group in depth will not be readily repeated. This is a novice study â to present, no similar study has been conducted in South Africa. All the athletes registered with the International Federation of Body Building South Africa were invited to participate in the study. Interested volunteers were asked to contact the researcher. More than 200 invitations were sent out to the existing database â only 19 athletes conveyed their interest in participation. Eventually, only 14 athletes partook in the full protocol. Blood assays were performed on each athlete on 3 different occasions, while anthropometric measurements and blood pressure readings were taken on 4 different occasions over the length of the competitive season. Each individual athlete recorded his AAS abuse, while some athletes provided sample diets as well. Data was captured on Excel spread sheets and forwarded to Department of Biostatistics, University of the Free State, South Africa. Along with the concomitant abuse of high doses of AAS over extended periods, the present study also found: - Minimal changes in blood pressure - Initial decrease in lean mass, followed by rapid increase in lean mass in just one week and failure to maintain that gain over the following weeks - Disturbed carbohydrate metabolism with increased risk for pre-diabetic status - Lipid profile changes, with decreased HDL, unchanged Total Cholesterol and decreased LDL - Liver enzyme changes highly suggestive of AAS-driven adverse effects - Hypogonadotrophic hypogonadism status - Very high Androgen Status for the cohort with mean total AAS abuse per week measuring 1638,3 mg, with average AAS cycle lengths of 17.43 weeks. In conclusion, it should be noted that the present studyâs cohort differed vastly from cohorts from other studies in the literature, as none of the latter observed cohorts under full pre-contest preparation conditions. It should also furthermore be understood that body builders under full pre-contest preparation will respond differently to the use of special diets, different training strategies and different types of AAS abused, than compared to when they train under normal out-of season conditions. The author recommends that sports physicians should continuously target their efforts at counselling adolescents and other athletes about the potential long-term harms of AAS abuse, as well as regularly and prudently follow-up on the potential adverse effects that may develop in current AAS abusers. The author further recommends that, if an opportunity to study such a secluded group of body builders would present itself again, it should be immediately fully utilised.

Shortboard surfing continues to increase in popularity. In South Africa, surfing is not yet truly a profession. Successful u/20 surfers are rewarded with lucrative sponsorships, prize money and selection for national surf teams. For many competitive u/20 surfers, their ultimate goal is to qualify for the lucrative World Qualifying Series (WQS) and World Championship Tour (WCT). The competitive junior surfer and his support team (family, coach, and sponsors) invest a lot of time, commitment and money in striving for success. Whilst the u/20 surfer strives for quality water time in all conditions, he will benefit should his support staff be well informed about mental skills and nutrition. The aim of this research was to identify variables which can influence the surferâs ability to perform consistently at a higher level of competition. Past research in surfing has shown that, although smaller in stature than other elite sportsmen, physical traits in surfing are less important than mental skills and correct nutrition. 107 Surfers entered in the 2008 Billabong Junior Series of 5 contests around South Africa. 41 Of these surfers participated in this research. Their anthropometric variables namely height, mass, body density, body mass index and % fat were recorded. Waist to hip, chest to waist and chest to hip ratios were measured. The Ottawa Mental Skills Assessment Tool was used to assess mental skills and a 24 hour dietary recall questionnaire was completed. The main findings were that with a shorter stature, the surfers chose a sport which suited their physique best. The mental skills of commitment self-confidence and goal setting scored high, but stress reactions and refocusing skills were poor. At the contest venues, the food and fluid available determined their diet. They had no definite pre heat, inter heat or post heat eating plans. We concluded that mental skills and correct nutrition are two factors which a competitive surfer can utilize to improve their surfing performance. We recommend that a 12 variable progressive forward discriminant analysis be applied to talent identification in surfing, as also to identify and to improve necessary skills which are lacking in the competitive u/20 surfer.

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Objectives: Rugby union is a contact sport with a high injury rate. The tackle situation in rugby union is the cause of most injuries. The aim of this study was to investigate biomechanical aspects of the tackle in professional rugby to identify possible mechanisms of injury in the tackle. From this recommendations can be made to make the tackle safer. Methods: Video material from six Super 14 rugby matches involving the Cheetahs was analysed. The number of tackles (20) resulting in injury to a player was reported and nine further associated factors explored by determining differences using 95% confidence intervals. Significance was set at p = 0.05 and calculated from the proportional number of injuries from each category relative to the total number of tackles made. An odds ratio was calculated to determine practical significance where clinical significance could not be found. A total number of 744 tackles were analysed which occurred during 480 minutes of rugby accounting for 7200 player minutes. Results: From the 744 tackles that were made or received, 20 (2.7%) tackles resulted in injury, accounting to 167 tackle injuries per 1000 player match hours. The study found that significantly more injuries (p = 0.048) were sustained by tacklers performing a tackle in the attacking 22m compared to the other field positions. Most of the tackles occurred in Channel 2+ (n = 622, 83.6%) which resulted to the vast majority of tackles occurring in this game situation. Seventeen (85.0%) of the 20 injuries were sustained during Channel 2+ play, of which 13 (65.0%) ball carriers and 4 (20.0%) tacklers were injured. This had an odds ratio with practical significance. The body part hit in the tackle was often not the body part injured. Muscle contusions were the most common type of injury. Conclusions: A high incidence of tackle injuries was recorded. The tackle remains the most dangerous phase of play in rugby union. Different biomechanical aspects occur in the tackle that contribute to injury. The field position where a tackle takes place was found to be an important risk factor in the cause of injury. Front-on tackles and high impact vectors are associated with increased injury rates. The channel of play was also an important area where ball carriers sustained injuries. Factors influencing the tackle situation in certain areas of the field and certain channels of play can be made safer by placing emphasis on mental coaching, composure in pressure situations and maintaining the correct playing and tackle techniques to prevent tackle injuries in these areas and channels of play. Further research on these aspects is recommended.

Objectives: The aim of this study was to determine the dehydration status of u/19 School rugby players during a game of rugby in the Hopetown district in high temperatures. Methods: This study was a cohort-analytical study on certain variables associated with hydration levels of u/19 rugby players from Hopetown High School during two matches in 2007 and two matches in 2009. The group of rugby players was subjected to a pre- evaluation (15min before the game) followed by a re-evaluation performed 10min after the game. In this way the dehydration status of the players could be determined. Thirty-one rugby players participated. Readings were taken of Urine-Specific Gravity (SG), blood haematocrit, and body mass of every rugby player before and after every rugby match. The student t-test was used to test for significant differences within the group. A significance level of 0.05 was used throughout the study. Results: The anthropometric characteristics in our study for 2007 and 2009 are very similar as expected, and showed a mean length of 177 ± 7-8 cm, ranging from 165 to 190 cm, a mean body mass of 71.5 ± 13.7kg and a mean body mass index (BMI) of 22.88 ± 3.98kg/m2. Between 3 (17%) and 10 (67%) of the players were dehydrated post-match according to the decrease in body mass. The pre-exercise urine specific gravity measures were significantly lower (p < 0.05) before all 4 matches than after the matches as expected, and most of the players could have been better hydrated at the beginning of the match. 20% - 94% of the players were dehydrated pre-match and almost all the players (93% and 100%) were dehydrated after the match. The pre-match mean haematocrit (HCT) and the post-match mean HCT was in the range of 0.46 - 0.47. However, in two of the matches significant differences (p < 0.05) in HCT were recorded. Conclusions: It was alarming to find that a large number of the players were dehydrated before the match, but more important, almost all of them after the match. Recommendations for fluid and electrolyte replacement must be carefully considered and monitored in rugby players to promote safe hydration and avoid hyponatremia.

Background: Concussion is a common medical problem which can have devastating complications, particularly in young adults and children. Due to the nature of rugby, concussions are frequently sustained by the players engaging in this contact sport. Since children are more susceptible to sustain a concussion, medical personnel such as doctors or paramedics should theoretically be the role players responsible for medical decision making next to the school rugby field. Coaches, who are often teachers, are often the primary source of medical support next to school sports field. Since failure to recognise or mismanagement of a concussion may lead to serious medical complications and delayed recovery, all role players involved with a potentially concussed child should be knowledgeable on the factors influencing medical decision making. These factors include knowledge on the prevention, recognition and management of a concussion, knowledge on the consequences of a sustained concussion and when to clear a child to Return to Play (RTP). Aims: This study aimed to report on the general and essential knowledge to be able to recognise a concussion of role players potentially involved with a concussed primary school rugby player and knowledge of role players regarding the prevention and consequences of concussion. In addition, knowledge and practices of role players regarding the management of a suspected or confirmed concussion, as well as knowledge and practices of role players regarding Return to Play (RTP) decision making following a concussion were assessed. Methods: A self-administered questionnaire was developed according to guidelines from literature to assess the child-specific concussion knowledge and practices of role players. These questionnaires were completed by primary school rugby coaches (n=51), paramedics (n = 39) and doctors (n = 20) in the Klerksdorp, Orkney, Stilfontein and Hartbeesfontein (KOSH) area in the North West Province. The outcome measures consisted of scores (out of a potential 100% if all the correct answers were given) on the prevention, management, recognition, RTP and consequences of a concussion. In addition, the knowledge regarded by literature as being essential to the safe practice of doctors were also assessed among all role players. Results: It was found that coaches and paramedics were generally the most senior persons responsible for medical decision making next to the rugby field. A substantial proportion of coaches (60.8%) were not BokSmart certified at the time of data collection and therefore not adhering to this requirement set out by SA Rugby. There was no relationship between the time since the coaches received their last concussion-related information and their concussion knowledge. There was also no relationship between the coachesâ concussion knowledge and whether they attended a recognised concussion training programme such as BokSmart. The only variable to show a relationship (p = 0.001) with the coachesâ overall essential knowledge needed for safe practice was the amount of years they have been coaching rugby. The coaches, who were also teachers, displayed a general lack in knowledge on the effect of a concussion on a childâs school work and the need for cognitive rest following a concussion. The paramedics displayed a widespread weakness in their knowledge pertaining to the cognitive aspects associated with a concussion. There was general consensus that the decision to clear a child to Return to Play (RTP) should rest with a doctor. However, the results from this study indicates that a considerable proportion of doctors (30.0%) were unaware of the fact that a child should be free from concussion symptoms not only during physical activity, but also at rest, which may result in premature RTP. The role players displayed a less than adequate knowledge on sport-related concussion with the coaches scoring 71.44 ± 12.03%, the paramedics scoring 67.01 ± 12.29% and the doctors scoring 76.67 ± 6.56% on the overall essential knowledge needed for safe practice Conclusions: Despite the fact that the doctors scored significantly better compared to the coaches and paramedics on their overall essential knowledge score (all of the essential knowledge items combined), very few doctors did not present with considerable gaps in their essential knowledge needed for safe practice when dealing with a concussed child. By implication the findings from this study indicates that children suffering from a concussion may be at risk for receiving inappropriate or insufficient medical care when sustaining a concussion. These findings should be communicated to sport governing bodies such as SA Rugby and further research undertaken to address the lack in knowledge among role players potentially dealing with concussed athletes as a matter of urgency.

Background: Exercise-induced bronchospasm (EIB) is a common medical condition which can have devastating complications, particularly in otherwise healthy active athletes. Since EIB is unpredictable but preventable, medical personnel and coaches are often the primary support givers in such events and need to be informed about the risk factors and proper management of the athlete with this, sometimes undiagnosed, respiratory problem. The periodic health evaluation (PHE) is mandatory in some, but not all, sports and covers a few basic questions regarding the athleteâs respiratory health. Aims: The objective of this study was to determine the prevalence of underlying respiratory disease in a population of varsity level athletes. In addition, the study aimed to test whether the addition of a specific tool would increase the sensitivity of the PHE as it is implemented by the International Olympic Committee (IOC), therefore investigating if spirometry before and after an exercise challenge would diagnose any new athletes with exercise-induced bronchospasm (EIB). Methods: Thirty-two participants met the inclusion criteria. Periodic health evaluations were done to enquire about a detailed history from the athletes and physical examination with special attention to the respiratory system. Baseline spirometry followed by an exercise challenge test and serial post-exercise spirometries were done on all the participants according to the guidelines provided by the American Thoracic Society. Results: The results of this study confirmed that a thorough history and clinical examination alone do not lead to the diagnosis of EIB. Furthermore, we conclude that a resting baseline spirometry does not indicate that an athlete is at risk for or has EIB. In the absence of eucapnic voluntary hyperpnea (EVH) as the preferred challenge test according to the International Olympic Committee-Medical Commission (IOC-MC), an exercise challenge test will be as valuable. Almost 10% of the athletes in our study, which were healthy according to the PHE and baseline spirometry, had a positive spirometry for EIB after an exercise challenge test as indicated by a fall of ⥠10% from the baseline forced expiratory volume in one second (FEV1).

Objectives: The aim of this study was to determine the effect of weight training on pain relief and fatigue in patients with fibromyalgia (FM). Methods: This study was a randomized control study on patients diagnosed with FM. The group of FM patients was subjected to inclusion and exclusion criteria. Randomization was done on the patients who have met the inclusion criteria by the Department of Biostatistics at the University of The Free State. The experimental group was subjected to a training programme under supervision while the control group received verbal instructions to follow a training programme and the benefits thereof (Glombiewski et al., 2010), but did not undergo supervised training. The training period was 12 weeks. The subjects maintained their ordinary daily chores and physical activity. The experimental group started a supervised strength training period. Training was carried out 3 times a week and. During the first 3 weeks patients started with 8 - 12 repetitions for each set, with loads of 40 â 60% of the one repetition maximum (1 RM) and continued during the next 4 weeks with 10 â 12 repetitions with loads of 60 â 70% of 1 RM. Subsequently, during week 8 â 12 the number of repetitions was 10 for each set with loads of 60 â 80% of 1 RM. In addition to the muscle strengthening exercises each session ended with 5 â 10 minutes of core strengthening. All training sessions included warm up and cool down exercises using either a treadmill or bicycle ergometer and muscle stretching. Moreover, the subjects continued their ordinary chores and physical activities. The patients did a 15 minute warm up consisting of 10 minutes light aerobic work followed by 30 â 40 minutes weight training followed by 10 â 15 minutes of cool down. The programme differed from a Monday, to a Wednesday, to a Friday, where different muscle groups were targeted by the weight training. Results: The anthropometric characteristics in the current study for the exercise and control group are very similar. The Student T-Test was used to test for significant differences between the control and experimental group Fibromyalgia Impact Questionnaire (FIQ) scores over the 12 weeks. A 95% confidence interval was used to determine the difference between the two groups. The confidence interval shows that there is no statistical difference between the FM experimental (FMT) and FM control group (FMC). The following variable, V = FIQ: W4-W1 is where the FIQ score of week 4 were subtracted from week 1. No statistical difference (p<0.05) was observed between the control and the exersice group between week 1 and 4. The exercise groupâs progress was statistically better (p<0.05) than control group in week 4 - 8. At week 8 the FMT groupâs fibromyalgia impact questionnaire score median was 39 compared to the FMC groupâs median of 63. Unfortunately, the exercise group deteriorated statistically significant (p<0.05) in the FIQ scores compared to control group improvement from week 8 â 12. Lastly, there was no statistical difference (p<0.05) between week 1 and week 12 between the FM control group and the exersise group regarding improvement of symptoms as reported in the FM impact questionnaire. Conclusions: It is still unclear what combination of type, intensity and duration of exercise treatment works best in the treatment of FM. It is important to recognize that in the case of a chronic pain disorder like FM, treatment must be focused not just on immediate symptom relief but also on maintaining long term lifestyle behaviour. As long as FM aetiology remains unclear, there is a need to explore mediating variables that can be used to intervene in order to ameliorate symptoms. Research efforts must continue to explore methods to relieve symptoms short term and support ongoing long term behaviour change to improve functioning and enhance the quality of life for patients with FM.

Background. Tuberculosis is increasing in the Free State and Northern Cape provinces of South Africa, but it is not clear how much of the disease is caused by reactivated latent infection and how much is attributed to interpersonal transmission. The discovery of the transposable DNA insertion sequence, IS6110, provided the desired polymorphism among different strains to track routes of transmission, study the degree of inter-person transmission versus reactivation, to detect laboratory contamination and disease outbreaks. Alternative methods include spoligotyping and the mycobacterial intergenic repetitive units or variable number of tandem repeats (MIRU-VNTR). Sustained studies performed on a small area in the Western Cape Province and some mines in the Gauteng Province of South Africa have found person-to-person transmission of tuberculosis to be high in these populations. In addition, resistance determinants to key antituberculosis drugs have remained unknown among tuberculosis causative organisms circulating in the Free State and Northern Cape. Thus, extensive DNA fingerprinting and gene mutation studies are needed to address these problems. Methods. An area in the Free State suitable for long-term surveillance studies was defined using available information from the governmental database, the 1996 census statistics, and tuberculosis (TB) case loads and transfer data obtained from the National Tuberculosis Database. Each clinicâs catchment information was provided by clinic managers and the population movement data from a 2002 student project. Sputum samples were collected and Mycobacterium tuberculosis isolated from tuberculosis positive patients from the defined area (Gamadi). Isoniazid resistant isolates received from a representative sample from the Free State and a few strains from the Northern Cape Province were also included in the study. IS6110-directed restriction-fragment-length polymorphism (RFLP) analysis was performed on all isolates and drug susceptibility testing (indirect proportion method) done on the Gamadi isolates. Subtyping of identical strains (RFLP clusters) and some of the isolates with less than six IS6110 bands was done using spoligotyping and the MIRU-VNTR typing. DNA sequencing analysis of the katG and rpoB genes was done in resistant isolates and a rapid PCR-based restriction enzyme katG gene mutation detecting method evaluated. Results. An area characterised by extreme poverty (unemployment rate 69.0%), a relatively young population (69.0% below 35 years) of 61534 and with high incidence of tuberculosis (840/100 000) suitable for long -term surveillance studies was identified in the Free State. The area is served by three clinics and a hospital and is situated near the rural town of Thaba Nchu in the Free State province. Eighty eight M. tuberculosis isolates and a mycobacterium-other-than-tuberculosis (MOTT) were isolated from the 286 sputum specimens collected from the Gamadi area. Only two M. tuberculosis isolates tested isoniazid (INH) resistant and no rifampicin (RIF) resistant isolates were found. The MOTT was resistant to INH (0.2, 1 and 5 µg/ml) and to RIF. Standard IS6110-based DNA fingerprinting of 84 of 88 (96.5%) isolates from the defined area was performed. Four of the isolates were cultured from duplicate sputum specimens provided by four patients. Two of these had identical fingerprint patterns to the first isolate of the patient and two had a different profile. The latter pair could be attributed to laboratory error. IS6110 sequences were not detected in six isolates. Fourteen isolates had less than six IS 6110 hybridisation bands and four strains were in clusters. The remaining 57 (88.9%) strains had distinct RFLP profiles with more than six bands. The number of IS6110 copies varied from seven to 21. A total of five strains was distributed in two clusters, one with two and the other with three members. Thirteen family groups, clustered at 65.0% on the similarity dendogram, each with two to eight strains, but no dominant groups were evident. A cluster of three isolates with five identical IS 6110 bands each was confirmed as one strain by MIRU-VNTR typing while two further isolates (both had three bands of different sizes) were confirmed as different strains by MIRU typing. A total of 37 isoniazid-resistant M. tuberculosis was analysed. DNA fingerprint profiles showed nine isolates with less than six insertions (24.3%). Six of these isolates were from the Free State and three from the Northern Cape Province. Three of these isolates were multidrug resistant. The remaining 28 isolates (75.7%) contained between 9 and 18 copies of the IS6110 insertion sequence. Twenty-six different IS 6110 RFLP types were identified. Only two clusters with two isolates, respectively, were found in each province. Eight clonally related groups (65.0% similarity) with two to four strains were present. Three clusters of two isolates (each with more than six bands) also exhibited identical spoligotype patterns. Spoligotyping of two of three isolates from a fourth cluster (4 RFLP bands each) showed two different banding patterns and all were shown to be different by MIRU-VNTR typing. The fifth cluster (2 bands) was made up of one isolate from each province. Spoligotyping of these strains was identical, but the MIRU was different. One isolate from Bloemfontein had identical IS 6110-RFLP and spoligotyping patterns to a susceptible isolate from Gamadi. Isoniazid resistance in 22/37 isolates was sequence linked to altered nucleotides of codon 315 of the katG gene. Twenty harboured the ACC variant at the codon. One strain carried the AAC mutation at this codon and the other GGC. The remaining 15 carried the wild type (AGC) genotype at this site. Two of the strains harbouring the AGC315ACC mutation belonged to the same IS6110 cluster. Two mutations were found at codon 463 (CGG ® CTG; CGG ® CCG). Thirteen MDR strains were investigated for rpoB gene alterations. Four of these isolates carried no mutations within the 157-bp amplified fragment while the others had various mutations. Analysis of an 808bp fragment of the katG gene from INH-resistant M. tuberculosis isolates after restriction with Msp I agreed with results obtained by sequencing. Thirteen isolates carried a pattern consisting of 228, 153, 146, 109, 79, 65 base pairs with the 153 bp fragment indicating the presence of the wild type AGC at codon 315 of the katG gene. Seventeen isolates demonstrated the 228, 146, 132, 109, 79, 65, 21 profile with the 132 bp fragments indicating the presence of an ACC mutation. Three isolates contained a mixed genotype and were digested into the fragments 228 bp, 153 bp, 146 bp, 132 bp, 109 bp, 79 bp, and 65 bp. Fragments with 146 bp and 65 bp are seen in strains with no mutation (bases CGG) at codon 463, while a 211 bp fragment shows a mutation at this spot. Four strains had the fragments 228, 211, 153, 109, and 79 bp. One strain was digested into six fragments of 228 bp, 211 bp, 132 bp, 109 bp 79 bp and 21 bp containing both a 315 (ACC) and 463 (CTG) codon mutation. Discussion and conclusions. An area consisting of ten villages and characterised by a high incidence of tuberculosis was defined for long-term surveillance studies. Resistance in the area appears to be low and compares favourably to the situation in the Free State. Strains received from this area were highly diverse, but the presence of a cluster of five isolates indicated the need for continuous investigation. Recent transmission of INH resistance in the Free State province is not a significant factor, but since the isolates from the Northern Cape were not representative, no deduction could be made for this province. Resistance to INH is mostly associated with mutation AGC to ACC at codon 315 of the katG gene. The absence of alterations in a proportion of isolates is in agreement with published data implicating the involvement of more genes in causing INH resistance. Resistance to RIF was associated with various point mutations in the 81-bp core region of the rpoB gene. The high proportion of the ACC allele found among INH-resistant strains, cost effectiveness, ease to perform and rapid results, make PCR-RFLP an attractive option for detection of resistance especially in resource-poor countries.

Adult multipotent stromal cells (MSCs) may repair tissue through the action of secreted factors on endogenous stem/progenitor cells. We determined the effects of MSC-secreted factors on adult cardiac progenitor cells (CPCs). Serum-free conditioned medium (CdM) was collected from MSCs isolated by plastic adherence (MSCs) and by magnetic sorting against the p75 nerve-growth factor receptor (p75MSCs). Compared to serum-free medium (α -MEM), CdM significantly increased adult rat CPC proliferation in a concentration-dependent manner, led to phosphorylation (Tyr705 ) and nuclear localization of signal transducer and activator of transcription 3 (STAT3) and was blocked by both AG490, a Janus kinase 2 (Jak2)/STAT3 inhibitor, and Stattic, a specific STAT3 (Tyr705 ) inhibitor. Also signaling through Jak2/STAT3, MSC CdM cytoprotective factors significantly increased survival of hypoxic CPCs compared to α -MEM. Intra-arterial infusion of p75MSC CdM 24 hours after myocardial infarction (MI) in mice significantly reduced myocardial necrosis at 48 hours after MI compared to α -MEM (vehicle). Echocardiography at 1 week after MI demonstrated significantly better cardiac function in p75MSC CdM-treated mice compared to controls. Thus in vivo benefits of MSCs may be derived in part by the action of their secreted factors on CPCs. Epicardial-derived cells are required for cardiac development, support myogenesis through secreted factors and participate in repair and remodeling after injury. We tested whether factors secreted by epicardial-derived precursor cells (EPDCs) would protect jeopardized ischemic myocardium after myocardial infarction and reperfusion (MI-I4R). Human epicardial progenitor cells, isolated from right atrial appendages removed during cardiac bypass surgery, were keratin-positive, epithelial in morphology and expressed TFs associated with proepicardium, epicardium and cardiac development. Upon progenitor cell epithelial-mesenchymal transition (EMT) into EPDCs, concentrated conditioned medium (EPI CdM) was generated. When compared to α -MEM (vehicle), intra-arterial infusion of human EPI CdM led to a reduction in infarct size of 50% in both immunodeficient and immunocompetent MI-I4R mice and improved cardiac function. These in vivo results were evident as early as 24 hours after MI, sustained for at least 1 month, and may derive in part through paracrine protection of jeopardized coronary microvasculature. Our results indicate that EPI CdM or a combination of its ligands may provide an effective treatment for MI. / acase@tulane.edu