Despite advances in treatment, heart failure remains one of the top killers in Canada. This recognition motivates a new research focus to harness the fundamental repair properties of the human heart, with human cardiac stem cells (CSCs) emerging as a promising cell candidate to regenerate damaged myocardium. The rationale of this approach is simple with ex vivo amplification of CSCs from clinical grade biopsies, followed by delivery to areas of injury, where they engraft and regenerate the heart. Currently, outcomes are limited by modest engraftment and poor long-term survival of the injected CSCs due to on-going cell loss during transplantation. As such, we explored the effect of cell encapsulation to increase CSC engraftment and survival after myocardial injection. Transcript and protein profiling of human atrial appendage sourced CSCs revealed strong expression the pro-survival integrin dimers αVβ3 and α5β1- thus rationalizing the integration of fibronectin and fibrinogen into a supportive intra-capsular matrix. Encapsulation maintained CSC viability and expression of pro-survival transcripts when compared to standard suspended CSCs. Media conditioned by encapsulated CSCs demonstrated superior production of pro-angiogenic/ cardioprotective cytokines, angiogenesis and recruitment of circulating angiogenic cells. Intra-myocardial injection of encapsulated CSCs after experimental myocardial infarction favorably affected long-term retention of CSCs, reduced scar burden and improved overall cardiac function. Taken together, cell encapsulation of CSCs prevents detachment induced cell death while boosting the mechanical retention of CSCs to enhance repair of damaged myocardium.

At an annual cost of over thirty billion dollars annually, the diagnosis and management of heart failure is one of the most significant public health concerns of the twenty first century, as nearly twenty percent of Americans will develop some form of heart failure in their lifetime. The incidence of newly diagnosed heart failure has remained stable over the last several years at approximately 650,000 diagnoses per year; however, due to several contributing factors the prevalence has continued to rise despite substantial advancements in interventional therapies. The three most significant contributing factors to the rising heart failure prevalence have been identified as 1) significant advancements in technology and medical intervention have dramatically improved the survival rate of those experiencing acute coronary events. This has resulted in a greater number of patients who then progress to chronic heart failure. 2) The management of those with chronic heart failure has been dramatically improved which has allowed those with the disease to live longer and 3) heart failure is in large part a disease associated with advancing age. As the population in the United States and other developed countries continue to grow, such a strong association will inevitably result in a rapidly increasing prevalence. Current clinically therapies for managing heart failure can be categorized into three major groups: pharmaceutical therapy, mechanical circulatory support, or cell-based therapy. Pharmaceutical therapies are used in the earlier stages of disease progression or to manage symptoms and comorbidities of later stage heart failure. Mechanical circulatory support is often implemented when the disease progresses to a more severe state, where volume and / or pressure overload of the ventricles is present. Many modalities of mechanical circulatory support serve as a bridge to transplant, as the only long-term treatment of advanced decompensated heart failure is cardiac transplantation. The third category of treatments for HF is cell-based or stem cell therapies. These therapies are still in their infancies but hold significant potential of cardiac regeneration and reversal of the pathologic remodeling associated with heart failure. While the management of the early stages of heart failure have improves, addressing end-stage failure remains a significant obstacle in resolving the U.S. of the heart failure epidemic. The use of ventricular assist devices (VADs) has improved the management of end-stage failure over the last few decades, but VADs serve mostly as a bridge to transplant, so eventually a donor organ and cardiac transplantation is required. As the population continues to grow, the number of patients in need of a donor heart will increase, leading to an even larger discrepancy between the number of donor organs available and those in severe need. While advancements in VAD technology have reduced potential complications and increased the duration and effectiveness of the mechanical circulatory support, a long-term permanent treatment is still very much in need. Cell-based cardiac therapy or cardiac stem cell therapy holds the greatest potential to solving this age-old problem. The ability to not only regenerate dead or damaged tissue in the heart but also reverse pathologic remodeling due to heart failure could cure millions of patients of heart failure, returning them to a healthy, fully functioning state. The last decade has shed much light on the potential of stem cell therapies, but also has illuminated significant barriers to creating a clinically acceptable treatment. While these barriers seem tall, it is crucial that much time and resources be invested into stem cell therapies for cardiac applications as they hold the greatest potential to being able to effectively treat, rather than manage, those with heart failure. In addition to regenerating dead of damaged myocardium, stem cell technology has the potential to grow an entire organ that is patient specific in its origin, and would fully alleviate having to wait for an available donor organ. The ability to grow an entire organ in the lab, which can later be transplanted, would forever change the way medicine is practiced, while saving millions if not billions of lives worldwide.

Given that chronic hyperglycemia generates toxic methylglyoxal, the detoxifying effect of glyoxalase-1 (Glo1) on chronic hyperglycemia induced explant-derived cardiac stem cell (EDC) dysfunction was investigated. Wildtype (WT) and Glo1 over-expressing (Glo1TG) mice with or without streptozotocin treatment were studied. Hyperglycemia reduced overall culture yields while increasing the reactive dicarbonyl content within WT mice. These intrinsic cell changes reduced the angiogenic potential and nanoparticle production by hyperglycemic EDCs while promoting cell senescence. Compared to transplant of normoglycemic WT EDCs, hyperglycemic EDCs reduced myocardial function following infarction by inhibiting angiogenesis and endogenous repair mechanisms. In contrast, EDCs from hyperglycemic Glo1TG mice decreased reactive dicarbonyl content and restored culture yields. Intramyocardial injection of hyperglycemic Glo1TG EDCs also boosted myocardial function and reduced scarring. These findings demonstrate that, while chronic hyperglycemia decreases the regenerative performance of EDCs, over-expression of Glo1 reduces dicarbonyl stress and rescues the adverse effects of hyperglycemia on EDCs.

No description available.

Ischaemic heart disease (IHD) is the leading cause of death worldwide. Currently, even optimal medical therapies do not attenuate deterioration of the left ventricular (LV) function completely. Stem cell therapies, and recently cardiac stem cell therapies, have emerged as potential novel treatments for IHD. However, clinical evidence from randomised controlled studies has shown mixed results. Thus understanding what patient-related factors may affect the therapeutic performance of the cells may help improving treatment outcomes. The studies described in this thesis aim to understand how cardiac progenitor cells (CPCs) can re-vascularise ischaemic myocardium and promote functional repair of the heart. Resident CPCs were isolated and expanded from the right atrial appendage of 68 patients following the ‘cardiosphere’ method (cardiosphere-derived cells or CDCs). They resemble mesenchymal progenitors as they lack the expression of endothelial and haematopoietic cell surface markers but express mesenchymal progenitor cell markers (e.g. CD105, CD90). Cell function was evaluated by support of angiogenesis, mesenchymal lineage differentiation potential in vitro, and improvement in heart function in vivo. Notably in vitro, CDC from different patients differed in their angiogenic supportive and differentiation potentials. In a rodent model of myocardial infarction (MI), transplantation of CDC reduced infarct size significantly (p<0.05). However, only those CDCs with a robust pro-angiogenic ability in vitro improved vessel density and heart systolic function (p<0.05) in vivo. A multiple regression model, which accounted for 51% of the variability observed, identified New York Heart Association (NYHA) class, smoking, hypertension, type of ischaemic disease and diseased vessel as independent predictors of angiogenesis. In addition, gene expression analyses revealed that differential gene expression of several extracellular matrix components (e.g. CUX1, COL1A2, BMP1 genes and microRNA-29b) could explain the differences observed in CDC’s vascular supportive function. In summary, this is the first description of variability in the pro-angiogenic and differentiation potential of CDCs and its correlation with their therapeutic potential. This study indicates that patient stratification may need to be included in the design of future trials to improve the efficacy of cell-based therapies.

Infarction irreversibly damages the heart, with formation of an akinetic scar that may lead to heart failure. Endogenous cardiac stem cells (CSCs) are a promising candidate cell source for restoring lost tissue and thereby preventing heart failure. CSCs would be most beneficial if administered soon after infarction, thus the aim of this project was to optimize CSC culture conditions to enhance their therapeutic potential for myocardial infarction. CSCs were isolated and expanded in vitro via the formation of cardiospheres to give cardiosphere-derived cells (CDCs). Neonatal rat CDCs were found to be heterogenous, containing cells expressing the cardiac stem cell marker, c-Kit, pluripotent cell markers, Oct-4, Sox 2, Klf-4 and Nanog, and early cardiac specific differentiation markers, Nkx 2.5 and GATA 4. Administration of CDCs to the infarcted rat heart increased the cardiac ejection fraction by 9%, capillary density by 9% and reduced scar volume by 33%, compared to the non-treated group. The proliferation rates and the expression of c-Kit were significantly decreased in CSCs isolated from aged rats and after extended culture in vitro, so, CSC culture was optimized using hypoxic preconditioning. Under hypoxia, CDC proliferation rates were 1.7-fold greater, and larger cardiosphere clusters were formed. Hypoxic CDCs had an increased cardiac stem cell population, in that c-Kit was increased by 220% and CD90 and CD105 were decreased by 55% and 35%, respectively, compared to normoxic CDCs. Further, hypoxia induced the expression of CXCR-4 (~3.2-fold), EPO (~3.0-fold) and VEGF (~1.5-fold), indicating that hypoxic preconditioning may stimulate stem cell homing and neovascularization in the infarcted myocardium. Notably, hypoxic CDCs were able to switch to anaerobic glycolytic metabolism and had approximately 80% lower oxygen consumption, suggesting that they may be better adapted to survive within the hypoxic infarct scar, compared with normoxic CDCs. Culture of CDCs with hypoxia-mimicking prolyl-4-hydroxylase inhibitors (PHDIs) using DMOG, BIC and a novel compound, EDBA, induced similar effects to hypoxic culture by increasing c-Kit, EPO, VEGF, CXCR-4, decreasing CD90 and CD105 and increasing glycolytic metabolism. However, PHDI treatment for 24 hours did not alter CDC proliferation rates and cells died after 24 hours. In conclusion, CDCs are a potential cell source for therapy after myocardial infarction and their therapeutic potential can be enhanced using hypoxia or PHDI-preconditioning techniques.