Owing to the relationship between extracellular vesicles (EVs) and physiological and pathological conditions, the interest in EVs is exponentially growing. EVs hold high hopes for novel diagnostic and translational discoveries. This review provides an expert-based update of recent advances in the methods to study EVs and summarizes currently accepted considerations and recommendations from sample collection to isolation, detection, and characterization of EVs. Common misconceptions and methodological pitfalls are highlighted. Although EVs are found in all body fluids, in this review, we will focus on EVs from human blood, not only our most complex but also the most interesting body fluid for cardiovascular research.

Advances in genomics technology over recent years have led to the surprising discovery that the genome is far more pervasively transcribed than was previously appreciated. Much of the newly-discovered transcriptome appears to represent long non-coding RNA (lncRNA), a heterogeneous group of largely uncharacterised transcripts. Understanding the biological function of these molecules represents a major challenge and in this review we discuss some of the progress made to date. One major theme of lncRNA biology seems to be the existence of a network of interactions with microRNA (miRNA) pathways. lncRNA has been shown to act as both a source and an inhibitory regulator of miRNA. At the transcriptional level, a model is emerging whereby lncRNA bridges DNA and protein by binding to chromatin and serving as a scaffold for modifying protein complexes. Such a mechanism can bridge promoters to enhancers or enhancer-like non-coding genes by regulating chromatin looping, as well as conferring specificity on histone modifying complexes by directing them to specific loci.

Background-Clinical trials in ischemic patients showed the safety and benefit of autologous bone marrow progenitor cell transplantation. Non-bone marrow progenitor cells with proangiogenic capacities have been described, yet they remain clinically unexploited owing to their scarcity, difficulty of access, and low ex vivo expansibility. We investigated the presence, antigenic profile, expansion capacity, and proangiogenic potential of progenitor cells from the saphenous vein of patients undergoing coronary artery bypass surgery. Methods and Results-CD34-positive cells, negative for the endothelial marker von Willebrand factor, were localized around adventitial vasa vasorum. After dissection of the vein from surrounding tissues and enzymatic digestion, CD34-positive/CD31-negative cells were isolated by selective culture, immunomagnetic beads, or fluorescence-assisted cell sorting. In the presence of serum, CD34-positive/CD31-negative cells gave rise to a highly proliferative population that expressed pericyte/mesenchymal antigens together with the stem cell marker Sox2 and showed clonogenic and multilineage differentiation capacities. We called this population "saphenous vein-derived progenitor cells" (SVPs). In culture, SVPs integrated into networks formed by endothelial cells and supported angiogenesis through paracrine mechanisms. Reciprocally, endothelial cell-released factors facilitated SVP migration. These interactive responses were inhibited by Tie-2 or platelet-derived growth factor-BB blockade. Intramuscular injection of SVPs in ischemic limbs of immunodeficient mice improved neovascularization and blood flow recovery. At 14 days after transplantation, proliferating SVPs were still detectable in the recipient muscles, where they established N-cadherin-mediated physical contact with the capillary endothelium. Conclusions-SVPs generated from human vein CD34-positive/CD31-negative progenitor cells might represent a new therapeutic tool for angiogenic therapy in ischemic patients. (Circulation. 2010;121:1735-1745.)Key Words: CD34 antigen Ⅲ pericytes Ⅲ angiogenesis factors Ⅲ ischemia Ⅲ cell therapy R ecent evidence indicating the presence of progenitor cells in arteries and veins has inspired hope for their application in regenerative vascular medicine. [1][2][3] In fetal and postnatal vessels, putative proangiogenic progenitors reside in the vasculogenic niche, which comprises adventitial stromal cells and mature vascular cells of the vasa vasorum. 3 We previously showed that CD34-positive (CD34 pos ) cells from the human fetal aorta coexpress stem cell markers such as CD133 and c-Kit, are clonogenic, and give rise to vascular cells and skeletal myocytes. 2 Local implantation of fetal aorta-derived CD34 pos /CD133-positive (CD133 pos ) cells promoted reparative neovascularization in models of ischemia and diabetic ulcers through incorporation into nascent vessels and paracrine stimulation of resident vascular cells. 2,4 Ethical concerns and immunogenic/tumorigenic problems limit the clinical use of embr...

Rationale: Pericytes are key regulators of vascular maturation, but their value for cardiac repair remains unknown. Objective: We investigated the therapeutic activity and mechanistic targets of saphenous vein-derived pericyte progenitor cells (SVPs) in a mouse myocardial infarction (MI) model. Methods and Results: SVPs have a low immunogenic profile and are resistant to hypoxia/starvation (H/S).Transplantation of SVPs into the peri-infarct zone of immunodeficient CD1/Foxn-1 nu/nu or immunocompetent CD1 mice attenuated left ventricular dilatation and improved ejection fraction compared to vehicle. Moreover, SVPs reduced myocardial scar, cardiomyocyte apoptosis and interstitial fibrosis, improved myocardial blood flow and neovascularization, and attenuated vascular permeability. SVPs secrete vascular endothelial growth factor A, angiopoietin-1, and chemokines and induce an endogenous angiocrine response by the host, through recruitment of vascular endothelial growth factor B expressing monocytes. The association of donor-and recipient-derived stimuli activates the proangiogenic and prosurvival Akt/eNOS/Bcl-2 signaling pathway. Moreover, microRNA-132 (miR-132) was constitutively expressed and secreted by SVPs and remarkably upregulated, together with its transcriptional activator cyclic AMP response element-binding protein, on stimulation by H/S or vascular endothelial growth factor B. We next investigated if SVP-secreted miR-132 acts as a paracrine activator of cardiac healing. In vitro studies showed that SVP conditioned medium stimulates endothelial tube formation and reduces myofibroblast differentiation, through inhibition of Ras-GTPase activating protein and methyl-CpG-binding protein 2, which are validated miR-132 targets. Furthermore, miR-132 inhibition by antimiR-132 decreased SVP capacity to improve contractility, reparative angiogenesis, and interstitial fibrosis in infarcted hearts. Key Words: pericytes-based cell therapy Ⅲ myocardial infarction Ⅲ angiogenesis Ⅲ VEGF-B Ⅲ microRNA-132 W ith myocardial infarction (MI) remaining a major cause of morbidity and mortality worldwide, cell therapy now aims to offer a novel option for cardiac repair. 1 Clinical trials showed that administration of bone marrowderived progenitor cells (PCs) improves left ventricular (LV) function in patients with coronary artery disease. 2-4 However, more specialized cells are warranted to fulfill specific regenerative needs of the ischemic myocardium. ConclusionPericytes provide the physical strength and nurturing signals that instruct neovessels to organize in a stable and efficient tubular network. 5 On the other hand, ischemic disease and associated risk factors may impair pericyte recruitment. 6 -8 Therefore, a supply-side approach with fresh pericytes from exogenous sources could be helpful therapeutically. However, difficulties in isolating and expanding bona-fide pericytes from accessible human tissues have so far precluded clinical applications.Two main mural cell populations, probably originating from a common emb...

Background-Diabetes mellitus impairs endothelial cell (EC) function and postischemic reparative neovascularization by molecular mechanisms that are not fully understood. microRNAs negatively regulate the expression of target genes mainly by interaction in their 3Ј untranslated region. Methods and Results-We found that microRNA-503 (miR-503) expression in ECs is upregulated in culture conditions mimicking diabetes mellitus (high D-glucose) and ischemia-associated starvation (low growth factors). Under normal culture conditions, lentivirus-mediated miR-503-forced expression inhibited EC proliferation, migration, and network formation on Matrigel (comparisons versus lentivirus.GFP control). Conversely, blocking miR-503 activity by either adenovirus-mediated transfer of a miR-503 decoy (Ad.decoymiR-503) or by antimiR-503 (antisense oligonucleotide) improved the functional capacities of ECs cultured under high D-glucose/low growth factors. We identified CCNE1 and cdc25A as direct miR-503 targets which are downregulated by high glucose/low growth factors in ECs. Next, we obtained evidence that miR-503 expression is increased in ischemic limb muscles of streptozotocin-diabetic mice and in ECs enriched from these muscles. Moreover, Ad.decoymiR-503 delivery to the ischemic adductor of diabetic mice corrected diabetes mellitus-induced impairment of postischemic angiogenesis and blood flow recovery. We finally investigated miR-503 and target gene expression in muscular specimens from the amputated ischemic legs of diabetic patients. As controls, calf biopsies of nondiabetic and nonischemic patients undergoing saphenous vein stripping were used. In diabetic muscles, miR-503 expression was remarkably higher, and it inversely correlated with cdc25 protein expression. Plasma miR-503 levels were also elevated in the diabetic individuals. Conclusions-Our Editorial see p 236 Clinical Perspective on p 291Because of their incapacity to regulate glucose influx, endothelial cells (ECs) represent an important target for diabetes mellitus-induced damage. In particular, it is well established that ECs cultured in high glucose show delayed replication, 3,4 abnormal cell cycling, 5 and increased apoptosis. 6 Progression through the cell cycle is a tightly regulated process that includes multiple checkpoints. An orderly ex- The present study is the first to provide evidence for a role of miRNAs in diabetes mellitus-induced endothelial defects contributing to impaired postischemic angiogenesis. In fact, here we show that in vitro culture conditions mimicking diabetes mellitus and ischemia upregulate miR-503 in ECs and that, in vivo, diabetes mellitus increases miR-503 expression in ECs from ischemic limb muscles. We also show that increased miR-503 is responsible for repressed cdc25A and CCNE1 expression in ECs cultured under conditions mimicking diabetes mellitus and ischemia. Moreover, miR-503-forced expression inhibited EC proliferation, migration, and network formation on Matrigel and it additionally reduced vascular smooth muscle ce...

Abstract-We evaluated the healing potential of human fetal aorta-derived CD133ϩ progenitor cells and their conditioned medium (CD133 ϩ CCM) in a new model of ischemic diabetic ulcer. Streptozotocin-induced diabetic mice underwent bilateral limb ischemia and wounding. One wound was covered with collagen containing 2ϫ10 4 CD133 ϩ or CD133 Ϫ cells or vehicle. The contralateral wound, covered with only collagen, served as control. Fetal CD133 ϩ cells expressed high levels of wingless (Wnt) genes, which were downregulated following differentiation into CD133Ϫ cells along with upregulation of Wnt antagonists secreted frizzled-related protein (sFRP)-1, -3, and -4. CD133ϩ cells accelerated wound closure as compared with CD133Ϫ or vehicle and promoted angiogenesis through stimulation of endothelial cell proliferation, migration, and survival by paracrine effects. CD133ϩ cells secreted high levels of vascular endothelial growth factor (VEGF)-A and interleukin (IL)-8. Consistently, CD133ϩ CCM accelerated wound closure and reparative angiogenesis, with this action abrogated by coadministering the Wnt antagonist sFRP-1 or neutralizing antibodies against VEGF-A or IL-8. In vitro, these effects were recapitulated following exposure of high-glucose-primed human umbilical vein endothelial cells to CD133 ϩ CCM, resulting in stimulation of migration, angiogenesis-like network formation and induction of Wnt expression. The promigratory and proangiogenic effect of CD133 ϩ CCM was blunted by sFRP-1, as well as antibodies against VEGF-A or IL-8. Key Words: ischemia Ⅲ wound healing Ⅲ diabetes Ⅲ stem cells Ⅲ angiogenesis C hronic wounds represent a relevant clinical and socioeconomic burden, with diabetic foot ulcers alone causing costs of 300 million pounds per annum to the United Kingdom National Health System. 1 Diabetic patients with foot ulcers associated with peripheral vascular disease manifest the worst outcome, with higher amputation and mortality rates than patients carrying nonischemic ulcers. 2,3 Although the efficacy of a topical gel formulation of recombinant human platelet-derived growth factor-BB was recently demonstrated in patients with nonischemic neuropathic ulcers, 4 most ischemic ulcers are refractory to conventional treatment and growth factor (GF) therapy. 5 Therefore, new strategies for the cure of life-threatening ischemic ulcers are urgently awaited.Preliminary evidence supports the potential of adult or fetal stem/progenitor cells for the healing of skin ulcers. 6 -8 However, because of the lack of an appropriate preclinical model, no information is available regarding the effectiveness of cell therapy on ischemic diabetic foot ulcers. The healing activity of stem cells is credited to their ability to transdifferentiate into the vascular and nonvascular components of injured tissue, as well as to secretion of GFs, which may activate endogenous modulators of angiogenesis in the recipient. 9 -11 Notably, fetal stem cells show significant advantages over their adult counterparts in terms of proliferative capa...

Background-The neurotrophin nerve growth factor (NGF) regulates neuron survival and differentiation. Implication in neovascularization is supported by statement of NGF and its high-affinity receptor at vascular level and by NGF property of stimulating vascular endothelial cell proliferation. The present study investigated the involvement of endogenous NGF in spontaneous reparative response to ischemia. Mechanisms and therapeutic potential of NGFinduced neovascularization were examined. Methods and Results-Unilateral limb ischemia was produced in CD1 mice by femoral artery resection. By ELISA and immunohistochemistry, we documented that statement of NGF and its high-affinity receptor is upregulated in ischemic muscles. The functional relevance of this phenomenon was assessed by means of NGF-neutralizing antibody. Chronic NGF blockade abrogated the spontaneous capillarization response to ischemia and augmented myocyte apoptosis. Then we tested whether NGF administration may exert curative effects. Repeated NGF injection into ischemic adductors increased capillary and arteriole density, reduced endothelial cell and myofiber apoptosis, and accelerated perfusion recovery, without altering systemic hemodynamics. In normoperfused muscles, NFG-induced capillarization was blocked by vascular endothelial growth factor-neutralizing antibodies, dominant-negative Akt, or NO synthase inhibition. Conclusions-These results indicate that NGF plays a functional role in reparative neovascularization. Furthermore, supplementation of the growth factor promotes angiogenesis through a vascular endothelial growth factor-Akt-NOmediated mechanism. In the setting of ischemia, potentiation of NGF pathway stimulates angiogenesis and arteriogenesis, thereby accelerating hemodynamic recovery. NGF might be envisaged as a utilitarian target for the treatment of ischemic vascular disease.

Cell-cell communication between cardiac and vascular cells and from stem and progenitor cells to differentiated cardiovascular cells is both an important and complex process, achieved through a diversity of mechanisms that have an impact on cardiovascular biology, disease and therapeutics. In recent years, evidence has accumulated suggesting that extracellular vesicles (EVs) are a new system of intercellular communication. EVs of different sizes are produced via different biogenesis pathways and have been shown to be released and taken up by most of known cell types, including heart and vascular cells, and stem and progenitor cells. This review will focus on exosomes, the smallest EVs (up to 100 nm in diameter) identified so far. Cells can package cargoes consisting of selective lipids, proteins and RNA in exosomes and such cargoes can be shipped to recipient cells, inducing expressional and functional changes. This review focuses on exosomes and microRNAs in the context of cardiovascular disease and repair. We will describe exosome biogenesis and cargo formation and discuss the available information on in vitro and in vivo exosomes-based cell-to-cell communication relevant to cardiovascular science. The methods used in exosome research will be also described. Finally, we will address the promise of exosomes as clinical biomarkers and their impact as a biomedical tool in stem cell-based cardiovascular therapeutics.