Rationale Embryonic stem cells (ESCs) hold great promise for cardiac regeneration but are susceptible to various concerns. Recently, salutary effects of stem cells have been connected to exosome secretion. ESCs have the ability to produce exosomes however their effect in the context of the heart is unknown. Objective Determine the effect of ESC-derived exosome for the repair of ischemic myocardium and whether c-kit+ CPCs function can be enhanced with ESC exosomes Methods and Results This study demonstrates that mouse ESC derived exosomes (mES Ex) possess ability to augment function in infarcted hearts. mES Ex enhanced neovascularization, cardiomyocyte survival and reduced fibrosis post infarction consistent with resurgence of cardiac proliferative response. Importantly, mES Ex augmented cardiac progenitor cell (CPC) survival, proliferation and cardiac commitment concurrent with increased c-kit+ CPCs in vivo 8 weeks after in vivo transfer along with formation of bonafide new cardiomyocytes in the ischemic heart. miRNA array revealed significant enrichment of miR290–295 cluster and particularly miR-294 in ESC exosomes. The underlying basis for the beneficial effect of mES Ex was tied to delivery of ESC specific miR-294 to CPCs promoting increased survival, cell cycle progression and proliferation. Conclusions mES Ex provide a novel cell free system that utilizes the immense regenerative power of ES cells while avoiding the risks associated with direct ES or ES derived cell transplantation and risk of teratomas. ESC exosomes possess cardiac regeneration ability and modulate both cardiomyocyte and CPC based repair programs in the heart.

Rational Transplantation of human CD34+ stem cells to ischemic tissues has been associated with reduced angina, improved exercise time and reduced amputation rates in phase 2 clinical trials and has been shown to induce neo-vascularization in pre-clinical models. Previous studies have suggested that paracrine factors secreted by these pro-angiogenic cells are responsible, at least in part, for the angiogenic effects induced by CD34+ cell transplantation. Objective Our objective was to investigate the mechanism of CD34+ stem cell induced pro-angiogenic paracrine effects and to examine if exosomes, a component of paracrine secretion, are involved. Methods and Results Exosomes collected from the conditioned media of mobilized human CD34+ cells had the characteristic size (40–90 nm; determined via dynamic light scattering), cup-shaped morphology (electron microscopy), expressed exosome-marker proteins CD63, phosphatidylserine (flow cytometry) and TSG101 (immunoblotting), besides expressing CD34+ cell lineage marker protein, CD34. In vitro, CD34+ exosomes replicated the angiogenic activity of CD34+ cells by increasing endothelial cell viability, proliferation and tube formation on Matrigel. In vivo, the CD34+ exosomes stimulated angiogenesis in Matrigel plug and corneal assays. Interestingly, exosomes from CD34+ cells, but not from CD34+ cell-depleted mononuclear cells had angiogenic activity. Conclusions Our data demonstrate that human CD34+ cells secrete exosomes that have independent angiogenic activity both in vitro and in vivo. CD34+ exosomes may represent a significant component of the paracrine effect of progenitor-cell transplantation for therapeutic angiogenesis.

Abstract-Persistent inflammatory response has adverse effects on left ventricular (LV) function and remodeling following acute myocardial infarction. We hypothesized that suppression of inflammation with interleukin (IL)-10 treatment attenuates LV dysfunction and remodeling after acute myocardial infarction. After the induction of acute myocardial infarction, mice were treated with either saline or recombinant IL-10, and inflammatory response and LV functional and structural remodeling changes were evaluated. IL-10 significantly suppressed infiltration of inflammatory cells and expression of proinflammatory cytokines in the myocardium. These changes were associated with IL-10 -mediated inhibition of p38 mitogen-activated protein kinase activation and repression of the cytokine mRNA-stabilizing protein HuR. IL-10 treatment significantly improved LV functions, reduced infarct size, and attenuated infarct wall thinning. Myocardial infarction-induced increase in matrix metalloproteinase (MMP)-9 expression and activity was associated with increased fibrosis, whereas IL-10 treatment reduced both MMP-9 activity and fibrosis. Small interfering RNA knockdown of HuR mimicked IL-10 -mediated reduction in MMP-9 expression and activity in NIH3T3 cells. Moreover, IL-10 treatment significantly increased capillary density in the infarcted myocardium which was associated with enhanced STAT3 phosphorylation. Taken together, our studies demonstrate that IL-10 suppresses inflammatory response and contributes to improved LV function and remodeling by inhibiting fibrosis via suppression of HuR/MMP-9 and by enhancing capillary density through activation of STAT3. (Circ Res. 2009;104:e9-e18.)

Abstract-Myocardial infarction rapidly depletes the endogenous cardiac progenitor cell pool, and the inefficient recruitment of exogenously administered progenitor cells limits the effectiveness of cardiac cell therapy. Recent reports indicate that interactions between the CXC chemokine stromal cell-derived factor 1 and its receptor CXC chemokine receptor 4 (CXCR4) critically mediate the ischemia-induced recruitment of bone marrow-derived circulating stem/progenitor cells, but the expression of CXCR4 in cardiac progenitor cells is very low. Here, we studied the influence of hypoxia on CXCR4 expression in cardiac progenitor cells, on the recruitment of intravenously administered cells to ischemic heart tissue, and on the preservation of heart function in a murine myocardial infarction model. We found that hypoxic preconditioning increased CXCR4 expression in CLK (cardiosphere-derived, Lin Ϫ c-kit ϩ progenitor) cells and markedly augmented CLK cell migration (in vitro) and recruitment (in vivo) to the ischemic myocardium. Four weeks after surgically induced myocardial infarction, infarct size and heart function were significantly better in mice administered hypoxia-preconditioned CLK cells than in mice treated with cells cultured under normoxic conditions. Furthermore, these effects were largely abolished by the addition of a CXCR4 inhibitor, indicating that the benefits of hypoxic preconditioning are mediated by the stromal cell-derived factor 1/CXCR4 axis, and that therapies targeting this axis may enhance cardiac-progenitor cell-based regenerative therapy. Key Words: cardiac progenitor cells Ⅲ hypoxia Ⅲ CXCR4 Ⅲ cell migration Ⅲ myocardial infarction I schemic heart disease and consequent heart failure remain the leading cause of morbidity and mortality worldwide. 1 Traditional therapies, such as angioplasty and thrombolytic agents, can relieve only the cause of infarction; no existing medication or procedure can effectively replace cardiac scarring with functional contractile tissue. However, newer therapies that incorporate recently identified populations of progenitor cells may regenerate cardiac tissue directly by inducing neovasculogenesis and cardiogenesis. [2][3][4][5][6][7][8][9][10] Resident cardiac progenitor cells may be particularly suitable for resurrecting dead myocardium because they are endogenous components of the adult heart and appear to be responsible for the physiological and pathological turnover of cardiac myocytes and other cardiac cells. 11 Cardiac progenitor cells are self-renewing, clonogenic, and multipotent, giving rise to myocytes, vascular smooth muscle cells, endothelial cells, and neural crest cells. 2,6,12 Although cardiac progenitor cells may seem to be the obvious choice for cell-based cardiac repair, the success of this approach is determined, in part, by the same factors that cause the endogenous cardiac repair system to fail. Within a day of myocardial infarction (MI), 40% of resident cardiac progenitor cells are depleted, 8 and the barriers imposed by cardiac damage may ...