Potential repair by cell grafting or mobilizing endogenous cells holds particular attraction in heart disease, where the meager capacity for cardiomyocyte proliferation likely contributes to the irreversibility of heart failure. Whether cardiac progenitors exist in adult myocardium itself is unanswered, as is the question whether undifferentiated cardiac precursor cells merely fuse with preexisting myocytes. Here we report the existence of adult heart-derived cardiac progenitor cells expressing stem cell antigen-1. Initially, the cells express neither cardiac structural genes nor Nkx2.5 but differentiate in vitro in response to 5 -azacytidine, in part depending on Bmpr1a, a receptor for bone morphogenetic proteins. Given intravenously after ischemia͞reperfusion, cardiac stem cell antigen 1 cells home to injured myocardium. By using a Cre͞Lox donor͞ recipient pair (␣MHC-Cre͞R26R), differentiation was shown to occur roughly equally, with and without fusion to host cells. C ardiomyocytes can be formed, at least ex vivo, from diverse adult pluripotent cells (1-5). Apart from therapeutic implications and obviating ethical concerns aroused by embryonic stem cell lines, adult cardiac progenitor cells might provide an explanation distinct from cell cycle reentry, for the reported rare occurrence of cycling ventricular muscle cells (6). However, recent publications suggest the failure of certain stem cells' specification into neurons, skeletal muscle, and myocardium in vivo (7,8) and recommend greater conservatism in evaluating claims of adult stem cell plasticity, for cogent reasons (9-11).The rarity of cardiogenic conversion by endogenous hematopoietic cells (2, 12), requirements for intracardiac injection (3), or mobilization by cytokines (13), uncertain proof for myocytes of host origin in transplanted human hearts (14), and the confounding possibility of cell fusion after grafting in vivo (15, 16) highlight unsettled issues surrounding stem cell plasticity in heart disease. For donor cell types already in clinical studies, the predominant in vivo effect of bone marrow or endothelial progenitor cells may be neoangiogenesis, not cardiac specification (17, 18), and skeletal myoblasts, despite integration and survival, are confounded by arrhythmias, perhaps reflecting lack of transdifferentiation (19). These obstacles underscore the need to seek cardiac progenitor cells beyond the few known sources. Materials and MethodsFlow Cytometry and Magnetic Enrichment. A ''total'' cardiac population was isolated from 6-to 12-wk-old C57BL͞6 mice by coronary perfusion with 0.025% collagenase, as for viable adult mouse cardiomyocytes (20). More typically, a ''myocytedepleted'' population was prepared, incubating minced myocardium in 0.1% collagenase (30 min, 37°C), lethal to most adult mouse cardiomyocytes (20). Cells were then filtered through 70-m mesh. Bone marrow cells (21) were compared, with or without collagenase and filtration. Cells were labeled with stem cell antigen 1 (Sca-1)-phycoerythrin (PE), Sca-1-FITC, c-kit-PE; CD4-...

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We previously described a mouse model of fibrotic ischemia/ reperfusion cardiomyopathy (I/RC) arising from daily, brief coronary occlusion. One characteristic of I/RC was the prolonged elevation of monocyte chemoattractant protein 1 (MCP-1), which was obligate to its phenotype and may contribute to the uptake of bloodborne cells. Here we describe in I/RC hearts a population of small spindle-shaped fibroblasts that were highly proliferative and expressed collagen I and ␣-smooth muscle actin (myofibroblast markers), CD34 (a precursor marker), and CD45 (a hematopoietic marker). These cells represented 3% of all nonmyocyte live cells. To confirm the cells' bone marrow origin, chimeric mice were created by the rescue of irradiated C57BL/6 mice with marrow from ROSA26, a congenic line expressing lacZ. I/RC resulted in a large population of spindle-shaped fibroblasts containing lacZ. We postulated that the fibroblast precursors represented a developmental path for a subset of monocytes, whose phenotype we have shown to be influenced by serum amyloid P (SAP). Thus, we administered SAP in vivo, which markedly reduced the number of proliferative spindle-shaped fibroblasts and completely prevented I/RC-induced fibrosis and global ventricular dysfunction. By contrast, SAP did not suppress the inflammation or chemokine expression seen in I/RC. SAP, a member of the pentraxin family, binds to Fc␥ receptors and modifies the pathophysiological function of monocytes. Our data suggest that SAP interferes with assumption of a fibroblast phenotype in a subset of monocytes and that SAP may be an important regulator in the linkage between inflammation and nonadaptive fibrosis in the heart. fibrosis ͉ heart ͉ monocyte chemoattractant protein 1 ͉ monocytes ͉ serum amyloid P

Background-Neutrophil-induced cardiomyocyte injury requires the expression of myocyte intercellular adhesion molecule (ICAM)-1 and ICAM-1-CD11b/CD18 adhesion. We have previously demonstrated interleukin (IL)-6 activity in postischemic cardiac lymph; IL-6 is the primary stimulus for myocyte ICAM-1 induction. Furthermore, we found that induction of IL-6 mRNA occurred very early on reperfusion of the infarcted myocardium. We hypothesized that the release of a preformed upstream cytokine induced IL-6 in leukocytes infiltrating on reperfusion. Methods and Results-Constitutive expression of TNF-␣ and not IL-1␤ was demonstrated in the normal canine myocardium and was localized predominantly in cardiac mast cells. Mast cell degranulation in the ischemic myocardium was documented by demonstration of a rapid release of histamine and TNF-␣ in the cardiac lymph after myocardial ischemia. Histochemical studies with FITC-labeled avidin demonstrated degranulating mast cells only in ischemic samples of canine myocardium. Immunohistochemistry suggested that degranulating mast cells were the primary source of TNF-␣ in the ischemic myocardium. In situ hybridization studies of reperfused myocardium localized IL-6 mRNA in infiltrating mononuclear cells and in mononuclear cells appearing in the postischemic cardiac lymph within the first 15 minutes of reperfusion. Furthermore, isolated canine mononuclear cells incubated with postischemic cardiac lymph demonstrated significant induction of IL-6 mRNA, which was partially blocked with a neutralizing antibody to TNF-␣. Conclusions-Cardiac mast cells degranulate after myocardial ischemia, releasing preformed mediators, such as histamine and TNF-␣. We suggest that mast cell-derived TNF-␣ may be a crucial factor in upregulating IL-6 in infiltrating leukocytes and initiating the cytokine cascade responsible for myocyte ICAM-1 induction and subsequent neutrophilinduced injury. (Circulation. 1998;98:699-710.)

Myocardial ischemia followed by reperfusion promotes a complex series of inflammatory reactions as noted in a variety of large animal studies. With development of genetically altered mice, there is intense interest in developing murine models to study mechanisms operative in cardiovascular disease. We developed a mouse model to study coronary artery occlusion and reperfusion effects and the method required to perform these studies both acutely and chronically. In mice, we applied a left anterior descending coronary artery occlusion either permanently or for 30 or 60 min followed by reperfusion allowing flow through the previously occluded coronary artery bed. Reperfusion was documented visually as well as by using Doppler ultrasound and histopathological techniques. The area at risk (AAR) and infarct size (IS) were assessed by EVans blue dye and triphenyltetrazolium chloride staining with computerized planimetry using an image analysis software program. The infarct as percentage of AAR and IS as percentage of the left ventricle in 13 mice with permanent occlusion was 68.6 +/- 4.4 and 28.0 +/- 2.8%, respectively. Reperfusion after occlusions of 60 and 30 min resulted in a significant decrease in IS as a percentage of the AAR compared with permanent occlusion. Histological examination of the ischemic and reperfused myocardium shows infiltration of leukocytes into the ischemic region as well as contraction bands classically associated with reperfusion. This new model allows assessment of AAR, IS, cardiac function, and pathophysiology in the mouse. With the current technology to develop genetically altered mice for overexpression or targeted mutations of various genes, this model is used to understand the complex pathophysiology of ischemia and reperfusion injury.

Previous studies have shown that proinflammatory cytokines, such as tumor necrosis factor (TNF), are expressed after acute hemodynamic overloading and myocardial ischemia͞infarction. To define the role of TNF in the setting of ischemia͞infarction, we performed a series of acute coronary artery occlusions in mice lacking one or both TNF receptors. Left ventricular infarct size was assessed at 24 h after acute coronary occlusion by triphenyltetrazolium chloride (TTC) staining in wild-type (both TNF receptors present) and mice lacking either the type 1 (TNFR1), type 2 (TNFR2), or both TNF receptors (TNFR1͞TNFR2). Left ventricular infarct size as assessed by TTC staining was significantly greater (P < 0.005) in the TNFR1͞ TNFR2-deficient mice (77.2% ؎ 15.3%) when compared with either wild-type mice (46.8% ؎ 19.4%) or TNFR1-deficient (47.9% ؎ 10.6%) or TNFR2-deficient (41.6% ؎ 16.5%) mice. Examination of the extent of necrosis in wild-type and TNFR1͞TNFR2-deficient mice by anti-myosin Ab staining demonstrated no significant difference between groups; however, the peak frequency and extent of apoptosis were accelerated in the TNFR1͞TNFR2-deficient mice when compared with the wild-type mice. The increase in apoptosis in the TNFR1͞TNFR2-deficient mice did not appear to be secondary to a selective up-regulation of the Fas ligand͞receptor system in these mice. These data suggest that TNF signaling gives rise to one or more cytoprotective signals that prevent and͞or delay the development of cardiac myocyte apoptosis after acute ischemic injury.

To better define the specific function of Mac-1 (CD11b) versus LFA-1 (CD11a) and the other CD11 integrins in vivo, we have disrupted murine CD11b by targeted homologous recombination in embryonic stem cells and generated mice which are homozygous for a mutation in CD11b . A null mutation was confirmed by Southern blotting, RNase protection assay, immunohistochemistry, and flow cytometry. Neutrophils isolated from mice deficient in Mac-1 were defective in adherence to keyhole limpet hemocyanin-coated glass, iC3b-mediated phagocytosis, and homotypic aggregation. When challenged by thioglycollate intraperitoneally, Mac-1-deficient mice had similar levels of neutrophil accumulation in the peritoneal cavity at 1, 2, and 4 h. Treatment with mAb to LFA-1 blocked 78% of neutrophil accumulation in Mac-1-deficient mice and 58% in wild-type mice. Neutrophil emigration into the peritoneal cavity 16 h after the implantation of fibrinogen-coated disks was not reduced in Mac-1-deficient mice whereas neutrophil adhesion to the fibrinogen-coated disks was reduced by Ͼ 90%. Neutrophils from Mac-1-deficient mice also showed reduced degranulation. Our results demonstrate that Mac-1 plays a critical role in mediating binding of neutrophils to fibrinogen and neutrophil degranulation, but is not necessary for effective neutrophil emigration, which is more dependent upon LFA-1. ( J. Clin. Invest. 1997. 99:1340-1350.)