Stem cell therapy is a promising tool to improve outcome after acute myocardial infarction (AMI), but needs to be optimized since results from clinical applications remain ambiguous. A potent source of stem cells is the stromal vascular fraction of adipose tissue (SVF), which contains high numbers of adipose derived stem cells (ASC). We hypothesized that: 1) intravenous injection can be used to apply stem cells to the heart. 2) Uncultured SVF cells are easier and safer when cultured ASCs. 3) Transplantation after the acute inflammation period of AMI is favorable over early injection. For this, AMI was induced in rats by 40min of coronary occlusion. One or seven days after AMI, rats were intravenously injected with vehicle, 5×10(6) uncultured rat SVF cells or 1×10(6) rat ASCs. Rats were analyzed 35 days after AMI. Intravenous delivery of both fresh SVF cells and cultured ASCs 7 days after AMI significantly reduced infarct size compared to vehicle. Similar numbers of stem cells were found in the heart, after treatment with fresh SVF cells and cultured ASCs. Importantly, no adverse effects were found after injection of SVF cells. Using cultured ASCs, however, 3 animals had shortness of breath, and one animal died during injection. In contrast to application at 7 days post AMI, injection of SVF cells 1 day post AMI resulted in a small but non-significant infarct reduction (p=0.35). Taken together, intravenous injection of uncultured SVF cells subsequent to the acute inflammation period, is a promising stem cell therapy for AMI.

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Substances from terrestrial plants and marine organisms have since long been recognized as important sources of bioactive substances. This has led to the development of a large variety of drugs to treat human diseases such as, among others, a number of antihypertensive, hypoglycemic, cardiovascular, antibiotic, and antineoplastic agents. More recently, the amazing biodiversity represented by the myriad of insect species has been realized to produce an equally exceptional source of bioactive chemicals with therapeutic potential. Many of these compounds serve as highly effective defensive and predatory chemicals and have enabled insects to survive for hundreds of millions of years and to diversify to the countless different species known today. As some of these chemicals possess meaningful pharmacological properties, they represent interesting candidates for new drug discovery and development programs. A few examples are substances with microcidal, cytotoxic, cytolytic, apoptotic, anti-angiogenic, or anticoagulant qualities. This paper addresses the significance of bioactive compounds from insects as lead compounds for producing new therapeutics.

Introduction Heart failure (HF) is an emerging epidemic with poor disease outcomes and differences in its prevalence, etiology and management between and within world regions. Hypertension (HT) and ischemic heart disease (IHD) are the leading causes of HF. In Suriname, South-America, data on HF burden are lacking. The aim of this Suriname Heart Failure I (SUHF–I) study, is to assess baseline characteristics of HF admitted patients in order to set up the prospective interventional SUHF-II study to longitudinally determine the effectiveness of a comprehensive HF management program in HF patients. Methods A cross-sectional analysis was conducted of Thorax Center Paramaribo (TCP) discharge data from January 2013-December 2015. The analysis included all admissions with primary or secondary discharge of HF ICD-10 codes I50-I50.9 and I11.0 and the following variables: patient demographics (age, sex, and ethnicity), # of readmissions, risk factors (RF) for HF: HT, diabetes mellitus (DM), smoking, and left ventricle (LV) function. T-tests were used to analyze continuous variables and Chi-square test for categorical variables. Differences were considered statistically significant when a p-value <0.05 is obtained. Results 895 patients (1:1 sex ratio) with either a primary (80%) or secondary HF diagnosis were admitted. Female patients were significantly older (66.2 ± 14.8 years, p < 0.01) at first admission compared to male patients (63.5 ± 13.7 years) and the majority of admissions were of Hindustani and Creole descent. HT, DM and smoking were highly prevalent respectively 62.6%, 38.9 and 17.3%. There were 379 readmissions (29.1%) and 7% of all admissions were readmissions within 30 days and 16% were readmissions for 31-365 day. IHD is more prevalent in patients from Asian descendant (52.2%) compared to African descendant (11.7%). Whereas, HT (39.3%) is more prevalent in African descendants compared to Asian descendants (12.7%). There were no statistically significant differences in age, sex, ethnicity, LV function and RFs between single admitted and readmitted patients. Conclusion RF prevalence, ethnic differences and readmission rates in Surinamese HF patients are in line with reports from other Caribbean and Latin American countries. These results are the basis for the SUHF-II study which will aid in identifying the country specific and clinical factors for the successful development of a multidisciplinary HF management program.

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Background Determining the effect of training on exercise capacity in chronic heart failure (CHF) patients is mainly done by measuring peak oxygen uptake (VO2 peak) through cardiopulmonary exercise testing (CPET) [1,2]. However, CPET is not always available, especially in low-and middle-income countries. On the contrary, the 6-minute walk test (6MWT), a simpler and inexpensive alternative can be utilized, even in low resource settings [2,3]. Moderate continuous intensity training (MCIT) is commonly recommended in CHF patients [4], but growing evidence demonstrates the superior benefits of high-intensity interval training (HIIT) on the exercise capacity [5,6]. However, the benefits are predominantly measured with the CPET and expressed in VO2 peak [1,2]. Especially for low resource settings, there is a need for studies describing the effect of HIIT in CHF patients using the 6MWT as an outcome measure. To the best of our knowledge, there is no systematic review on the effect of HIIT in CHF patients, measured solely with the 6MWT. Purpose This study aims to synthesize the literature on the effect of HIIT on the exercise capacity using the 6MWT in CHF patients. Methods We systematically searched within the PubMed, EBSCOhost, Cochrane and PEDro electronic databases to identify randomized controlled trials published until August 2020 with no date of publication or language restrictions. We included studies that met the following criteria: 1) a randomized controlled trial; 2) performed in a CHF population; 3) the use of the 6MWT as an outcome measure with a pre-and post-exercise measurement of the distance; 4) HIIT without the combination of another type of exercise training. The funnel plot was used to estimate publication bias and the Tool for the assEssment of Study qualiTy and reporting in EXercise (TESTEX) was used for quality assessment [7]. Results We found 169 studies, of which 164 were excluded for not meeting inclusion criteria, resulting in the inclusion of five studies (n=315, mean age = 61 years, 71.4% male). Three studies (n=163, mean age=58 years, 64.4% % male) used MCIT and two studies (n=152, mean age = 65 years, 78.5% male) usual care as the control group. The HIIT showed significant improvements on 6MWT distance (MD= 40.78 m; 95% CI 24.55–57.01; p value &lt;0.00001; I2=56%) compared to control groups (Figure 1). The funnel plot (Figure 2) shows asymmetry upon visual examination and could indicate presence of publication bias. The quality assessment score was between 10–12 points with an overall median score of 11.2. Conclusions The distance on the 6MWT significantly improves with HIIT compared to sedentary controls and MCIT. However, our results are based on a small number of studies with heterogeneity across the control groups. Nevertheless, this study does provide information for physical therapist from low-resource settings about the expected effect on the 6MWT, when providing HIIT to CHF patients. Funding Acknowledgement Type of funding sources: None.

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