073 Right Ventricle Contractile Reserve as a Pre-operative Tool for Assessing RV failure after Continuous Flow LVAD Implantation

IntroductionLatest generation continuous flow left ventricular assist devices (LVADs) have been proposed as an alternative to heart transplantation for end-stage heart failure. However, postoperative right ventricle (RV) dysfunction remains common and has a negative impact on prognosis. Purpose of our study was to identify echocardiographic or hemodynamic parameters that could predict early RV failure after LVAD implantation in patients with biventricular dysfunction.MethodsFourteen patients with biventricular dysfunction who have been evaluated for LVAD implantation were included. Right and left ventricular dysfunction were respectively defined as: tricuspid annular plane excursion < 16 mm (TAPSE) and LV ejection fraction < 35%. In all patients, preoperative measurements were obtained at rest. In 7 patients, right heart catheterization was performed simultaneously with increasing doses of dobutamine (15γ/Kg/min). Primary endpoint was death caused by right ventricle systolic dysfunction or need for right ventricle mechanical support within 30 days after surgery (RVSD+).ResultsMean recipient age was 58±7 years. Primary end-point (RVSD+) was noted in five patients. Preoperative demographic, echocardiographic and hemodynamic data were similar between RVSD+ and RVSD- patients (Table). Percent increase of TAPSE and systolic PAP between basal and high dobutamine dose was significantly lower in RVSD+ than in RVSD- patients.ConclusionPercent increase of TAPSE and systolic PAP induced by high dose dobutamine infusion might be two interesting criteria to assess RV contractile reserve and predict RV outcome after LVAD implantation in patient with biventricular dysfunction.Baseline Measurement (n=14)Change after Dobutamine infusion,% (n=7)RVSD-RVSD+pRVSD-RVSD+pN95TAPSE, mm14±214±20.955±526±20.03Systolic PAP, mmHg51±753±60.842±84±70.05Cardiac Output, l/min3.3±0.53.5±0.50.987±1093±470.7Pulm Vasc Res, Wood3.9±14.3±10.62±41-36±70.

Estimation of tissue contractility from cardiac cine-MRI using a biomechanical heart model

International audienceThe objective of this paper is to propose and assess an estimation procedure - based on data assimilation principles - well-suited to obtain some regional values of key biophysical parameters in a beating heart model, using actual Cine-MR images. The motivation is twofold: (1) to provide an automatic tool for personalizing the characteristics of a cardiac model in order to achieve predictivity in patient-specific modeling, and (2) to obtain some useful information for diagnosis purposes in the estimated quantities themselves. In order to assess the global methodology we specifically devised an animal experiment in which a controlled infarct was produced and data acquired before and after infarction, with an estimation of regional tissue contractility - a key parameter directly affected by the pathology - performed for every measured stage. After performing a preliminary assessment of our proposed methodology using synthetic data, we then demonstrate a full-scale application by first estimating contractility values associated with 6 regions based on the AHA subdivision, before running a more detailed estimation using the actual AHA segments. The estimation results are assessed by comparison with the medical knowledge of the specific infarct, and with late enhancement MR images. We discuss their accuracy at the various subdivision levels, in the light of the inherent modeling limitations and of the intrinsic information contents featured in the data

ISG15 Modulates Development of the Erythroid Lineage

Activation of erythropoietin receptor allows erythroblasts to generate erythrocytes. In a search for genes that are up-regulated during this differentiation process, we have identified ISG15 as being induced during late erythroid differentiation. ISG15 belongs to the ubiquitin-like protein family and is covalently linked to target proteins by the enzymes of the ISGylation machinery. Using both in vivo and in vitro differentiating erythroblasts, we show that expression of ISG15 as well as the ISGylation process related enzymes Ube1L, UbcM8 and Herc6 are induced during erythroid differentiation. Loss of ISG15 in mice results in decreased number of BFU-E/CFU-E in bone marrow, concomitant with an increased number of these cells in the spleen of these animals. ISG15-/- bone marrow and spleen-derived erythroblasts show a less differentiated phenotype both in vivo and in vitro, and over-expression of ISG15 in erythroblasts is found to facilitate erythroid differentiation. Furthermore, we have shown that important players of erythroid development, such as STAT5, Globin, PLC γ and ERK2 are ISGylated in erythroid cells. This establishes a new role for ISG15, besides its well-characterized anti-viral functions, during erythroid differentiation

Crosstalk Between Innate and T Cell Adaptive Immunity With(in) the Muscle

Growing evidence demonstrates a continuous interaction between the immune system and the skeletal muscle in inflammatory diseases of different pathogenetic origins, in dystrophic conditions such as Duchenne Muscular Dystrophy as well as during normal muscle regeneration. Although one component of the innate immunity, the macrophage, has been extensively studied both in disease conditions and during cell or gene therapy strategies aiming at restoring muscular functions, much less is known about dendritic cells and their primary immunological targets, the T lymphocytes. This review will focus on the dendritic cells and T lymphocytes (including effector and regulatory T-cells), emphasizing the potential cross talk between these cell types and their influence on the structure and function of skeletal muscle

Legal approach of the information in health

L'information constitue un besoin biologique et intellectuel indispensable à la survie des hommes. Cependant l'information demeure pour autant juridiquement une notion impalpable. A cette occasion, nous avons fait le choix d'étudier l'information sous l'angle de la santé. Dans le domaine de la santé, l'information, en tant que moyen de transmission entre les professionnels et les patients, fut pendant longtemps reléguée au second plan, voire même considérée comme non nécessaire et il faudra attendre la seconde moitié du 20e siècle, pour qu'une réaction ait lieu et que les individus fassent la demande d'une prise en charge plus équilibrée dans le domaine des échanges. Dans ce mouvement, le Droit a, bien entendu, joué un rôle non négligeable. Tant par la jurisprudence, que par la loi, il a accompagné la mutation relationnelle et le changement progressif de modèle. L'objectif de ces travaux est donc d'essayer d'appréhender ce que l'on entend par "information" dans le domaine de la santé. A notre sens, l'information constitue tout d'abord un outil de régulation car sous peine de sanctions, l'information doit circuler entre le patient et le praticien. L'information est également un outil d'appui de la relation de soins car les professions de santé peuvent être amenées à recourir à des outils de promotion leur permettant de venir toucher plus intimement le patient.The information constitute a biological and intellectual need indispensable to the survival of the Men. However the information remains for all that legally an impalpable notion. In this opportunity, we chose to study the information under the angle of the health. In the field of the health, the information, as means of transmission between the professionals and the patients, was relegated for a long time in the background, even considered as not necessity and it will be necessary to wait for the second half of the 20th century, so that a reaction takes place and so that the individuals made the request of a care more balanced in the field of the exchanges. In this movement, the right played, naturally, a not insignificant role. Both by the jurisprudence, and by the law, it accompanied the relational transformation and the progressive change of model. The objective of these works thus is to try to arrest what we understand by "information" in the field of the health. In our sense, the information constitutes first of all a tool of regulation because at the risk of penalties, the information has to circulate between the patient and the practitioner. The information is also a tool of support of the relation of care because health professions can be brought to resort to tools of promotion allowing them to come to touch more confidentially the patient

Mise en evidence d'un effet extra-surrenalien de l'ACTH sur l'insulinemie chez le lapin. Etude des variations circadiennes de l'insulinemie et de la reponse pancreatique a l'hyperglycemie provoquee

SIGLEINIST T 73789 / INIST-CNRS - Institut de l'Information Scientifique et TechniqueFRFranc

tCell to cell communication between adult cardiomyocytes and mesenchymal stem cells from human adipose tissue to improve cardiac cell therapy

La thérapie cellulaire pour le traitement de l'insuffisance cardiaque post-infarctus semble prometteuse même si le bénéfice fonctionnel observé actuellement en recherche clinique reste souvent limité. Parmi les différent types cellulaires utilisables, les cellules souches mésenchymateuses (MSC) reconnues pour leur capacité d'immunomodulation, de transdifférenciation et de sécrétion paracrine représentent un outil intéressant pour la régénération myocardique.L'objectif de ce travail a été de mieux comprendre les mécanismes mis en place par les MSC pour réparer le myocarde lésé afin de développer ensuite une stratégie visant à optimiser les effets thérapeutiques de la greffe de MSCs dans le cadre expérimental de l'insuffisance cardiaque post-infarctus. Pour cette étude, nous avons réalisé des cocultures entre cardiomyocytes adultes et les MSC dérivées du tissu adipeux, les cellules hMADS (human Multipotent Adipose Derived Stem cells) afin de mimer le microenvironnement cardiaque in vitro. Des travaux antérieurs à ma thèse réalisés au laboratoire avaient montré que la communication intercellulaire entre ces deux types cellulaires grâce à des structures nanotubulaires aboutissait à la reprogrammation du cardiomyocyte vers le stade progéniteur. Durant ma thèse, nous avons ensuite pu montrer in vitro, toujours grâce au système de coculture, que ce meme type de communication hetérologue via des connexions nanotubulaires constituées de f-actine et de tubuline, modifiait la sécrétion paracrine des cellules souches hMADS. Les cellules souches ainsi reprogrammées, par les échanges intercellulaires de matériel cardiaque améliorent de façon significative leur potentiel angiogénique et de chémoattraction in vitro. Le bénéfice sur les MSCs de la coculture a été confirmé dans le traitement de l'insuffisance cardiaque post-infarctus chez la souris. Dans ce modèle nous avons pu montré que les cellules souches cocultivées avaient un capacité de régénération myocardique nettement supérieures aux cellules souches naives et que l'amélioration fonctionnelle était associée à une stimulation de la vascularisation et de la mobilisation des progéniteurs cardiaques endogènes. Enfin, des résultats similaires ont été observés dans notre modèle préclinique d'ischémie-reperfusion myocardique porcin encourageant la poursuite des travaux de recherche basés sur la communication intercellulaire afin d'optimiser l'efficacité thérapeutique des cellules souches dans la reconstruction cardiaque..En conclusion, nos travaux ont mis en évidence que la communication intercellulaire entre les cardiomyocytes souffrants et les cellules souches conditionnent de façon importante les effets thérapeutiques des cellules souches et que la manipulation ex vivo de ces phénomènes pourrait constituer une approche pour optimiser la thérapie cellulaire cardiaque chez l'homme.Cell therapies represent one of the most promising approaches to rebuild damaged heart particularly those based on mesenchymal stem cells (MSC). These cells are known for their plasticity, immune privilege and strong self-renewal ability. Intramyocardial delivery of MSC ameliorates heart function after infarction in clinical studies but mechanisms by which MSC exert their therapeutic action is far from being understood and further investigations are required for improving the modest efficiency observed.The objective of this work was to better understand mechanisms by which MSC repair damaged myocardium in order to develop strategies optimizing their therapeutic effects. To mimic in vitro the microenvironment of an injured heart, we developed a species mismatch co-culture system consisting of terminally-differentiated cardiomyocytes (CM) and MSC from adipose tissue called hMADS for human Multipotent Adipose Derived Stem cells. Previous works in the laboratory showed that cell-to-cell communication processes between CM and hMADS involving tunnelling nanotubes (TNT) reprogram adult CM toward a progenitor-like state.During my PhD, we found that crosstalk between hMADS and CM through TNT altered the secretion by hMADS of cardioprotective soluble factors and thereby maximized the capacity of stem cells to promote angiogenesis and chemotaxis of bone-marrow multipotent cells. Additionally, engraftment experiments into mouse infracted hearts revealed that in vitro preconditioning of hMADS with CM increased the cell therapy efficacy of naive stem cells. Functional improvement was associated with higher angiogenesis and homing of bone marrow progenitor cells at the infarction site. Finally, similar results were observed in our preclinical study using a porcine model of myocardial infarction.In conclusion, our findings established the relationship between the paracrine regenerative action of MSC and the nanotubular croostalk with CM and emphasize that ex vivo manipulation of theses communication processes might be of interest for optimizing current cardiac cell therapies

La Thoracoscopie (indications en médecine humaine et perspectives en médecine vétérinaire )

LYON1-BU Santé (693882101) / SudocSudocFranceF

Evaluation de la survie immédiate et à moyen terme des patients ayant présenté un infarctus du myocarde compliqué d'un arrêt cardiorespiratoire

ROUEN-BU Médecine-Pharmacie (765402102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Direct regulation of BCL-2 by FLI-1 is involved in the survival of FLI-1-transformed erythroblasts

Rearrangement of the FLI-1 locus with ensuing overexpression of FLI-1 is an early event in Friend murine leukemia virus-induced disease. When overexpressed in primary erythroblasts, FLI-1 blocks erythropoeitin (Epo)-induced terminal differentiation and inhibits apoptosis normally induced in response to Epo withdrawal. We show here that the survival-inducing property of FLI-1 is associated with increased transcription of BCL-2. We further show that FLI-1 binds BCL-2 promoter sequences in transformed erythroblasts, and in vitro studies identify specific FLI-1-binding sites essential for the transactivation of the BCL-2 promoter by FLI-1. Analysis of FLI-1 mutants showed a correlation between the ability of FLI-1 to transactivate BCL-2 promoter sequences and their ability to inhibit apoptosis in the absence of Epo. Moreover, inhibitor studies confirmed the essential role of BCL-2 for FLI-1-transformed erythroblast survival. Finally, enforced expression of BCL-2 was sufficient to promote survival and terminal differentiation of erythroblasts in the absence of Epo. These results show that BCL-2 is an in vivo target of FLI-1 in FLI-1-transformed erythroblasts and that its deregulated expression is instrumental in the survival of these cells