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

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.

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

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

Validation of a biomechanical heart model using animal data with acute myocardial infarction

International audienceIn this paper, we validate a biomechanical heart model with animal data providing a controlled infarct condition with a follow-up over several weeks. First, we set up the personalized model using data coming from the healthy animal, and we show that the simulations compare accurately with the measured data, both for the tissue motion and for the blood pressures. Then, we demonstrate that we can also adequately represent the behavior of the acutely infarcted heart by changing only the parameters directly related to the pathology, and to the physiological state of the subject during the exams

Macrophages improve survival, proliferation and migration of engrafted myogenic precursor cells into MDX skeletal muscle.

Transplantation of muscle precursor cells is of therapeutic interest for focal skeletal muscular diseases. However, major limitations of cell transplantation are the poor survival, expansion and migration of the injected cells. The massive and early death of transplanted myoblasts is not fully understood although several mechanisms have been suggested. Various attempts have been made to improve their survival or migration. Taking into account that muscle regeneration is associated with the presence of macrophages, which are helpful in repairing the muscle by both cleansing the debris and deliver trophic cues to myoblasts in a sequential way, we attempted in the present work to improve myoblast transplantation by coinjecting macrophages. The present data showed that in the 5 days following the transplantation, macrophages efficiently improved: i) myoblast survival by limiting their massive death, ii) myoblast expansion within the tissue and iii) myoblast migration in the dystrophic muscle. This was confirmed by in vitro analyses showing that macrophages stimulated myoblast adhesion and migration. As a result, myoblast contribution to regenerating host myofibres was increased by macrophages one month after transplantation. Altogether, these data demonstrate that macrophages are beneficial during the early steps of myoblast transplantation into skeletal muscle, showing that coinjecting these stromal cells may be used as a helper to improve the efficiency of parenchymal cell engraftment

Pulmonary hemodynamic responses to inhaled NO in chronic heart failure depend on PDE5 G(-1142)T polymorphism

To evaluate the vasoconstrictor component of PH in CHF by investigating the hemodynamic response to inhaled nitric oxide (iNO) and to determine whether this response was influenced by the phosphodiesterase 5 gene (PDE5) G(1142)T polymorphism. CHF patients underwent right heart catheterization at rest and after 20 ppm of iNO and plasma cGMP and PDE5 G(1142)T polymorphism determinations. Of the 72 included CHF patients (mean age, 53±1 years; mean left ventricular ejection fraction, 29±1%; and mean pulmonary artery pressure, 25.5±1.3 mmHg), 54% had ischemic heart disease. Proportions of patients with the TT, GT, and GG genotypes were 39%, 42% and 19% respectively. Baseline hemodynamic characteristics were not significantly different across PDE5 genotype groups, although pulmonary capillary wedge pressure (PCWP) tended to be lower in the TT group (P=0.09). Baseline plasma cGMP levels were significantly lower in the TT than in the GG and GT patients. With iNO, PVR diminished in TT (-33%) but not GG (-1.6%) or GT (0%) patients (P=0.002); and PCWP increased more in TT than in GT (P<0.05) or GG (P<0.003) patients. The PDE5 G(-1142) polymorphism is therefore a major contributor to the iNO-induced PVR decrease in CHF

Human mesenchymal stem cells reprogram adult cardiomyocytes toward a progenitor-like state through partial cell fusion and mitochondria transfer: Cell fusion-mediated cardiomyocyte reprogramming.

International audienceBecause stem cells are often found to improve repair tissue including heart without evidence of engraftment or differentiation, mechanisms underlying wound healing are still elusive. Several studies have reported that stem cells can fuse with cardiomyocytes either by permanent or partial cell fusion processes. However, the respective physiological impact of these two processes remains unknown in part because of the lack of knowledge of the resulting hybrid cells. To further characterize cell fusion, we cocultured mouse fully differentiated cardiomyocytes with human multipotent adipose-derived stem (hMADS) cells as a model of adult stem cells. We found that heterologous cell fusion promoted cardiomyocyte reprogramming back to a progenitor-like state. The resulting hybrid cells expressed early cardiac commitment and proliferation markers such as GATA-4, myocyte enhancer factor 2C, Nkx2.5, and Ki67 and exhibited a mouse genotype. Interestingly, human bone marrow-derived stem cells shared similar reprogramming properties than hMADS cells but not human fibroblasts, which suggests that these features might be common to multipotent cells. Furthermore, cardiac hybrid cells were preferentially generated by partial rather than permanent cell fusion and that intercellular structures composed of f-actin and microtubule filaments were involved in the process. Finally, we showed that stem cell mitochondria were transferred into cardiomyocytes, persisted in hybrids and were required for somatic cell reprogramming. In conclusion, by providing new insights into previously reported cell fusion processes, our data might contribute to a better understanding of stem cell-mediated regenerative mechanisms and thus, the development of more efficient stem cell-based heart therapies. STEM CELLS 2011;29:812-824