New insights into the morphogenic role of stromal cells and their relevance for regenerative medicine. Lessons from the heart.

The term stromal cells is referred to cells of direct or indirect (hematopoietic) mesenchymal origin, and encompasses different cell populations residing in the connective tissue, which share the ability to produce the macromolecular components of the extracellular matrix and to organize them in the correct spatial assembly. In physiological conditions, stromal cells are provided with the unique ability to shape a proper three-dimensional scaffold and stimulate the growth and differentiation of parenchymal precursors to give rise to tissues and organs. Thus, stromal cells have an essential function in the regulation of organ morphogenesis and regeneration. In pathological conditions, under the influence of local pro-inflammatory mediators, stromal cells can be prompted to differentiate into myofibroblasts, which rather express a fibrogenic phenotype required for prompt deposition of reparatory scar tissue. Indeed, scarring may be interpreted as an emergency healing response to injury typical of evolved animals, like mammals, conceivably directed to preserve survival at the expense of function. However, under appropriate conditions, the original ability of stromal cells to orchestrate organ regeneration, which is typical of some lower vertebrates and mammalian embryos, can be resumed. These concepts underline the importance of expanding the knowledge on the biological properties of stromal cells and their role as key regulators of the three-dimensional architecture of the organs in view of the refinement of the therapeutic protocols of regenerative medicine

Notch signaling in ischemic damage and fibrosis: evidence and clues from the heart

Notch signaling is a major intercellular coordination mechanism highly conserved throughout evolution. In vertebrates, Notch signaling is physiologically involved in embryo development, including mesenchymal cell commitment, formation of heart tissues and angiogenesis. In post-natal life, Notch signaling is maintained as a key mechanism of cell–cell communication and its dysregulations have been found in pathological conditions such as ischemic and fibrotic diseases. In the heart, Notch takes part in the protective response to ischemia, being involved in pre- and post-conditioning, reduction of reperfusion-induced oxidative stress and myocardial damage, and cardiomyogenesis. Conceivably, the cardioprotective effects of Notch may depend on neo-angiogenesis, thus blunting lethal myocardial ischemia, as well as on direct stimulation of cardiac cells to increase their resistance to injury. Another post-developmental adaptation of Notch signaling is fibrosis: being involved in the orientation of mesenchymal cell fate, Notch can modulate the differentiation of pro-fibrotic myofibroblasts, e.g., by reducing the effects of the profibrotic cytokine TGF-β. In conclusion, Notch can regulate the interactions between heart muscle and stromal cells and switch cardiac repair from a pro-fibrotic default pathway to a pro-cardiogenic one. These features make Notch signaling a suitable target for new cardiotropic therapies

Human relaxin-2 (Serelaxin) attenuates oxidative stress in cardiac muscle cells exposed in vitro to hypoxia–reoxygenation. evidence for the involvement of reduced glutathione up-regulation

Serelaxin (RLX) designates the pharmaceutical form of the human natural hormone relaxin-2 that has been shown to markedly reduce tissue and cell damage induced by hypoxia and reoxygenation (HR). The evidence that RLX exerts similar protective effects on different organs and cells at relatively low, nanomolar concentrations suggests that it specifically targets a common pathogenic mechanism of HR-induced damage, namely oxidative stress. In this study we offer experimental evidence that RLX (17 nmol L-1), added to the medium of HR-exposed H9c2 rat cardiac muscle cells, significantly reduces cell oxidative damage, mitochondrial dysfunction and apoptosis. These effects appear to rely on the up-regulation of the cellular availability of reduced glutathione (GSH), a ubiquitous endogenous antioxidant metabolite. Conversely, superoxide dismutase activity was not influenced by RLX, which, however, was not endowed with chemical antioxidant properties. Taken together, these findings verify the major pharmacological role of RLX in the protection against HR-induced oxidative stress, and shed first light on its mechanisms of action

Relaxin, cardiac stem cells and heart regeneration

The notion that the adult heart of mammals including humans contain a small population of resident cardiac progenitor/stem cells (CSCs) have questioned the traditional paradigm of the myocardium as a post-mitotic terminally differentiated tissue. These cells, however, are relatively scarce and unable to be recruited in large number at the site of tissue damage. This has sparkled novel interest in the identification of molecules capable of stimulating the regenerative potentials of CSCs in their microenvironment. In this context, the peptide hormone relaxin (RLX), recently validated as a cardiovascular hormone, deserves a key place. This article summarizes the most recent findings of our group on the ability of RLX to modulate growth and differentiation of mouse neonatal cardiomyocytes, suggesting that this hormone, for which the heart is both a source and target organ, may participate in the endogenous mechanisms of myocardial repair/regeneration. Moreover, we have recently observed that RLX, by a Notch-1-mediated mechanism, inhibits cardiac myofibroblast differentiation and function, suggesting that the known anti-fibrotic effects of RLX may be part of a complex network of actions whereby this hormone facilitates cardiac stem cell growth and improves myocardial regeneration