Synergistic effects of combined cell therapy for chronic ischemic cardiomyopathy

Vasileios Karantalis, Viky Y. Suncion-Loescher, Luiza Bagno, Samuel Golpanian, Ariel Wolf, Cristina Sanina, Courtney Premer, Anthony J. Kanelidis, Frederic McCall, Bo Wang, Wayne Balkan, Jose Rodriguez, Marcos Rosado, Azorides Morales, Konstantinos Hatzistergos, Makoto Natsumeda, Irene Margitich, Ivonne Hernandez Schulman, Samirah A. Gomes, Muzammil MushtaqDarcy L. DiFede, Joel E. Fishman, Pradip Pattany, Juan Pablo Zambrano, Alan W. Heldman, Joshua M. Hare

Research output: Contribution to journalArticlepeer-review

126 Scopus citations


Background Both bone marrow-derived mesenchymal stem cells (MSCs) and c-kit+ cardiac stem cells (CSCs) improve left ventricular remodeling in porcine models and clinical trials. Using xenogeneic (human) cells in immunosuppressed animals with acute ischemic heart disease, we previously showed that these 2 cell types act synergistically. Objectives To more accurately model clinical applications for heart failure, this study tested whether the combination of autologous MSCs and CSCs produce greater improvement in cardiac performance than MSCs alone in a nonimmunosuppressed porcine model of chronic ischemic cardiomyopathy. Methods Three months after ischemia/reperfusion injury, Göttingen swine received transendocardial injections with MSCs alone (n = 6) or in combination with cardiac-derived CSCs (n = 8), or placebo (vehicle; n = 6). Cardiac functional and anatomic parameters were assessed using cardiac magnetic resonance at baseline and before and after therapy. Results Both groups of cell-treated animals exhibited significantly reduced scar size (MSCs -44.1 ± 6.8%; CSC/MSC -37.2 ± 5.4%; placebo -12.9 ± 4.2%; p < 0.0001), increased viable tissue, and improved wall motion relative to placebo 3 months post-injection. Ejection fraction (EF) improved (MSCs 2.9 ± 1.6 EF units; CSC/MSC 6.9 ± 2.8 EF units; placebo 2.5 ± 1.6 EF units; p = 0.0009), as did stroke volume, cardiac output, and diastolic strain only in the combination-treated animals, which also exhibited increased cardiomyocyte mitotic activity. Conclusions These findings illustrate that interactions between MSCs and CSCs enhance cardiac performance more than MSCs alone, establish the safety of autologous cell combination strategies, and support the development of second-generation cell therapeutic products.

Original languageEnglish
Pages (from-to)1990-1999
Number of pages10
JournalJournal of the American College of Cardiology
Issue number18
StatePublished - 3 Nov 2015
Externally publishedYes


  • cardiac
  • combination therapy
  • heart failure
  • mesenchymal stem cell


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