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The Reverse Remodeling Effect of Mesenchymal Stem Cells Is Independent From the Site of Epimyocardial Cell Transplantation

Arsalan, Mani MD*; Dhein, Stefan MD, PhD; Aupperle, Heike VMD, PhD; Rastan, Ardawan Julian MD, PhD; Barten, Markus Jan MD, PhD; Walther, Thomas MD, PhD*; Mohr, Friedrich Wilhelm MD, PhD; Garbade, Jens MD, PhD

Innovations:Technology and Techniques in Cardiothoracic and Vascular Surgery: November/December 2013 - Volume 8 - Issue 6 - p 433–439
doi: 10.1097/IMI.0000000000000004
Original Articles

Objective The transplantation of mesenchymal stem cells (MSCs) represents a promising approach for treating the ischemic and the nonischemic diseased heart. The positive effects of transplanting these cells could be shown, but the exact mechanisms remain unknown. We evaluated whether the injection site affects the improvement in left ventricular (LV) ejection fraction (EF) and angiogenesis in doxorubicin (Dox)–induced failing hearts.

Methods Heart failure was induced in New Zealand white rabbits by doxorubicin treatment, followed by right ventricular MSC transplantation (RV-MSC, n = 6), LV MSC transplantation (LV-MSC, n = 6), sham treatment (sham group, n = 6), or no therapy (Dox group, n = 5). Healthy rabbits were used as control group (n = 8). Cells were isolated after bone marrow aspiration and transplanted locally into the ventricular myocardium. After 4 weeks, cardiac function and capillary density (CD31 staining) were measured.

Results The transplantation of MSCs increased the EF significantly (LV-MSC, 39.0% ± 1.4%, and RV-MSC, 39.2% ± 2.6%, vs sham group, 29.8% ± 3.7%; P < 0.001), without significance between the MSC groups (P = 0.858). Neither the evidence of a transdifferentiation nor any signs of cell engraftment of transplanted cells could be found. The capillary density (capillaries/high-power field) increased in both MSC groups compared with the sham group (LV-MSC by 8.3% ± 3.4%; and RV-MSC, 8.1% ± 2.2%; P < 0.05), without significance between the two MSC groups (P = 0.927).

Conclusions Injection of autologous MSCs in doxorubicin-induced cardiomyopathic rabbit hearts improves EF and enhances angiogenesis. Despite local application, we observed global effects on heart function and capillary density without significant difference between right and LV injection. The paracrine mechanism might be one possible explanation for these findings.

From the *Department of Cardiac Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany; †Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany; and ‡Institute of Veterinary Pathology, University of Leipzig, Faculty of Veterinary Medicine, Leipzig, Germany.

Accepted for publication July 12, 2013.

Heike Aupperle, VMD, PhD, is now with Laboklin GmbH, Bad Kissingen, Germany.

Presented at the Annual Scientific Meeting of the International Society for Minimally Invasive Cardiothoracic Surgery, June 8 – 11, 2011, Washington, DC USA.

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Disclosure: The authors declare no conflicts of interest.

Address correspondence and reprint requests to Mani Arsalan, MD, Kerckhoff-Klinik GmbH, Benekestrasse 2-8, D-61231 Bad Nauheim, Germany. E-mail:

©2013 by the International Society for Minimally Invasive Cardiothoracic Surgery