Guided cardiopoiesis enhances therapeutic benefit of bone marrow human mesenchymal stem cells in chronic myocardial infarction

Atta Behfar, Satsuki Yamada, Ruben Crespo-Diaz, Jonathan J. Nesbitt, Lois A. Rowe, Carmen Perez-Terzic, Vinciane Gaussin, Christian Homsy, Jozef Bartunek, Andre Terzic

Research output: Contribution to journalArticlepeer-review

212 Scopus citations


Objectives: The goal of this study was to guide bone marrow-derived human mesenchymal stem cells (hMSCs) into a cardiac progenitor phenotype and assess therapeutic benefit in chronic myocardial infarction. Background: Adult stem cells, delivered in their nave state, demonstrate a limited benefit in patients with ischemic heart disease. Pre-emptive lineage pre-specification may optimize therapeutic outcome. Methods: hMSC were harvested from a coronary artery disease patient cohort. A recombinant cocktail consisting of transforming growth factor-beta1, bone morphogenetic protein-4, activin A, retinoic acid, insulin-like growth factor-1, fibroblast growth factor-2, alpha-thrombin, and interleukin-6 was formulated to engage hMSC into cardiopoiesis. Derived hMSC were injected into the myocardium of a nude infarcted murine model and followed over 1 year for functional and structural end points. Results: Although the majority of patient-derived hMSC in their native state demonstrated limited effect on ejection fraction, stem cells from rare individuals harbored a spontaneous capacity to improve contractile performance. This reparative cytotype was characterized by high expression of homeobox transcription factor Nkx-2.5, T-box transcription factor TBX5, helixloophelix transcription factor MESP1, and myocyte enhancer factor MEF2C, markers of cardiopoiesis. Recombinant cardiogenic cocktail guidance secured the cardiopoietic phenotype across the patient cohort. Compared with unguided counterparts, cardiopoietic hMSC delivered into infarcted myocardium achieved superior functional and structural benefit without adverse side effects. Engraftment into murine hearts was associated with increased human-specific nuclear, sarcomeric, and gap junction content along with induction of myocardial cell cycle activity. Conclusions: Guided cardiopoiesis thus enhances the therapeutic benefit of bone marrow-derived hMSC in chronic ischemic cardiomyopathy.

Original languageEnglish (US)
Pages (from-to)721-734
Number of pages14
JournalJournal of the American College of Cardiology
Issue number9
StatePublished - Aug 24 2010


  • BMP
  • DNA
  • FGF
  • GMP
  • IGF
  • IL
  • PCR
  • TGF
  • bone morphogenetic protein
  • deoxyribonucleic acid
  • fibroblast growth factor
  • good manufacturing practice
  • hMSC
  • human mesenchymal stem cell
  • insulin-like growth factor
  • interleukin
  • mRNA
  • messenger ribonucleic acid
  • polymerase chain reaction
  • transforming growth factor

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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