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Circulation Research. 2002;90:634-640
Published online before print March 7, 2002, doi: 10.1161/01.RES.0000014822.62629.EB
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(Circulation Research. 2002;90:634.)
© 2002 American Heart Association, Inc.

Clinical Research

Evidence for Cardiomyocyte Repopulation by Extracardiac Progenitors in Transplanted Human Hearts

Michael A. Laflamme, David Myerson, Jeffrey E. Saffitz, Charles E. Murry

From the Department of Pathology (M.A.L., D.M., C.E.M.), University of Washington, Seattle, Wash; Fred Hutchinson Cancer Research Center (D.M.), Seattle, Wash; and Departments of Pathology and Immunology (J.E.S.), Washington University School of Medicine, St. Louis, Mo.

Correspondence to Charles E. Murry, MD, PhD, Department of Pathology, Box 357470, Room D-514, Health Sciences Building, University of Washington, 1959 NE Pacific St, Seattle, WA 98195. E-mail murry@ u.washington.edu

Human myocardium has long been considered to have essentially no intrinsic regenerative capacity. Recent studies in rodent models, however, have suggested the presence of an extracardiac stem cell population, perhaps in bone marrow, that is capable of some reconstitution of cardiomyocytes after injury. To determine whether similar mechanisms exist in the human heart, we evaluated human female allograft hearts transplanted into male patients. The presence of Y chromosomes in cardiomyocytes would indicate these cells arose from the recipient, rather than the donor heart. We identified 5 male patients who had retained a female heart at least 9 months before death and necropsy. Remarkably, in each case, the transplanted heart contained a minute but readily detectable fraction of Y chromosome-positive cardiomyocytes. The mean percentage of cardiomyocytes arising from the host was estimated to be 0.04% with a median of 0.016%. Most Y-positive cardiomyocytes were associated with regions of acute rejection, suggesting such chimerism involves an injury event. Furthermore, the sole patient whose immediate cause of death was allograft rejection showed a much higher percentage of host-derived cardiomyocytes, up to 29% in local, 1-mm2 "hot spots." Thus, adult humans have extracardiac progenitor cells capable of migrating to and repopulating damaged myocardium, but this process occurs at very low levels.


Key Words: human cardiac allografts • stem cells • transdifferentiation • Y chromosome in situ hybridization • regeneration




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