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Clinical Research |
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
| Abstract |
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Key Words: human cardiac allografts stem cells transdifferentiation Y chromosome in situ hybridization regeneration
| Introduction |
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These findings in mouse models beg the question whether such mechanisms exist in the human heart. To address whether extracardiac progenitors give rise to cardiomyocytes, we chose to study human female-to-male cardiac transplants, because the presence of the Y chromosome in such hearts serves as an unambiguous extracardiac lineage marker. Moreover, experience in rodent models suggested that recruitment of bone marrow-derived precursors to the heart requires an injury event.4,5 This requirement should be met by transplant hearts, given the frequent occurrence of acute cellular rejection, chronic graft vascular disease (and resulting ischemic injury), and mechanical injury from routine surveillance biopsies to exclude rejection. Finally, based on animal evidence that such cells were likely rare,4 we chose to examine the large tissue blocks obtained at autopsy rather than the small tissue fragments obtained via surveillance biopsies. We report here the presence of a minute but readily detectable fraction of Y chromosome-positive cardiomyocytes (mean Y-positive percentage of 0.02% and median of 0.008%), thereby demonstrating very rare but definite replacement of the myocardium by cells of recipient origin. Correcting for the inherent false-positive rate of this technique as determined on male control hearts, we estimated a mean of
0.04% of cardiomyocytes to be of recipient origin.
While this manuscript was in the final stages of preparation, Quaini et al6 reported the discovery of Y-positive cardiomyocytes using confocal fluorescent microscopy on a similar series of human female-to-male cardiac transplant patients. In contrast to our own findings, these authors described a very remarkable degree of chimerism, estimating that a mean of 18% of the cardiomyocytes in their transplant hearts were of recipient origin. Although our own data confirm that the phenomenon of chimerism does occur, the much lower rate of incorporation has obviously different implications with regard to its physiological significance.
| Materials and Methods |
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The Y chromosome was detected by subsequent in situ hybridization with pY3.4,813 generously provided by Dr Y.F. Lau (University of California, San Francisco). The DNA probe was prepared from EcoRI-linearized plasmid, random prime-labeled with digoxigenin (DIG high-prime DNA labeling kit; Roche Diagnostics). Sections underwent repeated heat-induced epitope retrieval (sodium citrate buffer adjusted to pH 4.0 to 4.5), proteinase K digestion (0.01 µ g/mL at 37°C for 20 minutes in 200 mmol/L Tris-HCl, 300 mmol/L sodium acetate, 50 mmol/L EDTA, 1% SDS; pH 9.0), three brief rinses in 2x SSC (0.30 mol/L sodium chloride and 0.03 mol/L sodium citrate), and prehybridization (15 minutes at 40°C in 2x SSC with 50% deionized formamide and 0.1% Tween-20). Denaturation was performed at 98°C for 15 minutes with probe (600 pg/mL concentration, estimated by dot blot), in 2x SSC with 50% deionized formamide, 10% dextran sulfate, 0.1% Tween-20, and 400 µg/mL salmon sperm DNA. Overnight hybridization at 40°C was followed by a stringent wash (2x SSC with 50% formamide), also at 40°C. Detection was by peroxidase-conjugated sheep anti-digoxigenin antibody Fab fragments (1:100, Roche Diagnostics) and the chromagen diaminobenzidine. Nuclei were counterstained with hematoxylin with Scotts blue, and slides were coverslipped with Permount (Fisher).
Because the cardiac allografts typically contained large numbers of host-derived infiltrating leukocytes (containing Y chromosomes), rigorous criteria were used to determine whether a nucleus belonged to a cardiomyocyte. Nuclei had to be surrounded by red-colored, MF-20-stained cytoplasm and in the same focal plane as the MF-20-positive cytoplasm. Furthermore, cardiomyocytes had to be in a normal morphological relation to surrounding cardiomyocytes. Staining for the Y chromosome was regarded as positive if a punctate, dark brown signal was present within a given blue-stained nucleus and in the same focal plane. Y chromosome signals frequently showed an eccentric localization within the nucleus, both within cardiomyocytes and other cell types. The total count of Y-positive cardiomyocytes per section was determined by systematically raster-scanning the entire slide at x1000 magnification with an oil-immersion objective. The density of cardiomyocyte nuclei per section was determined by enumerating 30 square fields of 104-square microns each using a gridded ocular reticule at x1000. Fields were divided equally among subendocardial, midmyocardial, and subepicardial locations. The area of the section was quantitated by digital image analysis (Scion Image). The total number of cardiomyocyte nuclei per section was obtained by multiplying nuclear density times section area. Microscopic fields of interest were acquired via digital photography (Spot Diagnostic Instruments).
| Results |
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Remarkably, all sections examined except one (septal myocardium from patient 3);F2> contained unequivocal cardiomyocyte nuclei with a Y chromosome signal (see Figures 2 and 3 for representative examples). Overall, results for the 5 allograft hearts are summarized in Table 2. It should be noted that, although definite Y-positive cardiomyocytes could be found in virtually every specimen, these were extremely rare. The mean percentage of Y-positive cardiomyocytes was
0.02%, with a range of 0.005% to 0.07% and a median of 0.008%. Correcting for the false-negative rate as determined on the male control sections (47%), we estimated a mean of 0.04% of cardiomyocytes to be of recipient origin. In all instances, Y-positive cardiomyocytes appeared normally integrated and were morphologically indistinguishable from their Y-negative neighbors. No binucleated Y-positive cardiomyocytes were observed. One additional finding of interest was that, in contrast to the pattern of in situ hybridization noted in male control myocardium, the Y-positive cardiomyocytes in transplant hearts uniformly demonstrated a single punctate signal. (Compare inset of Figure 1B with insets of Figures 2 and 3).
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In general, Y-positive cardiomyocytes were quite widely distributed, with one notable exception. Myocardium from patient 5 (see Figure 3) showed an appreciably higher fraction of Y-positive cardiomyocytes (0.07%), and, in this case, they quite obviously coincided with foci of inflammation, signifying acute cellular rejection. Associated with rejection within the patients right ventricular myocardium were two "hot spots" with substantially higher densities of Y-positive cardiomyocytes, 14.5% and 10.8% (22 of 152 and 21 of 194 cardiomyocyte nuclei within a 1-mm-square area in each case). Because of the comparative rarity of Y-positive cardiomyocytes in the remaining subjects, no attempt was made to quantitate the "local" density of cardiomyocytes within these individuals. That said, where they occurred, Y-positive cardiomyocytes generally were in proximity to foci of acute rejection, as defined by the presence of inflammatory cell infiltrates. The converse was not true, however: in many areas, inflammation was widespread and the tissue was devoid of Y-positive cardiomyocytes (including portions of the myocardium in patient 4, who also demonstrated significant acute rejection; see Table 2).
Finally, in all sections, additional Y-positive cells were observed that would not appear to be either cardiomyocytes or leukocytes. Further studies to determine what cell types these represent are being undertaken.
| Discussion |
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In addition to those found in bone marrow, other cell types have been reported to give rise to cardiomyocytes. For example, Malouf et al16 reported that a cell line from rat liver transdifferentiated into cardiomyocytes after intramyocardial implantation. Clarke et al17 reported that neural stem cells transdifferentiated into cardiomyocytes, among other cell types, after implantation into blastocysts. Some investigators have proposed that skeletal myoblasts can transdifferentiate into cardiomyocytes after intramyocardial grafting, but detailed studies from our laboratory showed no transdifferentiation of either neonatal18 or adult skeletal muscle cells.19 Finally, Condorelli et al20 reported that neural stem cells and certain types of endothelial cells transdifferentiated into cardiomyocytes when cocultured with neonatal cardiomyocytes. Indeed, adult stem cells in general seem to have a much greater degree of multipotency than originally established.2124
As mentioned above, Quaini et al6 very recently reported that 18% of cardiomyocytes in transplanted hearts were derived from the host. Although our data confirm that this phenomenon of chimerism does occur, we found vastly lower fractions of host-derived cells (0.02% Y-positive myocytes, corresponding to
0.04% myocytes of recipient origin, a three orders of magnitude difference from the aforementioned study). In general terms, this enormous discrepancy could result from clinical differences in the patients under study or from technical differences in the ways the two estimates were derived. The only clinical parameter apparently different is the shorter interval between transplantation and death in their series versus our own. (We deliberately avoided cases with short transplant intervals, because we were concerned about the greater inflammatory infiltrate in these hearts leading to false-positive results; see below). The patients studied by Quaini et al6 had transplant-to-death intervals ranging from 4 to 552 days, versus the range of 9 to 50 months in our own series. Counterintuitively, they reported the highest rates of chimerism in patients who had their hearts the shortest time: 30% host-derived cardiomyocytes in three patients who died 4 to 28 days after transplantation (corresponding to
100 grams of new myocardium), versus 8% for their two patients at 396 and 552 days. Furthermore, they reported that the new cardiomyocytes were morphologically indistinguishable from host cells by posttransplant day 4. This would require that blast-to-adult myocyte differentiation exceeded normal development rates by several orders of magnitude. In contrast, previous studies from this laboratory have shown that neonatal rat cardiomyocytes hypertrophied at their normal developmental rate after grafting into the injured heart, taking >2 months to reach adult size.25 Finally, it is conceivable that immunosuppressive therapy could alter the rate of accumulation of chimerism. Because all the patients in the present series were on standard regimens, however, we would not expect this parameter to be substantially different between the patient population used by Quaini et al6 and our own. Further, a review of the clinical history of our own patient population did not reveal any additional pharmacological agents that would intuitively be expected to alter stem cell mobilization or differentiation (although this possibility is obviously impossible to totally exclude in human patients, given our current level of understanding). None of our transplant patients underwent cytotoxic chemotherapy, including patient 1 who expired from metastatic pancreatic cancer.
Although our data cannot definitively exclude a role for clinical variables, it seems more likely to us that technical differences underlie the vast difference in the results. Human cardiac allografts are infiltrated with a population of host-derived leukocytes within hours of engraftment, particularly macrophages and T lymphocytes, and cellular rejection is typically worst in the first year after transplantation. In female-to-male transplants, these leukocytes, of course, will contain Y chromosomes. To obtain a true count of cardiomyocyte chimerism, it is imperative that leukocyte nuclei not be mistaken for cardiomyocyte nuclei. To avoid this pitfall, we established very stringent criteria for identifying Y-positive cardiomyocytes (see Materials and Methods). Furthermore, our use of two chromagens detected at visible wavelengths permitted interpretation of the signals in a more familiar morphological context. This contrasts with the use of fluorescence microscopy by Quaini et al.6 Conventional microscopy offers much better detection of cell borders than does fluorescence microscopy, and identification of cell borders is critical in assigning a given nucleus to a cell type. We found a great many cases where leukocytes were sandwiched between cardiomyocytes and could have been misinterpreted as cardiomoycyte nuclei under fluorescent microscopy. Thus, it is possible that many of the chimeric cardiomyocytes reported by Quaini et al were actually leukocytes, misidentified as cardiomyocytes because of technical limitations. Finally, we note that in a much earlier attempt to use Y chromosome in situ hybridization to assess for transplant chimerism, Hruban et al26 were not able to detect any cardiomyocytes of recipient origin within two transplant hearts subsequently removed for graft failure. Given the extremely rare occurrence of such cells within our own series and the ease at which they could be overlooked, we can better reconcile the results of Hruban et al with our own.
Another observation of interest in the present study was that the Y-positive cardiomyocytes in the 5 transplant patients uniformly exhibited a single punctate in situ hybridization signal. This was not the case within male control myocardium, in which multiple Y chromosome signals were often observed within a single cardiomyocyte nucleus (see inset and multiple surrounding cardiomyocytes of Figure 1B). This observation of multiple Y chromosome signals within a given nucleus likely relates to nuclear polyploidy, a relatively common finding in adult human cardiomyocytes.27,28 Note that nonmyocytes within the male control hearts showed a single Y chromosome signal, consistent with their diploid status. The fact that all Y-positive nuclei in the transplanted hearts contained only a single hybridization signal raises the possibility that these cells may be exclusively diploid. This, in turn, could indicate a shorter lifespan as cardiomyocytes, reflective of their relatively recent origin from a mobilized progenitor cell type.
The existence of extracardiac stem cells capable of renewing myocardium represents a new paradigm for how the human heart, formerly viewed as essentially static in this regard, may respond to injury. In addition to determining the time course for such a phenomenon, obvious remaining questions of considerable interest include determination of the anatomic location of this stem cell population, whether such repopulation occurs in humans in other pathophysiological contexts (such as myocardial infarction), elucidation of the sequence of migration and transdifferentiation events, and whether this pathway is amenable to therapeutic intervention.
| Acknowledgments |
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Received January 24, 2002; revision received February 12, 2002; accepted February 15, 2002.
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A. Leri, J. Kajstura, and P. Anversa Cardiac Stem Cells and Mechanisms of Myocardial Regeneration Physiol Rev, October 1, 2005; 85(4): 1373 - 1416. [Abstract] [Full Text] [PDF] |
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M. H. Yamani, N. B. Ratliff, D. J. Cook, E. M. Tuzcu, Y. Yu, R. Hobbs, G. Rincon, C. Bott-Silverman, J. B. Young, N. Smedira, et al. Peritransplant Ischemic Injury Is Associated With Up-Regulation of Stromal Cell-Derived Factor-1 J. Am. Coll. Cardiol., September 20, 2005; 46(6): 1029 - 1035. [Abstract] [Full Text] [PDF] |
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D. L. Kraitchman, M. Tatsumi, W. D. Gilson, T. Ishimori, D. Kedziorek, P. Walczak, W. P. Segars, H. H. Chen, D. Fritzges, I. Izbudak, et al. Dynamic Imaging of Allogeneic Mesenchymal Stem Cells Trafficking to Myocardial Infarction Circulation, September 6, 2005; 112(10): 1451 - 1461. [Abstract] [Full Text] [PDF] |
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A. Deten, H. C. Volz, S. Clamors, S. Leiblein, W. Briest, G. Marx, and H.-G. Zimmer Hematopoietic stem cells do not repair the infarcted mouse heart Cardiovasc Res, January 1, 2005; 65(1): 52 - 63. [Abstract] [Full Text] [PDF] |
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M. Massa, V. Rosti, M. Ferrario, R. Campanelli, I. Ramajoli, R. Rosso, G. M. De Ferrari, M. Ferlini, L. Goffredo, A. Bertoletti, et al. Increased circulating hematopoietic and endothelial progenitor cells in the early phase of acute myocardial infarction Blood, January 1, 2005; 105(1): 199 - 206. [Abstract] [Full Text] [PDF] |
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E. Messina, L. De Angelis, G. Frati, S. Morrone, S. Chimenti, F. Fiordaliso, M. Salio, M. Battaglia, M. V.G. Latronico, M. Coletta, et al. Isolation and Expansion of Adult Cardiac Stem Cells From Human and Murine Heart Circ. Res., October 29, 2004; 95(9): 911 - 921. [Abstract] [Full Text] [PDF] |
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F. Fernandez-Aviles, J. A. San Roman, J. Garcia-Frade, M. E. Fernandez, M. J. Penarrubia, L. de la Fuente, M. Gomez-Bueno, A. Cantalapiedra, J. Fernandez, O. Gutierrez, et al. Experimental and Clinical Regenerative Capability of Human Bone Marrow Cells After Myocardial Infarction Circ. Res., October 1, 2004; 95(7): 742 - 748. [Abstract] [Full Text] [PDF] |
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M. Y. Flugelman and B. S. Lewis The promise of myocardial repair - towards a better understanding Eur. Heart J., September 1, 2004; 25(17): 1483 - 1485. [Full Text] [PDF] |
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D. A. Narmoneva, R. Vukmirovic, M. E. Davis, R. D. Kamm, and R. T. Lee Endothelial Cells Promote Cardiac Myocyte Survival and Spatial Reorganization: Implications for Cardiac Regeneration Circulation, August 24, 2004; 110(8): 962 - 968. [Abstract] [Full Text] [PDF] |
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H. C. Ott, S. Berjukow, R. Marksteiner, E. Margreiter, G. Bock, G. Laufer, and S. Hering On the fate of skeletal myoblasts in a cardiac environment: down-regulation of voltage-gated ion channels J. Physiol., August 1, 2004; 558(3): 793 - 805. [Abstract] [Full Text] [PDF] |
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A. Bayes-Genis, E. Muniz-Diaz, L. Catasus, M. Arilla, C. Rodriguez, J. Sierra, P. J. Madoz, and J. Cinca Cardiac chimerism in recipients of peripheral-blood and bone marrow stem cells Eur J Heart Fail, June 1, 2004; 6(4): 399 - 402. [Abstract] [Full Text] [PDF] |
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E. Hocht-Zeisberg, H. Kahnert, K. Guan, G. Wulf, B. Hemmerlein, T. Schlott, G. Tenderich, R. Korfer, U. Raute-Kreinsen, and G. Hasenfuss Cellular repopulation of myocardial infarction in patients with sex-mismatched heart transplantation Eur. Heart J., May 1, 2004; 25(9): 749 - 758. [Abstract] [Full Text] [PDF] |
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H. Reinecke, E. Minami, V. Poppa, and C. E. Murry Evidence for Fusion Between Cardiac and Skeletal Muscle Cells Circ. Res., April 2, 2004; 94(6): e56 - e60. [Abstract] [Full Text] [PDF] |
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L. G. MELO, A. S. PACHORI, D. KONG, M. GNECCHI, K. WANG, R. E. PRATT, and V. J. DZAU Gene and cell-based therapies for heart disease FASEB J, April 1, 2004; 18(6): 648 - 663. [Abstract] [Full Text] [PDF] |
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J. C. Chachques, C. Acar, J. Herreros, J. C. Trainini, F. Prosper, N. D'Attellis, J.-N. Fabiani, and A. F. Carpentier Cellular cardiomyoplasty: clinical application Ann. Thorac. Surg., March 1, 2004; 77(3): 1121 - 1130. [Abstract] [Full Text] [PDF] |
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I. M. Ghobrial, T. J. Bunch, N. M. Caplice, W. D. Edwards, D. V. Miller, and M. R. Litzow Fatal Coronary Artery Disease After Unrelated Donor Bone Marrow Transplantation Mayo Clin. Proc., March 1, 2004; 79(3): 403 - 406. [Abstract] [PDF] |
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Y. CHEN, Q. KE, Y. YANG, J. S. RANA, J. TANG, J. P. MORGAN, and Y.-F. XIAO Cardiomyocytes overexpressing TNF-{alpha} attract migration of embryonic stem cells via activation of p38 and c-Jun amino-terminal kinase FASEB J, December 1, 2003; 17(15): 2231 - 2239. [Abstract] [Full Text] [PDF] |
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H. M. Kvasnicka, C. Wickenhauser, J. Thiele, A. Deb, S. Wang, K. A. Skelding, D. Miller, D. Simper, and N. M. Caplice Quantifying Chimeric Cardiomyocytes * Response Circulation, August 26, 2003; 108 (8): e60 - e60. [Full Text] [PDF] |
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I. M. Barbash, P. Chouraqui, J. Baron, M. S. Feinberg, S. Etzion, A. Tessone, L. Miller, E. Guetta, D. Zipori, L. H. Kedes, et al. Systemic Delivery of Bone Marrow-Derived Mesenchymal Stem Cells to the Infarcted Myocardium: Feasibility, Cell Migration, and Body Distribution Circulation, August 19, 2003; 108(7): 863 - 868. [Abstract] [Full Text] [PDF] |
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Y. Zou, H. Takano, M. Mizukami, H. Akazawa, Y. Qin, H. Toko, M. Sakamoto, T. Minamino, T. Nagai, and I. Komuro Leukemia Inhibitory Factor Enhances Survival of Cardiomyocytes and Induces Regeneration of Myocardium After Myocardial Infarction Circulation, August 12, 2003; 108(6): 748 - 753. [Abstract] [Full Text] [PDF] |
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C. R. Cogle, S. M. Guthrie, R. C. Sanders, W. L. Allen, E. W. Scott, and B. E. Petersen An Overview of Stem Cell Research and Regulatory Issues Mayo Clin. Proc., August 1, 2003; 78(8): 993 - 1003. [Abstract] [PDF] |
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V. L. Souter, R. P. Kapur, D. R. Nyholt, K. Skogerboe, D. Myerson, C. C. Ton, K. E. Opheim, T. R. Easterling, L. E. Shields, G. W. Montgomery, et al. A Report of Dizygous Monochorionic Twins N. Engl. J. Med., July 10, 2003; 349(2): 154 - 158. [Full Text] [PDF] |
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S. Rangappa, J. W. C. Entwistle, A. S. Wechsler, and J. Y. Kresh Cardiomyocyte-mediated contact programs human mesenchymal stem cells to express cardiogenic phenotype J. Thorac. Cardiovasc. Surg., July 1, 2003; 126(1): 124 - 132. [Abstract] [Full Text] [PDF] |
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B. Leobon, I. Garcin, P. Menasche, J.-T. Vilquin, E. Audinat, and S. Charpak Myoblasts transplanted into rat infarcted myocardium are functionally isolated from their host PNAS, June 24, 2003; 100(13): 7808 - 7811. [Abstract] [Full Text] [PDF] |
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M. Rubart, K. B.S. Pasumarthi, H. Nakajima, M. H. Soonpaa, H. O. Nakajima, and L. J. Field Physiological Coupling of Donor and Host Cardiomyocytes After Cellular Transplantation Circ. Res., June 13, 2003; 92(11): 1217 - 1224. [Abstract] [Full Text] [PDF] |
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J. D. Dowell, M. Rubart, K. B.S. Pasumarthi, M. H. Soonpaa, and L. J. Field Myocyte and myogenic stem cell transplantation in the heart Cardiovasc Res, May 1, 2003; 58(2): 336 - 350. [Abstract] [Full Text] [PDF] |
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T. Reffelmann and R. A. Kloner Cellular cardiomyoplasty--cardiomyocytes, skeletal myoblasts, or stem cells for regenerating myocardium and treatment of heart failure? Cardiovasc Res, May 1, 2003; 58(2): 358 - 368. [Full Text] [PDF] |
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M. J. Goldenthal and J. Marin-Garcia Stem cells and cardiac disorders: an appraisal Cardiovasc Res, May 1, 2003; 58(2): 369 - 377. [Abstract] [Full Text] [PDF] |
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A. Luttun and P. Carmeliet De novo vasculogenesis in the heart Cardiovasc Res, May 1, 2003; 58(2): 378 - 389. [Abstract] [Full Text] [PDF] |
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P. Muller, M. Bohm, D. A. Taylor, R. Hruban, E. R. Rodriguez, and P. Goldschmidt-Clermont Chimerism as a Mechanism of Self-Repair * Response Circulation, March 11, 2003; 107 (9): e69 - e69. [Full Text] [PDF] |
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A. Deb, S. Wang, K. A. Skelding, D. Miller, D. Simper, and N. M. Caplice Bone Marrow-Derived Cardiomyocytes Are Present in Adult Human Heart: A Study of Gender-Mismatched Bone Marrow Transplantation Patients Circulation, March 11, 2003; 107(9): 1247 - 1249. [Abstract] [Full Text] [PDF] |
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B. E. Strauer and R. Kornowski Stem Cell Therapy in Perspective Circulation, February 25, 2003; 107(7): 929 - 934. [Full Text] [PDF] |
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N. M. Caplice and B. J. Gersh Stem Cells to Repair the Heart: A Clinical Perspective Circ. Res., January 10, 2003; 92(1): 6 - 8. [Full Text] [PDF] |
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G. Q. Daley, M. A. Goodell, and E. Y. Snyder Realistic Prospects for Stem Cell Therapeutics Hematology, January 1, 2003; 2003(1): 398 - 418. [Abstract] [Full Text] [PDF] |
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D. Orlic, J. M. Hill, and A. E. Arai Stem Cells for Myocardial Regeneration Circ. Res., December 13, 2002; 91(12): 1092 - 1102. [Abstract] [Full Text] [PDF] |
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H. Sauer, J. Hescheler, and M. Wartenberg Cardiac differentiation of mesenchymal stem cells in sex mis-matched transplanted hearts: self-repair or just a visit? Cardiovasc Res, December 1, 2002; 56(3): 357 - 358. [Full Text] [PDF] |
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P. Anversa, D. Torella, J. Kajstura, B. Nadal-Ginard, and A. Leri Myocardial regeneration Eur. Heart J. Suppl., November 1, 2002; 4(suppl_G): G67 - G71. [Abstract] [PDF] |
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P. Anversa, B. Nadal-Ginard, D. A. Taylor, P. J. Goldschmidt, R. Hruban, and E. R. Rodriguez Cardiac Chimerism: Methods Matter * Response Circulation, October 29, 2002; 106 (18): e129 - e131. [Full Text] [PDF] |
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D. A. Taylor, R. Hruban, E.R. Rodriguez, and P. J. Goldschmidt-Clermont Cardiac Chimerism as a Mechanism for Self-Repair: Does It Happen and If So to What Degree? Circulation, July 2, 2002; 106(1): 2 - 4. [Full Text] [PDF] |
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R. Glaser, M. M. Lu, N. Narula, and J. A. Epstein Smooth Muscle Cells, But Not Myocytes, of Host Origin in Transplanted Human Hearts Circulation, July 2, 2002; 106(1): 17 - 19. [Abstract] [Full Text] [PDF] |
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P. Muller, P. Pfeiffer, J. Koglin, H.-J. Schafers, U. Seeland, I. Janzen, S. Urbschat, and M. Bohm Cardiomyocytes of Noncardiac Origin in Myocardial Biopsies of Human Transplanted Hearts Circulation, July 2, 2002; 106(1): 31 - 35. [Abstract] [Full Text] [PDF] |
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K. B.S. Pasumarthi and L. J. Field Cardiomyocyte Cell Cycle Regulation Circ. Res., May 31, 2002; 90(10): 1044 - 1054. [Abstract] [Full Text] [PDF] |
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B. Nadal-Ginard and P. Anversa Chimera or Not Chimera? Circ. Res., May 17, 2002; 90 (9): e72 - e72. [Full Text] [PDF] |
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C.E. MURRY, M.L. WHITNEY, M.A. LAFLAMME, H. REINECKE, and L.J. FIELD Cellular Therapies for Myocardial Infarct Repair Cold Spring Harb Symp Quant Biol, January 1, 2002; 67(0): 519 - 526. [Abstract] [PDF] |
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