Stem Cell Factor Delivery into Heart Muscle After Heart Attack May Enhance Cardiac Repair and Reverse Injury


Stem Cell Factor or SCF is a small peptide that circulates throughout the bloodstream and eventually finds its way to the bone marrow where it summons bone marrow-based stem cells to the sight of injury for tissue repair purposes. Unfortunately, it takes injured tissues time to express SCF at high enough levels to recruit bone marrow stem cells to come and accelerate tissue healing. This is particularly the case in the heart after a heart attack. For this reason, scientists are trying to find new and better ways to increase SCF production in the damaged heart.

To that end, cardiologists at the Icahn School of Medicine at Mount Sinai have discovered that delivering SCF directly to damaged heart muscle after a heart attack seems to augment heart muscle repair and regenerate injured tissue.

“Our discoveries offer insight into the power of stem cells to regenerate damaged muscle after a heart attack,” said lead study author Kenneth Fish, Director of the Cardiology Laboratory for Translational Research, Cardiovascular Research Center, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai.

In this study, Fish and his colleagues used gene transfer to administer SCF to the heart shortly after inducing heart attacks in a pig model system in order to test its regenerative repair response. Fish and his coworkers developed a novel SCF gene transfer delivery system that stimulated the recruitment and expansion of adult cardiac stem cells directly to injury sites that reversed heart attack damage. In addition, the gene therapy improved cardiac function, decreased the death of heart muscle cells, increased regeneration of heart tissue blood vessels, and reduced the formation of heart tissue scarring.

“It is clear that the expression of the stem cell factor gene results in the generation of specific signals to neighboring cells in the damaged heart resulting in improved outcomes at the molecular, cellular, and organ level,” says Roger J. Haijar, senior study author and Director of the Cardiovascular Research Center at Mount Sinai. “Thus, while still in the early stages of investigation, there is evidence that recruiting this small group of stem cells to the heart could be the basis of novel therapies for halting the clinical deterioration in patients with advanced heart failure.”

The cell surface receptor for SCF is the c-Kit protein, and cells that possess the c-Kit protein are called c-Kit+ cells. c-Kit+ cells not only respond to SCF, but serve as resident cardiac stem cells that naturally increase in numbers after a heart attack and through cell proliferation are directly involved in cardiac repair.

To date, there is a great need for new interventional strategies for cardiomyopathy to prevent the progression of this disease to heart failure. Heart disease is the number one cause of death in the United States, with cardiomyopathy or an enlarged heart from heart attack or poor blood supply due to clogged arteries being the most common cause of the condition. Cardiomyopathy also causes a loss of heart muscle cells and changes in heart shape, which lead to the heart’s decreased pumping efficiency.

“Our study shows our SCF gene transfer strategy can mobilize a promising adult stem cell type to the damaged region of the heart to improve cardiac pumping function and reduce myocardial infarction sizes resulting in improved cardiac performance and potentially increase long-term survival and improve quality of life in patients at risk of progressing to heart failure,” says Dr. Fish.

“This study adds to the emerging evidence that a small population of adult stem cells can be recruited to the damaged areas of the heart and improve clinical outcomes,” says Dr. Hajjar.

A Home A Stem Cell Could Love


In our bodies, stem cell populations live in specific places that are specially designed to accommodate them known as “stem cell niches.” Stem cell niches host and maintain stem cell populations, but the dependence of particular stem cells on their niche varies. For example, in the fruit fly, Drosophila melanogaster, the germ line stem cell niche can drive stem cells that have already begun to differentiate to revert into undifferentiated stem cells (see Brawley C and Matunis E. Science 2004;304:1331–4 and Kai T and Spradling A. Nature 2004;428:564–9). However, hair follicle stem cells do not revert when they return to their niche even if this niche has been depleted of stem cells (see Hsu Y-C, Pasolli HA, Fuchs E. Cell 2011;144:92–105). Also, blood cell-making stem cells that normally live in bone marrow can leave their niche in the bone marrow without losing their stem cell properties (Cao Y-A, et al., Proc Natl Acad Sci USA 2004;101:221–6). Finally, neural stem cells can exist and even self-renew outside their niche (Conti L, et al., PLoS Biol 2005;3:e283).

In order to properly grow stem cells in culture and manipulate them for therapeutic purposes, scientists have attempted to recapitulate stem cell niches in culture but only with very limited success.

Nevertheless, trying to get stem cells that have been introduced into a patient’s to engraft or make the new body their home has required a better understanding of stem cell niches.

To that end, Professor Claudia Waskow and her colleagues at the Technische Universität Dresden in Germany have utilized a downright ingenious method to make a mouse that can support the transplantation of human blood stem cells. This is despite the species barrier and, these mice do not need to have their own resident stem cell population obliterated with radiation.

How did Waskow and others do this? They used a mutation of a receptor called the “Kit receptor” to facilitate the engraftment of human cells. “What is the Kit receptor,” you ask? The Kit receptor is a protein in the membranes of blood stem cells that binds a soluble protein called stem cell factor (SCF). Stem cell factor drives certain types of blood cells to grow, and also mediates stem cells survival, proliferation and differentiation. Activation of the Kit receptor can also cause blood stem cells to leave the bone marrow and move into the peripheral circulation.

The Kit Receptor - AKA CD117
The Kit Receptor – AKA CD117

In the mouse model system designed by Waskow and others, the human blood stem cells grow and even differentiate into all blood-specific cell types without any additional treatment, and this includes the cells of the innate immune system. This is a milestone discovery because such cells normally do not form properly in “humanized” mice, but in Waskow’s experiment, these immune cells were efficiently generated. Significantly, these transplanted stem cells can be maintained in the mouse over a longer period of time compared to previously existing mouse models.

“Our goal was to develop an optimal model for the transplantation and study of human blood stem cells,” says Claudia Waskow, who recently took office of the professorship for “animal models in hematopoiesis” at the medical faculty of the TU Dresden. Before, coming to TU Dresden, Dr. Waskow was a group leader at the DFG-Center for Regenerative Therapies Dresden where most of the study was conducted.

Waskow’s team used a naturally occurring mutation of the Kit receptor and introduced it into her laboratory mice that lacked a functional immune system. This circumvented the two major obstacles of blood stem cell transplantation: the rejection by the recipient’s immune system and absence of free niche space for the incoming donor stem cells in the recipient’s bone marrow. Typically, the animal or the patient is treated with radiation to deplete the bone marrow of resident stem cells. This step, known as conditioning, creates usable space in the bone marrow for the implanted stem cells to take up residence and set up shop. However, irradiation is toxic a whole host of different cell types, not just bone marrow stem cells, and, unfortunately, has several strong side effects.

This Kit mutation in the mouse modifies the stem cell niche of the recipient mouse so that the resident stem cells are easily displaced by the human donor stem cells that possess a functional Kit receptor. This replacement works so well that irradiation was unnecessary, which allowed the study of human blood development in a physiological setting.

Waskow would like to use this new model system to study diseases of the human blood and immune system or to test new treatment options.

These data show that the Kit receptor (also known as CD117) is important for the function of human blood stem cells in a transplantation setting. Further work will concentrate on applying this new knowledge about the role of the receptor to improve conditioning therapy in bone marrow transplantation patients.

A New Blood Vessel-Generating Stem Cell Discovered With Therapeutic Potential


The laboratory of Petri Salven at the University of Helsinki, Helsinki, Finland, has discovered a new type of stem cell that play a decisive role in the growth of new blood vessels. These stem cells are found in the walls of blood vessels and if protocols are developed to isolated these stem cells, they might very well provide news ways to treat cardiovascular diseases, cancer and many other diseases.

The growth of new blood vessels is known angiogenesis. Angiogenesis is required for the repair of damaged tissues or organs. A downside of angiogenesis is that tumors often secrete angiogenic factors that induce the circulatory system to remodel itself so that new blood vessels grow into the tumor and feed it so that it can grow faster. Thus angiogenesis research tries to promote the growth of new blood vessels when they are needed and inhibit angiogenesis when it is unwanted.

Several drugs that inhibit angiogenesis have been introduced as adjuvant cancer treatments. For example, the drug bevacizumab (Avastin) is a monoclonal antibody that specifically recognizes and binds to an angiogenic factor known as vascular endothelial growth factor or VEGF. When VEGF receptors on the surface of normal endothelial cells. When VEGF binds to receptors on the surfaces of endothelial cells, a signal is sent within those cells that initiate the growth and survival of new blood vessels. Bevacizumab binds tightly to VEGF, which prevents it from binding and activating the VEGF receptor.

Other angiogenesis inhibitors include sorafenib (Nexavar) and sunitinib (Sutent), which are small molecular inhibitors of the receptors that bind the angiogenic factors and the downstream targets of those receptors. Unfortunately, the present crop of angiogenesis inhibitors are not all that effective under certain conditions and they are also extremely expensive and have some very undesirable side effects.

Professor Salven has studied angiogenesis for some time, and his research has focused on the endothelial cells that compose blood vessels. Where do these cells come from and how can we make more or less of them as needed?

A long-standing assumption by scientists in the angiogenesis field was that new endothelial cells came from stem cells found in the bond marrow. This assumption makes sense since there are several stem cell populations in bone marrow that express blood vessel markers and can form blood vessels in culture. However, in 2008, Salven’s group published a paper that demonstrated that new endothelial cells could not come from bone marrow stem cells (see Purhonen S, et al., (2008). Proc Natl Acad Sci U S A. 105(18): 6620-5). Therefore, the mystery remained – from where do new endothelial cells come?

Salven has recently solved this conundrum in his recent paper that appeared in PLoS Biology. According to Salven, “We succeeded in isolating endothelial cells with a high rate of division in the blood vessels of mice. We found that these same cells in human blood vessels and blood vessels growing in malignant tumors in humans. These cells are known as vascular endothelial stem cells, abbreviated VESC. In a cell culture, one such cell is able to produce tends of millions of new blood vessels wall cells.”

Slaven continued: “Our study found that these important stem cells can be found as single cells among the ordinary endothelial cells in blood vessel walls. When the process of angiogenesis is launched, these cells begin to produce new blood vessel wall cells.”

Salven’s colleagues have tested the effects of these new endothelial cells in mice. A particular mouse strain that carries a mutation in the c-kit gene was examined in these experiments. The c-kit gene encodes a cell surface protein called CD117, which is a vital element in the cells that form blood vessels. IN these c-kit mutant mice, new growth of new blood vessels was very poor and the growth of malignant tumors was also quite poor. However, if new stem cells from animals that did not possess a mutation in the c-kit gene were implanted into these mutant mice, blood vessels quickly formed.

As previously mentioned, the cell surface protein CD117 does seem to mark VESCs, but other cells other than VESCs have CD117 on their surfaces. Therefore, isolating all CD177-expression cells only enriches preparations for VESCs; it does not isolate VESCs. Presently, Salven and his group are searching for better surface molecules that can be used to more effectively isolated VESCs from surrounding tissue. If this isolation succeeds, then it will be possible to isolated and propagate VESCs from patients with cardiovascular diseases and expand them in culture for therapeutic purposes.

Another potentially fertile field of research is to find a way to inhibit the activity of VESCs to prevent tumors from remodeling the circulatory system. By cutting of their blood supply, tumors will not only grow slower, but also not spread nearly as quickly.

See: Fang S, Wei J, Pentinmikko N, Leinonen H, Salven P (2012) Generation of Functional Blood Vessels from a Single c-kit+ Adult Vascular Endothelial Stem Cell. PLoS Biol 10(10): e1001407. doi:10.1371/journal.pbio.1001407