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(Circulation. 2001;104:I-207.)
© 2001 American Heart Association, Inc.

Thoracic Transplantation and Ventricular Assist Devices

Cell Transplantation for the Treatment of Acute Myocardial Infarction Using Vascular Endothelial Growth Factor–Expressing Skeletal Myoblasts

Ken Suzuki, MD, PhD; Bari Murtuza, MA, FRCS; Ryszard T. Smolenski, MD, PhD; Ivan A. Sammut, PhD; Noriko Suzuki, MD; Yasufumi Kaneda, MD, PhD; Magdi H. Yacoub, FRS

Department of Cardiothoracic Surgery, Imperial College School of Medicine, Heart Science Centre, Harefield Hospital, Middlesex, UK, and the Division of Gene Therapy Science, Osaka University, Osaka, Japan (Y.K.).

Correspondence to Professor Sir Magdi H. Yacoub, Department of Cardiothoracic Surgery, Harefield Hospital, Harefield, Middlesex, UB9 6JH, UK. E-mail k.suzuki{at}ic.ac.uk

Background— Vascular endothelial growth factor (VEGF) is a promising reagent for inducing myocardial angiogenesis. Skeletal myoblast transplantation has been shown to improve cardiac function in chronic heart failure models by regenerating muscle. We hypothesized that transplantation of VEGF-expressing myoblasts could effectively treat acute myocardial infarction by providing VEGF-induced cardioprotection through vasodilatation in the early phase, followed by angiogenesis effects in salvaging ischemic host myocardium combined with the functional benefits of newly formed, skeletal myoblast-derived muscle in the later phase.

Methods and Results— Primary rat skeletal myoblasts were transfected with the human VEGF₁₆₅ gene using hemagglutinating virus of Japan-liposome with >95% transfection efficiency. Four million of these myoblasts (VEGF group), control-transfected myoblasts (control group), or medium only (medium group) was injected into syngeneic rat hearts 1 hour after left coronary artery occlusion. Myocardial VEGF-expression increased for 2 weeks in the VEGF group, resulting in enhanced angiogenesis without the formation of tumors. Grafted myoblasts had differentiated into multinucleated myotubes within host myocardium. Infarct size (33.3±1.4%, 38.1±1.4%, and 43.7±1.6% for VEGF, control, and medium groups, respectively; P=0.0005) was significantly reduced with VEGF treatment, and cardiac function improved in the VEGF group (maximum dP/dt: 4072.0±93.6, 3772.5±101.1, and 3482.5±90.6 mm Hg/s in the 3 groups, respectively; P=0.0011; minimum dP/dt: -504.2±68.5, -2311.3±57.0, and -2124.0±57.9 mm Hg/s, respectively; P=0.0008).

Conclusions— This combined strategy of cell transplantation with gene therapy could be of importance for the treatment of acute myocardial infarction.

Key Words: cells • transplantation • gene therapy • angiogenesis • myocardial infarction