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(Circulation. 2009;119:281-289.)
© 2009 American Heart Association, Inc.

Molecular Cardiology

Multipotent Mesenchymal Stem Cells Acquire a Lymphendothelial Phenotype and Enhance Lymphatic Regeneration In Vivo

Claudius Conrad, MD, PhD; Hanno Niess; Ralf Huss, MD, PhD; Stephan Huber; Irene von Luettichau, MD, PhD; Peter J. Nelson, PhD; Harald C. Ott, MD; Karl-Walter Jauch, MD, PhD; Christiane J. Bruns, MD, PhD

From the Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (C.C., H.C.O.); Department of Surgery, University of Munich at Grosshadern, Munich, Germany (H.N., S.H., K.J., C.J.B.); Roche Diagnostics GmbH, Penzberg, Germany (R.H.); Department of Pediatrics, Munich University of Technology, Munich, Germany (I.v.L.): Medical Polyclinic, University of Munich, Munich, Germany (P.J.N.); and Department of Pathology, University of Munich, Munich, Germany (R.H.).

Correspondence to Claudius Conrad, MD, PhD, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114. E-mail CConrad1{at}partners.org

Received June 17, 2008; accepted October 23, 2008.

Background— The importance and therapeutic value of stem cells in lymphangiogenesis are poorly understood. We evaluated the potential of human and murine mesenchymal stem cells (MSCs) to acquire a lymphatic phenotype in vitro and to enhance lymphatic regeneration in vivo.

Methods and Results— We assessed the lymphendothelial differentiation of human and murine MSCs after induction with supernatant derived from human dermal microvascular endothelial cells, isolated lymphatic endothelial cells, and purified vascular endothelial growth factor (VEGF)-C in vitro. We used human or murine progenitor MSC lines and then characterized the lymphatic phenotype by morphology, migratory capacity, and the expression of lymphatic markers such as Prox-1, podoplanin, Lyve-1, VEGF receptor-2, and VEGF receptor-3. Using a murine lymphatic edema model, we assessed the potential of these cells to form a functional lymphatic vasculature in vivo after injection of syngeneic MSCs. Incubation with supernatant from lymphatic endothelial cells induced an endothelium-like morphology and the expression of lymphendothelial markers in both human and murine MSCs in vitro. MSCs showed migratory activity along a VEGF-C gradient, which was enhanced by VEGF-C conditioning. In vivo, the local application of MSCs resulted in a significant decrease in edema formation (–20.1%; P<0.01 versus untreated tails) after 3 weekly cell injections and restored the drainage of intradermally injected methylene blue after 7 weekly injections.

Conclusions— MSCs were capable of expressing a lymphatic phenotype when exposed to lymph-inductive media and purified VEGF-C. Migratory activity toward VEGF-C in vitro suggests homing capability in vivo. Restoration of lymphatic drainage after injection of MSCs in a lymphedema model indicates that MSCs play a role in lymphatic regeneration. The potential clinical application of MSC in wound healing and reduction of lymphatic edema warrants further research.

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Clinical Summaries
Circulation 2009 119: 201-203. [Extract] [Full Text]