Name: coronary progenitor cells and soluble biomarkers in cardiovascular prognosis after coronary angioplasty
Uploaded: 2020-01-28T13:00:00
Description: Watch this Scientific Journal Video about Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty at JoVE.com

The authors thank the support of Institutional Program E015; and Fondo Sectorial FOSSIS-CONACYT, SALUD-2014-1-233947.

This protocol meets the institutional guidelines from the human research Ethics Committee.
1. Coronary Angiography, Ultrasound, and Blood Sampling
<ol>
	<li>Request baseline clinical and demographic information before coronary intervention. Collect the individual&#39;s data: age, sex, current smoking status, body mass index (BMI), high blood pressure, dyslipidemia, diabetes mellitus, medications, and the indication for current coronary angiography.</li>
	<li>Perform coronary angiography thro...

<ol>
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S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endothelial+progenitor+cells:+novel+biomarker+and+promising+cell+therapy+for+cardiovascular+disease.">Endothelial progenitor cells: novel biomarker and promising cell therapy for cardiovascular disease.</a> Clinical Science (Lond). 120 (7), 263-283 (2011).</li><li>Samman Tahhan, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Progenitor+Cells+and+Clinical+Outcomes+in+Patients+With+Acute+Coronary+Syndromes.">Progenitor Cells and Clinical Outcomes in Patients With Acute Coronary Syndromes.</a> Circulation Research. 122 (11), 1565-1575 (2018).</li><li>Tomuli&#263;, V., Gobi&#263;, D., Luli&#263;, D., &#381;idan, D., Zaputovi&#263;, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Soluble+adhesion+molecules+in+patients+with+acute+coronary+syndrome+after+percutaneous+coronary+intervention+with+drug-coated+balloon,+drug-eluting+stent+or+bare+metal+stent.">Soluble adhesion molecules in patients with acute coronary syndrome after percutaneous coronary intervention with drug-coated balloon, drug-eluting stent or bare metal stent.</a> Medical Hypotheses. 95, 20-23 (2016).</li><li>Jaumdally, R., Varma, C., Macfadyen, R. J., Lip, G. Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Coronary+sinus+blood+sampling:+an+insight+into+local+cardiac+pathophysiology+and+treatment?.">Coronary sinus blood sampling: an insight into local cardiac pathophysiology and treatment?.</a> European Heart Journal. 28 (8), 929-940 (2007).</li><li>Kremastinos, D. T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intracoronary+cyclic-GMP+and+cyclic-AMP+during+percutaneous+transluminal+coronary+angioplasty.">Intracoronary cyclic-GMP and cyclic-AMP during percutaneous transluminal coronary angioplasty.</a> International Journal of Cardiology. 53 (3), 227-232 (1996).</li><li>Karube, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Measurement+of+cytokine+levels+by+coronary+sinus+blood+sampling+during+cardiac+surgery+with+cardiopulmonary+bypass.">Measurement of cytokine levels by coronary sinus blood sampling during cardiac surgery with cardiopulmonary bypass.</a> American Society for Artificial Internal Organs Journal. 42 (5), M787-M791 (1996).</li><li>Truong, Q. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Coronary+sinus+biomarker+sampling+compared+to+peripheral+venous+blood+for+predicting+outcomes+in+patients+with+severe+heart+failure+undergoing+cardiac+resynchronization+therapy:+the+BIOCRT+study.">Coronary sinus biomarker sampling compared to peripheral venous blood for predicting outcomes in patients with severe heart failure undergoing cardiac resynchronization therapy: the BIOCRT study.</a> Heart Rhythm. 11 (12), 2167-2175 (2014).</li><li>Su&#225;rez-Cuenca, J. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Coronary+circulating+mononuclear+progenitor+cells+and+soluble+biomarkers+in+the+cardiovascular+prognosis+after+coronary+angioplasty.">Coronary circulating mononuclear progenitor cells and soluble biomarkers in the cardiovascular prognosis after coronary angioplasty.</a> Journal of Cellular and Molecular Medicine. 23 (7), 4844-4849 (2019).</li><li>Su&#225;rez-Cuenca, J. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Relation+of+Coronary+Artery+Lumen+with+Baseline,+Post-angioplasty+Coronary+Circulating+Pro-Inflammatory+Cytokines+in+Patients+with+Coronary+Artery+Disease.">Relation of Coronary Artery Lumen with Baseline, Post-angioplasty Coronary Circulating Pro-Inflammatory Cytokines in Patients with Coronary Artery Disease.</a> Angiology Open Access. 7, 01 (2019).</li><li>Schmidt-Lucke, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Quantification+of+circulating+endothelial+progenitor+cells+using+the+modified+ISHAGE+protocol.">Quantification of circulating endothelial progenitor cells using the modified ISHAGE protocol.</a> PLoS One. 5 (1), e13790 (2010).</li><li>Moyer, C. F., Sajuthi, D., Tulli, H., Williams, J. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Synthesis+of+IL-1+alpha+and+IL-1+beta+by+arterial+cells+in+atherosclerosis.">Synthesis of IL-1 alpha and IL-1 beta by arterial cells in atherosclerosis.</a> American Journal of Pathology. 138 (4), 951-960 (1991).</li><li>Morales-Portano, J. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Echocardiographic+measurements+of+epicardial+adipose+tissue+and+comparative+ability+to+predict+adverse+cardiovascular+outcomes+in+patients+with+coronary+artery+disease.">Echocardiographic measurements of epicardial adipose tissue and comparative ability to predict adverse cardiovascular outcomes in patients with coronary artery disease.</a> International Journal of Cardiovascular Imaging. 34 (9), 1429-1437 (2018).</li><li>Huang, X., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endothelial+progenitor+cells+correlated+with+oxidative+stress+after+mild+traumatic+brain+injury.">Endothelial progenitor cells correlated with oxidative stress after mild traumatic brain injury.</a> Yonsei Medical Journal. 58 (5), 1012-1017 (2017).</li></ol>

Blood collection from the affected coronary artery may be difficult. Sometimes, the coronary artery is barely accessible. In this case, sampling from the venous sinus may be an alternative. We performed validation tests comparing circulating biomarkers in coronary artery vs. venous sinus, with no significant differences. However, the performance of circulating biomarkers was validated only for coronary sampling. Therefore, the performance of biomarkers obtained from the venous sinus remains to be explored.
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Coronary angioplasty and stenting represent a salvage procedure for patients with coronary artery disease (CAD). However, major adverse cardiovascular events (MACEs), including cardiovascular death, myocardial infarction, coronary restenosis, and episodes of angina or decompensate heart failure, may occur months after coronary intervention, prompting unscheduled visits to the hospital. MACEs are common worldwide and their morbi-mortality is high1.
Coronary ischemic injury induces early vascular response and reparative mechanisms involving mobilization of MPCs due to their differentiation ability and/or angio-reparative potential, as well as the production of soluble molecules like intercellular adhesion molecules (ICAMs), matrix metalloproteinases (MMPs), and reactive oxygen species, reflecting cell adhesion, tissue remodeling, and oxidative stress. Although intrinsic vascular features like plaque characteristics and coronary artery complexity have been used to predict MACEs, some studies have suggested that biomarkers related to the mechanisms of injury and repair occurring in the coronary endothelium could be very useful for the early identification and prognosis of cardiovascular events in patients with CAD submitted to coronary angioplasty2,3,4,5.
Continuous interest in understanding the mechanisms underlying CAD injury and repair has motivated investigators to study intracoronary circulating biomarkers, because coronary sampling more closely reflects vascular damage and repair6. However, characterization of coronary biomarkers in human studies has been scarce7,8,9. Therefore, the purpose of the present study was to describe a method to determine the amount of coronary circulating MPCs and soluble molecules, reflecting both vascular injury and repair, and to show whether these biomarkers are associated with MACEs and the clinical prognosis of CAD patients that underwent coronary angioplasty. This method is based on the use of vascular-related, circulating MPCs and soluble molecules obtained by sampling locations closest to the vessel damage. It may also be useful for clinical studies for lower limb ischemia, stroke, vasculitis, venous thrombosis, and other injuries involving vascular injury and repair.

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	<tbody>
		<tr>
			<td>BSA</td>
			<td>Roche</td>
			<td>10735086001</td>
			<td>Bovine Serum Albumin (BSA) as a buffering agent, stabilizer, standard and for blending.</td>
		</tr>
		<tr>
			<td>Calibration Beads</td>
			<td>Miltenyi Biotec / MACS</td>
			<td>#130-093-607</td>
			<td>MACQuant calibration beads are supplied in aqueous solution containing 0.05% sodium azide. 3.5 ml for up to 100 tests</td>
		</tr>
		<tr>
			<td>CD133/1 (AC133)-PE</td>
			<td>Milteny Biotec / MACS</td>
			<td>#130-080-801</td>
			<td>Antibody conjugated to R-Phycoerythrin in PBS/EDTA buffer</td>
		</tr>
		<tr>
			<td>CD184 (CXCR4)-PE-VIO770</td>
			<td>Miltenyi Biotec / MACS</td>
			<td>#130-103-798</td>
			<td>Monoclonal, Isotype recombinant human IgG1, conjugated</td>
		</tr>
		<tr>
			<td>CD309 (VEGFR-2/KDR)-APC</td>
			<td>Miltenyi Biotec / MACS</td>
			<td>#130-093-601</td>
			<td>Antibody conjugated to R-Phycoerythrin in PBS/EDTA buffer</td>
		</tr>
		<tr>
			<td>CD34-FITC</td>
			<td>Miltenyi Biotec / MACS</td>
			<td>#130-081-001</td>
			<td>The monoclonal antibody clone AC136 detecs a class III epitope of the CD34</td>
		</tr>
		<tr>
			<td>CD45- VioBlue</td>
			<td>Miltenyi Biotec / MACS</td>
			<td>#130-092-880</td>
			<td>Monoclonal CD45 Antibody, human conjugated</td>
		</tr>
		<tr>
			<td>Conical Tubes</td>
			<td>Thermo SCIENTIFIC</td>
			<td>#339651</td>
			<td>15ml conical centrifuge tubes</td>
		</tr>
		<tr>
			<td>Cytometry Tubes</td>
			<td>FALCON Corning Brand</td>
			<td>#352052</td>
			<td>5 mL Polystyrene Round-Bottom Tube. 12x75 style. Sterile.</td>
		</tr>
		<tr>
			<td>EDTA</td>
			<td>BIO-RAD</td>
			<td>#161-0729</td>
			<td>Heavy metals, (as Pb) &#60;10ppm, Fe &#60;0.01%, As &#60;1ppm, Insolubles &#60;0.005%</td>
		</tr>
		<tr>
			<td>Improved Neubauer</td>
			<td>Without brand</td>
			<td>Without catalog number</td>
			<td>Hemocytometer for cell counting. (range 0.1000mm, 0.0025mm2)</td>
		</tr>
		<tr>
			<td>K2 EDTA Blood Collection Tubes</td>
			<td>BD Vacutainer</td>
			<td>#367863</td>
			<td>Lilac plastic vacutainer tube (K2E) 10.8mg, 6 mL.</td>
		</tr>
		<tr>
			<td>Lymphoprep</td>
			<td>Stemcell Technologies</td>
			<td>01-63-12-002-A</td>
			<td>Sterile and checked on the presence of endotoxins. Density: 1.077&#177;0.001g/mL</td>
		</tr>
		<tr>
			<td>Paraformaldehyde</td>
			<td>SIGMA-ALDRICH</td>
			<td>#SZBF0920V</td>
			<td>Fixation of biological samples, (powder, 95%)</td>
		</tr>
		<tr>
			<td>Pipette Transfer 1,3mL</td>
			<td>CRM Globe</td>
			<td>PF1016, PF1015</td>
			<td>The transfer pipette is a tool that facilitates liquid transfer with greater accuracy.</td>
		</tr>
		<tr>
			<td>Test Tubes</td>
			<td>KIMBLE CHASE</td>
			<td>45060 13100</td>
			<td>Heat-resistant test tubes. SIZE/CAP 13 x 100 mm</td>
		</tr>
	</tbody>
</table>

coronary progenitor cells and soluble biomarkers in cardiovascular prognosis after coronary angioplasty

Major adverse cardiovascular events (MACEs) negatively impact the cardiovascular prognosis of patients undergoing coronary angioplasty due to coronary ischemic injury. The extent of coronary damage and the mechanisms of vascular repair are factors influencing the future development of MACEs. Intrinsic vascular features like the plaque characteristics and coronary artery complexity have demonstrated prognostic information for MACEs. However, the use of intracoronary circulating biomarkers has been postulated as a convenient method for the early identification and prognosis of MACEs, as they more closely reflect dynamic mechanisms involving coronary damage and repair. Determination of coronary circulating biomarkers during angioplasty, such as the number of subpopulations of mononuclear progenitor cells (MPCs) as well as the concentration of soluble molecules reflecting inflammation, cell adhesion, and repair, allows for assessment of future developments and the prognosis of MACEs 6 months post coronary angioplasty. This method is highlighted by its translational nature and better performance than peripheral blood circulating biomarkers regarding prediction of MACEs and its effect on the cardiovascular prognosis, which may be applied for risk stratification of patients with coronary artery disease undergoing angioplasty.

Coronary, venous sinus, and peripheral blood were collected from 52 patients that underwent coronary angiography (Figure 1) and showed a high prevalence of hypertension and dyslipidemia. At the clinical follow-up, 11 (21.1%) MACEs occurred 6 months after coronary angiography: death (n = 1), angina requiring hospital attendance (n = 6), myocardial infarction (n = 2), and/or evidence of heart failure (n = 4).
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Watch this Scientific Journal Video about Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty at JoVE.com

Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty

Development of major adverse cardiovascular events, which impact cardiovascular prognosis after coronary angioplasty, are influenced by the extent of coronary damage and vascular repair. The use of novel coronary cellular and soluble biomarkers, reactive to vascular damage and repair, are useful to predict the development of MACEs and prognosis.

Major adverse cardiovascular events (MACEs) negatively impact the cardiovascular prognosis of patients undergoing coronary angioplasty due to coronary ...

Although angioplasty helps patients with coronary artery disease, cardiovascular events can still occur after the procedure. As MPCs and soluble molecules are obtained from coronary circulation, they can be correlated to the degree of vascular damage and repair. Coronary MPC and soluble mediator levels therefore can be used to estimate cardiovasculary events and prognosis in patients with coronary artery disease undergoing coronary angioplasties.MPCs and soluble molecules may also be used to estimate complications and prognoses that occur under different ischemic settings, such as recurrent limb ischemiary stroke. Demonstrating the procedure will be Eduardo Vera-Gomez and Alejandro Hernandez-Patricio, lab technicians, and Karen De La Vega-Moreno and Carlos Zamora-Aleman, undergrad students. Also demonstrating will be Gabriela Alexandra Dominguez-Perez, a Master's of Science student, Alberto Melchor-Lopez, a PhD student, and Mario Antonio Tellez-Gonzalez, a Master's of Science collaborator.Within one hour of collection, transfer six milliliters of the harvested blood sample to a 15 milliliter conical tube and dilute the blood at a one to one ratio in PBS. Add two milliliters of density gradient medium to three test tubes and carefully transfer three equal aliquots of diluted blood into each tube of density gradient medium. Separate the cells by centrifugation and transfer the cells at the interface to a new tube.Wash the collected cells one time in two milliliters of PBS for six minutes, followed by six washes in two milliliters of fresh PBS per wash for two minutes. After the last wash, re-suspend the MPC-containing cell pellet in one milliliter of PBS for counting and add one times ten to the six cells to labeled five milliliter flow cytometry tubes. Pellet the cells by centrifugation and add 100 microliters of the appropriate antibody of interest, diluted in antibody incubation solution to each tube.Gently mix the cells with each added antibody cocktail for 10 seconds, and place the samples at four degrees Celsius, protected from light, for 20 minutes. At the end of the incubation, centrifuge the samples and re-suspend the pellets in 500 microliters of PBS supplemented with two millimolar EDTA. Using isotype-matched controls to set up the background staining, analyze the samples by flow cytometry according to standard protocols, gating on the lymphocytes in a forward by side scatter plot, to exclude residual granulocytes, cellular debris, and other particles.Set a gate to contain a high number of cells with a CD45-positive CD34-positive phenotype. Next, use the CD45-positive CD34-positive gate to select for kinase insert domain receptor CD133 or CD184-positive cells. The MPC sub-populations can then be identified by their specific cell surface markers and reported as the percentage of gated events.To determine the concentration of soluble biomarkers in the collected blood samples, first, wash the appropriate pre-coated ELISA plates two times with the kit-provided wash buffer and label the standard, sample, and control tubes. Centrifuge the blood sample to separate the blood components and aliquot the plasma into the sample tubes. Transfer the standards, samples, and controls to the appropriate wells and seal and incubate the plate at 37 degrees Celsius for 90 minutes.At the end of the incubation, discard the well contents and add the biotin detection antibody to each well. After a one hour incubation at 37 degrees Celsius, discard the plate contents and wash the wells three times with fresh wash buffer per wash. After the last wash, incubate the samples with Streptavidin working solution for 30 minutes at 37 degrees Celsius followed by three washes, as demonstrated.After the last wash, treat the samples with tetramethylbenzidine substrate for 30 minutes at 37 degrees Celsius. When the color develops, add stop solution from the kit and read the optical density absorbance in a microplate ELISA reader. To determine the concentration of tumor necrosis factor alpha, and interleukin-1 beta, using immunomagnetic multiplexing, label the standard, sample, and control tubes and vortex the magnetic bead vials for 30 seconds.Add beads to the appropriate wells of the multiplexing assay plate. When all of the beads have been added, securely insert the handheld magnetic plate washer, and wait two minutes for the beads to accumulate on the bottom of each well, before quickly inverting both the handheld magnetic plate washer, and the plate assembly over a waste container. Next, add 150 microliters of wash buffer to each well and wait 30 seconds to allow the beads to accumulate on the bottom.Discard the contents again as just demonstrated and add 25 microliters of universal assay buffer and 25 microliters of the prepared standards, samples, and controls. Seal the plate for an at least 60 minute incubation, protected from light at room temperature, and 500 rotations per minute. At the end of the incubation, add 150 microliters of wash buffer to each well and allow the beads to settle for 30 seconds.Then, use the plate washer to discard the well contents and label each well with 25 microliters of detection antibody mixture followed by two washes, as demonstrated. After the second wash, incubate the samples with 25 microliters of Streptavidin PE for 30 minutes at room temperature. At the end of the incubation, add 120 microliters of reading buffer to each well and seal the plate for a five minute incubation, protected from light at room temperature, for 500 rotations per minute.Then, load the plate onto a multiplexing assay reader and adjust the reading parameters according to each analyte. Coronary, venus-sinus, and peripheral blood were collected from 52 patients that underwent coronary angiography and demonstrated a high prevalence of hypertension and dyslipidemia. The baseline coronary concentration of most MPCs was significantly lower in patients who developed major adverse cardiovascular events, with a larger decrease in MPC subpopulations CD34-positive CD133-positive, and CD45-positive, CD34-positive, CD133-positive, CD184-positive.Likewise, patients who developed major adverse cardiovascular events had an increased baseline in coronary amounts of soluble ICAM-1 and lower amounts of metallomatrix protein 9. Coronary MPCs and soluble ICAM-1 demonstrated a prognostic ability for major adverse cardiovascular event-free survival. Interestingly, the expression of tumor necrosis factor alpha demonstrated variations according to the time of measurement and the location of the coronary sampling based on a comparison of different lumen areas at the same coronary artery, using intravascular ultrasound.During MPC isolation, be sure to transfer the blood onto the density gradient, and to collect the cells from the interface after centrifugation carefully. Periodic vortexing prevents bead precipitation and using a magnetic plate washer helps to keep the beads inside the wells during washes. Coronary MPCs and soluble molecules are useful for stratifying the risk of cardiovascular events during follow up after angioplasty, assisting in the provision of secondary preventions to high-risk individuals as this technique reflects the pathophysiological process that occurs during the cease of solution, it might be useful for conditions in which vascular biology plays a role.

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