Patent application title: CARDIAC STEM CELL AND MYOCYTE SECRETED PARACRINE FACTORS AND USESTHEREOF
Eduardo Marban (Beverly Hills, CA, US)
Jennifer Van Eyk (Baltimore, MD, US)
Miroslava Stasna (Baltimore, MD, US)
THE JOHNS HOPKINS UNIVERSITY
IPC8 Class: AG01N3368FI
Class name: Combinatorial chemistry technology: method, library, apparatus method of screening a library by measuring the ability to specifically bind a target molecule (e.g., antibody-antigen binding, receptor-ligand binding, etc.)
Publication date: 2014-09-18
Patent application number: 20140274765
The invention relates to secreted proteins from cardiac stem cells
(cardiospheres and cardiosphere-derived cells) or myocytes for diagnostic
and/or therapeutic use
19. A method for screening a cardiac patient as a candidate for stem cell therapy, said method comprising measuring in a biological sample from the patient the amount of one or more of apolipoprotein E precursor, atriopeptigen (ANP, ANF), adrenomedullin, brain acid soluble protein 1 (BASP1 protein), cathepsin B precursor, collagen alpha-1 (VI) chain precursor, connective tissue growth factor, cystatin E/M, Dkk3 protein, insulin-like growth factor-binding protein 2 precursor, interleukin-1 receptor-like 1 precursor (ST2), matrix metallopeptidase 2, metalloproteinase inhibitor 1 precursor (TIMP-1), metalloproteinase inhibitor 2 precursor (TIMP-2), mimecan precursor, procollagen type III alpha 1, procollagen type V alpha 1, procollagen type 1 alpha 1, procollagen type VI alpha 2, tropoelastin, or peptide fragments thereof, compared to a baseline value, wherein a statistically significant amount of the one or more proteins or peptide fragments thereof compared to the baseline value indicates that the patient would be likely to benefit from stem cell therapy.
20. The method of claim 19, wherein the statistically significant amount represents at least a 5% increase over baseline value.
21. The method of claim 19, wherein the cardiac patient is suffering from angina, acute myocardial injury, cellular necrosis and myocardium hypertrophy or heart failure.
22. The method of claim 19, wherein the biological sample is a whole blood sample, serum sample, plasma sample, tissue biopsy sample, a sample of cultured cells derived from tissue, or a sample of circulating stem cells such as EPC.
1.FIELD OF THE INVENTION
 The invention relates to secreted proteins from cardiac stem cells (cardiospheres and cardiosphere-derived cells) or myocytes for diagnostic and/or therapeutic use.
 Stem cells hold the promise to revolutionize future reparative medicine through the development of stem cell-based therapies. Transplanting stem cells (either embryonic or adult derived) into damaged myocardium is emerging as a novel means for acute repair and as an alternative to organ transplantation or ventricular assist devices in the treatment of end-stage heart failure. The crux for the success of this therapy will lie in being able to manipulate proliferating ES cells to differentiate specifically into cardiac muscle upon demand, and to predict which patients will benefit from such intervention. An alternative approach is to harness the endogenous stem cells and remaining viable myocytes to regenerate the needed myocardium. This could be accomplished if a contusive environment at the site of injury could be therapeutically produced through the use (or augmentation) of soluble proteins and or paracine factors.
 Existence of adult stem cells in mature tissues and organs such as bone marrow, brain, skin or liver has been demonstrated. Although adult stem cells are mostly considered to differentiate into cell types of tissue of their origin, they have also been found to form specialized cell types of other tissues. This transdifferentiation was reported for bone marrow stem cells, which can differentiate into e.g. cardiac cells (myocytes) and can induce cardiac regeneration. Although the heart has for considerable time been considered to be a terminally differentiated organ with cells not able to self-regenerate after injury or damage, the discovery of stem cells residing in heart has opened the possibility of their use for autologous heart cell repair. First reports about adult cardiac stem cells (CSCs) appeared in 2003 and from that time, the attempts to find the procedures for their isolation and expansion into sufficient quantity for therapeutic purposes have been made. Recently, successful methods for isolation and expansion of adult cardiac stem cells from heart biopsy specimens were reported. Endomyocardial biopsy specimen grown in primary culture developed spherical multicellular clusters, cardiospheres (CSps), which can be further plated yielding in cardiosphere-derived cells (CDCs)--expansion step to obtain reasonable numbers of cells for transplantation from small specimens in a timely manner. Cardiospheres and CDCs exhibit properties of stem cells, expressed certain markers characteristic for stem cells and promoted cardiac regeneration and function in a mouse infarct model.
 The present inventors have found that secreted proteins from cardiac stem cells or myocytes can be useful therapeutically in cardiac regenerative treatment by addition or by inducing enhanced cellular expression of one or more of proteins in isolated or cultured stem cells or myocytes prior to, at the time or following administration of therapy or they can be directly administered to the patient for enhancement of endogenous innate cardiac regeneration. Furthermore, detection of one or more of these proteins (fragment, isoform or modified form) and their binding partner(s) for diagnostic/prognostic assessment of patient viability and responsiveness to treatment and/or assessment of the regenerative potential of stem cells, directly. Thus, detection of one or more of these proteins and/or their binding partners allows better assessment and clinical intervention including regenerative therapy.
 There is a need to be able to predict patients that will respond to stem cell therapy and the ability to manipulate the efficacy of stem cell therapy in heart, the monitoring and or application (exogenous delivery or endogenous enhance production) of paracrine factors from stem cells or myocytes maybe able to met these needs.
Particular Embodiments of the Invention Include:
 1. Unique stem cell-secreted paracrine factors found exclusively in the cardiac stem cell media include interleukin 1 receptor like protein (also named ST2) and brain acid soluble protein 1, cathepsin B, Cu/Zn superoxide dismutase, cystatin E/M, insulin-like growth factor binding protein 2 and minecan (for additional proteins, see Table 1). IL-33, the binding partner (analyte) of ST2 is also a target. All proteins which interact or bind to these proteins are also potential modulating proteins.
 2. Unique myocyte secreted paracrine factors found exclusively in the myocyte media include atrial natriuretic peptide (ANP), apolipoprotien E, matrix metallopeptidase 2, metalloproteinase inhibitor 1, adrenomedullin and connective tissue growth factor (for additional proteins, see Table 1). Other proteins which interact or bind to these proteins are also potential modulating proteins.
 3. Use of the above-mentioned factors, and related factors, to predict susceptibility to cardiovascular disease and or efficacy of treatment of cardiac (or other types) stem cell therapy or endogenous enhancement of stem cell therapy including response of either exogenously applied stem cells or the endogenous stem cells, myocyte or other cell types present in the Injured zone (fibroblasts).
 4. The use of the above-mentioned secreted factors and/or their binding protein(s) alone or in combination to enhance honing, survival, engraftment and efficacy of stem cell therapy or cardiac regeneration therapy.
 5. A method monitoring one or more factors as a means of protein diagnostic(s)/prognostic(s), for example to test efficacy of stem cells prior to therapy in blood of patients or cell culture or media used to produce/harvest cells for regeneration therapy.
 6. A method monitoring one or more factors as a means of protein diagnostic(s)/prognostic(s) to assess patents inherent long term outcome of patent without treatment as well as to determine the potential responsiveness of patent to stem cell therapy.
 7. A method for screening for cell populations isolated from patients based on the cells ablity to secreted proteins or presence of their complementary cellular receptors to determine which cell population will be more suitable or more effective following injection into the patent.
 8. A method of monitoring paracrine proteins and their binding proteins that allows clinician intervention during the course of stem cell therapy and the application of personalized stem cell therapy.
 Interleukin-1 receptor (ST2), and its ligand IL33 as well as other paracrine factors including brain acid soluble protein 1, cathepsin B, Cu/Zn superoxide dismutase, cystatin E/M, insulin-like growth factor binding protein 2, and minecan, (for additional proteins, see Table 1) may increase the ability of stem cells (including cardiac or cardiac derived stem cells) to hone, survive or differentiation in the myocardial infracted zone as well as increase survival of the injured myocardium, fibroblasts or vascular tissue. In addition, the paracrine factors secreted from cardiac myocytes (healthy or injured) such as ANP (atrial natriuretic peptide), apolipoprotein E, matrix metallopeptidase 2, metalloproteinase inhibitor 1, adrenomedullin and connective tissue growth factor maybe work in a similar manner. Furthermore these proteins could affect the viability of the myocytes or their ability to transgenerate or alter other cell types (eg. vascular smooth muscle cells or endothelial cells). Thus, paracrine factors from either or both stem cells and/or myocytes maybe used as a diagnostic monitor or prognostic indicator of i) their ability to be involved in regeneration or ii) viability of the cells. As well, the addition of one or more paracrine factor could enhance therapeutically the viability of the stem cells and surrounding cardiac or vascular tissue and or ability to differentiate. Finally, measurement of the paracrine factor in setting of heart failure, AMI or angina may predict outcome as a reflection of their ability for endogenous or therapeutic application of stem cell therapy. In addition, this is a method to screen for paracrine factors.
 Diagnostic and prognostic markers can be used to measure cardiac stem cell and myocyte secreted factors and their binding partners for the in vivo assessment of the regeneration potential of individual patients. Specifically, ST2, its ligand IL33 and/or including brain acid soluble protein 1, cathepsin B, Cu/Zn superoxide dismutase, cystatin E/M, insulin-like growth factor binding protein 2 and minecan, atrial natriuretic peptide (ANP), apolipoprotein E, matrix metallopeptidase 2, metalloproteinase inhibitor 1, adrenomedullin and/or connective tissue growth factor (for additional proteins, see Table 1) can be used alone or in combination to provide a measurement of viability or efficacy of stem cell treatment or the long term regeneration potential of the injured myocardium (including but not exclusive to myocyte, fibroblast, endothelial, smooth muscle cells) in patients.
 Diagnostic/prognostic markers can be used to measure cardiac stem cell and myocyte secreted paracrine factors and/or their binding partners for the assessment of the potency, viability and/or efficacy of the exogenous stem cells prior to therapeutic application. Specifically, ST2, its ligand IL33 and/or including brain acid soluble protein 1, cathepsin B, Cu/Zn superoxide dismutase, cystatin E/M insulin-like growth factor binding protein 2 and minecan, atrial natriuretic peptide (ANP), apolipoprotein E, matrix metallopeptidase 2, metalloproteinase inhibitor 1, adrenomedullin and/or connective tissue growth factor (for additional proteins, see Table 1), can be used alone or in combination to assess test viability, efficacy and suitability of stem cells or other cell types for transplantation and regeneration therapy.
 Diagnostic/prognostic markers can be used alone or in combination to assess clinical outcome following acute myocardial infarction or heart failure as an indicator of the patients inherent ability to repair/regenerate injured myocardium by measuring one or more of the factors including ST2, IL33, brain acid soluble protein 1, cathepsin
 B, Cu/Zn superoxide dismutase, cystatin E/M , insulin-like growth factor binding protein 2 and minecan, atrial natriuretic peptide (ANP), apolipoprotein E, matrix metallopeptidase 2, metalloproteinase inhibitor 1, adrenomedullin and/or connective tissue growth factor (or their binding partners) in body fluid of patents (for additional proteins, see Table 1).
 Therapeutic target or protein application of paracrine factor(s) and/or their binding partners can be used through endogenous administration or the use of a method to enhancement in vivo cellular release in individual patents in order to improve cardiac heart regeneration. Specifically, ST2, its ligand IL33 and/or including brain acid soluble protein 1, cathepsin B, Cu/Zn superoxide dismutase, cystatin E/M, insulin-like growth factor binding protein 2 and minecan, atrial natriuretic peptide (ANP), apolipoprotein E, matrix metallopeptidase 2, metalloproteinase inhibitor 1, adrenomedullin and/or connective tissue growth factor (or their binding partners) could be increased alone or in combination, in the myocardium (at or near site of injury) to enhance the in vivo cardiac and vascular regeneration and stem cell action. Protein(s) could be administered at the time of heart injury (e.g. at time of myocardial infarction or during development of heart failure), either alone, or in advance of or at the time of or following administration of endogenous stem cell.
 Paracrine factor(s) and/or their binding partners can be used in stem cell culture to be used in regeneration therapy. Specifically, ST2, it ligand IL33 and/or including (but not exclusive) brain acid soluble protein 1, cathepsin B, Cu/Zn superoxide dismutase, cystatin E/M, insulin-like growth factor binding protein 2 and minecan, atrial natriuretic peptide (ANP), apolipoprotein E, matrix metallopeptidase 2, metalloproteinase inhibitor 1, adrenomedullin and connective tissue growth factor (see secreted factors Table 1), alone or in combination, can be added to the media of the cell culture to enhance preparation of stem cells prior to, at the time or following administration to patients.
 Personalized medicine applications can be used in stem cell therapy, through the monitoring of paracrine proteins and their binding protein will allow clinician intervene, choose effective dose and time course of stem cells and proteins therapy during the course of stem cell therapy.
 For adult autologous stem cell transplantation in subjects for whom therapy is to be performed, it is contemplated that 106 to 108 cells will be effective. These cells would be pretreated or injected at same time of the paracrine factors are added. Similar amounts of cardiac stem cells are expected to be effective. Determination of effective dosages can be done without undue experimentation by those of skill in the art. (See, e.g. [7-9]).
 All proteins listed in the Tables herein maybe therapeutically important for cell survival, proliferation or deformation in the injured area of the heart. As well, they may be biomarkers for assessment of cell viability and effectiveness, responsiveness of the patent to stem cell therapy and long term prognosis of development of heart failure or survival. Equivalent proteins from humans or other species including isoforms, splice varients and polymorphorisms/SNPs are also expected to be effective. These are known to and can be tested by those of skill in the art without undue experimentation. Proteins considered to be particularly useful are listed in Table 2.
 Another embodiment of the invention is a method to screen for paracrine factors from cells including stem cells. The method uses reversed phase HPLC to separate the intact proteins prior to MS.
 This application claims priority to U.S. provisional application no. 61/001,792, filed Nov. 2, 2007, which is hereby incorporated by reference.
BRIEF DESCRIPTION OF THE DRAWINGS
 FIG. 1: Cardiac cell analysis strategy
 FIG. 2: Representative chromatograms and reproducibility obtained by RPLC analysis for CSps, CDCs and NRVms with 9 final fractions used for ESI-MS/MS protein identification after trypsin digestion. Eight chromatograms are overlaid (100 μg/run) to demonstrate the reproducibility. Fraction containing albumin was not analyzed.
 FIGS. 3A-3C: Influence of proteins IL33, BASP1 and CTCF at different concentrations on proliferation of CDCs. BASP1 and CTCF increases proliferation of CDCs. Three proteins identified as potentially important secreted proteins, IL33, BASP 1 and CTCF, were tested at different concentrations on their ability to alter proliferation rate of rat CDCs. Detailed description is given in text. Note, CTCF began to alter proliferation by day 4 while BASP1 took longer and change was seen at day 7. On the other hand, IL33 had no affect during this time frame.
 Soluble proteins secreted from stem cells of any cell type including the myocytes near or at the site of injury can serve as interactive signals to the local environment, influencing survival, differentiation and stem cell engraftment as well as affects on the injured myocardium. We have identified the secretome of cardiac stem cells (cardiospheres and cardiosphere-derived cells) and compared these proteins to those specifically secreted from isolated neonatal myocytes. This has allowed us to hone in on potential regulatory pathways that will allow modulation of the stem cells differentiation into cardiac myocytes.
 The expression of any combination of the proteins, protein isoforms, protein polymorphorism, peptide fragment(s) protein with post-translational modifications thereof examined herein, or others, can be assayed with a method of the invention. For example, one can first measure the amount of expression of apolipoprotein E precursor compared to a baseline value, to determine if a significantly elevated or decreased amount is present in a patient sample. One can then further measure the amount of expression of adrenomedullin and/or Dkk3 protein compared to the baseline value. A significant increase (e.g. at least a statistically significant increase) in the amount of expression of one or more proteins, e.g. as listed in Table 2, compared to the baseline value indicates a greater likelihood that the patient is in need of, or would benefit from stem cell therapy.
 By "peptide fragment" is meant any fragment of a protein of interest of at least 10 amino acid residues, preferably at least 15, 20, 15, or 30 amino acid residues up to fragments that may be only a few (e.g. 1, 2, 3, 4, 5, 10, 15, etc.) residues shorter than the full length protein. Unless otherwise indicated, the terms "protein, "polypeptide" and "peptide" are used interchangeably herein.
 The amino acid sequences of the proteins of the invention, and the nucleic acids encoding them, are well-known and can be determined routinely, as well as downloaded from various known databases using the provided GenBank Accession numbers. See, e.g., the world wide web site, ncbi.nlm.nih.gov.
 The amount of expression of a protein of the invention can be determined by measuring the amount of the protein, or by measuring the amount of mRNA encoding the protein. The amount of a protein can be determined using any routine method known in the art, e.g. MS, an antibody, etc. For example, the method can encompass binding the protein to an antibody which is specific for it, under conditions that are effective for specifically binding the protein to the antibody. For example, an antibody or any sensor may be contacted with a histological preparation, and the amount of protein is determined by immunohistochemical staining. The amount of an mRNA can be determined using a nucleic acid probe for the mRNA. For example, the method can encompass hybridizing the mRNA to a nucleic acid probe which is specific for it, under conditions that are effective for specifically hybridizing the mRNA and the probe.
 Some methods involve the use of antibodies, any binding ligand or mass spectrometry tagged peptide specific for a protein of interest. Antibodies suitable for use in such assays are commercially available, or can be prepared routinely. Methods for preparing and using antibodies in assays for proteins of interest are conventional, and are described, e.g., in Green et al., Production of Polyclonal Antisera, in Immunochemical Protocols (Manson, ed.), (Humana Press 1992); Coligan et al., in Current Protocols in Immunology, Sec. 2.4.1 (1992); Kohler & Milstein (1975), Nature 256, 495; Coligan et al., sections 2.5.1-2.6.7; and Harlow et al., Antibodies: A Laboratory Manual, page 726 (Cold Spring Harbor Laboratory Pub. 1988).
 Any of a variety of antibodies can be used, including, e.g., polyclonal, monoclonal (mAbs), recombinant, humanized or partially humanized, single chain, Fab, and fragments thereof. The antibodies can be of any isotype, e.g., IgM, various IgG isotypes such as IgG1' IgG2a, etc., and they can be from any animal species that produces antibodies, including goat, rabbit, mouse, chicken or the like. The term, an antibody "specific for" a protein, means that the antibody recognizes a defined sequence of amino acids, or epitope, in the protein, and binds selectively to the protein and not generally to proteins unintended for binding to the antibody. The parameters required to achieve specific binding can be determined routinely, using conventional methods in the art.
 The baseline value for such measurements can be an average or mean from a population of normal subjects, i.e. those not suffering from heart disease, or, e.g. may be earlier measurements taken from the same patient, for example when progress of treatment is being monitored. Suitable baseline values can be determined by those of skill in the art without undue experimentation.
 Thus, a "baseline value" refers to the expression, as determined by the levels (amounts) of mRNA and/or protein, in normal tissue (e.g., the same type of tissue as the tested tissue, such as normal cardiac tissue or normal serum), from normal subjects that do not have heart disease. If desired, a pool of the same tissues from normal subjects can be used. Such baseline values may be available in a database compiled from the values and/or may be determined based on published data or on retrospective studies of patients' tissues, and other information as would be apparent to a person of ordinary skill implementing a method of the invention. Suitable baseline values may be selected using statistical tools that provide an appropriate confidence interval so that measured levels that fall outside the standard value can be accepted as being aberrant from a diagnostic perspective, and predictive of success in treatment, diagnosis or prognosis.
 A significantly elevated amount of an mRNA or a protein (or peptide fragment) of the invention compared to this baseline value, then, indicates that a patient or subject is likely to be responsive to stem cell therapy. If a protein whose expression is decreased in subjects that are expected to be less responsive, a significantly reduced amount of the protein or mRNA encoding it indicates that a test subject is less likely to respond.
 A "significant" increase in the amount of a protein or mRNA, as used herein, can refer to a difference which is reproducible or statistically significant, as determined using statistical methods that are appropriate and well-known in the art, generally with a probability value of less than five percent chance of the change being due to random variation. Some such statistical tests are described in the Examples herein. For example, a significant increase in the amount of mRNA or protein compared to a baseline value can be at least about 2.5-fold (e.g., at least about 5-fold, 10-fold, 20-fold, 25-fold, or more) higher.
 Methods for obtaining samples and preparing them for analysis (e.g., for detection of the amount of protein or mRNA encoding the protein) are conventional and well-known in the art.
 A "subject" or "patient", as used herein, includes any animal that has, or may have, heart disease, including experimentally induced heart disease, for example in laboratory animals (such as mouse, rat, rabbit, or guinea pig), farm animals, and domestic animals or pets (such as a cat or dog). Non-human primates and human patients, are included. Heart failure can be induced following heart attack or other injuries to the heart (pulmonary hypertension), viral infections, genetic disorders and many other affectors that weaken the heart muscle or vasculature. Furthermore, following AMI when heart muscle has been injured or destroyed, regeneration is required to replace the lost muscle cells and other cells required for functioning heart.
 A "sample" includes any biological sample, for example whole blood, serum, cardiac tissue, etc. obtained from a subject or patient. A sample also includes stem cell cultures, e.g. for therapeutic use in such patients.
 By "stem cell therapy" is meant the administration of cardiac myocytes or equivalent cells as described herein to a cardiac patient or to an animal with experimentally induced heart disease. The paracrine factor(s) could alter the honing, survival, proliferation and differentiation of all stem cells and progenitor cells found in the body including EPC, mesochymal, and hemopoetic stem cell. Administration of cells can be by any means known in the art, for example, by local injection, infusion,. Cells would be pretreated at optimal concentration most likely between pg/ml-1 μg/ml for a 10,000 cells (in 1 ml).
 By "heart disease" is meant by stable and unstable angina, myocardial ischemia, myocardial stunning, acute myocardial infarction, (minor necrotic cell death, heart failure induced by myocardial infraction, genetic disease, pulmonary hypertension and other injury to the myocardium which makes the heart work harder.
 By "treated" is meant that an effective amount of a chemotherapeutic drug or other anti-cancer procedure is administered to the subject. An "effective" treatment refers to a treatment that elicits a detectable response (e.g. a therapeutic response) in the subject.
 By "effective amount" is meant any amount that will elicit a detectable clinical response.
 A significant increase in the amount of expression of a secreted protein of the invention compared to the baseline value indicates that a subject is likely to be responsive to stem cell therapy. A subject that is "likely" to be responsive has greater than, e.g., at least about: a 25%, more likely 50%, 75%, chance to show an improvement in clinical symptoms.
 In order to determine the specificity of the secreted proteome ("secretome"), we compared proteins secreted into media conditioning adult cardiac stem cells (CSps and CDC) to proteins secreted from neonatal rat ventricular myocytes after analysis by reversed phase liquid chromatography and identification by mass spectrometry (FIG. 1). The cells were obtained under optimized conditions that minimize cell lysis, allowing us to distinguish between secreted proteins and those proteins that would be liberated upon cell death due to necrosis and/or apoptosis.
Sample Processing Specimen preparation, CSps, CDCs and NRVMs (rat neonatal myocytes) were harvested as previously described [1-3]. Briefly, cardiac tissue specimens from septum or left ventricule of Wistar Kyoto rats, 12 to 16 weeks old, were cut into small pieces, washed by PBS, enzymatically digested and grown in primary cultures as explants on fibronectin (from human plasma, BD Biosciences) coated Petri dishes in IMDM medium (Iscove's Modified Dulbecco's Medium, Invitrogen) supplemented with 20% fetal bovine serum (FBS), 1% penicillin-streptomycin, 1% L-glutamine and 0.1 mmol/L 2-mercaptoethanol at 37° C. and 5% CO2. After a few days, round, phase-bright generated cells migrating over a layer of fibroblast-like cells arose from explants were harvested and seeded at 2-3×104 cells/mL on poly-D-lysine (BD Biosciences) coated Petri dishes in cardiosphere-growing medium composed of 35% IMDM/65% DMEM-Ham F-12 Mix (Invitrogen) and supplemented with 3.5% fetal bovine serum (FBS), 1% penicillin-streptomycin, 1% L-glutamine, 0.1 mmol/L 2-mercaptoethanol, thrombin (1 unit/mL, Sigma), B-27 (diluted at ratio 1:50, Invitrogen), basic fibroblast growth factor (bFGF, 80 ng/mL, PeproTech), epidermal growth factor (EGF, 25 ng/mL, PeproTech) and cardiotrophin-1 (4 ng/mL, PeproTech). The yielded spherical multicellular clusters--cardiospheres (CSps) were collected for proteomic analysis or further processed by plating on fibronectin-coated flasks and growing as monolayers giving finally cardiosphere-derived cells (CDCs). Neonatal rat ventricular myocytes (NRVMs) were isolated by routine methods with overnight trypsin digestion from 2 days old Sprague-Dawley rats. Cardiospheres and cardiosphere-derived cells were observed. The cells were isolated under conditions with minimal cell death (18±2% for CSps and CDCs, n=3 and 10±1% for NRVMs, n=3) as assessed by Annexin V labeling. CSps, CDCs and NRVMs were further conditioned in media containing 1%
 FBS for 48 hours. After conditioning, media with cell secreted proteins were collected, filtered and concentrated in SpeedVac concentrator. Conditioning medium alone was processed the same way and served as control.
Reversed Phase Liquid Chromatography (RPLC)
 The liquid concentrates with secreted proteins and concentrates of media alone were mixed with solvent to final concentration of 20% (v/v) acetonitrile (ACN), 1% (v/v) trifluoroacetic acid (TFA), pH 2.3, vortexed and spun down at 18×1000 g for 30 min at 4° C. Samples of intact proteins were separated by RPLC in order to reduce the complexity of protein mixtures prior to mass spectrometry protein identification. 200 or 800 μg were injected into C18 column (50 mm, nanoporous particles, HPRP model of ProteomeLab PF 2D, Beckman Coulter, Calif., USA) in consecutive runs of 100 μg/run in order to avoid the clogging of the column by the high amount of albumin, using a linear gradient from 0% to 100% ACN/0.08% TFA over 35 minutes. The chromatogram was recorded at an absorbance wavelength of 214 nm. FIG. 2 shows representative chromatographs of multiple runs as well as the fractions pooled for MS analysis. 68 fractions were collected per run from 7 to 24 min (0.25 min/fraction) and combined into 9 final fractions, dried in SpeedVac concentrator, neutralized by ammonium bicarbonate, trypsin digested overnight at 37° C. and analyzed by mass spectrometry for protein identification and quantification. Fractions containing major amounts of albumin (between and 17.25 min of elution time, 50-53% acetonitrile) were excluded.
Mass Spectrometry and Protein Identification
 Dried samples with tryptic peptides after trypsin digestion of fractions were recovered in 8 μl of 0.1% (v/v) TFA and analyzed by a ThermoFinnigan LTQ ion trap with electrospray ionization or by a LTQ Orbitrap mass spectrometer (Thermo Electron Corporation, Mass., USA). Data obtained from MS spectra were submitted to NCBInr database search by using MASCOT search engine (Matrix Science Mascot Daemon, V2.1.3 -max. missed cleavages 2, peptide tolerance ±1.5 Da and MS/MS tol. ±0.8 Da, all species). After Mascot Daemon search, the files were transferred to Scaffold software (Version Scaffold-01--06--06, 2006 Proteome Software Inc., OR, USA) for Mascot result validation, visualization and comparison of protein identifications between individual samples. All identified proteins were further examinated for peptide and protein redundancy. The protein amino acid sequence was blasted against UniProt Knowledgebase (Swiss-Prot+TrEMBL) by using SIB
 BLAST network service (ExPASy). In case of protein multiple names or homology, only one protein name was used after the original peptide sequences obtained from our MS results were checked back for matching that protein by using multiple sequence alignment program ClustalW (EMBL-EBI). Also, the confirmation of a protein isoform was done based on matching a tryptic peptide fragment to a unique amino acid sequence of isoform of the intact protein.
Results of MS Experiments
 Three technical issues were overcome regarding analysis of the secretome, i) the secreted proteins are often at low concentration within the culture media, ii) the media is a large source of contamination (including albumin and iii) the need to distinguish between secreted proteins and those artificially liberated with cell death. This will be assessed this by both Annexin V labeling and increased detection of intercellular proteins (as outlined elsewhereherein). In Table 1 there are several protein highlighted which may arise from lysed cells due to their known intracellular location and the low level quantity present in the media. The remaining proteins are known to be secreted from cells or are membrane or membrane associated proteins.
 To maximize proteome coverage it was also important to reduce serum content of the media which would hinder detection of low abundant proteins during proteomic analysis. Initially, we analyzed a series of CSps or CDCs obtained from rat heart biopsies to neonatal myocytes grown under different conditions ranging from 6 hours to 4 days in 0%, 1% and 2% serum. We elected to use conditioned media with 1% serum and to collect the media after 48 hours, although earlier time points also worked. The collected media was filtered, concentrated, suspended in 20% (v/v) acetonitrile:1%TFA and separated by reversed phase HPLC using a linear gradient composed of 0.1% TFA and increasing concentrations of acetonitrile from 25% to 80%. Multiple fractions were collected, neutralized, digested with trypsin and analyzed by ESI/MS/MS for protein identification and quantification.
 We were able to observe 122 non-redundant proteins exclusively in media from cardiac stem cells or neonatal myocytes, with the majority (>90%) comprising known membrane, extracellular or secreted proteins. This indicates little contamination from dead cells. In the first set of experiments, greater than 2 fold more proteins were detected in cardiac stem cells than neonatal myocytes (60 vs. 27, respectively) and although the functional protein classes were conserved between the cell types, specific proteins and/or isoforms differed. Not surprisingly, we observed a large number of different collagen isoforms (10) with half (5) being cell-specific. Cell-specificity was also reflected with collagen regulation as TIMP2 and MMP2 were observed in neonatal myocytes and TIMP 1 uniquely present in the cardiac stem cells. Interestingly, a recent study showed that proteins secreted from ESC (normal and hypoxic) could inhibit hydrogen peroxide induced apoptosis, and this inhibition was due, at least in part, to TIMP. On the other hand, MMP2 Is increased in heart failure in both animal models and patient samples.
 Notable was the detection of two paracrine factors--the cardiac specific atrial natriuretic peptide or ANP was only detected in neonatal myocytes and not cardiac stem cells, while the soluble interleukin-1 receptor family member or ST2 was exclusive to cardiac stem cells (Table 1). ST2 is known to increase in myocytes with mechanical stress and heart failure where it has been linked to neurohormonal activation (e.g. (70,71) and reduces the endogenous affect of IL-33 (its ligand) of reducing hypertrophy and fibrosis. Furthermore, recently indirectly indicated at the gene level in C3H10T1/2 cells (a proliferative cell line) where ST2 is increased as is Wnt-5a, a know stem cell signaling factor.
 Additional proteins that were found to be exclusively present in the media analyzed from cardiac stem cells or myocytes are listed in Table 1. Proteins that may play a role (alone or in combination) found exclusively in the myocyte media are apolipoprotien E, matrix metallopeptidase 2 (and although its inhibitor (metalloprotease 2 inhibitor) is not altered the ratio of these two proteins maybe critical), and metalloproteinase inhibitor 1 (and although the corresponding matrix metallopeptidase 1 is not observed, the ratio of the two proteins maybe important). In fact, all metalloproteinase and their inhibitors may play a role in both stem cell and myocyte function and survival in the infracted or injured area of the heart. Additional proteins found exclusively in the cardiac stem cell media are brain acid soluble protein 1, cathepsin B, Cu/Zn superoxide dismutase, cystatin E/M, and the insulin-like growth factor binding protein 2 (although not observed insulin growth factor (IGF) and other analytes that bind this protein or to the IGF receptor maybe important).
 Brain soluble protein 1 is also named BASPI protein, neuronal axonal membrane protein NAP22 and the 22 kDa neuronal tissue-enriched acidic protein. This membrane protein is involved in cell projection and growth cones and was originally thought to be present exclusively in the brain. Cathepsin B also named APP secretase (APPS) contains a heavy and light chain within its amino acid sequence which after processing forms a dimmer with the heavy and light chains crosslinked by a disulfide bond. This protein in its active form is a thiol protease involved in degradation and turnover of proteins and is normally associated with the lysosome. Cystatin E/M is also called Cystatin M/E or cystatin 6 is a protease inhibitor. Insulin like growth factor binding protein 2 is also called IGFB-2, IBP-2 and IGF-binding protein 2 is secrteted and prolongs the half life of the IGF and has been shown to alter growth promoting affects on IGF on cell cultures. IGF and the insulin like growth factor binding protein 2 have been implicated in changes to may cells types including fibroblasts, lung epithelial cells, and glial cells but to our knowledge not cardiac derived stem cells or the cardiac myocyte.
 In another set of experiments, we carried out independent duplicate analysis of the secretome from CDC, CSps and NRVMs obtained from left ventricle of rat hearts.
 We identified a total of 161 proteins. With this set of data we were able to expand our list of potential candidate paracrine factors. Of specific interest is adrenomedullin and connective tissue growth factor which are present in the media of NRMV exclusively and minecan which is found exclusively in the media of cardiac stem cells. Minecan also called osteoglycin or osteoinductive factor is known to induce bone formation in conjunction with TFG beta 1 or TGF beta 2, and have been implicated in regulation of collagen fibrillogeneis of the cardiac stem cells or act also on cells in the surrounding regions of the injured heart.
 Adrenomedullin or AM is processed active domain of larger protein called ADML or ADM which also contains the proadrenomedullin N-20 terminal peptide (PAMP). AM and PAMP are potent hypotensive and vasodilator factors that have affects throughout the body including the kidney, brain and pituitary gland. It has been found in the ventricle. This protein has been implicated in differentiation of several stem cells but not cardiac derived cells or injured myocytes. Connective tissue growth factor is also termed hypertrophic chondrocyte-specific protein 24. This protein is a connective tissue mitoattractant that has been previously reported to be secreted by vascular endothelial cells but, to our knowledge not cardiac myocytes under normal physiological conditions but has been shown to increase in hearts with ongoing myocarditis.
 Furthermore, AM has been shown to induce proliferation and differentiation of chondrocytes, improve cell adhesion for fibroblasts, myofibroblasts, endothelial and epithelial cells and stimulate fibroblast growth factor-induced DNA synthesis. Therefore, fibroblast growth factor alone or its ratio with respect to connective tissue growth factor may be also important.
 Soluble proteins secreted from stem cells serve as interactive signals to the local environment, influencing survival, differentiation and engraftment. To characterize the secreted proteome ("secretome"), proteins found in the media conditioned by adult cardiac stem cells (CSCs) or neonatal rat ventricular myocytes (NRVMs) were obtained under optimized conditions that minimize cell lysis, allowing distinction between secreted proteins and those artificially liberated with cell death.
 CSCs were grown from rat septal or left ventricular explants and NRVMs were isolated under conditions with minimal cell death (18±2% [CSCs, n=3] and 10±1% [NRVMs, n=3] by Annexin V labeling). Conditioned media (1% serum) was collected after 48 hours, filtered, concentrated, resuspended in 20% (v/v) acetontile:1%TFA and separated by reversed phase HPLC. Collected fractions were digested with trypsin and analyzed by ESI/MS/MS for protein identification and quantification.
 90-110 proteins were identified exclusively in media from CSCs or NRVMs, with the majority (>85%) comprising known membrane, extracellular or secreted proteins. Of these, >2 fold more proteins were detected in CSCs than NRVMs (60 vs. 27, respectively). Functional protein classes were conserved between the cell types, although proteins and/or their isoforms could differ. Of interest, 10 different collagen isoforms were observed with 5 being cell-specific. Cell-specificity was also reflected with collagen regulation as TIMP2 and MMP2 were observed in NRVMs while TIMP 1 was uniquely present in CSCs. The signaling molecules, insulin-like growth factor binding protein 6 and 3, were present in CSCs, but only isoform 7 in NRVMs. Interestingly, the cardiac specific natriuretic hormone ANP was only detected in NRVMs and not CSCs, while the soluble interleukin-1 receptor family member ST2 was exclusive to CSCs. ST2 is known to increase in myocytes with mechanical stress and heart failure where it has been linked to neurohormonal activation.
 From these results, it is apparent that CSC and NRVM-specific secretomes display unique functionality including differential secretion of two cardiovascular hormones.
Cell Proliferation Assay
 Day 1: cardiosphere-derived cells from rat (CDCs) or neonatal myocytes or adult myocytes in IMDM medium (Iscove's Modified Dulbecco's Medium, Invitrogen) supplemented with 20% fetal bovine serum (FBS) were plated into 96-well plate in 8 rows except for blanks (last 2 wells in each row). Media (without the cells) were plated into last 2 wells of 1st row. Cells were incubated in 37° C. incubator for 48 hours.
 Day 3: the cells in wells were checked under microscope (the cells must be attached to the well bottoms). The media from all wells were aspired except for those of the 1st row using sterile Pasteur pipette. Then, 100 tl of appropriate protein solutions with increasing concentrations 1 pg/ml, 1 ng/ml, 100 ng/ml, 1 μg/ml in IMDM medium supplemented with 10% FBS (treated cells; each in duplicate) and 100 μl of the same media without a protein (controls--untreated cells; in duplicate) were added to attached cells in wells of each row. Last 2 wells in each row were filled with 100 μl of only media (blanks).
 10 μl of Cell Counting Kit-8 solution (Dojindo laboratories, Japan) were added to the 1st row of the plate (avoiding a direct light exposure). The cells in plate were incubated in 37° C. incubator for 2 hours and after that the absorbances of solutions in 1st row wells were read (λ=450 nm, SPECTRAmax M2, Molecular Devices, Sunnyvale, Calif.).
 Day 4: 10 μl of Cell Counting Kit WST-8 solution were added to the 2nd row of the plate, the cells in plate were incubated in 37° C. incubator for 2 hours and after that the absorbances of solutions were read.
 Day 5 to 10: the procedure of day 4 was repeated on each following plate row. Influence of proteins interleukin-33 (IL 33, ALX-522-098-0010, Apotech Corporation, USA), brain abundant membrane attached signal protein 1 (BASP1,H00010409-P01, Novus Biological, USA) and connective tissue growth factor (CTGF, CRC604B, Cell Sciences, USA) at different concentration on CDCs proliferation is shown in FIG. 3.
Cell Migration Assay.
 Modified Boyden chambers were equipped with 8 μm pore-size polycarbonate filters (Neuroprobe, Gaithersburg, Md.) coated with Matrigel (BD Bioscience, Palo Alto, Calif.). Cells (stem cells or myocytes) were either untreated or pretreated with appropriate protein for 24 hours. 220 μl of migration medium (DMEM--Dulbecco's Modified Eagle Medium with 0.1% BSA) was added to lower chamber with or without platelet-derived growth factor (PDGF) for chemattract and random migration assay, respectively. Cells (106/ml) were placed in upper chamber in 200 μl of migration medium, performed in triplicate. The assay was stopped after 4 hours at ° C. Cells that crossed the basement membrane and migrated to lower side of the filter were fixed and stained using HEMA3 system (Curtin, Matheson Scientific Inc., Houston, Tex.). Four random fields were counted at 400× magnification for each filter.
Oxidative Stress Assay.
 To evaluate the effect of oxidative stress, the cells (NRVMs, myocytes or stem cells) were exposed to hydrogen peroxide for a fixed period of time (1 hour of 100 μmol/L H2O2). Mitochondrial membrane potential (determinant of myocytes viability) was measured by using flow cytometric analysis of tetramethylrhodamine ethyl ester (TMRE) loaded cells. TMRE (100 nmol/L) was loaded for 20 min in the dark at 37° C. Myocytes were subjected to flow cytometry by activation with the 488 nm wavelength. Fluorescence was monitored and influence of H2O2 on changes of mitochondrial membrane potential was determined.
Effect of the Proteins on Cell Morphology Combined with Immunochistochemistry (Immunostaining, Immunocytochemistry, IHC).
 IHC is method for identification of specific tissue components by means of specific antigen/antibody (or other sensors) reaction tagged with a visible label (or other types of chemical labels). This method makes possible to visualize the distribution and localization of specific cellular components within a cell or tissue.
 First, the tissue for staining is fixed. Fixative procedure is optimized based on tissue and antigen/sensor used and various fixatives can be used. Usually, the tissue is formalin fixed and paraffin embedded. Prior to staining, tissue slides are deparaffinized (e.g. in xylol) and rehydrated in graded alcohol series and can be further pretreated with proteolytic enzymes, washed in distilled water and heated in microwave oven for epitope retrieval. Then nonspecific sites are blocked with serum or blocker protein, incubated with primary antibody (1:100-1:1,000), washed and incubated with secondary antibody-enzyme conjugate (1:2,000-1:5,000), washed and incubated with substrate and finally, the stained tissue is visualized.
Western Blotting for Validation of Proteins Detected by by Mass Spectrometry.
 The CSps-, CDC-, NRVM-media with secreted proteins/lysates or adult myocyte lysates were subjected to 1D gel electrophoresis (NuPage BisTris gels of various concentrations, 200 V, 35 to 55 minutes based on running buffer and gel concentration used), separated proteins were transferred into nitrocellulose membrane (NuPage transfer buffer, 100 V, 1 hour). Proteins on the membrane were visualized by dye Direct Blue 71, briefly destained by 40% ethanol/10% acetic acid, washed by lx Tris buffered saline solution (TBS; 20 mM Tris, 500 mM NaCl, pH 7.5) and transferred into blocking solution (5% of non fat dry milk in 1×TBS). The membrane was blocked overnight at 4° C., then washed by TTBS (0.1% Tween-20 in TBS) and incubated with appropriate primary antibody (1:100-1:1,000) for 4.5 hours. After that, the membrane was washed in TTBS and incubated with secondary antibody-enzyme conjugate (1:2,000-1:5,000), washed in TTBS and incubated with ImmunostarAP Substrate Pack (BioRad laboratories, Calif., USA) for 5 minutes. The membrane was placed in cassette with film and developed.
Tracking Stem Cells--Rats/Mice:
 Stem cells treated and non-treated are labeled with tracking agent such as iron as described by Terrovitis et al  or unique protein, chromosome, gene or chemical compound(s). For example, the ferumoxide-labeled CDCs (with and without treatment either exogenous protein or transgenically manipulated to produce proteins, see Smith et al.  for examples) is injected intramyocardially into normal (immunocompetent) rats or mice prior to or after induction of experimental of myocardial infarction. Rats may also undergo left thoracotomy in the fourth or fifth intercostals space under general anesthesia. The heart will be exposed and the cells injected directly into the myocardium at a single or multiple sites.
 The myocardial infarction can be produced by a number of methods including a permanent ligation of the left anterior descending coronary artery using a suture immediately before or after cell injection. Subsequently, the chest is closed and the animals are allowed to recover. Magnetic resonance imaging (MRI) images are obtained on a number of days after surgery such as day 2 and 21 or longer. After completion of this follow-up period, the rats will be sacrificed and the hearts subjected to histology.
 MRI: For MRI, animals were anesthetized and then placed prone, head first in the magnet. ECG-gated cine images of the heart are obtained. At least 3 consecutive short-axis slices will be acquired to completely cover the area of cell injection. Signal intensity will be measured in the myocardium (remote areas and areas of cell injection); noise is measured by creating regions of interest in the lungs. Contrast-to-noise ratios (signal intensity in the remote myocardium minus signal intensity in the areas of the cell injection divided by the SD of noise) will be calculated for each slice in which the signal void is visualized. In addition, percent signal area will be calculated as the area of visually determined signal void (manually defined region of interest containing area obviously darker than the surrounding myocardium) divided by the total left ventricular area in the same slice. Histological analysis of cell engraftment will be performed for number of proteins and for general pathological stains.
Echocardiography and Ventricular Function--Rats/Mice:
 Echocardiography will be performed in conscious animals before and after myocardial infarction. The anterior chest area is shaved and 2D images and M-mode tracings are recorded from the parasternal short-axis view at the level of papillary muscles. In addition, it maybe needed to evaluate the LV pressure and +and -dP/dt in the closed-chest preparation. (for example see Rota et al. )
 As well the abdominal aorta could be cannulated with a polyethylene catheter and the heart arrested in diastole (eg. injection of CdCl2), the thorax was opened, perfusion with phosphate buffer started. An aortic catheter connected to a pressure reservoir is used to adjust perfusion pressure to mean arterial blood pressure while simultaneously, the LV chamber is filled with formalin. After perfusion with buffer, the coronary vasculature is perfused with fixative. Subsequently, the heart is excised, and the weights and major axis from the base to the apex of the heart is measured. The volume of the myocardium is computed (4) by dividing the weight by the specific gravity of muscle tissue. Furthermore, paraffin-embedding of tissue could be done. In this case tissue slices would be stained with hematoxylin and eosin or used later for immunohistochemistry.
 References cited herein are hereby incorporated by reference.
  Messina E, De Angelis L, Frati G, Morrone S, Chimenti S, Fiordaliso F, Salio M, Battaglia M, Latronico M V G, Coletta M, Vivarelli E, Frati L, Cossu G, Giacomello A. Isolation and expansion of adult cardiac stem cells from human and murine heart. Circ Res. 2004;95:911-921.
  Smith R R, Barile L, Cho H C, Leppo M K, Hare J M, Messina E, Giacomello A, Abraham M R, Marban E. Regenerative potential of cardiosphere-derived cells expanded from percutaneous endomyocardial biopsy specimen. Circulation. 2007;115:896-908.
  Iravanian S, Nabutovsky Y, Kong C R, Saha S, Bursac N, Tung L. Functional reentry in cultured monolayers of neonatal cardiac cells. Am J Physiol Heart Circ Physiol. 2003;285:H449-H456.
 [4 ] Terrovitis J, Stuber M, Youssef A, Preece S, Leppo M, Kizana E, Schar M, Gerstenblith G, Weiss R G, Marban E, Abraham M R. Magnetic resonance imaging overestimates ferumoxide-labeled stem cell survival after transplantation in the heart. Circulation. 2008 Mar 25;117(12):1555-1562.
  Smith R R, Barile L, Cho H C, Leppo M K, Hare J M, Messina E, Giacomello A, Abraham M R, Marban E. Regenerative potential of cardiosphere-derived cells expanded from percutaneous endomyocardial biopsy specimens. Circulation. 2007 Feb 20;115(7):896-908.
  Rota M, Kajstura J, Hosoda T, Bearzi C, Vitale S, Esposito G, Iaffaldano G, Padin-Iruegas M E, Gonzalez A, Rizzi R, Small N, Muraski J, Alvarez R, Chen X, Urbanek K, Bolli R, Houser S R, Leri A, Sussman M A, Anversa P. Bone marrow cells adopt the cardiomyogenic fate in vivo. Proc Natl Acad Sci U S A. 2007 Nov 6;104(45): 17783-17788.
  Patel A N, Geffner L, Vina R F, Saslaysky J, Urschel H C Jr, Kormos R, Benetti F. Surgical treatment for congestive heart failure with autologous adult stem cell transplantation: a prospective randomized study. J Thorac Cardiovasc Surg. 2005;130(6):1631-8.
  Assmus B, Honold J, Schachinger V, Britten M B, Fischer-Rasokat U, Lehmann R, Teupe C, Pistorius K, Martin H, Abolmaali N D, Tonn T, Dimmeler S, Zeiher A M. Transcoronary transplantation of progenitor cells after myocardial infarction. N Engl J Med. 2006 21;355(12):1222-32.)
  Schuleri K H, Amado L C, Boyle A J, Centola M, Saliaris A P, Gutman M R, Hatzistergos K E, Oskouei B N, Zimmet J M, Young R G, Heldman A W, Lardo A C, Hare Early improvement in cardiac tissue perfusion due to mesenchymal stem cells. Am J Physiol Heart Circ Physiol. 2008 May;294(5):H2002-11.
Patent applications by Eduardo Marban, Beverly Hills, CA US
Patent applications by Jennifer Van Eyk, Baltimore, MD US
Patent applications by THE JOHNS HOPKINS UNIVERSITY
Patent applications in class By measuring the ability to specifically bind a target molecule (e.g., antibody-antigen binding, receptor-ligand binding, etc.)
Patent applications in all subclasses By measuring the ability to specifically bind a target molecule (e.g., antibody-antigen binding, receptor-ligand binding, etc.)