Treatment of Cardiovascular Disorders Using the Cell Differentiation Signaling Protein Nell1

Abstract

It has been identified in accordance with the present invention that Nell1 is essential for normal cardiovascular development by promoting proper formation of the heart and blood vessels. The present invention therefore provides therapeutic methods for treating cardiovascular disorders by employing a Nell1 protein or nucleic acid molecule.

Description

CROSS REFERENCE TO RELATED APPLICATIONS

[0001] This application asserts the priority of U.S. provisional application Ser. No. 60/995,854 filed Sep. 28, 2007, and U.S. provisional application Ser. No. 61/079,446, filed Jul. 10, 2008, the contents of which are incorporated herein by reference.

FIELD OF THE INVENTION

[0003] The present invention relates in general to therapeutic methods for treating cardiovascular disorders. More specifically, the present invention relates to therapeutic treatments of cardiovascular disorders by employing the cell differentiation signaling protein Nell 1, as well as functional derivatives thereof.

BACKGROUND OF THE INVENTION

[0004] Despite many available methods of treatment, cardiovascular disease is one the major causes of death each year in the U.S. Thus, there is still a need for more effective agents to prevent and treat cardiac tissue injury, especially cardiac tissue injury resulting from ischemia/reperfusion.

[0005] The Nell1 gene codes for a secreted trimeric protein that stimulates bone and cartilage precursor cells (osteoblasts and chondrocytes) to differentiate into mature bone and cartilage tissue (Zhang et al., 2002; Desai et al., 2006). Nell-1 is a protein kinase C (PKC) β-binding protein. The Nell1 cDNA and amino acid sequences from a variety of mammalian species, including human, rat and mouse, have been reported.

[0006] Overexpression of Nell1 has been reported to cause premature fusion of the growing cranial bone fronts, resulting in craniosynostosis in humans and transgenic mice carrying a rat Nell 1 transgene. A Nell1 knock-out mouse was also shown to exhibit several bone- and cartilage-related defects. There has been no characterization, however, of the impact of Nell 1, if any, on cardiovascular development.

SUMMARY OF THE INVENTION

[0007] It has been identified in accordance with the present invention that Nell1 is essential for normal cardiovascular development by promoting proper formation of the heart and blood vessels. The present invention therefore provides therapeutic methods for treating cardiovascular disorders by employing a Nell1 protein, functional derivatives thereof or nucleic acid molecule.

[0008] Cardiovascular disorders or conditions contemplated by the present invention are diseases that involve the heart or blood vessels (arteries and veins), including in particular myocardial infarction (or "MI"). By treating a cardiovascular disorder or condition with the present methodology, the disorder is prevented or is delayed; or alternatively, its progression is slowed down, the extent of the injury is reduced, and the recovery is accelerated.

[0009] In one embodiment, the present invention provides a method of treating a cardiovascular disorder by administering a Nell1 protein or functional derivatives thereof to a subject in need of the treatment. Nell 1 proteins suitable for use in the present method include wild type Nell 1 proteins from any mammalian species, as well as functional derivatives thereof. Nell1 proteins, as well as functional derivatives thereof, can be recombinantly produced or purified from a mammalian body or tissue.

[0010] In another embodiment, the present invention provides a method of treating a cardiovascular disorder by administering a nucleic acid molecule encoding a Nell1 protein to a subject in need of the treatment. The nucleic acid molecule can be provided in an expression vector, including viral vectors and non-viral vectors, suitable for effecting the expression of the Nell1 protein in the targeted tissue or cells.

[0011] In accordance with the present invention, a Nell1 protein, functional derivatives thereof, or nucleic acid molecule can be combined with an appropriate pharmaceutically acceptable carrier for administration. Administration can be conducted in any practical and convenient manner, including by ingestion, injection or implantation, for example.

[0012] In a specific embodiment, a Nell1 protein, functional derivatives thereof, or Nell1-encoding nucleic acid molecule is used in combination with cell-based therapy for the repair and regeneration of damaged cardiac muscles and blood vessels. For example, a Nell1 protein, functional derivatives thereof, or Nell1-encoding nucleic acid molecule can be administered together with cardiomyocytes for repopulation of cells in the injured site. Alternatively, a Nell 1 protein, functional derivatives thereof, or Nell 1-encoding nucleic acid molecule can be administered together with stem cells isolated from adult bone marrow for regeneration of damaged cardiac muscles and blood vessels.

BRIEF DESCRIPTION OF THE DRAWINGS

[0013] The file of this patent application contains drawings executed in color.

[0014] FIGS. 1A-1B show the cardiovascular defects in mice without Nell1 function (Nell1⁶R mutation). Homozygote fetuses at E18 days of gestation (Top) show decreased blood circulation (arrows) and unexpanded lungs compared to heterozygotes (bottom) and wild type animals (not shown). Fetuses were unable to breathe after birth or after caesarean recovery.

[0015] FIGS. 2A-2B (in color) demonstrate that Nell 1 protein is required for blood vessel formation and establishment of a complex vascular network. The loss of Nell 1 function resulted in a significant reduction of the number of blood vessels and extensive branching of the vasculature in Nell1⁶R mutants (FIG. 2B) compared to (FIG. 2A) normal fetuses. The decrease in blood vessel formation was observed throughout the fetal body.

[0016] FIGS. 3A-3B illustrate severe cardiovascular defects and neonatal lethality associated with the complete loss of Nell 1 function in the mouse. The cardiovascular defects resulting from the complete loss of Nell 1 function in Nell1⁶R was associated with decreased blood circulation into the heart muscles and predominance of increased numbers of immature cardiomyocytes. The dense packing of smaller cardiomyocytes in the mutant (FIG. 3B) was very apparent in the denser/darker staining with haematoxylin and eosin, compared to the wild type (FIG. 3A). These cardiovascular defects are evident in E18.5 day fetuses recovered by caesarean.

[0017] FIGS. 4A-4C illustrate a strategy for treatment of heart muscle injury after MI in rodents using direct injection of stem cells or drugs to the border zone.

[0018] FIG. 5 provides an alignment of the human (SEQ ID NO: 2) and murine (SEQ ID NO: 4) Nell1 proteins. The functional domains of the human Nell 1 protein are found in the essentially same regions as those identified in the murine Nell1 protein.

[0019] FIGS. 6A-6D. NELL1 Protein Treatment of Damaged Heart Tissue in Mice with Myocardial Infarction (MI). (6A) Untreated mouse hearts with MI due to the loss of blood supply from a ligation of the left anterior descending coronary artery had a readily visible creamy white looking damaged tissue on the surface of the heart (17 days post MI-induction). All Nell1 protein treated hearts had lesser amount of damaged tissue as illustrated in FIG. 7B to 7D. The damaged sections (outlined by blue lines) in controls were typically at least 50% while the treated hearts had barely visible (6B) to as high as 30% infarcts observed (6D).

[0020] FIGS. 7A-7F. Reduction of Damaged Heart Tissue Incurred From Myocardial Infarction in Nell1-treated Hearts. Longitudinal sections of normal hearts stained with either haematoxylin and eosin (7A) or masson-trichome (7B) show intense staining of the heart muscle and reveals a very compact organization of the muscle tissues in the right and left ventricles (ry and lv respectively), and the interventricular septum separating the two ventricular chambers (IVS). After a myocardial infarction event, the muscle tissues died due to a lack of oxygenated blood supply and the deterioration of the muscle architecture was evident by the large gaps in the tissue and the decreased intensity of the staining (7C; 17 days post-MI). Hearts with MI that were treated with the Nell1 protein had lesser damage in the heart tissue from the surface to just before the middle of the heart (7D and 7E). In some hearts the improvement was manifested even deeper into the middle section of the heart (7F).

DETAILED DESCRIPTION OF THE INVENTION

[0021] The present invention relates to therapeutic methods for treating cardiovascular conditions or disorders by employing the cell differentiation signaling protein Nell 1, as well as functional derivatives thereof.

[0022] The present invention is based on the surprising discovery by the inventor that the Nell 1 protein is essential for normal cardiovascular development by promoting proper formation of the heart and blood vessels. The inventor discovered that loss of Nell 1 resulted in several tissue and organ changes typical of cardiac muscle injury, including heart enlargement, tissue hypertrophy, decreased blood vessel formation and blood circulation. The inventor observed that microscopic examination of Nell1-deficient hearts showed heart enlargement and cardiomyopathy, conditions associated with events of myocardial infarction ("MI"). Although the basic vasculature system was observed during embryo development even without a functional Nell 1, the amount and complexity (branched network) was significantly reduced in Nell1 mutants. The therapeutic application of Nell 1 for heart muscle regeneration is therefore dependent not only on the protein's abilities to signal muscle cell maturation, but also in its capabilities to support the construction of the highly branched vasculature that is required to sustain new heart muscle formation and maintenance of heart function. The inventor also observed that microarray experiments indicate that Nell1 is essential for the proper formation of heart extracellular matrix, main structural components of heart muscle, and proper functioning of genes for heart metabolism and contraction.

[0023] Accordingly, the present invention provides methods for treating cardiovascular conditions or disorders by employing a Nell1 protein, functional derivatives thereof, or Nell1 nucleic acid molecules.

[0024] The term "condition," as used herein, refers to a disease or ailment. The term "disorder," as used herein, refers to a condition in which there is a disturbance of normal functioning. The term "cardiovascular," as used herein, refers to the heart and/or blood vessels.

[0025] Accordingly, the term "cardiovascular condition" or "cardiovascular disorder", as used herein, refers to diseases or aliments that involve the heart, blood vessels (e.g., arteries and veins). Generally, such diseases or aliments result in an abnormality in the cardiac structure, cardiac muscle, and/or cardiac function. The cardiovascular condition or disorder can be acute or chronic.

[0026] The term "cardiovascular condition" or "cardiovascular disorder" can be used interchangeably throughout the specification. Examples of a cardiovascular disease include aneurysms, angina, atherosclerosis, cardiomyopathy, congestive heart failure, coronary artery disease, and myocardial infarction, among others. Further examples of cardiovascular conditions include, for instances, blood vessels that have been revascularized. Such patients generally have a stent placed in a blood vessel (e.g., artery, etc.)

[0027] A cardiovascular condition especially suitable for being treated with the method of the present invention is myocardial infarction (or "MI"). MI, also known as a "heart attack" or "heart failure", is a medical condition that occurs when the blood supply to a part of the heart is interrupted. MI is often caused by partial or complete occlusion of one or more of the coronary arteries, usually due to rupture of an atherosclerotic plaque. The occlusion of the coronary artery results in cardiac ischemia. The resulting ischemia or oxygen shortage causes damage and potential death of heart tissue.

[0028] The term "treating" or "treatment" a disease, as used herein, refers to preventing or delaying the onset of the disease, or when the disease does occur, retard the progression or ameliorate the symptoms of the disease, reduce the extent of tissue injury or damage, or promote recovery of the injured tissue and regeneration of new functional tissue or cells.

[0029] The subject suitable for receiving a treatment in accordance with the present invention includes any mammalian subject in need of the treatment. In one embodiment, the subject is a human subject. A subject in need of treatment includes both subjects who have been determined to have a higher risk of developing a cardiovascular disease, and subjects who have a cardiovascular disease, as well as subjects who have recently experienced a cardiovascular event such as MI.

[0030] In one embodiment, the method of the present invention is achieved by administration of a Nell1 protein to a subject in need of the treatment.

[0031] "A Nell1 protein" as used herein, includes wild type (i.e., naturally occurring) Nell1 proteins of any mammalian origin, such as human, murine, rat and the like. Preferred Nell1 proteins for use in the present invention include human Nell1 protein (SEQ ID NO: 2), murine Nell1 protein (SEQ ID NO: 4), and rat Nell1 protein (SEQ ID NO: 6).

[0032] "A Nell1 protein" as used herein, also includes functional derivatives of a wild type Nell1 protein. A "functional derivative" refers to a modified Nell1 protein which has one or more amino acid substitutions, deletions or insertions as compared to a wild type Nell1 protein, and which retains substantially the activity of a wild type Nell1 protein. By "substantially" is meant at least 50%, at least 75%, or even at least 85% of the activity of a wild type Nell1 protein. According to the present invention, in order for the functional derivative to substantially retain the activity or function of a wild type Nell1 protein, the functional Nell1 derivative shares a sequence identity with the wild type Nell1 protein of at least 75%, at least 85%, at least 95% or even 99%.

[0033] The structure of Nell1 proteins has been characterized (see, e.g., Kuroda et al., 1999a; Kuroda et al., 1999b, Desai et al., 2006). For example, the murine Nell1 protein (SEQ ID NO: 4) is a protein of 810 amino acids, having a secretion signal peptide (amino acids #1 to 16), an N-terminal TSP-like module (amino acids #29 to 213), a Laminin G region (amino acids #86 to 210), von Willebrand factor C domains (amino acids #273 to 331 and 699 to 749), and a Ca²+-binding EGF-like domains (amino acids #549 to 586).

[0034] The secretion signal peptide domain of Nell1 protein is an amino acid sequence in the protein that is generally involved in transport of the protein to cell organelles where it is processed for secretion outside the cell. The N-terminal TSP-like module is generally associated with heparin binding. von Willebrand factor C domains are generally involved with oligomerization of Nell1 Laminin G domains of Nell1 protein are generally involved in adherence of Nell1 protein to specific cell types or other extracellular matrix proteins. The interaction of such domains with their counterparts is generally associated with, for example, processes such as differentiation, adhesion, cell signaling or mediating specific cell-cell interactions in order to promote cell proliferation and differentiation. The Ca²+-binding EGF-like domains of Nell1 binds protein kinase C beta, which is typically involved in cell signaling pathways in growth and differentiation.

[0035] The amino acid sequence of Nell1 protein is very highly conserved, especially across mammalian species. For example, the murine Nell1 protein shares about 93% sequence identity with the human Nell1 protein (SEQ ID NO: 2), which, in turn, shares about 90% sequence identity with the rat Nell1 protein (SEQ ID NO: 4). Those skilled in the art can use any of the well-known molecular cloning techniques to generate Nell1 derivatives having one or more amino acid substitutions, deletions or insertions, taking into consideration the functional domains (e.g., secretion signal peptide sequence, N-terminal TSP-like module, Laminin G region, von Willebrand factor C domain) of Nell1. See, for example, Current Protocols in Molecular Cloning (Ausubel et al., John Wiley & Sons, New York).

[0036] The minimum length of a Nell1 functional derivative is typically at least about 10 amino acids residues in length, more typically at least about 20 amino acid residues in length, even more typically at least about 30 amino acid residues in length, and still more typically at least about 40 amino acid residues in length. As stated above, wild type Nell1 protein is approximately about 810 amino acid residues in length. A Nell1 functional derivative can be at most about 810 amino acid residues in length. For example, a Nell1 functional derivative can be at most at most about 820, 805, 800, 790, 780, 750, 600, 650 600, 550, etc. amino acid residues in length.

[0037] Once a Nell1 protein derivative is made, such protein can be tested to determine whether such derivative retains substantially the activity or function of a wild type Nell1 protein. For example, the ability of a Nell1 derivative to bind PKC beta can be tested. Suitable assays for assessing the binding of Nell1 to PKC beta is described in e.g., Kuroda et al. (1999b). For example, protein-protein interaction can be analyzed by using the yeast two-hybrid system. Briefly, a modified Nell1 protein can be fused with GAL4 activating domain and the regulatory domain of PKC can be fused with the GAL4 DNA-binding domain. The activity of beta-galactosidase in yeast cells can be detected.

[0038] In addition, one can also test the ability of a Nell1 derivative to stimulate differentiation of precursor cells, which are in the cardiomyocyte lineage, towards mature cardiomyocytes. Maturity of cardiomyocytes can be assessed cellularly (histology) and molecularly (expression of cardiac-specific proteins or extracellular matrix materials). Still further, a Nell1 derivative can be tested for its ability to drive osteoblast precursors to mature bone cells, by detecting expression of late molecular bone markers or mineralization (i.e., calcium deposits). By comparing the activity of a Nell1 derivative with that of a wild type Nell1 protein in one or more of the assays such as those described above, one should be able to determine whether such derivative retains substantially the activity or function of a wild type Nell1 protein.

[0039] A Nell1 protein or functional derivative thereof may be prepared by methods that are well known in the art. One such method includes isolating or synthesizing DNA encoding the Nell 1 protein, and producing the recombinant protein by expressing the DNA, optionally in a recombinant vector, in a suitable host cell, including bacterial, yeast, insect or mammalian cells. Such suitable methods for synthesizing DNA are, for example, described by Caruthers et al. 1985. Science 230:281-285 and DNA Structure, Part A: Synthesis and Physical Analysis of DNA, Lilley, D. M. J. and Dahlberg, J. E. (Eds.), Methods Enzymol., 211, Academic Press, Inc., New York (1992).

[0040] Examples of suitable Nell1 nucleic acid sequences include SEQ ID NOs: 1, 3, and 5. A Nell1 protein or functional derivative may also be made synthetically, i.e. from individual amino acids, or semisynthetically, i.e. from oligopeptide units or a combination of oligopeptide units and individual amino acids. Suitable methods for synthesizing proteins are described by Stuart and Young in "Solid Phase Peptide Synthesis," Second Edition, Pierce Chemical Company (1984), Solid Phase Peptide Synthesis, Methods Enzymol., 289, Academic Press, Inc, New York (1997). Examples of suitable Nell1 amino acid sequences include SEQ ID NOs: 2, 4, 6, and derivatives thereof.

[0041] In another embodiment, the method of the present invention is achieved by administration of a nucleic acid molecule encoding a Nell1 protein or functional derivative to a subject in need of the treatment.

[0042] Suitable nucleic acid molecules for use in the present invention include nucleic acid molecules having a nucleotide sequence as set forth in SEQ ID NO: 1 (encoding the wild type human Nell1 protein), SEQ ID NO: 3 (encoding the wild type murine Nell1 protein), and SEQ ID NO: 5 (encoding the rat wild type Nell 1 protein), as well as degenerate sequences thereof. As used herein, the term "degenerate sequence" refers to a sequence formed by replacing one or more codons in the nucleotide sequence encoding wild type Nell1 protein with degenerate codes which encode the same amino acid residue (e.g., GAU and GAC triplets each encode the amino acid residue Asp).

[0043] In some embodiments, nucleic acid molecules for use in the methods of the present invention are provided in an expression vector. Expression vectors for use in the present methods include any appropriate gene therapy vectors, such as nonviral (e.g., plasmid vectors), retroviral, adenoviral, herpes simplex viral, adeno-associated viral, polio viruses and vaccinia vectors. Examples of retroviral vectors include, but are not limited to, Moloney murine leukemia virus (MoMuLV), Harvey murine sarcoma virus (HaMuSV), murine mammary tumor virus (MuMTV), and Rous Sarcoma Virus (RSV)-derived recombinant vectors. A Nell1-coding nucleotide sequence can be placed in an operable linkage to a promoter in the expression vector, wherein the promoter directs the expression of the Nell1 protein in the targeted tissue or cells, and includes both a constitutive promoter and a tissue or cell-specific promoter.

[0044] A Nell 1 protein, functional derivative thereof or Nell 1-encoding nucleic acid molecule can be combined with a pharmaceutically acceptable carrier and prepared in formulations suitable for administration to a subject by injections, implantations, inhalations, ingestions and the like. Pharmaceutically acceptable carriers are described hereinabove and include oils, water, saline solutions, gel, lipids, liposomes, resins, porous matrices, binders, fillers and the like, or combinations thereof. The carrier can be liquid, semi-solid, e.g. pastes, or solid carriers. Except insofar as any conventional media, agent, diluent or carrier is detrimental to the recipient or to the therapeutic effectiveness of the active ingredients contained therein, its use the present invention is appropriate. Examples of carriers include oils, water, saline solutions, gel, lipids, liposomes, resins, porous matrices, binders, fillers, patches, and the like, or combinations thereof. The carrier can also be a controlled release matrix that allows optimum release of a Nell1 protein or nucleic acid admixed therein.

[0045] The term "therapeutically effective amount" means the dose required to prevent or delay the onset, slow down the progression or ameliorate the symptoms of the disorder. Precise dosages depend on the disease state or condition being treated and other clinical factors, such as weight and condition of the subject, the subject's response to the therapy, the type of formulations and the route of administration. As a general rule, a suitable dose of a Nell 1 composition (i.e., including a Nell1 protein or nucleic acid) for the administration to adult humans ranges from about 0.001 mg to about 20 mg per kilogram of body weight. In some embodiments, a suitable dose of a Nell1 composition for the administration to adult humans is in the range of about 0.01 mg to about 5 mg per kilogram of body weight. However, the precise dosage to be therapeutically effective and non-detrimental can be determined by those skilled in the art.

[0046] A Nell1 protein, functional derivative thereof, or nucleic acid molecule can be administered to the subject in any practical and convenient manner. Suitable routes of administration include the oral, nasal, topical, transdermal, and parenteral (e.g., intravenous, intraperitoneal, intradermal, subcutaneous or intramuscular) route. In addition, a Nell1 protein, functional derivative thereof, or nucleic acid molecule can be introduced into the body, by injection or by surgical implantation or attachment, proximate to a preselected tissue or organ site such that the Nell1 material is able to enter the site by direct diffusion. For example, a Nell1 protein, functional derivative thereof, or nucleic acid can be provided in a patch or gel like substances, which, upon administration (by e.g., injection or implantation) can be taken up directly by tissues as a result of diffusing from a site of high concentration to one where there is very low level of the substance. If Nell1 protein, functional derivative thereof, or nucleic acid molecule is administered locally, the formulation is such that the Nell1 protein, functional derivative thereof, or nucleic acid molecule does not diffuse and adversely affect surrounding organs.

[0047] Alternatively, a Nell 1 protein, or functional derivative thereof, can be administered directly to injured and damaged tissue (e.g., infarct and surrounding border zones). Such administration, can be applied, for example, to treat cardiovascular defects, thus minimizing heart muscle injury or stimulating tissue repair processes in the heart after MI.

[0048] Other delivery systems and methods include, but are not limited to: a) catheter-based devices that permit site specific drug delivery to the heart muscle, b) via a thorascopic opening (small minimally invasive wound in the thoracic cavity; similar to laparascopic methods) through which a scope and guided injection device containing Nell1 protein, derivative thereof, or nucleic acid molecule is introduced, c) ultrasonic-based drug delivery methods (see, for example, Mayer et al., Advanced Drug Delivery Reviews, 2008, 60:1177-1192 and Bekeredjian et al., Ultrasound in Medicine and Biology, 2005, 31:687-691), and d) infusion into the pericardial space (see, for example, Xiao et al., Am. J. Physiol, Heart Circ. Physiol., 2008, 294:H12212-12218).

[0049] Important general considerations for design of delivery systems and compositions, and for routes of administration, for protein/peptide drugs may apply. For example, the appropriate delivery system for Nell1 protein and/or functional derivatives thereof will depend upon its particular nature, the particular clinical application, and the site of action.

[0050] Formulations for oral delivery or systemic delivery, for instance, may require certain considerations due to, for example, instability of Nell1 protein and/or functional derivatives thereof in the gastrointestinal tract, or exposure of Nell 1 protein and/or functional derivatives thereof to proteases. Any method known to those skilled in the art can be utilized to address such considerations.

[0051] For example, for oral delivery, an absorption-enhancing agent can be utilized. A wide variety of absorption-enhancing agents have been investigated and/or applied in combination with protein compositions for oral delivery and for delivery by other routes (van Hoogdalem, Pharmac. Ther. 44, 407-43, 1989; Davis, J. Pharm. Pharmacol. 44(Suppl. 1), 186-90, 1992). Most commonly, typical enhancers fall into the general categories of (a) chelators, such as EDTA, salicylates, and N-acyl derivatives of collagen, (b) surfactants, such as lauryl sulfate and polyoxyethylene-9-lauryl ether, (c) bile salts, such as glycholate and taurocholate, and derivatives, such as taurodihydrofusidate, (d) fatty acids, such as oleic acid and capric acid, and their derivatives, such as acylcarnitines, monoglycerides, and diglycerides, (e) non-surfactants, such as unsaturated cyclic ureas, (f) saponins, (g) cyclodextrins, and (h) phospholipids.

[0052] Alternatively, Nell 1 protein and/or functional derivative thereof, can be administered in combination with other drugs or substances that directly inhibit proteases and/or other potential sources of enzymatic degradation of proteins. Yet another alternative approach to prevent or delay gastrointestinal absorption of Nell1 protein and/or functional derivative thereof is to incorporate them into a delivery system that is designed to protect the protein from contact with the proteolytic enzymes in the intestinal lumen and to release the Nell1 protein and/or functional derivatives thereof at the site of cardiovascular injury. A more specific example of this strategy is the use of biodegradable microcapsules or microspheres, both to protect a protein from degradation, as well as to effect a prolonged release of active protein (see, for example, Deasy, in Microencapsulation and Related Processes, Swarbrick, ed., Marcell Dekker, Inc.: New York, 1984, pp. 1-60, 88-89, 208-11).

[0053] In a specific embodiment, a Nell 1 protein, functional derivative thereof, or nucleic acid molecule is administered to directly repair heart muscle after MI. Delivery can be performed via direct delivery to or near the injured heart muscle site (infarct and border zones) by injection, by catheter, via absorbable biomatrix (i.e. biocompatible porous) material, and the like, and combinations thereof. According to this embodiment, the Nell 1 composition is administered to the subject after the initial inflammatory responses subsides--usually within 72 hours, within 48 hours, within 36 hours, within 24 hours, or even within 18 hours of MI, in order to minimize the extent of the injury and achieve better therapeutic efficacy. There is a flood of inflammatory responses immediately after heart muscle injury. It is believed to be optimal to administer Nell 1 after this initial defensive response of the surrounding tissue. Regenerative processes, which naturally begins after the inflammatory response slows down, are where Nell1 is likely to work best.

[0054] Further according to the present invention, a Nell1 protein, functional derivative thereof, or Nell 1-encoding nucleic acid molecule can be used independently or in conjunction with additional therapeutic compositions useful for treating a cardiovascular condition.

[0055] In a specific embodiment, a Nell1 protein, functional derivative thereof, or Nell 1-encoding nucleic acid molecule is used together with stem cells for the repair and regeneration of damaged cardiac muscles and blood vessels.

[0056] Cell-based therapies for the repair and regeneration of damaged cardiac muscles and blood vessels utilize implantation of cells (such as cardiomyocytes), or introduction of stem cells isolated from adult bone marrow to develop new cardiac muscle in the area of implantation. See, e.g., Orlic et al., 2001; Rubart et al., 2006; Ott et al., 2006; Rosenthal et al., 2006. Without being bound by theory, the use of Nell1 increases the efficiency of cell-based therapies for the repair and regeneration of damaged cardiac muscles and blood vessels.

[0057] According to the present invention, a Nell1 protein or nucleic acid molecule can be co-delivered with the appropriate cells, e.g., cardiomyocytes or adult stem cells, directly to the damaged sites of a subject using biological matrices or direct injection methods already in practice for cell-based therapies.

[0058] In another embodiment, a Nell1 protein, functional derivative thereof, or Nell 1-encoding nucleic acid molecule is used in vitro to stimulate or promote the development and differentiation of stem cells into cardiomyocytes useful for the repair and regeneration of damaged cardiac muscles and blood vessels. See, for instance, example 7.

[0059] This invention is further illustrated by the following examples, which are not to be construed in any way as imposing limitations upon the scope thereof. The terms and expressions which have been employed in the present disclosure are used as terms of description and not of limitation, and there is no intention in the use of such terms and expressions of excluding any equivalents of the features shown and described or portions thereof. It is to be understood that various modifications are considered to be included within the scope of the invention. All the publications mentioned in the present disclosure are incorporated herein by reference.

Example 1

Nell1⁶R Mutant Mouse

[0060] The Nell1⁶R mutant mouse was used in the experiments described in the following examples. Generation, breeding and maintenance of this mutant mouse is described in U.S. Published Application 2006/0053503, which is incorporated herein by reference. Briefly, the mutant mouse contains a recessive neonatal-lethal point mutation in the Nell1 gene, originally induced by N-ethyl-N-nitrosourea (ENU). Nell1⁶R has T to A base change that converts a codon for cysteine into a premature stop codon (TGT to TGA; Cys(502)Ter), resulting in a severe truncation of the Nell1 protein product and a marked reduction in steady state levels of the Nell transcript.

Example 2

Heart Defects in Nell1⁶R Mutant Mouse

[0061] Formalin-fixed specimens were analyzed by heart length and width measurements. These measurements were completed on wild type, heterozygous, and mutant mice at the 18.5-day embryonic stage. Further observations were made using standard histological methods (haematoxylin and cosin staining on mouse sagittal sections).

[0062] Nell1⁶R mice were observed to have significantly enlarged hearts based on length and width measurements. As shown in Table 1, length measurements for all three genotypes did not differ significantly. However, based on the statistical T-test, the width measurements for mutant mice was significantly greater compared to the width for wild type and heterozygous mice, this confirming presence of an abnormal heart phenotype in mutant mice.

[0063] Examination of the haematoxylin and eosin-stained slides showed dramatically reduced blood flow out of the heart. As shown in FIGS. 1-2, wild-type and heterozygote mice showed arteries filled with blood whereas blood was not a very prominent feature in slides of mutant mice. Therefore, the loss of Nell 1 function resulted in a significant reduction of the number of blood vessels and extensive branching of the vasculature in mutants as compared to wild type fetuses. The decrease in blood vessel formation was observed throughout the fetal body.

[0064] In addition, a larger number of immature heart cells and lesser extracellular matrix were observed in mutant mice as compared to wild type mice (FIG. 3A-3B). The dense packing of smaller cardiomyocytes in the mutant (FIG. 3B) was very apparent in the denser/darker staining with haematoxylin and eosin, compared to the wild type (FIG. 3A).

TABLE-US-00001 TABLE 1 Measurements of Nell1⁶R Hearts Indicating Heart Enlargement Measurement (mm) of E18.5 fetal heart width and length of NelI1⁶R heterozygote and homozygote mutant mice compared with wild-type littermates. There is significant enlargement of fetal hearts in homozygote mutant compared to the heterozygotes and normal mice. Homozygote Heteozygote Wild-type Nell16R/Nell 16R +/Nell 1 6R +/+ Width 3.3 2.8 2.7 2.5 2.8 2.8 2.8 2.3 2.8 2.3 2.7 2.5 2.8 2.8 2.7 3.0 2.5 2.3 3.2 2.5 2.2 3.0 2.5 2.5 2.8 2.2 2.8 2.8 2.5 2.7 3.3 2.2 2.7 3.0 -- 2.2 3.0 -- 2.5 2.5 -- 2.3 2.5 -- -- 3.0 -- -- 2.5 -- -- No. of Fetuses 17 11 14 Average 2.853 2.530 2.476 Length 3.2 3.7 2.7 2.8 3.2 2.7 2.8 2.8 3.3 2.7 3.2 3.0 3.0 3.2 3.3 3.2 3.0 3.0 3.2 3.0 2.5 3.3 3.3 3.0 3.0 2.8 3.3 2.8 3.0 3.2 3.2 2.8 3.3 3.2 -- 2.7 3.2 -- 2.8 2.8 -- 3.0 2.5 -- -- 3.0 -- -- 2.8 -- -- No. of Fetuses 17 11 14 Average 2.984 3.091 2.988 T-Test p-values Mutant: Mutant: Heterozygote: Wild-type Heterozygote Wild-type Width 0.0012442891 0.0046893426 0.6143698331 Length 0.9351530349 0.2470911230 0.3514701862

[0065] These above cardiovascular defects were evident in E18.5 day fetuses recovered by caesarean. Additionally, wild type and heterozygote mice had spongy lungs that filled their entire thoracic cavity, while mutant mice had compact, dense lungs. Mutant mice did not survive birth. The severity of the heart and blood vessel defects were likely to be the cause of the death of the fetuses during the birth process reported earlier (Desai et al, 2006). Fetuses that were recovered by caesarean were unable to breathe as depicted in the collapsed lung in the mutants.

Example 3

ECM Genes Affected by Nell1 Influence Heart Development

[0066] A comprehensive gene expression analysis using public database (UCSC Genome Browser, Mouse Genome Informatics, Integrated Cartilage Gene Database, PubMed) was conducted to investigate the relationship between cardiovascular development and each of the 28 extracellular matrix (ECM) genes which were shown previously (Desai et al., 2006) to exhibit reduced expression in Nell1⁶R mutant mouse bodies. Of the 28 ECM genes studied, the bioinformatics analysis showed that the majority of genes with reduced expression in Nell-1 deficient mice are normally expressed in the heart (79% of the analyzed ECM genes; 22/28), blood vessels (71%; 20/28) and bone marrow (61%; 17/28) (See Table 2). The Mouse Genome Informatics database referenced several genes (Col15a1, Osf-2, Bmpr1a, Pkd1, Mfge8, Ptger4, Notch3) that have been mutated in mice and actually manifest abnormalities in cardiovascular development.

[0067] Mouse mutations in some of these genes display heart deformities commonly associated with heart enlargement, as shown in Table 3 below.

TABLE-US-00002 TABLE 2 Expression profile of genes in the Nell1 pathway and association with mutant mouse phenotypes. # abnormal Gene Expression bone heart # total Symbol Gene Name heart vascular blood marrow phenotype¹³ mutants¹³ Tnxb tenascin 10 10 11 11 2 Prg4 proteoglycan 4 33 12 12 1 Thbs3 thrombospondin 3 10 10 12 2 Col5a3 collagen 5 alpha 3 subunit Neurog2 neurogenin 2 5 Col5a1 procollagen type V, alpha 1 10 10 10 10 1 1 Col6a1 procollagen Type VI, aloha 1 10 16 12 10 1 Col15a1 procollagen type XV, alpha 1 10 19 10 12 1 1 Pacsin3 PKC and casein kinase 10 10 substrate in neurons 3 Tnc tenascin c 10 10 21 11 3 Col12a1 procollagen type XII, alpha 1 10 12 10 Chad chondroadherin 15 15 Osf2- osteoblast specific factor 2 10 10 10 1 2 pending Col17a1 procollagen type XVII alpha 1 Prkcc protein kinase C 2 Prkch protein kinase C, eta symbol 10 10 10 10 1 Bk- brain and kidney protein pending Ptk9l PTK9L protein tyrosine 10 10 10 10 kinase 9-like Npdc1 neural proliferation, 10 10 1 differentiation and control gene Bmpr1a bone morphogenetic protein 10 12 10 2 4 receptor type 1a Pkd1 polycystic kidney disease I 10 27 10 12 7 12 homolog Tnfrsf11b tumor necrosis factor (ligand) 10 34 12 3 Mfge8 milk fat globule-EGF factor 8 10 12 10 10 1 5 protein Matn3 matrilin 3, cartilage matrix 28 1 protein Bmp7 bone morphogenetic protein 10 10 8 type 7 Matn2 matrilin 2, cartilage matrix 10 10 10 10 2 protein 2 Ptger4 prostaglandin E receptor 4 10 10 10 3 4 Notch3 notch gene homolog 3 10 30 4 # of Genes 22 20 13 17 7 20 Percentage 79% 71% 46% 61% 25% 71%

TABLE-US-00003 TABLE 3 Mutated genes causing heart defects associated with enlargement Gene Defect Col6a1 Dilated descending aorta Bmprla Persistent truncus arteriosus Outflow tract formation abnormalities Pkd1 Vascular leaks/ruptures Endocardial cushion defects Abnormal atrial septum morphology Double outlet right ventricle Abnormal septation Bmp7 Lack of endocardial cushion formation Ptger4 Dilated left ventricle Patent ducrus arteriosus Congestive heart failure

Example 4

Gene Expression in Nell1⁶R Mutant Mouse

[0068] To define the involvement of Nell1 in the known molecular pathways that govern heart structure and function, a comprehensive gene expression analysis was conducted in the entire mouse genome (30,000 genes) of normal fetal hearts and those dissected from Nell1⁶R. This analysis consisted of 50 mutant fetal hearts separated into 4 pools of 10-13 hearts and 35 normal hearts separated into three pools of 10-12 hearts (18.5 days of gestation). RNAs were extracted from the pooled tissues, processed for microarray analysis on the Illumina Mouse V6 chips and scanned with Illumina Beadstation 500GX. Data was analyzed with the BeadStudio software and Gene Ontology Tree machine. At least 345 genes were identified that were differentially expressed between normal and mutant samples (at p value=0.001 for the microarray detection and differential p values; denotes a very high statistical significance). Table 4 lists a representative sampling of genes influenced by Nell1 that already have established functions in cardiovascular conditions. Table 4 also provides the literature references for the specific studies that have demonstrated these gene functions.

[0069] Table 4 shows a number of genes in the Nell1 pathway that have been implicated in the processes that ensue after heart failure. The ability of Nell1 to stimulate proteins that control cell differentiation and proper secretion of the cardiac ECM strongly suggests that this protein can restore proper ECM constitution and orientation in heart muscle after a heart attack, thereby preventing or alleviating heart muscle damage and subsequent loss of heart function (or death) resulting from MI.

Example 5

[0070] The data presented here were based on studies of the Nell1⁶R mutant mouse. Rodent Nell1 studies are believed to translate accurately to the human situation. The complete mouse Nell1 coding sequence has been reported (Genbank Accession No. AY622226; Desai et al., 2006). A comparison of this sequence with the most current human Nell1 gene in the public genome databases (UCSC Genome Browser and NCBI) indicates a very high homology of 87% gene sequence identity. The corresponding 810-amino acid residue polypeptides have a 93% identity in their amino acid sequences (FIG. 5). When one considers conservative substitution of similar amino acids, the human and mouse Nell1 proteins are 97% conserved. This remarkable degree of gene and protein structure conservation suggests the conservation of functions and fundamental mechanisms of Nell1-mediated pathways in human and mouse.

Example 6

Animal Model for Assessing Therapeutic Efficacy of Neil for MI

[0071] The efficacy of the Nell 1 protein for regenerating cardiac muscle after damage induced by a myocardial infarction (MI) is tested in a widely used and accepted in vivo animal model. Myocardial infarction is induced in a murine in vivo model by blocking the main blood supply line to the left ventricle. The surgical procedures for generating this model are described in detail by several publications (Patten et al., 1998; Tarnayski et al., 2004; Ahn et al., 2004).

[0072] Briefly, mice are anesthetized, restrained in a supine position, and intubated with pure oxygen regulated by a small animal ventilator. A thoracotomy is performed under a dissecting scope, at the fourth or fifth intercostal space of the left side, between the heart and lung margins. The thoracic surgical hole is enlarged using retractors and the pericardial sac is gently torn with fine forceps.

[0073] The left anterior descending coronary artery (LAD) is visualized and ligated by passing a tapered microsurgical needle (1/4 circle, 140 microns) with a black silk monofilament suture (size 7 or 8) underneath the coronary artery and tying the suture to completely stop the blood flow in the artery. A small polyethylene tubing (PE 10) 2-3 mm is placed between the tie and the LD to minimize cutting and severely injuring the artery.

[0074] Myocardial infarction is confirmed by observing for blanched or white appearance of the left vertical that correspond to the muscles that have lost blood supply and the alteration of the wave pattern (pronounced ST wave elevation) in an electrocardiogram. Since the LAD provides the blood supply to the left ventricle, this surgically-induced myocardial infarction will cause the death of myocardial tissue (necrosis) in the left bentricular wall and the anterior section of the interventricular section. The size of the myocardial infarction lesions/infarcts can be controlled by the exact position of the ligation along the LAD. Ligation at a high position (atrioventricular junction) will reduce blood flow to a larger area and make larger infarcts while ligations at lower areas will make medium or small lesions. Ligature position is kept constant for any given experimental group to keep the infarction size constate.

[0075] After myocardial infarction induction, the thoracic and skin wounds are sutured and mice are allowed to recover from anesthesia on a heating pad or with heat lamps.

[0076] To test the ability of Nell1 to repair cardiac tissue damage due to an acute myocardial infarction event, purified Nell1 protein are delivered directly into the surrounding tissue around the visible infarct and within the infarct. Direct delivery of Nell1 protein is performed by reopening the original thoracic wound used to induce the infarct.

[0077] Nell1 and functional derivatives thereof containing EGF like domains and/or the von Willebrand like domain of Nell1 are administered at 2-3 points along one side of the infarct border zone. In some animals, direct delivery of Nell1 protein is administered via microinjection, application of Nell1 in a gel or microspray, via nanoparticles, or time-release patches. In others, it is administered via a Nell1 protein expression vector (continuous delivery). Administration of Nell1 is performed after the initial surge of inflammatory response triggered by cardiac damage and at the time heart tissue attempts innate regenerative mechanisms (approximately 4-5 hrs after MI). The effects of Nell1 administration are evaluated by standard histology and immunohistochemistry techniques for detection of proteins associated with cardiac tissue regeneration (Orlic et al., 2001).

Example 7

In vitro Stem Cell Therapy

[0078] A promising approach in the field of heart muscle regeneration after MI is the introduction of either embryonic or adult mesenchymal stem cells into the damaged heart. However, data indicate that although new heart muscle cells can be regenerated that the new tissue may not necessarily display the full functional capacity of mature heart tissue (contractility).

[0079] To promote full functional capacity of mature heart tissue, Nell 1 protein and functional derivatives thereof containing EGF like domains and/or the von Willebrand like domain of Nell1 are co-delivered with stem cells to the injured heart muscle using the same strategies currently in use for stem cell delivery.

Example 8

Animal Model for Assessing Therapeutic Efficacy of Nell1 for Myocardial Ischemia and Reperfusion Injury

[0080] The efficacy of the Nell1 for regenerating cardiac muscle after damage induced by myocardial ischemia and reperfusion injury is tested in a widely used and accepted in vivo animal model. Myocardial ischemia and reperfusion injury is induced in an in vivo murine model as follow:

[0081] 1. After anesthesia, intubation and hook-up to a mouse ECG machine, the chest cavity of the mouse is opened at the intercostal space (usually 4^th or 5^th) and the opening is retracted to reveal the left side of the heart and to locate the LAD artery. The pericardial sac is torn gently with forceps and the LAD is positioned for easy access. All surgical steps are done under a dissecting microscope.

[0082] 2. A tapered needle (1/4 circle 140 microns) with a size 8 silk or monofilament suture is partially passed underneath the artery. A small tubing 1-1.5'' in length (e.g. polyethylene size 10 tubing) is placed on top and parallel to the LAD artery and perpendicular to the length of the needle. The suture is then pulled and a surgical tie is made such that the tubing is tied with the artery located beneath it.

[0083] 3. The interruption of blood flow to the left ventricular heart muscles is easily visualized by a blanched or white appearance of the affected region (where infarct develops). The ECG will confirm the ischemia by the alteration of the wave pattern (e.g. ST segment elevation, T wave anomalies) compared to the normal pattern. The change indicates that the LAD is successfully ligated and restricted blood flow to the left ventricle has functionally induced an ischemic event.

[0084] 4. The chest cavity and the skin are sutured such that one end of the tubing is sticking out of the thoracic area above the sutured skin. After the desired amount of time of ischemia, the tubing is gently pulled out to relax the knot/ligated suture thereby allowing reperfusion of blood into the affected area.

[0085] 5. Reperfusion is indicated by the return of the ECG pattern to normal or near normal pattern. Different groups of mice with varying times of occlusion before reperfusion are made.

[0086] 6. Varying concentrations of Nell1 protein are administered via intraperitoneal injection or using a catheter device that is placed before the chest cavity is closed after LAD ligation and ischemia. The catheter device allows for controlled delivery so that Nell1 protein can be delivered immediately after reperfusion or given time points after reperfusion is induced. In other models, Nell1 protein is administered by reopening the surgical sutures and re-entry to the chest cavity and direct Nell1 delivery by microinjection or gel patch.

Example 9

Animal Model for Assessing Therapeutic Efficacy of Neil for Cardiac Hypertrophy

[0087] The use of Nell1 protein as a therapeutic for cardiac hypertrophy is tested in a widely used and accepted in vivo animal model. Cardiac hypertrophy is generated by physical/surgical means [pressure-overload].

[0088] In the in vivo pressure overload animal model, the aorta of a mouse/rat or large animal is banded to reduce the diameter and thus the blood in the left ventricle builds up pressure and induces hypertrophy of the left ventricle (Tarnayski et al 2004). This type of animal model mimics the human condition of aortic stenosis where the narrowing of the aortic valve restricts blood flow from the left ventricle to the aorta. The persistent increased pressure in the left ventricle leads to increase in muscle mass (hypertrophy) of the walls. This model is generated as follows:

[0089] 1. Mice are anesthesized and a 5 mm transverse incision is made at the level of the left armpit, 2 mm away from the sternal border. A small incision (5 mm) is made at the 2^nd intercostal space and opened with microretractors.

[0090] 2. The thymus and fat covering the aortic area are pushed away and the pericardial sac is gently torn. The ascending portion of the aorta is located and bluntly dissected from the pulmonary trunk and forceps is placed underneath the ascending aorta

[0091] 3. A 7-0 silk suture is placed around the aorta and a loose knot is made. A 25 or 27 gauge needle (outer diameter of 0.51 mm) that is bent into an L shape is placed through the loose loop, positioned above and parallel to the aorta and a second knot is tied securely. The needle is retracted to yield a constricted aorta (60-80% constriction for a 27 gauge). Two more knots are tied.

[0092] 4. The chest cavity is closed by suturing ribs and then the skin wound.

[0093] Nell1 protein and functional derivatives thereof containing EGF like domains and/or the von Willebrand like domain of Nell 1 are administered as an injectable after the onset of hypertrophic changes and heart function anomalies detected by ECG. Times of administration are tested as one high dose after hypertrophy is diagnosed or at lower doses given multiple times (weekly) after hypertrophy is diagnosed. Efficacy of the treatment is evaluated by quantitative measurements of ventricular and heart size, physiological monitoring by ECG and other heart visualization tools, molecular markers for heart failure etc. as described earlier.

Example 10

Animal Model for Assessing Therapeutic Efficacy of Nell1 for Cardiomyopathy

[0094] The use of Nell1 protein as a therapeutic for cardiomyopathy is tested in a widely used and accepted in vivo animal model. The in vivo mouse model of cardiomyopathy is generated by gene-targeted approaches such as knock-outs or over-expression of a single gene, wherein the homozygotes (two mutant gene copies) and/or heterozygotes (one mutant copy) can survive to the juvenile or adult stage. Suitable in vivo mouse models of cardiomyopathy contain knock-outs or over-expression of genes and pathways (e.g., (extracellular matrix and matricellular proteins, tenascins, thrombospondins, matrilins, etc.) that are controlled by the Nell1 signaling protein. A specific example of an appropriate small animal model is the targeted knockout of the mouse Nov (Ccn3) gene reported by Heath et al. (BMC Developmental Biology 2008:8:18).

[0095] Briefly, Nov (Ccn3) mutant mice are generated. Imaging of hearts by echocardiograms and electrocardiograms are conducted to determine heart function and presence of visible heart structure anomalies prior to treatment.

[0096] Nell1 protein and functional derivatives thereof containing EGF like domains and/or the von Willebrand like domain of Nell1 are administered by intraperitoneal injection to young Nov (Ccn3) mutant mice and corresponding controls during the first two months of life. Various dosages and timing regimens are tested. After treatment, heart function parameters are measured in Nell1-treated and controls during the time that untreated mutant mice show the severe symptoms of cardiomyopathy, generally at 4-5 months in Nov mice.

[0097] After cardiovascular functional/physiological studies, the mice are sacrificed and hearts are dissected and fixed for morphological and histological evaluation such as: total heart size, chamber sizes (especially left ventricle), heart valve structure, chordae tendinae, interventricular septum, heart muscle cell (cardiomyocyte) size and appearance, vessels going in and out of the heart etc.

Example 11

NELL1 Protein Treatment of Heart Muscle Damage from Myocardial Infarction

[0098] The ability of Nell1 protein to trigger cellular pathway(s) for regeneration of damaged heart muscle was demonstrated in an in vivo mouse model. A heart attack or myocardial infarction was generated in 4-5 month old adult mice (strain C57B1/6J) by surgically tying the left anterior descending (LAD) coronary artery, which is the main blood supply line to the left ventricle (lv) and the interventricular septum (IVS). The left ventricle pumps oxygenated blood through the aorta into the rest of the body while the IVS divides the right and left ventricles of the heart. LAD ligation in animal models results in the damage and subsequent death of the heart muscle tissue. Table 5 summarizes the results of treating mouse hearts with the purified human NELL1 protein on the third day post-MI event. The NELL1 protein was diluted in phosphate buffered saline (PBS) and was delivered directly onto the damaged heart muscle as a very concentrated microdrop, while the mice were under anaesthesia and intubation for about an hour. Three mice were treated with 312 ng and four mice with 624 ng purified NELL1 protein. Four mice underwent the same cardiac surgery but were given a microdrop of PBS on the damaged heart tissue and served as controls. In addition to these controls, over 20 MI mice were previously generated and studied to obtain consistency in MI surgical and post-surgical techniques. These earlier "controls" displayed the same characteristics as controls represented in Table 5. All treated and untreated mice were maintained for an additional 14 days before they were sacrificed to collect hearts and other major organs (a total of 17 days post-MI). Heart size measurements indicated slight increases in both heart width and depth in Nell1-treated hearts. Remarkably ALL treated mice showed dramatically lesser visible areas of the infarcted tissue on the surface of the heart. In 6 out of 7 hearts the damaged tissue was only visible under the microscope after they were fixed in buffered formalin. FIG. 6A-6D show the range of improvement observed in NELL1-treated hearts, from barely visible to about 30% infarct sizes in comparison to the usual 50-90% infarct sizes seen in controls. FIG. 7A-7D present histological analysis of sectioned hearts stained with Masson-Trichome and further confirmed that there is decreased damage at the cellular level in the NELL1-treated hearts compared to the controls. At 17 days post-MI, heart muscle tissue is severely damaged such that huge gaps appear within the untreated heart muscle in the left ventricle to the interventricular septum. In contrast, there is a consistent and dramatic reduction in the amount of breakdown or damage observed in the heart muscle of treated mice. These data from an in vivo MI mouse model illustrates that clinical approaches that will enable delivery of Nell 1 protein directly onto damaged heart muscle will be effective in reducing the effects of an MI event.

TABLE-US-00004 TABLE 4 GENES IN NELL1 PATHWAY ASSOCIATED WITH KNOWN CARDIOVASCULAR DISORDERS UP (↑) OR DOWN (↓) REGULATION ASSOCIATION WITH HEART DISORDERS AND GENE and DESCRIPTION [p value ≦ 0.001] DISEASES REFERENCES Tpm2; tropomyosin 2, beta ↑4.3 Cardiac-specific myofibrillogenesis; Cardiomyopathy Denz et al., 2004 Dmn; desmuslin transcript ↑9.4 Hypertrophic Cardiomyopathy; heart failure Mizuno et al., 2001 variant 1 Acta1; skeletal muscle actin ↑2.8 Hypertrophic cardiomyopathy; heart failure Lim et al., 2001 alpha 1 Tpm1 tropomyosin alpha 1 ↑4.8 Hypertrophic cardiomyopathy; heart failure Wernicke et al., 2007; Kostin et al., 2007 Lgals3; lectin, ↑2.6 Acute heart failure biomarker; excellent predictor of mortality Van Kimmenade et al., Galactose binding, soluble 3 within 60 days; increases in failure prone hypertrophied 2006; Sharma et al., hearts; aortic stenosis; induces cardiac fibroblast proliferation, 2004 collagen deposition Spp1 ↑2.3 Heart contractility via control of ECM proteins Okamoto, 2007 Secreted phosphoprotein 1 Inflammation control in hypertrophy, myocardial infarction Singh et al., 2007 (osteopontin) and heart failure, valvular stenosis Fhl1 ↑1.3 Atrial fibrillation in cardiac arrhythmia; Chen et al., 2007 Four and a half limb domains β-adrenergic induced cardiomypathy and heart failure (β- Lim et al., 2001 blocker pathway); cardiac remodeling by transcriptional regulation and myofilament assembly Aqp1; aquaporin 1 ↑1.3 Myocardial edema Egan et al., 2006 ll6st ↑1.5 Cardiac hypertrophy Terrell et al., 2006 Interleukin 6 signal Coles et al., 2007 transducer Tnc ↓1.5 Inflammation induced tissue remodeling in acute myocardial Terasaki et al., 2007 Tenascin c infarction, acute myocarditis and cardiomyopathy, left ventricular remodeling Tnxb ↓1.8 Cardiac nerve sprouting after MI contributing to arrhythmia Lai et al., 2000 Tenascin xb and sudden cardiac death Igftbp5 ↓1.3 Atrophy; Adaptive cardiac hypertrophy Baurand et al., 2007 Insulin growth factor binding protein 5 Fgl2 ↓1.4 Acute congestive heart failure without structural Mu et al., 2007 Fibrinogen-like protein abnormalities; contractile dysfunction and rhythm abnormalities Ctgf; connective tissue ↓1.3 Excessive myocardial fibrosis and diastolic heart failure Koitabashi et al., 2007 growth factor Dpt; dermatopontin ↓1.5 ECM remodeling in myocardial infarction Takemoto et al., 2002 Ldlr; low density lipoprotein ↓1.5 Heart failure Weiss et al., 2006 receptor Nppb ↓1.3 Cardiac fibrosis Tamura et al., 2000 Natriuretic peptide precursor Congestive heart failure and myocardial infarction Hejmdal et al., 2007 type b Biomarker for heart failure Seferian et al., 2007 Doust et al., 2004 Nppa ↓1.5 Cardiac fibrosis Tamura et al., 2000 Natriuretic peptide precursor Congestive heart failure and myocardial infarction Hejmdal et al., 2007 type a Biomarker for heart failure Seferian et al., 2007 Doust et al., 2004 Ttn ↓1.4 Cardiac muscle dystrophies (contractility) Fougerousse et al., 1998; Titin Koatin et al., 2000 Cyr61 ↓1.7 Inflammatory cardiomyopathy Wittchen et al., 2007; Cysteine rich protein 61 Mo and Lau, 2006 Sgcb Cardiac muscle dystrophies Fougerousse et al., 1998 Sarcoglycan

TABLE-US-00005 TABLE 5 Results of Nell1 Protein Treatment of Damaged Heart Tissue in a Mouse Model with Myocardial Infarction Heart length Heart Width Heart Depth Estimated Infarct Size Mouse Weight Change Top-Bottom Left-Right Front-Back 17 days post-MI Number 17 day period (mm) (mm) (mm) (% left ventricle) Controls (PBS) m2589 0 8.32 5.84 4.91 75% m2588 +1.2 8.55 6.20 5.11 50% m2733 -0.9 8.78 7.01 5.69 60-70% m2764 +1.1 8.52 6.09 5.57 90% Average +0.35 8.54 6.28 5.32 ~70% Nell1 Protein Dose I (312 ng) m2550 -3.2 8.42 7.41 6.19 Infarct hardly visible until fixation; ~16% faint area m2597 -2.3 8.04 6.12 6.17 Infarct barely visible until fixation; 30% faint area m2553 -2.3 9.21 6.44 5.52 Infarct hardly visible until fixation; 30% faint area Average -2.6 8.56 6.66 5.96 ~25.3% Nell1 Protein Dose II (624 ng) m2668 +0.1 8.51 6.55 5.65 Infarct hardly visible until fixation; 25% faint area m2732 -0.1 8.94 6.44 5.73 Infarct hardly visible until fixation; 10% very small faint area m2726 -2.7 8.50 6.90 5.94 Infarct hardly visible until fixation; very faint layer difficult to estimate ra2727 -0.3 8.42 6.95 6.26 Visible infarct at ~30% Average -0.75 8.59 6.71 5.90 ~16.3%

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Sequence CWU 1

1

612966DNAHomo sapiens 1ggcgctgccg agccacctcc cccgccgccc gctagcaagt ttggcggctc caagccaggc 60gcgcctcagg atccaggctc atttgcttcc acctagcttc ggtgccccct gctaggcggg 120gaccctcgag agcgatgccg atggatttga ttttagttgt gtggttctgt gtgtgcactg 180ccaggacagt ggtgggcttt gggatggacc ctgaccttca gatggatatc gtcaccgagc 240ttgaccttgt gaacaccacc cttggagttg ctcaggtgtc tggaatgcac aatgccagca 300aagcattttt atttcaagac atagaaagag agatccatgc agctcctcat gtgagtgaga 360aattaattca gctgttccag aacaagagtg aattcaccat tttggccact gtacagcaga 420tggagagcag tggcctgagg gatgagattc ggtatcacta catacacaat gggaagccaa 480ggacagaggc acttccttac cgcatggcag atggacaatg gcacaaggtt gcactgtcag 540ttagcgcctc tcatctcctg ctccatgtcg actgtaacag gatttatgag cgtgtgatag 600accctccaga taccaacctt cccccaggaa tcaatttatg gcttggccag cgcaaccaaa 660agcatggctt attcaaaggg atcatccaag atgggaagat catctttatg ccgaatggat 720atataacaca gtgtccaaat ctaaatcaca cttgcccaac ctgcagtgat ttcttaagcc 780tggtgcaagg aataatggat ttacaagagc ttttggccaa gatgactgca aaactaaatt 840atgcagagac aagacttagt caattggaaa actgtcattg tgagaagact tgtcaagtga 900gtggactgct ctatcgagat caagactctt gggtagatgg tgaccattgc aggaactgca 960cttgcaaaag tggtgccgtg gaatgccgaa ggatgtcctg tccccctctc aattgctccc 1020cagactccct cccagtgcac attgctggcc agtgctgtaa ggtctgccga ccaaaatgta 1080tctatggagg aaaagttctt gcagaaggcc agcggatttt aaccaagagc tgtcgggaat 1140gccgaggtgg agttttagta aaaattacag aaatgtgtcc tcctttgaac tgctcagaaa 1200aggatcacat tcttcctgag aatcagtgct gccgtgtctg tagaggtcat aacttttgtg 1260cagaaggacc taaatgtggt gaaaactcag agtgcaaaaa ctggaataca aaagctactt 1320gtgagtgcaa gagtggttac atctctgtcc agggagactc tgcctactgt gaagatattg 1380atgagtgtgc agctaagatg cattactgtc atgccaatac tgtgtgtgtc aaccttcctg 1440ggttatatcg ctgtgactgt gtcccaggat acattcgtgt ggatgacttc tcttgtacag 1500aacacgatga atgtggcagc ggccagcaca actgtgatga gaatgccatc tgcaccaaca 1560ctgtccaggg acacagctgc acctgcaaac cgggctacgt ggggaacggg accatctgca 1620gagctttctg tgaagagggc tgcagatacg gtggaacgtg tgtggctccc aacaaatgtg 1680tctgtccatc tggattcaca ggaagccact gcgagaaaga tattgatgaa tgttcagagg 1740gaatcattga gtgccacaac cattcccgct gcgttaacct gccagggtgg taccactgtg 1800agtgcagaag cggtttccat gacgatggga cctattcact gtccggggag tcctgtattg 1860acattgatga atgtgcctta agaactcaca cctgttggaa cgattctgcc tgcatcaacc 1920tggcaggggg ttttgactgt ctctgcccct ctgggccctc ctgctctggt gactgtcctc 1980atgaaggggg gctgaagcac aatggccagg tgtggacctt gaaagaagac aggtgttctg 2040tctgctcctg caaggatggc aagatattct gccgacggac agcttgtgat tgccagaatc 2100caagtgctga cctattctgt tgcccagaat gtgacaccag agtcacaagt caatgtttag 2160accaaaatgg tcacaagctg tatcgaagtg gagacaattg gacccatagc tgtcagcagt 2220gtcggtgtct ggaaggagag gtagattgct ggccactcac ttgccccaac ttgagctgtg 2280agtatacagc tatcttagaa ggggaatgtt gtccccgctg tgtcagtgac ccctgcctag 2340ctgataacat cacctatgac atcagaaaaa cttgcctgga cagctatggt gtttcacggc 2400ttagtggctc agtgtggacg atggctggat ctccctgcac aacctgtaaa tgcaagaatg 2460gaagagtctg ttgttctgtg gattttgagt gtcttcaaaa taattgaagt atttacagtg 2520gactcaacgc agaagaatgg acgaaatgac catccaacgt gattaaggat aggaatcggt 2580agtttggttt ttttgtttgt tttgtttttt taaccacaga taattgccaa agtttccacc 2640tgaggacggt gtttggaggt tgccttttgg acctaccact ttgctcattc ttgctaacct 2700agtctaggtg acctacagtg ccgtgcattt aagtcaatgg ttgttaaaag aagtttcccg 2760tgttgtaaat catgtttccc ttatcagatc atttgcaaat acatttaaat gatctcatgg 2820taaatgttga tgtatttttt ggtttatttt gtgtactaac ataatagaga gagactcagc 2880tccttttatt tattttgttg atttatggat caaattctaa aataaagttg cctgttgtga 2940aaaaaaaaaa aaaaaaaaaa aaaaaa 29662810PRTHomo sapiens 2Met Pro Met Asp Leu Ile Leu Val Val Trp Phe Cys Val Cys Thr Ala 1 5 10 15 Arg Thr Val Val Gly Phe Gly Met Asp Pro Asp Leu Gln Met Asp Ile 20 25 30 Val Thr Glu Leu Asp Leu Val Asn Thr Thr Leu Gly Val Ala Gln Val 35 40 45 Ser Gly Met His Asn Ala Ser Lys Ala Phe Leu Phe Gln Asp Ile Glu 50 55 60 Arg Glu Ile His Ala Ala Pro His Val Ser Glu Lys Leu Ile Gln Leu 65 70 75 80 Phe Arg Asn Lys Ser Glu Phe Thr Ile Leu Ala Thr Val Gln Gln Lys 85 90 95 Pro Ser Thr Ser Gly Val Ile Leu Ser Ile Arg Glu Leu Glu His Ser 100 105 110 Tyr Phe Glu Leu Glu Ser Ser Gly Leu Arg Asp Glu Ile Arg Tyr His 115 120 125 Tyr Ile His Asn Gly Lys Pro Arg Thr Glu Ala Leu Pro Tyr Arg Met 130 135 140 Ala Asp Gly Gln Trp His Lys Val Ala Leu Ser Val Ser Ala Ser His 145 150 155 160 Leu Leu Leu His Val Asp Cys Asn Arg Ile Tyr Glu Arg Val Ile Asp 165 170 175 Pro Pro Asp Thr Asn Leu Pro Pro Gly Ile Asn Leu Trp Leu Gly Gln 180 185 190 Arg Asn Gln Lys His Gly Leu Phe Lys Gly Ile Ile Gln Asp Gly Lys 195 200 205 Ile Ile Phe Met Pro Asn Gly Tyr Ile Thr Gln Cys Pro Asn Leu Asn 210 215 220 His Thr Cys Pro Thr Cys Ser Asp Phe Leu Ser Leu Val Gln Gly Ile 225 230 235 240 Met Asp Leu Gln Glu Leu Leu Ala Lys Met Thr Ala Lys Leu Asn Tyr 245 250 255 Ala Glu Thr Arg Leu Ser Gln Leu Glu Asn Cys His Cys Glu Lys Thr 260 265 270 Cys Gln Val Ser Gly Leu Leu Tyr Arg Asp Gln Asp Ser Trp Val Asp 275 280 285 Gly Asp His Cys Arg Asn Cys Thr Cys Lys Ser Gly Ala Val Glu Cys 290 295 300 Arg Arg Met Ser Cys Pro Pro Leu Asn Cys Ser Pro Asp Ser Leu Pro 305 310 315 320 Val His Ile Ala Gly Gln Cys Cys Lys Val Cys Arg Pro Lys Cys Ile 325 330 335 Tyr Gly Gly Lys Val Leu Ala Glu Gly Gln Arg Ile Leu Thr Lys Ser 340 345 350 Cys Arg Glu Cys Arg Gly Gly Val Leu Val Lys Ile Thr Glu Met Cys 355 360 365 Pro Pro Leu Asn Cys Ser Glu Lys Asp His Ile Leu Pro Glu Asn Gln 370 375 380 Cys Cys Arg Val Cys Arg Gly His Asn Phe Cys Ala Glu Gly Pro Lys 385 390 395 400 Cys Gly Glu Asn Ser Glu Cys Lys Asn Trp Asn Thr Lys Ala Thr Cys 405 410 415 Glu Cys Lys Ser Gly Tyr Ile Ser Val Gln Gly Asp Ser Ala Tyr Cys 420 425 430 Glu Asp Ile Asp Glu Cys Ala Ala Lys Met His Tyr Cys His Ala Asn 435 440 445 Thr Val Cys Val Asn Leu Pro Gly Leu Tyr Arg Cys Asp Cys Val Pro 450 455 460 Gly Tyr Ile Arg Val Asp Asp Phe Ser Cys Thr Glu His Asp Glu Cys 465 470 475 480 Gly Ser Gly Gln His Asn Cys Asp Glu Asn Ala Ile Cys Thr Asn Thr 485 490 495 Val Gln Gly His Ser Cys Thr Cys Lys Pro Gly Tyr Val Gly Asn Gly 500 505 510 Thr Ile Cys Arg Ala Phe Cys Glu Glu Gly Cys Arg Tyr Gly Gly Thr 515 520 525 Cys Val Ala Pro Asn Lys Cys Val Cys Pro Ser Gly Phe Thr Gly Ser 530 535 540 His Cys Glu Lys Asp Ile Asp Glu Cys Ser Glu Gly Ile Ile Glu Cys 545 550 555 560 His Asn His Ser Arg Cys Val Asn Leu Pro Gly Trp Tyr His Cys Glu 565 570 575 Cys Arg Ser Gly Phe His Asp Asp Gly Thr Tyr Ser Leu Ser Gly Glu 580 585 590 Ser Cys Ile Asp Ile Asp Glu Cys Ala Leu Arg Thr His Thr Cys Trp 595 600 605 Asn Asp Ser Ala Cys Ile Asn Leu Ala Gly Gly Phe Asp Cys Leu Cys 610 615 620 Pro Ser Gly Pro Ser Cys Ser Gly Asp Cys Pro His Glu Gly Gly Leu 625 630 635 640 Lys His Asn Gly Gln Val Trp Thr Leu Lys Glu Asp Arg Cys Ser Val 645 650 655 Cys Ser Cys Lys Asp Gly Lys Ile Phe Cys Arg Arg Thr Ala Cys Asp 660 665 670 Cys Gln Asn Pro Ser Ala Asp Leu Phe Cys Cys Pro Glu Cys Asp Thr 675 680 685 Arg Val Thr Ser Gln Cys Leu Asp Gln Asn Gly His Lys Leu Tyr Arg 690 695 700 Ser Gly Asp Asn Trp Thr His Ser Cys Gln Gln Cys Arg Cys Leu Glu 705 710 715 720 Gly Glu Val Asp Cys Trp Pro Leu Thr Cys Pro Asn Leu Ser Cys Glu 725 730 735 Tyr Thr Ala Ile Leu Glu Gly Glu Cys Cys Pro Arg Cys Val Ser Asp 740 745 750 Pro Cys Leu Ala Asp Asn Ile Thr Tyr Asp Ile Arg Lys Thr Cys Leu 755 760 765 Asp Ser Tyr Gly Val Ser Arg Leu Ser Gly Ser Val Trp Thr Met Ala 770 775 780 Gly Ser Pro Cys Thr Thr Cys Lys Cys Lys Asn Gly Arg Val Cys Cys 785 790 795 800 Ser Val Asp Phe Glu Cys Leu Gln Asn Asn 805 810 32752DNAMus musculus 3gcgttggtgc gccctgcttg gcggggggcc tccggagcga tgccgatgga tgtgatttta 60gttttgtggt tctgtgtgtg caccgccagg acagtgctgg gctttgggat ggaccctgac 120cttcagatgg acatcatcac tgaacttgac cttgtgaaca ccaccctggg cgtcactcag 180gtggctggac tacacaatgc cagtaaggca tttctgtttc aagatgtaca gagagagatc 240cactcagccc ctcatgtgag tgagaagctg atccagctat tccggaataa gagtgagttt 300acctttttgg ctacagtgca gcagaagccg tccacctcag gggtgatact gtcgatccgg 360gagctggaac acagctattt tgaactggag agcagtggcc caagagaaga gatacgctat 420cattacatcc atggcggcaa gcccaggact gaggcccttc cctaccgcat ggccgatgga 480cagtggcaca aggtcgcgct gtctgtgagc gcctctcacc tcctactcca tgtcgactgc 540aataggattt atgagcgtgt gatagatcct ccggagacca accttcctcc aggaagcaat 600aagatcatct tcatgccgaa cggcttcatc acacagtgcc ccaacctaaa tcgcacttgc 660ccaacatgca gtgatttcct gagcctggtt caaggaataa tggatttgca agagcttttg 720gccaagatga ctgcaaaact gaattatgca gagacgagac ttggtcaact ggaaaattgc 780cactgtgaga agacctgcca agtgagtggg ctgctctaca gggaccaaga ctcctgggta 840gatggtgaca actgcaggaa ctgcacatgc aaaagtggtg ctgtggagtg ccgaaggatg 900tcctgtcccc cactcaactg ttccccagac tcacttcctg tgcatatttc tggccaatgt 960tgtaaagttt gcagaccaaa atgtatctat ggaggaaaag ttcttgctga gggccagcgg 1020attttaacca agacctgccg ggaatgtcga ggtggagtct tggtaaaaat cacagaagct 1080tgccctcctt tgaactgctc agagaaggat catattcttc cggagaacca gtgctgcagg 1140gtctgccgag gtcataactt ctgtgcagaa gcacctaagt gtggagaaaa ctcggaatgc 1200aaaaattgga atacaaaagc gacttgtgag tgcaagaatg gatacatctc tgtccagggc 1260aactctgcat actgtgaaga tatcgatgag tgtgcagcaa agatgcacta ctgtcatgcc 1320aacacggtgt gtgtcaactt gccggggtta tatcgctgtg actgcatccc aggatacatc 1380cgtgtggatg acttctcttg tacggagcat gatgattgtg gcagcggaca acacaactgt 1440gacaaaaatg ccatctgtac caacacagtc cagggacaca gctgtacctg ccagccaggc 1500tacgtgggaa atggtactgt ctgcaaagca ttctgtgaag agggttgcag atacggaggt 1560acctgtgtgg cccctaacaa atgtgtctgt ccttctggat tcacaggaag ccactgtgag 1620aaagatattg atgaatgtgc agagggattc gttgagtgcc acaaccactc ccgctgcgtt 1680aaccttccag ggtggtacca ctgtgagtgc agaagcggtt tccatgacga tgggacctat 1740tcactgtccg gggagtcctg cattgatatt gatgaatgtg ccttaagaac tcacacttgt 1800tggaatgact ctgcctgcat caacttagca ggaggatttg actgcctgtg tccctctggg 1860ccctcctgct ctggtgactg tccccacgaa ggggggctga agcataatgg gcaggtgtgg 1920attctgagag aagacaggtg ttcagtctgt tcctgtaagg atgggaagat attctgccgg 1980cggacagctt gtgattgcca gaatccaaat gttgaccttt tctgctgccc agagtgtgac 2040accagggtca ctagccaatg tttagatcaa agcggacaga agctctatcg aagtggagac 2100aactggaccc acagctgcca gcagtgccga tgtctggaag gagaggcaga ctgctggcct 2160ctagcttgcc ctagtttgag ctgtgaatac acagccatct ttgaaggaga gtgttgtccc 2220cgctgtgtca gtgacccctg cctggctgat aatattgcct atgacatcag aaaaacttgc 2280ctggacagct ctggtatttc gaggctgagc ggcgcagtgt ggacaatggc tggatctccc 2340tgtacaacct gtcaatgcaa gaatgggaga gtctgctgct ctgtggatct ggtgtgtctt 2400gagaataact gaagatttta aatggactca tcacatgaga aaatggacaa aatgaccatc 2460caacctgagg aagaggaggg gctgatttct ttttcttttt aaccacagtc aattaccaaa 2520gtctccatca gaggaaggcg tttgggttgc ctttaccact ttgctcatcc ttgctgacct 2580agtctagatg cctgcagtac cgtgtatttc ggtcgatggt tgttgagtct ccgtgctgta 2640aatcacattt cccttgtcag atcatttaca gatacattta aaggattcca tgataaatgt 2700taaagtacct tttgtttatt ttgtgtacca acataataga gacttggcac ca 27524810PRTMus musculus 4Met Pro Met Asp Val Ile Leu Val Leu Trp Phe Cys Val Cys Thr Ala 1 5 10 15 Arg Thr Val Leu Gly Phe Gly Met Asp Pro Asp Leu Gln Met Asp Ile 20 25 30 Ile Thr Glu Leu Asp Leu Val Asn Thr Thr Leu Gly Val Thr Gln Val 35 40 45 Ala Gly Leu His Asn Ala Ser Lys Ala Phe Leu Phe Gln Asp Val Gln 50 55 60 Arg Glu Ile His Ser Ala Pro His Val Ser Glu Lys Leu Ile Gln Leu 65 70 75 80 Phe Arg Asn Lys Ser Glu Phe Thr Phe Leu Ala Thr Val Gln Gln Lys 85 90 95 Pro Ser Thr Ser Gly Val Ile Leu Ser Ile Arg Glu Leu Glu His Ser 100 105 110 Tyr Phe Glu Leu Glu Ser Ser Gly Pro Arg Glu Glu Ile Arg Tyr His 115 120 125 Tyr Ile His Gly Gly Lys Pro Arg Thr Glu Ala Leu Pro Tyr Arg Met 130 135 140 Ala Asp Gly Gln Trp His Lys Val Ala Leu Ser Val Ser Ala Ser His 145 150 155 160 Leu Leu Leu His Val Asp Cys Asn Arg Ile Tyr Glu Arg Val Ile Asp 165 170 175 Pro Pro Glu Thr Asn Leu Pro Pro Gly Ser Asn Leu Trp Leu Gly Gln 180 185 190 Arg Asn Gln Lys His Gly Phe Phe Lys Gly Ile Ile Gln Asp Gly Lys 195 200 205 Ile Ile Phe Met Pro Asn Gly Phe Ile Thr Gln Cys Pro Asn Leu Asn 210 215 220 Arg Thr Cys Pro Thr Cys Ser Asp Phe Leu Ser Leu Val Gln Gly Ile 225 230 235 240 Met Asp Leu Gln Glu Leu Leu Ala Lys Met Thr Ala Lys Leu Asn Tyr 245 250 255 Ala Glu Thr Arg Leu Gly Gln Leu Glu Asn Cys His Cys Glu Lys Thr 260 265 270 Cys Gln Val Ser Gly Leu Leu Tyr Arg Asp Gln Asp Ser Trp Val Asp 275 280 285 Gly Asp Asn Cys Arg Asn Cys Thr Cys Lys Ser Gly Ala Val Glu Cys 290 295 300 Arg Arg Met Ser Cys Pro Pro Leu Asn Cys Ser Pro Asp Ser Leu Pro 305 310 315 320 Val His Ile Ser Gly Gln Cys Cys Lys Val Cys Arg Pro Lys Cys Ile 325 330 335 Tyr Gly Gly Lys Val Leu Ala Glu Gly Gln Arg Ile Leu Thr Lys Thr 340 345 350 Cys Arg Glu Cys Arg Gly Gly Val Leu Val Lys Ile Thr Glu Ala Cys 355 360 365 Pro Pro Leu Asn Cys Ser Glu Lys Asp His Ile Leu Pro Glu Asn Gln 370 375 380 Cys Cys Arg Val Cys Arg Gly His Asn Phe Cys Ala Glu Ala Pro Lys 385 390 395 400 Cys Gly Glu Asn Ser Glu Cys Lys Asn Trp Asn Thr Lys Ala Thr Cys 405 410 415 Glu Cys Lys Asn Gly Tyr Ile Ser Val Gln Gly Asn Ser Ala Tyr Cys 420 425 430 Glu Asp Ile Asp Glu Cys Ala Ala Lys Met His Tyr Cys His Ala Asn 435 440 445 Thr Val Cys Val Asn Leu Pro Gly Leu Tyr Arg Cys Asp Cys Ile Pro 450 455 460 Gly Tyr Ile Arg Val Asp Asp Phe Ser Cys Thr Glu His Asp Asp Cys 465 470 475 480 Gly Ser Gly Gln His Asn Cys Asp Lys Asn Ala Ile Cys Thr Asn Thr 485 490 495 Val Gln Gly His Ser Cys Thr Cys Gln Pro Gly Tyr Val Gly Asn Gly 500 505 510 Thr Val Cys Lys Ala Phe Cys Glu Glu Gly Cys Arg Tyr Gly Gly Thr 515 520 525 Cys Val Ala Pro Asn Lys Cys Val Cys Pro Ser Gly Phe Thr Gly Ser 530 535 540 His Cys Glu Lys Asp Ile Asp Glu Cys Ala Glu Gly Phe Val Glu Cys 545 550 555 560 His Asn His Ser Arg Cys Val Asn Leu Pro Gly Trp Tyr His Cys Glu 565 570 575 Cys Arg Ser Gly Phe His Asp Asp Gly Thr Tyr Ser Leu Ser Gly Glu 580 585 590 Ser Cys Ile Asp Ile Asp Glu Cys Ala Leu Arg Thr His Thr Cys Trp 595

600 605 Asn Asp Ser Ala Cys Ile Asn Leu Ala Gly Gly Phe Asp Cys Leu Cys 610 615 620 Pro Ser Gly Pro Ser Cys Ser Gly Asp Cys Pro His Glu Gly Gly Leu 625 630 635 640 Lys His Asn Gly Gln Val Trp Ile Leu Arg Glu Asp Arg Cys Ser Val 645 650 655 Cys Ser Cys Lys Asp Gly Lys Ile Phe Cys Arg Arg Thr Ala Cys Asp 660 665 670 Cys Gln Asn Pro Asn Val Asp Leu Phe Cys Cys Pro Glu Cys Asp Thr 675 680 685 Arg Val Thr Ser Gln Cys Leu Asp Gln Ser Gly Gln Lys Leu Tyr Arg 690 695 700 Ser Gly Asp Asn Trp Thr His Ser Cys Gln Gln Cys Arg Cys Leu Glu 705 710 715 720 Gly Glu Ala Asp Cys Trp Pro Leu Ala Cys Pro Ser Leu Ser Cys Glu 725 730 735 Tyr Thr Ala Ile Phe Glu Gly Glu Cys Cys Pro Arg Cys Val Ser Asp 740 745 750 Pro Cys Leu Ala Asp Asn Ile Ala Tyr Asp Ile Arg Lys Thr Cys Leu 755 760 765 Asp Ser Ser Gly Ile Ser Arg Leu Ser Gly Ala Val Trp Thr Met Ala 770 775 780 Gly Ser Pro Cys Thr Thr Cys Gln Cys Lys Asn Gly Arg Val Cys Cys 785 790 795 800 Ser Val Asp Leu Val Cys Leu Glu Asn Asn 805 810 52915DNARattus norvegicus 5aagcactggt ttcttgttag cgttggtgcg ccctgcttgg cgggggttct ccggagcgat 60gccgatggat gtgattttag ttttgtggtt ctgtgtatgc accgccagga cagtgttggg 120ctttgggatg gaccctgacc ttcagctgga catcatctca gagctcgacc tggtgaacac 180caccctggga gtcacgcagg tggctggact gcacaacgcc agtaaagcat ttctatttca 240agatgtacag agagagatcc attcggcccc tcacgtgagt gagaagctga tccagctatt 300ccggaataag agcgagttca cctttttggc tacagtgcag cagaaaccat ccacctcagg 360ggtgatactg tccatccggg agctggagca cagctatttt gaactggaga gcagtggccc 420aagagaagag atacgctacc attacataca tggtggaaag cccaggactg aggcccttcc 480ctaccgcatg gcagacggac aatggcacaa ggtcgcgctg tcagtgagcg cctctcacct 540cctgctccac atcgactgca ataggattta cgagcgtgtg atagaccctc cggagaccaa 600ccttcctcca ggaagcaatc tgtggcttgg gcaacgtaac caaaagcatg gctttttcaa 660aggaatcatc caagatggta agatcatctt catgccgaat ggtttcatca cacagtgtcc 720caacctcaat cgcacttgcc caacatgcag tgacttcctg agcctggttc aaggaataat 780ggatttgcaa gagcttttgg ccaagatgac tgcaaaactg aattatgcag agacgagact 840tggtcaactg gaaaattgcc actgtgagaa gacctgccaa gtgagtgggc tgctctacag 900ggaccaagac tcctgggtgg atggtgacaa ctgtgggaac tgcacgtgca aaagtggtgc 960cgtggagtgc cgcaggatgt cctgtccccc gctcaactgt tccccggact cacttcctgt 1020gcacatttcc ggccagtgtt gtaaagtttg cagaccaaaa tgtatctatg gaggaaaagt 1080tcttgctgag ggccagcgga ttttaaccaa gacctgccgg gaatgtcgag gtggagtctt 1140ggtaaaaatc acagaagctt gccctccttt gaactgctca gcaaaggatc atattcttcc 1200agagaatcag tgctgcaggg tctgcccagg tcataacttc tgtgcagaag cacctaagtg 1260cggagaaaac tcggaatgca aaaattggaa tacaaaagca acctgtgagt gcaagaatgg 1320atacatctct gtccagggca actctgcata ctgtgaagat attgatgagt gtgcagctaa 1380aatgcactat tgtcatgcca acaccgtgtg tgtcaacttg ccggggttgt atcgctgtga 1440ctgcgtccca gggtacatcc gtgtggatga cttctcttgt acggagcatg atgattgtgg 1500cagcggacaa cacaactgcg acaaaaatgc catctgtacc aacacagtcc agggacacag 1560ctgcacctgc cagccgggtt acgtgggaaa tggcaccatc tgcaaagcat tctgtgaaga 1620gggttgcaga tacggaggta cctgtgtggc tcctaacaag tgtgtctgtc cttctggatt 1680cacgggaagc cactgtgaga aagatattga tgaatgcgca gagggattcg ttgaatgcca 1740caactactcc cgctgtgtta acctgccagg gtggtaccac tgtgagtgca gaagcggttt 1800ccatgacgat gggacctact cactgtccgg ggagtcctgc attgatatcg atgaatgtgc 1860cttaagaact cacacttgtt ggaatgactc tgcctgcatc aacttagcag gaggatttga 1920ctgcctgtgt ccctctgggc cctcctgctc tggtgactgt ccccacgaag gagggctgaa 1980gcataatggg caggtgtgga ttctgagaga agacaggtgt tcagtctgtt cctgcaagga 2040tgggaagata ttctgccggc ggacagcttg tgattgccag aatccaaatg ttgacctttt 2100ttgctgccca gagtgcgata ccagggtcac cagccaatgt ttagatcaaa gtggacagaa 2160gctctatcga agtggagaca actggaccca cagctgccag cagtgccgat gtctggaagg 2220agaggcagac tgctggcctc tggcttgccc tagtttgggc tgtgaataca cagccatgtt 2280tgaaggggag tgttgtcccc gatgtgtcag tgacccctgc ctggctggta atattgccta 2340tgacatcaga aaaacttgcc tggacagctt tggtgtttcg aggctgagcg gagccgtgtg 2400gacaatggct ggatctcctt gtacaacctg caaatgcaag aatgggagag tctgctgctc 2460tgtggatctg gagtgtattg agaataactg aagattttaa atggactcgt cacgtgagaa 2520aatgggcaaa atgatcatcc cacctgagga agaagagggg ctgatttctt tttcttttta 2580accacagtca attaccaaag tctccatctg aggaaggcgt ttggattgcc tttgccactt 2640tgctcatcct tgctgaccta gtctagatgc ctgcagtacc gtgcatttcg gtcgatggtt 2700gttgagtctc agtgttgtaa atcgcatttc cctcgtcaga tcatttacag atacatttaa 2760aggggttcca tgataaatgt taatgtaact tttgtttatt ttgtgtactg acataataga 2820gacttggcac catttattta tttttcttga tttttggatc aaattctaaa aataaagttg 2880cctgttgcga aaaaaaaaaa aaaaaaaaaa aaaaa 29156802PRTRattus norvegicus 6Met Pro Met Asp Val Ile Leu Val Leu Trp Phe Cys Val Cys Thr Ala 1 5 10 15 Arg Thr Val Leu Gly Phe Gly Met Asp Pro Asp Leu Gln Leu Asp Ile 20 25 30 Ile Ser Glu Leu Asp Leu Val Asn Thr Thr Leu Gly Val Thr Gln Val 35 40 45 Ala Gly Leu His Asn Ala Ser Lys Ala Phe Leu Phe Gln Asp Val Gln 50 55 60 Arg Glu Ile His Ser Ala Pro His Val Ser Glu Lys Leu Ile Gln Leu 65 70 75 80 Phe Arg Asn Lys Ser Glu Phe Thr Phe Leu Ala Thr Val Gln Gln Lys 85 90 95 Pro Ser Thr Ser Gly Val Ile Leu Ser Ile Arg Glu Leu Glu His Ser 100 105 110 Tyr Phe Glu Leu Glu Ser Ser Gly Pro Arg Glu Glu Ile Arg Tyr His 115 120 125 Tyr Ile His Gly Gly Lys Pro Arg Thr Glu Ala Leu Pro Tyr Arg Met 130 135 140 Ala Asp Gly Gln Trp His Lys Val Ala Leu Ser Val Ser Ala Ser His 145 150 155 160 Leu Leu Leu His Ile Asp Cys Asn Arg Ile Tyr Glu Arg Val Ile Asp 165 170 175 Pro Pro Glu Thr Asn Leu Pro Pro Gly Ser Asn Leu Trp Leu Gly Gln 180 185 190 Arg Asn Gln Lys His Gly Phe Phe Lys Gly Ile Ile Gln Asp Gly Lys 195 200 205 Ile Ile Phe Met Pro Asn Gly Phe Ile Thr Gln Cys Pro Asn Leu Asn 210 215 220 Arg Thr Cys Pro Thr Cys Ser Asp Phe Leu Ser Leu Val Gln Gly Ile 225 230 235 240 Met Asp Leu Gln Glu Leu Leu Ala Lys Met Thr Ala Lys Leu Asn Tyr 245 250 255 Ala Glu Thr Arg Leu Gly Gln Leu Glu Asn Cys His Cys Glu Lys Thr 260 265 270 Cys Gln Val Ser Gly Leu Leu Tyr Arg Asp Gln Asp Ser Trp Val Asp 275 280 285 Gly Asp Asn Cys Gly Asn Cys Thr Cys Lys Ser Gly Ala Val Glu Cys 290 295 300 Arg Arg Met Ser Cys Pro Pro Leu Asn Cys Ser Pro Asp Ser Leu Pro 305 310 315 320 Val His Ile Ser Gly Gln Cys Cys Lys Val Cys Arg Pro Lys Cys Ile 325 330 335 Tyr Gly Gly Lys Val Leu Ala Glu Gly Gln Arg Ile Leu Thr Lys Thr 340 345 350 Cys Arg Glu Cys Arg Gly Gly Val Leu Val Lys Ile Thr Glu Ala Cys 355 360 365 Pro Pro Leu Asn Cys Ser Ala Lys Asp His Ile Leu Pro Glu Asn Gln 370 375 380 Cys Cys Arg Val Cys Pro Gly His Asn Phe Cys Ala Glu Ala Pro Lys 385 390 395 400 Cys Gly Glu Asn Ser Glu Cys Lys Asn Trp Asn Thr Lys Ala Thr Cys 405 410 415 Glu Cys Lys Asn Gly Tyr Ile Ser Val Gln Gly Asn Ser Ala Tyr Cys 420 425 430 Glu Asp Ile Asp Glu Cys Ala Ala Lys Met His Tyr Cys His Ala Asn 435 440 445 Thr Val Cys Val Asn Leu Pro Gly Leu Tyr Arg Cys Asp Cys Val Pro 450 455 460 Gly Tyr Ile Arg Val Asp Asp Phe Ser Cys Thr Glu His Asp Asp Cys 465 470 475 480 Gly Ser Gly Gln His Asn Cys Asp Lys Asn Ala Ile Cys Thr Asn Thr 485 490 495 Val Gln Gly His Ser Cys Thr Cys Gln Pro Gly Tyr Val Gly Asn Gly 500 505 510 Thr Ile Cys Lys Ala Phe Cys Glu Glu Gly Cys Arg Tyr Gly Gly Thr 515 520 525 Cys Val Ala Pro Asn Lys Cys Val Cys Pro Ser Gly Phe Thr Gly Ser 530 535 540 His Cys Glu Lys Asp Ile Asp Glu Cys Ala Glu Gly Phe Val Glu Cys 545 550 555 560 His Asn Tyr Ser Arg Cys Val Asn Leu Pro Gly Trp Tyr His Cys Glu 565 570 575 Cys Arg Ser Gly Phe His Asp Asp Gly Thr Tyr Ser Leu Ser Gly Glu 580 585 590 Ser Cys Ile Asp Ile Asp Glu Cys Ala Leu Arg Thr His Thr Cys Trp 595 600 605 Asn Asp Ser Ala Cys Ile Asn Leu Ala Gly Gly Phe Asp Cys Leu Cys 610 615 620 Pro Ser Gly Pro Ser Cys Ser Gly Asp Cys Pro His Glu Gly Gly Leu 625 630 635 640 Lys His Asn Gly Gln Val Trp Ile Leu Arg Glu Asp Arg Cys Ser Val 645 650 655 Cys Ser Cys Lys Asp Gly Lys Ile Phe Cys Arg Arg Thr Ala Cys Asp 660 665 670 Cys Gln Asn Pro Asn Val Asp Leu Phe Cys Cys Pro Glu Cys Asp Thr 675 680 685 Arg Val Thr Ser Gln Cys Leu Asp Gln Ser Gly Gln Lys Leu Tyr Arg 690 695 700 Ser Gly Asp Asn Trp Thr His Ser Cys Gln Gln Cys Arg Cys Leu Glu 705 710 715 720 Gly Glu Ala Asp Cys Trp Pro Leu Ala Cys Pro Ser Leu Gly Cys Glu 725 730 735 Tyr Thr Ala Met Phe Glu Gly Glu Cys Cys Pro Arg Cys Val Ser Asp 740 745 750 Pro Cys Leu Ala Gly Asn Ile Ala Tyr Asp Ile Arg Lys Thr Cys Leu 755 760 765 Asp Ser Phe Gly Val Ser Arg Leu Ser Gly Ala Val Trp Thr Met Ala 770 775 780 Gly Ser Pro Cys Thr Thr Cys Lys Cys Lys Asn Gly Arg Val Cys Cys 785 790 795 800 Ser Val

Claims

1. A method of treating a cardiovascular disorder in a subject in need thereof comprising administering a Nell1 protein to said subject.

2. The method of claim 1, wherein said Nell1 protein comprises an amino acid sequence as set forth in any one of SEQ ID NO: 2, SEQ ID NO: 4 or SEQ ID NO: 6.

3. A method of treating a cardiovascular disorder in a subject in need thereof comprising administering a nucleic acid coding for a Nell1 protein to said subject.

4. The method of claim 3, wherein said nucleic acid is an expression vector to effect expression of Nell1 in said subject.

5. The method of claim 4, wherein said expression vector is a viral or non-viral vector.

6. The method of any one of claims 1-5, wherein said cardiovascular disorder is myocardial infarction, heart failure, cardiac ischemia, hypertrophy, or cardiomyopathy.

7. The method of claim 6, wherein said Nell1 protein or said nucleic acid is administered systemically.

8. The method of claim 7, wherein said Nell1 protein or said nucleic acid is administered by ingestion, injection or implantation.

9. The method of claim 6, wherein said Nell1 protein or said nucleic acid is administered locally.

10. The method of claim 9, wherein said Nell1 protein or said nucleic acid is administered by injection or implantation at or near the site of cardiac muscle damage.

11. The method of claim 6, wherein said Nell1 protein or said nucleic acid is administered via catheter to or near the site of cardiac muscle damage.

12. The method of claim 6, wherein said Nell1 protein or said nucleic acid is administered in conjunction with cells for the repair and regeneration of damaged cardiac muscles and blood vessels.

13. The method of claim 12, wherein said cells are cardiomyocytes.

14. The method of claim 12, wherein said cells are stem cells.

15. A method of treating myocardial infarction in a subject in need thereof comprising administering a Nell1 protein to said subject.

16. A method of treating heart failure in a subject in need thereof comprising administering a Nell1 protein to said subject.

17. A method of treating cardiac ischemia in a subject in need thereof comprising administering a Nell1 protein to said subject.

18. A method of treating hypertrophy in a subject in need thereof comprising administering a Nell1 protein to said subject.

19. A method of cardiomyopathy in a subject in need thereof comprising administering a Nell1 protein to said subject.

20. The method of anyone of claims 15-19, wherein said Nell1 protein is administered in conjunction with cells.

21. The method of claim 20, wherein the cells are cardiomyocytes.

22. The method of claim 20, wherein the cells are stem cells.

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