Autologous transplantation of shock wave-treated bone marrow-derived mononuclear cells enhances vascularization and connexin43 expression in rat dilated cardiomyopathy

Objective: This study tested the hypothesis that autologous transplantation of shock wave (SW) -treated bone marrow-derived mononuclear cells (BMDMNCs) is superior to BMDMNC therapy alone for improving left ventricular (LV) function in dilated cardiomyopathy (DCM). Methods: Adult male Sprague-Dawley rats were divided into group 1 (saline-treated DCM), group 2 (BMDMNC implantation), group 3 (pre-implant SW applied to BMDMNCs), and group 4 (normal control). Rats were euthanized on day 90 following DCM induction. Results: The number of small vessels in implanted area was highest in group 3 (all p < 0.005). Connexin43 (Cx43) protein expression was significantly enhanced in group 3 compared to groups 1 and 2 (all p < 0.0003). While mRNA expressions of endothelial nitric oxide synthase and interleukin-10 were higher in groups 2-4 than in group 1 (all p < 0.05), caspase-3, endothelin-1 and matrix metalloproteinase-9 mRNA expressions were lower in groups 2-4 compared with group 1 (all p < 0.05). LV ejection fraction was higher, while mitochondrial oxidative stress and fibrosis of LV myocardium were lower, in groups 2-4 compared to group 1 (all p < 0.003). Conclusion: Pre-implantation SW treatment of BMDMNCs significantly enhanced myocardial vascularization and Cx43 expression which, however, offered no added improvement in LV function compared with BMDMNC treatment alone in rat dilated cardiomyopathy.