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Right arrow Myocardial infarction

Ann Thorac Surg 2005;79:1333-1337
© 2005 The Society of Thoracic Surgeons

Original articles: Cardiovascular

Is the Myofibrillarlytic Myocyte a Forme Fruste Apoptotic Myocyte?

Navneet Narula, MDa, Jagat Narula, MD, PhDb,*, Paul J. Zhang, MDa, Nezam Haider, PhDb, Puthiyaveettil N. Raghunath, PhDa, Robin Brittin, MSa, Joseph H. Gorman, III, MDa, Robert C. Gorman, MDb, John E. Tomaszewski, MDa

a Departments of Pathology and Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
b Division of Cardiology, University of California, Irvine, California

Accepted for publication September 7, 2004.

* Address reprint requests to Dr J. Narula, UCI Medical Center, 101 The City Dr, Bldg 53, Route 81, Orange, CA 92868-4080 (E-mail: narula{at}uci.edu).

BACKGROUND: Myofibrillarlytic (MFL) cells are commonly observed in subendocardial myocardium in myocardial infarction. Because ischemic damage to myocytes is also known to induce apoptosis, we evaluated the prevalence of apoptosis in MFL cells in nine ischemic cardiomyopathic hearts explanted during transplantation.

METHODS: Myocytes with partial or complete clearing of cytoplasm, observed commonly in the subendocardium, were recognized as MFL cells. Prevalence of apoptosis was defined by TUNEL and ISOL staining and further characterized by immunohistochemical staining for caspase-3, Bcl2, BCL-XL, Bax, proliferating cell nuclear antigen (PCNA), and Ki67.

RESULTS: Of 4131 MFL cells examined, 1305 (32%) possessed nuclei in a given histologic section; 1140 (88%) of the nucleated myocardial cells were TUNEL positive. Of 842 cells with normal appearance, 257 (31%) cells demonstrated nuclei in the given histologic section. TUNEL staining was observed in 5 (1.9%) in these control areas. All MFL cells stained positive for caspase 3. The antiapoptotic proteins, Bcl2 and BCL-XL, demonstrated intense upregulation within and surrounding MFL cells, whereas pro-apoptotic protein Bax expression was only seen at control level. The MFL cells had Ki67 negative and PCNA positive nuclei.

CONCLUSIONS: The present study demonstrates that the majority of MFL cells are apoptotic and are associated with upregulation of caspase 3. Simultaneous upregulation of Bcl2 represents a survival effort in these myocytes. This is consistent with the review of the literature that MFL cells are viable, persist in myocardium for long time and may be functionally reversible. Evidence for concurrent apoptosis and survival instinct represent a conceptual paradox and suggests that myocytes undergoing apoptosis should be amenable to reconstitution of function.




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