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The complex process of angiogenesis improves and maintains tissue perfusion by promoting new blood vessel development from pre-existing vasculature1. It is a tightly regulated, balanced process by pro-angiogenic and anti-angiogenic factors. Any deficiency in this system may lead to insufficient vessel maintenance or growth, causing severe ischemic diseases including myocardial disease, stroke, and neurodegenerative disorders. However, exaggerated vascular development is characteristic for conditions including cancer and inflammatory disorders2.
Developing therapies that aim to control angiogenesis to achieve favorable tissue regeneration is of key importance. Despite extensive preclinical and clinical investigations, attempts to stimulate angiogenesis using pro-angiogenic factors and microRNAs have failed to achieve desired outcomes3,4,5. Possible reasons for the transient effects include: limited longevity of angiogenic proteins and nucleic acids, and the finite number of targeted growth factors6,7. Although soluble angiogenic factors are essential for initiating angiogenesis, the maintenance and functionality of vasculature depend on supporting cell types including pericytes and smooth muscle cells8. The field of pro-angiogenic therapies is now exploring potential stem cell and progenitor cell sources that may provide angiogenic factors locally, while physically supporting newly developed vasculature, self-renewing or even differentiating into endothelial-like cells9,10. Finding the optimal angiogenic cell types with the capability to fulfill these functional requirements holds a great promise for ischemic tissue regeneration.
In order to successfully translate potential cell-based therapies into clinical trials, pre-clinical studies need to demonstrate their efficacy and highlight the underlying angiogenic mechanisms. Despite the high number of established angiogenesis assays, the field lacks a "gold-standard" in vitro assay that could reliably evaluate the efficacy of potential candidate cell types11,12,13. Most in vitro angiogenesis assays (including the endothelial proliferation, migration and tube formation assays) typically assess the effects of cells or compounds on endothelial cells' phenotypical changes or differentiation into tubular and network structures14,15. While these features are critical for angiogenesis, a "translatable" assay should also evaluate: 1) the augmentation or replacement of the supporting cell types including pericytes or smooth muscle cells, 2) the processing of ECM and/or basement membrane, and 3) the efficiency to promote the formation of functional microvasculature. In vivo angiogenesis models, including the corneal assay and Matrigel plug assay, recapitulate the unique in vivo microenvironment but are challenged by the difficulty of tracking administered cells to observe physical interactions. Furthermore, in in vivo models, xeno-immune rejection can occur while testing potential allogeneic cell therapy candidates16. Ex vivo angiogenesis models, particularly the aortic ring assay can provide: 1) easy observation and quantification of tubular structures, 2) accessory supportive cells, 3) ECM from host and artificial supplies, 4) exclusion of inflammatory components, and 5) quick and inexpensive setup17,18. Typically, the aortic ring assay can test the angiogenic potential of small secretory proteins, pharmacological agents, and transgenic rodent models19,20,21.
MSCs are promising candidates for vascular regeneration primarily through their paracrine-mediated effects22,23,24. MSCs have been shown to secrete key angiogenic factors including Vascular Endothelial Growth Factor (VEGF), Hepatocyte Growth Factor (HGF), Insulin-like Growth Factor-1 (IGF-1), basic Fibroblast Growth Factor (bFGF), and angiopoeitin-1 (Ang-1)25,26. MSCs can also detect and home to ischemic or inflamed tissues, however, the exact mechanisms are still under investigation. Increasingly, the literature supports the hypothesis that most MSCs arise from perivascular cells, co-express pericyte markers, and can behave like pericytes27. HUCPVCs are a young source of MSCs derived from the perivascular region of the human umbilical cord. They represent a population of MSCs with pericyte-like properties and have been characterized from both FTM and term umbilical cords. FTM HUCPVCs demonstrate a high expression of pericyte markers including CD146 and NG2, high proliferative and multilineage potential, immune-privileged properties, and display a robust paracrine profile28. FTM HUCPVCs are an ideal candidate cell type to promote regeneration of injured tissue through the promotion of new vasculature via their pericyte-like properties.
To test the angiogenic potential and pericyte-like properties of human MSCs, a very limited number of angiogenesis assays are available where positive angiotropic migration (hereafter referred to as "homing"), ECM processing, and development of physical interactions between cell types can be investigated, while obtaining quantitative data on microvasculature development.
Hereby we present a protocol that describes a novel application of the aortic ring assay. Human MSCs were co-cultured with developing rat-derived aortic endothelial networks to assess their contribution to tube formation, maturation, and homeostasis. This version of the aortic ring assay assesses the ability and potency of cell therapy candidates to home to sites of angiogenesis, perform and mediate ECM processing, and contribute to endothelial tubular development through establishing pericyte-like physical interactions. In addition to quantifying the net effect of MSCs on in vitro endothelial network formation and observing intercellular interactions, we also optimized a protocol to isolate MSCs from co-cultures. By performing flow cytometry and qPCR, it is possible to characterize changes in MSC phenotype and gene expression following co-culture. As model cell types, we compared ontogenetically early (prenatal) and late (adult) sources of human MSCs: FTM HUCPVCs and human bone marrow-derived MSCs (BMSC), respectively, in the aortic ring assay. We propose that the aortic ring assay can be used to study the angiogenic potential of any physically supporting cell type when under investigation for angiogenic regenerative applications.