Skip to main content
Top
Published in: Journal of Translational Medicine 1/2006

Open Access 01-06-2006 | Research

In vivo migration of labeled autologous natural killer cells to liver metastases in patients with colon carcinoma

Authors: Lina Matera, Alessandra Galetto, Marilena Bello, Cinzia Baiocco, Isabella Chiappino, Giancarlo Castellano, Alessandra Stacchini, Maria A Satolli, Michele Mele, Sergio Sandrucci, Antonio Mussa, Gianni Bisi, Theresa L Whiteside

Published in: Journal of Translational Medicine | Issue 1/2006

Login to get access

Abstract

Background

Besides being the effectors of native anti-tumor cytotoxicity, NK cells participate in T-lymphocyte responses by promoting the maturation of dendritic cells (DC). Adherent NK (A-NK) cells constitute a subset of IL-2-stimulated NK cells which show increased expression of integrins and the ability to adhere to solid surface and to migrate, infiltrate, and destroy cancer. A critical issue in therapy of metastatic disease is the optimization of NK cell migration to tumor tissues and their persistence therein. This study compares localization to liver metastases of autologous A-NK cells administered via the systemic (intravenous, i.v.) versus locoregional (intraarterial, i.a.) routes.

Patients and methods

A-NK cells expanded ex-vivo with IL-2 and labeled with 111In-oxine were injected i.a. in the liver of three colon carcinoma patients. After 30 days, each patient had a new preparation of 111In-A-NK cells injected i.v. Migration of these cells to various organs was evaluated by SPET and their differential localization to normal and neoplastic liver was demonstrated after i.v. injection of 99mTc-phytate.

Results

A-NK cells expressed a donor-dependent CD56+CD16+CD3- (NK) or CD56+CD16+CD3+ (NKT) phenotype. When injected i.v., these cells localized to the lung before being visible in the spleen and liver. By contrast, localization of i.a. injected A-NK cells was virtually confined to the spleen and liver. Binding of A-NK cells to liver neoplastic tissues was observed only after i.a. injections.

Conclusion

This unique study design demonstrates that A-NK cells adoptively transferred to the liver via the intraarterial route have preferential access and substantial accumulation to the tumor site.
Appendix
Available only for authorised users
Literature
1.
go back to reference Cooper MA, Fehniger TA, Caligiuri MA: The biology of human natural killer-cell subsets. Trends Immunol. 1991, 22: 633-640. 10.1016/S1471-4906(01)02060-9.CrossRef Cooper MA, Fehniger TA, Caligiuri MA: The biology of human natural killer-cell subsets. Trends Immunol. 1991, 22: 633-640. 10.1016/S1471-4906(01)02060-9.CrossRef
2.
go back to reference Soloski MJ: Recognition of tumor cells by the innate immune system. Curr Opin Immunol. 2001, 13: 154-162. 10.1016/S0952-7915(00)00198-9.CrossRefPubMed Soloski MJ: Recognition of tumor cells by the innate immune system. Curr Opin Immunol. 2001, 13: 154-162. 10.1016/S0952-7915(00)00198-9.CrossRefPubMed
3.
go back to reference Kuppen PJ, Gorter A, Hagenaars M, Jonges LE, Giezeman-Smits KM, Nagelkerke JF, Fleuren G, van de Velde CJH: Role of NK cells in adoptive immunotherapy of metastatic colorectal cancer in a syngeneic rat model. Immunol Rev. 2001, 184: 236-243. 10.1034/j.1600-065x.2001.1840121.x.CrossRefPubMed Kuppen PJ, Gorter A, Hagenaars M, Jonges LE, Giezeman-Smits KM, Nagelkerke JF, Fleuren G, van de Velde CJH: Role of NK cells in adoptive immunotherapy of metastatic colorectal cancer in a syngeneic rat model. Immunol Rev. 2001, 184: 236-243. 10.1034/j.1600-065x.2001.1840121.x.CrossRefPubMed
4.
go back to reference Dillman RO, Duma CM, Schiltz PM, DePriest C, Ellis RA, Okamoto K, Beutel LD, de Leon C, Chico S: Intracavitary placement of autologous lymphokine-activated killer (LAK) cells after resection of recurrent glioblastoma. J Immunother. 2004, 27: 398-404. 10.1097/00002371-200409000-00009.CrossRefPubMed Dillman RO, Duma CM, Schiltz PM, DePriest C, Ellis RA, Okamoto K, Beutel LD, de Leon C, Chico S: Intracavitary placement of autologous lymphokine-activated killer (LAK) cells after resection of recurrent glioblastoma. J Immunother. 2004, 27: 398-404. 10.1097/00002371-200409000-00009.CrossRefPubMed
5.
go back to reference Ishikawa E, Tsuboi K, Saijo K, Harada H, Takano S, Nose T, Ohno T: Autologous natural killer cell therapy for human recurrent malignant glioma. Anticancer Res. 2004, 24: 1861-1871.PubMed Ishikawa E, Tsuboi K, Saijo K, Harada H, Takano S, Nose T, Ohno T: Autologous natural killer cell therapy for human recurrent malignant glioma. Anticancer Res. 2004, 24: 1861-1871.PubMed
6.
go back to reference Klingemann HG, Martinson J: Ex vivo expansion of natural killer cells for clinical applications. Cytotherapy. 2004, 6: 15-22. 10.1080/14653240310004548.CrossRefPubMed Klingemann HG, Martinson J: Ex vivo expansion of natural killer cells for clinical applications. Cytotherapy. 2004, 6: 15-22. 10.1080/14653240310004548.CrossRefPubMed
7.
go back to reference Palumbo JS, Talmage KE, Massari JV, La Jeunesse CM, Flick MJ, Kombrinck KW, Jirousková M, Degen JL: Platelets and fibrinogen increase metastatic potential by impeding natural killer-mediated elimination of tumor cells. Blood. 2005, 105: 178-185. 10.1182/blood-2004-06-2272.CrossRefPubMed Palumbo JS, Talmage KE, Massari JV, La Jeunesse CM, Flick MJ, Kombrinck KW, Jirousková M, Degen JL: Platelets and fibrinogen increase metastatic potential by impeding natural killer-mediated elimination of tumor cells. Blood. 2005, 105: 178-185. 10.1182/blood-2004-06-2272.CrossRefPubMed
8.
go back to reference Fan Z, Yu P, Wang Y, Wang Y, Fu ML, Liu W, Sun Y, Fu YX: NK cell activation by LIGHT triggers tumor specific CD8+ T cell immunity to reject established tumors. Blood. 2005; Oct. 13, Fan Z, Yu P, Wang Y, Wang Y, Fu ML, Liu W, Sun Y, Fu YX: NK cell activation by LIGHT triggers tumor specific CD8+ T cell immunity to reject established tumors. Blood. 2005; Oct. 13,
9.
go back to reference Gerosa F, Baldani-Guerra B, Nisii C, Marchesini V, Carra G, Trinchieri G: Reciprocal activating interaction between natural killer cells and dendritic cells. J Exp Med. 2002, 195: 327-333. 10.1084/jem.20010938.PubMedCentralCrossRefPubMed Gerosa F, Baldani-Guerra B, Nisii C, Marchesini V, Carra G, Trinchieri G: Reciprocal activating interaction between natural killer cells and dendritic cells. J Exp Med. 2002, 195: 327-333. 10.1084/jem.20010938.PubMedCentralCrossRefPubMed
10.
go back to reference Moretta A: Natural killer cells and dendritic cells: rendezvous in abused tissues. Nat Rev Immunol. 2002, 2: 957-964. 10.1038/nri956.CrossRefPubMed Moretta A: Natural killer cells and dendritic cells: rendezvous in abused tissues. Nat Rev Immunol. 2002, 2: 957-964. 10.1038/nri956.CrossRefPubMed
11.
go back to reference Piccioli D, Sbrana S, Melandri E, Valiante NM: Contact-dependent stimulation and inhibition of dendritic cells by natural killer cells. J Exp Med. 2002, 195: 335-341. 10.1084/jem.20010934.PubMedCentralCrossRefPubMed Piccioli D, Sbrana S, Melandri E, Valiante NM: Contact-dependent stimulation and inhibition of dendritic cells by natural killer cells. J Exp Med. 2002, 195: 335-341. 10.1084/jem.20010934.PubMedCentralCrossRefPubMed
12.
go back to reference Cooper MA, Fehniger TA, Fuchs A, Colonna M, Caligiuri MA: NK cells and DC interaction. Trends Immunol. 2004, 25: 47-52. 10.1016/j.it.2003.10.012.CrossRefPubMed Cooper MA, Fehniger TA, Fuchs A, Colonna M, Caligiuri MA: NK cells and DC interaction. Trends Immunol. 2004, 25: 47-52. 10.1016/j.it.2003.10.012.CrossRefPubMed
13.
go back to reference Fujii S, Liu K, Smith C, Bonito AJ, Steinman RM: The linkage of innate to adaptive immunity via maturing dendritic cells in vivo requires CD40 ligation in addition to antigen presentation and CD80/86 costimulation. J Exp Med. 2004, 199: 1607-1618. 10.1084/jem.20040317.PubMedCentralCrossRefPubMed Fujii S, Liu K, Smith C, Bonito AJ, Steinman RM: The linkage of innate to adaptive immunity via maturing dendritic cells in vivo requires CD40 ligation in addition to antigen presentation and CD80/86 costimulation. J Exp Med. 2004, 199: 1607-1618. 10.1084/jem.20040317.PubMedCentralCrossRefPubMed
14.
go back to reference Pan PY, Gu P, Li Q, Xu D, Weber K, Chen SH: Regulation of dendritic cell function by NK cells: mechanisms underlying the synergism in the combination therapy of IL-12 and 4-1BB activation. J Immunol. 2004, 172: 4779-4789.CrossRefPubMed Pan PY, Gu P, Li Q, Xu D, Weber K, Chen SH: Regulation of dendritic cell function by NK cells: mechanisms underlying the synergism in the combination therapy of IL-12 and 4-1BB activation. J Immunol. 2004, 172: 4779-4789.CrossRefPubMed
15.
go back to reference Galetto A, Buttiglieri S, Forno S, Moro F, Mussa A, Matera L: Drug- and cell-mediated antitumor cytotoxicities modulate cross-presentation of tumor antigens by myeloid dendritic cells. Anticancer Drugs. 2003, 14: 833-843. 10.1097/00001813-200311000-00010.CrossRefPubMed Galetto A, Buttiglieri S, Forno S, Moro F, Mussa A, Matera L: Drug- and cell-mediated antitumor cytotoxicities modulate cross-presentation of tumor antigens by myeloid dendritic cells. Anticancer Drugs. 2003, 14: 833-843. 10.1097/00001813-200311000-00010.CrossRefPubMed
16.
go back to reference Mocikat R, Braumuller H, Gumy A, Egeter O, Ziegler H, Reusch U, Bubeck A, Louis J, Mailhammer R, Riethmüller G, Koszinowski U, Röcken M: Natural killer cells activated by MHC class Ilow targets prime dendritic cells to induce protective CD8 T cell responses. Immunity. 2003, 19: 561-569. 10.1016/S1074-7613(03)00264-4.CrossRefPubMed Mocikat R, Braumuller H, Gumy A, Egeter O, Ziegler H, Reusch U, Bubeck A, Louis J, Mailhammer R, Riethmüller G, Koszinowski U, Röcken M: Natural killer cells activated by MHC class Ilow targets prime dendritic cells to induce protective CD8 T cell responses. Immunity. 2003, 19: 561-569. 10.1016/S1074-7613(03)00264-4.CrossRefPubMed
17.
go back to reference Dhodapkar MV, Steinman RM, Krasovskya J, Munza C, Bhardwaja N: Antigen-specific inhibition of effector T cell function in humans after injection of immature dendritic cells. J Exp Med. 2001, 193: 233-238. 10.1084/jem.193.2.233.PubMedCentralCrossRefPubMed Dhodapkar MV, Steinman RM, Krasovskya J, Munza C, Bhardwaja N: Antigen-specific inhibition of effector T cell function in humans after injection of immature dendritic cells. J Exp Med. 2001, 193: 233-238. 10.1084/jem.193.2.233.PubMedCentralCrossRefPubMed
18.
go back to reference Schuler-Thurner B, Schultz ES, Berger TG, Weinlich G, Ebner S, Woerl P, Bender A, Feuerstein B, Fritsch PO, Romani N, Schuler G: Rapid induction of tumor-specific type I T helper cells in metastatic melanoma patients by vaccination with mature, cryopreserved, peptide-loaded monocyte-derived dendritic cells. J Exp Med. 2002, 195: 1279-1288. 10.1084/jem.20012100.PubMedCentralCrossRefPubMed Schuler-Thurner B, Schultz ES, Berger TG, Weinlich G, Ebner S, Woerl P, Bender A, Feuerstein B, Fritsch PO, Romani N, Schuler G: Rapid induction of tumor-specific type I T helper cells in metastatic melanoma patients by vaccination with mature, cryopreserved, peptide-loaded monocyte-derived dendritic cells. J Exp Med. 2002, 195: 1279-1288. 10.1084/jem.20012100.PubMedCentralCrossRefPubMed
20.
go back to reference Pillarisetty VG, Shah AB, Miller G, Bleier JI, DeMatteo RP: Liver dendritic cells are less immunogenic than spleen dendritic cells because of differences in subtype composition. J Immunol. 2004, 172: 1009-1117.CrossRefPubMed Pillarisetty VG, Shah AB, Miller G, Bleier JI, DeMatteo RP: Liver dendritic cells are less immunogenic than spleen dendritic cells because of differences in subtype composition. J Immunol. 2004, 172: 1009-1117.CrossRefPubMed
21.
go back to reference Zanon C, Grosso M, Clara R, Alabiso O, Chiappino I, Miraglia S, Martinetti R, Bortolini M, Rizzo M, Gazzera C: Combined regional and systemic chemotherapy by a mini-invasive approach for the treatment of colorectal liver metastases. Am J Clin Oncol. 2001, 24: 354-359. 10.1097/00000421-200108000-00007.CrossRefPubMed Zanon C, Grosso M, Clara R, Alabiso O, Chiappino I, Miraglia S, Martinetti R, Bortolini M, Rizzo M, Gazzera C: Combined regional and systemic chemotherapy by a mini-invasive approach for the treatment of colorectal liver metastases. Am J Clin Oncol. 2001, 24: 354-359. 10.1097/00000421-200108000-00007.CrossRefPubMed
22.
go back to reference Kobari M, Egawa S, Shibuya K, Sunamura M, Saitoh K, Matsuno S: Effect of intraportal adoptive immunotherapy on liver metastases after resection of pancreatic cancer. Br J Sur. 2000, 87: 43-48. 10.1046/j.1365-2168.2000.01336.x.CrossRef Kobari M, Egawa S, Shibuya K, Sunamura M, Saitoh K, Matsuno S: Effect of intraportal adoptive immunotherapy on liver metastases after resection of pancreatic cancer. Br J Sur. 2000, 87: 43-48. 10.1046/j.1365-2168.2000.01336.x.CrossRef
23.
go back to reference Allavena P, Bianchi G, Paganin C, Giardina G, Mantovani A: Regulation of adhesion and transendothelial migration of natural killer cells. Nat Immunol. 1996, 15: 107-116. Allavena P, Bianchi G, Paganin C, Giardina G, Mantovani A: Regulation of adhesion and transendothelial migration of natural killer cells. Nat Immunol. 1996, 15: 107-116.
24.
go back to reference Brand JM, Meller B, Von Hof K, Luhm J, Bahre M, Kirchner H, Frohn C: Kinetics and organ distribution of allogeneic natural killer lymphocytes transfused into patients suffering from renal cell carcinoma. Stem Cells Dev. 2004, 13: 307-314. 10.1089/154732804323099235.CrossRefPubMed Brand JM, Meller B, Von Hof K, Luhm J, Bahre M, Kirchner H, Frohn C: Kinetics and organ distribution of allogeneic natural killer lymphocytes transfused into patients suffering from renal cell carcinoma. Stem Cells Dev. 2004, 13: 307-314. 10.1089/154732804323099235.CrossRefPubMed
25.
go back to reference Morris MA, Ley K: Trafficking of natural killer cells. Curr Mol Med. 2004, 4: 431-438. 10.2174/1566524043360609.CrossRefPubMed Morris MA, Ley K: Trafficking of natural killer cells. Curr Mol Med. 2004, 4: 431-438. 10.2174/1566524043360609.CrossRefPubMed
26.
go back to reference Vujanovic NL, Yasumura S, Hirabayashi H, Lin WC, Watkins S, Herberman RB, Whiteside TL: Antitumor activity of subsets of human IL-2-activated natural killer cells in solid tissues. J Immunol. 1995, 154: 281-289.PubMed Vujanovic NL, Yasumura S, Hirabayashi H, Lin WC, Watkins S, Herberman RB, Whiteside TL: Antitumor activity of subsets of human IL-2-activated natural killer cells in solid tissues. J Immunol. 1995, 154: 281-289.PubMed
27.
go back to reference Yokoyama WM, Kim S, French AR: The dynamic life of natural killer cells. Ann Rev Immunol. 2004, 22: 405-429. 10.1146/annurev.immunol.22.012703.104711.CrossRef Yokoyama WM, Kim S, French AR: The dynamic life of natural killer cells. Ann Rev Immunol. 2004, 22: 405-429. 10.1146/annurev.immunol.22.012703.104711.CrossRef
28.
go back to reference Vermijlen D, Seynaeve C, Luo D, Kruhoffer M, Eizirik DL, Orntoft TF, Wisse E: High-density oligonucleotide array analysis reveals extensive differences between freshly isolated blood and hepatic natural killer cells. Eur J Immunol. 2004, 34: 2529-2540. 10.1002/eji.200324712.CrossRefPubMed Vermijlen D, Seynaeve C, Luo D, Kruhoffer M, Eizirik DL, Orntoft TF, Wisse E: High-density oligonucleotide array analysis reveals extensive differences between freshly isolated blood and hepatic natural killer cells. Eur J Immunol. 2004, 34: 2529-2540. 10.1002/eji.200324712.CrossRefPubMed
29.
go back to reference Doherty DG, O'Farrelly C: Innate and adaptive lymphoid cells in the human liver. Immunol Rev. 2000, 174: 5-20. 10.1034/j.1600-0528.2002.017416.x.CrossRefPubMed Doherty DG, O'Farrelly C: Innate and adaptive lymphoid cells in the human liver. Immunol Rev. 2000, 174: 5-20. 10.1034/j.1600-0528.2002.017416.x.CrossRefPubMed
30.
go back to reference Li Z, Lin H, Yang S, Diehl AM: Murine leptin deficiency alters Kupffer cell production of cytokines that regulate the innate immune system. Gatroenterology. 2002, 123: 1304-1310. 10.1053/gast.2002.35997.CrossRef Li Z, Lin H, Yang S, Diehl AM: Murine leptin deficiency alters Kupffer cell production of cytokines that regulate the innate immune system. Gatroenterology. 2002, 123: 1304-1310. 10.1053/gast.2002.35997.CrossRef
31.
go back to reference Nagler A, Lanier LL, Phillips J: Constitutive expression of high-affinity interleukin 2 receptors on human CD16-negative natural killer cells in vivo. J Exp Med. 1990, 171: 1527-1533. 10.1084/jem.171.5.1527.CrossRefPubMed Nagler A, Lanier LL, Phillips J: Constitutive expression of high-affinity interleukin 2 receptors on human CD16-negative natural killer cells in vivo. J Exp Med. 1990, 171: 1527-1533. 10.1084/jem.171.5.1527.CrossRefPubMed
32.
go back to reference Li S, Xu J, Makarenkova VP, Tjandrawan T, Vakkila J, Reichert T, Gooding W, Lagenaur CF, Achim CL, Chambers WH, Herberman RB, Whiteside TL, Vujanovic NL: A novel epitope of N-CAM defines precursors of human adherent NK cells. J Leukoc Biol. 2004, 76: 1187-1199. 10.1189/jlb.0802386.CrossRefPubMed Li S, Xu J, Makarenkova VP, Tjandrawan T, Vakkila J, Reichert T, Gooding W, Lagenaur CF, Achim CL, Chambers WH, Herberman RB, Whiteside TL, Vujanovic NL: A novel epitope of N-CAM defines precursors of human adherent NK cells. J Leukoc Biol. 2004, 76: 1187-1199. 10.1189/jlb.0802386.CrossRefPubMed
33.
go back to reference Seino K, Taniguchi M: Functional roles of NKT cell in the immune system. Front Biosci. 2004, 9: 577-587.CrossRef Seino K, Taniguchi M: Functional roles of NKT cell in the immune system. Front Biosci. 2004, 9: 577-587.CrossRef
34.
go back to reference Franitza S, Grabovsky V, Wald O, Weiss I, Beider K, Dagan M, Darash-Yahana M, Nagler A, Brocke S, Galun E, Alon R, Peled A: Differential usage of VLA-4 and CXCR4 by CD3+CD56+ NKT cells and CD56+CD16+ NK cells regulates their interaction with endothelial cells. Eur J Immunol. 2004, 34: 1333-1341. 10.1002/eji.200324718.CrossRefPubMed Franitza S, Grabovsky V, Wald O, Weiss I, Beider K, Dagan M, Darash-Yahana M, Nagler A, Brocke S, Galun E, Alon R, Peled A: Differential usage of VLA-4 and CXCR4 by CD3+CD56+ NKT cells and CD56+CD16+ NK cells regulates their interaction with endothelial cells. Eur J Immunol. 2004, 34: 1333-1341. 10.1002/eji.200324718.CrossRefPubMed
35.
go back to reference Kjaergaard J, Hokland ME, Agger R, Skovbo A, Nannmark U, Basse PH: Biodistribution and tumor localization of lymphokine-activated killer T cells following different routes of administration into tumor-bearing animals. Cancer Immunol Immunother. 2000, 48: 550-560. 10.1007/PL00006673.CrossRefPubMed Kjaergaard J, Hokland ME, Agger R, Skovbo A, Nannmark U, Basse PH: Biodistribution and tumor localization of lymphokine-activated killer T cells following different routes of administration into tumor-bearing animals. Cancer Immunol Immunother. 2000, 48: 550-560. 10.1007/PL00006673.CrossRefPubMed
36.
go back to reference Prlic M, Blazar BR, Farrar MA, Jameson SC: In vivo survival and homeostatic proliferation of natural killer cells. J Exp Med. 2003, 197: 967-976. 10.1084/jem.20021847.PubMedCentralCrossRefPubMed Prlic M, Blazar BR, Farrar MA, Jameson SC: In vivo survival and homeostatic proliferation of natural killer cells. J Exp Med. 2003, 197: 967-976. 10.1084/jem.20021847.PubMedCentralCrossRefPubMed
Metadata
Title
In vivo migration of labeled autologous natural killer cells to liver metastases in patients with colon carcinoma
Authors
Lina Matera
Alessandra Galetto
Marilena Bello
Cinzia Baiocco
Isabella Chiappino
Giancarlo Castellano
Alessandra Stacchini
Maria A Satolli
Michele Mele
Sergio Sandrucci
Antonio Mussa
Gianni Bisi
Theresa L Whiteside
Publication date
01-06-2006
Publisher
BioMed Central
Published in
Journal of Translational Medicine / Issue 1/2006
Electronic ISSN: 1479-5876
DOI
https://doi.org/10.1186/1479-5876-4-49

Other articles of this Issue 1/2006

Journal of Translational Medicine 1/2006 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.