Transplante de Células-tronco marcadas para o miocárdio de paciente com doença de chagas

Abstract

A 50-year old male individual with refractory heart failure secondary to dilated cardiomyopathy due to Chagas' disease was referred to our Institute that is authorized by the Brazilian Health Ministry to employ stem cell therapy for dilated cardiomyopathy, Chagas' disease and acute myocardial infarction.The myocardial perfusion study with 99 mTc SESTAMIBI showed large areas with low uptake in the anterior, apical and septal walls of the left ventricle (Fig. 1). Cardiac catheterization revealed severe left ventricular dysfunction (ejection fraction = 15.3%) and normal coronary arteries. Despite the optimization of medication, the clinical response remained poor. The patient was informed about the potential risks and benefits of the treatment with stem cell transplantation and signed the Term of Authorized Consent.After the approval of the Research Ethics Committee, the patient underwent stem cell transplantation.The patient received epidural anesthesia, and bone marrow cells were obtained by means of punctures in the iliac crest. Twenty milliliters of suspension of mononuclear cells were obtained employing the technique described in the literature 1 . Three milliliters of the suspension were labeled with 99mTc HMPAO. The mononuclear cell suspension was slowly injected (1 ml/minute) into the coronary arteries. Fifty per cent of the suspension was injected into the anterior descending artery, 25% into the left circumflex artery and 25% into the right coronary artery. The 99 mTc HMPAO-labeled cells were injected only into the anterior descending artery. New scintigraphic studies were performed 2 hours and 6 hours after the procedure, respectively. DiscussionIn patients for whom stem cell transplantation is indicated for the treatment of end stage dilated cardiomyopathy, if the coronary arteries are normal, the selective infusion of the mononuclear cell suspension into the anterior descending artery, the left circumflex artery and the right coronary artery will be our preferred technique. The infusion of the suspension is always made in the distal end of the proximal third of coronary arteries, after proof of absence of retrograde flow is obtained by making a previous injection of contrast medium through the infusion catheter.There were doubts, however, whether the cells were retained by the cardiac muscle. This is the reason why the infusion of 99 mTc HMPAO-labeled mononuclear cells was performed using the intracoronary technique previously described.Myocardial perfusion studies were repeated to analyze the same axes, 2 and 6 hours, respectively, after the transplantation of labeled mononuclear cells through the intracoronary route and revealed their uptake and retention in areas that had not uptaken SESTAMIBI before (Fig. 1). The whole-body scintigraphic image showed that the remaining Key wordsStem cell transplantation; Chagas' cardiomyopathy; Chagas' disease.Stem cell transplantation is a new therapy applied to produce cardiac regeneration through differentiation or increase of heart myocytes or neovascular proli...

Therapy of Chagas Disease: Implications for Levels of Prevention

“…For instance, cardiac transplant is a procedure that has been applied and has demonstrated clinical benefit in some patients with terminal heart failure [78]. Stem cell transplant is a new therapy applied to produce cardiac regeneration through distinction or increase heart myocytes or neovascular proliferation in patients in the final stage of congestive heart failure [79–81], but the results are still insufficient on Chagas disease, and there is no consensus about its efficacy [80]. …”

Cell Therapy in Chagas Disease

“…In a patient with chagasic cardiomyopathy, bone marrow mononuclear cells delivered by the intracoronary route were preferentially retained in diseased, hypoperfused areas of the myocardium [32]. Further studies using labeled cells confirmed these results (Barbosa, personal communication).…”

Uso De Terapia Celular Com Células-Tronco Nas Especialidades Médicas No Brasil: Revisão Sistemática

“…O transplante de CTs acaba sendo uma nova terapia com objetivo de produzir regeneração cardíaca pela diferenciação ou aumento dos miócitos cardíacos ou proliferação neovascular em pacientes no estágio final de insuficiência cardíaca congestiva secundária a cardiomiopatia dilatada idiopática ou chagásica, na cardiopatia isquêmica crônica e no infarto agudo do miocárdio, dentre outras degenerações cardíacas. Porém, os resultados destas aplicações clínicas ainda são desconhecidos não perdendo seu potencial, mas não deixam de serem promissores e na maioria dos casos mostram um percentual regenerativo importante para pacientes submetidos à terapia (JACOB et al, 2007). Moreira et al (2011) descreveram o uso de injeção de CTs no Infarto Agudo do Miocárdio (IAM) sendo este um teste, quase exclusivo, da via anterógrada Intra-Arterial Coronariana (IAC).…”

“…No entanto, a circulação sanguínea na área de infarto pode ser gravemente afetada, dificultando o potencial acesso das células injetadas na área em que elas são necessárias para a reparação tecidual. Jacob et al (2007) apresentaram o uso de CTs através de injeção intracoronariana após infarto do miocárdio e procedimento de punções da crista ilíaca e uso dessas células para tratamento do estágio final de pacientes com cardiopatia dilatada. O caso relatado mostra que, após infusão de células mononucleares pela técnica intracoronariana, uma significativa quantidade dessas células é atraída para áreas previamente não funcionais do miocárdio e nelas retidas (provavelmente miocárdio fibrótico).…”